Pediatrics Commons^™

Covid-19 Associated Worry And Emotional Distress In Youth And Young Adults With Chronic Kidney Disease., Joann Carlson, Erin M. Jones, Sharon Manne, Matthew B. Matheson, Lyndsay A. Harshman, Bradley A. Warady, Susan Furth, Stephen R. Hooper, Rebecca J. Johnson

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: The COVID-19 (C19) pandemic impacted youth mental/behavioral health with a 25% increase in prevalence of anxiety and depression worldwide. Little is known about the emotional impact of C19 for children with Chronic Kidney Disease (CKD). The purpose of the current study is to describe C19-related distress and worry among youth with CKD.

METHODS: C19 questionnaire adapted from the SARS-CoV-19 worry scale was completed for participants. Covariate data were collected at or prior to C19 questionnaire administration.Analyses examined rates of C19 emotional distress and worry and included logistic regression to identify associations with socioeconomic and disease-related covariates.

RESULTS: The sample …

The Management Of Dietary Fiber Intake In Children With Chronic Kidney Disease - Clinical Practice Recommendations From The Pediatric Renal Nutrition Taskforce., An Desloovere, Nonnie Polderman, José Renken-Terhaerdt, Vanessa Shaw, Caroline Anderson, Larry A. Greenbaum, Christina L. Nelms, Leila Qizalbash, Stella Stabouli, Jetta Tuokkola, Bradley A. Warady, Johan Vande Walle, Fabio Paglialonga, Rukshana Shroff, Evelien Snauwaert

Manuscripts, Articles, Book Chapters and Other Papers

The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber …

Case Report: Prominent Coronary Artery Flow In Fetuses With Congenital Heart Disease, Is It A Marker Of In Utero Distress?, Mohamed Aashiq Abdul Ghayum, Maria Kiaffas, Ashley Warta, Melanie Kathol, David Christopher Mundy, Kelsey Brattrud, Nitin Madan

Manuscripts, Articles, Book Chapters and Other Papers

Prominent coronary artery (CA) flow observed on a fetal echocardiogram has been associated with fetal growth restriction and myocardial dysfunction. We present two cases with this finding, in the presence of congenital heart disease (CHD) and absence of growth restriction or myocardial dysfunction. Both the cases rapidly progressed to extremis, necessitating emergent delivery. Our cases highlight the importance of recognizing prominent CA flow in fetuses with CHD as a potential marker for in utero distress.

Occult Abdominal Trauma Screening In The Evaluation Of Suspected Child Physical Abuse., Tagrid M. Ruiz-Maldonado, Joanne N. Wood, Antoinette L. Laskey, Christopher S. Greeley, Angela Bachim, Daniel M. Lindberg, James Anderst, John Melville, Carmen Coombs, Nancy S. Harper, Lori Frasier, Farah W. Brink, Caitlin E. Crumm, Kristine A. Campbell

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVES: Occult abdominal trauma (OAT) screening with transaminases, followed by abdominal computed tomography (CT) for transaminase values greater than 80 IU/L, has been recommended in cases of suspected physical abuse. This study aimed to evaluate case characteristics associated with OAT evaluation and determine OAT prevalence in these children.

METHODS: Injured children aged younger than 60 months undergoing Child Abuse Pediatrics (CAP) consultation for suspected physical abuse from February 2021 to May 2023 were identified in CAPNET, a multicenter research network. Children with symptoms or signs of intra-abdominal injury were excluded. We identified case characteristics associated with transaminase screening …

Case Report: Disseminated Herpes Simplex Virus Complicated By Hemophagocytic Lymphohistiocytosis In A Neonate, Nicholas Tadros, Nihal Godiwala

School of Medicine Faculty Publications

Neonatal herpes simplex virus (HSV) infection carries a high mortality rate due to its potential to cause disseminated disease involving multiple organ systems, which can rapidly progress to shock and death if not promptly treated. In rare cases, neonates may mount an uncontrolled inflammatory response leading to hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory syndrome. We present a case of neonatal HSV infection complicated by HLH, highlighting the challenges of managing both conditions concurrently. Our therapeutic approach demonstrated a reduction in systemic inflammation and viral load; however, despite these efforts, the patient developed multiorgan failure and ultimately died from the initial …

Implementing A Remote Patient Monitoring Program To Improve Nutrition Status In Infant With Cystic Fibrosis, Jessica Jones, Stacie Hunter, Kelli Williams, Petrissa Ncomo, Rapheal Peeples, Alex Pottorff, Lauren Lazar, Meghana Sathe

2025

No abstract provided.

Diabetes Device Knowledge And Confidence Among School Nurses: A Mixed Methods Study, Cassandra F. Moffitt

Nursing Theses and Dissertations

Problem: Type 1 diabetes is one of the most common chronic medical conditions in childhood. While manageable, these children may spend half of their day in the school setting and often need assistance from a school nurse to manage their care.

Theory: Bandura’s Social Cognitive Theory (1977) served as the theoretical framework for this study.

Research Questions: The research questions explored knowledge, confidence, and additional predictors of confidence related to diabetes devices.

Design/Methods: An explanatory sequential mixed methods design was used. The Diabetes Device Confidence Scale (DDCS) was used to measure device confidence, while Subscale 10 of the KAT-1 instrument …

Measuring The Prevalence Of Microcytosis Of Red Blood Cells Among Different Pediatric Age Groups. A Retrospective Study., Sarah Mohammad Atef Mostafa, Mary Shaker Zakher Gerges

Journal of Medicine in Scientific Research

Aim: Detect the prevalence of microcytosis of red blood cells (RBCs) and pattern of morphological classification of anemia among different paediatric age groups during their visit to the out-patient clinics in the hospital. Methods: An observational study was carried out during the period from January 2022 to April 2023. All pediatric patients (aged from day one to18years old) complete blood count (CBC) reports recorded on the hospital laboratory outpatient’s database were included. Age, gender, and RBCs parameters; haemoglobin, red cell distribution width (RDW) and mean corpuscular volume (MCV) were collected, percentages of distribution of microcytosis and type of anemia among …

American Society Of Hematology/International Society On Thrombosis And Haemostasis 2024 Updated Guidelines For Treatment Of Venous Thromboembolism In Pediatric Patients, Paul Monagle, Muayad Azzam, Rachel Bercovitz, Marisol Betensky, Rukhmi Bhat, Tina Biss, Brian Branchford, Leonardo R. Brandão, Anthony K.C. Chan, E. Vincent S. Faustino, Julie Jaffray, Sophie Jones, Hassan Kawtharany, Bryce A. Kerlin, Nicole Kucine, Riten Kumar, Christoph Male, Marie-Claude Pelland-Marcotte, Leslie Raffini, Chittalsinh M. Raulji, Sarah E. Sartain, Clifford M. Takemoto, Cristina Tarango, C. Heleen Van Ommen, Maria C. Velez, Sara K. Vesely, John Wiernikowski, Suzan Williams, Hope P. Wilson, Gary Woods, Ayesha Zia, Reem A. Mustafa

Journal Articles: Pediatrics

BACKGROUND: The American Society of Hematology (ASH) guidelines on treatment of pediatric venous thromboembolism (VTE) were published in 2018. In the last 6 years, there has been a 10-fold increase in the number of children involved in VTE treatment trials.

OBJECTIVE: The ASH Committee on Quality and Guidelines agreed to update the pediatric guidelines in conjunction with the International Society on Thrombosis and Haemostasis (ISTH). These ASH/ISTH evidence-based guidelines are intended to support patients, clinicians, and other health care professionals in the management of pediatric patients with VTE.

METHODS: ASH/ISTH formed a multidisciplinary guideline panel to minimize potential bias from …

Differential Plasma Carotenoid Profiles In Hypertensive Disorders Of Pregnancy, Colman Freel, Jonah Scheffler, Rebecca Drakowski, Elizabeth Lyden, Matthew Van Ormer, Melissa K. Thoene, Paras K. Mishra, Corrine K. Hanson, Ann Anderson-Berry

Journal Articles: Pediatrics

Background: Hypertensive disorders of pregnancy (HDP) affect one in six pregnancies globally. The etiology of HDP remains unclear but is known to involve oxidative stress. While the body produces endogenous antioxidants, antioxidative nutrients, like carotenoids, remain critical in modulating oxidative stress. The statuses of several carotenoids have been linked to hypertension in both pregnant and non-pregnant populations. However, their associations with the spectrum of HDP, including gestational hypertension (GH), chronic hypertension (CH), and preeclampsia (PE), remains unclear. Our objective was to quantify and compare carotenoid intake and plasma levels among HDP. Methods: We conducted a prospective cohort study …

Anaplastic Large Cell Lymphoma In Children And Adolescents, Eric J. Lowe, Wilhelm Woessmann

Department of Pediatrics Faculty Publications

Anaplastic lymphoma kinase (ALK)-positive anaplastic large-cell lymphoma (ALCL) accounts for >95% of ALCL cases in children and adolescents. The first description of ALCL as a CD30-positive lymphoma in 1985 was followed by the detection of chromosomal translocations involving the ALK gene at chromosome 2p23. The pathogenesis of ALK-positive ALCL is based on signalling from the constitutive active ALK kinase. The clinical characteristics, therapy regimens and outcome data were reported in the 1990s and 2000s. Different chemotherapy regimens led to astonishingly similar long-term event-free survival rates of 70%, independent of the drugs, doses and duration of therapy. Additionally, patients with relapsed …

Reduced Slow Wave Sleep Is Associated With Increased Risk Of Short Stature In Children: A Cross-Sectional Study, Zhaohua Chen, Yuan Shi, Fei Lei, Xujun Feng, Lu Tan, Taomei Li, Junying Zhou, Yuanfeng Sun, Jiamin Liao, Yun Li, Zhoulong Yu, Jian Jiao, Yanyan Wang, Larry D. Sanford, Michael V. Vitiello, Ye Zhang, Rong Ren, Xiangdong Tang

Department of Biomedical and Translational Sciences Faculty Publications

Objective: Although growth hormone was shown to be specifically released during slow wave sleep (SWS), no population-based evidence has demonstrated the association between sleep quality and childhood height. To address this gap, our study aims to investigate the relationship between SWS and height of children.

Methods: We analyzed polysomnography data and z-scores for height in 2527 suspected obstructive sleep apnea (OSA) children (537 non-OSA children and 1990 OSA children) collected over the past 16 years. Different grades of z-scores for height and SWS were classified by the quartile method, and the lowest z-scores for height quartile defined short stature as …

Closing Racial And Ethnic Disparity Gaps In Pediatric Asthma Follow Up Care - A Quality Improvement Initiative, Ayodele Ayeko

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Closing racial and ethnic disparity gaps in pediatric asthma follow up care - A quality improvement initiative

Ayodele Ayeko

Introduction/Background: Inadequate management of asthma significantly contributes to poor asthma control, poor quality of life (QOL), and high hospitalization rates among pediatric patients. The Global Initiative for Asthma (GINA) guidelines offer recommendations designed to enhance asthma control and improve the quality of life for those affected (2015), including recommendations for close follow up care. At WVU Medicine Children’s Hospital (WVUMCH), insufficient asthma control has been associated with lower clinic follow-up rates and an increase in hospitalization. Although educational initiatives …

Body Composition In Preterm Infants: Current Insights And Emerging Perspectives, Sreekanth Viswanathan, Melissa Thoene, Zaineh Alja'nini, Pradeep Alur, Kera Mcnelis

Journal Articles: Pediatrics

In recent years, significant advancements in respiratory and nutritional care have markedly improved the survival rates of preterm infants and enhanced long-term health outcomes. Despite these improvements, emerging research highlights the lasting impacts of early growth patterns on an individual's health trajectory. Adults born prematurely face a higher incidence of health issues related to their early birth. The American Academy of Pediatrics recommends that preterm infants should achieve growth rates similar to those of fetuses, with clinicians emphasizing nutrition delivery to help these infants reach their expected weight for gestational age. However, this approach often results in altered body composition, …

Postnatal Growth Assessment Of The Very-Low-Birth-Weight Preterm Infant, Kera Mcnelis, Melissa Thoene, Katie A. Huff, Ting Ting Fu, Zaineh Alja'nini, Sreekanth Viswanathan

Journal Articles: Pediatrics

Preterm birth represents a nutritional emergency and a sudden dissociation of the maternal-placental-fetal unit that regulates metabolic and endocrine physiology. Growth demonstrates health and is a signal of physiological well-being. Growth is expensive for a critically ill infant and possible only after other homeostasis energy demands are met. Despite an expert-stated goal that preterm infants should grow at a similar rate to their gestational age-matched fetal counterparts, this is not the reality for many preterm infants. Other investigators have proposed new metrics for growth quality in the neonatal intensive care unit. This review discusses growth assessment and standards in very-low-birth-weight …

Rvd2 Mitigates Tnfɑ-Induced Mitochondrial Reactive Oxygen Species Through Nrf2 Signaling In Placental Trophoblasts, Taija Hahka, Deekshika Sekar, Prakash Kumar Sahoo, Aiswariya Ravi, Colman Freel, Chandan Krishnamoorthy, Sankar Ramamurthy, Rebekah Rapoza, Rebecca Drakowski, Anum Akbar, Matthew Van Ormer, Melissa Thoene, Corrine K. Hanson, Tara Nordgren, Sathish Kumar Natarajan, Ann Anderson-Berry

Journal Articles: Pediatrics

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are marked by elevated levels of TNFα, which increases reactive oxygen species (ROS) and disrupts metabolism of trophoblasts. Resolvin D2 (RvD2), an omega-3 fatty acid-derived lipid mediator, is known to resolve inflammation, but its role in protecting trophoblasts by promoting antioxidant responses to alleviate ROS remains unclear. Nuclear translocation of nuclear factor erythroid 2-related factor 2 (NRF2) controls cellular defense mechanisms against oxidative stress and helps with the maintenance of cellular redox homeostasis. Upon translocation to nucleus, NRF2 activates the antioxidant response element (ARE), inducing the expression of genes that can mitigate ROS. Hence, …

Efficacy And Safety Of Thrombolysis For Pediatric Venous Thromboembolism: A Systematic Review And Meta-Analysis, Hassan Kawtharany, Muayad Azzam, Aseel Alkhader, Marisol Betensky, Qais Hamarsha, Hadi K. Abou Zeid, Razan Mansour, Carine Tabak, Payal Patel, Sarah L. Baghdadi, Rachel S. Bercovitz, Rukhmi Bhat, Tina Biss, Brian R. Branchford, Leonardo R. Brandão, Anthony K.C. Chan, E. Vincent S. Faustino, Julie Jaffray, Sophie Jones, Bryce A. Kerlin, Nicole Kucine, Riten Kumar, Christoph Male, Marie-Claude Pelland-Marcotte, Leslie Raffini, Chittalsinh M. Raulji, Sarah E. Sartain, Clifford M. Takemoto, Cristina Tarango, C Heleen Van Ommen, Maria C. Velez, Sara K. Vesely, John Wiernikowski, Suzan Williams, Hope P. Wilson, Gary Woods, Ayesha Zia, Paul Monagle, Reem A. Mustafa

Journal Articles: Pediatrics

We conducted this systematic review to evaluate outcomes of thrombolysis followed by anticoagulation vs anticoagulation alone in pediatric patients with venous thromboembolism (VTE). This systematic review addresses mortality, VTE resolution, recurrence, bleeding, and organ-specific outcomes in 5 PICO (population, intervention, comparison, outcomes) questions on thrombolysis across pulmonary embolism (PE), extremity deep vein thrombosis (DVT), right atrial thrombosis (RAT), cerebral sinus venous thrombosis (CSVT), and renal vein thrombosis (RVT). Meta-analysis reported risk ratios or differences (95% confidence intervals [CIs]), and absolute effects per 1000 patients. Certainty of evidence was assessed using GRADE (Grading of recommendation, assessment, Development, and Evaluation) guidelines. Thirteen …

Improving Hospital Discharge Readiness Among Caregivers Of Children With Complex Medical Needs, Megan M. Bruce

Graduate Theses, Dissertations, and Problem Reports (ETD)

Advancements in medicine and technologies have led to an increase in the population of children living with complex and chronic health conditions. Children with medical complexities (CMCs) and their caregivers frequently have challenges navigating home life after transitioning from hospital to home-based care. A 14-week doctoral capstone project was conducted at Dayton Children’s Hospital to improve caregiver readiness for hospital discharge. Project participants included caregivers of CMCs (n = 6) admitted to the hospital and pediatric acute care occupational therapists (n = 4). The Pediatric Readiness for Hospital Discharge Scale – Long Form (Peds-RHDS) was used as a pre-and post-intervention …

Impact Of Sensory Diets On Occupational Performance, Kyndra Holloway, Cassandra Howard, Makena Collin, Princess Pillos

Occupational Therapy | MSOT Capstone Projects

This study investigates the impact of individualized sensory diets on children’s occupational performance in daily life. Sensory diets are structured, child-specific interventions designed to facilitate improved sensory processing by integrating activities into established routines. They involve a tailored home program plan, consistent application, and interventions aligned with the child’s specific sensory needs (Wilbarger, 1995).Using a multiple single-case study design, this research examined the outcomes of sensory diets prescribed alongside direct occupational therapy (OT) services for four white male children aged 3 years, 11 months to 5 years, and 8 months with neurodevelopmental disorders.

Participants were recruited through Developmental FX (DFX) …

Ocd Lesions Of The Lateral Femoral Condyle And The Impact Of The Location On Recovery, Catharine Kral, Joshua Cummings, Ellie Helton, Shannon Margherio, Brian S. Harvey, Kevin Latz

Posters

Descriptive study based on Zhou, Liang, et al. we categorized the LFC OCD lesions into weight bearing and non-weight bearing lesions to assess clinical and radiographic variables and evaluate the need for progression to operative management.

Tickborne Illness, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Introducing An Eating Disorder Protocol In The Pediatric Primary Care Setting, Brandi Bozarth

DNP Projects

Background: The incidence of eating disorders has been on the rise, often beginning in adolescence and continuing well into adulthood. Consequences of untreated disrupted eating patterns can affect multiple body systems and are responsible for thousands of deaths annually. Despite these facts, research and data regarding eating disorders in adolescent patients are severely deficient. There is also a lack of standardization regarding assessing eating disorders in the pediatric primary care setting, as there are no specific guidelines or screening processes recommended by the American Academy of Pediatrics for the detection of eating disorders.

Purpose: The purpose of this project is …

Trends And Outcomes In Fixation Of Distal Radius Fractures In Elderly Patients: Should Gender Play A Role In Surgical Decision Making?, Rabia Qureshi, Kenny Ling, Sydney Laramie

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

Impact Of Teriparatide On Surgical And Medical Outcomes In Osteoporotic Patients Undergoing Multilevel Anterior Cervical Discectomy And Fusion, Samuel Akhnoukh, Uttsav Patel, Kenny Ling, Ivan Zapolsky

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF) are at increased risk of pseudarthrosis and perioperative complications, including higher rates of reoperation compared to non-osteoporotic individuals. Teriparatide, an anabolic agent used in osteoporosis treatment, has shown promise in enhancing fusion and reducing complications in lumbar spine procedures, but its role in multi-level ACDF remains unclear.

Purpose: The purpose of this study was to evaluate the impact of postoperative teriparatide use on outcomes in osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF). Specifically, the study aimed to determine whether teriparatide could reduce long-term complications such as …

Identifying Authenticity In Orthopaedic Residency Applications: Can Selection Committees Detect Ai-Written Personal Statements, Samir Baig, Lekha Yaramada, David E. Komatsu, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

Hypertensive Status Predicts 30-Day Postoperative Complications Following Open Reduction Internal Fixation Of Distal Radius Fractures, Nishank Mehta, Emma Smolev, Dorian Cohen, Kenny Ling, Becka Konnayil, Samantha Muhlrad, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The primary objective of this study was to investigate the association between preoperative hypertension and postoperative complications following open reduction internal fixation of distal radius fractures.

Methods: All patients who underwent open reduction internal fixation (ORIF) for distal radius fractures (DRF) between 2015 to 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Postoperative complications were reported within 30 days of procedure. We identified a total of 26,138 patients and 31.5% (n=8,225) of patients had hypertension. Hypertension was defined as blood pressure greater than 140/90 as documented in the medical record, requiring …

Femoral Avascular Necrosis And Triptan Therapy: A Multicenter Retrospective Study, Joseph Bisiani, Francisco Martos Jr., Brian Lynch

Stony Brook Orthopaedic and Musculoskeletal Journal

Aims: Migraines are one of the most common neurological disorders that patients typically suffer from. One of the more common prescription medications for migraines are triptans, which can lead to vasoconstriction throughout the peripheral vasculature as a potential side effect. However, a possible risk of femoral avascular necrosis may arise from these treatments, as it has been well known that a lack of blood flow to the femur can arise due to this peripheral vasoconstriction. Therefore, research is warranted for whether taking anti-migraine medications is associated with a higher risk of developing avascular necrosis within the femur, an area highly …

Extensor Tendon Injuries: Does Repair Technique Influence Re- Rupture Rate?, Rahul Rai, Joseph Bisiani, Athikur Rahman, David Komatsu, Lawrence Hurst

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Extensor tendon injuries are common injuries to the hand. When poorly managed, these injuries can have significant long-term effects on a patient’s hand function. There are multiple described repair techniques to repair an injured extensor tendon. The aim of this study was to determine if there was a correlation between extensor tendon repair technique and subsequent re-rupture rate.

Methods: A retrospective analysis was conducted on patients who underwent extensor tendon repair at our institution, utilizing the electronic medical record database of patients with extensor tendon injuries from 2015 to 2024. Data were collected on patient demographics, injury mechanisms, tendon …

Biomechanical Comparison Of Posterolateral Fibula Plating With Independent Syndesmotic Screw Fixation Versus Direct Lateral Plating With Syndesmotic Screw Fixation Through Plate, Dmitriy Butsenko, Zack Bonick, J Gary Bledsoe, Michael E. Doany

Stony Brook Orthopaedic and Musculoskeletal Journal

Syndesmotic fixation has been extensively investigated. Screw size, number, position, orientation, and flexible fixation options have all been investigated at length. There is however a lack of knowledge of any difference between an independent syndesmotic screw versus onethrough a lateral plate. The purpose therefore is to perform a biomechanical assessment of syndesmotic fixation comparing independent screw vs screw through plate combination, analyzing torsional strength of both constructs. To perform this, seven matched cadaveric through tibia-fibula lower leg specimens were prepared by creating an oblique fracture performing surgical syndesmotic disruption. The specimens were then randomized into the direct lateral through plate …

Association Between Glp-1 Agonist Use And Site-Specific Fracture Risk: A Retrospective Cohort Analysis, Nathan Zou, Joseph Bisiani, Brian Lynch

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Type 2 diabetes and obesity rates are expected to rise, possibly increasing the usage of Glucagon-like peptide-1 (GLP-1) agonists. Use of these agents for nondiabetic patients for weight loss I s approaching the number prescribed for diabetes. GLP-1 agonists may influence bone metabolism by promoting formation and reducing resorption, but their impact on fracture risk remains unclear. While some studies show no association, others suggest increased vulnerability. Most prior research has examined overall fracture risk without considering specific skeletal sites. This study aimed to compare site-specific fracture rates in adults with T2DM or obesity receiving GLP-1 therapy with those …