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Foglia EE, Shah BA, DeShea L, Lander K, Kamath-Rayne BD, Herrick HM, Zaichkin J, Lee S, Bonafide C, Song C, Hallford G, Lee HC, Kapadia V, Leone T, Josephsen J, Gupta A, Strand ML, Beasley WH, Szyld E. Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors. Resusc Plus 2024; 17:100515. [PMID: 38094660 PMCID: PMC10716019 DOI: 10.1016/j.resplu.2023.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 04/11/2024] Open
Abstract
Aim Neonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth. Methods A voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression. Results Between 11/7/22-12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns. Conclusion Few NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.
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Affiliation(s)
- Elizabeth E. Foglia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Birju A. Shah
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lise DeShea
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathryn Lander
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Beena D. Kamath-Rayne
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Heidi M. Herrick
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Sura Lee
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Christopher Bonafide
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Clara Song
- Southern California Permanente Medical Group, Anaheim, CA, United States
| | - Gene Hallford
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Henry C. Lee
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Vishal Kapadia
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
| | - Tina Leone
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Justin Josephsen
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Arun Gupta
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marya L. Strand
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - William H. Beasley
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Edgardo Szyld
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - for the American Academy of Pediatrics Delivery Room Intervention, Evaluation DRIVE Network
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
- Positive Pressure, PLLC, Shelton, WA, United States
- Southern California Permanente Medical Group, Anaheim, CA, United States
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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Noyd DH, Chen S, Bailey AM, Janitz AE, Baker AA, Beasley WH, Etzold NC, Kendrick DC, Kibbe WA, Oeffinger KC. Informatics tools to implement late cardiovascular risk prediction modeling for population management of high-risk childhood cancer survivors. Pediatr Blood Cancer 2023; 70:e30474. [PMID: 37283294 DOI: 10.1002/pbc.30474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Clinical informatics tools to integrate data from multiple sources have the potential to catalyze population health management of childhood cancer survivors at high risk for late heart failure through the implementation of previously validated risk calculators. METHODS The Oklahoma cohort (n = 365) harnessed data elements from Passport for Care (PFC), and the Duke cohort (n = 274) employed informatics methods to automatically extract chemotherapy exposures from electronic health record (EHR) data for survivors 18 years old and younger at diagnosis. The Childhood Cancer Survivor Study (CCSS) late cardiovascular risk calculator was implemented, and risk groups for heart failure were compared to the Children's Oncology Group (COG) and the International Guidelines Harmonization Group (IGHG) recommendations. Analysis within the Oklahoma cohort assessed disparities in guideline-adherent care. RESULTS The Oklahoma and Duke cohorts both observed good overall concordance between the CCSS and COG risk groups for late heart failure, with weighted kappa statistics of .70 and .75, respectively. Low-risk groups showed excellent concordance (kappa > .9). Moderate and high-risk groups showed moderate concordance (kappa .44-.60). In the Oklahoma cohort, adolescents at diagnosis were significantly less likely to receive guideline-adherent echocardiogram surveillance compared with survivors younger than 13 years old at diagnosis (odds ratio [OD] 0.22; 95% confidence interval [CI]: 0.10-0.49). CONCLUSIONS Clinical informatics tools represent a feasible approach to leverage discrete treatment-related data elements from PFC or the EHR to successfully implement previously validated late cardiovascular risk prediction models on a population health level. Concordance of CCSS, COG, and IGHG risk groups using real-world data informs current guidelines and identifies inequities in guideline-adherent care.
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Affiliation(s)
- David H Noyd
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Anna M Bailey
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Ashley A Baker
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - William H Beasley
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma, USA
| | - Nancy C Etzold
- Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David C Kendrick
- Department of Medical Informatics, The University of Oklahoma Health Sciences Center, Tulsa, Oklahoma, USA
| | - Warren A Kibbe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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DeShea L, Rolfs S, McCoy M, Beasley WH, Szyld E, Makkar A. Medical Marijuana Legalization in Oklahoma: Effects on Neonatal Exposure to Opiates. Am J Perinatol 2023. [PMID: 36452967 DOI: 10.1055/a-1990-8311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The U.S. opioid epidemic has been characterized by increases in opioid misuse, overdose deaths, and neonatal opioid withdrawal syndrome. Research suggests that marijuana legalization has contributed to decreased use of opiates, although many studies had methodological weaknesses and failed to address the pregnant population. Implementation of medical cannabis laws has the potential to reduce maternal opioid use and, therefore, neonatal exposure to the drugs. This study aimed to examine the association between Oklahoma's implementation of state medical marijuana laws and the neonatal exposure to opioids. STUDY DESIGN Electronic medical records at two sites (Oklahoma City and Lawton) were searched for results of cord, urine, and meconium screens to detect amphetamines, barbiturates, benzodiazepines, cocaine, ethanol, opiates, phencyclidine, and tetrahydrocannabinol (THC). Two study periods were compared: 19 months before Oklahoma's medical marijuana law took effect and 19 months after legalization began. RESULTS A total of 16,804 babies were born alive at the two sites during the study period. The rate of positive THC tests per 1,000 liveborn infants significantly increased from 16.2 per 1,000 during the prelaw period to 22.2 per 1,000 during the postlaw period (p = 0.004). Neonatal opioid exposure incidence showed a nonsignificant decrease from 7.6 positive tests per 1,000 liveborn infants to 6.8 per 1,000 from prelaw to postlaw period (p = 0.542). The number of positive tests for THC and concomitant use of opioids doubled from the prelaw period (n = 4) to postlaw (n = 9), but there were too few cases for statistical significance. Infants at the more rural site had significantly higher rates for amphetamines, benzodiazepines, and THC, with a trend toward higher rates for opiates. CONCLUSION Marijuana legalization was related to significant increases in positive test rates for THC, but no significant change/association was noted for neonatal exposure to opioids. KEY POINTS · Prior studies have not examined neonatal exposure to opioids following marijuana legalization.. · Oklahoma's new law led to higher neonatal marijuana exposure.. · Legalization of medical marijuana did not change Oklahoma's neonatal opioid positivity rate..
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Affiliation(s)
- Lise DeShea
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Shanna Rolfs
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Mike McCoy
- OU Health, Comanche County Memorial Hospital, Neonatal Intensive Care Unit, Lawton, Oklahoma
| | - William H Beasley
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Edgardo Szyld
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Abhishek Makkar
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Anzalone AJ, Sun J, Vinson AJ, Beasley WH, Hillegass WB, Murray K, Hendricks BM, Haendel M, Geary CR, Bailey KL, Hanson CK, Miele L, Horswell R, McMurry JA, Porterfield JZ, Vest MT, Bunnell HT, Harper JR, Price BS, Santangelo SL, Rosen CJ, McClay JC, Hodder SL. Community risks for SARS-CoV-2 infection among fully vaccinated US adults by rurality: A retrospective cohort study from the National COVID Cohort Collaborative. PLoS One 2023; 18:e0279968. [PMID: 36603014 DOI: 10.1371/journal.pone.0279968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While COVID-19 vaccines reduce adverse outcomes, post-vaccination SARS-CoV-2 infection remains problematic. We sought to identify community factors impacting risk for breakthrough infections (BTI) among fully vaccinated persons by rurality. METHODS We conducted a retrospective cohort study of US adults sampled between January 1 and December 20, 2021, from the National COVID Cohort Collaborative (N3C). Using Kaplan-Meier and Cox-Proportional Hazards models adjusted for demographic differences and comorbid conditions, we assessed impact of rurality, county vaccine hesitancy, and county vaccination rates on risk of BTI over 180 days following two mRNA COVID-19 vaccinations between January 1 and September 21, 2021. Additionally, Cox Proportional Hazards models assessed the risk of infection among adults without documented vaccinations. We secondarily assessed the odds of hospitalization and adverse COVID-19 events based on vaccination status using multivariable logistic regression during the study period. RESULTS Our study population included 566,128 vaccinated and 1,724,546 adults without documented vaccination. Among vaccinated persons, rurality was associated with an increased risk of BTI (adjusted hazard ratio [aHR] 1.53, 95% confidence interval [CI] 1.42-1.64, for urban-adjacent rural and 1.65, 1.42-1.91, for nonurban-adjacent rural) compared to urban dwellers. Compared to low vaccine-hesitant counties, higher risks of BTI were associated with medium (1.07, 1.02-1.12) and high (1.33, 1.23-1.43) vaccine-hesitant counties. Compared to counties with high vaccination rates, a higher risk of BTI was associated with dwelling in counties with low vaccination rates (1.34, 1.27-1.43) but not medium vaccination rates (1.00, 0.95-1.07). Community factors were also associated with higher odds of SARS-CoV-2 infection among persons without a documented vaccination. Vaccinated persons with SARS-CoV-2 infection during the study period had significantly lower odds of hospitalization and adverse events across all geographic areas and community exposures. CONCLUSIONS Our findings suggest that community factors are associated with an increased risk of BTI, particularly in rural areas and counties with high vaccine hesitancy. Communities, such as those in rural and disproportionately vaccine hesitant areas, and certain groups at high risk for adverse breakthrough events, including immunosuppressed/compromised persons, should continue to receive public health focus, targeted interventions, and consistent guidance to help manage community spread as vaccination protection wanes.
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Affiliation(s)
| | - Jing Sun
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - William B Hillegass
- University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Kimberly Murray
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - Brian M Hendricks
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Melissa Haendel
- University of Colorado Anschutz Medical School, Aurora, CO, United States of America
| | - Carol Reynolds Geary
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Kristina L Bailey
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Corrine K Hanson
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Lucio Miele
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ronald Horswell
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Julie A McMurry
- Oregon State University, Corvallis, Oregon, United States of America
| | | | - Michael T Vest
- Christiana Care Health System, Newark, Delaware, United States of America
| | - H Timothy Bunnell
- Nemours Children's Health, Wilmington, Delaware, United States of America
| | - Jeremy R Harper
- Owl Health Networks, Indianapolis, Indiana, United States of America
| | - Bradley S Price
- West Virginia University, Morgantown, West Virginia, United States of America
| | - Susan L Santangelo
- Maine Health Institute for Research, Portland, Maine, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Clifford J Rosen
- Maine Health Institute for Research, Portland, Maine, United States of America
| | - James C McClay
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sally L Hodder
- West Virginia University, Morgantown, West Virginia, United States of America
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5
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Anzalone AJ, Horswell R, Hendricks BM, Chu S, Hillegass WB, Beasley WH, Harper JR, Kimble W, Rosen CJ, Miele L, McClay JC, Santangelo SL, Hodder SL. Higher hospitalization and mortality rates among SARS-CoV-2-infected persons in rural America. J Rural Health 2023; 39:39-54. [PMID: 35758856 PMCID: PMC9349606 DOI: 10.1111/jrh.12689] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Rural communities are among the most underserved and resource-scarce populations in the United States. However, there are limited data on COVID-19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS-CoV-2-infected persons stratified by residential rurality. METHODS This retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS-CoV-2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all-cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90-day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan-Meier survival estimates and mixed-effects logistic regression. FINDINGS Of 1,033,229 diagnosed COVID-19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban-adjacent and nonurban-adjacent rural dwellers with COVID-19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16-1.21 and aOR 1.29, CI 1.24-1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29-1.43 and 1.37, CI 1.26-1.50), respectively. All secondary outcomes were more likely among rural patients. CONCLUSIONS Hospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID-19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.
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Affiliation(s)
- Alfred Jerrod Anzalone
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Great Plains IDeA-CTR, Omaha, Nebraska, USA
| | - Ronald Horswell
- Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA
- LA CaTS Center, Baton Rouge, Louisiana, USA
| | - Brian M. Hendricks
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - San Chu
- Pennington Biomedical Research Centre, Baton Rouge, Louisiana, USA
- LA CaTS Center, Baton Rouge, Louisiana, USA
| | - William B. Hillegass
- University of Mississippi Medical Center, Jackson, Mississippi, USA
- Mississippi Center for Clinical and Translational Research, Jackson, Mississippi, USA
| | - William H. Beasley
- University of Oklahoma, Norman, Oklahoma, USA
- Oklahoma Clinical and Translational Science Institute, Oklahoma City, Oklahoma, USA
| | | | - Wesley Kimble
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
| | - Clifford J. Rosen
- Maine Medical Center Research Institute, Scarborough, Maine, USA
- Northern New England Clinical & Translational Research Network, Burlington, Vermont, USA
| | - Lucio Miele
- LA CaTS Center, Baton Rouge, Louisiana, USA
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - James C. McClay
- University of Nebraska Medical Center, Omaha, Nebraska, USA
- Great Plains IDeA-CTR, Omaha, Nebraska, USA
| | - Susan L. Santangelo
- Maine Medical Center Research Institute, Scarborough, Maine, USA
- Northern New England Clinical & Translational Research Network, Burlington, Vermont, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sally L. Hodder
- West Virginia University, Morgantown, West Virginia, USA
- West Virginia Clinical and Translational Sciences Institute, Morgantown, West Virginia, USA
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Sandhu T, DeShea L, Jagarapu J, Savani RC, Chuo J, Azzuqa A, Beasley WH, Hallford G, Makkar A. Multicenter study assessing physicians' and transport teams' attitudes and expectations about utilizing telemedicine to manage critical neonatal transports. J Telemed Telecare 2022:1357633X221104563. [PMID: 35765233 DOI: 10.1177/1357633x221104563] [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: 11/15/2022]
Abstract
BACKGROUND Managing critically ill neonates has unique challenges, and the transport team plays an important role in stabilizing and facilitating the transfer of these neonates from lower-level nurseries to tertiary centers, and the use of telemedicine in transport (tele-transport) can potentially benefit patient care. We conducted a multicenter study to assess the readiness for utilizing telemedicine as an adjunct to guide the care of critically ill neonates among physicians and transport team members (TTMs). This is the first multicenter study that explored physicians' and TTMs' perceptions of telemedicine usage and its value in neonatal transport. METHODS A confidential, voluntary survey on pre-implementation attitudes toward telemedicine usage during neonatal transport was conducted as part of a quality improvement initiative. This survey involved physicians and TTMs from four academic institutions whose responses were entered into an online survey using REDCap®. The survey inquired about satisfaction with the current practice of phone consultation and the perception of using telemedicine to optimize the management of neonates during transport. RESULTS The overall response rate for the survey was 60.1%; 82 of 127 (64.6%) physicians and 64 of 116 (55.2%) TTMs responded to the surveys. Half of the physicians and less than one-fourth of the TTMs had prior experience with telemedicine other than that used on neonatal transport. TTMs expressed greater concern about the inconvenience of video (55% vs. physicians 35% agree or strongly agree) and its time consumption (84% vs. physicians 50%). More than 70% of physicians and less than half of TTMs endorsed the potential for added value and quality improvement with video capability. Almost half of TTMs reported concern about video calls reducing their autonomy in patient care. Physicians expressed confidence in management decisions they would make after video calls (72% confident or very confident) and less confidence (49%) about both the phone assessment by TTMs and their decisions based on phone assessment. In contrast, TTMs were confident or very confident (94%) in both sharing their assessment over the phone and executing patient management after a phone call, compared with 70% for decisions made after video calls. CONCLUSIONS Physicians and TTMs had distinct opinions on the use of telemedicine during neonatal transport. Physicians were more likely than TTMs to agree with statements about the potential for improving quality of care, while TTMs were more likely than physicians to say video calls would be time-consuming and inconvenient. We speculate some differences may stem from the TTMs' concern about losing their autonomy. Therefore, during implementation, it is critical for physicians and TTMs to agree on a shared mental model of indications for telemedicine during transport and its value to the patient care.
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Affiliation(s)
- Tavleen Sandhu
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lise DeShea
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jawahar Jagarapu
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, TX, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, The University of Texas Southwestern Medical Center/Children's Medical Center, Dallas, TX, USA
| | - John Chuo
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, 12317University of Pittsburgh School of Medicine/UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - William H Beasley
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gene Hallford
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abhishek Makkar
- Division of Neonatal-Perinatal Medicine, The Department of Pediatrics, 6186The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Larcade R, DeShea L, Lang GA, Caballero MT, Ferretti A, Beasley WH, Tipple TE, Vain N, Prudent L, Lang ML, Polack F, Ofman G. Maternal-fetal immunologic response to SARS-CoV-2 infection in a symptomatic vulnerable population: A prospective cohort. J Infect Dis 2021; 225:800-809. [PMID: 34865064 DOI: 10.1093/infdis/jiab591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19 disproportionally affects pregnant women and their newborn, yet little is known about the variables that modulate the maternal-fetal immune response to infection. METHODS We prospectively studied socioeconomic, biologic and clinical factors affecting humoral immunity in 87 unvaccinated pregnant women admitted to hospital in the Buenos Aires metropolitan area for symptoms consistent with COVID-19 disease. RESULTS The number of days between symptom onset and childbirth predicted maternal and newborn virus Spike protein Receptor Binding Domain (RBD)-specific IgG. These findings suggest newborns may benefit less when mothers deliver soon after COVID-19 infection. Similarly, a longer time between symptom onset and birth predicted higher in utero transfer of maternal IgG and its concentration in cord blood. Older gestational ages at birth were associated with lower maternal IgG: cord blood IgG ratios. Eighty seven percent of women with confirmed SARS-CoV-2 infection developed RBD-specific IgA responses in breast milk within 96 h of childbirth. IgA was not significantly associated with time from infection but correlated with maternal serum IgG and placental transfer. CONCLUSIONS These results demonstrate the combined role of biologic, clinical and socioeconomic variables associated with maternal SARS-CoV-2 RBD-specific antibodies and supports early vaccination strategies for COVID-19 in socioeconomically vulnerable pregnant women.
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Affiliation(s)
| | - Lise DeShea
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Gillian A Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | - Mauricio T Caballero
- Fundación INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - William H Beasley
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | - Trent E Tipple
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA
| | | | | | - Mark L Lang
- The University of Oklahoma Health Sciences Center, Oklahoma City, USA, Department of Microbiology and Immunology, Oklahoma City; USA
| | | | - Gaston Ofman
- The University of Oklahoma Health Sciences Center, Department of Pediatrics, Oklahoma City, USA.,Fundación INFANT, Buenos Aires, Argentina
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Duggan EC, Piccinin AM, Clouston S, Koval AV, Robitaille A, Zammit AR, Wu C, Brown CL, Lee LO, Finkel D, Beasley WH, Kaye J, Terrera GM, Katz M, Lipton RB, Deeg D, Bennett DA, Praetorius Björk M, Johansson B, Spiro A, Weuve J, Hofer SM. A Multi-study Coordinated Meta-analysis of Pulmonary Function and Cognition in Aging. J Gerontol A Biol Sci Med Sci 2019; 74:1793-1804. [PMID: 30825374 PMCID: PMC6777093 DOI: 10.1093/gerona/glz057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing these findings has been limited by differences in measurements and samples, and by study design and statistical analyses confounding between-person differences with within-person changes. In this article, we conducted a coordinated analysis and summary meta-analysis of new results on the aging-related dynamics linking pulmonary function and cognitive performance. METHODS We performed coordinated analysis of bivariate growth models in data from 20,586 participants across eight longitudinal studies to examine individual differences in baseline level, rate of change, and occasion-specific variability in pulmonary and cognitive functioning. Results were summarized using meta-analysis. RESULTS We found consistent but weak baseline and longitudinal associations in levels of pulmonary and cognitive functioning, but no associations in occasion-specific variability. CONCLUSIONS Results provide limited evidence for a consistent link between simultaneous changes in pulmonary and cognitive function in a normal aging population. Further research is required to understand patterns of onset of decline and differences in rates of change within and across physical and cognitive functioning domains, both within-individuals and across countries and birth cohorts. Coordinated analysis provides an efficient and rigorous approach for replicating and comparing results across independent longitudinal studies.
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Affiliation(s)
- Emily C Duggan
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Andrea M Piccinin
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Sean Clouston
- Department of Family, Population and Preventive Medicine, Stony Brook University, New York
| | - Andriy V Koval
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Annie Robitaille
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Andrea R Zammit
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, China
| | - Cassandra L Brown
- Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Lewina O Lee
- Department of Psychiatry, Boston University School of Medicine, Massachusetts
| | - Deborah Finkel
- Department of Psychology, Indiana University Southeast, New Albany
| | - William H Beasley
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland
| | | | - Mindy Katz
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Richard B Lipton
- Saul B. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Dorly Deeg
- Department of Epidemiology and Biostatistics, VU University Medical Center and Amsterdam Public Health Research Institute, the Netherlands
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Marcus Praetorius Björk
- Department of Psychology and Centre for Ageing and Health, AgeCap, University of Gothenburg, Sweden
| | - Boo Johansson
- Department of Psychology and Centre for Ageing and Health, AgeCap, University of Gothenburg, Sweden
| | - Avron Spiro
- Department of Psychiatry, Boston University School of Medicine, Massachusetts
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Department of Veterans Affairs Boston Healthcare System
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Scott M Hofer
- Department of Psychology, University of Victoria, Victoria, BC, Canada
- Department of Neurology, Oregon Health & Science University, Portland
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Rodgers JL, Garrison SM, O'Keefe P, Bard DE, Hunter MD, Beasley WH, van den Oord EJCG. Responding to a 100-Year-Old Challenge from Fisher: A Biometrical Analysis of Adult Height in the NLSY Data Using Only Cousin Pairs. Behav Genet 2019; 49:444-454. [PMID: 31392459 DOI: 10.1007/s10519-019-09967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
In 1918, Fisher suggested that his research team had consistently found inflated cousin correlations. He also commented that because a cousin sample with minimal selection bias was not available the cause of the inflation could not be addressed, leaving this inflation as a challenge still to be solved. In the National Longitudinal Survey of Youth (the NLSY79, the NLSY97, and the NLSY-Children/Young Adult datasets), there are thousands of available cousin pairs. Those in the NLSYC/YA are obtained approximately without selection. In this paper, we address Fisher's challenge using these data. Further, we also evaluate the possibility of fitting ACE models using only cousin pairs, including full cousins, half-cousins, and quarter-cousins. To have any chance at success in such a restricted kinship domain requires an available and highly-reliable phenotype; we use adult height in our analysis. Results provide a possible answer to Fisher's challenge, and demonstrate the potential for using cousin pairs in a stand-alone analysis (as well as in combination with other biometrical designs).
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Koval AV, Beasley WH. Abstract: Exploring Crawford-Ferguson Family of Rotations Through an Interactive Visual System. Multivariate Behav Res 2014; 49:288-289. [PMID: 26735197 DOI: 10.1080/00273171.2014.912918] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Andrey V Koval
- a Department of Psychology and Human Development , Vanderbilt University
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11
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Uman MA, Beasley WH, Tiller JA, Lin YT, Krider EP, Weidmann CD, Krehbiel PR, Brook M, Few AA, Bohannon JL, Lennon CL, Poehler HA, Jafferis W, Gulick JR, Nicholson JR. An unusual lightning flash at kennedy space center. Science 2010; 201:9-16. [PMID: 17777737 DOI: 10.1126/science.201.4350.9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A lightning flash that struck the 150-meter weather tower at Kennedy Space Center was studied by several research groups using varioul techniques. The flash had unusually large peak currents and a stepped leader of relatively short duration. The charged regions neutralized by the three return strokes were located within a horizontal layer between heights of about 6 and 8 kilometers, where environmental temperatures were about -10 degrees to -20 degrees C. The charge source for the first return stroke coincided with a vertical shaft of precipitation inferred to have been graupel or hail. Charge sources for subsequent strokes were near the edge of the detectable precipitation echo. The overall channel length was about 10 kilometers. A Vertically oriented intracloud discharge occurred after the three return strokes.
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Johnson DR, Beasley WH, Bard DE. Abstract: A Multi-Level Model of Individual Differences in Speed/Accuracy Tradeoff (SATin). Multivariate Behav Res 2008; 43:654-655. [PMID: 26771431 DOI: 10.1080/00273170802640475] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Individuals performing an experimental cognitive task have a choice whether to favor accuracy, speed, or weight them both equally. Models of speed/ accuracy tradeoff have been proposed in the assessment literature ( van der Linden, 2007 ) and experimental literature ( Ratcliff & Rouder, 1998 ). However, these models do not estimate individual differences in choice of speed/ accuracy tradeoff at between- and within-subjects levels. The top of Figure 1 presents the equations and path diagram for the SATin model. Individual differences in speed/ accuracy tradeoff will be modeled at two levels with, 1) variability in Tradeoff (between-subject level, Level 2) and 2) variability in c (within-subject level, Level 1). An individual's Tradeoff factor score represents the individual's distributional position relative to others regarding whether they favor speed (values < 0), accuracy (values > 0), or neither (value = 0). A negative c indicates that the individual is trading off speed and accuracy for these particular trials, whereas a positive and zero c indicate the individual is not trading off. [Figure: see text] Panels 1 and 2 illustrate Simpson's paradox, where speed/ accuracy tradeoff occurs in opposing directions at between- and within-subject levels. This highlights the need for a multi-level model as the researcher would draw opposing conclusions by observing only one of these levels. Simulations studies compared the SATin model to a popular model in cognitive psychology that uses speed alone to estimate ability. SATin outperformed this model by accounting for substantially more variance in actual ability.
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Gallagher FW, Beasley WH. Evaluation of a one-dimensional cloud model for yellow and green thunderstorms. Appl Opt 2003; 42:505-510. [PMID: 12570273 DOI: 10.1364/ao.42.000505] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many observers have reported observations of green light emanating from severe thunderstorms in the midwestern United States. Spectral measurements have demonstrated that the dominant wavelength of the light is in the green portion of the visible spectrum and that this is not just a subjective impression. According to the theory proposed by Bohren and Fraser [Bull. Am. Meteorol. Soc. 74, 2185 (1993)], two effects combine to produce green light from thunderstorms. First, incident solar radiation is reddened by selective scattering by air molecules and particles in the atmosphere before it enters the cloud. Second, the radiation that passes through an optically thick cloud is attenuated in the longer wavelengths because of selective absorption by liquid water. Model calculations indicate that realizable combinations of mean drop diameters, mean liquid-water contents, and cloud thicknesses can satisfy the conditions required for shifting the dominant wavelength of the incident solar radiation to green.
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Affiliation(s)
- Frank W Gallagher
- School of Meteorology, University of Oklahoma, Norman, Oklahoma 73019, USA.
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14
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Abstract
Observations of the spectrum of light from thunderstorms indicate that the radiance amplitude of the near-IR portion of the spectrum is often relatively greater in comparison with the amplitude of the radiance of the visible portion of the spectrum than it is in the spectrum of solar radiation at the surface. Observational data suggest that two mechanisms may cause this effect. The first is the reduction in the shorter wavelengths due to selective scattering, and the second is selective reflection from foliage.
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Affiliation(s)
- Frank W Gallagher
- School of Meteorology, University of Oklahoma, Norman, Oklahoma 73019, USA.
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15
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Eack KB, Beasley WH, Rust WD, Marshall TC, Stolzenburg M. Initial results from simultaneous observation of X-rays and electric fields in a thunderstorm. ACTA ACUST UNITED AC 1996. [DOI: 10.1029/96jd01705] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
The anterior descending coronary artery was obtained from each of 160 subjects aged 2 to 30 years who died suddenly. The arteries were examined for early atheromatous changes and the mothers were asked about the way the children had been fed during early infancy. No evidence was found for the hypothesis that breast feeding confers protection against coronary artery disease. The mothers' smoking history at the time of the birth bore no relationship to the pathological findings in the arteries. It therefore seems unlikely that the type of feeding in infancy, or maternal smoking during pregnancy, are factors influencing the risk of coronary disease.
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Williams GF, Beasley WH. Points: The oesophageal obturator airway. West J Med 1981. [DOI: 10.1136/bmj.282.6260.322-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In a study of myocardial magnesium and calcium levels in 1236 samples of heart muscle taken at necropsy in 28 centres in England and Wales, samples from patients who died from ischaemic heart disease had a mean Mg level 23 microgram/g lower and a mean Ca level 4 microgram/g higher than the mean for the total series after allowance had been made for a number of relevant factors. Mg levels were slightly higher and Ca levels slightly lower in sudden than in lingering deaths. There was no evidence of any association between the tissue levels and the levels of Mg or Ca in domestic tap-water, but there was a weak association between mean tissue Mg level and IHD mortality rates in the various towns.
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20
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Ahmed W, Beasley WH. Carcinoma of stomach with a metastasis in the clitoris. J Pak Med Assoc 1979; 29:62-3. [PMID: 107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Thompson J, Jones DD, Beasley WH. The effect of metal ions on the activity of delta-aminolevulinic acid dehydratase. Br J Ind Med 1977; 34:32-36. [PMID: 843461 PMCID: PMC1008169 DOI: 10.1136/oem.34.1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The effects of lead, iron, copper, and zinc ions on delta-aminolevulinic acid dehydratase from red blood cell haemolysates in humans, both in the absence and presence of plasma proteins, have been investigated. delta-aminolevulinic acid dehydratase (ALAD) was not found to be a specific indicator of blood lead concentrations since it was also inhibited by copper and activated by zinc. Plasma protein protected the enzyme from both inhibition and activation. ALAD activity was found to be an indicator of the total metal ion concentration in the blood and was therefore considered to be of doubtful value in screening large populations for increased lead absorption.
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Abstract
In a study of the blood lead levels of 626 healthy blood donors no differences were found between men and women, but there was a significant increase with age. Resident donors had a higher blood lead than students, and the level in residents increased with living in the Aberystwyth area up to about 20 years. The levels in the students did not increase with residence in Aberystwyth. No differences were found in the blood lead of donors living in different wards of Aberystwyth and none between the blood lead of donors living in the rural area and those in the town. Almost half of the local resident donors had a level above the "normal" range.
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23
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Williams GF, Beasley WH, Fisher CB. Safe resuscitation at birth. Lancet 1973; 2:211 passim. [PMID: 4124297 DOI: 10.1016/s0140-6736(73)93053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25
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