1
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Langhan ML, Boyer DL, Hsu D, Moffatt ME, Pitts SA, Atlas MP, Aye T, Chess P, Curran ML, Czaja AS, Dammann CEL, Fussell J, George RP, Herman BE, High P, James SH, Kamin DS, Karnik R, Kesselheim J, Lopez MA, Mahan JD, McFadden V, McGann KA, Mehta JJ, Rama J, Robinson BW, Sauer C, Stafford DEJ, Turner DA, Weiss P, Yussman SM, Schwartz A, Mink R. Implementing Entrustable Professional Activities in Pediatric Fellowships: Facilitating the Process. Pediatrics 2024:e2023065024. [PMID: 38757175 DOI: 10.1542/peds.2023-065024] [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] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Entrustable professional activities (EPAs) will be used for initial certification by the American Board of Pediatrics by 2028. Less than half of pediatric fellowships currently use EPAs for assessment, yet all will need to adopt them. Our objectives were to identify facilitators and barriers to the implementation of EPAs to assess pediatric fellows and to determine fellowship program directors' (FPD) perceptions of EPAs and Milestones. METHODS We conducted a survey of FPDs from 15 pediatric subspecialties. EPA users were asked about their implementation of EPAs, barriers encountered, and perceptions of EPAs. Nonusers were queried about deterrents to using EPAs. Both groups were asked about potential facilitators of implementation and their perceptions of Milestones. RESULTS The response rate was 65% (575/883). Of these, 344 (59.8%) were EPA users and 231 (40.2%) were nonusers. Both groups indicated work burden as a barrier to implementation. Nonusers reported more barriers than users (mean [SD]: 7 [3.8] vs 5.8 [3.4], P < .001). Both groups identified training materials and premade assessment forms as facilitators to implementation. Users felt that EPAs were easier to understand than Milestones (89%) and better reflected what it meant to be a practicing subspecialty physician (90%). In contrast, nonusers felt that Milestones were easy to understand (57%) and reflected what it meant to be a practicing subspecialist (58%). CONCLUSIONS Implementing EPA-based assessment will require a substantial investment by FPDs, facilitated by guidance and easily accessible resources provided by multiple organizations. Perceived barriers to be addressed include FPD time constraints, a need for additional assessment tools, and outcomes data.
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Affiliation(s)
| | - Donald L Boyer
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah Hsu
- Stanford University School of Medicine, Stanford, California
| | - Mary E Moffatt
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Sarah A Pitts
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark P Atlas
- Zucker School of Medicine at Hofstra-Northwell, Cohen Children's Medical Center, Queens, New York
| | - Tandy Aye
- Stanford University School of Medicine, Stanford, California
| | - Patricia Chess
- University of Rochester Medical Center, Rochester, New York
| | - Megan L Curran
- University of Colorado School of Medicine, Aurora, Colorado
| | - Angela S Czaja
- University of Colorado School of Medicine, Aurora, Colorado
| | | | - Jill Fussell
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Roshan P George
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Pamela High
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Scott H James
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel S Kamin
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ruchika Karnik
- Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Kesselheim
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle A Lopez
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - John D Mahan
- The Ohio State University College of Medicine, Columbus, Ohio
| | | | | | - Jay J Mehta
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Rama
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Bradley W Robinson
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cary Sauer
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - David A Turner
- American Board of Pediatrics, Chapel Hill, North Carolina
| | - Pnina Weiss
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, Illinois; and
| | - Richard Mink
- Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation, Torrance, California
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Chiel LE, Stevens EL, Bishay LC, Collins MS, Rama JA, Edgar L, McLean S, Haynes I, Muzumdar H, Weiss P, Boyer D, Giles BL. Pediatric Pulmonary Milestones 2.0: Development, Lessons Learned, and Future Directions. ATS Sch 2024; 5:19-31. [PMID: 38628297 PMCID: PMC11019770 DOI: 10.34197/ats-scholar.2023-0075ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/05/2023] [Indexed: 04/19/2024] Open
Abstract
Pediatric pulmonology fellowship training programs are required by the Accreditation Council for Graduate Medical Education to report Pediatric Subspecialty Milestones biannually to track fellow progress. However, several issues, such as lack of subspecialty-specific context and ambiguous language, have raised concerns about their validity and applicability to use for fellow assessment and curriculum development. In this Perspective, we briefly share the process of the Pediatric Pulmonology Milestones 2.0 Work Group in creating new specialty-specific Milestones and tailoring information on the Harmonized Milestones to pediatric pulmonologists, with the goal of improving the Milestones' utility for stakeholders, including pulmonology fellows, faculty, program directors, and accrediting bodies. In addition, we created a supplemental guide to better link the Milestones to pulmonary-specific scenarios to create a shared mental model between stakeholders and remove a potential detriment to validity. Through the process, a number of guiding principles were clarified, including: 1) every Milestone should be able to be assessed independently, without overlap with other Milestones; 2) there should be clear developmental progression from one Milestone to the next; 3) Milestones should be based on the unique skills expected of pediatric pulmonologists; and 4) health equity should be a core component to highlight as a top priority to all stakeholders. In this Perspective, we describe these principles that guided formulation of the Pediatric Pulmonary Milestones to help familiarize the pediatric pulmonary community with the new Milestones. In addition, we share lessons learned and challenges in our process to inform other specialties that may soon participate in this process.
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Affiliation(s)
- Laura E. Chiel
- Division of Pulmonary Medicine, Department
of Pediatrics, Boston Children’s Hospital, Harvard Medical School,
Boston, Massachusetts
| | - Erica L. Stevens
- Division of Pulmonology, Allergy, and
Immunology, Department of Pediatrics, Norton Children’s Hospital,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Lara C. Bishay
- Division of Pulmonology and Sleep
Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Keck
School of Medicine of University of Southern California, Los Angeles,
California
| | - Melanie S. Collins
- Division of Pediatric Pulmonary Medicine,
Department of Pediatrics, Connecticut Children’s Hospital, University of
Connecticut School of Medicine, Harford, Connecticut
| | - Jennifer A. Rama
- Division of Pediatric Pulmonology,
Department of Pediatrics, Texas Children’s Hospital, Baylor College of
Medicine, Houston, Texas
| | - Laura Edgar
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Sydney McLean
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Ida Haynes
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Hiren Muzumdar
- Division of Pulmonology, Department of
Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Pnina Weiss
- Division of Pulmonary, Allergy,
Immunology, and Sleep Medicine, Department of Pediatrics, Yale Medicine, New
Haven, Connecticut
| | - Debra Boyer
- Division of Pulmonary and Sleep Medicine,
Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State
University College of Medicine, Columbus, Ohio; and
| | - B. Louise Giles
- Division of Pediatric Pulmonology,
Department of Pediatrics, Comer Children’s Hospital, University of
Chicago School of Medicine, Chicago, Illinois
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Czaja AS, Mink RB, Herman BE, Weiss P, Turner DA, Curran ML, Stafford DEJ, Myers AL, Langhan ML. Exploring Factors for Implementation of EPAs in Pediatric Subspecialty Fellowships: A Qualitative Study of Program Directors. J Med Educ Curric Dev 2024; 11:23821205231225011. [PMID: 38268726 PMCID: PMC10807342 DOI: 10.1177/23821205231225011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To understand fellowship program directors' (FPDs) perspectives on facilitators and barriers to using entrustable professional activities (EPAs) in pediatric subspecialty training. METHODS We performed a qualitative study of FPDs, balancing subspecialty, program size, geographic region and current uses of EPAs. A study coordinator conducted 1-on-1 interviews using a semistructured approach to explore EPA use or nonuse and factors supporting or preventing their use. Investigators independently coded transcribed interviews using an inductive approach and the constant comparative method. Group discussion informed code structure development and refinement. Iterative data collection and analysis continued until theoretical sufficiency was achieved, yielding a thematic analysis. RESULTS Twenty-eight FPDs representing 11 pediatric subspecialties were interviewed, of whom 16 (57%) reported current EPA use. Five major themes emerged: (1) facilitators including the intuitive nature and simple wording of EPAs; (2) barriers such as workload burden and lack of a regulatory requirement; (2) variable knowledge and training surrounding EPAs, leading to differing levels of understanding; (3) limited current use of EPAs, even among self-reported users; and (4) complementary nature of EPAs and milestones. FPDs acknowledged the differing strengths of both EPAs and milestones but sought additional knowledge about the value added by EPAs for assessing trainees, including the impact on outcomes. CONCLUSIONS Identified themes can inform effective and meaningful EPA implementation strategies: Supporting and educating FPDs, ongoing assessment of the value of EPAs in training, and practical integration with current workflow. Generating additional data and engaging stakeholders is critical for successful implementation for the pediatric subspecialties.
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Affiliation(s)
- Angela S. Czaja
- Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard B. Mink
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bruce E. Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Megan L. Curran
- Department of Pediatrics, Section of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane E. J. Stafford
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Angela L. Myers
- Department of Pediatrics, Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Melissa L. Langhan
- Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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4
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Phatak UP, Encandela J, Green M, Slade M, Osborn R, Weiss P. Feedback Culture Perceived by Trainees in an Academic Institution: A Mixed Methods Study. Hosp Pediatr 2023; 13:984-991. [PMID: 37791431 DOI: 10.1542/hpeds.2022-007004] [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: 10/05/2023]
Abstract
OBJECTIVES Lack of a well-functioning institutional feedback culture can undermine acquisition of skills essential for high quality patient care. The objective of this study was to assess feedback culture perceived by resident and fellow trainees, utilizing a mixed methods design. METHODS Pediatric fellows and residents completed an anonymous feedback environment survey consisting of 7 constructs: source credibility, feedback quality, feedback delivery, reinforcing feedback, constructive feedback, source availability, and promotion of feedback seeking, using a 7-point Likert scale. Trainee ratings were compared using two-sided Fisher's exact tests. Multivariable analyses used a linear regression model. For the qualitative study, semistructured interviews of residents were conducted. The constant comparative method was used to incrementally code, categorize data, and derive themes. RESULTS Fifty-two residents and 21 fellows completed the survey (response rates 65% and 47%, respectively). Scores were more favorable for fellows compared with residents in 6 of 7 feedback constructs (P < .05), including on multivariate analysis. Hispanic ethnicity and female gender were associated with lower scores on source credibility (P = .04) and constructive feedback (P = .03), respectively. Two qualitative themes were identified: expectation of efficiency in patient care compromises the quality and quantity of feedback, and a culture that prioritizes courtesy over candor negatively impacts feedback quality. These themes were more pronounced when residents worked with pediatric subspecialists compared with hospitalists. CONCLUSIONS We described the feedback culture, which was less favorable in the residency program. The need for efficient patient care and a culture of courtesy adversely impacted the quality of feedback, especially among subspecialists.
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Affiliation(s)
- Uma Padhye Phatak
- Yale School of Medicine
- Department of Pediatrics
- Pediatric Gastroenterology, Hepatology and Nutrition
| | - John Encandela
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Michael Green
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
- Divisions of General Medicine, Department of Internal Medicine
| | - Martin Slade
- Yale School of Medicine
- Yale Teaching and Learning Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Rachel Osborn
- Yale School of Medicine
- Department of Pediatrics
- Hospital Medicine
| | - Pnina Weiss
- Yale School of Medicine
- Department of Pediatrics
- Pulmonology, Allergy, Immunology, and Sleep Medicine
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5
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Ostfeld-Johns S, Leverette D, Dioneda B, Malcolm J, Crittenden F, Carr C, Taylor A, Amaya K, Weiss P, Grossman M, Berkwitt A. Improving Diversity, Equity, and Inclusion Content in Pediatrics Grand Rounds. Acad Pediatr 2023; 23:1502-1504. [PMID: 37321407 DOI: 10.1016/j.acap.2023.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Sharon Ostfeld-Johns
- From the Department of Pediatrics, Section of Hospital Medicine, Yale School of Medicine, New Haven, CT (S Ostfeld-Johns, M Grossman, and A Berkwitt); Department of Internal Medicine, Section of General Internal Medicine Program in Hospital Medicine, Yale School of Medicine, New Haven, CT (S Ostfeld-Johns).
| | - Desiree Leverette
- Pediatrics Residency Program, Yale School of Medicine, New Haven, CT (D Leverette, B Dioneda, J Malcolm, F Crittenden, and C Carr)
| | - Brittany Dioneda
- Pediatrics Residency Program, Yale School of Medicine, New Haven, CT (D Leverette, B Dioneda, J Malcolm, F Crittenden, and C Carr)
| | - Jessica Malcolm
- Pediatrics Residency Program, Yale School of Medicine, New Haven, CT (D Leverette, B Dioneda, J Malcolm, F Crittenden, and C Carr)
| | - Faith Crittenden
- Pediatrics Residency Program, Yale School of Medicine, New Haven, CT (D Leverette, B Dioneda, J Malcolm, F Crittenden, and C Carr)
| | - Chanelle Carr
- Pediatrics Residency Program, Yale School of Medicine, New Haven, CT (D Leverette, B Dioneda, J Malcolm, F Crittenden, and C Carr)
| | - Andrew Taylor
- Department of Pediatrics - Section of Education Administrative Offices, Yale School of Medicine, New Haven, CT (A Taylor)
| | - Karina Amaya
- Department of Pediatrics - Section of Education Administrative Offices, Yale School of Medicine, New Haven, CT (A Taylor)
| | - Pnina Weiss
- and the Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale School of Medicine, New Haven, CT (P Weiss)
| | - Matthew Grossman
- From the Department of Pediatrics, Section of Hospital Medicine, Yale School of Medicine, New Haven, CT (S Ostfeld-Johns, M Grossman, and A Berkwitt)
| | - Adam Berkwitt
- From the Department of Pediatrics, Section of Hospital Medicine, Yale School of Medicine, New Haven, CT (S Ostfeld-Johns, M Grossman, and A Berkwitt)
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6
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Mink RB, Carraccio CL, Herman BE, Weiss P, Turner DA, Stafford DEJ, McGann KA, Kesselheim J, Hsu DC, High PC, Fussell JJ, Curran ML, Chess PR, Sauer C, Pitts S, Myers AL, Mahan JD, Dammann CEL, Aye T, Schwartz A. Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment. BMC Med Educ 2023; 23:720. [PMID: 37789289 PMCID: PMC10548580 DOI: 10.1186/s12909-023-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.
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Affiliation(s)
- Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
| | | | - Bruce E Herman
- University of Utah School of Medicine, Salt Lake, UT, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Diane E J Stafford
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Pamela C High
- Alpert Medical School of Brown University, Providence, RI, USA
- Developmental-Behavioral Pediatrics, Hasbro Children's Hospital, Providence, RI, USA
| | - Jill J Fussell
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Cary Sauer
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Angela L Myers
- Center for Wellbeing, Children's Mercy Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Tandy Aye
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Alan Schwartz
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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7
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Weiss P. Recruitment into Pediatric Pulmonary Fellowship Programs: The Bigger the Better? ATS Sch 2023; 4:250-253. [PMID: 37795113 PMCID: PMC10547034 DOI: 10.34197/ats-scholar.2023-0091ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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8
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Langhan ML, Stafford DEJ, Myers AL, Herman BE, Curran ML, Czaja AS, Turner DA, Weiss P, Mink R. Clinical competency committee perceptions of entrustable professional activities and their value in assessing fellows: A qualitative study of pediatric subspecialty program directors. Med Teach 2023; 45:650-657. [PMID: 36420760 DOI: 10.1080/0142159x.2022.2147054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To examine the composition and processes of Clinical Competency Committees (CCCs) assigning entrustable professional activity (EPA) levels of supervision for pediatric subspecialty fellows and to examine fellowship program director (FPD) perspectives about using EPAs to determine fellows' graduation readiness. METHODS A qualitative study was performed using one-on-one interviews with a purposeful sample of pediatric subspecialty FPDs to yield a thematic analysis. Semi-structured interview guides were used for participants who self-identified as EPA users or non-users. Inductive analysis and coding were performed on transcripts until theoretical sufficiency was attained. RESULTS Twenty-eight FPDs were interviewed. There was significant variability in the composition and processes of CCCs across subspecialties. FPDs felt that CCCs intuitively understand what entrustment means, allowing for ease of application of level of supervision (LOS) scales and consensus. FPDs perceived that EPAs provided a global assessment of fellows and are one tool to determine graduation readiness. CONCLUSIONS Although there was variability in the makeup and processes of CCCs across subspecialties, FPDs believe EPAs are intuitive and relatively easy to implement. Consensus can be reached easily using EPA-specific LOS scales focusing on entrustment. FPDs desire a better understanding of how EPAs should be used for graduation.
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Affiliation(s)
- Melissa L Langhan
- Department of Pediatrics and Emergency Medicine, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Diane E J Stafford
- Department of Pediatrics, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela L Myers
- Department of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Megan L Curran
- Department of Pediatrics, Section of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angela S Czaja
- Department of Pediatrics, Section of Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Pnina Weiss
- Department of Pediatrics, Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richard Mink
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
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10
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Myers AL, Fussell JJ, Moffatt ME, Boyer D, Ross R, Dammann CEL, Degnon L, Weiss P, Sauer C, Vinci RJ. The Importance of Subspecialty Pediatricians to the Health and Wellbeing of the Nation's Children. J Pediatr 2023:13365. [PMID: 36894130 DOI: 10.1016/j.jpeds.2023.02.011] [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] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
Through this review of published literature, it is clear that children benefit in measurable ways when they receive care from trained pediatric subspecialists. The improved outcomes provided by pediatric subspecialists supports the care provided in the patient's pediatric medical home and emphasizes the importance of care coordination between all components of the pediatric workforce. The AAP highlights this in a recent policy statement by stating the care provided by pediatric clinicians "encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care" Explicit in this statement is the emphasis on the role of complex care coordination between pediatric specialist and primary care pediatricians and that collaboration and guidance by the pediatrician is central to providing optimal care of patients. 65 Improving health outcomes early in life is an important public health strategy for modifying the complications from childhood chronic disease and highlights the role of pediatricians in mitigating the long-term consequences of antecedents of adult disease. 66 The recent announcement of the National Academies of Science, Engineering, and Medicine (NASEM)'s plan for a Consensus Study on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-being is a related and exciting development, on a national scale. 67 In response to shortages and geographic maldistributions of pediatric subspecialists, the NASEM committee intends to assess the impact of current pediatric clinical workforce trends on child health and well-being, in order to develop informed strategies to ensure an adequate, high-quality pediatric workforce, with a robust research portfolio that informs those recommendations. While this large, national initiative will surely lead to a better understanding of and strategies to implement across the pediatric subspecialty workforce, more well-designed studies that specifically measure child outcomes related to access to pediatric subspecialty care, would add meaningfully to the body of pediatric literature and to our national pediatric advocacy initiatives.
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Affiliation(s)
- Angela L Myers
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Jill J Fussell
- Professor, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR
| | - Mary E Moffatt
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Debra Boyer
- DIO/Chief Medical Education Officer, Professor of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Robert Ross
- Children's Hospital of Michigan, Professor of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | | | | | - Pnina Weiss
- Professor of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Cary Sauer
- Professor of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert J Vinci
- Professor of Pediatrics, Boston University School of Medicine, Boston, MA
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11
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Oermann CM, Lahiri T, Peterson-Carmichael SL, Weiss P. The history of workforce concerns in pediatric pulmonary Medicine. Pediatr Pulmonol 2023; 58:683-689. [PMID: 32986316 DOI: 10.1002/ppul.25094] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022]
Abstract
Children are affected by a broad spectrum of acute and chronic respiratory disorders. The number of children with respiratory disease is increasing, as are the complexity of disease pathophysiology and the management demands on pediatric pulmonologists. Despite slowly increasing numbers of board-certified pediatric pulmonologists, large areas of the country are underserved and there is a perception of an impending workforce crisis. There are multiple reasons for these concerns. A joint effort between the Pediatric Pulmonology Division Directors Association and Pediatric Pulmonary Training Directors Association was undertaken to address these issues.
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Affiliation(s)
- Christopher M Oermann
- Department of Pediatrics, Kansas City School of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Thomas Lahiri
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | | | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Esther CR, Oermann CM, Ross KR, Weiss P. An assessment of fellowship training issues affecting the pediatric pulmonary medicine workforce. Pediatr Pulmonol 2023; 58:665-669. [PMID: 33497527 DOI: 10.1002/ppul.25256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/11/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Charles R Esther
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Kristie R Ross
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Halimi F, Sabouret P, Huberman JP, Cohen S, Ouazana L, Hoffman O, Assouline S, Guedj-Meynier D, Schwartz J, Weiss P, Lafont C, Lellouche N. Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.
Purpose
We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.
Methods
Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women >2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.
Results
Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.
Conclusions
The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women >2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS
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Affiliation(s)
- F Halimi
- Private Hopital of Parly II, Rythmology , Le Chesnay , France
| | - P Sabouret
- Hospital Pitie-Salpetriere , Paris , France
| | - J P Huberman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Cohen
- National College of French Cardiologists, Cardiology , Paris , France
| | - L Ouazana
- National College of French Cardiologists, Cardiology , Paris , France
| | - O Hoffman
- National College of French Cardiologists, Cardiology , Paris , France
| | - S Assouline
- National College of French Cardiologists, Cardiology , Paris , France
| | - D Guedj-Meynier
- National College of French Cardiologists, Cardiology , Paris , France
| | - J Schwartz
- National College of French Cardiologists, Cardiology , Paris , France
| | - P Weiss
- National College of French Cardiologists, Cardiology , Paris , France
| | - C Lafont
- University Hospital Henri Mondor, Public Health , Creteil , France
| | - N Lellouche
- University Hospital Henri Mondor, Rythmology Department , Creteil , France
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Völp D, Weiss P. Digital transformation and sustainability in process manufacturing. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255410] [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: 11/11/2022]
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Kochhar R, Geer J, Guandalini C, Weiss P. 0846 Severe OSA in a 17yr old patient with Prader Willi Syndrome and poorly controlled Diabetes Mellitus. Sleep 2022. [DOI: 10.1093/sleep/zsac079.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Prader Willi Syndrome (PWS), while rare, is the most common genetic cause of obesity. It is caused by a functional loss of paternally expressed genes from chromosomal region 15q11-13. PWS is characterized by short stature, neurodevelopmental delay, obsessive-compulsive behaviors, hypothalamic dysfunction, and hyperphagia, associated with an aberrant satiety response and elevated levels of ghrelin. Excessive daytime sleepiness (EDS) and sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea, are common.
Report of Cases: A 17-year-old male, with PWS, morbid obesity, autism, and diabetes mellitus (DM) type-2 was referred for evaluation of snoring and EDS (Epworth Sleepiness Score 16). He had recently been admitted with diabetic ketoacidosis associated with binge eating. He had no prior sleep testing. He denied sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy. He had a body mass index of 54 kg/m2 with short stature (1.6m). On exam, he had a Mallampati score of 4 and 1+ tonsils. A recent echocardiogram was normal. Polysomnography showed sleep latency of 10 mins, apnea-hypopnea index (AHI) of 148/hr, nadir oxygen saturation of 73%, with 45% of total sleep time < 90%. Hypoventilation was not present. He was prescribed auto-titrating positive airway pressure (PAP) therapy. His mother was instructed to start locking access to food again. He was treated with insulin and metformin, with a plan to start on a glucagon-like peptide-1 (GLP-1) agonist. He had been on growth hormone (GH) previously, but in the context of his other morbidities, it was not reinitiated.
Conclusion
It is critical to screen and monitor patients with PWS for OSA, as SDB occurs in almost 70%. While PAP therapy may improve OSA, there is often residual EDS (likely due to underlying hypothalamic dysfunction), and alerting agents may be needed. GH can be considered for short stature but is contraindicated in patients with morbid obesity, untreated severe OSA, and uncontrolled diabetes. Management of diabetes, obesity, and hyperphagia in patients with PWS is challenging. Supervision and strict limitation of food intake using physical barriers are important. While data are limited, GLP-1 agonists may provide potential benefits for weight, glycemic, and appetite control in patients with PWS.
Support (If Any)
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Weiss P, Rama J, Gerber LM, Qiu Y, Li STT, Duncan JG, Naifeh MM, Stevenson MD, Mauer E, Abramson EL. Scholarly activity training in pediatric pulmonology fellowship programs. Pediatr Pulmonol 2022; 57:982-990. [PMID: 35018735 DOI: 10.1002/ppul.25815] [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: 09/23/2021] [Revised: 12/12/2021] [Accepted: 01/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Scholarly activity training is a required component of pediatric pulmonology fellowship programs. However, there are no data on resources and barriers to training and factors associated with fellow productivity. METHODS We surveyed US pediatric pulmonology fellowship program directors (FPDs) between March and October 2019. Our primary outcome was fellow productivity (>75% of fellows in the past 5 years had a manuscript accepted in a peer-reviewed journal). Analyses included descriptive statistics, χ2 and Fisher's exact tests for categorical values, and t-test or Wilcoxon rank-sum test for numerical values. RESULTS Sixty-one percent (33/54) of FPDs completed the survey. Seventy-nine percent reported that most fellows completed clinical, basic science, or translational research. However, only 21% reported that most fellows pursued research positions after graduation; academic clinical positions were more common. For 21%, lack of funding and competing clinical responsibilities were barriers to completing the scholarly activity. Only 39% had highly productive programs; those FPDs were more likely to be highly satisfied with fellow scholarly activity products (p = 0.049) and have >6 publications in the previous 3 years (p = 0.03). Fifty-two percent of FPDs believed that pediatric pulmonary training should be shortened to 2 years for those pursuing clinical or clinician-educator careers. CONCLUSIONS Barriers to scholarly activity training in pediatric pulmonology programs threaten the pipeline of academic pediatric pulmonologists and physician-investigators. Aligning fellow scholarly activity and clinical training with the skills required in their postgraduate positions could optimize the utilization of limited resources and better support career development.
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Affiliation(s)
- Pnina Weiss
- Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rama
- Section of Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Linda M Gerber
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Yuqing Qiu
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Su-Ting T Li
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jennifer G Duncan
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Monique M Naifeh
- Section of Hospital Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michelle D Stevenson
- Division of Emergency Medicine, Department of Pediatrics, Norton Children's and University of Louisville, Louisville, Kentucky, USA
| | - Elizabeth Mauer
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erika L Abramson
- Division of General Pediatrics, Department of Pediatrics and Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Burns AM, Moore DJ, Forster CS, Powell W, Thammasitboon S, Hostetter MK, Weiss P, Boyer D, Ward MA, Blankenburg R, Heyman MB, Rassbach CE, McPhillips H, French A, Nguyen S, Byrne BJ, Parsons DW, Gonzalez F, Nowalk AJ, Ho J, Kumar S, Orange JS, Ackerman KG. Physician-Scientist Training and Programming in Pediatric Residency Programs: A National Survey. J Pediatr 2022; 241:5-9.e3. [PMID: 34280401 DOI: 10.1016/j.jpeds.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Audrea M Burns
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
| | - Daniel J Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Ian Burr Division of Pediatric Endocrinology and Diabetes, Nashville, TN
| | - Catherine S Forster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Weston Powell
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Satid Thammasitboon
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mark A Ward
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Melvin B Heyman
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA
| | - Heather McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Anthony French
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Suong Nguyen
- Department of Pediatrics, Washington University Medical Center, St. Louis Children's Hospital, St Louis, MO
| | - Bobbi J Byrne
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN
| | - Donald Williams Parsons
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Fernando Gonzalez
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA
| | - Andrew J Nowalk
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jacqueline Ho
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Shelley Kumar
- Center for Research Innovation and Scholarship in Medical Education, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Jordan S Orange
- Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, Vagelos College of Physicians and Surgeons, New York, NY
| | - Kate G Ackerman
- Department of Pediatrics, University of Rochester/UR Medicine Golisano Children's Hospital, Rochester, NY
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Hatfield M, Ciaburri R, Shaikh H, Wilkins KM, Bjorkman K, Goldenberg M, McCollum S, Shabanova V, Weiss P. Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event. Hosp Pediatr 2022; 12:181-190. [PMID: 35102377 DOI: 10.1542/hpeds.2021-006267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/14/2023]
Abstract
OBJECTIVE Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.
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Affiliation(s)
| | | | - Henna Shaikh
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | | | - Kurt Bjorkman
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | | | - Sarah McCollum
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Pnina Weiss
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
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21
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Herregods N, Maksymowych WP, Jans L, Otobo TM, Sudoł-Szopińska I, Meyers AB, Van Rossum M, Kirkhus E, Panwar J, Appenzeller S, Weiss P, Tse S, Doria AS, Lambert R, Jaremko JL. Atlas of MRI findings of sacroiliitis in pediatric sacroiliac joints to accompany the updated preliminary OMERACT pediatric JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system: Part I: Active lesions. Semin Arthritis Rheum 2021; 51:1089-1098. [PMID: 34311986 DOI: 10.1016/j.semarthrit.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Magnetic resonance imaging (MRI) is an increasingly important tool for identifying involvement of the sacroiliac joints (SIJ) in juvenile idiopathic arthritis (JIA). The key feature for diagnosing active sacroiliitis is bone marrow edema (BME), but other features of active arthritis such as joint space inflammation, inflammation in an erosion cavity, capsulitis and enthesitis can be seen as well. Structural changes may also be seen. Systematic MRI assessment of inflammation and structural damage may aid in monitoring the disease course, choice of therapeutics and evaluating treatment response. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the SIJ in the pediatric population, as well as the different MRI features of SIJ inflammation. This atlas demonstrates fundamental MRI disease features of active inflammation in a format that can serve as a reference for assessing SIJ arthritis according to the updated preliminary JAMRIS (Juvenile Idiopathic Arthritis MRI Score) scoring system proposed by the MRI in JIA working group of Outcome Measures in Rheumatology and Clinical Trials (OMERACT). The atlas is intended to be read in conjunction with its companion Part 2, Structural Lesions.
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Affiliation(s)
- N Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | | | - Lbo Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - T M Otobo
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, and Department of Diagnostic Imaging, The Hospital for Sick Children and Department of Translational Medicine, SickKids Research Institute, Peter Gilgan Center for Research and Learning, University of Toronto, Toronto, Canada
| | - I Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - A B Meyers
- Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Maj Van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - E Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - J Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - S Appenzeller
- Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
| | - P Weiss
- University of Pennsylvania Perelman School of Medicine, Division of Rheumatology, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania, Philadelphia, USA
| | - Sml Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - A S Doria
- Department of Medical Imaging, University of Toronto, Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rgw Lambert
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - J L Jaremko
- Canada Department of Radiology and Diagnostic Imaging, University of Alberta and WC Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
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22
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Turner DA, Schwartz A, Carraccio C, Herman B, Weiss P, Baffa JM, Chess P, Curran M, Dammann C, High P, Hsu D, Pitts S, Sauer C, Aye T, Fussell J, Kesselheim J, Mahan J, McGann K, Myers A, Mink R. Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation. Acad Med 2021; 96:S22-S28. [PMID: 34183598 DOI: 10.1097/acm.0000000000004091] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.
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Affiliation(s)
- David A Turner
- D.A. Turner is vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, and consulting professor, Duke University Medical Center, Durham, North Carolina. At the time this work was completed, he was associate professor, Duke University Medical Center, Durham, North Carolina
| | - Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina at the time this work was completed
| | - Bruce Herman
- B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Pnina Weiss
- P. Weiss is vice chair of education and associate professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Jeanne M Baffa
- J.M. Baffa is emeritus associate professor of pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Patricia Chess
- P. Chess is professor, University of Rochester Medical Center, Rochester, New York
| | - Megan Curran
- M. Curran is associate professor, Department of Pediatrics, University of Colorado-Denver, Denver, Colorado
| | - Christiane Dammann
- C. Damman is professor, Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts
| | - Pamela High
- P. High is professor, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Deborah Hsu
- D. Hsu is professor, Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Sarah Pitts
- S. Pitts is assistant professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cary Sauer
- C. Sauer is associate professor, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tandy Aye
- T. Aye is associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jill Fussell
- J. Fussell is professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Kesselheim
- J. Kesselheim is associate professor, Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - John Mahan
- J. Mahan is professor, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kathleen McGann
- K. McGann is vice chair of education and professor, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Angie Myers
- A. Myers is professor of pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Richard Mink
- R. Mink is professor of pediatrics, The David Geffen School of Medicine at University of California Los Angeles (UCLA) and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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Otobo TM, Herregods N, Jaremko JL, Lambert RG, Sudoł-Szopińska I, Meyers AB, Kirkhus E, Weiss P, Tse SM, Appenzeller S, Conaghan PG, Rumsey DG, Stimec J, Jans L, Van Rossum M, Tzaribachev N, Carrino J, Papakonstantinou O, Tolend M, Moineddin R, Haroon N, Maksymowych WP, Doria AS. POS1323 SACROILIAC JOINT MRI ABNORMALITIES IN JUVENILE SPONDYLOARTHRITIS: AN UPDATE OF DEFINITIONS AND SCORING OF THE OMERACT JUVENILE IDIOPATHIC ARTHRITIS MRI SCORE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Preliminary definitions for SIJ lesions in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging score has been reported1. Investigators identified the need to revise the JAMRIS-SIJ item definitions.Objectives:To update the JAMRIS-SIJ definitions and scoring method.Methods:The OMERACT JAMRI working group was convened to discuss the performance of the score in a reliability exercise using 30 patients. Twenty investigators (12 radiologists, 8 rheumatologists) decided which definitions and scoring methods to be revised, retained or added.Results:The revised JAMRI-SIJ is in the Table 1.Table 1.Revised OMERACT JAMRIS-SIJ.ComponentDefinitionSegmentation/sliceScore range/sliceBone Marrow Edema (BME)An ill-defined area of high bone marrow signal intensity within the subchondral bone in the ilium or sacrum on fluid sensitive images4 quadrants/SIJ0-8BME IntensityPresence of hyperintensity of the marrow on fluid sensitive images using the signal of the presacral veins or cerebrospinal fluid as reference1 score/SIJ0-2BME DepthContinuing increased signal on fluid sensitive images of depth ≥ 5mm/ ≥ 1cm from the articular surface using the signal of the presacral veins or cerebrospinal fluid as reference1 score/SIJ0-2OsteitisAn ill-defined area of high bone marrow signal intensity within the subchondral bone in the ilium or sacrum on contrast enhanced T1 weighted sequences4 quadrants/SIJ0-8CapsulitisIncreased signal on fluid sensitive or contrast enhanced T1 weighted sequences involving the superior portion of the SIJ capsulesuperior halves/SIJ0-2Joint space fluidHigh signal intensity equivalent to the CSF on fluid sensitive sequences within the joint space of the cartilaginous portion of the SIJhalves/SIJ0-4Joint space enhancementIncreased signal intensity on contrast enhanced T1 weighted sequences within the joint space of the cartilaginous portion of the SIJhalves/SIJ0-4Inflammation in erosion cavityIncreased signal intensity on fluid sensitive or contrast enhanced T1 weighted sequences in an erosion cavity of the cartilaginous portion of the SIJhalves/SIJ0-4EnthesitisIncreased signal intensity in bone marrow and/or adjacent soft tissue on fluid sensitive or contrast enhanced T1 weighted sequences at sites where ligaments and tendons attach to a bone excluding retroarticular enthesitisScore per case0-1Damage DomainSclerosisA substantially wider than normal area of very low bone marrow signal intensity within the subchondral bone in the ilium or sacrum on a non-fat suppressed sequence, preferably a non-fat suppressed T1 weighted sequence. This feature must also be present on all other sequences, as available4 quadrants/SIJ0-8ErosionA focal loss of the low signal of cortical bone at the osteochondral interface and adjacent marrow matrix on T1 weighted images4 quadrants/SIJ0-8Fat metaplasia lesionHomogeneous increased signal intensity within the subchondral bone marrow on T1weighted images4 quadrants/SIJ0-8BackfillA high signal on non-contrast enhanced T1 weighted sequences in a typical location for an erosion, with signal intensity greater than normal bone marrow, clearly demarcated from adjacent bone marrow by an irregular band of low signal reflecting sclerosis at the border of the original erosionhalves/SIJ0-4AnkylosisPresence of signal equivalent to regional bone marrow continuously bridging a portion of the joint space between the iliac and sacral boneshalves/SIJ0-4Statement of overarching consideration for all definitions: “[…] in comparison to physiological changes normally seen on MRI examinations of age- and sex-matched children, and visible in 2 planes wherever available.”Conclusion:Revised JAMRIS-SIJ has been developed. Validation steps are underway.References:[1]Otobo TM, et al. Preliminary Definitions for Sacroiliac Joint Pathologies in the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Imaging Score (OMERACT JAMRIS-SIJ). The Journal of rheumatology. 2019;46(9):1192-7.Acknowledgements:The authors acknowledge The Hospital for SickKids Research Trainee Competition (RESTRACOMP) and Queen Elizabeth II/Edward Dunlop Foundation Scholarship In Science and Technology (QEII-GSST) at the University of Toronto for funding provided to Dr. Tarimobo M. Otobo. The authors also acknowledge Prof. Dr. Desiree van der Heijde for providing expert commentary.Disclosure of Interests:None declared
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Cipris A, Moreira NA, do Espirito Santo TS, Weiss P, Villas-Boas CJ, Kaiser R, Guerin W, Bachelard R. Subradiance with Saturated Atoms: Population Enhancement of the Long-Lived States. Phys Rev Lett 2021; 126:103604. [PMID: 33784122 DOI: 10.1103/physrevlett.126.103604] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/16/2021] [Indexed: 05/12/2023]
Abstract
Dipole-dipole interactions are at the origin of long-lived collective atomic states, often called subradiant, which are explored for their potential use in novel photonic devices or in quantum protocols. Here, we study subradiance beyond the single-excitation regime and experimentally demonstrate a 200-fold increase in the population of these modes, as the saturation parameter of the driving field is increased. We attribute this enhancement to a mechanism similar to optical pumping through the well-coupled superradiant states. The lifetimes are unaffected by the pump strength, as the system is ultimately driven toward the single-excitation sector. Our study is a new step in the exploration of the many-body dynamics of large open systems.
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Affiliation(s)
- A Cipris
- Université Côte d'Azur, CNRS, Institut de Physique de Nice, 06560 Valbonne, France
| | - N A Moreira
- Instituto de Física de São Carlos, Universidade de São Paulo, 13566-590 São Carlos, SP, Brazil
| | - T S do Espirito Santo
- Instituto de Física de São Carlos, Universidade de São Paulo, 13566-590 São Carlos, SP, Brazil
| | - P Weiss
- Université Côte d'Azur, CNRS, Institut de Physique de Nice, 06560 Valbonne, France
| | - C J Villas-Boas
- Departamento de Física, Universidade Federal de São Carlos, Rodovia Washington Luís, km 235-SP-310, 13565-905 São Carlos, SP, Brazil
| | - R Kaiser
- Université Côte d'Azur, CNRS, Institut de Physique de Nice, 06560 Valbonne, France
| | - W Guerin
- Université Côte d'Azur, CNRS, Institut de Physique de Nice, 06560 Valbonne, France
| | - R Bachelard
- Departamento de Física, Universidade Federal de São Carlos, Rodovia Washington Luís, km 235-SP-310, 13565-905 São Carlos, SP, Brazil
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Abramson EL, Weiss P, Naifeh M, Stevenson MD, Duncan JG, Rama JA, Mauer E, Gerber LM, Li STT. Scholarly Activity During Pediatric Fellowship. Pediatrics 2021; 147:peds.2020-013953. [PMID: 33262266 DOI: 10.1542/peds.2020-013953] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The educational requirements for pediatric fellows include at least 12 months of scholarly activity and generation of a work product. Yet there lacks detailed guidance on how programs can best integrate scholarly activity training into fellowships. Our objectives were to understand the resources and barriers to training and identify factors associated with productivity. METHODS We surveyed pediatric fellowship program directors (FPDs) nationally in 2019. Data analysis included descriptive statistics, χ2 and Fisher's exact tests, and multivariable modeling to identify factors associated with high productivity (>75% of fellows in the past 5 years had an article from their fellowship accepted). RESULTS A total of 499 of 770 FPDs responded (65%). A total of 174 programs (35%) were highly productive. The most frequent major barriers were a lack of funding for fellows to conduct scholarship (21%, n = 105) and lack of sufficient divisional faculty mentorship (16%, n = 79). The median number of months for scholarship with reduced clinical obligations scholarship was 17. A total of 40% (n = 202) of FPDs believed training should be shortened to 2 years for clinically oriented fellows. Programs with a T32 and a FPD with >5 publications in the past 3 years were twice as likely to be productive. Not endorsing lack of adequate Scholarship Oversight Committee expertise and a research curriculum as barriers was associated with increased productivity (odds ratio = 1.83-1.65). CONCLUSIONS Despite significant protected fellow research time, most fellows do not publish. Ensuring a program culture of research may provide the support needed to take projects to publication. The fellowship community may consider reevaluating the fellowship duration, particularly for those pursing nonresearch focused careers.
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Affiliation(s)
- Erika L Abramson
- Division of General Pediatrics, Department of Pediatrics and .,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Pnina Weiss
- Department of Pediatrics, Section of Respiratory Medicine, Allergy Immunology and Sleep Medicine, Yale University School of Medicine, Yale University, New Haven, Connecticut
| | - Monique Naifeh
- Department of Pediatrics, Section of Pediatric Hospital Medicine, University of Oklahoma Health Sciences Center and University of Oklahoma, Oklahoma City, Oklahoma
| | - Michelle D Stevenson
- Division of Emergency Medicine, Department of Pediatrics, Norton Children's and University of Louisville, Louisville, Kentucky
| | - Jennifer G Duncan
- Division of Critical Care Medicine, Department of Pediatrics, School of Medicine, Washington University, St Louis, Missouri
| | - Jennifer A Rama
- Section of Pulmonary Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; and
| | - Elizabeth Mauer
- Divison of Biostatistics.,Division of General Pediatrics, Department of Pediatrics and
| | - Linda M Gerber
- Divison of Biostatistics.,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Su-Ting T Li
- University of California, Davis, Sacramento, California
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Reichert W, Tomaiko E, Patel M, Zawaneh M, Weiss P, Su W. Improving pulmonary vein isolation during cryoballoon ablation using the re-look angiography technique. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation for pulmonary vein (PV) antral isolation is contact-dependent. Currently, occlusion assessment using the cryoballoon is most commonly performed using contrast venogram prior to ablation. However, there is a known difference in balloon size/shape between the inflated and ablation state, due to significant increase in cryoballoon pressure, which can cause potential undetected leak and, thus, failure of PV isolation. This phenomenon is currently not detected using standard techniques and effectiveness of mitigation techniques have not been assessed.
Purpose
We hypothesize that repeat injection of contrast five seconds after the initiation of cryoballoon ablation can be used to assess changes in shape and confirm ongoing occlusion during ablation; the re-look angiography technique. The incidence of PVI leak and the ability for the relook angiography to remedy the leak is assessed.
Methods
A total of 125 patients (440 PVs) undergoing cryoballoon ablation (Medtronic Arctic Front Advance Balloon™) were assessed using the re-look angiography technique unless they required occlusion with a segmental approach. Fifteen patients were excluded from contrast use due to renal insufficiency.
Results
Successful single occlusion was seen in 330 (75%) PVs and the re-look angiography technique was employed in each of those events. In 180 of the 330 (55%) single PV occlusions, a new PV leak undetected during the initial PV angiogram was identified. This prompted repositioning of the balloon to achieve complete PV isolation in 85 of 180 of the PV cases, with 95 of the cases requiring additional segmental ablation to complete full PV isolation.
Conclusion
A significant amount of insufficient PV antral contact during cryo-ablation may not be detected with conventional single PV angiography and may explain inadequate PV isolation. The re-look angiography technique is a simple tool to confirm robust balloon contact and guide repositioning as well as identify the need for additional segmental ablation. Additional follow up is needed for translation to improved clinical outcomes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- W Reichert
- Banner University Medical Center Phoenix, Phoenix, United States of America
| | - E Tomaiko
- Banner University Medical Center Phoenix, Phoenix, United States of America
| | - M Patel
- Banner University Medical Center Phoenix, Phoenix, United States of America
| | - M Zawaneh
- Banner University Medical Center Phoenix, Phoenix, United States of America
| | - P Weiss
- Banner University Medical Center Phoenix, Phoenix, United States of America
| | - W Su
- Banner University Medical Center Phoenix, Phoenix, United States of America
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Lapidot Y, Amir A, Ben-Simon S, Veitsman E, Cohen-Ezra O, Davidov Y, Weiss P, Bradichevski T, Segev S, Koren O, Ben-Ari Z, Safran M. Alterations of the salivary and fecal microbiome in patients with primary sclerosing cholangitis. Hepatol Int 2020; 15:191-201. [PMID: 32949377 DOI: 10.1007/s12072-020-10089-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 04/15/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a chronic, progressive liver disease known for its frequent concurrence with inflammatory bowel disease. PSC can progress to cirrhosis, end-stage liver disease, hepatobiliary cancer, and/or colorectal cancer. The etiopathogenesis of PSC remains poorly understood, and, as such, pharmacotherapy has yet to be definitively established. Little is known about the salivary microbiome in PSC and PSC-IBD. This study aimed to evaluate the oral microbiome of patients with PSC, with association to these patient's fecal microbial composition. METHODS Saliva, fecal samples and Food Frequency Questionnaires were collected from 35 PSC patients with or without concomitant inflammatory bowel disease and 30 age- and BMI-matched healthy volunteers. 16S rRNA gene sequencing was performed using Illumina MiSeq platform. RESULTS The salivary microbial signature of PSC was significantly altered as compared to healthy controls, independent of concomitant IBD, and was comprised of 19 significantly altered species, of which, eight species were consistently overrepresented in both fecal and saliva of patients with PSC, including Veillonella, Scardovia and Streptococcus. CONCLUSIONS PSC is characterized by microbial dysbiosis in the gut and the salivary microbiome, independently from IBD. The PSC dysbiotic signature includes a reduction in autochthonous bacteria and an increased relative abundance of pathogenic bacteria, including an invasion of oral bacteria to the gut. PSC is a strong modulator of the microbial profile, in the gut and the oral microbiome. These results may lead to the development of biomarkers for screening and early diagnosis or the development of personalized medicine in PSC.
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Affiliation(s)
- Y Lapidot
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel. .,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel. .,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - A Amir
- Cancer Research Center, Sheba Medical Center, Ramat-Gan, Israel
| | - S Ben-Simon
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - E Veitsman
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Liver Unit, Rambam Health Care Campus, Haifa, Israel
| | - O Cohen-Ezra
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Y Davidov
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - P Weiss
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - T Bradichevski
- Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
| | - S Segev
- Medical Screening Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - O Koren
- Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Z Ben-Ari
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Safran
- Liver Research Laboratory, Sheba Medical Center, Tel Hashomer, Israel.,Liver Diseases Center, Sheba Medical Center, Tel Hashomer, Israel
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Burns AM, Ackerman KG, Thammasitboon S, Rassbach CE, Ward MA, Blankenburg RL, Forster CS, McPhillips HA, Wenger TL, Powell WT, Heyman MB, Hogarty MD, Boyer D, Hostetter M, Weiss P, Nguyen ST, Parsons DW, Moore DJ, Byrne BJ, French AR, Orange JS. Fixing the leaky pipeline: identifying solutions for improving pediatrician-scientist training during pediatric residency. Pediatr Res 2020; 88:163-167. [PMID: 32179872 DOI: 10.1038/s41390-020-0837-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Audrea M Burns
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
| | - Kate G Ackerman
- Department of Pediatrics, University of Rochester/UR Medicine Golisano Children's Hospital, Rochester, NY, USA
| | - Satid Thammasitboon
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA, USA
| | - Mark A Ward
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rebecca L Blankenburg
- Department of Pediatrics, Stanford University School of Medicine/Stanford Children's Hospital, Palo Alto, CA, USA
| | - Catherine S Forster
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences/Children's National Medical Center, Washington, DC, USA
| | - Heather A McPhillips
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Tara L Wenger
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Weston T Powell
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Melvin B Heyman
- Department of Pediatrics, School of Medicine, UCSF Benioff Children's Hospital, University California San Francisco, San Francisco, CA, USA
| | - Michael D Hogarty
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Margaret Hostetter
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Suong T Nguyen
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Donald Williams Parsons
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Daniel J Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA
| | - Bobbi J Byrne
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anthony R French
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Jordan S Orange
- Department of Pediatrics, New York-Presbyterian/Morgan Stanley Children's Hospital, New York City, NY, USA
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29
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Aguzzi J, Flexas MM, Flögel S, Lo Iacono C, Tangherlini M, Costa C, Marini S, Bahamon N, Martini S, Fanelli E, Danovaro R, Stefanni S, Thomsen L, Riccobene G, Hildebrandt M, Masmitja I, Del Rio J, Clark EB, Branch A, Weiss P, Klesh AT, Schodlok MP. Exo-Ocean Exploration with Deep-Sea Sensor and Platform Technologies. Astrobiology 2020; 20:897-915. [PMID: 32267735 DOI: 10.1089/ast.2019.2129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
One of Saturn's largest moons, Enceladus, possesses a vast extraterrestrial ocean (i.e., exo-ocean) that is increasingly becoming the hotspot of future research initiatives dedicated to the exploration of putative life. Here, a new bio-exploration concept design for Enceladus' exo-ocean is proposed, focusing on the potential presence of organisms across a wide range of sizes (i.e., from uni- to multicellular and animal-like), according to state-of-the-art sensor and robotic platform technologies used in terrestrial deep-sea research. In particular, we focus on combined direct and indirect life-detection capabilities, based on optoacoustic imaging and passive acoustics, as well as molecular approaches. Such biologically oriented sampling can be accompanied by concomitant geochemical and oceanographic measurements to provide data relevant to exo-ocean exploration and understanding. Finally, we describe how this multidisciplinary monitoring approach is currently enabled in terrestrial oceans through cabled (fixed) observatories and their related mobile multiparametric platforms (i.e., Autonomous Underwater and Remotely Operated Vehicles, as well as crawlers, rovers, and biomimetic robots) and how their modified design can be used for exo-ocean exploration.
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Affiliation(s)
- J Aguzzi
- Instituto de Ciencias del Mar (ICM-CSIC), Barcelona, Spain
- Stazione Zoologica Anton Dohrn, Naples, Italy
| | - M M Flexas
- California Institute of Technology, Pasadena, California, USA
| | - S Flögel
- GEOMAR Helmholtz Centre for Ocean Research Kiel, Kiel, Germany
| | - C Lo Iacono
- Instituto de Ciencias del Mar (ICM-CSIC), Barcelona, Spain
- National Oceanographic Center (NOC), University of Southampton, Southampton, United Kingdom
| | | | - C Costa
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA)-Centro di ricerca Ingegneria e Trasformazioni agroalimentari - Monterotondo, Rome, Italy
| | - S Marini
- Stazione Zoologica Anton Dohrn, Naples, Italy
- National Research Council of Italy (CNR), Institute of Marine Sciences, La Spezia, Italy
| | - N Bahamon
- Instituto de Ciencias del Mar (ICM-CSIC), Barcelona, Spain
- Centro de Estudios Avanzados de Blanes (CEAB-CSIC), Blanes, Spain
| | - S Martini
- Sorbonne Université, CNRS, Laboratoire d'Océanographie de Villefranche, Villefranche-sur-mer, France
| | - E Fanelli
- Stazione Zoologica Anton Dohrn, Naples, Italy
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - R Danovaro
- Stazione Zoologica Anton Dohrn, Naples, Italy
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - S Stefanni
- Stazione Zoologica Anton Dohrn, Naples, Italy
| | | | - G Riccobene
- Istituto Nazionale di Fisica Nucleare (INFN), Laboratori Nazionali del Sud, Catania, Italy
| | - M Hildebrandt
- German Research Center for Artificial Intelligence (DFKI), Bremen, Germany
| | - I Masmitja
- SARTI, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - J Del Rio
- SARTI, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - E B Clark
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California, USA
| | - A Branch
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California, USA
| | | | - A T Klesh
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California, USA
| | - M P Schodlok
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California, USA
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30
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Kamnerdsiri W, Rodríguez Martinez J, Fox C, Weiss P. P-02-5 Clinical Correlation Between Erectile Function and Ejaculatory Function in the Czech Male Population. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Mathieu N, Moussa L, Demarquay C, Semont A, Linard C, Chapel A, Milliat F, Barritault D, Weiss P. Strategies to improve Adipose Mesenchymal Stromal Cell Therapeutic Effect: Application to pelvic radiotherapy side effects. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Timme KH, Hafler JP, Encandela J, Colson ER, Weinzimer SA, Asnes A, Gaither JR, Guest J, Murtha TD, Weiss P. Fellows as Medical Educators: Implementation and Evaluation of a Curriculum to Improve Pediatric Fellow Teaching Skills. Acad Pediatr 2020; 20:140-142. [PMID: 31330315 DOI: 10.1016/j.acap.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/11/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Kathleen H Timme
- Department of Pediatrics (KH Timme), University of Utah School of Medicine, Salt Lake City, Utah.
| | - Janet P Hafler
- Teaching and Learning Center (JP Hafler and J Encandela), Yale University School of Medicine, New Haven, Conn
| | - John Encandela
- Teaching and Learning Center (JP Hafler and J Encandela), Yale University School of Medicine, New Haven, Conn
| | - Eve R Colson
- Washington University School of Medicine (ER Colson), St Louis, Mo
| | - Stuart A Weinzimer
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Andrea Asnes
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Julie R Gaither
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Julie Guest
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Tanya D Murtha
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
| | - Pnina Weiss
- Department of Pediatrics (SA Weinzimer, A Asnes, JR Gaither, J Guest, TD Murtha, and P Weiss), Yale University School of Medicine, New Haven, Conn
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33
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Mink R, Herman BE, Carraccio C, Aye T, Baffa JM, Chess PR, Fussell JJ, Sauer CG, Stafford DEJ, Weiss P, Curran ML, Dammann CEL, High PC, Hsu D, Kesselheim JC, Mahan JD, McGann KA, Myers AL, Pitts S, Turner DA, Schwartz A. Agreement of Program Directors With Clinical Competency Committees for Fellow Entrustment. J Med Educ Curric Dev 2020; 7:2382120520936613. [PMID: 32844115 PMCID: PMC7418246 DOI: 10.1177/2382120520936613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/29/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Fellowship program directors (FPD) and Clinical Competency Committees (CCCs) both assess fellow performance. We examined the association of entrustment levels determined by the FPD with those of the CCC for 6 common pediatric subspecialty entrustable professional activities (EPAs), hypothesizing there would be strong correlation and minimal bias between these raters. METHODS The FPDs and CCCs separately assigned a level of supervision to each of their fellows for 6 common pediatric subspecialty EPAs. For each EPA, we determined the correlation between FPD and CCC assessments and calculated bias as CCC minus FPD values for when the FPD was or was not a member of the CCC. In addition, we examined the effect of program size, FPD understanding of EPAs, and subspecialty on the correlations. Data were obtained in fall 2014 and spring 2015. RESULTS A total of 1040 fellows were assessed in the fall and 1048 in the spring. In both periods and for each EPA, there was a strong correlation between FPD and CCC supervision levels (P < .001). The correlation was somewhat lower when the FPD was not a CCC member (P < .001). Overall bias in both periods was small. CONCLUSIONS The correlation between FPD and CCC assignment of EPA supervision levels is strong. Although slightly weaker when the FPD is not a CCC member, bias is small, so this is likely unimportant in determining fellow entrustment level. The similar performance ratings of FPDs and CCCs support the validity argument for EPAs as competency-based assessment tools.
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Affiliation(s)
- Richard Mink
- Department of Pediatrics, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA
| | - Bruce E Herman
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeanne M Baffa
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Patricia R Chess
- Department of Pediatrics and Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Jill J Fussell
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cary G Sauer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Diane E J Stafford
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Pnina Weiss
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Megan L Curran
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Pamela C High
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Deborah Hsu
- Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer C Kesselheim
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - John D Mahan
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Angela L Myers
- Department of Pediatrics, Children’s Mercy, School of Medicine, University of Missouri–Kansas City, Kansas City, MO, USA
| | - Sarah Pitts
- Divisions of Adolescent Medicine and of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Turner
- Department of Pediatrics, Division of Pediatric Critical Care, Duke Children’s Hospital, Durham, NC, USA
| | - Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA; Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN)
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34
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Weiss P, Mauer E, Gerber LM, Boyer D, Abramson EL. Funding sources and effects of limited funding in pediatric pulmonology fellowship programs. Pediatr Pulmonol 2020; 55:221-225. [PMID: 31578809 DOI: 10.1002/ppul.24536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The pediatric pulmonology workforce is at risk. Access to pediatric pulmonologists to meet patient needs is limited and recruitment of new trainees to replace the aging, retiring physician population may be inadequate. Furthermore, sources of funding for graduate medical education are insecure. However, no prior studies have identified the funding sources of pediatric pulmonology fellowships or the effects of funding constraints. METHODS We conducted a national survey of pediatric pulmonology training directors (PPTD) in the United States between 1 November, 2016 and 9 February, 2017 to examine the sources of funding for pediatric pulmonary fellows and the effect of funding limitations. RESULTS We obtained data from 48 PPTD, representing 89% of pediatric pulmonology programs (N = 54). Limitations in funding restricted program size in 31% of programs. A significant number of programs had no funding to cover educational resources such as advanced degrees (38%), courses (23%), society membership (25%), and journals and books (15%). Twenty seven percent of PPTD perceived their program as financially insecure for academic year 2019 and beyond. CONCLUSIONS Insufficient funding has limited the size of pediatric pulmonology programs and access to important educational resources. It is critical to ensure that there is adequate funding for pediatric pulmonology fellowship programs, as insecurity further endangers the pediatric pulmonology workforce and future provision of care for children with respiratory diseases.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Linda M Gerber
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Debra Boyer
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Erika L Abramson
- Departments of Pediatrics and Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
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35
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Guerin W, Santo TSDE, Weiss P, Cipris A, Schachenmayer J, Kaiser R, Bachelard R. Collective Multimode Vacuum Rabi Splitting. Phys Rev Lett 2019; 123:243401. [PMID: 31922857 DOI: 10.1103/physrevlett.123.243401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Indexed: 06/10/2023]
Abstract
We report the experimental observation of collective multimode vacuum Rabi splitting in free space. In contrast to optical cavities, the atoms couple to a continuum of modes, and the optical thickness of the cloud provides a measure of this coupling. The splitting, also referred as normal mode splitting, is monitored through the Rabi oscillations in the scattered intensity, and the results are fully explained by a linear-dispersion theory.
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Affiliation(s)
- W Guerin
- Université Côte d'Azur, CNRS, INPHYNI, F-06560 Valbonne, France
| | - T S do Espirito Santo
- Instituto de Física de São Carlos, Universidade de São Paulo, 13566-590 São Carlos, São Paulo, Brazil
- IPCMS (UMR 7504) and ISIS (UMR 7006), Université de Strasbourg, CNRS, 67000 Strasbourg, France
| | - P Weiss
- Université Côte d'Azur, CNRS, INPHYNI, F-06560 Valbonne, France
| | - A Cipris
- Université Côte d'Azur, CNRS, INPHYNI, F-06560 Valbonne, France
| | - J Schachenmayer
- IPCMS (UMR 7504) and ISIS (UMR 7006), Université de Strasbourg, CNRS, 67000 Strasbourg, France
| | - R Kaiser
- Université Côte d'Azur, CNRS, INPHYNI, F-06560 Valbonne, France
| | - R Bachelard
- Université Côte d'Azur, CNRS, INPHYNI, F-06560 Valbonne, France
- Departamento de Física, Universidade Federal de São Carlos, Rodovia Washington Luís, km 235-SP-310, 13565-905 São Carlos, São Paulo, Brazil
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36
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Hivernaud V, Grimaud F, Guicheux J, Portron S, Pace R, Pilet P, Sourice S, Wuillem S, Bertin H, Roche R, Espitalier F, Weiss P, Corre P. Comparing “intra operative” tissue engineering strategies for the repair of craniofacial bone defects. Journal of Stomatology, Oral and Maxillofacial Surgery 2019; 120:432-442. [DOI: 10.1016/j.jormas.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 01/02/2023]
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37
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Weiss P, Myers AL, McGann KA, Mason KE, Kesselheim JC, Fleming G, Barron C, Klasner A, Heyman MB, Weiss DL, Mauer E, Gerber LM, Abramson EL. Funding Sources and Perceived Financial Insecurity in Pediatric Subspecialty Fellowship Programs. Acad Pediatr 2019; 19:815-821. [PMID: 31200029 DOI: 10.1016/j.acap.2019.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Shortages of pediatric subspecialists exist in many fields with insufficient recruitment of new fellows. The current system of funding graduate medical education is inadequate. We examined funding sources for trainee salary and educational expenses in pediatric fellowship programs, effects of funding constraints, and program characteristics associated with financial insecurity as reported by fellowship program directors (FPD). METHODS We conducted a national survey of FPD between November 1, 2016 and February 9, 2017. We used multivariable logistic regression to examine the association between perceived financial insecurity, program characteristics, and funding sources for fellow salary. RESULTS We obtained data from 519 FPD, representing 14 different pediatric subspecialties. FPD reported that funding limitations restricted program size and educational resources in 22% and 36% of programs, respectively. Nineteen percent of FPD perceived funding of their program to be insecure. Programs with 7 or more fellows (OR .50 [95% CI .27-.90], P = .03) or hospital or graduate medical education/Children's Hospital graduate medical education funding (OR .58 [95% CI .35-.96], P = .04) were less likely to be perceived as insecure. Conversely, programs with extramural (OR 1.74 [95% CI 1.07-2.81], P = .03) or division funding (OR 1.70 [95% CI 1.02-2.82], P = .04) or in subspecialties with more than 25% unfilled positions or programs (OR 1.86 [95% CI 1.11-3.09], P = .02) were more likely to be perceived as insecure. CONCLUSIONS Perceived financial insecurity of fellowship programs was strongly associated with program size, funding source, and unfilled positions, limiting recruitment and resources. Stable funding of fellowship programs is critical to maintain an adequate pediatric subspecialty workforce.
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Affiliation(s)
- Pnina Weiss
- Yale University School of Medicine (P Weiss), New Haven, Conn.
| | - Angela L Myers
- Children's Mercy Kansas City (AL Myers), Kansas City, Mo
| | | | - Katherine E Mason
- The Warren Alpert Medical School at Brown University (KE Mason and C Barron), Providence, RI
| | | | - Geoffrey Fleming
- Vanderbilt University School of Medicine (G Fleming), Nashville, Tenn
| | - Christine Barron
- The Warren Alpert Medical School at Brown University (KE Mason and C Barron), Providence, RI
| | - Ann Klasner
- University of Alabama at Birmingham (A Klasner), Birmingham, Ala
| | - Melvin B Heyman
- University of California at San Francisco (MB Heyman), San Francisco, Calif
| | | | - Elizabeth Mauer
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
| | - Linda M Gerber
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
| | - Erika L Abramson
- Weill Cornell Medicine (E Mauer, LM Gerber, and EL Abramson), New York, NY
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Heyman MB, Weiss P, Boyer D, Fussell J, Imundo L, Aye T, Jarjour IT, Spicer R, Bale J. Challenges of Funding Pediatric Fellowship Programs-Invited Commentary from the Council of Pediatric Subspecialties. J Pediatr 2019; 204:4-6.e1. [PMID: 30579474 DOI: 10.1016/j.jpeds.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Melvin B Heyman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
| | - Pnina Weiss
- Department of Pediatrics, Yale University, New Haven, CT
| | - Debra Boyer
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Jill Fussell
- Department of Pediatrics, University of Arkansas, Little Rock, AZ
| | - Lisa Imundo
- Department of Pediatrics, Columbia University, New York, NY
| | - Tandy Aye
- Department of Pediatrics, Stanford University, Stanford, CA
| | - Imad T Jarjour
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Robert Spicer
- Department of Pediatrics, Children's Hospital, Omaha, NB
| | - James Bale
- Department of Pediatrics, University of Utah, Salt Lake City, UT
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Buchtová N, D’Orlando A, Judeinstein P, Chauvet O, Weiss P, Le Bideau J. Water dynamics in silanized hydroxypropyl methylcellulose based hydrogels designed for tissue engineering. Carbohydr Polym 2018; 202:404-408. [DOI: 10.1016/j.carbpol.2018.08.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 01/18/2023]
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Figueiredo L, Pace R, D'Arros C, Réthoré G, Guicheux J, Le Visage C, Weiss P. Assessing glucose and oxygen diffusion in hydrogels for the rational design of 3D stem cell scaffolds in regenerative medicine. J Tissue Eng Regen Med 2018; 12:1238-1246. [DOI: 10.1002/term.2656] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 01/17/2018] [Accepted: 02/17/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Figueiredo
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - R. Pace
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - C. D'Arros
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - G. Réthoré
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - J. Guicheux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes, PHU 4 OTONN; Nantes France
| | - C. Le Visage
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - P. Weiss
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton; Université de Nantes, ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes, PHU 4 OTONN; Nantes France
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Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
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Kamnerdsiri W, Rodríguez J, Weiss P. 176 Men's Sexual Satisfaction Factors: Correlation Between Erectile Function and Premature Ejaculation. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wirth K, Held A, Kalbe E, Kessler J, Saliger J, Karbe H, Fink G, Weiss P. Das revidierte Kölner Apraxie-Screening (KAS-R) als diagnostisches Verfahren für Patienten mit rechtshemisphärischem Schlaganfall. Fortschr Neurol Psychiatr 2016; 84:633-639. [DOI: 10.1055/s-0042-115843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - E. Kalbe
- Medizinische Psychologie/Neuropsychologie & Gender Studies, Center für Neuropsychologische Diagnostik und Intervention (CeNDI), Uniklinik Köln
| | - J. Kessler
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - J. Saliger
- Neurologisches Rehabilitationszentrum Godeshöhe, Bonn
| | - H. Karbe
- Neurologisches Rehabilitationszentrum Godeshöhe, Bonn
| | - G. Fink
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
| | - P. Weiss
- Klinik und Poliklinik für Neurologie, Uniklinik Köln
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44
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Weiss P, Kryger M, Knauert M. Impact of extended duty hours on medical trainees. Sleep Health 2016; 2:309-315. [PMID: 29073389 DOI: 10.1016/j.sleh.2016.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 04/19/2016] [Revised: 07/11/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023]
Abstract
Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for duty hours have been instituted (2003) and revised (2011). These changes were based on studies of the effects of sleep deprivation on human performance and specifically on the effect of extended shifts on resident performance. These requirements necessitated significant restructuring of resident schedules. Concerns were raised that these changes have impaired continuity of care, resident education and supervision, and patient safety. We review the studies on the effect of extended work hours on resident well-being, education, and patient care as well as those assessing the effect of work hour restrictions. Although many studies support the adverse effects of extended shifts, there are some conflicting results due to factors such as heterogeneity of protocols, schedules, subjects, and environments. Assessment of the effect of work hour restrictions has been even more difficult. Recent data demonstrating that work hour limitations have not been associated with improvement in patient outcomes or resident education and well-being have been interpreted as support for lifting restrictions in some specialties. However, these studies have significant limitations and should be interpreted with caution. Until future research clarifies duty hours that optimize patient outcomes, resident education, and well-being, it is recommended that current regulations be followed.
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Affiliation(s)
- Pnina Weiss
- Section of Pediatric Respiratory Medicine and Medical Education, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064.
| | - Meir Kryger
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208057, New Haven, CT 06520-8057
| | - Melissa Knauert
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, 333 Cedar St, PO Box 208057, New Haven, CT 06520-8057
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Abstract
Positive airway pressure (PAP) is considered first-line therapy for moderate to severe obstructive sleep apnea and may also be considered for mild obstructive sleep apnea, particularly if it is symptomatic or there are concomitant cardiovascular disorders. Continuous PAP is most commonly used. Other modes, such as bilevel airway pressure, autotitrating positive airway pressure, average volume assured pressure support, and adaptive support ventilation, play important roles in the management of sleep-related breathing disorders. This article outlines the indications, description, and comfort features of each mode. Despite the proven efficacy of PAP in treating obstructive sleep apnea syndrome and its sequelae, adherence to therapy is low. Close follow-up of patients for evaluation of adherence to and effectiveness of treatment is important.
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Affiliation(s)
- Pnina Weiss
- Pediatric Respiratory Medicine and Medical Education, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Meir Kryger
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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Fleming GM, Brook MM, Herman BE, Kennedy C, McGann KA, Mason KE, Weiss P, Myers AL. Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey. Acad Pediatr 2016; 16:415-418. [PMID: 27150512 DOI: 10.1016/j.acap.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Geoffrey M Fleming
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn.
| | - Michael M Brook
- University of California San Francisco, San Francisco, Calif
| | - Bruce E Herman
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Chris Kennedy
- Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Kathleen A McGann
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Katherine E Mason
- Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Pnina Weiss
- Department of Pediatrics, Yale University, New Haven, Conn
| | - Angela L Myers
- Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
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Krejcová L, Binter J, Pastor Z, Weiss P, Klapilova K. P-06-001 Female sexual response to erotic texts is associated with attitudes towards sexuality. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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48
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Macaluso T, Bourdin C, Buloup F, Mille ML, Sainton P, Sarlegna FR, Taillebot V, Vercher JL, Weiss P, Bringoux L. Kinematic features of whole-body reaching movements underwater: Neutral buoyancy effects. Neuroscience 2016; 327:125-35. [PMID: 27095713 DOI: 10.1016/j.neuroscience.2016.04.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
Abstract
Astronauts' training is conventionally performed in a pool to reproduce weightlessness by exploiting buoyancy which is supposed to reduce the impact of gravity on the body. However, this training method has not been scientifically validated yet, and requires first to study the effects of underwater exposure on motor behavior. We examined the influence of neutral buoyancy on kinematic features of whole-body reaching underwater and compared them with those produced on land. Eight professional divers were asked to perform arm reaching movements toward visual targets while standing. Targets were presented either close or far from the subjects (requiring in the latter case an additional whole-body displacement). Reaching movements were performed on land or underwater in two different contexts of buoyancy. The divers either wore a diving suit only with neutral buoyancy applied to their center of mass or were additionally equipped with a submersible simulated space suit with neutral buoyancy applied to their body limbs. Results showed that underwater exposure impacted basic movement features, especially movement speed which was reduced. However, movement kinematics also differed according to the way buoyancy was exerted on the whole-body. When neutral buoyancy was applied to the center of mass only, some focal and postural components of whole-body reaching remained close to land observations, notably when considering the relative deceleration duration of arm elevation and concomitant forward trunk bending when reaching the far target. On the contrary, when neutral buoyancy was exerted on body segments, movement kinematics were close to those reported in weightlessness, as reflected by the arm deceleration phase and the whole-body forward displacement when reaching the far target. These results suggest that astronauts could benefit from the application of neutral buoyancy across the whole-body segments to optimize underwater training and acquire specific motor skills which will be used in space.
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Affiliation(s)
- T Macaluso
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - C Bourdin
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - F Buloup
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - M-L Mille
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France; Université de Toulon, 83957 La Garde, France; Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Chicago, IL 60611, United States
| | - P Sainton
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - F R Sarlegna
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - V Taillebot
- COMEX S.A., 36 Bvd des Océans, 13009 Marseille, France
| | - J-L Vercher
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France
| | - P Weiss
- COMEX S.A., 36 Bvd des Océans, 13009 Marseille, France
| | - L Bringoux
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288 Marseille Cedex 09, France.
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Affiliation(s)
- James M Smoliga
- Department of Physical Therapy, High Point University, High Point, NC 27268, USA
| | - Pnina Weiss
- Pediatric Respiratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
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Guillory X, Tessier A, Gratien GO, Weiss P, Colliec-Jouault S, Dubreuil D, Lebreton J, Le Bideau J. Glycidyl alkoxysilane reactivities towards simple nucleophiles in organic media for improved molecular structure definition in hybrid materials. RSC Adv 2016. [DOI: 10.1039/c6ra01658h] [Citation(s) in RCA: 17] [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: 12/16/2022] Open
Abstract
We report the first comprehensive study of the reactivity in organic media of (3-glycidyloxypropyl)trialkoxysilanes towards common nucleophiles. Their reactivity have to be emphasized in order to design and to improve new sol–gel hybrid synthesis.
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Affiliation(s)
- X. Guillory
- Institut des Matériaux Jean Rouxel (IMN)
- UMR 6502
- 44322 Nantes
- France
- IFREMER
| | - A. Tessier
- CEISAM
- UMR 6230, équipe Symbiose
- 44322 Nantes
- France
| | - G.-O. Gratien
- Institut des Matériaux Jean Rouxel (IMN)
- UMR 6502
- 44322 Nantes
- France
- CEISAM
| | - P. Weiss
- LIOAD
- INSERM U791
- 44042 Nantes
- France
| | | | - D. Dubreuil
- CEISAM
- UMR 6230, équipe Symbiose
- 44322 Nantes
- France
| | - J. Lebreton
- CEISAM
- UMR 6230, équipe Symbiose
- 44322 Nantes
- France
| | - J. Le Bideau
- Institut des Matériaux Jean Rouxel (IMN)
- UMR 6502
- 44322 Nantes
- France
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