Medical Specialties Commons^™

Anticipated Resource Utilization For Injury Versus Non-Injury Pediatric Visits To Emergency Departments, Mark R. Zonfrillo, Michelle L. Macy, Lawrence J. Cook, Tomohiko Funai, Rachel Stanley, James M. Chamberlain, For The Pediatric Emergency Care Applied Research Network (Pecarn)

Pediatrics Faculty Publications

Background

Childhood injuries are increasingly treated in emergency departments (EDs) but the relationship between injury severity and ED resource utilization has not been evaluated. The objective of this study was to compare resource utilization for pediatric injury-related ED visits across injury-severity levels and with non-injury visits, using standardized, validated scales.

Methods

A retrospective analysis of 2004-2008 ED visits from the Pediatric Emergency Care Applied Research Network Core Data Project. Maximum Abbreviated Injury Scale severity (MAIS) and Severity Classification System (SCS) scores were calculated and compared. MAIS and SCS are ordinal scales from 1 (minor injury) to 6, and 1 (low …

Molecular And Behavioral Profiling Of Dbx1-Derived Neurons In The Arcuate, Lateral And Ventromedial Hypothalamic Nuclei., Katie Sokolowski, Tuyen Tran, Shigeyuki Esumi, Yasmin Kamal, Livio Oboti, Julieta Lischinsky, Meredith Goodrich, Andrew Lam, Margaret Carter, Yasushi Nakagawa, Joshua G. Corbin

Pediatrics Faculty Publications

BACKGROUND: Neurons in the hypothalamus function to regulate the state of the animal during both learned and innate behaviors, and alterations in hypothalamic development may contribute to pathological conditions such as anxiety, depression or obesity. Despite many studies of hypothalamic development and function, the link between embryonic development and innate behaviors remains unexplored. Here, focusing on the embryonically expressed homeodomain-containing gene Developing Brain Homeobox 1 (Dbx1), we explored the relationship between embryonic lineage, post-natal neuronal identity and lineage-specific responses to innate cues. We found that Dbx1 is widely expressed across multiple developing hypothalamic subdomains. Using standard and inducible fate-mapping to …

"When Should I Tell?": Perspectives On Disclosure To Their Children Among Parents With Perinatally Acquired Hiv., Cynthia D Fair, Hannah Allen, Constance Trexler, Janet Osherow, Lawrence D'Angelo

Pediatrics Faculty Publications

Adolescents and young adults (AYA) with perinatally acquired HIV (PHIV) engage in developmentally expected behaviors, such as establishing relationships and having children. Previous research has focused on pregnancy management/outcomes of AYA with PHIV. However, little research has focused on the parenting experiences of this emerging cohort and on their views of disclosure to their offspring. This article examines data from a pilot study of five AYA parents with PHIV on disclosure to their child(ren) (n = 7, 6 HIV-negative). Disclosure of their own HIV status to their children is on the minds of parents with PHIV. However, few currently have …

The Clinical Outcome Study For Dysferlinopathy, Elizabeth Harris, Catherine Bladen, Anna Mayhew, Meredith James, Karen Bettinson, Avital Cnaan, The Jain Cos Consortium

Pediatrics Faculty Publications

Objective: To describe the baseline clinical and functional characteristics of an international cohort of 193 patients with dysferlinopathy.

Methods: The Clinical Outcome Study for dysferlinopathy (COS) is an international multicenter study of this disease, evaluating patients with genetically confirmed dysferlinopathy over 3 years. We present a cross-sectional analysis of 193 patients derived from their baseline clinical and functional assessments.

Results: There is a high degree of variability in disease onset, pattern of weakness, and rate of progression. No factor, such as mutation class, protein expression, or age at onset, accounted for this variability. Among patients with clinical diagnoses of Miyoshi …

Incidence Of X And Y Chromosomal Aneuploidy In A Large Child Bearing Population., Carole Samango-Sprouse, Eser Kırkızlar, Megan P Hall, Patrick Lawson, Zachary Demko, Susan M Zneimer, Kirsten J Curnow, Susan Gross, Andrea Gropman

Pediatrics Faculty Publications

BACKGROUND: X&Y chromosomal aneuploidies are among the most common human whole-chromosomal copy number changes, but the population-based incidence and prevalence in the child-bearing population is unclear.

METHODS: This retrospective analysis of prospectively collected data leveraged a routine non-invasive prenatal test (NIPT) using parental genotyping to estimate the population-based incidence of X&Y chromosome variations in this population referred for NIPT (generally due to advanced maternal age).

RESULTS: From 141,916 women and 29,336 men, 119 X&Y chromosomal abnormalities (prevalence: 1 in 1,439) were identified. Maternal findings include: 43 cases of 45,X (40 mosaic); 30 cases of 47,XXX (12 mosaic); 3 cases of …

Safe Infant Sleep Interventions: What Is The Evidence For Successful Behavior Change?, Rachel Y. Moon, Fern R Hauck, Eve R Colson

Pediatrics Faculty Publications

Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for >4000 deaths annually in the USA. Evidence-based recommendations for reducing the risk of sleep-related deaths have been published, but some caregivers resist adoption of these recommendations. Multiple interventions to change infant sleep-related practices of parents and professionals have been implemented. In this review, we will discuss illustrative examples of safe infant sleep interventions and evidence of their effectiveness. Facilitators of and barriers to change, as well as the limitations of the data currently available for these interventions, …

Age-Related Effect Of Viral-Induced Wheezing In Severe Prematurity, Geovanny F. Perez, Amisha Jain, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Mary C. Rose, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Premature children are prone to severe viral respiratory infections in early life, but the age at which susceptibility peaks and disappears for each pathogen is unclear.

Methods: A retrospective analysis was performed of the age distribution and clinical features of acute viral respiratory infections in full-term and premature children, aged zero to seven years.

Results: The study comprised of a total of 630 hospitalizations (n = 580 children). Sixty-seven percent of these hospitalizations occurred in children born full-term (>37 weeks), 12% in preterm (32–37 weeks) and 21% in severely premature children (<32 weeks). The most common viruses identified were rhinovirus (RV; 60%) and respiratory syncytial virus (RSV; 17%). Age-distribution analysis of each virus identified that severely premature children had a higher relative frequency of RV and RSV in their first three years, relative to preterm or full-term children. Additionally, the probability of RV- or RSV-induced wheezing was higher overall in severely premature children less than three years old.

Conclusions: Our results indicate that the vulnerability …

Dc Beadm1™: Towards An Optimal Transcatheter Hepatic Tumour Therapy., Andrew L Lewis, Matthew R Dreher, Vincent O'Byrne, David Grey, Marcus Caine, Anthony Dunn, Yiqing Tang, Brenda Hall, Kirk D Fowers, Carmen Gacchina Johnson, Karun V. Sharma, Bradford J Wood

Pediatrics Faculty Publications

Clinical use of DC Bead™ loaded with doxorubicin (DEBDOX™) or irinotecan (DEBIRI™), for the treatment of primary and secondary tumours of the liver respectively, is showing great promise. Recently there has been a tendency to select smaller bead size ranges to treat tumours in an effort to allow more drug dose to be administered, improve tumoural penetration and resultant drug delivery and tumour coverage. Herein we describe the development and performance characterisation of a new DC Bead size range (DC BeadM1 (TM), 70-150 μm) capable of an increased bead delivery in the distal vasculature, corresponding to greater tumour coverage and …

Examination Of Reticulocytosis Among Chronically Transfused Children With Sickle Cell Anemia., Megha Kaushal, Colleen Byrnes, Zarir Khademian, Natalie Duncan, Naomi L.C. Luban, Jeffery L Miller, Ross M. Fasano, Emily Riehm Meier

Pediatrics Faculty Publications

Sickle cell anemia (SCA) is an inherited hemolytic anemia with compensatory reticulocytosis. Recent studies have shown that increased levels of reticulocytosis during infancy are associated with increased hospitalizations for SCA sequelae as well as cerebrovascular pathologies. In this study, absolute reticulocyte counts (ARC) measured prior to transfusion were analysed among a cohort of 29 pediatric SCA patients receiving chronic transfusion therapy (CTT) for primary and secondary stroke prevention. A cross-sectional flow cytometric analysis of the reticulocyte phenotype was also performed. Mean duration of CTT was 3.1 ± 2.6 years. Fifteen subjects with magnetic resonance angiography (MRA) -vasculopathy had significantly higher …

Supersilac Quantitative Proteome Profiling Of Murine Middle Ear Epithelial Cell Remodeling With Nthi, Stephanie Val, Katelyn Burgett, Kristy J. Brown, Diego A. Preciado

Pediatrics Faculty Publications

Background

Chronic Otitis Media with effusion (COME) develops after sustained inflammation and is characterized by secretory middle ear epithelial metaplasia and effusion, most frequently mucoid. Non-typeable Haemophilus influenzae (NTHi), the most common acute Otitis Media (OM) pathogen, is postulated to promote middle ear epithelial remodeling in the progression of OM from acute to chronic. The goals of this study were to examine histopathological and quantitative proteomic epithelial effects of NTHi challenge in a murine middle ear epithelial cell line.

Methods

NTHi lysates were generated and used to stimulate murine epithelial cells (mMEEC) cultured at air-liquid interface over 48 hours– …

Sexual Minority (Lgbtq) Youth And Role Of Health Care Provider, Mandakini Sadhir, Stephanie J. Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Adolescence is a time period of physical, psychological and cognitive changes. It is an important phase for an individual to discover who they really are (self-identity), how they are perceived (social identity) and how they fit into the environment they live in.¹ One of the major tasks of adolescence is sexual maturation and sexual and /or gender identity development.² Adolescents who are developing as gay, lesbian, bisexual or transgender face a tremendous challenge of establishing their identity which is often complex.³ They cope with the feelings of being different and are in constant dilemmas about revealing their …

Role Of Elosulfase Alfa In Mucopolysaccharidosis Iva., Debra S. Regier, Pranoot Tanpaiboon

Pediatrics Faculty Publications

Mucopolysaccharidosis type IVA (MPS IVA or Morquio A) is an autosomal recessive lysosomal storage disease which results in a striking skeletal phenotype, but does not negatively impact the intellect of the patient. MPS IVA has a phenotypic continuum that ranges from a severe and rapidly progressing form to a slowly progressive form. The clinical diagnosis is often made in the preschool years based on abnormal bone findings on physical examination and dysplasia on radiographic imaging. Supportive care has been the mainstay in caring for patients. Orthopedic physicians often form the core of the care team due to the early and …

Three Year Old Male With Multiple Dieulafoy Lesions Treated With Epinephrine Injections Via Therapeutic Endoscopy, Christina L. Baldwin, Michael Wilsey

Pediatrics Faculty Publications

Dieulafoy lesions, vascular anomalies typically found along the gastrointestinal tract, have been viewed as rare and obscure causes of sudden intestinal bleeding, especially in pediatric patients. Since their discovery in the late 19th century, the reported incidence has increased. This is due to an increased awareness of, and knowledge about, their presentation and to advanced endoscopic diagnosis and therapy. Our patient was a three-year-old male, without a complex medical history. He presented to the emergency department with acute hematemesis with blood clots and acute anemia requiring blood transfusion. Endoscopy revealed four isolated Dieulafoy lesions along the lesser curvature of the …

Incorporating Pharmacodynamic Considerations Into Caffeine Therapeutic Drug Monitoring In Preterm Neonates, Tian Yu, Alfred H. Balch, Robert Ward, E. Kent Korgenski, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Background

This study sought to assess the pharmacokinetic and pharmacodynamic relationships of caffeine citrate therapy in preterm neonates who had therapeutic drug monitoring (TDM) in the post-extubation period.

Methods

A retrospective observational study was conducted in preterm neonates who received caffeine citrate therapy for apnea of prematurity and had TDM done in the post-extubation period between January 2006 and October 2011. The relationships between pharmacodynamic effects (heart rate, respiratory rate, episodes of apnea, adverse events) and caffeine serum concentrations were explored.

Results

A total of 177 blood samples were obtained from 115 preterm neonates with a median (range) gestational age …

Amikacin Pharmacokinetics In Pediatric Patients With Burn Injuries Compared To Those With Oncology Conditions, Xiaoxi Liu, Anne Smits, Tian Yu, Stephanie Wead, Alice Neely, Richard J. Kagan, Daniel P. Healy, Karel Allegaert, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Physiologic changes due to disease status can lead to highly variable pharmacokinetics (PK) of amikacin in children. Therefore, considerations should be given when determining optimal amikacin does for patients with a specific diseases. Improved understanding of factors influencing PD can allow for the optimizing of dosage regimens to reduce adverse effects.

The aim of the study was to undertake a comparative pharmacometic analysis of amikacin use in pediatric patients with burn injuries verses those with oncology conditions.

Predictors Of Increasing Injury Severity Across Suspected Recurrent Episodes Of Non-Accidental Trauma, Jonathan D. Thackeray, Peter Minneci, Jennifer N. Cooper, Jonathan I. Groner, Katherine Deans

Pediatrics Faculty Publications

Background

Little is known about how the severity of injury changes with recurrent events of suspected non-accidental trauma (NAT). Our objective was to determine risk factors for escalating severity of injury in children with multiple events of suspected NAT.

Methods

This retrospective longitudinal cohort study included children from a pediatric Medicaid accountable care organization with ≥ 1 non-birth related episode containing an International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology code for NAT or a skeletal survey between 2007 and 2011. Subsequent potential NAT events were defined as independent episodes with codes for either NAT, a …

Challenges Of Internet And Social Media Use In Adolescents, Mandakini Sadhir, Stephanie J. Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

There has been tremendous growth in use of technology in recent decades. The majority of teens now have access to a desktop/laptop computer as well as a gaming console and smartphone. With growing internet and social media use teens now face challenges including cyberbullying, sexting and problematic internet use that result in various health implications. Health care providers are in unique position to educate adolescents and families about current challenges and provide age appropriate guidance to promote healthy internet behaviors.

Effect Of Vitamins C And E On Endothelial Function In Type 1 Diabetes Mellitus, Rachel-Marie Cazeau, Hong Huang, John A. Bauer, Robert P. Hoffman

Pediatrics Faculty Publications

Background/Objectives. Endothelial dysfunction due to hyperglycemia-induced oxidative damage is an important predictor of future cardiovascular risk in patients with type 1 diabetes mellitus (T1DM) and is present in adolescent T1DM. We hypothesized that combined treatment with the antioxidant vitamins C and E might improve endothelial function (EF) and other biochemical risk factors in adolescents with T1DM. Subjects/Methods. Open-label antioxidant supplementation was given for six weeks with endpoint measurements collected at baseline and study completion. Endpoints measured included EF and plasma measurements of biochemical endothelial risk. Results. Two males and 7 females were studied. Mean age was 12.9 ± 0.9 yrs; …

Effect Of Metformin On Body Mass Index In Adolescent Females With Polycystic Ovary Syndrome, Alissa Briggs, Mandakini Sadhir, Maya Todd, Hatim A. Omar

Pediatrics Faculty Publications

Polycystic ovary syndrome (PCOS) is often associated with obesity, insulin resistance, irregular menstrual periods and pelvic pain. Treatment involves hormonal methods for regulation of menstrual cycle, lifestyle changes and metformin for improving insulin resistance and weight. The aim of our study was to compare changes in body mass index (BMI) of adolescent female with PCOS treated with metformin as compared to lifestyle modification only. Participants: Adolescent and young adult females aged I0-25 years diagnosed with PCOS seen for at least two visits for at least one year on the same treatment. Based on treatment plan, participants were categorized as metformin …

Chinese Adolescent In Hong Kong, Mandakini Sadhir

Pediatrics Faculty Publications

No abstract provided.

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80 % of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during …

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80% of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during childhood …

Prospective Testing And Redesign Of A Temporal Biomarker Based Risk Model For Patients With Septic Shock: Implications For Septic Shock Biology, Hector R. Wong, Natalie R. Cvijanovich, Nick Anas, Geoffrey L. Allen, Neal J. Thomas, Robert J. Freishtat, +17 Additional Authors

Pediatrics Faculty Publications

The temporal version of the pediatric sepsis biomarker risk model (tPERSEVERE) estimates the risk of a complicated course in children with septic shock based on biomarker changes from days 1 to 3 of septic shock. We validated tPERSEVERE performance in a prospective cohort, with an a priori plan to redesign tPERSEVERE if it did not perform well. Biomarkers were measured in the validation cohort (n = 168) and study subjects were classified according to tPERSEVERE. To redesign tPERSEVERE, the validation cohort and the original derivation cohort (n = 299) were combined and randomly allocated to training (n = 374) and …

Overweight Predicts Poorer Exercise Capacity In Congenital Heart Disease Patients, Karen Kuehl, Alicia Tucker, Munziba Khan, Paula Goldberg, E. Anne Greene, Megan Smith

Pediatrics Faculty Publications

Background

Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults.

Methods

Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender …

Evaluation Of An Innovative Leadership Training Program For Chinese Students: Subjective Outcome Evaluation, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

As a part of the Global Youth Leadership Program (GYLP), a 30-h “Service Leadership” subject was provided to 48 undergraduate students studying at The Hong Kong Polytechnic University (PolyU) or Peking University (PKU). This study evaluated the subjective outcomes of the “Service Leadership” subject, including students’ views on the course contents, lecturers, and perceived benefits from the course. A majority of students in the program showed very positive perceptions of the course content, lecturers, and course benefits, with more than 85% of the students indicating that they were very satisfied with this subject and would suggest their friends to take …

Segmented Nitinol Guidewires With Stiffness-Matched Connectors For Cardiovascular Magnetic Resonance Catheterization: Preserved Mechanical Performance And Freedom From Heating., Burcu Basar, Toby Rogers, Kanishka Ratnayaka, Adrienne E Campbell-Washburn, Jonathan R Mazal, William H Schenke, +4 Additional Authors

Pediatrics Faculty Publications

BACKGROUND: Conventional guidewires are not suitable for use during cardiovascular magnetic resonance (CMR) catheterization. They employ metallic shafts for mechanical performance, but which are conductors subject to radiofrequency (RF) induced heating. To date, non-metallic CMR guidewire designs have provided inadequate mechanical support, trackability, and torquability. We propose a metallic guidewire for CMR that is by design intrinsically safe and that retains mechanical performance of commercial guidewires.

METHODS: The NHLBI passive guidewire is a 0.035" CMR-safe, segmented-core nitinol device constructed using short nitinol rod segments. The electrical length of each segment is less than one-quarter wavelength at 1.5 Tesla, which eliminates …

Use Of Modeling And Simulation In The Design And Conduct Of Pediatric Clinical Trials And The Optimization Of Individualized Dosing Regimens, Chris Stockmann, J. S. Barrett, Jessica K. Roberts, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Mathematical models of drug action and disease progression can inform pediatric pharmacotherapy. In this tutorial, we explore the key issues that differentiate pediatric from adult pharmacokinetic (PK) / pharmacodynamic (PD) studies, describe methods to calculate the number of participants to be enrolled and the optimal times at which blood samples should be collected, and therapeutic drug monitoring methods for individualizing pharmacotherapy. The development of pediatric‐specific drug dosing dashboards is also highlighted, with an emphasis on clinical‐relevance and ease of use.

The Role Of Self-Leadership In Service Leadership, Daniel T. L. Shek, Cecilia M. S. Ma, Ting Ting Liu, Andrew M. H. Siu

Pediatrics Faculty Publications

One of the core beliefs of the service leadership curriculum proposed by the Hong Kong Institute of Service Leadership and Management is that ‘Every day, every human occupies a position of leadership and possesses the potential to improve his leadership quality and effectiveness’. This core belief is in sharp contrast to some of the mainstream leadership theories that only a few people and elites can be leaders. In this paper, a lecture plan regarding the nature of self-leadership with reference to service leadership is presented. The topics include definitions and concepts of self-leadership, relationships between self-leadership and service leadership, ways …

General Education Program In A New 4-Year University Curriculum In Hong Kong: Findings Based On Multiple Evaluation Strategies, Daniel T. L. Shek, Lu Yu, Florence K. Y. Wu

Pediatrics Faculty Publications

Since the 2012−2013 academic year, undergraduate programs in Hong Kong have been changed from 3 years to 4 years, with the additional year focusing primarily on general education. A new general education framework entitled General University Requirements (GUR) implemented at The Hong Kong Polytechnic University (PolyU) was examined in a 5-year longitudinal project. Based on different evaluation strategies, including objective outcome evaluation, subjective outcome evaluation and qualitative evaluation (focus groups, case studies, and document analyses), findings consistently showed that students had positive perceptions of the subject content, teachers as well as teaching and learning methods in GUR subjects. A large …

Evaluation Of A General Education Program In Hong Kong: Secondary Data Analyses Based On Student Feedback Questionnaires, Daniel T. L. Shek, Lu Yu, Joe Ngai

Pediatrics Faculty Publications

The General University Requirements (GUR) at The Polytechnic University of Hong Kong (PolyU) has been developed and implemented since the 2012–13 academic year under the reform of education system in Hong Kong. To examine the effectiveness of GUR at PolyU, the present study investigated student’s subjective perception in the academic years of 2012–13 and 2013–14 using the Student Feedback Questionnaires. Results showed that the GUR subjects were generally well-received by the students. Besides, students held different perceptions of different GUR components, and there was improvement in students’ learning experience and staff teaching over time. While there was an increased satisfaction …