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Anderson BJ, Zappa M, Glickstein B, Taylor-Swanson L. "The History of Chinese Medicine Really Is Very Detailed Regarding Pandemics": A Qualitative Analysis of Evidence-Based Practice and the Use of Chinese Herbal Medicine by Licensed Acupuncturists During the COVID-19 Pandemic in the United States. J Integr Complement Med 2023; 29:738-746. [PMID: 37307022 PMCID: PMC10663696 DOI: 10.1089/jicm.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: The objective of this qualitative study was to understand how licensed acupuncturists determined treatment strategies for patients with symptoms likely related to COVID-19 using Chinese herbal medicine (CHM) and the impact of the pandemic upon their clinical practice. Methods: A qualitative instrument was developed with questions aligned with when participants started treating patients with symptoms likely related to COVID-19 and the availability of information related to the use of CHM for COVID-19. Interviews took place between March 8 and May 28, 2021, and were transcribed verbatim by a professional transcription service. Inductive theme analysis and ATLAS.ti Web software were used to determine themes. Results: Theme saturation was achieved after 14 interviews lasting 11-42 min. Treatment predominantly started before mid-March 2020. Four themes emerged (1) information sources; (2) diagnostic and treatment decision-making; (3) practitioner experience; (4) resources and supplies. Conclusion: Primary sources of information informing treatment strategies came from China through professional networks and were widely disseminated throughout the United States. Scientific studies evaluating the effectiveness of CHM for COVID-19 were generally not deemed useful for informing patient care because treatment had been initiated before they were published and because of limitations associated with the research and the ability to apply it to real world practice.
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Affiliation(s)
- Belinda J. Anderson
- College of Health Professions, Pace University, New York, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Melissa Zappa
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Anderson BJ, Zappa M, Leininger BD, Taylor-Swanson L. Cross-Sectional Survey of Acupuncturists in the United States Who Prescribed Chinese Herbal Medicine for Patients with Symptoms Likely Related to COVID-19. J Integr Complement Med 2023; 29:510-517. [PMID: 36893307 PMCID: PMC10457619 DOI: 10.1089/jicm.2022.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Objective: The objective of this study was to examine the prescribing of Chinese herbal medicine (CHM) by licensed acupuncturists in the United States during the COVID-19 pandemic. Methods: A 28-question survey with nine branching questions was disseminated through collegial networks, paid advertisements, and a study website in April-July 2021. Participants indicated that they were licensed acupuncturists who treated more than five patients for symptoms likely related to COVID-19 to gain entry to the full survey. Surveys were undertaken electronically through the Research Electronic Data Capture (REDCap) system. Results: The survey was undertaken by 103 participants representing all US geographic regions and had an average of 17 years in practice. Sixty-five percent received or intended to receive the COVID-19 vaccine. Phone and videoconference were the predominant methods of patient contact; granules and pill forms of CHM were the most prescribed. A wide variety of information sources were used in devising patient treatments inclusive of anecdotal, observational, and scientific sources. Most patients were not receiving biomedical treatment. Ninety-seven percent of participants reported that they had no patients die of COVID-19, and the majority reported that <25% of their patients developed long hauler syndrome (post-acute sequelae SARS-CoV-2 infection). Conclusions: This study demonstrates that licensed acupuncturists were treating COVID-19 infected individuals in the United States during the early stages of the pandemic, and for many such patients this was the only therapeutic intervention they had access to from a licensed health care provider. Information disseminated from China through collegial networks, along with published sources including scientific studies, informed the approach to treatment. This study provides insight into an unusual circumstance in which clinicians needed to establish evidence-based approaches to the treatment of a new disease during a public health emergency.
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Affiliation(s)
- Belinda J. Anderson
- College of Health Professions, Pace University, New York, New York, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa Zappa
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Brent D. Leininger
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, Minnesota, USA
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Teets R, Nielsen A, Moonaz S, Anderson BJ, Mah DM, Walter E, Milanes M, Jyung H, Soto Cossio LE, Meissner P, McKee MD, Kligler B. Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study. Glob Adv Integr Med Health 2023; 12:27536130231202515. [PMID: 37779670 PMCID: PMC10540610 DOI: 10.1177/27536130231202515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
Background Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care. Objective To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings. Methods This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10 weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up. Results 93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic. Conclusions Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.
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Affiliation(s)
- Raymond Teets
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | - Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
| | - Steffany Moonaz
- Department of Clinical and Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA
| | - Belinda J Anderson
- College of Health Professions, Pace University, New York, NY, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Pacific College of Health and Science, New York, NY, USA
| | - Donna M Mah
- Pacific College of Health and Science, New York, NY, USA
| | - Eve Walter
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | | | - Hyowoun Jyung
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Institute for Family Health, New York, NY, USA
| | | | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Family Medicine & Community Health, University of Massachusetts Medical School, North Worcester, NY, USA
| | - Benjamin Kligler
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, Woodstock, NY, USA
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrative Health Coordinating Center, US Veterans Health Administration, Washington, NY, USA
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Dudla S, Herron PD, Marantz PR, Milan FB, Campbell C, Anderson BJ. Comparing scientific worldviews between allopathic medical degree and East Asian medicine degree students utilizing the thinking about science survey instrument (TSSI). BMC Med Educ 2021; 21:546. [PMID: 34711228 PMCID: PMC8553399 DOI: 10.1186/s12909-021-02956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Integrative medicine has become a new healthcare model due to the growing evidence base for complementary and integrative therapies. However, some question whether complementary and integrative therapies can truly be integrated with biomedicine due to differences in underlying paradigms and theoretical bases. This study aimed to explore differences in scientific worldviews between students studying East Asian medicine and those completing an allopathic medical degree using the validated Thinking about Science Survey Instrument (TSSI). METHODS 122 medical students from Albert Einstein College of Medicine (Einstein) and 48 East Asian medicine students from the Pacific College of Health and Science (Pacific College) participated in this study. Participants completed the TSSI, a 60-item Likert-scale instrument that quantitatively measures the sociocultural resistance to, and support for science. Item and category means were compared between each group using an independent sample t-test. RESULTS Distinct differences were seen between the two groups of students with regard to age, gender distribution and prior education. Einstein students were generally supportive of science and Pacific College students were generally supportive of/positively neutral to science. Einstein students more strongly affirmed the relationship of science in relation to the categories of Epistemology, Public Health, Emotion and Aesthetics, the Economy, and Public Policy. Pacific College students more strongly affirmed the relationship between science and the category Race and Gender. There were no differences in the categories of Environment and Resource, Science for All, and Religion and Morality. CONCLUSION This study suggests that there are differences underlying the scientific worldviews of Einstein and Pacific College students, particularly with regard to Epistemology and Public Health. Such differences may be related to the different theoretical knowledge bases and ways of viewing health within the two disciplines. Despite demographic and educational differences between the two groups their overall scientific worldviews were similar with neither group expressing disparate views. This suggests that both groups may be receptive to the value of other paradigms. Providing courses that focus on different therapeutic approaches and paradigms during medical training may foster interprofessional understanding and collaborative practice between health professionals of different medical disciplines.
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Affiliation(s)
- Saikaew Dudla
- Pacific College of Health and Science, 110 William St, New York, NY, 10038, USA.
| | - Patrick D Herron
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Paul R Marantz
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Felise B Milan
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Corbin Campbell
- American University, 4400 Massachusetts Ave, NW, Washington, DC, 20016, USA
| | - Belinda J Anderson
- Pacific College of Health and Science, 110 William St, New York, NY, 10038, USA
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- Pace University, 163 William St, New York, NY, 10038, USA
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Anderson BJ, Dudla S, Marantz PR, Kligler BE, Leininger BD, Evans R. Survey analysis to determine the impact of evidence informed practice education upon East Asian medicine faculty clinical instruction and students' skills, knowledge, attitudes and behaviors within a master's degree program. BMC Med Educ 2021; 21:256. [PMID: 33947384 PMCID: PMC8094568 DOI: 10.1186/s12909-021-02690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Between 2013 and 2018 Pacific College of Health and Science (formerly Pacific College of Oriental Medicine) trained faculty and developed curriculum in evidence informed practice (EIP), with support from a grant from the National Institutes of Health (NIH). A three-credit (45 h) Foundations of EIP course, and online EIP learning modules (developed as part of a previous NIH R25 award), were used for faculty and student training. In addition, EIP was incorporated into 73% of the East Asian medicine degree program. Clinical integration of EIP in the College clinic was enhanced by improving access to reference sources, including additional EIP-related questions to the patient intake forms, requiring the use of a patient-centered outcome instrument, and assessing students' clinical EIP competencies. METHODS Master's degree students' self-reported EIP skills, knowledge, attitudes and behaviors were assessed before and after taking the Foundations of EIP course using a 17-question paper-based survey with an additional open-ended comments section. The survey was administered in 29 courses across all three Pacific College campuses. Clinical faculty self-reported EIP instruction, focusing on the EIP content and instructional approaches that were utilized, was evaluated on the New York City campus using a paper-based survey before and after changes were made to enhance the clinical integration of EIP. RESULTS A total of 1181 completed EIP-course surveys consisting of 657 pre-EIP course surveys and 524 post-EIP course surveys were analyzed. There was a statistically significant improvement in students' EIP skills, knowledge and behaviors after completing the EIP course. Students' perception of the importance of EIP was high before and after the EIP course. Little change in Faculty's EIP-related clinical instruction was evident following the EIP-related changes that were made to the Clinic. CONCLUSION Our study suggests that the three-credit (45 h) EIP course was effective at improving the EIP skills, knowledge and behaviors of this group of East Asian medicine students who were undertaking a master's degree that qualified them for licensure in acupuncture in the US. These students also demonstrated a high level of recognition for the importance of research and EIP both before and after the course. Training faculty clinical supervisors and providing greater access to evidence sources in the College clinic did not appear to increase EIP instructional activity.
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Affiliation(s)
- Belinda J Anderson
- Pace University, College of Health Professions, 163 Williams St, New York, NY, 10038, USA.
- Pacific College of Health and Science, 110 William St, New York, NY, 10038, USA.
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
| | - Saikaew Dudla
- Pacific College of Health and Science, 110 William St, New York, NY, 10038, USA
| | - Paul R Marantz
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Benjamin E Kligler
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
- United States Department of Veterans Affairs, Washington, D.C., USA
| | | | - Roni Evans
- University of Minnesota, Minneapolis, MN, 55455, USA
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Anderson BJ, Meissner P, Mah DM, Nielsen A, Moonaz S, McKee MD, Kligler B, Milanes M, Guerra H, Teets R. Barriers and Facilitators to Implementing Bundled Acupuncture and Yoga Therapy to Treat Chronic Pain in Community Healthcare Settings: A Feasibility Pilot. J Altern Complement Med 2021; 27:496-505. [PMID: 33720749 PMCID: PMC8236295 DOI: 10.1089/acm.2020.0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: To identify factors associated with implementing bundled group acupuncture and yoga therapy (YT) to treat underserved patients with chronic pain in community health center (CHC) settings. This is not an implementation science study, but rather an organized approach for identification of barriers and facilitators to implementing these therapies as a precursor to a future implementation science study. Design: This study was part of a single-arm feasibility trial, which aimed to test the feasibility of bundling GA and YT for chronic pain in CHCs. Treatment outcomes were measured before and after the 10-week intervention period. Implementation feasibility was assessed through weekly research team meetings, weekly yoga provider meetings, monthly acupuncture provider meetings, and weekly provider surveys. Settings: The study was conducted in New York City at two Montefiore Medical Group (MMG) sites in the Bronx, and one Institute for Family Health (IFH) site in Harlem. Subjects: Participants in the feasibility trial were recruited from IFH and MMG sites, and needed to have had lower back, neck, or osteoarthritis pain for >3 months. Implementation stakeholders included the research team, providers of acupuncture and YT, referring providers, and CHC staff. Results: Implementation of these therapies was assessed using the Consolidated Framework for Implementation Research. We identified issues associated with scheduling, treatment fidelity, communication, the three-way disciplinary interaction of acupuncture, yoga, and biomedicine, space adaptation, site-specific logistical and operational requirements, and patient-provider language barriers. Issues varied as to their frequency and resolution difficulty. Conclusions: This feasibility trial identified implementation issues and resolution strategies that could be further explored in future implementation studies. Clinical Trial Registration No.: NCT04296344.
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Affiliation(s)
- Belinda J Anderson
- College of Health Professions, Pace University, New York, NY, USA.,School of Nursing and Health Studies, Monmouth University, West Long Branch, NJ, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.,Pacific College of Health and Science, San Diego, CA, USA
| | - Paul Meissner
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donna M Mah
- Pacific College of Health and Science, San Diego, CA, USA
| | - Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - M Diane McKee
- Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Benjamin Kligler
- Integrative Health Coordinating Center, US Veterans Health Administration, Washington, DC, USA
| | | | - Hernidia Guerra
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Nielsen A, Teets R, Moonaz S, Anderson BJ, Walter E, Milanes M, Mah DM, Diane McKee M, Kligler B. Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot. Glob Adv Health Med 2020; 9:2164956120964716. [PMID: 33150053 PMCID: PMC7580149 DOI: 10.1177/2164956120964716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic pain is prevalent in the United States, with impact on physical and
psychological functioning as well as lost work productivity. Minority and lower
socioeconomic populations have increased prevalence of chronic pain with less
access to pain care, poorer outcomes, and higher risk of fatal opioid overdose.
Acupuncture therapy is effective in treating chronic pain conditions including
chronic low back pain, neck pain, shoulder pain, and knee pain from
osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible
and effective, and specifically so for underserved and diverse populations at
risk for health outcome disparities. Acupuncture therapy also encourages patient
engagement and activation. As chronic pain improves, there is a natural
progression to want and need to increase activity and movement recovery. Diverse
movement approaches are important for improving range of motion, maintaining
gains, strengthening, and promoting patient engagement and activation. Yoga
therapy is an active therapy with proven benefit in musculoskeletal pain
disorders and pain associated disability. The aim of this quasi-experimental
pilot feasibility trial is to test the bundling of these 2 effective care
options for chronic pain, to inform both the design for a larger randomized
pragmatic effectiveness trial as well as implementation strategies across
underserved settings.
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ray Teets
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Institute for Family Health, New York
| | - Steffany Moonaz
- Research Department, Maryland University of Integrative Medicine, Laurel, Maryland
| | - Belinda J Anderson
- College of Health Professions, Pace University, New York.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,Pacific College of Health and Science, San Diego, California and New York
| | - Eve Walter
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Institute for Family Health, New York
| | | | - Donna M Mah
- Pacific College of Health and Science, San Diego, California and New York
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Benjamin Kligler
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York.,US Veterans Health Administration Integrative Health Coordinating Center, Washington, DC
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DiMeglio LA, Kanapka LG, DeSalvo DJ, Anderson BJ, Harrington KR, Hilliard ME, Laffel LM, Tamborlane WV, Van Name MA, Wadwa RP, Willi SM, Woerner S, Wong JC, Miller KM. Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study. Diabet Med 2020; 37:1308-1315. [PMID: 32096282 PMCID: PMC9065795 DOI: 10.1111/dme.14276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
AIM To assess the associations between demographic and clinical characteristics and sensor glucose metrics in young children with type 1 diabetes, using masked, continuous glucose monitoring data from children aged 2 to < 8 years. RESEARCH DESIGN AND METHODS The analysis included 143 children across 14 sites in the USA, enrolled in a separate clinical trial. Eligibility criteria were: age 2 to <8 years; type 1 diabetes duration ≥3 months; no continuous glucose monitoring use for past 30 days; and HbA1c concentration 53 to <86 mmol/mol (7.0 to <10.0%). All participants wore masked continuous glucose monitors up to 14 days. RESULTS On average, participants spent the majority (13 h) of the day in hyperglycaemia (>10.0 mmol/l) and a median of ~1 h/day in hypoglycaemia (<3.9 mmol/l). Participants with minority race/ethnicity and higher parent education levels spent more time in target range, 3.9-10.0 mmol/l, and less time in hyperglycaemia. More time in hypoglycaemia was associated with minority race/ethnicity and younger age at diagnosis. Continuous glucose monitoring metrics were similar in pump and injection users. CONCLUSIONS Given that both hypo- and hyperglycaemia negatively impact neurocognitive development, strategies to increase time in target glucose range for young children are needed.
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Affiliation(s)
- L A DiMeglio
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - L G Kanapka
- Jaeb Center for Health Research, Tampa, FL, USA
| | - D J DeSalvo
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B J Anderson
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K R Harrington
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - M E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - L M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | | | - R P Wadwa
- Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA
| | - S M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Woerner
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - J C Wong
- University of California San Francisco, San Francisco, CA, USA
| | - K M Miller
- Jaeb Center for Health Research, Tampa, FL, USA
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Anderson BJ, Kligler BE, Marantz PR, Gomes S, Casalaina WJ, Fuenmayor M, Ginsberg J, Greenough KA, Reznikova O, Saronson RL, Zhang H, Evans R. Developing, Integrating, and Implementing Evidence-Informed Practice Curricula Throughout a Chinese Medicine Degree Program. J Altern Complement Med 2020; 26:463-472. [PMID: 32345028 PMCID: PMC7310291 DOI: 10.1089/acm.2019.0456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: To train faculty and develop curricula in evidence-informed practice (EIP) within a Chinese medicine degree program. Setting: Pacific College of Oriental Medicine (New York). Design: Faculty EIP training was undertaken through utilization of online EIP modules, and development and completion of a 3-credit (45 h) online Foundations of EIP course. This was supplemented by faculty meetings and one-on-one support from department chairs. Curriculum development was undertaken by an EIP Curriculum Committee. The committee followed a modified Delphi process to develop EIP course learning outcomes (CLOs), and to make changes to the College's clinic policies and procedures. EIP assignments were developed for each course in accordance with the CLO. Results: Ninety-one percent of the faculty and 97% of clinical supervisors received formal EIP training. Thirty-five percent of all didactic faculty, 38% of faculty teaching courses with EIP incorporated, and 30% of clinical supervisors completed 10 or more h of EIP training during this project. Faculty also received informal EIP training through participation in department and general faculty meetings. Seventy-three percent of the Master's degree curriculum, inclusive of 40 didactic courses and fifteen 60-h clinic shifts, were modified to incorporate EIP. EIP CLOs and corresponding assignments were developed. Clinic intake forms were modified to facilitate undertaking EIP in the College clinic. Issues related to how EIP is defined in conjunction with the nature of available scientific research in Chinese medicine required discussion and resolution. Conclusions: Training faculty and developing curricula in EIP within Chinese medicine colleges has unique challenges that must be factored into the strategies and processes. Factors that contributed to the success of this project were having faculty drive the process, integrating EIP content within existing curricula, gradual exposure, identifying champions, relating EIP to practice building, and openly discussing opposing perspectives.
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Affiliation(s)
- Belinda J Anderson
- Pacific College of Oriental Medicine, New York, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Stacy Gomes
- Pacific College of Oriental Medicine, New York, NY, USA
| | | | | | | | | | | | | | - Helen Zhang
- Pacific College of Oriental Medicine, New York, NY, USA
| | - Roni Evans
- University of Minnesota, Minneapolis, MN, USA
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10
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Van Name MA, Miller KM, Commissariat PV, Whitehouse AL, Harrington KR, Anderson BJ, Mantravadi MG, Levy W, DeSalvo DJ, Tamborlane WV, Hilliard ME, Laffel LM, DiMeglio LA. Greater parental comfort with lower glucose targets in young children with Type 1 diabetes using continuous glucose monitoring. Diabet Med 2019; 36:1508-1510. [PMID: 31295359 PMCID: PMC7027357 DOI: 10.1111/dme.14074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - K M Miller
- Jaeb Center for Health Research, Tampa, FLa
| | | | | | | | - B J Anderson
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - M G Mantravadi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - W Levy
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - D J DeSalvo
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | | | - M E Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | | | - L A DiMeglio
- Indiana University School of Medicine, Indianapolis, IN, USA
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Anderson BJ, Sinclair J. Food, fads, allergies and anaphylaxis with propofol. Anaesthesia 2019; 74:1223-1226. [PMID: 31254287 DOI: 10.1111/anae.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 11/30/2022]
Affiliation(s)
- B J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - J Sinclair
- Starship Children's Hospital, Auckland, New Zealand
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McGill DE, Volkening LK, Butler DA, Wasserman RM, Anderson BJ, Laffel LM. Text-message responsiveness to blood glucose monitoring reminders is associated with HbA 1c benefit in teenagers with Type 1 diabetes. Diabet Med 2019; 36:600-605. [PMID: 30734361 PMCID: PMC6462241 DOI: 10.1111/dme.13929] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate an 18-month text-messaging intervention in teenagers with Type 1 diabetes and to assess factors associated with text responsiveness and glycaemic benefit. METHODS Teenagers with diabetes (N = 147), aged 13-17 years, received two-way text reminders at self-selected times to check blood glucose levels and reply with blood glucose results. RESULTS At baseline, the participants (48% boys, 78% white, 63% pump-treated) had a mean ± sd age of 14.9 ± 1.3 years, diabetes duration of 7.1 ± 3.9 years and HbA1c concentration of 69 ± 12 mmol/mol (8.5 ± 1.1%). The mean proportion of days with ≥1 blood glucose response declined over time (0-6 months, 60 ± 26% of days, 7-12 months, 53 ± 31% of days, 13-18 months, 43 ± 33% of days). Over 18 months, 49% responded with ≥1 blood glucose result on ≥50% of days (high responders). Regression analysis controlling for baseline HbA1c revealed no significant change in HbA1c from baseline to 18 months in high responders (P = 0.54) compared with a significant HbA1c increase in low responders (+0.3%, P = 0.01). In participants with baseline HbA1c ≥64 mmol/mol (≥8%), high responders were 2.5 times more likely than low responders to have a clinically significant [≥5.5 mmol/mol (≥0.5%)] HbA1c decrease over 18 months (P < 0.05). In participants with baseline HbA1c <64 mmol/mol(<8%), high responders were 5.7 times more likely than low responders to have an 18-month HbA1c <58 mmol/mol (<7.5%; P < 0.05). CONCLUSIONS Teenagers with Type 1 diabetes who responded to text reminders on ≥50% of days over 18 months experienced clinically significant glycaemic benefit. There remains a need to tailor interventions to maintain teenager engagement and optimize improvements.
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Affiliation(s)
- D E McGill
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - L K Volkening
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - D A Butler
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - R M Wasserman
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - B J Anderson
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - L M Laffel
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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13
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Anderson BJ, Jurawanichkul S, Kligler BE, Marantz PR, Evans R. Interdisciplinary Relationship Models for Complementary and Integrative Health: Perspectives of Chinese Medicine Practitioners in the United States. J Altern Complement Med 2019; 25:288-295. [PMID: 30523704 PMCID: PMC6437621 DOI: 10.1089/acm.2018.0268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The combination of biomedicine and traditional and complementary medicine (T&CM) is often referred to as integrative medicine. However, the degree to which the medical disciplines are integrated varies between medical settings, and it is believed by some to be impossible due to epistemological and paradigmatic differences. Clinicians' perspectives are important determinants of how different medical disciplines are used together. This study explores the perspectives of experienced Chinese medicine practitioners when asked about the most ethical model (opposition, integration, or pluralism) for the relationship between biomedicine and T&CM. DESIGN Thirty-one Chinese medicine practitioners, undertaking a doctoral upgrade program at the Pacific College of Oriental Medicine, participated in this study. Participants were asked to read a publication discussing three models (opposition, integration, and pluralism) for the relationship between biomedicine and T&CM and then discuss, via an online forum within Moodle learning management system, the most ethical model. An inductive content analysis of the forum posts was undertaken to identify common themes, followed by member checking. RESULTS The data were found to contain six major and six minor themes. There was a clear preference for pluralism. The Chinese medicine practitioners expressed reservations about the integrative model, and, above all, cared about the quality of patient care. Much dialogue occurred around issues related to a power imbalance within health care, and possible cooptation issues. Paradigmatic differences and a lack of compatibility between biomedical research models and the practice of Chinese medicine were seen as problematic to the validity of research findings. Interprofessional education was viewed as critical for the development of respect, shared patient care, and referrals between clinicians from different disciplines. CONCLUSIONS This study provides insight into the issues associated with combining biomedicine and T&CM that are perceived by Chinese medicine practitioners. Such insights are important for the development and management of clinical settings that provide complementary and integrative health care, especially as the provision of insurance coverage for T&CM increases.
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Affiliation(s)
- Belinda J. Anderson
- Pacific College of Oriental Medicine, New York, NY
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Roni Evans
- University of Minnesota, Minneapolis, MN
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Hullender Rubin LE, Anderson BJ, Craig LB. Acupuncture and in vitro fertilisation research: Current and future directions. Acupunct Med 2018; 36:117-122. [DOI: 10.1136/acupmed-2016-011352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/03/2022]
Abstract
Background Acupuncture is a common adjuvant treatment to support patients undergoing in vitro fertilisation (IVF). However, the impact of acupuncture and the different roles it can play in IVF remain unclear. Objective In this paper, we present an overview and critique of the current evidence on acupuncture's impact on IVF-related stress, describe harms, and propose future directions for investigation. Conclusion Two to three acupuncture sessions performed on or around the day of embryo transfer are insufficient interventions to improve IVF birth outcomes but provide significant IVF-related stress reduction. Research investigating acupuncture to support IVF is heterogeneous and confounded by the lack of an appropriate comparator. However, evidence suggests several acupuncture sessions improve endometrial thickness, reduce stress, and improve patient satisfaction. Observational studies suggest more sessions are associated with increases in clinical pregnancy and live birth rates. An optimised acupuncture intervention with a reasonable comparator is necessary for future studies, with evidence-based guidance on technique and number of sessions. Acupuncture should not be rejected as an adjuvant therapy for IVF, but more studies are needed to clarify acupuncture's role in supporting IVF cycles.
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Affiliation(s)
- Lee E Hullender Rubin
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Portland Acupuncture Studio, Portland, Oregon, USA
| | - Belinda J Anderson
- Academic Department, Pacific College of Oriental Medicine - New York Campus, New York, USA
| | - LaTasha B Craig
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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15
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Goss PW, Middlehurst A, Acerini CL, Anderson BJ, Bratina N, Brink S, Calliari L, Forsander G, Goss JL, Maahs D, Milosevic R, Pacaud D, Paterson MA, Pitman L, Rowley E, Wolfsdorf J. ISPAD Position Statement on Type 1 Diabetes in Schools. Pediatr Diabetes 2018; 19:1338-1341. [PMID: 30295419 DOI: 10.1111/pedi.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Rolle A, Paredes S, Cortínez LI, Anderson BJ, Quezada N, Solari S, Allende F, Torres J, Cabrera D, Contreras V, Carmona J, Ramírez C, Oliveros AM, Ibacache M. Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients. Br J Anaesth 2018; 120:969-977. [PMID: 29661414 DOI: 10.1016/j.bja.2018.01.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/28/2017] [Accepted: 01/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. METHODS Forty patients, ASA I-III, 18-60 yr old, weighing 47-126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. RESULTS A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=-5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV<3.84). CONCLUSIONS We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. CLINICAL TRIAL REGISTRATION NCT02557867.
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Affiliation(s)
- A Rolle
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Paredes
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L I Cortínez
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - B J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - N Quezada
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Solari
- Departamento de Laboratorio Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Allende
- Departamento de Laboratorio Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Torres
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Cabrera
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | - V Contreras
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Carmona
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Ramírez
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A M Oliveros
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Ibacache
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Möstl C, Isavnin A, Boakes PD, Kilpua EKJ, Davies JA, Harrison RA, Barnes D, Krupar V, Eastwood JP, Good SW, Forsyth RJ, Bothmer V, Reiss MA, Amerstorfer T, Winslow RM, Anderson BJ, Philpott LC, Rodriguez L, Rouillard AP, Gallagher P, Nieves-Chinchilla T, Zhang TL. Modeling observations of solar coronal mass ejections with heliospheric imagers verified with the Heliophysics System Observatory. Space Weather 2017; 15:955-970. [PMID: 28983209 PMCID: PMC5601179 DOI: 10.1002/2017sw001614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/18/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
We present an advance toward accurately predicting the arrivals of coronal mass ejections (CMEs) at the terrestrial planets, including Earth. For the first time, we are able to assess a CME prediction model using data over two thirds of a solar cycle of observations with the Heliophysics System Observatory. We validate modeling results of 1337 CMEs observed with the Solar Terrestrial Relations Observatory (STEREO) heliospheric imagers (HI) (science data) from 8 years of observations by five in situ observing spacecraft. We use the self-similar expansion model for CME fronts assuming 60° longitudinal width, constant speed, and constant propagation direction. With these assumptions we find that 23%-35% of all CMEs that were predicted to hit a certain spacecraft lead to clear in situ signatures, so that for one correct prediction, two to three false alarms would have been issued. In addition, we find that the prediction accuracy does not degrade with the HI longitudinal separation from Earth. Predicted arrival times are on average within 2.6 ± 16.6 h difference of the in situ arrival time, similar to analytical and numerical modeling, and a true skill statistic of 0.21. We also discuss various factors that may improve the accuracy of space weather forecasting using wide-angle heliospheric imager observations. These results form a first-order approximated baseline of the prediction accuracy that is possible with HI and other methods used for data by an operational space weather mission at the Sun-Earth L5 point.
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Affiliation(s)
- C Möstl
- Space Research Institute Austrian Academy of Sciences Graz Austria
- IGAM-Kanzelhöhe Observatory, Institute of Physics University of Graz Graz Austria
| | - A Isavnin
- Department of Physics University of Helsinki Helsinki Finland
| | - P D Boakes
- Space Research Institute Austrian Academy of Sciences Graz Austria
- IGAM-Kanzelhöhe Observatory, Institute of Physics University of Graz Graz Austria
| | - E K J Kilpua
- Department of Physics University of Helsinki Helsinki Finland
| | - J A Davies
- RAL Space Rutherford Appleton Laboratory Harwell UK
| | - R A Harrison
- RAL Space Rutherford Appleton Laboratory Harwell UK
| | - D Barnes
- RAL Space Rutherford Appleton Laboratory Harwell UK
- University College London London UK
| | - V Krupar
- Institute of Atmospheric Physics CAS Prague Czech Republic
| | - J P Eastwood
- Blackett Laboratory Imperial College London London UK
| | - S W Good
- Blackett Laboratory Imperial College London London UK
| | - R J Forsyth
- Blackett Laboratory Imperial College London London UK
| | - V Bothmer
- Institute for Astrophysics University of Göttingen Göttingen Germany
| | - M A Reiss
- IGAM-Kanzelhöhe Observatory, Institute of Physics University of Graz Graz Austria
| | - T Amerstorfer
- Space Research Institute Austrian Academy of Sciences Graz Austria
| | - R M Winslow
- Institute for the Study of Earth, Oceans, and Space University of New Hampshire Durham New Hampshire USA
| | - B J Anderson
- Applied Physics Laboratory The Johns Hopkins University Laurel Maryland USA
| | - L C Philpott
- Department of Earth, Ocean and Atmospheric Sciences University of British Columbia Vancouver British Columbia Canada
| | - L Rodriguez
- Solar Terrestrial Center of Excellence-SIDC Royal Observatory of Belgium Brussels Belgium
| | - A P Rouillard
- Institut de Recherche en Astrophysique et Planétologie Université de Toulouse (UPS) Toulouse France
- Centre National de la Recherche Scientifique Toulouse France
| | - P Gallagher
- School of Physics Trinity College Dublin Ireland
| | | | - T L Zhang
- Space Research Institute Austrian Academy of Sciences Graz Austria
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18
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Russell CT, Strangeway RJ, Zhao C, Anderson BJ, Baumjohann W, Bromund KR, Fischer D, Kepko L, Le G, Magnes W, Nakamura R, Plaschke F, Slavin JA, Torbert RB, Moore TE, Paterson WR, Pollock CJ, Burch JL. Structure, force balance, and topology of Earth's magnetopause. Science 2017; 356:960-963. [PMID: 28572393 DOI: 10.1126/science.aag3112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/25/2017] [Accepted: 05/12/2017] [Indexed: 11/02/2022]
Abstract
The magnetopause deflects the solar wind plasma and confines Earth's magnetic field. We combine measurements made by the four spacecraft of the Magnetospheric Multiscale mission to demonstrate how the plasma and magnetic forces at the boundary affect the interaction between the shocked solar wind and Earth's magnetosphere. We compare these forces with the plasma pressure and examine the electron distribution function. We find that the magnetopause has sublayers with thickness comparable to the ion scale. Small pockets of low magnetic field strength, small radius of curvature, and high electric current mark the electron diffusion region. The flow of electrons, parallel and antiparallel to the magnetic field, reveals a complex topology with the creation of magnetic ropes at the boundary.
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Affiliation(s)
- C T Russell
- Earth Planetary and Space Sciences, University of California, Los Angeles, CA 90095, USA.
| | - R J Strangeway
- Earth Planetary and Space Sciences, University of California, Los Angeles, CA 90095, USA
| | - C Zhao
- Earth Planetary and Space Sciences, University of California, Los Angeles, CA 90095, USA
| | - B J Anderson
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723-6099, USA
| | - W Baumjohann
- Space Research Institute, Austrian Academy of Sciences, Schmiedlstr. 6, 8010 Graz, Austria
| | - K R Bromund
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - D Fischer
- Space Research Institute, Austrian Academy of Sciences, Schmiedlstr. 6, 8010 Graz, Austria
| | - L Kepko
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA.,University of New Hampshire, Durham, NH 03824, USA
| | - G Le
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - W Magnes
- Space Research Institute, Austrian Academy of Sciences, Schmiedlstr. 6, 8010 Graz, Austria
| | - R Nakamura
- Space Research Institute, Austrian Academy of Sciences, Schmiedlstr. 6, 8010 Graz, Austria
| | - F Plaschke
- Space Research Institute, Austrian Academy of Sciences, Schmiedlstr. 6, 8010 Graz, Austria
| | - J A Slavin
- Climate and Space Sciences and Engineering, University of Michigan, Ann Arbor, MI 48109-2143, USA
| | - R B Torbert
- University of New Hampshire, Durham, NH 03824, USA
| | - T E Moore
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - W R Paterson
- Earth Planetary and Space Sciences, University of California, Los Angeles, CA 90095, USA
| | - C J Pollock
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J L Burch
- Southwest Research Institute, San Antonio, TX 78228-0510, USA
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Kim DJ, Lee AS, Yttredahl AA, Gómez-Rodríguez R, Anderson BJ. Repeated threat (without direct harm) alters metabolic capacity in select regions that drive defensive behavior. Neuroscience 2017; 353:106-118. [PMID: 28433648 DOI: 10.1016/j.neuroscience.2017.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
To understand the behavioral consequences of intermittent anticipatory stress resulting from threats without accompanying physiological challenges, we developed a semi-naturalistic rodent housing and foraging environment that can include threats that are unpredictable in timing. Behavior is automatically recorded while rats forage for food or water. Over three weeks, the threats have been shown to elicit risk assessment behaviors, increase defensive burying and increase adrenal gland weight. To identify brain regions activated by this manipulation, we measured cytochrome c oxidase (COX), which is tightly coupled to neural activity. Adolescent male Sprague-Dawley rats were randomly assigned to control (CT) or unpredictable threat/stress (ST) housing conditions consisting of two tub cages, one with food and another with water, separated by a tunnel. Over three weeks (P31-P52), the ST group received randomly timed (probability of 0.25), simultaneous presentations of ferret odor, an abrupt light, and sound at the center of the tunnel. The ST group had consistently fewer tunnel crossings than the CT group, but similar body weights. Group differences in COX activity were detected in regions implicated in the control of defensive burying. There was an increase in COX activity in the hypothalamic premammillary dorsal nucleus (PMD) and lateral septum (LS), whereas a decrease was observed in the periaqueductal gray (PAG) and CA3 region of the hippocampus. There were no significant differences in the anterior cingulate cortex, prefrontal cortex, striatum or motor cortex. The sites with changes in metabolic capacity are candidates for the sites of plasticity that may underlie the behavioral adaptations to intermittent threats.
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Affiliation(s)
- D J Kim
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-5230, United States; Graduate Program in Integrative Neuroscience, Stony Brook University, Stony Brook, NY 11794-5230, United States
| | - A S Lee
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-5230, United States
| | - A A Yttredahl
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-5230, United States; Graduate Program in Integrative Neuroscience, Stony Brook University, Stony Brook, NY 11794-5230, United States
| | - R Gómez-Rodríguez
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-5230, United States
| | - B J Anderson
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-5230, United States; Graduate Program in Integrative Neuroscience, Stony Brook University, Stony Brook, NY 11794-5230, United States.
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Anderson BJ, Kligler B, Cohen HW, Marantz PR. Survey of Chinese Medicine Students to Determine Research and Evidence-Based Medicine Perspectives at Pacific College of Oriental Medicine. Explore (NY) 2016; 12:366-74. [PMID: 27473310 DOI: 10.1016/j.explore.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Indexed: 10/21/2022]
Abstract
CONTEXT Research literacy and the practice of evidence-based medicine (EBM) are important initiatives in complementary and alternative medicine (CAM), which requires cultural change within educational institutions for successful implementation. OBJECTIVE To determine the self-assessed research and EBM perspectives of Chinese medicine Masters degree students at Pacific College of Oriental Medicine, New York campus (PCOM-NY). DESIGN AND METHODS A survey with 17 close-ended questions and one open-ended question was administered through Survey Monkey to students at PCOM-NY. RESULTS The survey was sent to 420 Masters students and 176 (41.9%) responded. Students in all four years of the Masters degree indicated a generally high degree of interest in, and support for the value of research. However, increasing years (one to four years) in the program was associated with lower interest in post-graduation research participation and entering the doctoral program, and the fourth year students reported low levels of interest in having greater research content and training in their Masters degree programs. Students who responded to the open-ended question (23% of respondents) expressed enthusiasm for research and concerns about the relevance of research in Chinese medicine. CONCLUSIONS Consistent with findings in similar studies at CAM colleges, interest in research, and EBM of the PCOM-NY Masters students appeared to decline with increasing years in the program. Concerns around paradigm and epistemological issues associated with research and EBM among Chinese medicine students and practitioners warrants further investigation, and may be an important challenge for integrative medicine.
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Affiliation(s)
- Belinda J Anderson
- Pacific College of Oriental Medicine, 110 William Street, 19th Floor, New York, NY 10038; Albert Einstein College of Medicine, Bronx, NY.
| | - Benjamin Kligler
- Albert Einstein College of Medicine, Bronx, NY; Beth Israel Medical Center, New York, NY
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21
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Gold MA, Tzilos GK, Stein LAR, Anderson BJ, Stein MD, Ryan CM, Zuckoff A, DiClemente C. A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents. J Pediatr Adolesc Gynecol 2016; 29:26-32. [PMID: 26514957 PMCID: PMC4670811 DOI: 10.1016/j.jpag.2015.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/06/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. RESULTS The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex. CONCLUSION Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.
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Affiliation(s)
- MA Gold
- Columbia University Medical Center, Department of Pediatrics, Division of Child and Adolescent Health, Mailman School of Public Health, Department of Population and Family Health, and New York-Presbyterian Hospital, New York, NY
| | - GK Tzilos
- Brown University, Department of Psychiatry & Human Behavior, Providence, RI
| | - LAR Stein
- University of Rhode Island, Department of Psychology, Kingston, RI
| | | | - MD Stein
- Brown University, Department of Medicine, Public Health & Public Policy, Providence, RI
| | - CM Ryan
- University of Pittsburgh, Department of Psychiatry, Psychology, Health and Community Systems, Pittsburgh, PA
| | - A Zuckoff
- University of Pittsburgh, Departments of Psychology and Psychiatry, Pittsburgh, PA
| | - C DiClemente
- University of Maryland, Department of Psychology, Maryland, MD
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22
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Anderson BJ, Kligler B, Taylor B, Cohen HW, Marantz PR. Faculty survey to assess research literacy and evidence-informed practice interest and support at Pacific College of Oriental Medicine. J Altern Complement Med 2014; 20:705-12. [PMID: 25120170 DOI: 10.1089/acm.2014.0138] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Educating healthcare practitioners to understand, critically evaluate, and apply evidence to the clinical practice of complementary and alternative medicine has been an important initiative for the National Institutes of Health National Center for Complementary and Alternative Medicine. OBJECTIVE To determine the self-assessed research skills and interest of faculty at Pacific College of Oriental Medicine (New York campus) and their likely support of, and participatory interest in, an evidence-based medicine (EBM) training program. DESIGN The survey was administered in Survey Monkey. All questions were close-ended with 5-point Likert answers, except for one open-ended question at the end of the survey. SETTING One of three campuses of Pacific College of Oriental Medicine (PCOM), the largest Chinese medicine college in the United States. PARTICIPANTS 102 faculty employed at PCOM. RESULTS The response rate was 88.7%. Responses illustrated a generally high degree of interest and support for research, EBM, and institutional participation in research activities. Faculty who responded to the open-ended question (19.6% of respondents) expressed concerns about the relevance of research to Chinese medicine and the possibility of co-option by biomedicine. CONCLUSIONS While faculty were overall supportive and interested in research and EBM, the results are consistent with the hypothesis that success of EBM training programs could be enhanced by soliciting and addressing faculty concerns and by being inclusive of approaches that honor the traditions of Chinese medicine and its own forms of clinical evidence.
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Stein MD, Caviness CM, Kurth ME, Audet D, Olson J, Anderson BJ. Varenicline for smoking cessation among methadone-maintained smokers: a randomized clinical trial. Drug Alcohol Depend 2013; 133:486-93. [PMID: 23953658 PMCID: PMC3818400 DOI: 10.1016/j.drugalcdep.2013.07.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 07/03/2013] [Accepted: 07/08/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND With smoking rates far exceeding the general population, methadone-maintained (MMT) opiate-dependent smokers experience high rates of tobacco-related health consequences. Previous treatment studies have used nicotine replacement and produced low quit rates. METHODS We test, using a three-group randomized design, the efficacy of varenicline versus placebo, in comparison with nicotine replacement therapy (NRT) that combines nicotine patch prescription plus ad libitum nicotine rescue, for smoking cessation. We recruited methadone-maintained smokers from nine treatment centers in southern New England and provided six months of treatment, and a minimal behavioral intervention at baseline (NCI's 5A's). Outcomes included carbon monoxide (CO) confirmed 7-day point smoking cessation prevalence at 6 months and self-reported change in mean cigarettes per day. RESULTS The 315 participants had a mean age of 40, with 50% male and 79% non-Hispanic White, smoked an average of 19.6 (± 10.4) cigarettes/day, and had a mean daily methadone dose of 109 mg. Intent-to-treat analyses, with missing considered to be smoking, showed the rate of CO-confirmed 7-day abstinence at 6-months was 5.4% overall, with varenicline 3.7% compared to placebo 2.2%, and NRT 8.3% (p>.05). Adherence rates during the 7-days immediately prior to 6-month assessment were 34.2% in varenicline, 34.4% in placebo, and 48.8% in NRT. Between baseline and 6-months there was an overall self-reported mean reduction of 8.3 cigarettes/day. CONCLUSION Varenicline did not increase quit rates over placebo. Smoking cessation rates in methadone-maintained smokers are low and novel treatment strategies are required.
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Affiliation(s)
- M D Stein
- General Medicine Research Unit, Butler Hospital, Providence, RI 02906, United States; Warren Alpert Medical School of Brown University, Providence, RI 02912, United States.
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Anderson BJ, Herron PD, Downie SA, Myers DC, Milan FB, Olson TR, Kligler BE, Sierpina VS, Kreitzer MJ. Interprofessional Student Education: Exchange Program Between Albert Einstein College of Medicine and Pacific College of Oriental Medicine. Explore (NY) 2012; 8:377-81. [DOI: 10.1016/j.explore.2012.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
AIMS To determine incidence rates of severe hypoglycaemia and compare incidence rates by insulin regimen in a diverse sample of youth with Type 1 diabetes from two sites. METHODS In this observational study, 255 youth (51% female) aged 9-15 years receiving varied insulin regimens provided data prospectively for a median of 1.2 years. Reported episodes of severe hypoglycaemia, defined as episodes requiring help from another person for oral treatment or episodes resulting in seizure/coma, and current insulin regimens were collected systematically. Incidence rates were calculated and compared according to insulin regimen in bivariate and multivariate analyses. RESULTS At first encounter, participants had a median age of 12.2 years (range 9.0-15.0), median diabetes duration of 4.4 years (range 1.0-13.0) and mean HbA(1c) of 67 ± 12 mmol/mol (8.3 ± 1.1%). The incidence rate was 37.6/100 patient-years for all severe hypoglycaemia and 9.6/100 patient-years for seizure/coma. The incidence rate for severe hypoglycaemia was 31.8/100 patient-years on continuous subcutaneous insulin infusion (pump therapy), 34.4/100 patient-years on basal-bolus injections and 46.1/100 patient-years on NPH (NPH vs. pump therapy: P = 0.04). The incidence rate for seizure/coma was 4.5/100 patient-years on pump therapy, 11.1/100 patient-years on basal-bolus injections and 14.4/100 patients-years on NPH (NPH vs. pump therapy: P = 0.004). In the multivariate analysis, the rate of seizure/coma was significantly higher for those on NPH vs. pump therapy (rate ratio 2.9, P = 0.03). CONCLUSIONS Rates of severe hypoglycaemia in youth with Type 1 diabetes remain high. Pump therapy was associated with lower rates of all severe hypoglycaemia and seizure/coma in comparison with NPH.
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Affiliation(s)
- M L Katz
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA 02215, USA
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Markowitz JT, Volkening LK, Butler DA, Antisdel-Lomaglio J, Anderson BJ, Laffel LMB. Re-examining a measure of diabetes-related burden in parents of young people with Type 1 diabetes: the Problem Areas in Diabetes Survey - Parent Revised version (PAID-PR). Diabet Med 2012; 29:526-30. [PMID: 21883443 PMCID: PMC3510480 DOI: 10.1111/j.1464-5491.2011.03434.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS In a pediatric patients, the burden of diabetes lies within the family. In the current era of intensive insulin therapy, perceived parental burden may affect the family's efforts at effective diabetes management. The aims of this study were to re-examine and revise a measure of perceived parental burden associated with caring for a child with diabetes in the current era. METHODS A geographically diverse population of young people (N = 376) with Type 1 diabetes and their parents included participants in the Juvenile Diabetes Research Foundation continuous glucose monitoring study and patients from the Joslin Diabetes Center. Participants provided data on demographics, diabetes management, diabetes-specific family conflict, and quality of life at baseline and after 6 months of follow-up. RESULTS Young people were 12.9 ± 2.7 years old with diabetes duration of 6.3 ± 3.5 years. Mean HbA(1C) was 8.0 ± 1.2%(64 mmol/mol), 58% received insulin pump therapy, and young people monitored blood glucose 5.2 ± 2.3 times/day. Factor analysis yielded two factors, 'Immediate Burden' and 'Theoretical Burden'. The Problem Areas in Diabetes Survey - Parent Revised version (PAID-PR) demonstrated excellent internal consistency (Cronbach's α = 0.87; factor 1 α = 0.78; factor 2 α = 0.83). Greater parental burden was associated with more frequent blood glucose monitoring, higher HbA(1C) levels, greater diabetes-specific family conflict, and lower quality of life. Test-retest analysis was acceptable (r = 0.62). CONCLUSIONS The PAID-PR demonstrated excellent internal consistency, good test-retest reliability, and associations with diabetes-specific family conflict and quality of life. This brief measure may have both clinical and research utility in the management of young people with Type 1 diabetes.
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Affiliation(s)
- J T Markowitz
- Pediatric, Adolescent, & Young Adult Section, Joslin Diabetes Center, Boston, MA 02215, USA
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Alleyn CR, Laffel LMB, Volkening LK, Anderson BJ, Nansel TR, Wysocki T, Weissberg-Benchell J. Comparison of longitudinal point-of-care and high-performance liquid chromatography HbA1c measurements in a multi-centre trial. Diabet Med 2011; 28:1525-9. [PMID: 21824185 PMCID: PMC3220776 DOI: 10.1111/j.1464-5491.2011.03404.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Point-of-care HbA(1c) is routine in clinical practice. Comparison of point-of-care HbA(1c) against laboratory measurements across sites and over time is warranted. METHODS One hundred and twenty-one young persons with Type 1 diabetes from four centres provided 450 paired samples collected over 10 months for point-of-care HbA(1c) and central laboratory-based high-performance liquid chromatography (HPLC) HbA(1c) determinations. Change in HbA(1c) over time was assessed by difference from initial to final HbA(1c) and by growth modelling with annualized slope calculation. Change in HbA(1c) was categorized as improved (decrease of ≥ 0.5% or negative slope), no change (± 0.4% of initial HbA(1c) or slope = 0) or worsened (increase of ≥ 0.5% or positive slope). RESULTS The 450 paired samples (median of four pairs/patient) were highly correlated (r = 0.97, P < 0.0001), as were time-specific and site-specific pairs (r = 0.94 to 0.98, P < 0.0001). Initial-to-final point-of-care HbA(1c) and HPLC HbA(1c) changes were 0.3 ± 1.1% (range -2.7 to 4.1) and 0.4 ± 1.2% (-3.9 to 4.5), respectively, with 21% of patients (n = 26) discordant for change categories. ΔHbA(1c) by point-of-care HbA(1c) vs. HPLC HbA(1c) differed across the HbA(1c) range and by ≥ 0.5% absolute difference in ΔHbA(1c) in 14 (54%) of the 26 patients discordant for HbA(1c) change categories. Mean annual HbA(1c) slope was 0.4 ± 1.5% (-5.4 to 4.8) for point-of-care HbA(1c) and 0.4 ± 1.6% (-6.9 to 5.2) for HPLC HbA(1c), with 18% (n = 22 pairs) discordant for change categories. CONCLUSIONS Assessment of absolute HbA(1c) change may not be different for point-of-care HbA(1c) compared with HPLC HbA(1c); however, misclassification of patients by discrete cut-off values may occur with point-of-care HbA(1c) compared with HPLC HbA(1c) determinations.
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Affiliation(s)
- C R Alleyn
- Joslin Diabetes Center, Boston, MA 02215, USA
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Abstract
AIMS Adherence to diabetes-related tasks is an important construct. The Diabetes Self-Management Profile is a validated, semi-structured interview assessing adherence in paediatric patients with Type 1 diabetes. We created and validated a brief questionnaire version of the Diabetes Self-Management Profile called the Diabetes Self-Management Questionnaire. METHODS Young people with Type 1 diabetes, ages 9-15 years (n = 338) and their parents provided data from chart review, interview and questionnaires. RESULTS Diabetes Self-Management Questionnaire scores correlated significantly with Diabetes Self-Management Profile scores, HbA(1c) , blood glucose monitoring frequency and other measures associated with adherence and/or glycaemic control (P ≤ 0.01 for all). Young people and parent scores were correlated (r = 0.55, P < 0.0001). The Diabetes Self-Management Questionnaire demonstrated modest internal consistency (Cronbach's α = 0.59), adequate for a brief measure of multidimensional adherence. In addition, factor analysis confirmed one factor. CONCLUSIONS This brief adherence questionnaire demonstrated construct validity in young people 9-15 years old and their parents and may have utility in clinical and research settings.
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Abstract
BACKGROUND Thiopentone elimination has been described using Michaelis-Menten pharmacokinetics in adults after prolonged infusion or overdose, but there are few reports of elimination in neonates. METHODS Time-concentration profiles for neonates (n=37) given single-dose thiopentone were examined using both first-order (constant clearance) and mixed-order (Michaelis-Menten) elimination processes using nonlinear mixed effects models. These profiles included a 33-week post-menstrual age (PMA) neonate given an overdose. A two-compartment mamillary model was used to fit data. Parameter estimates were standardized to a 70 kg person using allometric models. RESULTS There were 197 observations available for analysis from neonates with a mean post-menstrual age of 35 (SD 4.5) weeks and a mean weight of 2.5 (SD 0.9) kg. They were given a mean thiopentone dose of 3 (SD 0.4) mg/kg as a rapid bolus. Clearance at 26 weeks PMA was 0.015 l/min/70 kg and increased to 0.119 l/min/70 kg by 42 weeks PMA. The maximum rate of elimination (V(max)) at 26 weeks PMA was 0.22 mg/min/70 kg and increased to 4.13 mg/min/70 kg by 42 weeks PMA. These parameter estimates are approximately 40% adult values at term gestation. The Michaelis constant (K(m)) was 28.3 [between subject variability (BSV) 46.4%, 95% confidence interval (CI) 4.49-99.2] mg/l; intercompartment clearance was 0.44 (BSV 97.5%, 95% CI 0.27-0.63) l/min/70 kg; central volume of distribution was 46.4 (BSV 29.2%, 95% CI 41.7-59.8) l/70 kg; peripheral volume of distribution was 95.7 (BSV 70.3%, 95% CI 61.3-128) l/70 kg. CONCLUSIONS Both first-order and mixed-order processes satisfactorily described elimination. First-order elimination adequately described the time-concentration profile in the premature neonate given an overdose. Clearance is immature in the pre-term neonate although there is rapid maturation around 40 weeks PMA, irrespective of post-natal age.
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Affiliation(s)
- P Larsson
- Department of Physiology & Pharmacology, Section of Anaesthesiology & Intensive Care, Karolinska Institute, Stockholm, Sweden.
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Cortínez LI, Anderson BJ, Penna A, Olivares L, Muñoz HR, Holford NHG, Struys MMRF, Sepulveda P. Influence of obesity on propofol pharmacokinetics: derivation of a pharmacokinetic model. Br J Anaesth 2010; 105:448-56. [PMID: 20710020 DOI: 10.1093/bja/aeq195] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The objective of this study was to develop a pharmacokinetic (PK) model to characterize the influence of obesity on propofol PK parameters. METHODS Nineteen obese ASA II patients undergoing bariatric surgery were studied. Patients received propofol 2 mg kg(-1) bolus dose followed by a 5-20-40-120 min, 10-8-6-5 mg kg(-1) h(-1) infusion. Arterial blood samples were withdrawn at 1, 3, 5 min after induction, every 10-20 min during propofol infusion, and every 10-30 min for 2 h after stopping the propofol infusion. Arterial samples were processed by high-performance liquid chromatography. Time-concentration data profiles from this study were pooled with data from two other propofol PK studies available at http://www.opentci.org. Population PK modelling was performed using non-linear mixed effects model. RESULTS The study involved 19 obese adults who contributed 163 observations. The pooled analysis involved 51 patients (weight 93 sd 24 kg, range 44-160 kg; age 46 sd 16 yr, range 25-81 yr; BMI 33 sd 9 kg m(-2), range 16-52 kg m(-2)). A three-compartment model was used to investigate propofol PK. An allometric size model using total body weight (TBW) was superior to all other models investigated (linear TBW, free fat mass, lean body weight, normal fat mass) for all clearance parameters. Variability in V2 and Q2 was reduced by a function showing a decrease in both parameters with age. CONCLUSIONS We have derived a population PK model using obese and non-obese data to characterize propofol PK over a wide range of body weights. An allometric model using TBW as the size descriptor of volumes and clearances was superior to other size descriptors to characterize propofol PK in obese patients.
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Affiliation(s)
- L I Cortínez
- Departamento de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Hospital Clínico U. Católica, Marcoleta 367, PO Box 114-D, Santiago, Chile.
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Merry AF, Gibbs RD, Edwards J, Ting GS, Frampton C, Davies E, Anderson BJ. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial. Br J Anaesth 2010; 104:80-8. [PMID: 20007794 PMCID: PMC2791549 DOI: 10.1093/bja/aep338] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Acetaminophen is often used with a non-steriodal anti-inflammatory drug for acute pain. Hitherto, these drugs have had to be given separately, typically at different time intervals. Maxigesic® tablets combine acetaminophen and ibuprofen in clinically appropriate doses to simplify administration and dosage regimen. We compared this combination with each of the constituent drugs for the relief of pain after extraction of third molar teeth. Methods Adults (more than 16 yr) having one or more wisdom teeth removed under general or local anaesthesia were instructed to take two tablets before operation, then two tablets every 6 h for up to 48 h of: (i) a combination of acetaminophen 500 mg and ibuprofen 150 mg per tablet (Maxigesic®); (ii) acetaminophen 500 mg per tablet alone; or (iii) ibuprofen 150 mg per tablet alone. The primary outcome measure was the area under the curve (AUC) of the 100 mm visual analogue scale pain measurements taken for up to 48 h after surgery, divided by time, at rest and on activity. Pharmacokinetic data were collected in a subset of patients. Results The mean (sem) time-corrected AUC on rest and activity, respectively, were: combination group 22.3 (3.2) and 28.4 (3.4); acetaminophen group 33.0 (3.1) and 40.4 (3.3); and ibuprofen group 34.8 (3.2) and 40.2 (3.4); P<0.01 for each of the four comparisons of combination vs constituent drug. There was no pharmacokinetic interaction between acetaminophen and ibuprofen administered together. Conclusions Maxigesic® tablets provide superior pain relief after oral surgery to acetaminophen or ibuprofen alone.
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Affiliation(s)
- A F Merry
- Department of Anaesthesiology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Anderson BJ, Akçakaya HR, Araújo MB, Fordham DA, Martinez-Meyer E, Thuiller W, Brook BW. Dynamics of range margins for metapopulations under climate change. Proc Biol Sci 2009; 276:1415-20. [PMID: 19324811 DOI: 10.1098/rspb.2008.1681] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We link spatially explicit climate change predictions to a dynamic metapopulation model. Predictions of species' responses to climate change, incorporating metapopulation dynamics and elements of dispersal, allow us to explore the range margin dynamics for two lagomorphs of conservation concern. Although the lagomorphs have very different distribution patterns, shifts at the edge of the range were more pronounced than shifts in the overall metapopulation. For Romerolagus diazi (volcano rabbit), the lower elevation range limit shifted upslope by approximately 700 m. This reduced the area occupied by the metapopulation, as the mountain peak currently lacks suitable vegetation. For Lepus timidus (European mountain hare), we modelled the British metapopulation. Increasing the dispersive estimate caused the metapopulation to shift faster on the northern range margin (leading edge). By contrast, it caused the metapopulation to respond to climate change slower, rather than faster, on the southern range margin (trailing edge). The differential responses of the leading and trailing range margins and the relative sensitivity of range limits to climate change compared with that of the metapopulation centroid have important implications for where conservation monitoring should be targeted. Our study demonstrates the importance and possibility of moving from simple bioclimatic envelope models to second-generation models that incorporate both dynamic climate change and metapopulation dynamics.
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Affiliation(s)
- B J Anderson
- UKPopNet, Department of Biology (Area 18), University of York, PO Box 373, York YO10 5YW, UK
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Anand KJS, Anderson BJ, Holford NHG, Hall RW, Young T, Shephard B, Desai NS, Barton BA. Morphine pharmacokinetics and pharmacodynamics in preterm and term neonates: secondary results from the NEOPAIN trial. Br J Anaesth 2008; 101:680-9. [PMID: 18723857 DOI: 10.1093/bja/aen248] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Relationships between plasma morphine concentrations and neonatal responses to endotracheal tube (ETT) suctioning are unknown in preterm neonates. METHODS Ventilated preterm neonates (n=898) from 16 centres were randomly assigned to placebo (n=449) or morphine (n=449). After an i.v. loading dose (100 microg kg(-1)), morphine infusions [23-26 weeks postmenstrual age (PMA) 10 microg kg(-1) h(-1); 27-29 weeks 20 microg kg(-1) h(-1); and 30-32 weeks 30 microg kg(-1) h(-1)] were established for a maximum of 14 days. Open-label morphine (20-100 microg kg(-1)) was given for pain or agitation. Morphine assay and neonatal response to ETT suctioning was measured at 20-28 and 70-76 h after starting the drug infusion and at 10-14 h after discontinuation of the study drug. The concentration-effect response was investigated using non-linear mixed effects models. RESULTS A total of 5119 data points (1598 measured morphine concentrations and 3521 effect measures) were available from 875 neonates for analysis. Clearance was 50% that of the mature value at 54.2 weeks PMA (CLmat(50)) and increased from 2.05 litre h(-1) 70 kg(-1) at 24 weeks PMA to 6.04 litre h(-1) 70 kg(-1) at 32 weeks PMA. The volume of distribution in preterm neonates was 190 litre 70 kg(-1) (CV 51%) and did not change with age. There was no relationship between morphine concentrations (range 0-440 microg litre(-1)) and heart rate changes associated with ETT suctioning or with the Premature Infant Pain Profile. CONCLUSIONS A sigmoid curve describing maturation of morphine clearance is moved to the right in preterm neonates and volume of distribution is increased compared with term neonates. Morphine does not alter the neonatal response to ETT suctioning.
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Affiliation(s)
- K J S Anand
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
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Palmer GM, Atkins M, Anderson BJ, Smith KR, Culnane TJ, McNally CM, Perkins EJ, Chalkiadis GA, Hunt RW. I.V. acetaminophen pharmacokinetics in neonates after multiple doses. Br J Anaesth 2008; 101:523-30. [PMID: 18628265 DOI: 10.1093/bja/aen208] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pharmacokinetics of an i.v. prodrug of acetaminophen (propacetamol) in neonates after repeat dosing are reported, with scant data for i.v. acetaminophen formulation. METHODS Neonates from an intensive care unit received 6-hourly prn i.v. acetaminophen dosed according to postmenstrual age (PMA): 28-32 weeks, 10 mg kg(-1); 32-36 weeks, 12.5 mg kg(-1); and > or =36 weeks, 15 mg kg(-1). A maximum of five blood samples for assay and liver function tests (LFTs) were collected. A one-compartment linear disposition model (zero-order input; first-order elimination) was used to describe time-concentration profiles using population modelling (NONMEM). RESULTS Fifty neonates, median (range) PMA 38.6 (32-45) weeks, mean (SD) weight 2.9 (0.7) kg, received a mean of 15 doses over a median 4 days with 189 serum acetaminophen and 231 LFT measurements. Standardized population parameter estimates for a term neonate were clearance (CL) 5.24 (CV 30.5%) litre h(-1) 70 kg(-1) and volume of distribution (V) 76 (29.6%) litre 70 kg(-1). CL increased with PMA from 4.4 litre h(-1) 70 kg(-1) at 34 weeks to 6.3 litre h(-1) 70 kg(-1) at 46 weeks. The presence of unconjugated hyperbilirubinaemia was associated with reduced CL: 150 micromol litre(-1) associated with 40% CL reduction. Acetaminophen concentrations between 10 and 23 mg litre(-1) at steady state are predicted after 15 mg kg(-1) 6-hourly for a neonate of PMA 40 weeks. Hepatic enzyme analysis of daily samples changed significantly for one patient whose alanine aminotransferase concentration tripled. CONCLUSIONS The parameter estimates are similar to those described for propacetamol. There was no evidence of hepatotoxicity. Unconjugated hyperbilirubinaemia impacts upon CL, dictating dose reduction.
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Affiliation(s)
- G M Palmer
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia.
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Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics 2008; 29:245-56. [PMID: 18240287 DOI: 10.1002/bem.20403] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
According to conventional wisdom within the acupuncture community, acupuncture points and meridians are special conduits for electrical signals. This view gained popularity after anecdotal reports and clinical studies asserted that these anatomical structures are characterized by lower electrical impedance compared to adjacent controls. To ascertain whether evidence exists to support or refute this claim, we conducted a systematic review of studies directly evaluating the electrical characteristics of acupuncture structures and appropriate controls. We searched seven electronic databases until August 2007, hand-searched references, and consulted technical experts. We limited the review to primary data human studies published in English. A quality scoring system was created and employed for this review. A total of 16 articles representing 18 studies met inclusion criteria: 9 examining acupuncture points and 9 examining meridians. Five out of 9 point studies showed positive association between acupuncture points and lower electrical resistance and impedance, while 7 out of 9 meridian studies showed positive association between acupuncture meridians and lower electrical impedance and higher capacitance. The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. However, the preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data.
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Affiliation(s)
- Andrew C Ahn
- Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts 02215, USA.
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Abstract
Interpretation of analgesic and antipyretic responses documented after paracetamol administration is confused because response is not directly related to concentration in the blood, but rather to an effect compartment. The effect compartment does not have real measurable concentrations, but concentrations equate approximately to those observed in the cerebrospinal fluid. A time delay exists before drug reaches the effect compartment, and the equilibration half-time between the central and effect compartment is described by a single first-order parameter (Teq or T(1/2)keo), reported to be approximately 1 h for paracetamol. Paediatric analgesic studies are limited because they have only explored postoperative pain after tonsillectomy or day-stay surgery. Other pain types and pain confounders have not been investigated. Adult studies are also similarly limited. Studies investigating antipyresis have not explored the maximum response, limiting the precision of any EC(50) estimate. The influence of the cyclical nature of fever or initial temperature is seldom accounted for in antipyretic studies. Target effect compartment concentrations of 5 mg/l for fever and 10 mg/l for pain do not seem unreasonable on the basis of current literature. Speed of onset may be shortened by giving a larger initial dose or improving absorption characteristics. Consequent plasma concentration achieved, differences in effect compartment equilibration times, and the shape of the effect compartment concentration-response curve help to explain differences between common analgesic/antipyretic drugs.
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Affiliation(s)
- I A Gibb
- Reckitt Benckiser Healthcare International, Nottingham, UK
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Abstract
Growth and development can be investigated using readily observable demographic factors such as weight and age. Size is the primary covariate and can be referenced to a 70-kg person with allometry using a coefficient of 0.75 for clearance and 1 for volume. The use of these coefficients is supported by fractal geometric concepts and observations from diverse areas in biology. Fat free mass (FFM) might be expected to do better than total body weight when there are wide variations in fat affecting body composition. Clearance pathways develop in the fetus before birth. The use of postnatal age as a descriptor of maturation is unsatisfactory because birth may occur prematurely; therefore postmenstrual age is a superior predictor of elimination function. A sigmoid E(max) model (Hill equation) describes gradual maturation of clearance in early life leading to a mature adult clearance achieved at a later age.
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Affiliation(s)
- B J Anderson
- Department of Anaesthesiology, University of Auckland School of Medicine, Auckland, New Zealand.
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Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med 2007; 13:38-48. [PMID: 17515023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To provide an overview of the use of acupuncture as an adjunct therapy for in vitro fertilization (IVF), including an evidence-based evaluation of its efficacy and safety and an examination of possible mechanisms of action. DESIGN Literature review using PubMed, the Science Citation Index, The Cochrane Library (Database of Systematic Reviews and Central Register of Controlled Trials), the New England School of Acupuncture library databases, and a cross-referencing of published data, personal libraries, and Chinese medicine textbooks. RESULTS Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy. However, this conclusion should be interpreted with caution because most studies reviewed had design limitations, and the acupuncture interventions employed often were not consistent with traditional Chinese medical principles. The reviewed literature suggests 4 possible mechanisms by which acupuncture could improve the outcome of IVF: modulating neuroendocrinological factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression. CONCLUSIONS More high-quality randomized, controlled trials incorporating placebo acupuncture controls, authentic acupuncture interventions, and a range of outcome measures representative of both clinical outcomes and putative mechanistic processes are required to better assess the efficacy of acupuncture as an adjunct for IVF.
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Marcus R, Varma JK, Medus C, Boothe EJ, Anderson BJ, Crume T, Fullerton KE, Moore MR, White PL, Lyszkowicz E, Voetsch AC, Angulo FJ. Re-assessment of risk factors for sporadic Salmonella serotype Enteritidis infections: a case-control study in five FoodNet Sites, 2002-2003. Epidemiol Infect 2007; 135:84-92. [PMID: 16756692 PMCID: PMC2870546 DOI: 10.1017/s0950268806006558] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2006] [Indexed: 11/07/2022] Open
Abstract
Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002-2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23-125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.
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Affiliation(s)
- R Marcus
- Connecticut Emerging Infections Program, New Haven, CT 06510, USA.
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Abstract
Growth and development are two linked processes that distinguish children from adults. The use of size as the primary covariate during pharmacokinetic (PK) analyses allows exploration of the effects of age. Allometric scaling models have assisted understanding of the developmental clearance changes in common analgesic drugs such as paracetamol, morphine, tramadol and local anaesthetics agents. Single nucleotide polymorphisms (pharmacogenomics [PG]) and their impact on hepatic drug metabolism for opioids, tramadol, non-steroidal anti-inflammatory drugs (NSAIDs) and drug receptor responses are increasingly reported. Altered chemical structure or formulations of common analgesics alter pharmacodynamic (PD) effects enhancing safety and efficacy for NSAIDs by stereoselectivity and the addition of nitric oxide, for intravenous paracetamol by formulation and structural difference from propacetamol and for local anaesthetics through stereoselectivity. This article focuses upon recent data for analgesics used in paediatric pain management including paracetamol, NSAIDs, morphine, tramadol, amide local anaesthetics and ketamine. It centres on PK and clinical studies in neonates, infants and children. PG studies are acknowledged as potentially allowing individual drug therapy tailoring through a decrease in between-patient population variability, although the impact of PG in the very young is less certain. There are few data describing age-related PD changes in children despite recognition that the number, affinity and type of receptors or the availability of natural ligands changes with age.
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Affiliation(s)
- B J Anderson
- University of Auckland, Auckland, New Zealand, and Department of Anaesthesia and Pain Management, Royal Children's Hospital, Victoria, Australia.
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Allegaert K, Anderson BJ, Vrancken M, Debeer A, Desmet K, Cosaert K, Tibboel D, Devlieger H. Impact of a paediatric vial on the magnitude of systematic medication errors in neonates. ACTA ACUST UNITED AC 2006. [DOI: 10.1185/146300906x105096] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bednarczyk R, Zansky S, Anderson BJ. Irradiated and Pasteurized Food use in Long Term Care Facilities, Nys 2005. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s41-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The aim of this study was to investigate methods of practice, assess skill level, and evaluate attitudes towards fibreoptic intubation in the anaesthetic community of New Zealand. A postal survey questionnaire was sent to all vocationally registered anaesthetists in New Zealand and to all New Zealand anaesthetic trainees registered with the Australian and New Zealand College of Anaesthetists. There were 611 survey questionnaires posted and 386 (63%) respondents. Almost all respondents (98% of specialists, 100% of trainees) had access to fibreoptic equipment in public and 92% of respondents performed fibreoptic intubation. The median number of fibreoptic intubations performed per year was 3 for consultants and 4 for trainees. Respondents were either self taught or colleague taught (82%). Most learnt the technique on patients (92%). There were 14% who considered themselves experienced, 30% competent, 34% adequate and 20% novice. Skills were maintained by clinical patient mix in 73%. Fibreoptic intubation was considered a skill required by all anaesthetists in 87%, and 66% considered it the gold standard for expected difficult airways. Lack of clinical cases requiring the skill and lack of practice were identified as the primary barriers to skill development. Consultants had greater opportunity to learn fibreoptic intubation skills during daily practice than trainees. Only 18% of trainees had a formal airway management program available to them at their place of work. There appears to be a need to increase available opportunities to perform fibreoptic intubation to enable maintenance and improvement of fibreoptic skills in our community. A formalized program of teaching fibreoptic intubation may offer greater opportunity for learning and skill development.
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Affiliation(s)
- A J Dawson
- Department of Anaesthesia, Auckland City Hospital, Wellington Public Hospital and Auckland Children's Hospital, Auckland and Wellington, and Auckland University Medical School, Auckland, New Zealand
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Anderson BJ, Gopalakrishnan V, Ramakrishnan S, Zukoski CF. Scattering for mixtures of hard spheres: comparison of total scattering intensities with model. Phys Rev E Stat Nonlin Soft Matter Phys 2006; 73:031407. [PMID: 16605524 DOI: 10.1103/physreve.73.031407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Indexed: 05/08/2023]
Abstract
The angular dependence of the intensity of x-rays scattered from binary and ternary hard sphere mixtures is investigated and compared to the predictions of two scattering models. Mixture ratio and total volume fraction dependent effects are investigated for size ratios equal to 0.51 and 0.22. Comparisons of model predictions with experimental results indicate the significant impact of the role of particle size distributions in interpreting the angular dependence of the scattering at wave vectors probing density fluctuations intermediate between the sizes of the particles in the mixture.
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Affiliation(s)
- B J Anderson
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
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Anderson BJ. Prophylactic valacyclovir to prevent outbreaks of primary herpes gladiatorum at a 28-day wrestling camp. Jpn J Infect Dis 2006; 59:6-9. [PMID: 16495626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Herpes gladiatorum (HG) plagues the sport of wrestling, especially in high school wrestlers and summer camps they attend. This study evaluated the usage of valacyclovir to prevent acquisition of primary HG, due to herpes simplex virus type 1 (HSV-1), in high school wrestlers at a 28-day wrestling camp. At the beginning and end of camp, IgM and IgG anti-HSV-1 antibodies were collected. Out of 332 male wrestlers, aged 13-20, who entered camp, 94 elected to participate in blood sampling. Sixty-four were on antiviral medication. Among the 94 wrestlers, 28 (29.8%) had positive IgG anti-HSV-1 titers. Of this group, 66 of 94, were HSV-1 IgG seronegative. At the end of camp, 55 of these original seronegative individuals elected to participate in blood sampling and none had detectable IgM anti-HSV-1 and -2 antibodies. Compared to previous years without antiviral usage, introducing prophylactic valacyclovir reduced clinical HG outbreaks by 87% at this 28-day wrestling camp. Due to the high prevalence of this virus in high school wrestlers, serological testing should be done at the beginning of each season. HSV-1 seropositive individuals should consider being on antiviral medication throughout the season to minimize the risk of transmitting the virus to other wrestlers.
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Affiliation(s)
- B J Anderson
- Boynton Health Service, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Abstract
The administration of ibuprofen or any other nonselective cyclooxygenase (COX) inhibitor drug in early neonatal life is associated with a reduction of glomerular filtration, which reduces the elimination of drugs dependent on renal function for clearance. However, the relationship between COX inhibitor drug indication (prophylactic or therapeutic) and the magnitude of this effect remains unclear. Observations collected in two population pharmacokinetic studies, in preterm neonates, investigating amikacin and vancomycin were used to estimate: i) the impact of ibuprofen administration on the clearance of these drugs; and ii) the difference between prophylactic and therapeutic administration of ibuprofen on this clearance. Prophylactic administration of ibuprofen to preterm neonates on the first day of life to enhance closure of an asymptomatic patent ductus arteriosus (PDA) reduced amikacin clearance by 21% while coadministration of ibuprofen to induce closure of a symptomatic PDA resulted in an 18% reduction in vancomycin clearance in the first month of postnatal life. A significant and clinically relevant reduction in drug clearance is observed when ibuprofen is coadministered independent of indication, postmenstrual or postnatal age. Population modeling with covariate analyses can provide us with the tools to further disentangle the impact of nonselective COX-inhibitors on renal drug clearance.
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Affiliation(s)
- K Allegaert
- Neonatal Intensive Care Unit, Division of Woman and Child, University Hospital, Gasthuisberg, Leuven, Belgium.
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Abstract
AIMS To review clinical features and outcome of children with severe Staphylococcus aureus sepsis (SAS) presenting to a paediatric intensive care unit (PICU) with particular focus on ethnicity, clinical presentation, cardiac involvement, and outcome. METHODS Retrospective chart review of patients coded for SAS over 10 years (October 1993 to April 2004). RESULTS There were 58 patients identified with SAS over the 10 year study period; 55 were community acquired. This accounted for 4% of hospital admissions for SAS over this time; children with staphylococcal illness comprised 1% of all admissions to the PICU. Maori and Pacific children with SAS were overly represented in the PICU (81%) from a paediatric population where they contribute 21.6%. Musculoskeletal symptoms (79%) dominated presentation rather than isolated pneumonia (10%). An aggressive search for foci and surgical drainage of infective foci was required in 50% of children. Most children had multifocal disease (67%) and normal cardiac valves (95%); the few children (12%) presenting with methicillin resistant S aureus (MRSA) had community acquired infection. The median length of stay in the PICU was 3 (mean 5.8, SD 7.6, range 1-44) days. The median length of stay in hospital was 15 (mean 21, SD 22.7, range 2-149) days. Mortality due to SAS was 8.6% (95% CI 1.4-15.8%) compared with the overall mortality for the PICU of 6% (95% CI 5.3-6.7%). Ten children had significant morbidity after discharge. CONCLUSIONS Community acquired SAS affects healthy children, is multifocal, and has high morbidity and mortality, in keeping with the high severity of illness scores on admission. It is imperative to look for sites of dissemination and to drain and debride foci. Routine echocardiography had low yield in the absence of pre-existing cardiac lesions, persisting fever, or persisting bacteraemia.
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Affiliation(s)
- F Miles
- Paediatric Intensive Care Unit, Auckland Children's Hospital, New Zealand.
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