Medical Specialties Commons^™

Treatment Guidelines For Hyponatremia: Stay The Course, Richard H Sterns, Helbert Rondon-Berrios, Horacio J Adrogué, Tomas Berl, Volker Burst, David M Cohen, Mirjam Christ-Crain, Martin Cuesta, Guy Decaux, Michael Emmett, Aoife Garrahy, Fabrice Gankam-Kengne, John K Hix, Ewout J Hoorn, Kamel S Kamel, Nicolaos E Madias, Alessandro Peri, Julie Refardt, Mitchell H Rosner, Mark Sherlock, Stephen M Silver, Alain Soupart, Chris J Thompson, Joseph G Verbalis

Faculty, Staff and Students Publications

International guidelines designed to minimize the risk of complications that can occur when correcting severe hyponatremia have been widely accepted for a decade. On the basis of the results of a recent large retrospective study of patients hospitalized with hyponatremia, it has been suggested that hyponatremia guidelines have gone too far in limiting the rate of rise of the serum sodium concentration; the need for therapeutic caution and frequent monitoring of the serum sodium concentration has been questioned. These assertions are reminiscent of a controversy that began many years ago. After reviewing the history of that controversy, the evidence supporting …

Early Immune Factors Associated With The Development Of Post-Acute Sequelae Of Sars-Cov-2 Infection In Hospitalized And Non-Hospitalized Individuals, Jacqueline M Leung, Michelle J Wu, Pouya Kheradpour, Chen Chen, Katherine A Drake, Gary Tong, Vanessa K Ridaura, Howard C Zisser, William A Conrad, Natalia Hudson, Jared Allen, Christopher Welberry, Celine Parsy-Kowalska, Isabel Macdonald, Victor F Tapson, James N Moy, Christopher R Defilippi, Ivan O Rosas, Mujeeb Basit, Jerry A Krishnan, Sairam Parthasarathy, Bellur S Prabhakar, Mirella Salvatore, Charles C Kim

Faculty, Staff and Students Publications

BACKGROUND: Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to post-acute sequelae of SARS-CoV-2 (PASC) that can persist for weeks to years following initial viral infection. Clinical manifestations of PASC are heterogeneous and often involve multiple organs. While many hypotheses have been made on the mechanisms of PASC and its associated symptoms, the acute biological drivers of PASC are still unknown.

METHODS: We enrolled 494 patients with COVID-19 at their initial presentation to a hospital or clinic and followed them longitudinally to determine their development of PASC. From 341 patients, we conducted multi-omic profiling on peripheral blood …

Adipose Tissue Lymphocytes And Obesity, Feng Gao, Benjamin Litchfield, Huaizhu Wu

Faculty, Staff and Students Publications

Obesity is associated with chronic inflammation in adipose tissue (AT), mainly evidenced by infiltration and phenotypic changes of various types of immune cells. Macrophages are the major innate immune cells and represent the predominant immune cell population within AT. Lymphocytes, including T cells and B cells, are adaptive immune cells and constitute another important immune cell population in AT. In obesity, CD8+ effector memory T cells, CD4+ Th1 cells, and B2 cells are increased in AT and promote AT inflammation, while regulatory T cells and Th2 cells, which usually function as immune regulatory or type 2 inflammatory cells, are reduced …

Neutrophil-Derived Activin-A Moderates Their Pro-Netotic Activity And Attenuates Collateral Tissue Damage Caused By Influenza A Virus Infection, Georgios Divolis, Evgenia Synolaki, Athanasia Doulou, Ariana Gavriil, Christina C Giannouli, Anastasia Apostolidou, Martyn L Foster, Martin M Matzuk, Panagiotis Skendros, Ioanna-Evdokia Galani, Paschalis Sideras

Faculty, Staff and Students Publications

BACKGROUND: Pre-neutrophils, while developing in the bone marrow, transcribe the Inhba gene and synthesize Activin-A protein, which they store and release at the earliest stage of their activation in the periphery. However, the role of neutrophil-derived Activin-A is not completely understood.

METHODS:To address this issue, we developed a neutrophil-specific Activin-A-deficient animal model (S100a8-Cre/Inhba fl/fl mice) and analyzed the immune response to Influenza A virus (IAV) infection. More specifically, evaluation of body weight and lung mechanics, molecular and cellular analyses of bronchoalveolar lavage fluids, flow cytometry and cell sorting of lung cells, as well as histopathological analysis of lung tissues, …

Perspectives From Cystinosis: Access To Healthcare May Be A Confounding Factor For Variant Classification, Chen-Han Wilfred Wu, Alicja Tomaszewski, Louisa Stark, Fernando Scaglia, Ewa Elenberg, Fredrick R Schumaker

Faculty, Staff and Students Publications

Genetic variability persists across diverse populations, and it may impact the characterization of heritable diseases in different ancestral groups. Cystinosis is a metabolic disease caused by pathogenic variants in the CTNS gene causing the cellular accumulation of cystine. We attempted to assess the currently poorly characterized prevalence of cystinosis by employing a population genetics methodology. However, we encountered a significant challenge due to genetic variations across different populations, and the consideration of potential disparities in access to healthcare made our results inconclusive. Pathogenic CTNS variants were identified in a representative global population cohort using The Human Gene Mutation Database (HGMD) …

Designing A Best Possible Caregiver History To Facilitate Disposition Planning For Older Adults In Emergency Departments, Karen De Sola-Smith, Matthew Growdon, Anita N Chary, Jennifer D Portz, Kenneth Lam

Faculty, Staff and Students Publications

Introduction: Detailed information about caregivers is crucial for planning disposition from emergency departments (EDs), but it is unclear what specific information is useful for ED clinicians and how that information should be presented.

Methods: We used a Design Thinking approach to develop a standardized format-which we call a "Best Possible Caregiver History" (BPCH)-for displaying useful caregiver information to ED clinicians. The key steps of this approach are needfinding, followed by iterative cycles of ideation, rapid prototyping, and testing. For needfinding, we used semi-structured interviews of four ED clinicians on current practices for discovering and documenting caregiver information. For ideation and …

A Woman With Bilateral Pheochromocytoma And Tuberous Sclerosis Complex, Maleeha Zahid, Shalini Koshy, Jawairia Shakil, Helmi S Khadra, Luan D Truong, Archana R Sadhu

Faculty, Staff and Students Publications

BACKGROUND/OBJECTIVE: Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors. Here, we report an unusual case of synchronous PPGL in an asymptomatic patient with tuberous sclerosis complex (TSC).

CASE REPORT: A 49-year-old woman with a history of TSC and end-stage renal disease was referred for evaluation of bilateral adrenal and retroperitoneal masses. She denied chest pain, palpitations, headaches, or previous hypertensive crisis. The laboratory test results showed a plasma normetanephrine level of 20.20 nmol/L (normal range, 0.00-0.89 nmol/L) and plasma chromogranin A level Chromogranin A (CgA) levels of 1518 ng/mL (normal range, 0-103 ng/mL). The plasma metanephrine level was normal. After …

An Interactive, Case-Based Workshop On The Patient Experience For Internal Medicine Residents, Julian Swanson, Doris Lin, Kristen A Staggers, Priti Dangayach

Faculty, Staff and Students Publications

INTRODUCTION: The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care.

METHODS: We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to …

Clinical Utility Of Plasma Microbial Cell-Free Dna Sequencing In Determining Microbiologic Etiology Of Infectious Syndromes In Solid Organ Transplant Recipients, Jesal R Shah, Muhammad Rizwan Sohail, Todd Lasco, John A Goss, Mayar Al Mohajer, Sarwat Khalil

Faculty, Staff and Students Publications

BACKGROUND: Metagenomic next-generation sequencing (mNGS) is increasingly being used for microbial detection in various infectious syndromes. However, data regarding the use of mNGS in solid organ transplant recipients (SOTR) are lacking.

OBJECTIVES: To describe and analyze real-world clinical impact of mNGS using plasma microbial cell-free DNA (mcfDNA) in SOTR.Design: Retrospectively reviewed all adult SOTR who underwent mNGS testing using plasma mcfDNA at Baylor St Luke's Medical Center from March 2017 to February 2023.

METHODS: Clinical impact (positive, neutral, and negative) was assessed using standardized objective criteria. Three Infectious Diseases physicians independently performed clinical adjudication to determine the correlation of mcfDNA …

Spatial Transcriptomics Resolve An Emphysema-Specific Lymphoid Follicle B Cell Signature In Chronic Obstructive Pulmonary Disease, Joselyn Rojas-Quintero, Scott A Ochsner, Felicia New, Prajan Divakar, Chen Xi Yang, Tianshi David Wu, Jerid Robinson, Darshan Shimoga Chandrashekar, Nicholas E Banovich, Ivan O Rosas, Maor Sauler, Farrah Kheradmand, Amit Gaggar, Camilla Margaroli, Raul San Jose Estepar, Neil J Mckenna, Francesca Polverino

Faculty, Staff and Students Publications

Rationale

Within chronic obstructive pulmonary disease (COPD), emphysema is characterized by a significant yet partially understood B cell immune component.

Objectives

To characterize the transcriptomic signatures from lymphoid follicles (LFs) in ever-smokers without COPD and patients with COPD with varying degrees of emphysema.

Methods

Lung sections from 40 patients with COPD and ever-smokers were used for LF proteomic and transcriptomic spatial profiling. Formalin- and O.C.T.-fixed lung samples obtained from biopsies or lung explants were assessed for LF presence. Emphysema measurements were obtained from clinical chest computed tomographic scans. High-confidence transcriptional target intersection analyses were conducted to resolve emphysema-induced transcriptional networks. …

Clinical Evaluation Of A Fully Electronic Microfluidic White Blood Cell Analyzer, Jianye Sui, Zhongtian Lin, Shahriar Azizpour, Fei Chen, Sunanda Gaur, Kelly Keene, Farzad Soleimani, Tanaya Bhowmick, Zubaid Rafique, Mehdi Javanmard

Faculty, Staff and Students Publications

The White Blood Cell (WBC) count is one of the key parameters signaling the health of the immune system. Abnormal WBC counts often signal a systemic insult to the body such as an underlying infection or an adverse side effect to medication. Typically, the blood collected is sent to a central lab for testing, and results come back within hours, which is often inconvenient and may delay time-sensitive diagnosis or treatment. Here, we present the CytoTracker, a fully electronic, microfluidic based instant WBC analyzer with the potential to be used at point-of-care. The CytoTracker is a lightweight, portable, affordable platform …

Sex-Specific Outcomes Of Lbbap Versus Biventricular Pacing: Results From I-Clas, Faiz A Subzposh, Parikshit S Sharma, Óscar Cano, Shunmuga Sundaram Ponnusamy, Bengt Herweg, Francesco Zanon, Marek Jastrzebski, Jiangang Zou, Mihail G Chelu, Kevin Vernooy, Zachary I Whinnett, Girish M Nair, Manuel Molina-Lerma, Karol Curila, Kenneth A Ellenbogen, Pugazhendhi Vijayaraman

Faculty, Staff and Students Publications

Background: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) has been associated with greater clinical improvement in women than men. Recently, left bundle branch area pacing (LBBAP) has been shown to be an alternative form of CRT.

Objectives: The purpose of this study was to investigate sex-specific outcomes for death and heart failure events in a large, international, multicenter, cohort of patients undergoing CRT with BVP or LBBAP.

Methods: In this international study of 1,778 patients (575 female and 1203 male), sex-specific survival analysis was performed to compare the effect of LBBAP-CRT relative to BVP-CRT on the combined endpoint of …

Optimizing Immunogenicity And Product Presentation Of A Sars-Cov-2 Subunit Vaccine Composition: Effects Of Delivery Route, Heterologous Regimens With Self-Amplifying Rna Vaccines, And Lyophilization, William R Lykins, Jeroen Pollet, Jessica A White, Brian Keegan, Leroy Versteeg, Ulrich Strych, Wen-Hsiang Chen, Raodoh Mohamath, Gabi Ramer-Denisoff, Sierra Reed, Christina Renshaw, Samuel Beaver, Alana Gerhardt, Emily A Voigt, Mark A Tomai, Robert Sitrin, Robert K M Choy, Frederick J Cassels, Peter J Hotez, Maria Elena Bottazzi, Christopher B Fox

Faculty, Staff and Students Publications

INTRODUCTION: Dozens of vaccines have been approved or authorized internationally in response to the ongoing SARS-CoV-2 pandemic, covering a range of modalities and routes of delivery. For example, mucosal delivery of vaccines via the intranasal (i.n.) route has been shown to improve protective mucosal responses in comparison to intramuscular (i.m.) delivery. As we gain knowledge of the limitations of existing vaccines, it is of interest to understand if changes in product presentation or combinations of multiple vaccine modalities can further improve immunological outcomes.

METHODS: We investigated a commercial-stage SARS-CoV-2 receptor binding domain (RBD) antigen adjuvanted with a clinical-stage TLR-7/8 agonist …

Improving Neuropathological Analysis With Aβgan: Addressing Morphology Imbalance For Efficient Alzheimer's Disease Diagnosis, Sujatha Alla, Prasanthi Chidipudi, Nagesh Bheesetty, Vedvikash Reddy Velur, Joshit Mohanty, Puneeth Bheesetty, Marisha Jmukhadze, Narendra Lakshmana Gowda, Sai Gireesh Komaragiri

Engineering Management & Systems Engineering Faculty Publications

Histopathologists are experiencing a digital revolution in their field thanks to the digitization of Whole Slide Images (WSIs), which are microscope slides of tissue that can measure gigapixels in size. With so much high resolution data at their disposal, computer vision techniques can now be used to automate laboratory processes, create visual standards, and increase analysis throughput, all of which reduce the workload of pathologists [1]. The "gold" standard in neuropathology, particularly for Alzheimer's Disease- is pathological diagnosis made by looking at White Matter Inclusions (WSIs) in brain tissue. Semi-quantitative scoring in accordance with the standards established by the Consortium …

Demographic And Diagnostic Factors In Physical Therapy Attendance, William Leatherwood, Adrian Torres, Sofia Hidalgo Perea, Megan Paulus

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Previous studies have demonstrated physical therapy (PT) to be an effective nonoperative treatment for various orthopedic diagnoses. However, patients may dismiss PT in favor of another intervention for their injury. While there are many studies on PT, there is little data on patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement.

Methods: This is a retrospective study of patients seen in Stony Brook Orthopedic clinics from 08/01/2022 – 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary …

Intraoperative Nerve Stimulation As A Functional Assessment Of Acute Stretch Injury In The Rat Median Nerve, Matthew Gluck, Pierce J. Ferriter Jr., Christoph A. Schroen, Christina M. Beck, Zachary L. Bernstein, Todd A. Rubin, Michael R. Hausman, Paul J. Cagle

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Peripheral nerve injuries (PNIs) are common complications of upper extremity injuries, yet few clinical options exist to quickly and accurately assess motor nerve function intraoperatively. PNIs are a significant source of not only disability to the patient, but also cost. This study’s purpose was to evaluate the utility of intraoperative nerve stimulation in an
animal model.

Methods: A 20% stretch injury was induced in right median nerves using a custom-made stretch applicator, while left median nerves served as a control. A Checkpoint surgical nerve stimulator (Checkpoint Surgical, Cleveland, OH) was used to assess baseline nerve function in …

An Updated Ligament Evaluation Of Perilunate Instability, Emil S. Vutescu, Cris Min, Elias Georgas, Paul G. Arauz, Yi-Qian Qin, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: Perilunate dislocations are rare and high-energy proximal carpal row injuries that are associated with long-term disability. The current accepted pathomechanism of this injury is progressive radial to ulnar intrinsic ligament tearing, as described by Mayfield in 1980. Since his description several other ligaments have been described as critical stabilizers of the proximal carpal row.

Purpose: To achieve perilunate instability in a biomechanical model and evaluate integrity of recently described carpal ligamentous stabilizers.

Methods: We tested six fresh-frozen cadaveric upper extremities and loaded them to failure in extension, ulnar deviation and carpal supination using a previously validated three-point …

Can Artificial Intelligence Create Research Hypotheses For Patellofemoral Instability?, Claire Parker, Sofia Hidalgo Perea, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: The purpose of this study was to elucidate if artificial intelligence (AI) can generate novel research hypotheses regarding patellofemoral instability (PFI) in the pediatric population that have not previously been investigated. We hypothesized that AI would be able to generate new hypotheses that have not yet been presented or published.

Methods: In December of 2023, Chat Generative Pre-trained Transformer-3.5 (ChatGPT) was used to create a list of 25 research hypotheses about PFI in both the adult and pediatric population. The prompt used to generate the list of hypotheses was: “List 25 detailed and reproducible research ideas regarding …

Age-Related Differences In 30-Day Postoperative Complications Following Aseptic Revision Total Shoulder Arthroplasty: A Comparison Of Patients Under And Over 80 Years Old, Rachel A. Loyst, Patricia Cerri-Droz, Stephen H. Liu, Kenny Ling, Dorian Cohen, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: This study investigates the association between patients < 80 years old and patients 80 years old and 30-day postoperative complications following aseptic revision total shoulder arthroplasty (TSA).

Materials and methods: All patients who underwent revision TSA between 2015 and 2022 from the American College of Surgeons National Surgical Quality Improvement (NSQIP) database were surveyed for this study. Patient demographics, comorbidities, and 30-day postoperative complication data were analyzed. Logistic regression was used to analyze the postoperative complications associated in patients greater than or equal to 80 years old.

Results: Compared to patients < 80 years old, patients 80 years old were independently associated with a significantly greater likelihood of experiencing any complication (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.23-2.11; P < .001), non-home discharge (OR 3.68, 95% CI 2.58-5.25; P < .001), and length of stay (LOS) > 2 days (OR 1.57, 95% CI 1.18-2.10; P = 0.002).

Conclusions: Compared to patients < 80 years old, patients 80 years old were independently associated with a significantly greater likelihood of experiencing any complication, non-home discharge, and LOS > 2 days. A better understanding of the age as a risk factor …

Aging In Place With A Warming Climate: Housing Design And Policies For Aging With Extreme Heat, Nichole M. Kain

Antioch University Dissertations & Theses

Aging populations—particularly in areas prone to extreme heat—are facing unique residential challenges. In the past 10 years, extreme heat has killed more people in the United States (U.S.) than all other weather hazards combined, and it is expected to get hotter, with extreme heat events predicted to happen more often in the future. People over the age of 65 are disproportionately represented as the majority of heat victims, and are likely to perish in their own homes during these events. Every day, 10,000 people turn age 65 in the U.S. and many are choosing to age and retire in places …

Pediatric Dentists’ Considerations Concerning Obesity-Related Education For Parents Of Young Children: Who Should Educate About What, How And When?, Arianne Swanson Dds, Ms, James R. Boynton Dds, Ms, Larry B. Salzmann Dds, Yu-Ju Yang Dds, Marita R. Inglehart Dipl. Psych., Dr. Phil., Dr. Phil. Habil

The Journal of the Michigan Dental Association

This study aimed to explore pediatric dentists' perspectives on obesity-related interventions for parents of young children. A web-based survey was administered to 210 American Academy of Pediatric Dentistry members. Findings revealed that respondents considered it important for various healthcare professionals, especially pediatricians and nurse practitioners, to engage in obesity-related parent education. Strong consensus existed on educating parents about the link between early childhood caries and diet, soft drink and fruit juice consumption, and healthy snacking. The study also found positive attitudes correlated with increased engagement in objective weight determination, data collection, and diet/nutrition counseling.

Traditional Chinese Medicine: Employing Integrative Medicine As An Approach To Treat Cancer, Jade Hudson

CMC Senior Theses

This thesis explores the history of Traditional Chinese Medicine (TCM) through its depiction in the four classics of TCM and examines the evolution of the field to date. The five categories of TCM treatments analyzed in this paper include acupuncture, dietary therapy, herbal medicine, moxibustion, and physical exercise. Research highlights significant positive outcomes in cancer patients who incorporate TCM alongside modern cancer treatments, such as reduced nausea, vomiting, fatigue, anorexia, pain, and improvements in quality of life and overall well-being. However, notable risks associated with TCM herbal medicine and moxibustion underscore the need for further research into these practices before …

Catalyzing Communities Of Research Rigour Champions, Audrey C Brumback, William X Q Ngiam, Dana M Lapato, David B Allison, Christin L Daniels, Michael Dougherty, Haley F Hazlett, Kara L Kerr, Susan Pusek, Naomi Schrag

Children’s Nutrition Research Center Staff Publications

The biomedical sciences must maintain and enhance a research culture that prioritizes rigour and transparency. The US National Institute of Neurological Disorders and Stroke convened a workshop entitled 'Catalyzing Communities of Research Rigor Champions' that brought together a diverse group of leaders in promoting research rigour and transparency (identified as 'rigour champions') to discuss strategies, barriers and resources for catalyzing technical, cultural and educational changes in the biomedical sciences. This article summarizes 2 days of panels and discussions and provides an overview of critical barriers to research rigour, perspectives behind reform initiatives and considerations for stakeholders across science. Additionally, we …

A Deadly Case Of Encephalopathy, Brenna Ostertag, Md, Gita D Gelfer, Do, Andrea Roast, Md

Poster Presentations

No abstract provided.

The Differential Expands: Ataxia From Paraneoplastic Cerebellar Degeneration, Dominic Thomas, Md, Amy Dechet, Md

Poster Presentations

No abstract provided.

A Comprehensive Review Of Advances In Hepatocyte Microencapsulation: Selecting Materials And Preserving Cell Viability, Hailian Wang, Lebin Wen, Fengdi Jiang, Pengyu Ren, Yixin Yang, Siyuan Song, Zhengteng Yang, Yi Wang

Children’s Nutrition Research Center Staff Publications

Liver failure represents a critical medical condition with a traditionally grim prognosis, where treatment options have been notably limited. Historically, liver transplantation has stood as the sole definitive cure, yet the stark disparity between the limited availability of liver donations and the high demand for such organs has significantly hampered its feasibility. This discrepancy has necessitated the exploration of hepatocyte transplantation as a temporary, supportive intervention. In light of this, our review delves into the burgeoning field of hepatocyte transplantation, with a focus on the latest advancements in maintaining hepatocyte function, co-microencapsulation techniques, xenogeneic hepatocyte transplantation, and the selection of …

Sustainability Via Active Garden Education (Sage): The Process Of Incorporating Watering Into Structured Preschool Curriculum, Rebecca E Lee, Anel Arriola, Elizabeth Lorenzo, Erica G Soltero, Jacob Szeszuski

Children’s Nutrition Research Center Staff Publications

School gardens provide rich outdoor learning opportunities for young children. Practical considerations about garden maintenance, in particular, watering, can impeed success. This manuscript chronicles the development of garden maintenance strategies in Sustainability via Active Garden Education (SAGE). SAGE installed raised-bed gardens and provided a complete curriculum focused on increasing children's active time and improving healthy eating habits while fostering garden stewardship. SAGE was implemented by trained research personnel in four early care and education (ECE) facilities in Houston, Texas (SAGE 1, Summer, 2013), one ECE facility in Phoenix, Arizona (SAGE 2, Spring, 2017), and 24 ECE facilities in Phoenix, Arizona …

Expert Review Of Child And Caregiver Critiques Of A Therapeutic Guided Imagery Therapy Mobile Application Targeting Disorders Of Gut-Brain Interaction In Children, John M Hollier, Tiantá A Strickland, C Michael Fordis, Robert J Shulman, Debbe Thompson

Faculty, Staff and Students Publications

BACKGROUND: A guided imagery therapy mobile application (GIT App) is a novel platform for treating children with disorders of gut-brain interaction (DGBI). Previous feedback from child/caregiver dyads suggested modifications for our App prototype. However, their feedback had the potential to affect the intervention's efficacy. Thus, we aimed to have their critiques vetted by relevant experts prior to further App refinement.

OBJECTIVE: Compare expert reviews of the GIT App with end-users' (i.e., child/caregiver dyads') feedback.

METHODS: This mixed-methods study with experts included a hands-on App evaluation, a survey assessing usability, and focus groups comparing their perspectives with those previously provided by …

Adjusting For Covariates Representing Potential Confounders, Mediators, Or Competing Predictors In The Presence Of Measurement Error: Dispelling A Potential Misapprehension And Insights For Optimal Study Design With Nutritional Epidemiology Examples, Roger S Zoh, Diana M Thomas, Carmen D Tekwe, Xiaoxin Yu, Colby J Vorland, Nikhil V Dhurandhar, David M Klurfeld, David B Allison

Children’s Nutrition Research Center Staff Publications

Background: Variables such as dietary intake are measured with error yet frequently used in observational epidemiology. Although this limitation is sometimes noted, these variables are still often modeled as covariates without formal correction or sincere dialogue about measurement unreliability potentially weakening the validity of statistical conclusions. Further, larger sample sizes increase power (bias) to detect spurious correlations. Counterintuitively, recent work suggested a non-monotonic relationship between confounder unreliability and how much controlling for the confounder reduces (or induces) bias when testing for an exposure-outcome association. If true, such non-monotonicity would be especially concerning for applications such as nutrition, where measurement reliability …

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 …