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Chen S, Anderson MP. On the Use of Multiple Imputation Approach in Pediatric Research. J Pediatr 2024:114083. [PMID: 38705231 DOI: 10.1016/j.jpeds.2024.114083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Sixia Chen
- Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma, Health Sciences Center, Oklahoma City, OK
| | - Michael P Anderson
- Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Anderson MP, Bard D. A Gentle Introduction to Latent Class Analysis for Researchers in Pediatrics. J Pediatr 2024:114069. [PMID: 38642884 DOI: 10.1016/j.jpeds.2024.114069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Michael P Anderson
- Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma health Sciences Center, CHB 350, 801 NE 13(th) Street, Oklahoma City, OK.
| | - David Bard
- Department of Pediatrics, College of Medicine, The University of Oklahoma health Sciences Center, 940 NE 13(th) St., Suite 4900, Oklahoma City, Ok 73104.
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Brown SR, Assy J, Anderson MP, Thiagarajan RR, Brogan TV. Outcomes After Respiratory Extracorporeal Life Support in Teens and Young Adults: An Extracorporeal Life Support Organization Registry Analysis. Crit Care Med 2024; 52:11-19. [PMID: 38095517 DOI: 10.1097/ccm.0000000000006049] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVES A recent study from Germany found that survival after respiratory extracorporeal life support (ECLS) was lower among patients 10-20 years old than 20-30 years old. The objective of this study was to compare survival between teenage and young adult patients who receive respiratory ECLS. DESIGN Retrospective cohort study. SETTING Extracorporeal Life Support Organization registry, an international prospective quality improvement database. PATIENTS All patients ages 16-30 years cannulated for respiratory indications from 1990 to 2020 were included. Patients were divided into two groups, teens (16-19 yr old) and young adults (20-30 yr old). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was survival to discharge. Variables were considered for the multivariate logistic regression model if there was both a statistically significant difference (p ≤ 0.05) and a clinically meaningful absolute difference between the groups. A total of 5,751 patients were included, of whom 1,653 (29%) were teens and 4,098 (71%) were young adults. Survival to discharge was higher in young adults than teens, 69% versus 63% (p < 0.001). Severity of illness was higher among teens; however, survival within each stratum defined by Pao2/Fio2 ratio was higher in young adults than in teens. Use of venoarterial ECLS was higher in teens than in young adults, 15% versus 7%, respectively. Teens were more likely to receive high-frequency oscillatory ventilation and this therapy was associated with a longer time from admission to ECLS initiation. After adjusting for variables that differ significantly between the groups, the odds ratio for survival in young adults compared with teens was 1.14 (95% CI, 1.004-1.3). CONCLUSIONS In this large multicenter retrospective study, mortality was higher in teens than in young adults who received respiratory ECLS. This difference persisted after adjusting for multiple variables and the mechanism underlying these findings remains unclear.
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Affiliation(s)
- Stephanie R Brown
- Division of Pediatric Critical Care Medicine, Oklahoma Children's Hospital, Oklahoma City, OK
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jana Assy
- Department of Pediatrics, Division of Pediatric Critical Care, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Michael P Anderson
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ravi R Thiagarajan
- Cardiac Intensive Care Unit, Boston Children's Hospital, Boston, MA
- Department of Cardiology, Harvard Medical School, Boston, MA
| | - Thomas V Brogan
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
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McGuire SP, Anderson MP, Maatman TK, Roch AM, Butler JR, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, Zyromski NJ. Opioid analgesia in necrotizing pancreatitis: Incidence and timing of a hidden crisis. Am J Surg 2022; 225:927-930. [PMID: 36792453 DOI: 10.1016/j.amjsurg.2022.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Rates of opioid usage during necrotizing pancreatitis (NP) disease course are unknown. We hypothesized that a significant number of NP patients were prescribed opioid analgesics chronically. METHODS Single institution IRB-approved retrospective study of 230 NP patients treated between 2015 and 2019. RESULTS Data were available for 198/230 (86%) patients. 166/198 (84%) were discharged from their index hospitalization with a prescription for an opioid. At the first clinic visit following hospitalization, 110/182 (60%) were using opioids. Six months after disease onset, 72/163 (44%) continued to require opioids. At disease resolution, 38/144 (26%) patients remained on opioid medications. The rate of active opioid prescriptions at six months after disease onset declined throughout the period studied from 68% in 2015 to 39% in 2019. CONCLUSIONS Opioid prescriptions are common in NP. Despite decline over time, 1 in 4 patients remain on opioids at disease resolution. These data identify an opportunity to adjust analgesic prescription practice in NP patients.
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Affiliation(s)
- S P McGuire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M P Anderson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J R Butler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - T K Nguyen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C M Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Couloures KG, Anderson MP, Hill CL, Chen A, Buckmaster MA. Creation of a Pediatric Sedation Risk Assessment Scoring System: A Novel Method to Stratify Risk. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1745831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThis study aimed to create a pediatric sedation scoring system independent of the American Society of Anesthesiology Physical Status (ASA-PS) classification that is predictive of adverse events, facilitates objective stratification, and resource allocation. Multivariable regression and machine learning algorithm analysis of 134,973 sedation encounters logged in to the Pediatric Sedation Research Consortium (PSRC) database between July 2007 and June 2011. Patient and procedure variables were correlated with adverse events with resultant β-regression coefficients used to assign point values to each variable. Point values were then summed to create a risk assessment score. Validation of the model was performed with the 2011 to 2013 PSRC database followed by calculation of ROC curves and positive predictive values. Factors identified and resultant point values are as follows: 1 point: age ≤ 6 months, cardiac diagnosis, asthma, weight less than 5th percentile or greater than 95th, and computed tomography (CT) scan; 2 points: magnetic resonance cholangiopancreatography (MRCP) and weight greater than 99th percentile; 4 points: magnetic resonance imaging (MRI); 5 points: trisomy 21 and esophagogastroduodenoscopy (EGD); 7 points: cough at the time of examination; and 18 points: bronchoscopy. Sum of patient and procedural values produced total risk assessment scores. Total risk assessment score of 5 had a sensitivity of 82.69% and a specificity of 26.22%, while risk assessment score of 11 had a sensitivity of 12.70% but a specificity of 95.29%. Inclusion of ASA-PS value did not improve model sensitivity or specificity and was thus excluded. Higher risk assessment scores predicted increased likelihood of adverse events during sedation. The score can be used to triage patients independent of ASA-PS with site-specific cut-off values used to determine appropriate sedation resource allocation.
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Affiliation(s)
- Kevin G. Couloures
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Michael P. Anderson
- Department of Biostatistics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - C. L. Hill
- Duke Clinical Research Institute, Durham, North Carolina, United States
| | - Allshine Chen
- Department of Biostatistics, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - Mark A. Buckmaster
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Szyld E, Anderson MP, Shah BA, Roehr CC, Schmölzer GM, Fabres JG, Weiner GM. Risk calculator for advanced neonatal resuscitation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001376. [PMID: 36053630 PMCID: PMC8966524 DOI: 10.1136/bmjpo-2021-001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022] Open
Abstract
In order to predict which newborns will require advanced resuscitation (ANR), we developed an ANR risk calculator (calculator) using a bootstrap sample size of 52 973 from a case-control study of newborns ≥34 weeks gestation. Multivariable logistic regression coefficients were obtained for the 10 original risk factors and two interaction terms. The area under the receiving-operating characteristic curve predicting ANR was 0.9243. ANR prediction is improved by accounting for perinatal variables, beyond factors known prenatally. Prospective validation of this model is warranted in a clinical setting.
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Affiliation(s)
- Edgardo Szyld
- Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael P Anderson
- Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Birju A Shah
- Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Charles C Roehr
- Newborn Services, Southmead Hospital, Bristol, UK.,University of Bristol Faculty of Health Sciences, Bristol, UK
| | | | - Jorge G Fabres
- Neonatology, Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile
| | - Gary M Weiner
- Neonatology, C S Mott Children's Hospital, Ann Arbor, Michigan, USA
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Walters DC, Lawrence R, Kirby T, Ahrendsen JT, Anderson MP, Roullet JB, Murphy EJ, Gibson KM. Postmortem Analyses in a Patient With Succinic Semialdehyde Dehydrogenase Deficiency (SSADHD): II. Histological, Lipid, and Gene Expression Outcomes in Regional Brain Tissue. J Child Neurol 2021; 36:1177-1188. [PMID: 33557678 PMCID: PMC8349921 DOI: 10.1177/0883073820987742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study has extended previous metabolic measures in postmortem tissues (frontal and parietal lobes, pons, cerebellum, hippocampus, and cerebral cortex) obtained from a 37-year-old male patient with succinic semialdehyde dehydrogenase deficiency (SSADHD) who expired from SUDEP (sudden unexplained death in epilepsy). Histopathologic characterization of fixed cortex and hippocampus revealed mild to moderate astrogliosis, especially in white matter. Analysis of total phospholipid mass in all sections of the patient revealed a 61% increase in cortex and 51% decrease in hippocampus as compared to (n = 2-4) approximately age-matched controls. Examination of mass and molar composition of major phospholipid classes showed decreases in phospholipids enriched in myelin, such as phosphatidylserine, sphingomyelin, and ethanolamine plasmalogen. Evaluation of gene expression (RT2 Profiler PCR Arrays, GABA, glutamate; Qiagen) revealed dysregulation in 14/15 GABAA receptor subunits in cerebellum, parietal, and frontal lobes with the most significant downregulation in ∊, θ, ρ1, and ρ2 subunits (7.7-9.9-fold). GABAB receptor subunits were largely unaffected, as were ionotropic glutamate receptors. The metabotropic glutamate receptor 6 was consistently downregulated (maximum 5.9-fold) as was the neurotransmitter transporter (GABA), member 13 (maximum 7.3-fold). For other genes, consistent dysregulation was seen for interleukin 1β (maximum downregulation 9.9-fold) and synuclein α (maximal upregulation 6.5-fold). Our data provide unique insight into SSADHD brain function, confirming astrogliosis and lipid abnormalities previously observed in the null mouse model while highlighting long-term effects on GABAergic/glutamatergic gene expression in this disorder.
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Affiliation(s)
- DC Walters
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - R Lawrence
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - T Kirby
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - JT Ahrendsen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - MP Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - J-B Roullet
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
| | - EJ Murphy
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - KM Gibson
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA,Correspondence: Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Health Sciences Building Room 210C, Washington State University, 412 E. Spokane Falls Boulevard, Spokane, WA 99202-2131; phone 509-358-7954; fax 508-358-7667;
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Rodden LN, Chutake YK, Gilliam K, Lam C, Soragni E, Hauser L, Gilliam M, Wiley G, Anderson MP, Gottesfeld JM, Lynch DR, Bidichandani SI. Methylated and unmethylated epialleles support variegated epigenetic silencing in Friedreich ataxia. Hum Mol Genet 2021; 29:3818-3829. [PMID: 33432325 PMCID: PMC7861014 DOI: 10.1093/hmg/ddaa267] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 08/26/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
Friedreich ataxia (FRDA) is typically caused by homozygosity for an expanded GAA triplet-repeat in intron 1 of the FXN gene, which results in transcriptional deficiency via epigenetic silencing. Most patients are homozygous for alleles containing > 500 triplets, but a subset (~20%) have at least one expanded allele with < 500 triplets and a distinctly milder phenotype. We show that in FRDA DNA methylation spreads upstream from the expanded repeat, further than previously recognized, and establishes an FRDA-specific region of hypermethylation in intron 1 (~90% in FRDA versus < 10% in non-FRDA) as a novel epigenetic signature. The hypermethylation of this differentially methylated region (FRDA-DMR) was observed in a variety of patient-derived cells; it significantly correlated with FXN transcriptional deficiency and age of onset, and it reverted to the non-disease state in isogenically corrected induced pluripotent stem cell (iPSC)-derived neurons. Bisulfite deep sequencing of the FRDA-DMR in peripheral blood mononuclear cells from 73 FRDA patients revealed considerable intra-individual epiallelic variability, including fully methylated, partially methylated, and unmethylated epialleles. Although unmethylated epialleles were rare (median = 0.33%) in typical patients homozygous for long GAA alleles with > 500 triplets, a significantly higher prevalence of unmethylated epialleles (median = 9.8%) was observed in patients with at least one allele containing < 500 triplets, less severe FXN deficiency (>20%) and later onset (>15 years). The higher prevalence in mild FRDA of somatic FXN epialleles devoid of DNA methylation is consistent with variegated epigenetic silencing mediated by expanded triplet-repeats. The proportion of unsilenced somatic FXN genes is an unrecognized phenotypic determinant in FRDA and has implications for the deployment of effective therapies.
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Affiliation(s)
- Layne N Rodden
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yogesh K Chutake
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kaitlyn Gilliam
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christina Lam
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisabetta Soragni
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Lauren Hauser
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Gilliam
- Department of Electrical and Computer Engineering, University of Oklahoma, Norman, OK, USA
| | - Graham Wiley
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Michael P Anderson
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joel M Gottesfeld
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - David R Lynch
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sanjay I Bidichandani
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Ranallo CD, Thurman TL, Holt SJ, Frank-Pearce SG, Anderson MP, Heulitt MJ. Effect of Nitric Oxide Delivery Device on Tidal Volume Accuracy During Mechanical Ventilation at Small Tidal Volumes. Respir Care 2020; 65:1641-1647. [PMID: 32518087 DOI: 10.4187/respcare.07105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Inhaled nitric oxide (INO) is used in infants as a therapy for elevated pulmonary vascular resistance. When INO is delivered at low tidal volumes, displayed inspiratory and expiratory volumes vary widely. We hypothesize that volume is removed by the sampling line during the ventilation cycle, and this results in a net volume loss at low tidal volumes. This study aimed to measure the volumes delivered and to assess the accuracy of displayed ventilator values using a test lung. METHODS A test lung was connected to a ventilator and an INO delivery system. All tests were performed with stable mode settings across volumes of 18, 30, 42, and 60 mL. Flow measured with a pneumotachometer attached between the test lung and the circuit assessed the percent error between inspiratory and expiratory volumes measured by the pneumotachometer measured and displayed on the ventilator under various INO/sample line conditions to determine where and how much volume was being displaced. RESULTS Displayed and measured inspiratory volumes had small variations between the INO/sample line conditions and baseline. However, expiratory volumes, with the sample line connected, exhibited large percent error values that increased (-14, -20, -27, and -34) as tidal volume decreased (60, 42, 30, and 18 mL) and error was significantly larger compared to baseline in all tidal volumes (P < .01) with and without INO delivery. CONCLUSIONS We concluded that inspiratory volumes were not affected by INO delivery, but additional removal of volume in the expiratory phase of the breath cycle by the sampling line results in a large error in the displayed expiratory volume.
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Affiliation(s)
- Courtney D Ranallo
- Department of Pediatrics/Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Tracy L Thurman
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Shirley J Holt
- Department of Respiratory Care, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Summer G Frank-Pearce
- College of Public Health, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma
| | - Michael P Anderson
- College of Public Health, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma
| | - Mark J Heulitt
- Spence and Becky Wilson Baptist Children's Hospital, Memphis, Tennessee
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Halaka M, Hired ZA, Rutledge GE, Hedgepath CM, Anderson MP, St John H, Do JM, Majmudar PR, Walker C, Alawawdeh A, Stephen HM, Reagor CC, Adereti J, Jamison K, Iglesias KP, Kirmani KZ, Conway RE. Differences in Endothelin B Receptor Isoforms Expression and Function in Breast Cancer Cells. J Cancer 2020; 11:2688-2701. [PMID: 32201539 PMCID: PMC7066022 DOI: 10.7150/jca.41004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
The endothelins and their receptors are best known for their regulation of the vascular system. Their widespread expression in epithelial cells and their overexpression in some tumors has prompted investigation into their ability to regulate cancer progression. In this study, we assessed the mRNA expression of the major endothelin B receptor gene (EDNRB) isoforms and found differences in both mRNA and protein expression in normal breast cells and breast cancer cell lines. Knocking down the EDNRB gene in breast cancer cells altered invasiveness toward endothelin 3 (ET3), and we observed EDNRB isoform-specific regulation of breast cancer cell invasion and cell signaling, as well as isoform- and subtype-specific differences in breast cancer patient survival. The results reported in this study emphasize the importance of the endothelin B receptor in breast cancer. To our knowledge, this study is the first to clarify the differential expression and roles of specific EDNRB isoforms in breast cancer.
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Affiliation(s)
- Meena Halaka
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Zuhaila A Hired
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Grace E Rutledge
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Carly M Hedgepath
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Michael P Anderson
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Haley St John
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Jessica M Do
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Parth R Majmudar
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Caleb Walker
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Asma Alawawdeh
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Hannah M Stephen
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Caleb C Reagor
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Jeanette Adereti
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Kiara Jamison
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Katherine P Iglesias
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Khadija Z Kirmani
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
| | - Rebecca E Conway
- Department of Biology, College of Liberal Arts and Sciences, Lipscomb University, 1 University Park Drive, Nashville, TN 37204, USA
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Caldwell A, Qasimyar H, Shumate L, Anderson MP, Cherry A, Bryant C, Bax A. Structured Curriculum to Improve Pediatric Resident Confidence and Skills in Providing Parenting Advice. J Osteopath Med 2019; 119:748-755. [PMID: 31657828 DOI: 10.7556/jaoa.2019.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Context Residents receive little parenting education despite its potential to improve parenting behavior and decrease child maltreatment despite the inclusion of parenting content on board certification examinations. Teaching residents how to discuss parenting and foster positive parent-child relationships is essential to treating the whole person in osteopathic pediatric medicine. Objective To improve pediatric and internal medicine-pediatric residents' knowledge, confidence, and skills in providing parenting advice. Methods Four toddler parenting and discipline modules were developed. During continuity clinic, residents viewed and discussed modules with faculty. Residents completed a confidence and knowledge questionnaire before and after the curriculum, provided a self-report of use of skills learned, and completed a feasibility survey. Faculty also completed a feasibility survey. Results Forty-one of 61 residents (67%) participated in the study. Before participation, the median (interquartile range [IQR]) resident score for confidence in giving advice was 6.0 (4.0-7.0) (on a 10-point scale), increasing to 7.0 (6.0-8.0) for those completing 1 to 3 modules and 8.0 (8.0-9.0) for those completing 4 modules. Median (IQR) score on board-style questions was 8.0 (7.0-9.0) (on a 12-point scale) before participating in the modules and 8.5 (7.5-9.5) for those completing 1 to 3 modules and 9.0 (7.0-9.0) for those completing 4 modules after participation; the increase was not statistically significant. Nine faculty and 29 residents completed the modules and responded to the exit survey regarding feasibility and acceptability of the curriculum. On a 4-point scale (4 being excellent), sessions had an overall mean (SD) rating of 3.7 (0.5) by faculty and 3.5 (0.5) by residents. Most residents (27 [93.1%]) reported interest in more modules, and 28 residents (96.6%) reported using information learned from the modules during clinic visits. Conclusion Confidence delivering parenting advice increased among residents who completed the curriculum modules. Faculty and residents reported high feasibility ratings, and residents endorsed application of skills during clinic visits and interest in more modules.
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Rodney JP, Thompson JL, Anderson MP, Burkhart HM. Neonatal vocal fold motion impairment after complex aortic arch reconstruction: What should parents expect after diagnosis? Int J Pediatr Otorhinolaryngol 2019; 120:40-43. [PMID: 30753981 DOI: 10.1016/j.ijporl.2019.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To study the incidence, sequelae, follow up, and recovery rate of vocal fold motion impairment (VFMI) after complex aortic arch reconstruction in neonates. STUDY DESIGN Retrospective case control study. METHODS We retrospectively evaluated 105 neonates who underwent complex aortic arch reconstruction from 2014 to 2016. We compared patients that did have VFMI compared to a control group of patients with normal vocal fold movement. Descriptive statistics were computed for all demographic and clinical variables by treatment group. RESULTS 36% of patients were evaluated for VFMI (n = 38) by an otolaryngologist. The incidence of VFMI was 22% (n = 23). Females were more likely to have VFMI (p = 0.02). Aspiration was more common in patients with VFMI (p = 0.006). The difference in age, weight, incidence of pneumonia, nasogastric tube, gastrostomy, total length of stay, genetic anomaly, and reintubation was not significant between the VFMI group and control group (p > 0.05). Tracheostomy was not performed in any patients with unilateral paralysis. Only 61% of patients followed up in clinic (n = 14). 64% of patients showed improvement or resolution (n = 9). Average time to improvement was 4.8 months. Average time to complete resolution was 10.5 months. CONCLUSIONS VFMI after complex aortic arch reconstruction is relatively common. Despite increased aspiration in patients with VFMI, pneumonia did not occur at all in either group. Tracheostomy was not necessary in any patients with a unilateral paralysis. Most patients showed an improvement in the VFMI within 5 months of surgery. Our data support the need for otolaryngology follow-up after the diagnosis of VFMI.
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Affiliation(s)
- Jennifer P Rodney
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
| | - Jess L Thompson
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Michael P Anderson
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States; College of Public Health, Biostatistics and Epidemiology, United States
| | - Harold M Burkhart
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
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Capino AC, Johnson PN, Williams PK, Anderson MP, Bedwell S, Miller JL. Pilot Study Comparing Modified Finnegan Scoring Versus Adjusted Scoring System for Infants With Iatrogenic Opioid Abstinence Syndrome After Cardiothoracic Surgery. J Pediatr Pharmacol Ther 2019; 24:148-155. [PMID: 31019408 DOI: 10.5863/1551-6776-24.2.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the modified Finnegan Scoring System (modified Finnegan) with an Adjusted Scoring System Criteria (adjusted Finnegan) for infants after cardiothoracic surgery with iatrogenic opioid abstinence syndrome (IOAS). METHODS This was a retrospective, observational pilot study. This study was conducted in a tertiary care academic hospital. Infants after cardiothoracic surgery with IOAS transferred between the pediatric intensive care unit and neonatal intensive care unit between January 1, 2014, and January 31, 2016, were included retrospectively. The main outcome variable was to compare the area under the curve for the mean modified Finnegan versus adjusted Finnegan. RESULTS Twenty-five patients were included in the study. Twenty patients with at least 30 scores were included in the final analysis. Overall, the modified Finnegan scores were at least 2 points higher than the adjusted Finnegan. The difference in area under the curve was 34.6 (p < 0.001). CONCLUSIONS Use of the modified Finnegan tool for older infants with IOAS could overestimate withdrawal, leading to unnecessary interventions.
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Owora AH, Carabin H, Garwe T, Anderson MP. Are we validly assessing major depression disorder risk and associated factors among mothers of young children? A cross-sectional study involving home visitation programs. PLoS One 2019; 14:e0209735. [PMID: 30615650 PMCID: PMC6322825 DOI: 10.1371/journal.pone.0209735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/15/2017] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
Failure to account for misclassification error accruing from imperfect case-finding instruments can produce biased estimates of suspected major depression disorder (MDD) risk factor associations. The objective of this study was to estimate the impact of misclassification error on the magnitude of measures of association between suspected risk factors and MDD assessed using the Center of Epidemiological Studies on Depression—Short Form during the prenatal and postnatal periods. Baseline data were collected from 520 mothers participating in two home visitation studies in Oklahoma City between 2010 and 2014. A Bayesian binomial latent class model was used to compare the prevalence proportion ratio (PPR) between suspected risk factors and MDD with and without adjustment for misclassification error and confounding by period of MDD symptom on-set. Adjustment for misclassification error and confounding by period of MDD on-set (prenatal vs postnatal) showed that the association between suspected risk factors and MDD is underestimated (-) and overestimated (+) differentially in different source populations of low-income mothers. The median bias in the magnitude of PPR estimates ranged between -.47 (95% Bayesian Credible Intervals [BCI]: -10.67, 1.90) for intimate partner violence to +.06 (95%BCI: -0.37, 0.47) for race/ethnicity among native-born US residents. Among recent Hispanic immigrants, bias ranged from -.77 (95%BCI: -15.31, 0.96) for history of childhood maltreatment to +.10 (95%BCI: -0.17, 0.39) for adequacy of family resources. Overall, the extent of bias on measures of association between maternal MDD and suspected risk factors is considerable without adjustment for misclassification error and is even higher for confounding by period of MDD assessment. Consideration of these biases in MDD prevention research is warranted.
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Affiliation(s)
- Arthur H. Owora
- Department of Public Health, Falk College, Syracuse University, Syracuse, New York, United States of America
- * E-mail:
| | - Hélène Carabin
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Tabitha Garwe
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Michael P. Anderson
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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Dannelley JF, Johnson PN, Anderson MP, Oestreich K, Siatkowski RM, Miller JL. Assessment of Outcomes With a Sedation Protocol During Laser Photocoagulation in Preterm Infants With Retinopathy of Prematurity. J Pediatr Pharmacol Ther 2018; 23:410-416. [PMID: 30429696 PMCID: PMC6213621 DOI: 10.5863/1551-6776-23.5.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the success of a sedation protocol of fentanyl and midazolam infusions for infants undergoing laser photocoagulation for retinopathy of prematurity. METHODS This retrospective study included infants receiving a sedation protocol for laser photocoagulation during a 4-year period. The primary objective was protocol success, defined as completion without interruption, absence of protocol dose deviations, and absence of interventions. Secondary objectives compared outcomes between those with and without opioid/benzodiazepine exposure. A logistic regression was used to assess the effect of prior opioid/benzodiazepine exposure on requirement for fentanyl infusion increases. RESULTS Twenty-six infants were included. Seven (26.9%) had protocol success. Sixteen (61.5%) had protocol success, excluding dose deviations. Seventeen (65.4%) experienced ≥1 cardiopulmonary adverse events. Photocoagulation was completed in all cases. CONCLUSIONS Most achieved protocol success, when eliminating dosing deviations. These data indicate that flexibility is needed in fentanyl and midazolam infusion titration, based on clinical response.
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Hanas JS, Hocker JR, Ramajayam G, Prabhakaran V, Rajshekhar V, Oommen A, Manoj JJ, Anderson MP, Drevets DA, Carabin H. Distinguishing neurocysticercosis epilepsy from epilepsy of unknown etiology using a minimal serum mass profiling platform. Exp Parasitol 2018; 192:98-107. [PMID: 30096291 DOI: 10.1016/j.exppara.2018.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/08/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
Abstract
Neurocysticercosis is associated with epilepsy in pig-raising communities with poor sanitation. Current internationally recognized diagnostic guidelines for neurocysticercosis rely on brain imaging, a technology that is frequently not available or not accessible in areas endemic for neurocysticercosis. Minimally invasive and low-cost aids for diagnosing neurocysticercosis epilepsy could improve treatment of neurocysticercosis. The goal of this study was to test the extent to which patients with neurocysticercosis epilepsy, epilepsy of unknown etiology, idiopathic headaches and among different types of neurocysticercosis lesions could be distinguished from each other based on serum mass profiling. For this, we collected sera from patients with neurocysticercosis-associated epilepsy, epilepsy of unknown etiology, recovered neurocysticercosis, and idiopathic headaches then performed binary group comparisons among them using electrospray ionization mass spectrometry. A leave one [serum sample] out cross validation procedure was employed to analyze spectral data. Sera from neurocysticercosis patients was distinguished from epilepsy of unknown etiology patients with a p-value of 10-28. This distinction was lost when samples were randomized to either group (p-value = 0.22). Similarly, binary comparisons of patients with neurocysticercosis who has different types of lesions showed that different forms of this disease were also distinguishable from one another. These results suggest neurocysticercosis epilepsy can be distinguished from epilepsy of unknown etiology based on biomolecular differences in sera detected by mass profiling.
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Affiliation(s)
- Jay S Hanas
- Dept. of Biochemistry, University of Oklahoma Health Sciences Center (HSC), Oklahoma City, 73104, USA
| | - James R Hocker
- Dept. of Biochemistry, University of Oklahoma Health Sciences Center (HSC), Oklahoma City, 73104, USA
| | - Govindan Ramajayam
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | | | - Vedantam Rajshekhar
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Anna Oommen
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Josephine J Manoj
- Dept. of Neurological Sciences, Christian Medical College, Vellore, 632004, India
| | - Michael P Anderson
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, 73104, USA
| | - Douglas A Drevets
- Dept. of Internal Medicine, University of Oklahoma HSC, And the VA Medical Center, Oklahoma City, 73104, USA
| | - Hélène Carabin
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, 73104, USA.
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Abstract
Objective: To determine the safety of ibuprofen used for postoperative pain control following palatoplasty in pediatric patients. Design: Retrospective chart review. Setting: Tertiary care, pediatric hospital. Participants: Patients who received ibuprofen for postoperative pain control after palatoplasty. Main Outcome Measures: Number of doses of ibuprofen given during hospitalization and the presence of postoperative primary or secondary bleeding following palatoplasty. Detection of postoperative hemorrhage was obtained from (1) chart review from inpatient hospitalization after palatoplasty, (2) chart review of each patient’s 3-week postoperative clinic visit, and (3) phone call to caretakers from primary author. Results: Thirty-two patients underwent palatoplasty who received ibuprofen for control of postoperative pain. Mean number of inpatient doses given was 4.8 (range: 1-17). None (0%) experienced hemorrhage in the hospital before discharge. Thirty-two (100%) patients were seen at a 3-week follow-up and no (0%) episodes of postoperative hemorrhage were noted. Seventeen (53%) caretakers of patients responded to contact by phone and confirmed no subsequent bleeding. Conclusions: Ibuprofen may not increase postoperative hemorrhage after palatoplasty. Further studies will be needed to evaluate safety on a larger scale.
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Affiliation(s)
| | - Michael P. Anderson
- Department of Biostatistics and Epidemiology, College of Public Health, Oklahoma University, Oklahoma City, OK, USA
| | - Robert S. Glade
- Department of Otolaryngology, Oklahoma State University, Tulsa, OK, USA
- Department of Oral and Maxillofacial Surgery, Oklahoma University, Oklahoma City, OK, USA
- Pediatric ENT of Oklahoma, Oklahoma City, Oklahoma, OK, USA
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Leavens EL, Meier E, Tackett AP, Miller MB, Tahirkheli NN, Brett EI, Carroll DM, Driskill LM, Anderson MP, Wagener TL. The impact of a brief cessation induction intervention for waterpipe tobacco smoking: A pilot randomized clinical trial. Addict Behav 2018; 78:94-100. [PMID: 29128712 DOI: 10.1016/j.addbeh.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 10/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers. METHODS Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up. RESULTS Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p<0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p>0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10). CONCLUSIONS The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation.
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Krishnan S, Anderson MP, Fields DA, Misra M. Abdominal obesity adversely affects bone mass in children. World J Clin Pediatr 2018; 7:43-48. [PMID: 29456931 PMCID: PMC5803564 DOI: 10.5409/wjcp.v7.i1.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/05/2017] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the effect of childhood obesity and insulin resistance on bone health.
METHODS We conducted a cross sectional study in pubertal adolescents and young adults 13-20 years old who were either overweight/obese or normal weight. Participants were Tanner 3 or above for pubertal stage, and had fasting blood work done to measure glucose, insulin, C-reactive protein and lipid levels. Homeostatic model of insulin resistance (HOMA-IR) was calculated using the formula (Fasting Blood Glucose *Insulin/405). Body composition and bone mineral density were measured using dual energy X-ray absorptiometry (DXA; Hologic QDR 4500, Waltham, MA, United Kingdom).
RESULTS Percent trunk fat was associated inversely with whole body bone mineral content (BMC), whereas HOMA-IR was associated positively with whole body BMC.
CONCLUSION Our results suggest that abdominal adiposity may have an adverse effect on whole body bone parameters and that this effect is not mediated by insulin resistance.
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Affiliation(s)
- Sowmya Krishnan
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, Oklahoma City, OK 73104, United States
| | - Michael P Anderson
- College of Public Health, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, United States
| | - David A Fields
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Harold Hamm Diabetes Center, Oklahoma City, OK 73104, United States
| | - Madhusmita Misra
- Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA 02114, United States
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Bax AC, Shawler PM, Anderson MP, Wolraich ML. The Relationship Between Pediatric Residents' Experiences Being Parented and Their Provision of Parenting Advice. Front Pediatr 2018; 6:395. [PMID: 30619790 PMCID: PMC6299100 DOI: 10.3389/fped.2018.00395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The Resident Parenting Questionnaire (RPQ) was developed to assess (a) the relationship between pediatric residents' upbringing and their parenting advice style and (b) factors associated with confidence and resource use when delivering parenting advice. Methods: Three hundred and one pediatric residents from 15 United States residency programs completed the RPQ with upbringing and advice responses categorized using Baumrind's parenting model (authoritative, authoritarian, permissive). Chi-square/Fisher's exact tests, Bowker's test of symmetry, and regression analyses assessed associations between residents' upbringing, parenting advice style/content, and confidence in providing parenting advice. Results: Most participants indicated being raised authoritatively (68%) and giving authoritative parenting advice (83%), but advice differed based on how they perceived their upbringing (p < 0.001). Residents noting authoritative upbringing were more likely to give authoritative advice (85%) while others tended to give advice differing from upbringing (e.g., those perceiving authoritarian upbringing were more likely to give authoritative/permissive). Analyses suggest resident race, acculturation, future plans, and resident level are associated with parenting advice type. Confidence in giving parenting advice decreased significantly as patient age increased and increased with resident level advancement. Residents reported consulting attending physicians for parenting advice guidance more than any other evidence-based resources. Conclusion: Most pediatric residents appear to be aware of appropriate authoritative parenting advice regardless of upbringing, especially as they advance through residency. Residents may benefit from opportunities to reflect upon their upbringing, particularly if raised in authoritarian or permissive styles. Targeted training of residents on evidence-based parenting strategies, particularly for older pediatric patients, appears warranted.
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Affiliation(s)
- Ami C Bax
- Section on Developmental and Behavioral Pediatrics, Department of Pediatrics, Child Study Center, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Paul M Shawler
- Section on Developmental and Behavioral Pediatrics, Department of Pediatrics, Child Study Center, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Michael P Anderson
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
| | - Mark L Wolraich
- Section on Developmental and Behavioral Pediatrics, Department of Pediatrics, Child Study Center, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, United States
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Ivanov VA, Wolf RF, Papin JF, Anderson MP, Hill CL, Welliver RC. Apnea induction for invasive lung function testing in infant olive baboons: Comparison of intravenous propofol versus hyperventilation. J Med Primatol 2017; 47:46-50. [PMID: 29023804 DOI: 10.1111/jmp.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND In various types of pulmonary research, pulmonary function testing (PFT) is performed to quantify the severity of lung disease. Induction of apnea and positive pressure ventilation are required for accurate PFT measurements in non-cooperative subjects. We compared two methods of apnea induction in infant olive baboons (Papio anubis). METHODS Pulmonary function testing results were compared during apnea induced by hyperventilation (CO2 washout) vs. intravenous propofol (1 dose 10 mg/kg). PFT was evaluated using a hot-wire pneumotachometer incorporated within an Avea ventilator in nine 1-month-old baboons. RESULTS Propofol induced apnea faster and more reliably. In both groups, PFT values passed the statistical equivalence test and were not significantly different (Student's t-test). There was a trend toward less data variability after propofol administration. CONCLUSIONS Intravenous propofol was non-inferior to CO2 washout for apnea induction in infant olive baboons. Propofol induced apnea faster and more reliably and yielded less variable PFT results.
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Affiliation(s)
- Vadim A Ivanov
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Roman F Wolf
- Oklahoma City VA Health Care System, Oklahoma City, OK, USA
| | - James F Papin
- Oklahoma Baboon Research Reserve, Oklahoma City, OK, USA
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Prabhakaran V, Drevets DA, Ramajayam G, Manoj JJ, Anderson MP, Hanas JS, Rajshekhar V, Oommen A, Carabin H. Comparison of monocyte gene expression among patients with neurocysticercosis-associated epilepsy, Idiopathic Epilepsy and idiopathic headaches in India. PLoS Negl Trop Dis 2017. [PMID: 28622332 PMCID: PMC5489221 DOI: 10.1371/journal.pntd.0005664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Neurocysticercosis (NCC), a neglected tropical disease, inflicts substantial health and economic costs on people living in endemic areas such as India. Nevertheless, accurate diagnosis using brain imaging remains poorly accessible and too costly in endemic countries. The goal of this study was to test if blood monocyte gene expression could distinguish patients with NCC-associated epilepsy, from NCC-negative imaging lesion-free patients presenting with idiopathic epilepsy or idiopathic headaches. Methods/Principal findings Patients aged 18 to 51 were recruited from the Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India, between January 2013 and October 2014. mRNA from CD14+ blood monocytes was isolated from 76 patients with NCC, 10 Recovered NCC (RNCC), 29 idiopathic epilepsy and 17 idiopathic headaches patients. A preliminary microarray analysis was performed on six NCC, six idiopathic epilepsy and four idiopathic headaches patients to identify genes differentially expressed in NCC-associated epilepsy compared with other groups. This analysis identified 1411 upregulated and 733 downregulated genes in patients with NCC compared to Idiopathic Epilepsy. Fifteen genes up-regulated in NCC patients compared with other groups were selected based on possible relevance to NCC, and analyzed by qPCR in all patients’ samples. Differential gene expression among patients was assessed using linear regression models. qPCR analysis of 15 selected genes showed generally higher gene expression among NCC patients, followed by RNCC, idiopathic headaches and Idiopathic Epilepsy. Gene expression was also generally higher among NCC patients with single cyst granulomas, followed by mixed lesions and single calcifications. Conclusions/Significance Expression of certain genes in blood monocytes can distinguish patients with NCC-related epilepsy from patients with active Idiopathic Epilepsy and idiopathic headaches. These findings are significant because they may lead to the development of new tools to screen for and monitor NCC patients without brain imaging. Taenia solium is a parasite normally transmitted between humans and pigs in areas with poor sanitation. Neurocysticercosis (NCC) occurs when humans are infected with larvae of T. solium that are shed with human feces and the larvae establish in the brain. NCC is often accompanied by neurological symptoms such as epilepsy. In fact, NCC causes approximately one-third of epilepsy cases in areas where T. solium is common. Unfortunately, diagnosis of NCC requires brain computerized tomography or magnetic resonance imaging, tools rarely accessible to people living where NCC is prevalent. This study tested whether genes expressed in blood monocytes, a type of white blood cell, could distinguish between people with epilepsy caused by NCC from those with epilepsy of unknown cause (idiopathic). We compared gene expression in people with NCC and epilepsy, people with idiopathic epilepsy, people cured of NCC and people without NCC or epilepsy but with headaches. We identified 15 genes which were expressed differently in the four different groups indicating that monocyte gene expression patterns in people with NCC and epilepsy are different than people with idiopathic epilepsy. These findings could lead to better understanding how humans respond to NCC and to diagnostic tests which would not require brain imaging.
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Affiliation(s)
| | - Douglas A. Drevets
- Dept. of Internal Medicine, University of Oklahoma HSC, and the VA Medical Center, Oklahoma City, United States of America
| | - Govindan Ramajayam
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Josephine J. Manoj
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Michael P. Anderson
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, United States of America
| | - Jay S. Hanas
- Dept. of Biochemistry and Dept. of Surgery, University of Oklahoma HSC, Oklahoma City, United States of America
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Anna Oommen
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Hélène Carabin
- Dept. of Biostatistics and Epidemiology, University of Oklahoma HSC, Oklahoma City, United States of America
- * E-mail:
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Smith CL, Benear A, Anderson MP, Soto J, Arnold S, Sisson SB. The Relationship between Outdoor Time and TV Viewing Time With Children’s Physical Activity At Child Care. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519659.70707.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pierson BW, Cardon BS, Anderson MP, Glade RS. A Comparison of Nonopioid and Opioid Oral Analgesia following Pediatric Palatoplasty. Cleft Palate Craniofac J 2017; 54:170-174. [DOI: 10.1597/15-135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective This article evaluates postoperative analgesia in pediatric palatoplasty patients using nonopioid oral medications. Design This study was a retrospective chart review. Setting The setting for this study was a tertiary-care children's hospital. Participants Study participants were pediatric patients who underwent palatoplasty procedures performed by a single surgeon. Interventions Interventions included nonopioid and opioid oral medications for postoperative analgesia. Main Outcome Measures The adequacy of nonopioid versus opioid oral analgesia was assessed by (1) time to discontinue IV fluid, (2) total IV morphine doses for breakthrough pain, (3) daily IV morphine doses for breakthrough pain, (4) time to discharge from the hospital, and (5) perioperative weight change. Group comparisons of outcome measures were performed using a two one-sided test. Results A total of 61 patients were identified who received three standard pain regimens: acetaminophen + ibuprofen (12), hydrocodone/acetaminophen (23), and hydrocodone/acetaminophen + ibuprofen (26). There was sufficient evidence to suggest equivalence in outcome measures for acetaminophen + ibuprofen versus hydrocodone/acetaminophen and hydrocodone/acetaminophen + ibuprofen for the following: time to discontinue IV fluid ( P = .02, 90% confidence interval [CI] = –0.42 to 0.17; P = .007, 90% CI = –0.28 to 0.34), daily IV morphine doses ( P = .023, 90% [CI] = –0.83 to 0.65; P = .032, 90% [CI] = –0.92 to 0.28), time to discharge from the hospital ( P = .017, 90% [CI] = –0.40 to 0.27; P = .015, 90% [CI] = –0.24 to 0.39), and perioperative weight change ( P = .002; 90% CI = –0.25 to 0.46; P < .0001; 90% CI = –0.34 to 0.18). There was no sufficient evidence to suggest equivalence for total IV morphine doses ( P = .189, 90% CI = –1.51 to 1.78; P = .169, 90% CI = –1.51 to 0.88). Conclusions Oral acetaminophen and ibuprofen alone may provide similar analgesia to traditional regimens with reduced risks following pediatric palatoplasty.
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Affiliation(s)
- Brandon W. Pierson
- Department of Otolaryngology–Head and Neck Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Brandon S. Cardon
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Michael P. Anderson
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma
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Hughes KM, Johnson PN, Anderson MP, Sekar KC, Welliver RC, Miller JL. Comparison of Amikacin Pharmacokinetics in Neonates Following Implementation of a New Dosage Protocol. J Pediatr Pharmacol Ther 2017; 22:33-40. [PMID: 28337079 DOI: 10.5863/1551-6776-22.1.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary aim was to compare attainment of goal serum amikacin concentrations using two dosage regimens in patients admitted to a neonatal intensive care unit. Secondary objectives included comparison of percentages of supratherapeutic trough concentrations, and subtherapeutic and supratherapeutic peak concentrations. METHODS This was an Institutional Review Board-approved, retrospective study of neonates receiving amikacin during January-December 2013 (group 1) and January-December 2014 (group 2). Group 1 received amikacin dosage consistent with published recommendations, whereas group 2 was dosed using a modified protocol that was based on postmenstrual and postnatal age. Goal serum amikacin peak concentration was defined as 20 to 35 mg/L; hence, subtherapeutic and supratherapeutic peak concentrations were defined as <20 mg/L and >35 mg/L, respectively. Supratherapeutic trough concentrations were >8 mg/L. Between-group analysis was performed using Wilcoxon-Mann-Whitney test, Student t-test or χ2, or Fisher exact analysis as appropriate with a p value <0.05. RESULTS A total of 278 neonates were included (group 1: n = 144; group 2: n = 134). Most patients were male (60%) and were admitted for prematurity or respiratory distress (77%). The median gestational age in group 1 was 34.4 weeks (range, 30.0-37.9 weeks) versus group 2 at 36.9 weeks (range, 31.4-38.9 weeks), whereas the postnatal age was similar between both groups at 4 days. There was a significant increase in attaining goal peak amikacin concentrations between groups 1 and 2, 34% versus 84%, p < 0.001, and decrease in supratherapeutic peak concentrations, 65% versus 12%, p < 0.001. There was no significant difference in subtherapeutic peak or supratherapeutic trough concentrations. CONCLUSIONS A modified neonatal amikacin dosage protocol resulted in increased peak amikacin serum concentration compared with published dosage recommendations. Future research should focus on determination of the optimal dosage regimen in neonates.
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Bagley JE, Barnett J, Baldwin J, DiGiacinto D, Anderson MP. On-the-Job Pain and Injury as Related to Adaptive Ergonomic Equipment in the Sonographer’s Workplace and Area. Journal of Diagnostic Medical Sonography 2016. [DOI: 10.1177/8756479316677018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The proportion of sonographers who scan in pain is increasing, in spite of recommendations and guidelines for proper body mechanics and for the use of ergonomic equipment in the workplace. No study has examined in detail the type of equipment that is available to sonographers in the workplace and whether sonographers who have access to ergonomic equipment are scanning in pain. This study evaluated the proportions of sonographers who had access to various types of ergonomic equipment and compared the results with the prevalence of scanning-related pain. Most sonographers had access to ergonomic features manufactured into ultrasound machines but had less access to equipment provided by employers, such as scanning chairs and cable braces. Sonographers who had access to machines that had swiveling keyboards reported less pain and injury than those who did not.
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Affiliation(s)
| | - Jade Barnett
- University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | | | - Dora DiGiacinto
- University of Oklahoma Health Sciences Center, Tulsa, OK, USA
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Hiebert JC, Rhodes RM, Anderson MP, Vasan NR. Patient Opinion on the Affordable Care Act in an Otolaryngology Practice: the Ideological Divide. J Okla State Med Assoc 2016; 109:441-445. [PMID: 29280606] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE: To assess patient opinion on the Patient Protection and Affordable Care Act (PPACA) in an Otolaryngology practice and the factors that influence those opinions. STUDY DESIGN: Observational study. METHODS: An anonymous survey assessing patient opinion on the PPACA, demographic information, political affiliation, medical diagnosis, and insurance status was distributed to patients in three separate Otolaryngology clinics (General, cancer, and Low-income/Indigent) from April to June 2014. A total of 300 surveys were distributed and 207 were used for final analysis. The primary study outcome measures were patient opinion of the PPACA and statistically significant variables affecting that opinion. The association of Support for the PPACA and variables were tested using the Chi-square test. RESULTS: The only variables that showed a significant association with support for the PPACA were Political Party (p<0.0001) and Ethnicity (p=0.0050). Specifically, a higher proportion of Democrats support the PPACA than Republicans and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. CONCLUSION: Our survey of current Otolaryngology patients mirrors national findings of the division between Republicans and Democrats in their attitudes towards the Affordable Care Act. Political party appears to be the most significant factor in shaping patient opinion on this controversial subject regardless of insurance status or cancer diagnosis and a higher proportion of African Americans and Hispanic/Latinos support the PPACA than Whites and Native Americans. LEVEL OF EVIDENCE: IV.
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Lora KR, Davy B, Hedrick V, Ferris AM, Anderson MP, Wakefield D. Assessing Initial Validity and Reliability of a Beverage Intake Questionnaire in Hispanic Preschool-Aged Children. J Acad Nutr Diet 2016; 116:1951-1960. [PMID: 27554270 DOI: 10.1016/j.jand.2016.06.376] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/24/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Understanding the relationship between high-calorie beverage consumption and weight gain requires an accurate report of dietary intake. A critical need exists to develop and test the psychometrics of brief quantitative tools for minority pediatric populations. OBJECTIVE To modify the adult beverage intake questionnaire (BEVQ-15) for Hispanic preschool-aged children (BEVQ-PS) and test its validity and test-retest reliability in children aged 3 to 5 years. DESIGN Cross-sectional. The modified quantitative 12-beverage category questionnaire assessed consumption of water, fruit juice, sweetened juice drinks, whole milk, reduced-fat milk, low-fat milk, flavored milk, carbonated sweetened drinks, diet carbonated drinks, sweet tea, tea with or without artificial sweetener, and sport drinks consumed during the past month. Hispanic mothers (n=109) recruited from day-care centers provided one 4-day food intake record (FIR) and completed two BEVQ-PS surveys during a 2-week period for their preschool-aged child. Data collection was conducted through one-on-one interviews in Spanish. Validity was assessed by comparing amounts (in grams) and energy intake (in kilocalories) for each beverage category between the first BEVQ-PS and the mean of the FIRs using paired t tests and Pearson's correlation coefficient. Criteria for validity were nonsignificant mean differences in grams and kilocalories from the first BEVQ-PS and mean of the FIRs beverage categories, and significant correlation coefficients between beverage categories. Test-retest reliability was assessed by comparing grams and kilocalories for each beverage category in the first BEVQ-PS with those from the second BEVQ-PS using Pearson's correlation coefficient. The criterion for reliability was a significant correlation coefficient between beverage categories. Significance was set at P<0.05. RESULTS Mean differences between the first BEVQ-PS and FIR for water (42.4±23.1 g), sweetened juice drinks (-1.6±11.0 g), whole milk (18.3±9.91 g), sweetened carbonated drinks (-13.0±7.9 g), and total sugar-sweetened beverages (SSB) (1.4±8.9 g) were not significantly different, but were significantly correlated (r=0.20 to 0.37; P<0.05). Thus, validity criteria were met. With the exception of flavored milk and tea with or without artificial sweeteners, the remaining beverage categories-total beverages and SSB-in the first BEVQ-PS were correlated with those from the second BEVQ-PS (r=0.20 to 0.68; P<0.05), meeting reliability criteria. CONCLUSIONS Researchers and clinicians may use the BEVQ-PS to assess SSB, water, and whole-milk intake in Hispanic children. Additional modifications should be evaluated to assess total beverage intake.
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Cherry AS, Mignogna MR, Roddenberry Vaz A, Hetherington C, McCaffree MA, Anderson MP, Gillaspy SR. The contribution of maternal psychological functioning to infant length of stay in the Neonatal Intensive Care Unit. Int J Womens Health 2016; 8:233-42. [PMID: 27390534 PMCID: PMC4930234 DOI: 10.2147/ijwh.s91632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Assess maternal psychological functioning within the Neonatal Intensive Care Unit (NICU) and its contribution to neonate length of stay (LOS) in the NICU. STUDY DESIGN Mothers of infants admitted to the NICU (n=111) were assessed regarding postpartum depression, postpartum social support, postpartum NICU stress, and maternal anxiety at 2 weeks postpartum. Illness severity was assessed with the Clinical Risk Index for Babies (CRIB). RESULTS Postpartum depression was not significantly correlated with LOS, but was significantly correlated with trait anxiety (r=0.620), which was significantly correlated with LOS (r=0.227). Among mothers with previous mental health history, substance abuse history and CRIB score were the best predictors of LOS. For mothers without a prior mental health issues, delivery type, stress associated with infant appearance, and CRIB scores were the best predictors of LOS. In this group, LOS was found to increase on average by 7.06 days per one unit increase in stress associated with infant appearance among mothers with the same delivery type and CRIB score. CONCLUSION Significant correlations of trait anxiety, stress associated with infant appearance, and parental role with LOS support the tenet that postpartum psychological functioning can be associated with NICU LOS.
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Affiliation(s)
- Amanda S Cherry
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Melissa R Mignogna
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Angela Roddenberry Vaz
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Carla Hetherington
- Neonatal Perinatal Medicine, Department of Pediatrics, University of Oklahoma, College of Medicine, Oklahoma City, OK
| | - Mary Anne McCaffree
- Neonatal Perinatal Medicine, Department of Pediatrics, University of Oklahoma, College of Medicine, Oklahoma City, OK
| | - Michael P Anderson
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK, USA
| | - Stephen R Gillaspy
- Section of General and Community Pediatrics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Chutake YK, Lam CC, Costello WN, Anderson MP, Bidichandani SI. Reversal of epigenetic promoter silencing in Friedreich ataxia by a class I histone deacetylase inhibitor. Nucleic Acids Res 2016; 44:5095-104. [PMID: 26896803 PMCID: PMC4914082 DOI: 10.1093/nar/gkw107] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 09/28/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 12/27/2022] Open
Abstract
Friedreich ataxia, the most prevalent inherited ataxia, is caused by an expanded GAA triplet-repeat sequence in intron 1 of the FXN gene. Repressive chromatin spreads from the expanded GAA triplet-repeat sequence to cause epigenetic silencing of the FXN promoter via altered nucleosomal positioning and reduced chromatin accessibility. Indeed, deficient transcriptional initiation is the predominant cause of transcriptional deficiency in Friedreich ataxia. Treatment with 109, a class I histone deacetylase (HDAC) inhibitor, resulted in increased level of FXN transcript both upstream and downstream of the expanded GAA triplet-repeat sequence, without any change in transcript stability, suggesting that it acts via improvement of transcriptional initiation. Quantitative analysis of transcriptional initiation via metabolic labeling of nascent transcripts in patient-derived cells revealed a >3-fold increase (P < 0.05) in FXN promoter function. A concomitant 3-fold improvement (P < 0.001) in FXN promoter structure and chromatin accessibility was observed via Nucleosome Occupancy and Methylome Sequencing, a high-resolution in vivo footprint assay for detecting nucleosome occupancy in individual chromatin fibers. No such improvement in FXN promoter function or structure was observed upon treatment with a chemically-related inactive compound (966). Thus epigenetic promoter silencing in Friedreich ataxia is reversible, and the results implicate class I HDACs in repeat-mediated promoter silencing.
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Affiliation(s)
- Yogesh K Chutake
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Christina C Lam
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Whitney N Costello
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Michael P Anderson
- Department of Biochemistry & Molecular Biology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Sanjay I Bidichandani
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA Department of Biostatistics & Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, OK 73104, USA
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Matheny JD, Wagener TL, Anderson MP. Tobacco Industry Influences in the Oklahoma Legislature. J Okla State Med Assoc 2015; 108:441-449. [PMID: 26817060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify recent tobacco industry influences in the Oklahoma Legislature. METHODS Relevant public records were compiled and published online in searchable databases. Activities related to two contested tobacco-related legislative initiatives were analyzed. Analyses of voting behavior controlled for party affiliation. RESULTS Legislators receiving the largest amounts of campaign contributions and gifts from tobacco lobbyists performed actions necessary to advance tobacco industry objectives. Several significant associations with voting behavior were observed, the strongest of which was between votes on a pro-tobacco industry bill and gifts from tobacco lobbyists. Most lobbyists'gifts were meals. CONCLUSIONS Tobacco industry influence in the Oklahoma Legislature is enhanced through tobacco lobbyists' campaign contributions and gifts. Greater investments are made in legislative leaders, those serving as champions or spokespersons, and others taking key roles in advancing tobacco industry objectives. Exposing such influences may diminish their effects. Given the egregious and uniquely destructive behavior of the tobacco industry, lawmakers could, as an ethical matter of principle, refuse tobacco lobbyists' money and seek to remedy past harms.
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Abstract
DNA barcodes are short strands of 255-700 nucleotide bases taken from the cytochrome c oxidase subunit 1 (COI) region of the mitochondrial DNA. It has been proposed that these barcodes may be used as a method of differentiating between biological species. Current methods of species classification utilize distance measures that are heavily dependent on both evolutionary model assumptions as well as a clearly defined "gap" between intra- and interspecies variation. Such distance measures fail to measure classification uncertainty or to indicate how much of the barcode is necessary for classification. We propose a sequential naïve Bayes classifier for species classification to address these limitations. The proposed method is shown to provide accurate species-level classification on real and simulated data. The method proposed here quantifies the uncertainty of each classification and addresses how much of the barcode is necessary.
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Ciro CA, Anderson MP, Hershey LA, Prodan CI, Holm MB. Instrumental activities of daily living performance and role satisfaction in people with and without mild cognitive impairment: a pilot project. Am J Occup Ther 2015; 69:6903270020p1-10. [PMID: 25871600 PMCID: PMC4453037 DOI: 10.5014/ajot.2014.015198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated differences in observed performance of instrumental activities of daily living (IADLs) and self-reported satisfaction with social role performance between people with amnestic mild cognitive impairment (a-MCI) and age- and gender-matched control participants. METHOD We measured observed performance of 14 IADLs using the Independence, Safety, and Adequacy domains of the Performance Assessment of Self-Care Skills (PASS) and the Patient-Reported Outcomes Measurement Information Systems (PROMIS) to examine satisfaction with social role performance. RESULTS Total PASS scores were significantly lower in participants with a-MCI (median=40.6) than in control participants (median=44.2; p=.006). Adequacy scores were also significantly lower. No significant differences were found between groups on the PROMIS measures. CONCLUSION IADL differences between groups were related more to errors in adequacy than to safety and independence. Occupational therapy practitioners can play a key role in the diagnosis and treatment of subtle IADL deficits in people with MCI.
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Affiliation(s)
- Carrie A Ciro
- Carrie A. Ciro, PhD, OTR/L, FAOTA, is Assistant Professor, University of Oklahoma Health Sciences Center, Oklahoma City;
| | - Michael P Anderson
- Michael P. Anderson, PhD, is Assistant Professor, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Linda A Hershey
- Linda A. Hershey, MD, PhD, is Professor, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Calin I Prodan
- Calin I. Prodan, MD, is Associate Professor, Veterans Affairs Medical Center, Oklahoma City, OK
| | - Margo B Holm
- Margo B. Holm, PhD, OTR/L, FAOTA, ABDA, is Professor Emerita, University of Pittsburgh, Pittsburgh, PA
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Thompson BM, Haidet P, Borges NJ, Carchedi LR, Roman BJB, Townsend MH, Butler AP, Swanson DB, Anderson MP, Levine RE. Team cohesiveness, team size and team performance in team-based learning teams. Med Educ 2015; 49:379-85. [PMID: 25800298 DOI: 10.1111/medu.12636] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/28/2013] [Accepted: 09/29/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the relationships among variables associated with teams in team-based learning (TBL) settings and team outcomes. METHODS We administered the National Board of Medical Examiners (NBME) Psychiatry Subject Test first to individuals and then to teams of Year three students at four medical schools that used TBL in their psychiatry core clerkships. Team cohesion was analysed using the Team Performance Scale (TPS). Bivariate correlation and linear regression analysis were used to analyse the relationships among team-level variables (mean individual TPS scores for each team, mean individual NBME scores of teams, team size, rotation and gender make-up) and team NBME test scores. A hierarchical linear model was used to test the effects of individual TPS and individual NBME test scores within each team, as well as the effects of the team-level variables of team size, team rotation and gender on team NBME test scores. Individual NBME test and TPS scores were nested within teams and treated as subsampling units. RESULTS Individual NBME test scores and individual TPS scores were positively and statistically significantly (p < 0.01) associated with team NBME test scores, when team rotation, team size and gender make-up were controlled for. Higher team NBME test scores were associated with teams rotating later in the year and larger teams (p < 0.01). Gender make-up was not significantly associated. CONCLUSIONS The results of an NBME Psychiatry Subject Test administered to TBL teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education.
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Affiliation(s)
- Britta M Thompson
- Department of Paediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA; Office of Medical Education, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
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Bagley JE, Randall K, Anderson MP. A comparison of sonography and radiography student scores in a cadaver anatomy class before and after the implementation of synchronous distance education. Ultrasound 2015; 23:59-66. [PMID: 27433237 DOI: 10.1177/1742271x14567173] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distance education is a solution to expand medical imaging education to students who might not otherwise be able to obtain the education. It can be a mechanism to reduce the health care worker shortage in underserved areas. In some cases, distance education may be a disruptive technology, and might lower student performance. This study compares student scores in a cadaver anatomy course in the four cohorts preceding the implementation of distance education to the first three cohorts that took the course using a multiple campus design. The means and medians of the lecture exam average, the laboratory component score, and the final course score of the nondistance education cohorts were compared with those of the distance education cohorts using nonparametric statistical analysis. Scores in an anatomy course were compared by campus placement among the distance education cohorts, and the independent effect of distance education on the laboratory component, lecture examination average, and final course scores, while controlling for cumulative grade point average and site (originating/distant), was assessed. Students receiving the course in a nondistance education environment scored higher in the anatomy course than the students who took the course in a distance education environment. Students on the distant campus scored lower than students on the originating site. Distance education technology creates new opportunities for learning, but can be a disruptive technology. Programs seeking to implement distance education into their curriculum should do so with knowledge of the advantages and disadvantages.
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Affiliation(s)
- Jennifer Elaine Bagley
- Department of Medical Imaging and Radiation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Tulsa, USA
| | - K Randall
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, Tulsa, USA
| | - M P Anderson
- Department of Public Health, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Pant C, Sferra TJ, Olyaee M, Gilroy R, Anderson MP, Rastogi A, Pandya PK, Deshpande A. Emergency department visits related to Clostridium difficile infection: results from the nationwide emergency department sample, 2006 through 2010. Acad Emerg Med 2015; 22:117-9. [PMID: 25545404 DOI: 10.1111/acem.12552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/12/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to estimate emergency department (ED) visits for Clostridium difficile infection in the United States for the years 2006 through 2010. METHODS Estimates of ED visits for C. difficile infection were calculated in patients 18 years and older using the Nationwide Emergency Department Sample. RESULTS During the calendar years 2006 through 2010, there were an estimated total of 491,406,018 ED visits. Of these, 462,160 ED visits were associated with a primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of C. difficile. The C. difficile infection ED visit rate (visits/100,000 census population) increased from 34.1 in 2006 to 42.3 in 2010, an increase of 24% (p < 0.01). There was also a significant overall increased trend in the number of ED visits for C. difficile from 2006 through 2010 (p < 0.01). The highest ED visit rate for C. difficile was observed for patients 65 years and older (163.18 per 100,000), while the lowest visit rate was for patients aged 18 to 24 years (5.10 per 100,000). The greatest increase in C. difficile infection visits occurred in the age group 18 to 24 years. CONCLUSIONS These results indicate an increased trend of ED visits for C. difficile in the period 2006 through 2010 with an overall population-adjusted increase of 24%. This represents important complementary data to previous studies reporting an increase in the rate of C. difficile infections in the U.S. hospitalized population.
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Affiliation(s)
- Chaitanya Pant
- Division of Gastroenterology, Hepatology and Motility; Department of Internal Medicine; University of Kansas Medical Center; Kansas City KS
| | - Thomas J. Sferra
- Division of Pediatric Gastroenterology, Hepatology and Nutrition; Department of Pediatrics; Case Western Reserve University School of Medicine; UH Rainbow Babies & Children's Hospital; Cleveland OH
| | - Mojtaba Olyaee
- Division of Gastroenterology, Hepatology and Motility; Department of Internal Medicine; University of Kansas Medical Center; Kansas City KS
| | - Richard Gilroy
- Division of Gastroenterology, Hepatology and Motility; Department of Internal Medicine; University of Kansas Medical Center; Kansas City KS
| | - Michael P. Anderson
- Department of Biostatistics and Epidemiology; University of Oklahoma Health Sciences Center; Oklahoma City OK
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility; Department of Internal Medicine; University of Kansas Medical Center; Kansas City KS
| | - Prashant K. Pandya
- Division of Gastroenterology, Hepatology and Motility; Department of Internal Medicine; University of Kansas Medical Center; Kansas City KS
| | - Abhishek Deshpande
- Medicine Institute Center for Value Based Care Research and Department of Infectious Diseases; Medicine Institute; Cleveland Clinic; Cleveland OH
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Pant C, Sferra TJ, Deshpande A, Olyaee M, Gilroy R, Anderson MP, Donskey C. Clostridium difficile infection in hospitalized patients with cystic fibrosis. Infect Control Hosp Epidemiol 2014; 35:1547-8. [PMID: 25419780 DOI: 10.1086/678607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chaitanya Pant
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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Pant C, Anderson MP, Deshpande A, Grunow JE, O'Connor JA, Philpott JR, Sferra TJ. Trends in hospitalizations of children with inflammatory bowel disease within the United States from 2000 to 2009. J Investig Med 2014; 61:1036-8. [PMID: 23797749 DOI: 10.2310/jim.0b013e31829a4e25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence and prevalence of pediatric inflammatory bowel disease (IBD) seems to be increasing in North America and Europe. Our objective was to evaluate hospitalization rates in children with IBD in the United States during the decade 2000 to 2009. METHODS We analyzed cases with a discharge diagnosis of Crohn disease (CD) and ulcerative colitis (UC) within the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality. RESULTS We identified 61,779 pediatric discharges with a diagnosis of IBD (CD, 39,451 cases; UC, 22,328 cases). The number of hospitalized children with IBD increased from 11,928 to 19,568 (incidence, 43.5-71.5 cases per 10,000 discharges per year; P < 0.001). For CD, the number increased from 7757 to 12,441 (incidence, 28.3-45.0; P < 0.001) and for UC, 4171 to 7127 (15.2-26.0; P < 0.001). Overall, there was a significant increasing trend for pediatric hospitalizations with IBD, CD, and UC (P < 0.001). In addition, there was an increase in IBD-related complications and comorbid disease burden (P < 0.01). CONCLUSION There was a significant increase in the number and incidence of hospitalized children with IBD in the United States from 2000 to 2009.
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Affiliation(s)
- Chaitanya Pant
- Section of Gastroenterology and Nutrition, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Pant C, Anderson MP, Deshpande A, Grunow JE, O'Connor JA, Philpott JR, Sferra TJ. Trends in hospitalizations of children with inflammatory bowel disease within the United States from 2000 to 2009. J Investig Med 2014. [PMID: 23797749 DOI: 10.231/jim.0b013e31829a4e25] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence and prevalence of pediatric inflammatory bowel disease (IBD) seems to be increasing in North America and Europe. Our objective was to evaluate hospitalization rates in children with IBD in the United States during the decade 2000 to 2009. METHODS We analyzed cases with a discharge diagnosis of Crohn disease (CD) and ulcerative colitis (UC) within the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality. RESULTS We identified 61,779 pediatric discharges with a diagnosis of IBD (CD, 39,451 cases; UC, 22,328 cases). The number of hospitalized children with IBD increased from 11,928 to 19,568 (incidence, 43.5-71.5 cases per 10,000 discharges per year; P < 0.001). For CD, the number increased from 7757 to 12,441 (incidence, 28.3-45.0; P < 0.001) and for UC, 4171 to 7127 (15.2-26.0; P < 0.001). Overall, there was a significant increasing trend for pediatric hospitalizations with IBD, CD, and UC (P < 0.001). In addition, there was an increase in IBD-related complications and comorbid disease burden (P < 0.01). CONCLUSION There was a significant increase in the number and incidence of hospitalized children with IBD in the United States from 2000 to 2009.
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Affiliation(s)
- Chaitanya Pant
- Section of Gastroenterology and Nutrition, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Abstract
OBJECTIVE To investigate the epidemiology of GI bleeding in hospitalized children in the United States. METHODS Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the year 2009. The data were weighted to generate national-level estimates. RESULTS There were 23,383 pediatric discharges with a diagnosis of GI bleeding accounting for 0.5% of all discharges. Children with a GI bleed compared to those without were more likely to be male (54.5% vs. 45.8%; P < 0.001), older (children ≥11 years; 50.8% vs. 38.7%; P < 0.001), and admitted to a teaching hospital (70.5% vs. 56.4%; P < 0.001). Children 11-15 years of age had the highest incidence of GI bleeding (84.2 per 10,000 discharges) and children less than 1 year of age the lowest (24.4 per 10,000 discharges). The highest incidence of GI bleeding was attributable to cases coded as blood in stool (17.6 per 10,000 discharges) followed by hematemesis (11.2 per 10,000 discharges). Those with a GI bleed had a higher co-morbid burden (12.3% vs. 2.3%; P < 0.001) and severity of illness (40.1% vs. 14.5%; P < 0.001). The highest mortality rates associated with GI bleeding were observed in cases with intestinal perforation (8.7%) and esophageal perforation (8.4%). GI bleeding was independently associated with a higher risk of mortality (aOR 1.68, CI 1.53-1.84). CONCLUSIONS Our results describe the epidemiology of GI bleeding in hospitalized children within the United States. We found a substantial risk of mortality attributable to GI bleeding in this patient population. Our study is limited by the exclusion of non-hospitalized children, the reliance on ICD-9-CM codes and the absence of longitudinal follow up of patients.
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Affiliation(s)
- Chaitanya Pant
- Department of Medicine, Kansas University Medical Center , Kansas City, KS , USA
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Pant C, Deshpande A, Olyaee M, Anderson MP, Bitar A, Steele MI, Bass PF, Sferra TJ. Epidemiology of acute pancreatitis in hospitalized children in the United States from 2000-2009. PLoS One 2014; 9:e95552. [PMID: 24805879 PMCID: PMC4012949 DOI: 10.1371/journal.pone.0095552] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/28/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Single-center studies suggest an increasing incidence of acute pancreatitis (AP) in children. Our specific aims were to (i) estimate the recent secular trends, (ii) assess the disease burden, and (iii) define the demographics and comorbid conditions of AP in hospitalized children within the United States. METHODS We used the Healthcare Cost and Utilization Project Kids' Inpatient Database, Agency for Healthcare Research and Quality for the years 2000 to 2009. Extracted data were weighted to generate national-level estimates. We used the Cochrane-Armitage test to analyze trends; cohort-matching to evaluate the association of AP and in-hospital mortality, length of stay, and charges; and multivariable logistic regression to test the association of AP and demographics and comorbid conditions. RESULTS We identified 55,012 cases of AP in hospitalized children (1-20 years of age). The incidence of AP increased from 23.1 to 34.9 (cases per 10,000 hospitalizations per year; P<0.001) and for all-diagnoses 38.7 to 61.1 (P<0.001). There was an increasing trend in the incidence of both primary and all-diagnoses of AP (P<0.001). In-hospital mortality decreased (13.1 to 7.6 per 1,000 cases, P<0.001), median length of stay decreased (5 to 4 days, P<0.001), and median charges increased ($14,956 to $22,663, P<0.001). Children with AP compared to those without the disease had lower in-hospital mortality (adjusted odds ratio, aOR 0.86, 95% CI, 0.78-0.95), longer lengths of stay (aOR 2.42, 95% CI, 2.40-2.46), and higher charges (aOR 1.62, 95% CI, 1.59-1.65). AP was more likely to occur in children older than 5 years of age (aORs 2.81 to 5.25 for each 5-year age interval). Hepatobiliary disease was the comorbid condition with the greatest association with AP. CONCLUSIONS These results demonstrate a rising incidence of AP in hospitalized children. Despite improvements in mortality and length of stay, hospitalized children with AP have significant morbidity.
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Affiliation(s)
- Chaitanya Pant
- Department of Medicine, Kansas University Medical Center, Kansas City, Kansas, United States of America
| | - Abhishek Deshpande
- Medicine Institute Center for Value Based Care, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Mojtaba Olyaee
- Department of Medicine, Kansas University Medical Center, Kansas City, Kansas, United States of America
| | - Michael P. Anderson
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Anas Bitar
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Marilyn I. Steele
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Pat F. Bass
- Departments of Medicine and Pediatrics, Louisiana Health Sciences Center-Shreveport, Shreveport, Louisiana, United States of America
| | - Thomas J. Sferra
- Department of Pediatrics, Case Western Reserve University School of Medicine, UH Rainbow Babies & Children’s Hospital, Cleveland, Ohio, United States of America
- * E-mail:
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Bagley JE, DiGiacinto D, Lawyer J, Anderson MP. Health Care Students Who Frequently Use Facebook Are Unaware of the Risks for Violating HIPAA Standards. Journal of Diagnostic Medical Sonography 2014. [DOI: 10.1177/8756479314530509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social networking creates easy opportunities to violate HIPAA (Health Insurance Portability and Accountability Act). The purpose of this study is to determine if students who frequently update their Facebook statuses have the ability to identify certain Facebook postings as HIPAA violations. An anonymous survey was distributed to students on a university campus of a health sciences center, containing questions related to how often Facebook was used or accessed, how often students updated their Facebook statuses, and whether they could identify if specific online postings constituted HIPAA violations. Students’ HIPAA scenario responses were compared to their frequency of Facebook status updates, and students who frequently updated their information were more likely to incorrectly identify a HIPAA violation—namely, photos of patients posted to Facebook, even those devoid of identifying information. No other HIPAA violation scenarios demonstrated an association with frequencies of use or status updates. Further research needs to be conducted to see what traits or behaviors put students at risk for violating HIPAA through social networking sites.
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Affiliation(s)
| | - Dora DiGiacinto
- The University of Oklahoma Health Sciences Center, Tulsa, OK, USA
| | - Jaclyn Lawyer
- The University of Oklahoma Health Sciences Center, Tulsa, OK, USA
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Ernst KD, Cline WL, Dannaway DC, Davis EM, Anderson MP, Atchley CB, Thompson BM. Weekly and consecutive day neonatal intubation training: comparable on a pediatrics clerkship. Acad Med 2014; 89:505-510. [PMID: 24448036 DOI: 10.1097/acm.0000000000000150] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether medical student intubation proficiency with a neonatal mannequin differs according to weekly or consecutive day practice sessions during a six-week pediatric clerkship. METHOD From July 2010 through June 2011, the authors prospectively randomized 110 third-year medical students into three neonatal intubation practice groups: standard (control; no practice sessions), weekly (practice once/week for four consecutive weeks), or consecutive day (practice once/day for four consecutive days). At baseline, students performed intubation during individual sessions using a neonatal mannequin (SimNewB). Two reviewers, blinded to practice group, viewed videotapes of intubations and independently scored students on equipment selection, procedural skill steps, length of intubation attempts (in seconds), and the number of attempts (up to three) needed for a successful intubation. Videotaped individual final assessment intubation sessions during week six were evaluated in the same manner. RESULTS Students in the weekly and consecutive day practice groups performed better at the final assessment on all variables than students in the standard group (P < .001), but over six weeks, the authors detected no differences between the two distributed practice formats for any outcomes of interest. CONCLUSIONS Practice improved all aspects of neonatal intubation performance, including choosing the correct equipment, properly performing the skill steps, length of time to successful intubation, and success rate, for novice health care providers in a simulation setting. Over six weeks, neither practice format proved superior, but it remains unclear whether one format is superior for learning and skill retention over the long term or in actual practice.
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Affiliation(s)
- Kimberly D Ernst
- Dr. Ernst is associate professor and director of medical education in newborn medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Cline was, at the time of this study, neonatology fellow, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, and she is currently a clinical neonatologist in private practice, CoxHealth South, Springfield, Missouri. Dr. Dannaway is assistant professor and assistant director, Neonatal Fellowship Program, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Ms. Davis is a graduate student, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Anderson is assistant professor and statistician, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Atchley was, at the time of this study, neonatology fellow, and she is currently assistant professor, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Thompson is assistant dean for medical education and is affiliated with the Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Noori S, McCoy M, Anderson MP, Ramji F, Seri I. Changes in cardiac function and cerebral blood flow in relation to peri/intraventricular hemorrhage in extremely preterm infants. J Pediatr 2014; 164:264-70.e1-3. [PMID: 24183212 DOI: 10.1016/j.jpeds.2013.09.045] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 09/04/2013] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether changes in cardiac function and cerebral blood flow (CBF) precede the occurrence of peri/intraventricular hemorrhage (P/IVH) in extremely preterm infants. STUDY DESIGN In this prospective observational study, 22 preterm infants (gestational age 25.9 ± 1.2 weeks; range 23-27 weeks) were monitored between 4 and 76 hours after birth. Cardiac function and changes in CBF and P/IVH were assessed by ultrasound every 12 hours. Changes in CBF were also followed by continuous monitoring of cerebral regional oxygen saturation (rSO2) and by calculating cerebral fractional oxygen extraction. RESULTS Five patients developed P/IVH (1 patient grade II and 4 patients grade IV). Whereas measures of cardiac function and CBF remained unchanged in neonates without P/IVH, patients with P/IVH tended to have lower left ventricular output and had lower left ventricle stroke volume and cerebral rSO2 and higher cerebral fractional oxygen extraction during the first 12 hours of the study. By 28 hours, these variables were similar in the 2 groups and myocardial performance index was lower and middle cerebral artery mean flow velocity higher in the P/IVH group. P/IVH was detected after these changes occurred. CONCLUSIONS Cardiac function and CBF remain stable in very preterm neonates who do not develop P/IVH during the first 3 postnatal days. In very preterm neonates developing P/IVH during this period, lower systemic perfusion and CBF followed by an increase in these variables precede the development of P/IVH. Monitoring cardiac function and cerebral rSO2 may identify infants at higher risk for developing P/IVH before the bleeding occurs.
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Affiliation(s)
- Shahab Noori
- Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Michael McCoy
- Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michael P Anderson
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Faridali Ramji
- Department of Pediatric Imaging, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Istvan Seri
- Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Feng Q, Vickers KC, Anderson MP, Levin MG, Chen W, Harrison DG, Wilke RA. A common functional promoter variant links CNR1 gene expression to HDL cholesterol level. Nat Commun 2013; 4:1973. [PMID: 23748922 PMCID: PMC3873874 DOI: 10.1038/ncomms2973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/10/2012] [Accepted: 05/08/2013] [Indexed: 12/17/2022] Open
Abstract
CB1 receptor blockers increase HDL-C levels. Although genetic variation in the CB1 receptor – encoded by the CNR1 gene – is known to influence HDL-C level as well, human studies conducted to date have been limited to genetic markers such as haplotype tagging SNPs. Here we identify rs806371 in the CNR1 promoter as the causal variant. We resequenced the CNR1 gene and genotype all variants in a DNA biobank linked to comprehensive electronic medical records. By testing each variant for association with HDL-C level in a clinical practice-based setting, we localize a putative functional allele to a 100bp window in the 5′-flanking region. Assessment of variants in this window for functional impact on electrophoretic mobility shift assay identified rs806371 as a novel regulatory binding element. Reporter gene assays confirm that rs806371 reduces HDL-C gene expression, thereby linking CNR1 gene variation to HDL-C level in humans.
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Affiliation(s)
- Q Feng
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Lammers EM, Johnson PN, Ernst KD, Hagemann TM, Lawrence SM, Williams PK, Anderson MP, Miller JL. Association of Fentanyl With Neurodevelopmental Outcomes in Very-Low-Birth-Weight Infants. Ann Pharmacother 2013; 48:335-42. [DOI: 10.1177/1060028013514026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Opioids are commonly used in the neonatal intensive care unit (NICU). Negative neurodevelopmental effects in the short-term setting have been associated with opioids ; however, long-term studies have been limited. Objective: The primary objective was to determine if there is a dose relationship between fentanyl and neurodevelopmental outcomes, as measured by Bayley Scales of Infant and Toddler Development (Bayley-III) composite scores for language, cognition, and motor skills. Secondary objectives included comparison of Bayley-III scores and neurodevelopmental impairment classification based on fentanyl exposure. Methods: A retrospective evaluation of 147 very-low-birth-weight infants with Bayley-III scores obtained at a chronological age of 6 months to 2 years at clinic follow-up was conducted. Univariate and multivariable linear regression analyses were used to determine if there was a dose-related association between fentanyl and neurodevelopmental outcomes. To evaluate secondary outcomes, patients were divided based on cumulative fentanyl dose (“high-dose” versus “low/no-dose”). Results: The univariate analysis found a statistically significant decrease in cognition ( P = .034) and motor skills scores ( P = .006). No association was found in the multi-variable regression between fentanyl cumulative dose and Bayley-III scores. There was a significant decrease in the motor skills score between the high-dose versus low/no-dose group, 94 ± 20 versus 102 ± 15, respectively ( P = .026); however, no statistical differences were noted for language or cognition scores or neurological impairment classification. Conclusions: When controlling for other variables, the cumulative fentanyl dose did not correlate with neurodevelopmental outcomes. Further evaluation of benefits and risks of opioids in premature infants are needed.
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Affiliation(s)
| | - Peter N. Johnson
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | | | | | | | | | | | - Jamie L. Miller
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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Abstract
OBJECTIVE To investigate the association of Clostridium difficile infection (CDI) with the outcomes of hospitalized patients with end-stage renal disease (ESRD). METHODS We extracted all adult cases with a discharge diagnosis of ESRD or CDI from the United States Nationwide Inpatient Sample 2009 database. Outcome variables (mortality, length of hospital stay [LOS], and hospitalization charges), demographic information, and comorbidity data were collected. Data were evaluated by univariate and multiple regression analyses. RESULTS We identified 184,139 cases with ESRD of which 2.8% had CDI. Comparison of patients with ESRD + CDI to those with only ESRD revealed in-hospital mortality (13.2% vs 5.3%; P < 0.001), LOS (17.3 vs 7.1 days; P < 0.001), and charges ($124,846 vs $56,663; P < 0.001) to be more than 2-fold greater. In the ESRD cohort (ESRD only and ESRD + CDI), CDI was independently associated with greater mortality (adjusted odds ratio, 2.15; 95% CI, 2.07-2.24; P < 0.001), longer LOS (mean difference, 9.4 days; 95% CI, 9.2-9.5; P < 0.001), and higher charges (mean difference, $62,824; 95% CI, 61,615-64,033; P < 0.001). CONCLUSIONS Clostridium difficile infection is associated with significantly worse outcomes in hospitalized patients with ESRD.
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Affiliation(s)
- Chaitanya Pant
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Vickers KC, Levin MG, Anderson MP, Xu Q, Anzinger J, Kruth HS, Remaley AT. Abstract 46: High-Density Lipoproteins Control Monocyte Differentiation Through microRNA Intercellular Communication. Arterioscler Thromb Vasc Biol 2013. [DOI: 10.1161/atvb.33.suppl_1.a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many HDL-microRNAs (miRNA) are well-characterized post-transcriptional regulators of inflammation, and are significantly increased on HDL with hypercholesterolemia and atherosclerosis in humans and mice. Therefore, we hypothesize that inflammatory cells uniquely control their own gene expression through cellular miRNA export to HDL and then regulate recipient cell gene expression through HDL-mediated miRNA delivery. To test this hypothesis, we used high-throughput proteomics, Open Arrays, small RNA sequencing, and gene expression microarrays. Human monocytes (plasma elutriation) were differentiated into dendritic cells and multiple macrophage phenotypes. Each cell-type was incubated with pure reconstituted HDL (rHDL), which was then purified from culture media by apolipoprotein A-I immunoprecipitation after 24 h, and both cellular and HDL-miRNAs were profiled using TaqMan Open Arrays. Macrophages were found to export high levels of miRNAs to HDL that inhibit monocyte/macrophage differentiation (miR-146a, miR-223); however, monocytes were also found to export many miRNAs associated with differentiation, including miR-92a, miR-222, miR-17, miR-20a, miR106a, and miR-21. Furthermore, many miRNAs were found to be transcribed in inflammatory cells, but completely exported to HDL and not retained in the cell. Most interestingly, HDL treatment was found to induce miR-223 transcription in monocytes, as determined by primary miR-223 transcript levels; however, intracellular levels of the mature form (miR-223) did not change. These results suggest that HDL induces the export of miRNAs it transports. PAR-CLIP with high-throughput small RNA sequencing was used to demonstrate that miRNAs are transferred from macrophages to endothelial cells and loaded onto cellular Argonaute 2-continaining RNA-induced silencing complexes. To demonstrate this in mice, human HDL, containing endogenous levels of miR-223, were injected into miR-223-null mice and inflammation-associated miRNA delivery was mapped in vivo. In summary, we found profound differences in the cellular response to HDL treatment and HDL-miRNA communication amongst inflammatory cell phenotypes that are physiologically relevant to cardiovascular disease.
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Affiliation(s)
| | | | | | - Qing Xu
- NHLBI, National Institutes of Health, Bethesda, MD
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Pant C, Anderson MP, Deshpande A, Altaf MA, Grunow JE, Atreja A, Sferra TJ. Health care burden of Clostridium difficile infection in hospitalized children with inflammatory bowel disease. Inflamm Bowel Dis 2013. [PMID: 23478808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Children with inflammatory bowel disease (IBD), similar to adults, are at increased risk of acquiring a Clostridium difficile infection (CDI). Our objective was to characterize the health care burden associated with CDI in hospitalized pediatric patients with IBD. METHODS We extracted and analyzed cases with a discharge diagnosis of IBD or CDI from the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database. RESULTS In our primary analysis, we evaluated pediatric cases with a principal diagnosis of IBD or CDI. For the year 2009, we identified 12,610 weighted cases with IBD of which 3.5% had CDI. In children with IBD, CDI was independently associated with lengthier hospital stays (8.0 versus 6.0 days; adjusted regression coefficient, 2.1 days; 95% confidence interval [CI], 1.4-2.8), higher charges ($45,126 versus $34,703; adjusted regression coefficient, $11,506; 95% CI, 6192-16,820), and greater need for parenteral nutrition (15.9% versus 12.1%; adjusted odds ratio, 1.5; 95% CI, 1.1-2.0) and blood transfusion (17.7% versus 9.8%; adjusted odds ratio, 1.8; 95% CI, 1.4-2.4). There were no deaths. We made similar observations in a subanalysis of cases with principal or secondary diagnoses of IBD or CDI. The incidence of CDI in patients with IBD increased between 2000 and 2009 from 21.7 to 28.0 cases per 1000 IBD cases per year (P < 0.001). There was a significant increase in CDI complicating ulcerative colitis (28.1 versus 42.2, P < 0.001) but not for Crohn's disease (18.3 versus 20.3). CONCLUSIONS CDI represents a significant health care burden in hospitalized children with IBD.
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Affiliation(s)
- Chaitanya Pant
- Section of Gastroenterology & Nutrition, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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