Medicine and Health Sciences Commons^™

Design And Implementation Of Multicenter Pediatric And Congenital Studies With Cardiovascular Magnetic Resonance: Big Data In Smaller Bodies, Michael P Dilorenzo, Simon Lee, Rahul H Rathod, Francesca Raimondi, Kanwal M Farooqi, Supriya S Jain, Margaret M Samyn, Tiffanie R Johnson, Laura J Olivieri, Mark A Fogel, Wyman W Lai, Pierangelo Renella, Andrew J Powell, Sujatha Buddhe, Caitlin Stafford, Jason N Johnson, Willem A Helbing, Kuberan Pushparajah, Inga Voges, Vivek Muthurangu, Kimberley G Miles, Gerald Greil, Colin J Mcmahon, Timothy C Slesnick, Brian M Fonseca, Shaine A Morris, Jonathan H Soslow, Lars Grosse-Wortmann, Rebecca S Beroukhim, Heynric B Grotenhuis

Faculty, Staff and Student Publications

Cardiovascular magnetic resonance (CMR) has become the reference standard for quantitative and qualitative assessment of ventricular function, blood flow, and myocardial tissue characterization. There is a preponderance of large CMR studies and registries in adults; However, similarly powered studies are lacking for the pediatric and congenital heart disease (PCHD) population. To date, most CMR studies in children are limited to small single or multicenter studies, thereby limiting the conclusions that can be drawn. Within the PCHD CMR community, a collaborative effort has been successfully employed to recognize knowledge gaps with the aim to embolden the development and initiation of high-quality, …

Feasible Diet And Circadian Interventions Reduce In Vivo Progression Of Flt3-Itd-Positive Acute Myeloid Leukemia, Megan Rodriguez, Baharan Fekry, Brianna Murphy, Mary Figueroa, Tiewei Cheng, Margaret Raber, Lisa Wartenberg, Donna Bell, Lisa Triche, Karla Crawford, Huaxian Ma, Kendra Allton, Ruwaida Ahmed, Jaime Tran, Christine Ranieri, Marina Konopleva, Michelle Barton, Cesar Nunez, Kristin Eckel-Mahan, Joya Chandra

Faculty, Staff and Student Publications

BACKGROUND: Acute myeloid leukemia (AML) with an internal tandem duplication in the fms-like tyrosine kinase receptor 3 gene (FLT3-ITD) is associated with poor survival, and few studies have examined the impact of modifiable behaviors, such as nutrient quality and timing, in this subset of acute leukemia.

METHODS: The influence of diet composition (low-sucrose and/or low-fat diets) and timing of diet were tested in tandem with anthracycline treatment in orthotopic xenograft mouse models. A pilot clinical study to test receptivity of pediatric leukemia patients to macronutrient matched foods was conducted. A role for the circadian protein, BMAL1 (brain and muscle ARNT-like …

Secondhand Tobacco Smoke Exposure In Homes And Vehicles In Youth: Disparities Among Racial, And Sexual And Gender Minorities, Rajesh Talluri, Sahil S Shete, Surendra S Shastri, Sanjay Shete

Faculty, Staff and Student Publications

BACKGROUND: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies.

METHODS: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models …

Investigation Of Setmelanotide, An Mc4r Agonist, For Obesity In Individuals With Smith-Magenis Syndrome, Julia Lazareva, Stephanie R Sisley, Sheila M Brady, Ann C M Smith, Sarah H Elsea, Jeremy J Pomeroy, Christian L Roth, Jennifer E Sprague, Martin Wabitsch, Jill Garrison, Jack A Yanovski

Children’s Nutrition Research Center Staff Publications

Background: Smith Magenis Syndrome (SMS) is a rare genetic disorder caused by RAI1 haploinsufficiency. Obesity in people with SMS is believed partially due to dysfunction of the proximal melanocortin 4 receptor (MC4R) pathway. We therefore studied effects of treatment with the MC4R agonist setmelanotide on obesity and hunger, as well as metabolic, cardiac and safety, in individuals with SMS.

Methods: People with SMS received once-daily setmelanotide injections, with the dose titrated bi-weekly to a maximum of 3 mg over ∼1 month; and a full-dose treatment duration of 3mo. The primary outcome was percent change in body weight. Secondary outcomes included …

Racial And Ethnic Disparities In Acuity Of Presentation Among Children With Newly Diagnosed Acute Leukemia, Lena E Winestone, Kelly D Getz, Yimei Li, Evanette Burrows, Michael E Scheurer, Vicky Tam, M Monica Gramatges, Jennifer J Wilkes, Tamara P Miller, Alix E Seif, Karen R Rabin, Brian T Fisher, Richard Aplenc

Center for Medical Ethics and Health Policy Staff Publications

We evaluated disparities in disease burden, organ dysfunction, vital signs, and timing of therapy in children newly presenting with acute leukemia. Among 899 patients with acute leukemia diagnosed at two large children's hospitals, a priori lab-based definitions of high disease burden, infection risk, renal dysfunction, and coagulopathy were applied to electronic health record data. Black patients with acute myeloid leukemia had increased prevalence of elevated white blood cell count and uric acid; Black patients with acute lymphoblastic leukemia demonstrated increased prevalence of coagulopathy. Black patients' presentation more frequently included multiple lab abnormalities consistent with advanced physiologic dysfunction. No differences were …

Exploring The Relationship Between Vaccine Hesitancy And Mothers’ Perspectives On Covid-19 Vaccines For Children Ages 5–11 Years During The Omicron Predominant Period 2021–2022: A Qualitative Study, Tiffany A Suragh, David Adzrago, Marlyn A Allicock, Paul G Yeh, Paula Cuccaro

Faculty, Staff and Student Publications

Background: The United States Food and Drug Administration authorized COVID-19 vaccines for children ages 5-11 years in October 2021 during the Omicron predominant period. Parental vaccine hesitancy was prevalent during this time, resulting in low childhood COVID-19 vaccine uptake. Most studies exploring factors influencing parental vaccine hesitancy have focused on racial and ethnic minorities and lower socioeconomic populations; however, there is little knowledge of the drive drivers of vaccine hesitancy among White parents with higher education and socioeconomic statuses.

Methods: We conducted semi-structured interviews with a sample of 15 White mothers of children ages 5-11 years in Atlanta, GA, between …

Streptococcus Pneumoniae Serotype 19a In Hospitalized Children With Invasive Pneumococcal Disease After The Introduction Of Conjugated Vaccines In Lima, Peru, Theresa J Ochoa, Olguita Del Águila, Isabel Reyes, Eduardo Chaparro, María E Castillo, Francisco Campos, Andrés Saenz, Roger Hernandez, Alessandra Luna-Muschi, Franco Castillo-Tokumori, Andrea E Montero, Brayan E Gonzales, Erik H Mercado

Faculty, Staff and Student Publications

BACKGROUND: The Pneumococcal conjugate vaccine (PCV) has decreased cases of invasive pneumococcal disease (IPD) worldwide. However, the impact of PCVs introduction may be affected by the serotype distribution in a specific context.

METHODS: Cross-sectional multicenter passive surveillance study of IPD cases in pediatric patients hospitalized in Lima, Peru between 2016 and 2019 (after PCV13 introduction) to determine the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae. Serotyping was performed by a sequential multiplex PCR and confirmed by whole genome sequencing.

RESULTS: Eighty-five S. pneumoniae isolates were recovered (4.07/100,000 among childrenage). Serotype 19A was the most common (49.4%). Children infected with …

Exploring Sexual Orientation Disparities Regarding The Interplay Of Childhood Sexual Abuse, Self-Reported Diabetes Status, And Depression Among Adults In The United States, Sumaita Choudhury, Paul G Yeh, Kaitlyn L Zajack-Garcia, Christine M Markham

Faculty, Staff and Student Publications

Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative to further investigate the role of depression and the differential associations of exposure to ACEs with diabetes prevalence by sexual orientation. We explored sexual orientation disparities regarding the relationship between CSA and diabetes and examined the moderating role of depression. A total of 29,903 participants from the 2021 Behavioral Risk …

A Comparative Study Of Venezuelan Immigrants’ Pre- And Post-Migration Concerns For Their Children In The United States And Colombia, Aigerim Alpysbekova, Pablo Montero-Zamora, Mary H Soares, Carolina Scaramutti, Sumeyra Sahbaz, Maria Duque, Tara Bautista, Maria Fernanda Garcia, Christopher P Salas-Wright, Mildred M Maldonado-Molina, Melissa M Bates, Augusto Pérez-Gómez, Juliana Mejía Trujillo, Eric C Brown, Seth J Schwartz

Faculty, Staff and Student Publications

Research suggests that forced migration may lead to cultural stress and psychological distress. However, little is known about immigrant parents' pre- and post-migration concerns for their children's welfare. The present study examined the concerns of Venezuelan parents who migrated to the United States versus those who migrated to Colombia, and whether post-migration concerns were related to cultural stressors, mental health, and cultural identity. A sample of 609 Venezuelan immigrants completed surveys and responded to an open-ended prompt asking about pre- and post-migration concerns for children's welfare. Lack of safety was the most common pre-migration concern for Venezuelans in the U.S., …

The Associations Of Physical Activity And Sedentary Behavior With Self-Rated Health In Chinese Children And Adolescents, Yahan Liang, Youzhi Ke, Yang Liu

Human Movement Studies & Special Education Faculty Publications

Objective

The study aimed to analyze the independent and joint associations of physical activity (PA) and sedentary behavior (SB) with self-rated health (SRH) among Chinese children and adolescents.

Methods

Cross-sectional data on moderate-to-vigorous physical activity (MVPA), school-based PA, extracurricular physical activity (EPA), screen time (ST), homework time, and SRH were assessed through a self-report questionnaire in the sample of 4227 Chinese children and adolescents aged 13.04 ± 2.62 years. Binary logistic regression was used to compare gender differences in PA, SB, and SRH among children and adolescents, and analyses were adjusted for age and ethnicity.

Results

In independent associations, boys …

Teachers' Perception On Physical Activity Promotion In Kindergarten Children In China: A Qualitative Study Connecting Social Ecological Model, Yahan Liang, Fangyuan Ju, Yueran Hao, Jia Yang, Yang Liu

Human Movement Studies & Special Education Faculty Publications

Background

Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations.

Methods

Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai …

Superior Sagittal Sinus Thrombectomy In Pediatric Head Injury, Phillip Mitchell Johansen, Bronson Ciavarra, Ryan Mccormack, Matthew Kole, Gary Spiegel, Stephen Alan Fletcher

Faculty, Staff and Student Publications

Introduction: Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture. In such cases, venous infarction may be a severe and life-threatening complication of head injury.

Case presentation: A 2-year-old …

Outcomes Of Simultaneous Lengthening And Acl Reconstruction In Fibular Hemimelia: A Retrospective Case Series, Bradley Reeves, Brennan Roper, Reba Salton, Ava Baumann, Radomir Dimovski, Nancy Hadley-Miller, Jay Albright

Faculty, Staff and Student Publications

BACKGROUND: Fibular hemimelia is the most common congenital long bone deficiency. It is often associated with femoral and tibial deficiencies which result in a clinically evident leg length discrepancy. The primary soft tissue concern is ACL/PCL deficiency. If treatment includes bony lengthening, joint stability is imperative to avoid complications. In this study, we detail a novel technique for long bone lengthening and ACL reconstruction in a single, cohesive surgery. This consolidates the need for multiple procedures and offers improved limb length symmetry and knee stability for this patient population. Clinical outcomes of pediatric patients with hemimelia who underwent either femoral …

Rising Prevalence Of Mild Chronic Gastritis In Children: A Single Center Experience, Rohit Josyabhatla, Mary Lauren Wood, Amber Gafur, Nina Tatevian, Amanda S Tchakarov, Syed Shahrukh Hashmi, Jon Marc Rhoads, Melissa Renee Van Arsdall

Faculty, Staff and Student Publications

OBJECTIVES AND METHODS: We analyzed upper endoscopic and histological findings in 3 cohorts of children undergoing upper gastrointestinal endoscopy over a 10-year period. Five hundred seventy-nine patients were identified, with 244 (42%), 199 (35%), and 136 (23%) in the 2011, 2015, and 2019 cohorts, respectively. The most common symptoms and signs were abdominal pain, vomiting, failure to thrive, and diarrhea.

RESULTS: The number of patients who had histological evidence of chronic gastritis increased from 2011 (n = 70, 29%) to 2015 (n = 106, 53%) and 2019 (n = 92, 68%;

CONCLUSIONS: There has been a significant rise in the …

Association Between Serum Vitamin D Status And Uterine Leiomyomas: A Case-Control Study, Chukwuemeka Chukwubuikem Okoro, Okechukwu Christian Ikpeze, George Uchenna Eleje, Gerald Okanandu Udigwe, Chukwuemeka Okwudili Ezeama, Joseph Odirichukwu Ugboaja, Chukwunonso Isaiah Enechukwu, Osita Samuel Umeononihu, Chukwudi Anthony Ogabido, Charlotte Blanche Oguejiofor, Tobechi Kingsley Njoku, Richard Obinwanne Egeonu, Chigozie Geoffrey Okafor, Hillary Ikechukwu Obiagwu, Chukwudubem Chinagorom Onyejiaka, Afam Ben Obidike, Christian Ejike Onah, Ifeanyi Uzukwu, Amarachukwu Doris Okoro, Evaristus Chino Ezema, Adaobi Maryann Ibekwe, Joseph Ifeanyichukwu Ikechebelu

Faculty, Staff and Student Publications

OBJECTIVE: Uterine leiomyoma is a common gynecological condition that negatively affects women's quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas.

METHODS: This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in …

Novel Oppositional Defiant Disorder Or Conduct Disorder 24 Months After Traumatic Brain Injury In Children And Adolescents, Daniel S Lowet, Florin Vaida, John R Hesselink, Linda Ewing-Cobbs, Russell J Schachar, Sandra B Chapman, Erin D Bigler, Elisabeth A Wilde, Ann E Saunders, Tony T Yang, Olga Tymofiyeva, Mingxiong Huang, Jeffrey E Max

Faculty, Staff and Student Publications

Objective: The authors sought to identify predictive factors of new-onset or novel oppositional defiant disorder or conduct disorder assessed 24 months after traumatic brain injury (TBI).

Methods: Children ages 5 to 14 years who had experienced TBI were recruited from consecutive hospital admissions. Soon after injury, participants were assessed for preinjury characteristics, including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, and family function, and the presence and location of lesions were documented by MRI. Psychiatric outcomes, including novel oppositional defiant disorder or conduct disorder, were assessed 24 months after injury.

Results: Of the children without preinjury oppositional defiant disorder, conduct …

Practical Quality Improvement Changes For A Low-Resourced Pediatric Unit, Phoebe H Yager, Kevin Mary Callans, Aubrey Samost-Williams, Jose A Bonilla, Luis J G Flores, Susana C A Hasbun, Angel E A Rodríguez, Alejandra B A Cárdenas, Alexia M L Núñez, Asitha D L Jayawardena, Evelyn J Zablah, Christopher J Hartnick

Faculty, Staff and Student Publications

Background: This work describes a sustainable and replicable initiative to optimize multi-disciplinary care and uptake of clinical best practices for patients in a pediatric intensive care unit in Low/Middle Income Countries and to understand the various factors that may play a role in the reduction in child mortality seen after implementation of the Quality Improvement Initiative.

Methods: This was a longitudinal assessment of a quality improvement program with the primary outcome of intubated pediatric patient mortality. The program was assessed 36 months following implementation of the quality improvement intervention using a t-test with linear regression to control for co-variates. …

Impact Of Covid-19 On Nationwide Pediatric Complicated Sinusitis Trends Throughout 2018–2022, Gianna Rosamilia, Kyung Hyun Lee, Soham Roy, Catherine Hart, Zhen Huang

Faculty, Staff and Student Publications

Objectives: To describe and analyze the trends of pediatric sinusitis cases from 2018 to 2022 across the country utilizing the Pediatric Hospital Information System (PHIS) database focusing on volumes, socioeconomics, and severity of cases.

Study design: Retrospective Cohort Study.

Methods: A retrospective cohort study using the Pediatric Health Information System (PHIS) database, which consists of 50 children's hospitals was performed. Regions were defined according to PHIS guidelines. We evaluated percentage of sinusitis cases demographic and socioeconomic information and subgrouped by region throughout 2018-2022.

Results: In all regions there were a greater number of sinusitis cases post-COVID compared to pre-COVID, with …

Increased Rate Of Multidrug-Resistant Gram-Negative Bacterial Infections In Hospitalized Immunocompromised Pediatric Patients, Sarah Khafaja, Yara Salameh, Celina F Boutros, Cherine Awad, Kawthar Faour, Nadim Tfaily, Sarah Merhi, Zeinab El Zein, Samer Bou Karroum, Dana Oweini, Danielle Fayad, George F Araj, Ramia Zakhour, Ghassan S Dbaibo

Faculty, Staff and Student Publications

Introduction: Multidrug resistant Gram-negative bacterial infections are considered a major public health threat. Immunocompromised pediatric patients are at a great risk of severe or overwhelming infections. The aim of this study was to describe the frequency of infections with multidrug resistant (MDR) Gram-negative bacteria (GNB) in immunocompromised pediatric patients and to determine the risk factors. In addition, we aimed to identify the antimicrobial resistance patterns of these isolates.

Materials and methods: This was a retrospective observational study conducted at the American University of Beirut Medical Center (AUBMC) from 2009 to 2017. The study included immunocompromised patients 18 years of age …

Responsive Neurostimulation For People With Drug-Resistant Epilepsy And Autism Spectrum Disorder, Madeline C Fields, Christina Marsh, Onome Eka, Emily A Johnson, Lara V Marcuse, Churl-Su Kwon, James J Young, Maite Lavega-Talbott, Mohankumar Kurukumbi, Gretchen Von Allmen, John Zempel, Daniel Friedman, Nathalie Jette, Anuradha Singh, Ji Yeoun Yoo, Leah Blank, Fedor Panov, Saadi Ghatan

Faculty, Staff and Student Publications

PURPOSE: Individuals with autism spectrum disorder (ASD) have comorbid epilepsy at much higher rates than the general population, and about 30% will be refractory to medication. Patients with drug-resistant epilepsy (DRE) should be referred for surgical evaluation, yet many with ASD and DRE are not resective surgical candidates. The aim of this study was to examine the response of this population to the responsive neurostimulator (RNS) System.

METHODS: This multicenter study evaluated patients with ASD and DRE who underwent RNS System placement. Patients were included if they had the RNS System placed for 1 year or more. Seizure reduction and …

Impact Of Maternal Depressive Symptoms On Offspring Executive Functions: A Systematic Review, Júlia De Souza Rodrigues, María Pastor-Valero, Lucas R Trambaiolli, Ana Beatriz Bozzini, Alicia Matijasevich

Faculty, Staff and Student Publications

OBJECTIVE: To conduct a thorough examination of the current understanding of the effect of maternal depression exposure on the executive functions (EFs) of offspring.

METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement, a comprehensive search for peer-reviewed cohort studies was performed on the MEDLINE (via PubMed), ScienceDirect, LILACS, PsycINFO, and SciELO databases. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation framework.

RESULTS: Thirty-three cohort studies from different countries, …

Practice Patterns Of Cardiovascular Magnetic Resonance Use In The Diagnosis Of Pediatric Myocarditis: A Survey-Based Study, Hannah M Jacobs, Jonathan H Soslow, Matthew D Cornicelli, Shae A Merves, Ruchira Garg, Mehul D Patel, Arpit Agarwal, Nilanjana Misra, Michael P Dilorenzo, M Jay Campbell, Jeremy Steele, Jennifer Co-Vu, Joshua D Robinson, Simon Lee, Jason N Johnson

Faculty, Staff and Student Publications

Background: Cardiovascular magnetic resonance (CMR) is used to diagnose myocarditis in adults and children based on the original Lake Louise criteria (LLC) and more recently the revised LLC. The major change included in the revised LLC was the incorporation of parametric mapping, which significantly increases the sensitivity and specificity of diagnosis. Subsequently, scientific statements have recommended the use of parametric mapping in the diagnosis of myocarditis in children. However, there are some challenges to parametric mapping that are unique to the pediatric population. Our goal is to characterize clinical CMR and parametric mapping practice patterns for the diagnosis of myocarditis …

Linking Trauma To Mental Health In The Statewide Texas Youth Depression And Suicide Research Network (Tx-Ydsrn), Lynnel C Goodman, Joshua S Elmore, Taryn L Mayes, Abu Minhajuddin, Holli Slater, Joseph C Blader, Israel Liberzon, Regina B Baronia, Emily J Bivins, Jacquelyn M Lagrone, Sierra Jackson, Sarah L Martin, Ryan Brown, Jair C Soares, Sarah M Wakefield, Madhukar H Trivedi

Faculty, Staff and Student Publications

Rates of youth depression and suicide are rising worldwide and represent public health crises. The present study examined the relationship between trauma history and symptoms of depression, suicidal ideation, and anxiety among suicidal and depressed youth. A diverse group of 1000 8-20-year-olds enrolled in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN) reported their trauma history (Traumatic Events Screening Inventory for Children) and symptoms of depression (Patient Health Questionnaire for adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder scale; GAD-7), and suicidality (Concise Health Risk Tracking scale; CHRT-SR). Nearly half of the sample reported exposure to multiple categories of traumatic …

Incorporating Variable Rbe In Impt Optimization For Ependymoma, Hadis Moazami Goudarzi, Gino Lim, David Grosshans, Radhe Mohan, Wenhua Cao

Faculty, Staff and Student Publications

PURPOSE: To study the dosimetric impact of incorporating variable relative biological effectiveness (RBE) of protons in optimizing intensity-modulated proton therapy (IMPT) treatment plans and to compare it with conventional constant RBE optimization and linear energy transfer (LET)-based optimization.

METHODS: This study included 10 pediatric ependymoma patients with challenging anatomical features for treatment planning. Four plans were generated for each patient according to different optimization strategies: (1) constant RBE optimization (ConstRBEopt) considering standard-of-care dose requirements; (2) LET optimization (LETopt) using a composite cost function simultaneously optimizing dose-averaged LET (LET

RESULTS: We found that the LETopt plans consistently achieved increased LET in …

Race, Ethnicity, Language, And The Treatment Of Low-Risk Febrile Infants, Colleen K Gutman, Paul L Aronson, Nidhi V Singh, Michelle L Pickett, Kamali Bouvay, Rebecca S Green, Britta Roach, Hannah Kotler, Jessica L Chow, Emily A Hartford, Mark Hincapie, Ryan St Pierre-Hetz, Jessica Kelly, Laura Sartori, Jennifer A Hoffmann, Jacqueline B Corboy, Kelly R Bergmann, Bolanle Akinsola, Vanessa Ford, Natalie J Tedford, Theresa T Tran, Sasha Gifford, Amy D Thompson, Andrew Krack, Mary Jane Piroutek, Samantha Lucrezia, Sunhee Chung, Nabila Chowdhury, Kathleen Jackson, Tabitha Cheng, Christian D Pulcini, Nirupama Kannikeswaran, Larissa L Truschel, Karen Lin, Jamie Chu, Neh D Molyneaux, Myto Duong, Leslie Dingeldein, Jerri A Rose, Carly Theiler, Sonali Bhalodkar, Emily Powers, Muhammad Waseem, Ahmed Lababidi, Xinyu Yan, Xiang-Yang Lou, Rosemarie Fernandez, K Casey Lion

Faculty, Staff and Students Publications

IMPORTANCE: Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language.

OBJECTIVE: To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection.

DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 …

Preteen Suicide Risk Screening In The Pediatric Outpatient Setting: A Clinical Pathway, Laura Hennefield, Ellen-Ge Denton, Peggy G Chen, Arielle H Sheftall, Lynsay Ayer

2020-Current year OA Pubs

We are in a youth mental health crisis with unprecedented and staggeringly high rates of suicidal ideations and suicide behaviors in preteens. In the United States, 14.5% of children aged 9-10 have experienced suicidal thoughts and behaviors, including 1.3% with a suicide attempt. American Academy of Pediatrics guidelines call for universal suicide risk screening of youth aged 12 years and older during preventative health care visits and screening in preteens aged 8-11 years when clinically indicated. However, what constitutes a clinical indication at 8-11 years can be difficult to systematically detect, and pediatric practitioners may not be equipped with necessary …

Characterization And Z-Score Calculation Of Cardiovascular Magnetic Resonance Imaging Parameters In Patients After The Fontan Operation: A Fontan Outcome Registry Using Cardiovascular Magnetic Resonance Examinations Study, Tarek Alsaied, Manish Aggarwal, Et Al.

2020-Current year OA Pubs

BACKGROUND: Cardiac magnetic resonance (CMR) offers valuable hemodynamic insights post-Fontan, but is limited by the absence of normative single ventricle data. The Fontan Outcomes Registry using CMR Examinations (FORCE) is a large international Fontan-specific CMR registry. This study used FORCE registry data to evaluate expected CMR ventricular size/function and create Fontan-specific z-scores adjusting for ventricular morphology (VM) in healthier Fontan patients.

METHODS: "Healthier" Fontan patients were defined as patients free of adverse outcomes, who are New York Heart Association class I, have mild or less valve disease, and < 30% aortopulmonary collateral burden. General linear modeling was performed on 70% of the dataset to create z-scores for volumes and function. Models were tested using the remainder (30%) of the data. The z-scores were compared between children and adults. The z-scores were also compared between "healthier" Fontan and patients with adverse outcomes (death, listing for transplantation, or multiorgan disease).

RESULTS: The "healthier" Fontan population included 885 patients (15.0 ± 7.6 years) …

Protein Biomarkers Gdf15 And Fgf21 To Differentiate Mitochondrial Hepatopathies From Other Pediatric Liver Diseases, Johan L K Van Hove, Marisa W Friederich, Dana K Strode, Roxanne A Van Hove, Kristen R Miller, Rohit Sharma, Hardik Shah, Jane Estrella, Linda Gabel, Simon Horslen, Rohit Kohli, Mark A Lovell, Alexander G Miethke, Jean P Molleston, Rene Romero, James E Squires, Estella M Alonso, Stephen L Guthery, Binita M Kamath, Kathleen M Loomes, Philip Rosenthal, Krupa R Mysore, Laurel A Cavallo, Pamela L Valentino, John C Magee, Shikha S Sundaram, Ronald J Sokol, Childhood Liver Disease Research Network (Children)

Faculty, Staff and Students Publications

BACKGROUND: Mitochondrial hepatopathies (MHs) are primary mitochondrial genetic disorders that can present as childhood liver disease. No recognized biomarkers discriminate MH from other childhood liver diseases. The protein biomarkers growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 (FGF21) differentiate mitochondrial myopathies from other myopathies. We evaluated these biomarkers to determine if they discriminate MH from other liver diseases in children.

METHODS: Serum biomarkers were measured in 36 children with MH (17 had a genetic diagnosis); 38 each with biliary atresia, α1-antitrypsin deficiency, and Alagille syndrome; 20 with NASH; and 186 controls.

RESULTS: GDF15 levels compared to controls were …

A Comprehensive Analysis Of Neuroblastoma Incidence, Survival, And Racial And Ethnic Disparities From 2001 To 2019, Kevin Campbell, David A Siegel, Puja J Umaretiya, Shifan Dai, Andras Heczey, Philip J Lupo, Jeremy M Schraw, Trevor D Thompson, Michael E Scheurer, Jennifer H Foster

Faculty, Staff and Students Publications

BACKGROUND: We characterize the incidence and 5-year survival of children and adolescents with neuroblastoma stratified by demographic and clinical factors based on the comprehensive data from United States Cancer Statistics (USCS) and the National Program of Cancer Registries (NPCR).

METHODS: We analyzed the incidence of neuroblastoma from USCS (2003-2019) and survival data from NPCR (2001-2018) for patients less than 20 years old. Incidence trends were calculated by average annual percent change (AAPC) using joinpoint regression. Differences in relative survival were estimated comparing non-overlapping confidence intervals (CI).

RESULTS: We identified 11,543 primary neuroblastoma cases in USCS. Age-adjusted incidence was 8.3 per …

Associations Of Chronic Pain With Psychosocial Outcomes After Traumatic Brain Injury: A Nidilrr And Va Tbi Model Systems Collaborative Project, Robin Hanks, Jessica M Ketchum, Mackenzie Peckham, Mitch Sevigny, Angelle M Sander, Aaron M Martin, Stephanie Agtarap, Cynthia L Beaulieu, Librada Callender, Flora M Hammond, Jean Lengenfelder, Amanda R Rabinowitz, William C Walker, Jeanne M Hoffman, Cynthia Harrison-Felix, Risa Nakase-Richardson

Faculty, Staff and Students Publications

OBJECTIVE: To examine the differences in participation, life satisfaction, and psychosocial outcomes among individuals with traumatic brain injury (TBI) endorsing current, past, or no chronic pain.

SETTING: Community.

PARTICIPANTS: Three thousand eight hundred four TBI Model Systems participants 1 to 30 years of age postinjury classified into 1 of 3 groups based on their pain experience: current pain, past pain, no pain completed a Pain Survey at their usual follow-up appointment which on average was approximately 8 years postinjury.

DESIGN: Multisite, cross-sectional observational cohort study.

MAIN OUTCOME MEASURES: Sociodemographic and injury characteristics and psychosocial outcomes (ie, satisfaction with life, depression, …