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O'Donnell R, Hinderer KA, Belanger D, Chenard D, Boyle E, Borrup K, Fish M, Brimacombe M, Rogers S. Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool. J Emerg Nurs 2024; 50:342-353. [PMID: 38597852 DOI: 10.1016/j.jen.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.
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Raboin K, Ellis D, Nichols G, Hughes M, Brimacombe M, Rubin K. Advancing Newborn Screening Long-Term Follow-Up: Integration of Epic-Based Registries, Dashboards, and Efficient Workflows. Int J Neonatal Screen 2024; 10:27. [PMID: 38651392 PMCID: PMC11036281 DOI: 10.3390/ijns10020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
The Connecticut Newborn Screening (NBS) Network, in partnership with the Connecticut Department of Public Health, strategically utilized the Epic electronic health record (EHR) system to establish registries for tracking long-term follow-up (LTFU) of NBS patients. After launching the LTFU registry in 2019, the Network obtained funding from the Health Resources and Services Administration to address the slow adoption by specialty care teams. An LTFU model was implemented in the three highest-volume specialty care teams at Connecticut Children's, involving an early childhood cohort diagnosed with an NBS-identified disorder since the formation of the Network in March 2019. This cohort grew from 87 to 115 over the two-year project. Methods included optimizing registries, capturing external data from Health Information Exchanges, incorporating evidence-based guidelines, and conducting qualitative and quantitative evaluations. The early childhood cohort demonstrated significant and sustainable improvements in the percentage of visits up-to-date (%UTD) compared to the non-intervention legacy cohort of patients diagnosed with an NBS disorder before the formation of the Network. Positive trends in the early childhood cohort, including %UTD for visits and condition-specific performance metrics, were observed. The qualitative evaluation highlighted the achievability of practice behavior changes for specialty care teams through responsive support from the nurse analyst. The Network's model serves as a use case for applying and achieving the adoption of population health tools within an EHR system to track care delivery and quickly fill identified care gaps, with the aim of improving long-term health for NBS patients.
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Affiliation(s)
- Katherine Raboin
- Connecticut Newborn Screening Network, Connecticut Children’s, Hartford, CT 06106, USA; (K.R.); (D.E.); (G.N.)
| | - Debra Ellis
- Connecticut Newborn Screening Network, Connecticut Children’s, Hartford, CT 06106, USA; (K.R.); (D.E.); (G.N.)
| | - Ginger Nichols
- Connecticut Newborn Screening Network, Connecticut Children’s, Hartford, CT 06106, USA; (K.R.); (D.E.); (G.N.)
| | - Marcia Hughes
- Center for Social Research, University of Hartford, Hartford, CT 06105, USA;
| | - Michael Brimacombe
- Research Operations and Development, Connecticut Children’s, Hartford, CT 06106, USA;
- Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT 06106, USA
| | - Karen Rubin
- Connecticut Newborn Screening Network, Connecticut Children’s, Hartford, CT 06106, USA; (K.R.); (D.E.); (G.N.)
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Burgwardt N, Healy JM, Menendez A, Regan M, Moote D, Bilbao N, Riba-Wolman R, Brimacombe M, Finck C. Validating the Modified McGill Thyroid Nodule Score for Assessment of Preoperative Risk of Pediatric Thyroid Malignancy. J Pediatr Surg 2024:S0022-3468(24)00191-X. [PMID: 38614945 DOI: 10.1016/j.jpedsurg.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer in adults. It was developed by a multidisciplinary team using established evidence-based risk factors for thyroid cancer. The modified McGill Thyroid Nodule Score (mMTNS) was developed to predict malignancy risk in children. A pilot study suggested the mMTNS was able to assess malignancy risk in children with indeterminate cytology on fine needle aspiration (FNA). This study seeks to validate these findings. METHODS Retrospective chart review identified subjects who underwent FNA biopsy and subsequent resection. Each patient was assigned a score to compare to final pathology. Statistical analysis was performed with SPSS. All tests were 2-tailed and statistical significance defined p < 0.05. Logistic regression used to determine predictive values of scores. RESULTS 46 patients ≤21 years of age underwent resection of a thyroid nodule. Female predominance of 85% (n = 39). 78% (n = 36) of patients had palpable nodule. 65% (n = 30) found to have benign pathology and 35% (n = 16) found to have malignancy. Malignant nodules associated with greater mean mMTNS compared to benign [13.63 vs 7.23]. An mMTNS greater >12 had sensitivity of 86.7%, specificity of 90.3%, positive predictive value of 81.3%, and negative predictive value of 93.3%. CONCLUSION Our data suggests the mMTNS continues to be a useful adjunct in predicting malignancy risk of pediatric thyroid nodules. An mMTNS >12 has a high risk for malignancy, which can aid in counseling and clinical decision making, particularly when there is indeterminate cytology on FNA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicolle Burgwardt
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA.
| | - James M Healy
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Ana Menendez
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Maia Regan
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Douglas Moote
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Nordie Bilbao
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Rebecca Riba-Wolman
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Michael Brimacombe
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
| | - Christine Finck
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06016, USA
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Schissler K, Stewart S, Phamduy T, Brimacombe M, Waynik I, Hoppa E. High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic. Pediatr Emerg Care 2023; 39:895-899. [PMID: 37205837 DOI: 10.1097/pec.0000000000002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES There was an overall decline in pediatric emergency department visits during the COVID-19 pandemic. Caregivers are educated to bring febrile neonates promptly to the emergency department; however, for infants aged 29 to 60 days, there may not be the same urgency especially during a pandemic. There may have been a resultant change in the clinical and laboratory high-risk markers and infection rates in this patient population during the pandemic. METHODS This was a single-center retrospective cohort study of infants aged 29 to 60 days presenting to the emergency department of an urban tertiary care children's hospital because of fever (>38°C) between March 11 and December 31, 2020, compared with those presenting in the same period during the 3 prior years (2017 through 2019). Patients were categorized as having high-risk criteria on a predetermined definition of ill appearance, white blood cell count, and urinalysis based on our hospital's evidence-based pathway. Information on infection type was also collected. RESULTS A total of 251 patients were included in the final analysis. Comparison of the prepandemic and pandemic cohorts showed a significant increase in the proportion of patients with urinary tract infections ( P = 0.017) and bacteremia ( P = 0.02) and those presenting with high-risk white blood cell count ( P = 0.028) and urinalysis ( P = 0.034). There was no significant difference in patient demographics or in high-risk ill appearance ( P = 0.208). CONCLUSIONS This study demonstrates a significant increase in the rates of urinary tract infection and bacteremia in addition to the objective markers used to risk-stratify febrile infants aged 29 to 60 days. This supports the need for attentiveness in evaluating these febrile infants in the emergency department.
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Affiliation(s)
| | - Sidney Stewart
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington
| | - Timothy Phamduy
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington
| | - Michael Brimacombe
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington
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Pace JL, Drummond M, Brimacombe M, Cheng C, Chiu D, Luczak SB, Shroff JB, Zeng F, Kanski GM, Kakazu R, Cohen A. Unpacking the Tibial Tubercle-Trochlear Groove Distance: Evaluation of Rotational Factors, Trochlear Groove and Tibial Tubercle Position, and Role of Trochlear Dysplasia. Am J Sports Med 2023; 51:16-24. [PMID: 36300815 DOI: 10.1177/03635465221125780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The tibial tubercle to trochlear groove (TT-TG) distance is often utilized for determining the surgical treatment for patients with patellar instability (PI). It is thought to directly represent the position of the TT on the tibia. Recent work has shown that the measurement of the TT-TG distance is multifactorial. PURPOSE To investigate the relationship between relative tibial external rotation (rTER) and trochlear dysplasia (TD), as well as the location of the TG and TT in patients with and without PI, and to correlate these and other anatomic measurements with the TT-TG distance. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 89 patients with PI who underwent magnetic resonance imaging were identified with 92 matched control patients. A standardized measurement protocol on axial magnetic resonance imaging determined rTER, the proximal and distal TG lateralization (pTGL and dTGL, respectively) ratios, and the TT lateralization (TTL) ratio. Other measures of interest included the lateral trochlear inclination angle, sulcus angle, and lateral patellar inclination angle. Univariate regression was used to determine the associations of TD (lateral trochlear inclination angle, sulcus angle) with rTER and the TG position, and multivariate regression was used to model associations among all the variables with the proximal and distal TT-TG distances. RESULTS rTER was significantly higher in the study group (P < .001), and univariate regression showed a significant association between dysplasia measures and rTER (P < .001). The pTGL ratio was lower in the study group (P = .025), but there was no difference in the dTGL ratio (P = .090) or the TTL ratio (P = .098) between the groups. There were no associations between dysplasia measures and the pTGL and dTGL ratios (P > .05). Multivariate regression showed that the proximal TT-TG distance is predicted by the sulcus angle, pTGL ratio, rTER, and TTL ratio (P < .05) and that the distal TT-TG distance is predicted by the lateral patellar inclination angle, dTGL ratio, sulcus angle, rTER, and TTL ratio (P < .05). CONCLUSION rTER had a significant association with TD. The position of the proximal TG was more medial in patients with PI. There was no significant difference in the TTL ratio between patients with and without PI. The TT-TG distance was associated with multiple anatomic measures and was not solely predicated on the position of the TT.
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Affiliation(s)
- J Lee Pace
- Children's Health Andrews Institute for Orthopaedics & Sports Medicine, Plano, Texas, USA
| | | | | | - Chris Cheng
- Department of Orthopedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - David Chiu
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - S Brandon Luczak
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jeffrey B Shroff
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Francine Zeng
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Greg M Kanski
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Kakazu
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andrew Cohen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Dailey J, Kozhaya L, Dogan M, Hopkins D, Lapin B, Herbst K, Brimacombe M, Grandonico K, Karabacak F, Schreiber J, Liang BTL, Salazar JC, Unutmaz D, Hyams JS. Antibody Responses to SARS-CoV-2 After Infection or Vaccination in Children and Young Adults With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1019-1026. [PMID: 34528661 PMCID: PMC8499989 DOI: 10.1093/ibd/izab207] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Characterization of neutralization antibodies to SARS-CoV-2 infection or vaccination in children and young adults with inflammatory bowel disease (IBD) receiving biologic therapies is crucial. METHODS We performed a prospective longitudinal cohort study evaluating SARS-CoV-2 spike protein receptor binding domain (S-RBD) IgG positivity along with consistent clinical symptoms in patients with IBD receiving infliximab or vedolizumab. Serum was also obtained following immunization with approved vaccines. The IgG antibody to the spike protein binding domain of SARS-CoV-2 was assayed with a fluorescent bead-based immunoassay that takes advantage of the high dynamic range of fluorescent molecules using flow cytometry. A sensitive and high-throughput neutralization assay that incorporates SARS-CoV-2 spike protein onto a lentivirus and measures pseudoviral entry into ACE2-angiotensin converting enzyme 2 (ACE2) expressing human embryonic kidney 293 (HEK-293) cells was used. RESULTS There were 436 patients enrolled (mean age, 17 years, range 2-26 years; 58% male; 71% Crohn's disease, 29% ulcerative colitis, IBD-unspecified). Forty-four (10%) of enrolled subjects had SARS-CoV-2 S-RBD IgG antibodies. Compared to non-IBD adults (ambulatory) and hospitalized pediatric patients with PCR documented SARS-CoV-2 infection, S-RBD IgG antibody levels were significantly lower in the IBD cohort and by 6 months post infection most patients lacked neutralizing antibody. Following vaccination (n = 33), patients had a 15-fold higher S-RBD antibody response in comparison with natural infection, and all developed neutralizing antibodies to both wild type and variant SARS-CoV-2. CONCLUSIONS The lower and less durable SARS-CoV-2 S-RBD IgG response to natural infection in IBD patients receiving biologics puts them at risk of reinfection. The robust response to immunization is likely protective.
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Affiliation(s)
- Joelynn Dailey
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Lina Kozhaya
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Mikail Dogan
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Dena Hopkins
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Blaine Lapin
- Division of Rheumatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Katherine Herbst
- Division of Research, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Michael Brimacombe
- Division of Research, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kristen Grandonico
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT, USA
| | - Fatih Karabacak
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - John Schreiber
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Bruce Tsan-Liang Liang
- Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Juan C Salazar
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Derya Unutmaz
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Jeffrey S Hyams
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT, USA
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Sinha R, Brimacombe M, Romano JC. Impact of Gender in Congenital Heart Surgery – Results from a National Survey. J Thorac Cardiovasc Surg 2022; 165:1669-1677. [PMID: 35842276 DOI: 10.1016/j.jtcvs.2022.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/28/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are limited data regarding the impact of gender within congenital heart surgery. Our aim was to assess gender-related experiences by surgeons in this field. METHODS A cross-sectional survey was emailed to practicing congenital heart surgeons to ascertain the perception of gender in 5 domains: training, professional career, clinical practice, personal life, and career outlook. RESULTS The survey response rate was 94% (17/18) for women and 44% (112/257) for men. More than half of women (53%) were discouraged from pursuing congenital heart surgery (P < .001) and reported a negative impact of gender in attaining their first congenital heart surgery job (P < .001) compared with men. Despite similar demographics, women reported lower starting annual salaries ($150K-$250K vs $250K-$400K), lower current annual salaries ($500K-$750K vs $750K-$1M), lower academic ranks (clinical instructor 6% vs 4% [P = .045], assistant professor 35% vs 19% [P = .19], associate professor 41% vs 25% [P = .24], and professor 6% vs 41% [P = .005]) along with lower annual salaries at the associate professor ($500K-$750K vs $1M-$1.25M) and professor levels ($1M-$1.25M vs >$1.5M) compared with men. Sexual harassment was experienced more frequently by women both in training (65% vs 6%, P < .001) and in practice (65% and 4%, P < .001). CONCLUSIONS This survey highlights many areas of gender-related differences: discouragement due to gender to pursue congenital heart surgery, sexual harassment in training and practice, salary and academic rank differentials, negative gender perception at work, and lower career satisfaction for women. Despite various differences between both genders, the majority in each group would choose to enter this profession again as well as encourage others to do so.
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Affiliation(s)
- Raina Sinha
- Division of Cardiac Surgery, Connecticut Children's Medical Center, University of Connecticut, Hartford, Conn.
| | - Michael Brimacombe
- Department of Research, Connecticut Children's Medical Center, Hartford, Conn
| | - Jennifer C Romano
- Congenital Heart Center, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
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Luczak SB, Cheng C, Hedgecock JP, Brimacombe M, Pace JL. Patellar Height Correlates Modestly With Trochlear Dysplasia: A Magnetic Resonance Imaging Analysis. Arthrosc Sports Med Rehabil 2022; 4:e1031-e1037. [PMID: 35747649 PMCID: PMC9210383 DOI: 10.1016/j.asmr.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/16/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose To evaluate whether there is a correlation between the position of the patella and trochlear morphology in patients with and without patellar instability using exclusively MRI measurements. Methods MRI scans of knees in patients with patellofemoral instability and knees of patients with an ACL (anterior cruciate ligament) tear as a control group were reviewed. Measurements of patellar position (Canton-Deschamps ratio, Patellar Trochlear Index, and lateral patellar inclination) and trochlear morphology (lateral trochlear inclination and sulcus angle) were obtained from each scan. Bivariate and multivariate analysis was performed to identify correlations between study group, demographics, and patellofemoral joint measurements. Results There were 70 knees in the patellofemoral instability group and 60 knees in the control group. Bivariate analysis showed a significant difference in all measurements between the patellar instability group and the control group. Multivariate analysis showed modest correlations between patellar position and trochlear morphology. The Caton-Deschamps (CD) ratio correlated with patellar trochlear index (P < .001) and lateral trochlear inclination (P < .001). The respective R-square goodness of fit was 41.1%. Patellar trochlear index correlated with CD ratio (P < .001), lateral trochlear inclination (P < .001), lateral patellar inclination (P < .001), and patellar instability group (P = .011). The R-sq goodness of fit was 37.3%. Lateral patellar inclination correlated with patellar trochlear index (P < .001), Lateral trochlear inclination (P < .001), and age at first dislocation or injury (P = .02). The R-sq goodness of fit was 68.56%. Conclusions Using MRI-based measurements of the patellofemoral joint, we identified modest, but significant, correlations between measures of patellar height (patellar trochlear index, CD ratio, and lateral patellar inclination) and trochlear dysplasia. This correlation is unclear and is likely multifactorial, but on the basis of this work, a causal relationship between trochlear dysplasia and patella alta cannot be established. Clinical Relevance Radiographic evaluation of the patella and how it relates to the surrounding boney anatomy provides important information regarding our understanding of patella instability and its treatment.
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Hollenbach J, Collins M, Brimacombe M, Hogan A. The Effect of COVID-19 on The September Asthma Peak. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pierz K, Brimacombe M, Õunpuu S. Percutaneous hamstring lengthening in cerebral palsy: Technique and gait outcomes based on GMFCS level. Gait Posture 2022; 91:318-325. [PMID: 34823200 DOI: 10.1016/j.gaitpost.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increased knee flexion at initial contact and in stance is a common problem for children with cerebral palsy. Surgical correction with percutaneous hamstring lengthening is an alternative to open hamstring lengthening; however, outcomes are less well documented, and there is concern about increasing anterior pelvic tilt. The purpose of this study was to evaluate the short-term outcomes of percutaneous hamstring lengthenings in children with cerebral palsy using comprehensive gait analysis techniques. RESEARCH QUESTION Does percutaneous hamstring lengthening improve knee function, and do knee and anterior pelvic tilt outcomes vary by GMFCS level? METHODS A convenience sample of 52 patients with both pre and post-surgical gait analyses was evaluated retrospectively for changes in gait function in terms of temporal-spatial parameters, kinematics and kinetics. Patients were divided into two GMFCS subgroups: GMFCS level I/II and III. RESULTS The percutaneous hamstring lengthening results in statistically significant improvements in knee function during gait with increased knee extension at initial contact (mean 32° SD 13° to mean 21° SD 11°, p = 0.000) and improved mean knee flexion in stance (mean 23° SD 12° to mean 16° SD 11°, p = 0.000) for the total study cohort. Beneficial changes were found for knee function in both GMFCS level subgroups; however, there was an increase in pelvic tilt pre to post-surgery in the GMFCS level III subgroup (mean 21° SD 8° to mean 26° SD 6°, p = 0.012) but not the GMFCS level I/II subgroup (mean 18° SD 7° to mean 20° SD 8°, p = 0.427). SIGNIFICANCE Percutaneous hamstring lengthening can improve knee function for all patients; however, the impact on anterior pelvic tilt varies by GMFCS level, with increasing anterior tilt for GMFCS level III only. This study highlights the importance of understanding differences in surgical outcomes by GMFCS level to better predict post-surgical function.
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Affiliation(s)
- Kristan Pierz
- Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, United States; Orthopedic Surgery, University of Connecticut School of Medicine, United States.
| | - Michael Brimacombe
- Research Department, Connecticut Children's Medical Center, United States.
| | - Sylvia Õunpuu
- Center for Motion Analysis, Division of Orthopedics, Connecticut Children's Medical Center, United States; Orthopedic Surgery, University of Connecticut School of Medicine, United States.
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Phamduy TT, Smith S, Herbst KW, Phamduy PT, Brimacombe M, Hogan AH, Salazar JC, Sturm J. Kawasaki Disease Hospitalizations in the United States 2016-2020: A Comparison of Before and During the Coronavirus Disease 2019 Era. Pediatr Infect Dis J 2021; 40:e407-e412. [PMID: 34382611 PMCID: PMC8505141 DOI: 10.1097/inf.0000000000003289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute vasculitis of young children. A comparison of US hospitalization rates and epidemiologic features of KD in 2020 to those of precoronavirus disease years has yet to be reported. METHODS Using a large, inpatient database, we conducted a retrospective cohort study and analyzed data for patients with (1) diagnosis coding for KD, (2) IV immunoglobulin treatment administered during hospitalization and (3) discharge date between January 1, 2016, and December 30, 2020. Severe cases were defined as those requiring adjunctive therapy or IV immunoglobulin-resistant therapy. RESULTS The annual number of KD hospitalizations were stable from 2016 to 2019 (n = 1652, 1796, 1748, 1692, respectively) but decreased in 2020 (n = 1383). KD hospitalizations demonstrated seasonal variation with an annual peak between December and April. A second peak of KD admissions was observed in May 2020. The proportion of KD cases classified as severe increased to 40% in 2020 from 33% during the years 2016-2019 (P < 0.01). Median age in years increased from 2.9 in subjects hospitalized from 2016 to 2019 to 3.2 in 2020 (P = 0.002). CONCLUSIONS Compared with the previous 4 years, the annual number of pediatric KD admissions decreased, and children discharged with diagnostic codes for KD in 2020 were generally older and more likely to have severe morbidity possibly reflective of misdiagnosed multisystem inflammatory syndrome in children. Clinicians should be wary of a possible rise in KD rates in the postcoronavirus disease 2019 era as social distancing policies are lifted and other viruses associated with KD return.
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Affiliation(s)
- Timothy T. Phamduy
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sharon Smith
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
| | | | - Paul T. Phamduy
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
- Division of Research, Connecticut Children’s Medical Center
- Division of Pediatric Hospital Medicine, Connecticut Children’s Medical Center
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, Connecticut
| | | | - Alexander H. Hogan
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Pediatric Hospital Medicine, Connecticut Children’s Medical Center
| | - Juan C. Salazar
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Pediatric Infectious Diseases and Immunology, Connecticut Children’s Medical Center, Hartford, Connecticut
| | - Jesse Sturm
- From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
- Division of Emergency Medicine, Connecticut Children’s Medical Center
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12
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Dailey J, Kozhaya L, Dogan M, Hopkins D, Lapin B, Herbst K, Brimacombe M, Grandonico K, Karabacak F, Schreiber J, Liang BTL, Salazar JC, Unutmaz D, Hyams JS. Antibody Responses to SARS-CoV-2 after Infection or Vaccination in Children and Young Adults with Inflammatory Bowel Disease. medRxiv 2021. [PMID: 34159338 DOI: 10.1101/2021.06.12.21258810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Characterization of neutralization antibodies to SARS-CoV-2 infection or vaccination in children and young adults with inflammatory bowel disease (IBD) receiving biologic therapies is crucial. Methods W e performed a prospective longitudinal cohort study evaluating SARS-CoV-2 Spike protein receptor binding domain (S-RBD) IgG positivity along with consistent clinical symptoms in patients with IBD receiving infliximab or vedolizumab. Serum was also obtained following immunization with approved vaccines. IgG antibody to the spike protein binding domain of SARS-CoV-2 was assayed with a fluorescent bead-based immunoassay that takes advantage of the high dynamic range of fluorescent molecules using flow cytometry. A sensitive and high-throughput neutralization assay that incorporates SARS-CoV-2 Spike protein onto a lentivirus and measures pseudoviral entry into ACE2 expressing HEK-293 cells was used. Results 436 patients were enrolled (mean age 17 years, range 2-26 years, 58% male, 71% Crohn’s disease, 29% ulcerative colitis, IBD-unspecified). 44 (10%) of enrolled subjects had SARS-CoV-2 S-RBD IgG antibodies. Compared to non-IBD adults (ambulatory) and hospitalized pediatric patients with PCR documented SARS-CoV-2 infection, S-RBD IgG antibody levels were significantly lower in the IBD cohort and by 6 months post infection most patients lacked neutralizing antibody. Following vaccination (n=33) patients had a 15-fold higher S-RBD antibody response in comparison to natural infection, and all developed neutralizing antibodies to both wild type and variant SARS-CoV-2. Conclusions and Relevance The lower and less durable SARS-CoV-2 S-RBD IgG response to natural infection in IBD patients receiving biologics puts them at risk of reinfection. The robust response to immunization is likely protective. Summary Our study showed a low and poorly durable SARS-CoV-2 S-RBD neutralizing IgG response to natural infection in IBD patients receiving biologics potentially putting them at risk of reinfection. However, they also had a robust response to immunization that is likely protective.
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13
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Hyams JS, Brimacombe M, Haberman Y, Walters T, Gibson G, Mo A, Mack D, Griffiths A, Boyle B, LeLeiko N, Markowitz J, Rosh J, Patel A, Shah S, Baldassano R, Pfefferkorn M, Sauer C, Dailey J, Venkateswaran S, Kugathasan S, Denson LA. Clinical and Host Biological Factors Predict Colectomy Risk in Children Newly Diagnosed With Ulcerative Colitis. Inflamm Bowel Dis 2021; 28:151-160. [PMID: 33904583 PMCID: PMC8804885 DOI: 10.1093/ibd/izab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Develop a clinical and biological predictive model for colectomy risk in children newly diagnosed with ulcerative colitis (UC). METHODS This was a multicenter inception cohort study of children (ages 4-17 years) newly diagnosed with UC treated with standardized initial regimens of mesalamine or corticosteroids (CS) depending upon initial disease severity. Therapy escalation to immunomodulators or infliximab was based on predetermined criteria. Patients were phenotyped by clinical activity per the Pediatric Ulcerative Colitis Activity Index (PUCAI), disease extent, endoscopic/histologic severity, and laboratory markers. In addition, RNA sequencing defined pretreatment rectal gene expression and high density DNA genotyping by the Affymetrix UK Biobank Axiom Array. Coprimary outcomes were colectomy over 3 years and time to colectomy. Generalized linear models, Cox proportional hazards multivariate regression modeling, and Kaplan-Meier plots were used. RESULTS Four hundred twenty-eight patients (mean age 13 years) started initial theapy with mesalamine (n = 136), oral CS (n = 144), or intravenous CS (n = 148). Twenty-five (6%) underwent colectomy at ≤1 year, 33 (9%) at ≤2 years, and 35 (13%) at ≤3 years. Further, 32/35 patients who had colectomy failed infliximab. An initial PUCAI ≥ 65 was highly associated with colectomy (P = 0.0001). A logistic regression model predicting colectomy using the PUCAI, hemoglobin, and erythrocyte sedimentation rate had a receiver operating characteristic area under the curve of 0.78 (95% confidence interval [0.73, 0.84]). Addition of a pretreatment rectal gene expression panel reflecting activation of the innate immune system and response to external stimuli and bacteria to the clinical model improved the receiver operating characteristic area under the curve to 0.87 (95% confidence interval [0.82, 0.91]). CONCLUSIONS A small group of children newly diagnosed with severe UC still require colectomy despite current therapies. Our gene signature observations suggest additional targets for management of those patients not responding to current medical therapies.
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Affiliation(s)
- Jeffrey S Hyams
- Connecticut Children’s Medical Center, Hartford, Connecticut, USA,Address correspondence to: Jeffrey S. Hyams, MD, Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’s Medical Center, Hartford, CT ()
| | | | - Yael Haberman
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA,Sheba Medical Center, Tel-HaShomer, affiliated with Tel-Aviv University, Ramat Gan, Israel
| | | | - Greg Gibson
- Georgia Tech University, Atlanta, Georgia, USA
| | - Angela Mo
- Georgia Tech University, Atlanta, Georgia, USA
| | - David Mack
- Children’s Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Neal LeLeiko
- Hasbro Children’s Hospital, Providence, Rhode Island, USA
| | | | - Joel Rosh
- Goryeb Children’s Hospital, Morristown, New Jersey, USA
| | | | - Sapana Shah
- Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Baldassano
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Joelynn Dailey
- Connecticut Children’s Medical Center, Hartford, Connecticut, USA
| | | | | | - Lee A Denson
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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14
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Braun E, Sack AM, Sayed D, Manion S, Hamm B, Brimacombe M, Tollette M, Khan TW, Orr W, Nicol A. Reducing Radiation Exposure in Lumbar Transforaminal Epidural Steroid Injections with Pulsed Fluoroscopy: A Randomized, Double-blind, Controlled Clinical Trial. Pain Physician 2018; 21:53-60. [PMID: 29357331 PMCID: PMC6413313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Fluoroscopy-guided lumbar transforaminal epidural steroid injections (L-TFESI) result in radiation exposure that carries risks to patients, physicians, and procedural staff. OBJECTIVE We aim to evaluate the feasibility of using pulsed fluoroscopy to safely reduce radiation exposure during L-TFESI. STUDY DESIGN This is a prospective, double-blind, randomized controlled trial. SETTING This study took place in a single-center, academic, outpatient interventional pain management clinic. METHODS Patients undergoing L-TFESI were randomly assigned to either continuous mode fluoroscopy (high-dose), pulsed fluoroscopy with 8 pulses per second (medium-dose), or pulsed fluoroscopy with one pulse per second (low-dose). Data on radiation doses and other clinical and demographic factors were also collected. RESULTS In total, 231 cases were analyzed in the high-dose group (n = 81), medium-dose group (n = 72), and low-dose group (n = 78). Mean radiation effective dose (µSv) was 121 in the high-dose group, 57.9 in the medium-dose group, and 34.8 in the low-dose group (P < 0.001). The incidence of inadequate image quality in the pulsed groups was 6% (9/150). The body mass index (BMI, mean ± SD) was significantly higher in patients with inadequate image quality (37.3 ± 7.2) than with adequate quality (30.5 ± 7.2, P = 0.005). LIMITATIONS Radiation doses were measured using the meter on C-arm fluoroscopes rather than by direct measurement. CONCLUSIONS The use of pulsed fluoroscopy during L-TFESI resulted in radiation dose reduction of up to 72.1% without causing any significant adverse events. Pulsed fluoroscopy should be considered as an initial fluoroscopic setting for L-TFESI to reduce radiation exposure. KEY WORDS Radiation, epidural, fluoroscopy, injection, exposure, pulse.
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Affiliation(s)
- Edward Braun
- University of Kansas Medical Center, Kansas City, KS
| | - Andrew M Sack
- University of Kansas Medical Center, Kansas City, KS
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, KS
| | - Smith Manion
- University of Kansas Medical Center, Kansas City, KS
| | - Brian Hamm
- University of Kansas Medical Center, Kansas City, KS
| | | | | | - Talal W Khan
- University of Kansas Medical Center, Kansas City, KS
| | - Walter Orr
- University of Kansas Medical Center, Kansas City, KS
| | - Andrea Nicol
- University of Kansas Medical Center, Kansas City, KS
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15
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Stevens D, Goetz J, Brimacombe M. 0568 EFFECT OF VARYING DIET INTENSITIES ON WEIGHT LOSS INTERVENTION FOR OSA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.567] [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: 11/12/2022] Open
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Abstract
The purpose of this pilot study was to evaluate the acceptability and feasibility of a 10-week community-based, culturally tailored mental health intervention, called Healthy Sudanese Families, with 12 South Sudanese refugee women living in a metropolitan area of the Midwestern United States. This mixed-methods study used the Dinka and Arabic versions of the Hopkins Symptoms Checklist-25 to measure indicators of anxiety and depression and a final focus group to evaluate the women's responses to the intervention. The women found the mental health intervention acceptable and relevant. Methodological challenges encountered in cross-cultural research with refugees are discussed.
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Affiliation(s)
- Martha Baird
- a School of Nursing , University of Kansas Medical Center , Kansas City , Kansas , USA
| | - Milan Bimali
- b Department of Preventive Medicine and Public Health , University of Kansas School of Medicine , Wichita , Kansas , USA
| | - Ashley Cott
- c Rediscover Mental Health , Kansas City , Missouri , USA
| | - Michael Brimacombe
- d Department of Biostatistics , University of Kansas Medical Center , Kansas City , Kansas , USA
| | | | - Christine Daley
- f Department of Preventive Medicine and Public Health , University of Kansas Medical Center , Kansas City , Kansas , USA
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17
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Kellogg M, Petrov D, Agarwal N, Patel N, Agarwal P, Brimacombe M, Gandhi C, Prestigiacomo C, Hansberry D. Effects of Meteorological Variables on the Incidence of Rupture of Intracranial Aneurysms in Central New Jersey. J Neurol Surg A Cent Eur Neurosurg 2016; 78:238-244. [DOI: 10.1055/s-0036-1594308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Marissa Kellogg
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, United States
| | - Dimitriy Petrov
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Nitesh Patel
- Deparment of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, United States
| | - Prateek Agarwal
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Michael Brimacombe
- Department of Biostatistics, Kansas University Medical Center, Kansas City, Kansas, United States
| | - Chirag Gandhi
- Deparment of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, United States
| | - Charles Prestigiacomo
- Deparment of Neurological Surgery, New Jersey Medical School, Newark, New Jersey, United States
| | - David Hansberry
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States
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18
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Hammoud K, Brimacombe M, Yu A, Goodloe N, Haidar W, El Atrouni W. Vancomycin Trough and Acute Kidney Injury: A Large Retrospective, Cohort Study. Am J Nephrol 2016; 44:456-461. [PMID: 27788522 DOI: 10.1159/000452427] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The association between vancomycin trough (VT) and acute kidney injury (AKI) at the recommended doses remains controversial. METHODS The authors conducted a retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h. Data collected included 2 main predictors: average VT (including only VTs before the occurrence of AKI), first VT and other possible risk factors for AKI. The baseline characteristics/variables between patients with AKI and patients with no AKI were compared. Logistic regression models were used to develop multivariate models. The authors divided the patients into 4 subgroups: (1) VT <10, (2) 10 ≤ VT < 15, (3) 15 ≤ VT < 20 and (4) VT ≥20 µg/ml. All subgroups were compared to subgroup 2 (reference group). RESULTS AKI occurred in 12.85% of patients while on vancomycin. The incidence of AKI in subgroups 1-4 was 8.02, 13.61, 13.70 and 31.82%, respectively, using the first VT, that is significantly higher in subgroup 4. Using average VT, AKI incidence was 5, 10.38, 19.01 and 25.58%, respectively, that is significantly higher in subgroups 3 and 4. On multivariate logistic regression, average VT, first VT, average VT >15, first VT >15, methicillin-resistant Staphylococcus aureus infection and morbid obesity were significantly associated with increased incidence of AKI. CONCLUSION Clinicians should be careful when aiming for a VT >15 μg/ml as this is associated with increased incidence of AKI.
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Affiliation(s)
- Kassem Hammoud
- Department of Infectious Diseases, University of Kansas Medical Center, Kansas City, Kans., USA
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19
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Gupta A, Murillo D, Yarlagadda SG, Wang CJ, Nawabi A, Schmitt T, Brimacombe M, Bryan CF. Donor-specific antibodies present at the time of kidney transplantation in immunologically unmodified patients increase the risk of acute rejection. Transpl Immunol 2016; 37:18-22. [DOI: 10.1016/j.trim.2016.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/16/2022]
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20
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Affiliation(s)
- Tami Wisniewski
- Department of Preventive Medicine & Community Health, New Jersey Medical School-UMDNJ Newark, NJ, USA
| | - Xue Ming
- Department of Neurology, New Jersey Medical School-UMDNJ, Newark, NJ, USA
| | - Michael Brimacombe
- Department of Preventive Medicine & Community Health, New Jersey Medical School-UMDNJ Newark, NJ, USA
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21
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Howe EE, Kalender-Rich JL, Brimacombe M, Polsak M, Lowry B, Vansaghi L. Using Teaching Excellence Surveys to Evaluate Improvements in Teaching Confidence. Kans J Med 2015. [DOI: 10.17161/kjm.v8i1.11511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: There are many surveys to assess teaching excellence, but few validated tools to assess improvements in teaching confidence among faculty over time. We hypothesized that previously validated surveys for learner evaluation of faculty teaching excellence also can be used as a self-evaluation tool to assess changes in faculty teaching skills confidence over time. METHODS: A cohort study was designed using a composite survey from two previously validated surveys (SETQ and CanMEDS) on teaching excellence. The composite survey was administered before and after a faculty development course on teaching excellence at the University of Kansas Medical Center in the Spring of 2012. Course “completers” attended more than 50% of the course and “non-completers” attended 50% or less of the course. RESULTS: The overall mean change in survey result scores on a five-point Likert scale was nearly one point for “completers” (mean difference = 0.92, SD = 0.41) as opposed to 0.34 for “non-completers” (SD = 0.34, p = 0.001). The Cronbach’s alpha coefficients for the pre-course surveys were 0.83 and 0.85 versus 0.88 and 0.83 for the post-course surveys, indicating a high internal consistency for both survey instruments. CONCLUSIONS: Measurable improvements in teaching skills confidence occur following faculty professional development courses. These improvements can be assessed more efficiently by using previously validated and reliable assessment tools in new and innovative ways.
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22
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Muraru M, Atrouni WE, Brimacombe M, Clough L, Ganguly N, Waller S. 1580Sexual Health of HIV Infected Patients Attending KUMC ID Clinic. Open Forum Infect Dis 2014. [PMCID: PMC5781716 DOI: 10.1093/ofid/ofu052.1126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mihai Muraru
- Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Wissam El Atrouni
- Internal Medicine/Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Michael Brimacombe
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS
| | - Lisa Clough
- Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Nivedita Ganguly
- Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
| | - Stephen Waller
- Infectious Diseases, University of Kansas Medical Center, Kansas City, KS
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23
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Lisbon D, Allin D, Cleek C, Roop L, Brimacombe M, Downes C, Pingleton SK. Improved Knowledge, Attitudes, and Behaviors After Implementation of TeamSTEPPS Training in an Academic Emergency Department: A Pilot Report. Am J Med Qual 2014; 31:86-90. [PMID: 25143410 DOI: 10.1177/1062860614545123] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
TeamSTEPPS is a validated, formal patient safety curriculum created by the Agency for Healthcare Research and Quality (AHRQ) for the development of high-functioning multidisciplinary teams. TeamSTEPPS was implemented in an academic emergency department (ED), including all ED hospital staff as well as physicians and residents. It was hypothesized that extensive interprofessional education combined with implementation of specific tools would increase knowledge of TeamSTEPPS principles, attitudes, and behaviors. The TeamSTEPPS knowledge test and the AHRQ Hospital Survey attitude test were administered at 0, 45, and 90 days after training. Behaviors were evaluated using an observation tool that was developed to document huddle occurrence. Knowledge and attitudes significantly improved 45 days from baseline (P < .05) and were sustained by day 90. In this pilot study, the implementation of TeamSTEPPS training in a multidisciplinary team in an academic ED led to increased knowledge and improved communication attitudes. Adoption of a specific behavior, the huddle, also was observed.
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Affiliation(s)
- David Lisbon
- University of Kansas Medical Center, Kansas City, KS
| | - Dennis Allin
- University of Kansas Medical Center, Kansas City, KS
| | - Carol Cleek
- University of Kansas Hospital, Kansas City, KS
| | - Lori Roop
- University of Kansas School of Medicine, Kansas City, KS
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24
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Sharma S, Thapa R, Jeevanantham V, Myers T, Hu C, Brimacombe M, Vacek JL, Dawn B, Gupta K. Comparison of lipid management in patients with coronary versus peripheral arterial disease. Am J Cardiol 2014; 113:1320-5. [PMID: 24560066 DOI: 10.1016/j.amjcard.2014.01.405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/13/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
Peripheral arterial disease (PAD), similar to coronary artery disease (CAD), is a significant predictor of cardiovascular morbidity and mortality. Guidelines recommend a low-density lipoprotein (LDL) goal of <100 mg/dl for both groups. We assessed whether lipid control and statin use were as aggressively applied to PAD as to patients with CAD. This retrospective study of patients with the diagnosis of CAD, PAD, or both CAD and PAD compared lipid levels and statin use. For comparison of statins, we used a statin potency unit (1 potency unit=10 mg of simvastatin). Among 11,134 subjects (CAD 9,563, PAD 596, and both CAD and PAD 975), mean LDL in the PAD group was higher than the CAD (92 vs 83 mg/dl, respectively, p<0.001) and the combined CAD and PAD groups (92 vs 80 mg/dl, respectively, p<0.001). Fewer patients with PAD achieved a target LDL of <100 mg/dl compared with CAD (62% vs 78%, respectively, p<0.001) and the combined group (62% vs 79%, respectively, p<0.001). Similar differences were noted for a target LDL of <70 mg/dl. Compared with the CAD group, a lesser number of patients with PAD received statin therapy (76% vs 100%, respectively, p<0.001) with lower mean potency unit (5.3 vs 8.1, respectively, p<0.001). In conclusion, our study demonstrated lower use and less aggressive application of statins in patients with PAD compared with patients with CAD, ensuing lower mean LDL in the CAD and combined PAD and CAD groups. Our study suggests that physicians are more aggressive with lipid control in patients with CAD compared with patients with PAD alone.
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Affiliation(s)
- Suresh Sharma
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Rashmi Thapa
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Vinodh Jeevanantham
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Taylor Myers
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Casper Hu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Michael Brimacombe
- Department of Biostatistics, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - James L Vacek
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Buddhadeb Dawn
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas
| | - Kamal Gupta
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, Kansas.
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25
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Sharma S, Thapa R, Myers T, Hu C, Brimacombe M, Vacek JL, Dawn B, Gupta K. Abstract 290: Comparison of Lipid Control in Patients with Coronary versus Peripheral Arterial Disease. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Patients with Peripheral artery disease (PAD) have similar cardiovascular morbidity and mortality as those with established coronary artery disease (CAD). Thus the recommended LDL goal is < 100 mg/dl for both CAD and PAD patients. This study assesses the degree of lipid control and statin drug use in CAD and PAD patients in current clinical practice.
Methods:
We did a retrospective chart review of patients with a diagnosis of PAD, CAD and both PAD and CAD seen at our institution between Jan 2009 to March 2012. Demographic data, lipid levels and statin use were compared between CAD, PAD and PAD & CAD groups. To enable comparison of the doses of various statins, we used statin potency unit where 1 potency unit = 10mg of Simvastatin.
Results:
There were a total of 11498 subjects in the chart review (CAD-9879, PAD-623, both PAD & CAD -996). PAD patients were younger with more females & lower BMI compared to CAD and both PAD & CAD groups (Table 1). Mean LDL level in the PAD group was 93.4±35.5 mg/dL, CAD group was 82.7±33.1 mg/dL and both PAD & CAD group was 80.5±31.0 mg/dL. Although all groups had a mean LDL of < 100mg/dL, significantly fewer number of PAD patients achieved target LDL <100 mg/dl and LDL <70 mg/dl, as compared to CAD and combined group (Table 1). The PAD group had significantly higher mean total cholesterol and mean LDL levels as compared to the CAD group and combined PAD & CAD group (Table 1). The mean HDL and mean triglyceride (TG) levels in PAD group were significantly higher than the CAD and combined PAD & CAD group. The PAD patients had significantly greater use of less potent statins than the CAD and PAD & CAD groups which was not compensated for by a higher mean dose of the lower potency statins (Table 1). PAD patients were receiving significantly lower mean potency unit of statins as compared to PAD and combined CAD and PAD group (Table 1).
Conclusion:
Even though both PAD and CAD groups had mean LDL < 100mg/dL, we found that lipid control assessed by absolute mean lipid levels were significantly better in patients with CAD and combined PAD & CAD group. Thus, our study indicates that physicians tend to be more aggressive with lipid control in patients with a diagnosis of CAD when compared to patients with PAD alone.
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Affiliation(s)
| | | | | | - Casper Hu
- Univ of Kansas Med Cntr, Kansas City, KS
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Alexander M, Dang E, Floyd LR, Sharpe TT, Weber MK, Szetela C, Zoorob R, Wedding D, Fry-Johnson Y, Levine R, Powell S, Mitchell K, Rupp T, Ohlemiller M, Cook K, Mengel M, Pitt R, Baillie S, O'Connor M, Paley B, Stuber M, Guiton G, Adubato S, Brimacombe M, Zimmerman-Bier B, Braddock S, Rudeen KP. Educating Health Professionals about Fetal Alcohol Spectrum Disorders. American Journal of Health Education 2013. [DOI: 10.1080/19325037.2007.10598996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Martha Alexander
- a Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Elizabeth Dang
- a Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Louise R. Floyd
- a Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Tanya T. Sharpe
- a Centers for Disease Control and Prevention , Atlanta , Georgia
| | - Mary Kate Weber
- a Centers for Disease Control and Prevention , Atlanta , Georgia
| | | | - Roger Zoorob
- b Meharry Medical College , Nashville , Tennessee
| | - Danny Wedding
- c Missouri Institute of Mental Health , St. Louis , Missouri
| | | | | | | | - Kathleen Mitchell
- e National Organization on Fetal Alcohol Syndrome , Washington , D.C
| | - Tara Rupp
- e National Organization on Fetal Alcohol Syndrome , Washington , D.C
| | | | - Keely Cook
- g Saint Louis University , St. Louis , Missouri
| | - Mark Mengel
- g Saint Louis University , St. Louis , Missouri
| | - Rosalyn Pitt
- h Tennessee State University , Nashville , Tennessee
| | - Susan Baillie
- i University of California , Los Angeles , California
| | - Mary O'Connor
- i University of California , Los Angeles , California
| | - Blair Paley
- i University of California , Los Angeles , California
| | | | | | - Susan Adubato
- k University of Medicine and Dentistry of New Jersey , Newark , New Jersey
| | - Michael Brimacombe
- k University of Medicine and Dentistry of New Jersey , Newark , New Jersey
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Zitter JN, Maldjian P, Brimacombe M, Fennelly KP. Inhaled Dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients. J Crit Care 2012; 28:218.e1-7. [PMID: 23266402 DOI: 10.1016/j.jcrc.2012.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lobar or segmental collapse of the lung in mechanically ventilated patients is a common occurrence in the intensive care unit. Management is labor and time intensive and not highly effective. METHODS We conducted a randomized, placebo-controlled, double-blind pilot study to determine whether nebulized Dornase alfa improves radiologic and clinical outcomes in ventilated patients with lobar atelectasis. Drug or placebo was administered twice daily until extubation, death, or transfer. The primary outcome was the total chest x-ray score: secondary outcomes of interest were oxygenation, lung compliance, and rate of extubation over the first 5 days. The groups consisted of 14 intervention patients and 16 control patients. RESULTS There were no significant differences in "Total Chest X-Ray Score" or compliance over the 5 days of study. There was an improvement in oxygenation for the intervention group at day 5 (P = .03). In addition, this group was less likely to remain intubated over the first 24 hours of the study, a difference that did not persist over the course of the study. CONCLUSIONS Dornase alfa does not improve the appearance of atelectasis on chest radiographs, or the "Total Chest X-Ray Score" over the first 5 days of treatment in mechanically ventilated patients. The intervention group's higher rate of extubation during the first 24 hours as well as its improved oxygenation on day 5 were likely chance findings given the multiple potential confounders for extubation and low study power.
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Affiliation(s)
- Jessica Nutik Zitter
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
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Abstract
Background: In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions. Objective: To examine the association of socioeconomic status (SES) with ASD prevalence. Methods: Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data. Results: 586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0–21.1)) in tracts with median income >US$90,000 than in tracts with median income ≤US$30,000 (7.1 (95% CI 5.7–8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts ( p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5–3.1) when comparing highest with lowest income tracts. Conclusions: In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services.
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Affiliation(s)
- Pauline Thomas
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
- Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Walter Zahorodny
- Department of Pediatrics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Bo Peng
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Soyeon Kim
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Nisha Jani
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - William Halperin
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
| | - Michael Brimacombe
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
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Abstract
As a screening tool to identify symptoms of autonomic dysfunction, the Pediatric Autonomic Symptoms Scale was administered to parents of children with familial dysautonomia, autism spectrum disorders, and age-matched controls. The total scores for the presence of symptoms were compared among the 3 groups for each section and overall. The Pediatric Autonomic Symptoms Scale distinguished controls from children with familial dysautonomia and autism spectrum disorders with scores from each section and overall scores. Familial dysautonomia children scored significantly higher in visceral symptoms, while children with autism spectrum disorders scored significantly higher in psychosocial symptoms. In familial dysautonomia, the concordance for the presence of symptoms within sections and overall scores ranged from 71% to 100%. The concordance for absence of autonomic dysfunction symptoms in controls ranged from 75% to 87.5%. The Pediatric Autonomic Symptoms Scale is comprehensive and can profile autonomic dysfunction in the 2 neurodevelopmental disorders. Its usefulness in other pediatric disorders remains to be studied.
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Affiliation(s)
- Xue Ming
- Department of Neurosciences and Neurology, New Jersey Medical School, Newark, NJ, USA.
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Brimacombe M. Lawrence Brimacombe. West J Med 2010. [DOI: 10.1136/bmj.c3177] [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: 11/04/2022]
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Barbieri M, Paolisso G, Kimura M, Gardner JP, Boccardi V, Papa M, Hjelmborg JV, Christensen K, Brimacombe M, Nawrot TS, Staessen JA, Pollak MN, Aviv A. Higher circulating levels of IGF-1 are associated with longer leukocyte telomere length in healthy subjects. Mech Ageing Dev 2010; 130:771-6. [PMID: 19913048 DOI: 10.1016/j.mad.2009.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 10/06/2009] [Accepted: 10/24/2009] [Indexed: 01/21/2023]
Abstract
Mutations that inhibit the insulin-like growth factor-1 (IGF-1) extend the lifespan of worms, flies and mice. However, it appears that relatively low circulating levels of IGF-1 in humans are associated with aging-related diseases and diminished longevity. As leukocyte telomere length (LTL) is ostensibly a biomarker of human aging, we examined the relationship between LTL and blood IGF-1 in a healthy cohort. Our sample comprised 476 healthy, unrelated Caucasians (208 men and 268 women), aged 16-104 years, living in the West Coast of Southern Italy. We measured LTL by Southern blots and IGF-1 by enzyme-linked immunoassay. Both IGF-1 and LTL diminished with age (IGF-1, r=-0.601, P<0.001; LTL, r=-0.706, P<0.001). Age-adjusted LTL was positively associated with IGF-1 level throughout the age range of the cohort (r=0.270, P<0.001). IGF-1 accounted for about 10% of the inter-individual variation in LTL over and above the effect of age. Our findings suggest that both circulating IGF-1 and LTL are indices of healthy aging in humans. Further research will be necessary to establish whether LTL will ultimately be used in clinical settings as an index of healthy aging.
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Affiliation(s)
- Michelangela Barbieri
- Department of Geriatric Medicine and Metabolic Diseases, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy
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Roche M, Neti PVSV, Kemp FW, Agrawal A, Attanasio A, Douard V, Muduli A, Azzam EI, Norkus E, Brimacombe M, Howell RW, Ferraris RP. Radiation-induced reductions in transporter mRNA levels parallel reductions in intestinal sugar transport. Am J Physiol Regul Integr Comp Physiol 2009; 298:R173-82. [PMID: 19907007 DOI: 10.1152/ajpregu.00612.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
More than a century ago, ionizing radiation was observed to damage the radiosensitive small intestine. Although a large number of studies has since shown that radiation reduces rates of intestinal digestion and absorption of nutrients, no study has determined whether radiation affects mRNA expression and dietary regulation of nutrient transporters. Since radiation generates free radicals and disrupts DNA replication, we tested the hypotheses that at doses known to reduce sugar absorption, radiation decreases the mRNA abundance of sugar transporters SGLT1 and GLUT5, prevents substrate regulation of sugar transporter expression, and causes reductions in sugar absorption that can be prevented by consumption of the antioxidant vitamin A, previously shown by us to radioprotect the testes. Mice were acutely irradiated with (137)Cs gamma rays at doses of 0, 7, 8.5, or 10 Gy over the whole body. Mice were fed with vitamin A-supplemented diet (100x the control diet) for 5 days prior to irradiation after which the diet was continued until death. Intestinal sugar transport was studied at days 2, 5, 8, and 14 postirradiation. By day 8, d-glucose uptake decreased by approximately 10-20% and d-fructose uptake by 25-85%. With increasing radiation dose, the quantity of heterogeneous nuclear RNA increased for both transporters, whereas mRNA levels decreased, paralleling reductions in transport. Enterocytes of mice fed the vitamin A supplement had > or = 6-fold retinol concentrations than those of mice fed control diets, confirming considerable intestinal vitamin A uptake. However, vitamin A supplementation had no effect on clinical or transport parameters and afforded no protection against radiation-induced changes in intestinal sugar transport. Radiation markedly reduced GLUT5 activity and mRNA abundance, but high-d-fructose diets enhanced GLUT5 activity and mRNA expression in both unirradiated and irradiated mice. In conclusion, the effect of radiation may be posttranscriptional, and radiation-damaged intestines can still respond to dietary stimuli.
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Affiliation(s)
- Marjolaine Roche
- Department of Pharmacology and Physiology, New Jersey Medical School, NJ, USA
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Brimacombe M, Walter D, Salberg L. Gender disparity in a large nonreferral-based cohort of hypertrophic cardiomyopathy patients. J Womens Health (Larchmt) 2009; 17:1629-34. [PMID: 19049357 DOI: 10.1089/jwh.2007.0734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic disease of the heart muscle that affects 1 in 500 people. HCM is highly heterogeneous in its clinical presentation and severity. HCM research has typically been carried out using hospital-based and referral populations. The Hypertrophic Cardiomyopathy Association (HCMA) is a patient support group founded in 1996. The HCMA membership and related database represent a large, heterogeneous, and diverse nonhospital and nonreferral-based HCM patient population. METHODS To examine gender disparities in self-reported symptom and medication patterns among HCM patients participating in the HCMA database, HCMA patient information was entered into an Access database. Patients were added to the HCMA database when they joined or requested information from the HCMA. Consenting patients were interviewed by phone or mailed an intake survey. RESULTS Information was available for 1228 HCM patients from 49 states and 32 countries (549 females, 679 males). Females were significantly more likely to report a family history of HCM to experience chest pain, fatigue, lightheadedness, and palpitations and to be taking non-HCM-related medications. In terms of symptom clustering, 44.9% of females had four or five symptoms vs. 31.4% of the males. CONCLUSIONS The HCMA patient database represents a nonhospital-based patient cohort useful in scientific investigations of HCM. Observed gender-related disparities in HCM symptom profiles are significant but are subject to the design and self-report-based limitations of the HCM database.
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Affiliation(s)
- M Brimacombe
- Department of Preventive Medicine, NJMS-UMDNJ, Newark, New Jersey 07101-1709, USA.
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Aviv A, Chen W, Gardner JP, Kimura M, Brimacombe M, Cao X, Srinivasan SR, Berenson GS. Leukocyte telomere dynamics: longitudinal findings among young adults in the Bogalusa Heart Study. Am J Epidemiol 2009; 169:323-9. [PMID: 19056834 PMCID: PMC2638944 DOI: 10.1093/aje/kwn338] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Leukocyte telomere length (LTL) is ostensibly a biomarker of human aging. Cross-sectional analyses have found that LTL is relatively short in a host of aging-related diseases. These studies have also provided indirect estimates of age-dependent LTL shortening. In this paper, the authors report findings of the first comprehensive longitudinal study of 450 whites and 185 African Americans in Louisiana (aged 31.4 and 37.4 years at baseline (1995-1996) and follow-up (2001-2006) examinations, respectively) participating in the Bogalusa Heart Study. Rate of change in LTL was highly variable among individuals, with some displaying a paradoxical gain in LTL during the follow-up period. The most striking observation was that age-dependent LTL shortening was proportional to LTL at baseline examination. At both baseline and follow-up examinations, African Americans had longer LTLs than whites, and smokers had shorter LTLs than nonsmokers. The longer LTL in African Americans than in whites explained in part the faster rate of LTL shortening observed among African Americans. These findings underscore the complexity of leukocyte telomere dynamics in vivo and suggest that determinants in addition to the "end-replication problem" contribute to telomere shortening in vivo.
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Affiliation(s)
- Abraham Aviv
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA.
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Chen W, Gardner JP, Kimura M, Brimacombe M, Cao X, Srinivasan SR, Berenson GS, Aviv A. Leukocyte telomere length is associated with HDL cholesterol levels: The Bogalusa heart study. Atherosclerosis 2009; 205:620-5. [PMID: 19230891 DOI: 10.1016/j.atherosclerosis.2009.01.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 01/14/2009] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study examined the relationships of high-density lipoprotein cholesterol (HDL-C) with LTL and the rate of its shortening. BACKGROUND Diminished levels of HDL-C are associated with an increased risk for atherosclerosis. Shortened leukocyte telomere length (LTL) also entails an increased atherosclerotic risk. METHODS We studied 472 Whites and 190 African Americans (AfAs) enrolled in the Bogalusa Heart Study. Subjects were examined serially 3-13 times for HDL-C over an average period of 27.8 years from childhood through young adulthood. LTL was measured twice during adulthood at a mean age of 31.5 years (baseline exam) and 37.8 years (follow-up exam). HDL-C trajectories with age were constructed and the area under the curve (AUC) was used as a measure of cumulative HDL-C levels. RESULTS Multivariate regression analyses showed that LTL was positively associated with HDL-C in childhood (regression coefficient (bp per mg/dL) beta=3.1, p=0.024), adulthood (beta=4.4, p=0.058) and AUC from childhood to adulthood (beta=12.2, p=0.0004) in the combined sample of AfAs and Whites. The association between LTL and HDL-C AUC was stronger in females (beta=18.5, p<0.001) than in males (beta=2.9, p=0.590) (difference in slopes p=0.037). A slower rate of LTL shortening per year was associated with higher HDL-C AUC in the total sample (p=0.033), adjusting for baseline LTL. CONCLUSIONS As HDL-C exerts anti-oxidant and anti-inflammatory effects and LTL registers the accruing burden of oxidative stress and inflammation, the association between HDL-C and LTL might be explained by the lifelong status of oxidative stress and inflammation.
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Affiliation(s)
- Wei Chen
- Tulane Center for Cardiovascular Health, Tulane University Health Sciences, New Orleans, LA 70112, United States.
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Abstract
The prevalence of sleep related complaints is reported by questionnaire studies to be as high as 83.3% in children with autism spectrum disorders (ASD). Questionnaire studies report the presence of various parasomnia in ASD. However, no polysomnographic study reports non-REM parasomnias and only a single study reports REM related parasomnias in ASD. We investigated the prevalence and characteristics of sleep disorders by polysomnographic study and questionnaires in a cohort of 23 children with ASD and 23 age-matched children of a non-autistic comparison group. The results showed significantly more non-REM parasomnias in 14 children with ASD on polysomnograms (PSG) and 16 ASD children by questionnaire, a finding that was not associated with medication use, other comorbid medical or psychiatric disorders, or sleep disordered breathing. Of the 14 children with ASD who had PSG evidence of parasomnia, 11 of them had a history suggestive of parasomnia by questionnaire. There was a high sensitivity but a low specificity of parasomnia in ASD by questionnaire in predicting the presence of parasomnia in the PSG. Of the parasomnias recorded in the laboratory, 13 ASD children had Disorders of Partial Arousal, consistent with sleep terrors or confusional arousals. Furthermore, multiple episodes of partial arousal occurred in 11 of the 13 ASD children who had PSG evidence of Disorders of Partial Arousal. Of the 11 ASD children with multiple episodes of partial arousal, 6 ASD children had multiple partial arousals during both nights' PSG study. Sleep architecture was abnormal in children with ASD, characterized by increased spontaneous arousals, prolonged REM latency and reduced REM percentage. These results suggest a high prevalence of parasomnia in this cohort of children with ASD and a careful history intake of symptoms compatible with parasomnia could be prudent to diagnose parasomnia in ASD children when performing a PSG is not possible.
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Affiliation(s)
- Xue Ming
- Department of Neuroscience, UMDNJ-New Jersey Medical School, Newark, NJ
| | - Ye-Ming Sun
- Creedmoor Psychiatric Center, Queens Village, NY and Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Roberto V. Nachajon
- Pediatric Sleep Disorders Center, St. Joseph Children’s Hospital, Paterson, NJ
- Sleep/Wake Center, Palisades General Medical Center, North Bergen, NJ
| | - Michael Brimacombe
- Department of Preventive Medicine, UMDNJ-New Jersey Medical School, Newark, NJ
| | - Arthur S. Walters
- Center for Sleep Disorders Treatment, Research and Education, New Jersey Neuroscience Institute at JFK Medical Center, Seton Hall University, School of Graduate Medical Education, Edison, NJ
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Safford MM, Brimacombe M, Zhang Q, Rajan M, Xie M, Thompson W, Kolassa J, Maney M, Pogach L. Patient complexity in quality comparisons for glycemic control: an observational study. Implement Sci 2009; 4:2. [PMID: 19126229 PMCID: PMC2632611 DOI: 10.1186/1748-5908-4-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 01/06/2009] [Indexed: 11/25/2022] Open
Abstract
Background Patient complexity is not incorporated into quality of care comparisons for glycemic control. We developed a method to adjust hemoglobin A1c levels for patient characteristics that reflect complexity, and examined the effect of using adjusted A1c values on quality comparisons. Methods This cross-sectional observational study used 1999 national VA (US Department of Veterans Affairs) pharmacy, inpatient and outpatient utilization, and laboratory data on diabetic veterans. We adjusted individual A1c levels for available domains of complexity: age, social support (marital status), comorbid illnesses, and severity of disease (insulin use). We used adjusted A1c values to generate VA medical center level performance measures, and compared medical center ranks using adjusted versus unadjusted A1c levels across several thresholds of A1c (8.0%, 8.5%, 9.0%, and 9.5%). Results The adjustment model had R2 = 8.3% with stable parameter estimates on thirty random 50% resamples. Adjustment for patient complexity resulted in the greatest rank differences in the best and worst performing deciles, with similar patterns across all tested thresholds. Conclusion Adjustment for complexity resulted in large differences in identified best and worst performers at all tested thresholds. Current performance measures of glycemic control may not be reliably identifying quality problems, and tying reimbursements to such measures may compromise the care of complex patients.
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Affiliation(s)
- Monika M Safford
- Deep South Center on Effectiveness at Birmingham VA Medical Center and University of Alabama at Birmingham, Birmingham, AL, USA.
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Postigo L, Heredia G, Illsley NP, Torricos T, Dolan C, Echalar L, Tellez W, Maldonado I, Brimacombe M, Balanza E, Vargas E, Zamudio S. Where the O2 goes to: preservation of human fetal oxygen delivery and consumption at high altitude. J Physiol 2008; 587:693-708. [PMID: 19074967 DOI: 10.1113/jphysiol.2008.163634] [Citation(s) in RCA: 75] [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: 01/21/2023] Open
Abstract
Fetal growth is decreased at high altitude (> 2700 m). We hypothesized that variation in fetal O(2) delivery might account for both the altitude effect and the relative preservation of fetal growth in multigenerational natives to high altitude. Participants were 168 women of European or Andean ancestry living at 3600 m or 400 m. Ancestry was genetically confirmed. Umbilical vein blood flow was measured using ultrasound and Doppler. Cord blood samples permitted calculation of fetal O(2) delivery and consumption. Andean fetuses had greater blood flow and oxygen delivery than Europeans and weighed more at birth, regardless of altitude (+208 g, P < 0.0001). Fetal blood flow was decreased at 3600 m (P < 0.0001); the decrement was similar in both ancestry groups. Altitude-associated decrease in birth weight was greater in Europeans (-417 g) than Andeans (-228 g, P < 0.005). Birth weight at 3600 m was > 200 g lower for Europeans at any given level of blood flow or O(2) delivery. Fetal haemoglobin concentration was increased, decreased, and the fetal / curve was left-shifted at 3600 m. Fetuses receiving less O(2) extracted more (r(2) = 0.35, P < 0.0001). These adaptations resulted in similar fetal O(2) delivery and consumption across all four groups. Increased umbilical venous O(2) delivery correlated with increased fetal O(2) consumption per kg weight (r(2) = 0.50, P < 0.0001). Blood flow (r(2) = 0.16, P < 0.001) and O(2) delivery (r(2) = 0.17, P < 0.001) correlated with birth weight at 3600 m, but not at 400 m (r(2) = 0.04, and 0.03, respectively). We concluded that the most pronounced difference at high altitude is reduced fetal blood flow, but fetal haematological adaptation and fetal capacity to increase O(2) extraction indicates that deficit in fetal oxygen delivery is unlikely to be causally associated with the altitude- and ancestry-related differences in fetal growth.
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Affiliation(s)
- Lucrecia Postigo
- Hospital Materno-Infantil, Universidad de San Andreas Mayor, La Paz, Bolivia
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de Luise C, Brimacombe M, Pedersen L, Sørensen HT. Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 2008; 20:412-8. [PMID: 19039282 DOI: 10.1007/bf03325146] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Identifying predictors for mortality following hip fracture is essential in order to improve survival, especially among the elderly. We compared mortality after hip fracture to controls without hip fracture, and assessed the impact of comorbidity on mortality following hip fracture in a population-based cohort study. METHODS The health care databases in Western Denmark (1.4 million inhabitants) were used to identify all persons > or = 40 years of age with first-time hospitalization for hip fracture between 1/1/1998 and 1/31/2003. Five population controls without hip fracture were matched to hip fracture patients on age and gender. Prior hospitalization for selected comorbidities among hip fracture subjects was assessed from hospital discharge registries. Cox regression analysis was used to compute crude and adjusted relative risks and 95% confidence intervals for 30-day, 90-day, and 1-year mortality associated with hip fracture, and with prior hospital history of selected comorbidities. RESULTS The cohort was followed for an average of 22 months. Females comprised 71% of the cohort and 90% was aged 65 years or older. Compared to persons without hip fracture, persons with hip fracture had from 2 to >3-fold higher risk of death at 1 year. History of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), dementia, tumor, and malignancy increased adjusted 1-year mortality from 50% to 3-fold among persons with hip fracture. CONCLUSIONS Hip fracture increased 1-year mortality more than 3-fold compared with mortality without hip fracture. Among hip fracture subjects, the presence of selected comorbidities further increased the risk of mortality after hip fracture.
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Ming X, Brimacombe M, Malek JH, Jani N, Wagner GC. Autism spectrum disorders and identified toxic land fills: co-occurrence across States. Environ Health Insights 2008; 2:55-59. [PMID: 21572830 PMCID: PMC3091342 DOI: 10.4137/ehi.s830] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
It is believed that gene by environmental interactions contribute to the pathogenesis of autism spectrum disorders (ASD). We hypothesize that ASD are associated with early and repeated exposures to any of a number of toxicants or mixtures of toxicants. It is the cumulative effects of these repeated exposures acting upon genetically susceptible individuals that lead to the phenotypes of ASD. We report our initial observations of a considerable overlap of identified toxic landfills in the State of New Jersey and the residence of an ASD cohort, and a correlation between the identified toxic Superfund sites on each U.S. state and the total number of diagnosed cases of ASD in those states. The residence of 495 ASD patients in New Jersey by zip code and the toxic landfill sites were plotted on a map of Northern New Jersey. The area of highest ASD cases coincides with the highest density of toxic landfill sites while the area with lowest ASD cases has the lowest density of toxic landfill sites. Furthermore, the number of toxic Superfund sites and autism rate across 49 of the 50 states shows a statistically significant correlation (i.e. the number of identified superfund sites correlates with the rate of autism per 1000 residents in 49 of the states (p = 0.015; excluding the state of Oregon). These significant observations call for further organized studies to elucidate possible role(s) of environmental toxicants contributing to the pathogenesis of ASD.
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Affiliation(s)
- Xue Ming
- Departments of Neurosciences and Pediatrics, UMDNJ-New Jersey Medical School, Newark, NJ
| | - Michael Brimacombe
- Department of Preventive Medicine, UMDNJ-New Jersey Medical School, Newark, NJ
| | - Joanne H. Malek
- Department of Psychology, Rutgers University, New Brunswick, NJ
| | - Nisha Jani
- Department of Preventive Medicine, UMDNJ-New Jersey Medical School, Newark, NJ
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Clarke RJ, Högnason K, Brimacombe M, Townes-Anderson E. Cone and rod cells have different target preferences in vitro as revealed by optical tweezers. Mol Vis 2008; 14:706-20. [PMID: 18432315 PMCID: PMC2383278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 03/03/2008] [Indexed: 11/28/2022] Open
Abstract
PURPOSE When neural circuits are damaged in adulthood, regenerating and sprouting processes must distinguish appropriate targets to recreate the normal circuitry. We tested the ability of adult nerve cells to target specific cells in culture using the retina as a model system. METHODS Under sterile culture conditions, retinal cells, isolated from tiger salamander retina, were micromanipulated with optical tweezers to create pairs of first-order photoreceptor cells with second- or third-order retinal neurons. The development of cell contact and presynaptic varicosities, the direction and amount of neuritic growth, and nerve cell polarity were assessed after seven days in vitro. Cultures were labeled for rod opsin to distinguish rod from cone cells and for the alpha subunit of the trimeric G protein Go (Go alpha) to identify cone-dominated and mixed rod-cone ON bipolar cells. RESULTS Quantitative analysis of growth demonstrated that target preferences were cell-specific: Cone cells preferred second-order bipolar cells, whereas rod cells grew toward third-order neurons, which include amacrine and ganglion cells. In addition, when rod cells grew toward bipolar cells, they chose an abnormally high number of Go alpha-positive bipolar cells. These growth patterns were not affected by tweezers manipulation or the amount of growth. Cell orientation of the photoreceptor also did not affect preferences: Cells oriented away from dendritic processes could reorient their axonal pole toward the target cell. CONCLUSIONS Cone cells preferred normal partners, and rod cells preferred novel partners. These intrinsic preferences indicate that adult nerve cells can have differing capacities for targeting even if they come from the same cell class. Further,these differences may help explain the patterns of photoreceptor sprouting seen in retinal degeneration in which rod, but not cone, cells invade the inner retinal layers where third-order neurons are located.
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Affiliation(s)
- Robert J. Clarke
- Department of Neurology and Neuroscience, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
| | - Kormákur Högnason
- Department of Pharmacology and Physiology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
| | - Michael Brimacombe
- Department of Preventive Medicine and Community Health, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
| | - Ellen Townes-Anderson
- Department of Neurology and Neuroscience, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
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Kimura M, Hjelmborg JVB, Gardner JP, Bathum L, Brimacombe M, Lu X, Christiansen L, Vaupel JW, Aviv A, Christensen K. Telomere length and mortality: a study of leukocytes in elderly Danish twins. Am J Epidemiol 2008; 167:799-806. [PMID: 18270372 DOI: 10.1093/aje/kwm380] [Citation(s) in RCA: 226] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Leukocyte telomere length, representing the mean length of all telomeres in leukocytes, is ostensibly a bioindicator of human aging. The authors hypothesized that shorter telomeres might forecast imminent mortality in elderly people better than leukocyte telomere length. They performed mortality analysis in 548 same-sex Danish twins (274 pairs) aged 73-94 years, of whom 204 pairs experienced the death of one or both co-twins during 9-10 years of follow-up (1997-2007). From the terminal restriction fragment length (TRFL) distribution, the authors obtained the mean TRFL (mTRFL) and the mean values of the shorter 50% (mTRFL(50)) and shortest 25% (mTRFL(25)) of TRFLs in the distribution and computed the mode of TRFL (MTRFL). They analyzed the proportions of twin pairs in which the co-twin with the shorter telomeres died first. The proportions derived from the intrapair comparisons indicated that the shorter telomeres predicted the death of the first co-twin better than the mTRFL did (mTRFL: 0.56, 95% confidence interval (CI): 0.49, 0.63; mTRFL(50): 0.59, 95% CI: 0.52, 0.66; mTRFL(25): 0.59, 95% CI: 0.52, 0.66; MTRFL: 0.60, 95% CI: 0.53, 0.67). The telomere-mortality association was stronger in years 3-4 than in the rest of the follow-up period, and it grew stronger with increasing intrapair difference in all telomere parameters. Leukocyte telomere dynamics might help explain the boundaries of the human life span.
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Affiliation(s)
- Masayuki Kimura
- Center of Human Development and Aging, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA
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Kimura M, Hjelmborg JVB, Gardner JP, Bathum L, Brimacombe M, Lu X, Christiansen L, Vaupel JW, Aviv A, Christensen K. Telomere length and mortality: a study of leukocytes in elderly Danish twins. Am J Epidemiol 2008. [PMID: 18270372 DOI: 10.1093/aje/kwm380.telomere] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Leukocyte telomere length, representing the mean length of all telomeres in leukocytes, is ostensibly a bioindicator of human aging. The authors hypothesized that shorter telomeres might forecast imminent mortality in elderly people better than leukocyte telomere length. They performed mortality analysis in 548 same-sex Danish twins (274 pairs) aged 73-94 years, of whom 204 pairs experienced the death of one or both co-twins during 9-10 years of follow-up (1997-2007). From the terminal restriction fragment length (TRFL) distribution, the authors obtained the mean TRFL (mTRFL) and the mean values of the shorter 50% (mTRFL(50)) and shortest 25% (mTRFL(25)) of TRFLs in the distribution and computed the mode of TRFL (MTRFL). They analyzed the proportions of twin pairs in which the co-twin with the shorter telomeres died first. The proportions derived from the intrapair comparisons indicated that the shorter telomeres predicted the death of the first co-twin better than the mTRFL did (mTRFL: 0.56, 95% confidence interval (CI): 0.49, 0.63; mTRFL(50): 0.59, 95% CI: 0.52, 0.66; mTRFL(25): 0.59, 95% CI: 0.52, 0.66; MTRFL: 0.60, 95% CI: 0.53, 0.67). The telomere-mortality association was stronger in years 3-4 than in the rest of the follow-up period, and it grew stronger with increasing intrapair difference in all telomere parameters. Leukocyte telomere dynamics might help explain the boundaries of the human life span.
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Affiliation(s)
- Masayuki Kimura
- Center of Human Development and Aging, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103, USA
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Awopetu O, Brimacombe M, Cohen D. Fetal alcohol syndrome disorder pilot media intervention in New Jersey. Can J Clin Pharmacol 2008; 15:e124-e131. [PMID: 18299640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The New Jersey Fetal Alcohol Spectrum Disorders Task Force launched the âBe in the kNOwâ multimedia public education campaign in July 2006. The campaign continued until December 2006. OBJECTIVE To report on the pilot media intervention campaign in Essex and Atlantic Counties, New Jersey, with the goal of identifying strategies to help prevent Fetal Alcohol Syndrome Disorder (FASD). METHODS The campaign used various media outlets from July 2006 to December 2006, including billboard posters along New Jersey transit routes serving Atlantic City and Newark, local newspapers and radio public service announcements. Messages were distributed in English and Spanish and were primarily aimed at Essex and Atlantic counties. Printed material was distributed throughout the community. All media materials included an 800 number for the New Jersey Family Health Line. Data was collected from individual callers. RESULTS A total of 49 Fetal Alcohol Syndrome (FAS) related telephone calls were received through the Family Health Line over the six-month period. An increase from the 5-6 FAS calls typically received in a six-month period. Callers were located throughout New Jersey with 24.5% from Essex County, 12.2% from Mercer County, and 12.2% from Bergen County. 69% of callers identified themselves as white, 25% black, and 6% other. 76% of callers were female. Ages ranged from 8 to 50. CONCLUSION The media intervention reached a wide geographic audience, provoking interest beyond the initial target area and expected age ranges. The results, however, point to the difficulty of raising awareness of FASD.
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Affiliation(s)
- O Awopetu
- School of Public Health- University of Medicine and Dentistry of New Jersey, USA
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Kimura M, Cherkas LF, Kato BS, Demissie S, Hjelmborg JB, Brimacombe M, Cupples A, Hunkin JL, Gardner JP, Lu X, Cao X, Sastrasinh M, Province MA, Hunt SC, Christensen K, Levy D, Spector TD, Aviv A. Offspring's leukocyte telomere length, paternal age, and telomere elongation in sperm. PLoS Genet 2008; 4:e37. [PMID: 18282113 PMCID: PMC2242810 DOI: 10.1371/journal.pgen.0040037] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 12/28/2007] [Indexed: 12/23/2022] Open
Abstract
Leukocyte telomere length (LTL) is a complex genetic trait. It shortens with age and is associated with a host of aging-related disorders. Recent studies have observed that offspring of older fathers have longer LTLs. We explored the relation between paternal age and offspring's LTLs in 4 different cohorts. Moreover, we examined the potential cause of the paternal age on offspring's LTL by delineating telomere parameters in sperm donors. We measured LTL by Southern blots in Caucasian men and women (n=3365), aged 18-94 years, from the Offspring of the Framingham Heart Study (Framingham Offspring), the NHLBI Family Heart Study (NHLBI-Heart), the Longitudinal Study of Aging Danish Twins (Danish Twins), and the UK Adult Twin Registry (UK Twins). Using Southern blots, Q-FISH, and flow-FISH, we also measured telomere parameters in sperm from 46 young (<30 years) and older (>50 years) donors. Paternal age had an independent effect, expressed by a longer LTL in males of the Framingham Offspring and Danish Twins, males and females of the NHLBI-Heart, and females of UK Twins. For every additional year of paternal age, LTL in offspring increased at a magnitude ranging from half to more than twice of the annual attrition in LTL with age. Moreover, sperm telomere length analyses were compatible with the emergence in older men of a subset of sperm with elongated telomeres. Paternal age exerts a considerable effect on the offspring's LTL, a phenomenon which might relate to telomere elongation in sperm from older men. The implications of this effect deserve detailed study.
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Affiliation(s)
- Masayuki Kimura
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Lynn F Cherkas
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital Campus, Kings College London, London, United Kingdom
| | - Bernet S Kato
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital Campus, Kings College London, London, United Kingdom
| | - Serkalem Demissie
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, United States of America
| | - Jacob B Hjelmborg
- The Institute of Public Health, Epidemiology and Statistics, University of Southern Denmark, Odense, Denmark
| | - Michael Brimacombe
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Adrienne Cupples
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, United States of America
| | - Janice L Hunkin
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital Campus, Kings College London, London, United Kingdom
| | - Jefferey P Gardner
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Xiaobin Lu
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Xiaojian Cao
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Malinee Sastrasinh
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
| | - Michael A Province
- Division of Statistical Genomics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Steven C Hunt
- Cardiovascular Genetics, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kaare Christensen
- The Institute of Public Health, Epidemiology and Statistics, University of Southern Denmark, Odense, Denmark
| | - Daniel Levy
- The National Heart, Lung, and Blood Institute's Framingham Heart Study, Boston, Massachusetts, United States of America
| | - Tim D Spector
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital Campus, Kings College London, London, United Kingdom
| | - Abraham Aviv
- The Center of Human Development and Aging, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jeresey, United States of America
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Tasslimi A, Wenger P, Pentakota SR, Brimacombe M, Burday M, Sinha A. Invasive pneumococcal disease in an underimmunized, high HIV prevalence population. J Infect 2008; 56:99-102. [DOI: 10.1016/j.jinf.2007.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/16/2007] [Accepted: 11/20/2007] [Indexed: 11/16/2022]
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Brimacombe M, Nayeem A, Adubato S, Dejoseph M, Zimmerman-Bier B. Fetal alcohol syndrome related knowledge assessment and comparison in New Jersey health professional groups. Can J Clin Pharmacol 2008; 15:e57-e65. [PMID: 18192706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND There is a need to educate health professionals in regard to Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders across many health and allied health fields. OBJECTIVE Conduct evaluations of educational programs designed to assess knowledge, attitudes and beliefs in relation to Fetal Alcohol Spectrum Disorders (FASD) among health and allied health professionals in the northeastern United States. METHODS FASD related educational efforts were carried out and evaluated in New Jersey for various health-related professional groups over a four-month period using a common set of materials. Pre and post-test evaluation comprised 20 questions on FASD recognition, diagnosis, treatment, and prevention. Groups surveyed included nurses, social workers, counselors, therapists, clinicians and allied health professionals comprising physician assistants, dieticians, physical therapists, occupational therapists. RESULTS Results showed that a majority of health care professionals in New Jersey possess basic knowledge related to FASD and the effects of alcohol on a child in utero. They also had significant awareness of the importance of early diagnosis and the importance of reducing secondary disabilities. The study did however reveal areas for improvement in some professional groups. CONCLUSIONS FASD is the most important preventable cause of mental retardation. Health professionals attending workshops typically had a good basic understanding of FASD, though with some weaknesses specific to their discipline. Educational efforts in regard to FASD should be sensitive to the various health professionals engaged in preventing, diagnosing and treating FASD.
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Affiliation(s)
- M Brimacombe
- School of Public Health-UMDNJ, New Jersey Medical School - University of Medicine and Dentistry of New Jersey, USA.
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Abstract
Individuals with autism spectrum disorder are heterogeneous in clinical presentation, concurrent disorders, and developmental outcomes. This study characterized the clinical co-occurrences and potential subgroups in 160 children with autism spectrum disorders who presented to The Autism Center between 1999 and 2003. Medical and psychiatric co-occurrences included sleep disorders, epilepsy, food intolerance, gastrointestinal dysfunction, mood disorder, and aggressive and self-injurious behaviors. Sleep disorders were associated with gastrointestinal dysfunction (P < .05) and mood disorders (P < .01). Food intolerance was associated with gastrointestinal dysfunction (P = .001). Subjects with mood disorder tended to develop aggressive or self-injurious behaviors (P < .05). Developmental regression was not associated with increased co-occurrence of medical or psychiatric disorders. Medical co-occurrence did not present as a risk factor for psychiatric co-occurrence, and vice versa. These results showed a high prevalence of multiple medical and psychiatric co-occurrences. There may be common pathophysiologic mechanisms resulting in clinical subgroups of autism spectrum disorders. Recognition of the co-occurrence of concurrent disorders may provide insight into the therapeutic strategy.
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Affiliation(s)
- Xue Ming
- Department of Neuroscience, University of Medicine and Dentistry, New Jersey Medical School, Newark, NJ, USA.
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de Luise C, Brimacombe M, Pedersen L, Sørensen HT. Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study. Eur J Epidemiol 2007; 23:115-22. [DOI: 10.1007/s10654-007-9211-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 11/07/2007] [Indexed: 12/27/2022]
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Abstract
Autism spectrum disorders (ASD) are manifest as impairments in social interaction, language and speech development, and the appearance of repetitive behaviors with restricted interests. Motor impairments in individuals with ASD have been categorized as "associated symptoms". The objective of this study was to describe the prevalence of motor deficits in ASD. Specifically, using retrospective clinical record review, we report the prevalence of hypotonia, motor apraxia, reduced ankle mobility, history of gross motor delay, and toe-walking, as well as the improvement of these symptoms with age, in a cohort of 154 children with ASD. The possible association of motor deficits with epilepsy or developmental regression was also assessed. To address whether the motor deficits in children with ASD were properly identified and treated, we evaluated whether the children with the motor deficits were more likely to receive physical and/or occupational therapies as compared to the children with ASD who did not show motor deficits. Hypotonia was the most common motor symptom in our ASD cohort (51%) and this appeared to improve over time, as suggested by the significant reduction in prevalence in older children (p=0.002). Likewise, motor apraxia (34%) showed a tendency to be more prevalent among younger children as compared with older children (p=0.06). Historical intermittent toe-walking was found in 19% of children while reduced ankle mobility was a rare occurrence. Gross motor delay was reported in 9% of children, all of whom gained motor independence by the time of examination. Except for gross motor delay, ASD children with fine motor deficits were not more likely to receive interventional services, as compared with ASD children without the motor deficits. The results suggest that fine motor control and programming deficits are common co-occurrence of children with ASD in this cohort. The reduced prevalence of these motor deficits in older children suggests improvement over time, whether through natural progression, results of interventional therapy, or the combination of the two. However, ASD children with the motor deficits were not more likely to receive service than those without the motor deficits.
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Affiliation(s)
- Xue Ming
- Department of Neurosciences and Neurology, UMDNJ-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 8100, Newark, NJ 07103, USA.
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