1
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Goldberg DJ, Hu C, Lubert AM, Rathod RH, Penny DJ, Petit CJ, Schumacher KR, Ginde S, Williams RV, Yoon JK, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Cartoski MJ, Detterich JA, Yetman AT, John AS, Richmond ME, Yung D, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Almaguer M, Zak V, McBride MG, Goldstein BH, Pearson GD, Paridon SM. The Fontan Udenafil Exercise Longitudinal Trial: Subgroup Analysis. Pediatr Cardiol 2023; 44:1691-1701. [PMID: 37382636 DOI: 10.1007/s00246-023-03204-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023]
Abstract
The Pediatric Heart Network's Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT02741115) demonstrated improvements in some measures of exercise capacity and in the myocardial performance index following 6 months of treatment with udenafil (87.5 mg twice daily). In this post hoc analysis, we evaluate whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. The effect of udenafil on exercise was evaluated within subgroups defined by baseline characteristics, including peak oxygen consumption (VO2), serum brain-type natriuretic peptide level, weight, race, gender, and ventricular morphology. Differences among subgroups were evaluated using ANCOVA modeling with fixed factors for treatment arm and subgroup and the interaction between treatment arm and subgroup. Within-subgroup analyses demonstrated trends toward quantitative improvements in peak VO2, work rate at the ventilatory anaerobic threshold (VAT), VO2 at VAT, and ventilatory efficiency (VE/VCO2) for those randomized to udenafil compared to placebo in nearly all subgroups. There was no identified differential response to udenafil based on baseline peak VO2, baseline BNP level, weight, race and ethnicity, gender, or ventricular morphology, although participants in the lowest tertile of baseline peak VO2 trended toward larger improvements. The absence of a differential response across subgroups in response to treatment with udenafil suggests that the treatment benefit may not be restricted to specific sub-populations. Further work is warranted to confirm the potential benefit of udenafil and to evaluate the long-term tolerability and safety of treatment and to determine the impact of udenafil on the development of other morbidities related to the Fontan circulation.Trial Registration NCT0274115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | | | - Adam M Lubert
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, 53226, USA
| | - Richard V Williams
- Division of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, 84132, USA
| | - J K Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, Phoenix, AZ, 85016, USA
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Benjamin P Frischhertz
- Division of Cardiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, Kansas City, MO, 64108, USA
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Mark J Cartoski
- Nemours Cardiac Center, Nemours / Alfred I. DuPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Jon A Detterich
- Division of Cardiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, 90027, USA
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, 68114, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, 20010, USA
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Delphine Yung
- Division of Pediatric Cardiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Christopher K Davis
- Division of Cardiology, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, 92123, USA
| | - Shabana Shahanavaz
- Division of Cardiology, St. Louis Children's Hospital, St. Louis, MO, 63110, USA
| | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC, 27705, USA
| | - Marisa Almaguer
- Cincinnati Children's Hospital and Medical Center, Heart Institute, Cincinnati, OH, 45229, USA
| | | | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Bryan H Goldstein
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, 20892, USA
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA
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2
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Hopkins SR, Dominelli PB, Davis CK, Guenette JA, Luks AM, Molgat-Seon Y, Sá RC, Sheel AW, Swenson ER, Stickland MK. Face Masks and the Cardiorespiratory Response to Physical Activity in Health and Disease. Ann Am Thorac Soc 2021; 18:399-407. [PMID: 33196294 PMCID: PMC7919154 DOI: 10.1513/annalsats.202008-990cme] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
To minimize transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease (COVID-19), the U.S. Centers for Disease Control and Prevention and the World Health Organization recommend wearing face masks in public. Some have expressed concern that these may affect the cardiopulmonary system by increasing the work of breathing, altering pulmonary gas exchange and increasing dyspnea, especially during physical activity. These concerns have been derived largely from studies evaluating devices intentionally designed to severely affect respiratory mechanics and gas exchange. We review the literature on the effects of various face masks and respirators on the respiratory system during physical activity using data from several models: cloth face coverings and surgical masks, N95 respirators, industrial respirators, and applied highly resistive or high-dead space respiratory loads. Overall, the available data suggest that although dyspnea may be increased and alter perceived effort with activity, the effects on work of breathing, blood gases, and other physiological parameters imposed by face masks during physical activity are small, often too small to be detected, even during very heavy exercise. There is no current evidence to support sex-based or age-based differences in the physiological responses to exercise while wearing a face mask. Although the available data suggest that negative effects of using cloth or surgical face masks during physical activity in healthy individuals are negligible and unlikely to impact exercise tolerance significantly, for some individuals with severe cardiopulmonary disease, any added resistance and/or minor changes in blood gases may evoke considerably more dyspnea and, thus, affect exercise capacity.
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Affiliation(s)
| | - Paolo B. Dominelli
- Department of Pediatrics, University of California, San Diego, California
| | | | - Jordan A. Guenette
- Centre for Heart Lung Innovation
- Department of Physical Therapy, Faculty of Medicine, and
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew M. Luks
- St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Yannick Molgat-Seon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | | | - A. William Sheel
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Erik R. Swenson
- St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
- G. F. MacDonald Centre for Lung Health (Covenant Health) and
- Medicine Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
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3
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Hopkins SR, Sá RC, Prisk GK, Elliott AR, Kim NH, Pazar BJ, Printz BF, El-Said HG, Davis CK, Theilmann RJ. Abnormal pulmonary perfusion heterogeneity in patients with Fontan circulation and pulmonary arterial hypertension. J Physiol 2020; 599:343-356. [PMID: 33026102 DOI: 10.1113/jp280348] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The distribution of pulmonary perfusion is affected by gravity, vascular branching structure and active regulatory mechanisms, which may be disrupted by cardiopulmonary disease, but this is not well studied, particularly in rare conditions. We evaluated pulmonary perfusion in patients who had undergone Fontan procedure, patients with pulmonary arterial hypertension (PAH) and two groups of controls using a proton magnetic resonance imaging technique, arterial spin labelling to measure perfusion. Heterogeneity was assessed by the relative dispersion (SD/mean) and gravitational gradients. Gravitational gradients were similar between all groups, but heterogeneity was significantly increased in both patient groups compared to controls and persisted after removing contributions from large blood vessels and gravitational gradients. Patients with Fontan physiology and patients with PAH have increased pulmonary perfusion heterogeneity that is not explainable by differences in mean perfusion, gravitational gradients, or large vessel anatomy. This probably reflects vascular remodelling in PAH and possibly in Fontan physiology. ABSTRACT Many factors affect the distribution of pulmonary perfusion, which may be disrupted by cardiopulmonary disease, but this is not well studied, particularly in rare conditions. An example is following the Fontan procedure, where pulmonary perfusion is passive, and heterogeneity may be increased because of the underlying pathophysiology leading to Fontan palliation, remodelling, or increased gravitational gradients from low flow. Another is pulmonary arterial hypertension (PAH), where gravitational gradients may be reduced secondary to high pressures, but remodelling may increase perfusion heterogeneity. We evaluated regional pulmonary perfusion in Fontan patients (n = 5), healthy young controls (Fontan control, n = 5), patients with PAH (n = 6) and healthy older controls (PAH control) using proton magnetic resonance imaging. Regional perfusion was measured using arterial spin labelling. Heterogeneity was assessed by the relative dispersion (SD/mean) and gravitational gradients. Mean perfusion was similar (Fontan = 2.50 ± 1.02 ml min-1 ml-1 ; Fontan control = 3.09 ± 0.58, PAH = 3.63 ± 1.95; PAH control = 3.98 ± 0.91, P = 0.26), and the slopes of gravitational gradients were not different (Fontan = -0.23 ± 0.09 ml min-1 ml-1 cm-1 ; Fontan control = -0.29 ± 0.23, PAH = -0.27 ± 0.09, PAH control = -0.25 ± 0.18, P = 0.91) between groups. Perfusion relative dispersion was greater in both Fontan and PAH than controls (Fontan = 1.46 ± 0.18; Fontan control = 0.99 ± 0.21, P = 0.005; PAH = 1.22 ± 0.27, PAH control = 0.91 ± 0.12, P = 0.02) but similar between patient groups (P = 0.13). These findings persisted after removing contributions from large blood vessels and gravitational gradients (all P < 0.05). We conclude that patients with Fontan physiology and PAH have increased pulmonary perfusion heterogeneity that is not explained by differences in mean perfusion, gravitational gradients, or large vessel anatomy. This probably reflects the effects of remodelling in PAH and possibly in Fontan physiology.
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Affiliation(s)
- Susan R Hopkins
- Department of Radiology, University of California, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, CA, USA
| | - Rui C Sá
- Department of Medicine, University of California, San Diego, CA, USA
| | - G Kim Prisk
- Department of Radiology, University of California, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, CA, USA
| | - Ann R Elliott
- Department of Medicine, University of California, San Diego, CA, USA
| | - Nick H Kim
- Department of Medicine, University of California, San Diego, CA, USA
| | - Beni J Pazar
- Department of Radiology, University of California, San Diego, CA, USA
| | - Beth F Printz
- Department of Radiology, University of California, San Diego, CA, USA.,Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
| | - Howaida G El-Said
- Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
| | - Christopher K Davis
- Rady Children's Hospital-San Diego, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego, CA, USA
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4
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Goldberg DJ, Zak V, Goldstein BH, Schumacher KR, Rhodes J, Penny DJ, Petit CJ, Ginde S, Menon SC, Kim SH, Kim GB, Nowlen TT, DiMaria MV, Frischhertz BP, Wagner JB, McHugh KE, McCrindle BW, Shillingford AJ, Sabati AA, Yetman AT, John AS, Richmond ME, Files MD, Payne RM, Mackie AS, Davis CK, Shahanavaz S, Hill KD, Garg R, Jacobs JP, Hamstra MS, Woyciechowski S, Rathge KA, McBride MG, Frommelt PC, Russell MW, Urbina EM, Yeager JL, Pemberton VL, Stylianou MP, Pearson GD, Paridon SM. Results of the FUEL Trial. Circulation 2019; 141:641-651. [PMID: 31736357 DOI: 10.1161/circulationaha.119.044352] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Fontan operation creates a total cavopulmonary connection, a circulation in which the importance of pulmonary vascular resistance is magnified. Over time, this circulation leads to deterioration of cardiovascular efficiency associated with a decline in exercise performance. Rigorous clinical trials aimed at improving physiology and guiding pharmacotherapy are lacking. METHODS The FUEL trial (Fontan Udenafil Exercise Longitudinal) was a phase III clinical trial conducted at 30 centers. Participants were randomly assigned udenafil, 87.5 mg twice daily, or placebo in a 1:1 ratio. The primary outcome was the between-group difference in change in oxygen consumption at peak exercise. Secondary outcomes included between-group differences in changes in submaximal exercise at the ventilatory anaerobic threshold, the myocardial performance index, the natural log of the reactive hyperemia index, and serum brain-type natriuretic peptide. RESULTS Between 2017 and 2019, 30 clinical sites in North America and the Republic of Korea randomly assigned 400 participants with Fontan physiology. The mean age at randomization was 15.5±2 years; 60% of participants were male, and 81% were white. All 400 participants were included in the primary analysis with imputation of the 26-week end point for 21 participants with missing data (11 randomly assigned to udenafil and 10 to placebo). Among randomly assigned participants, peak oxygen consumption increased by 44±245 mL/min (2.8%) in the udenafil group and declined by 3.7±228 mL/min (-0.2%) in the placebo group (P=0.071). Analysis at ventilatory anaerobic threshold demonstrated improvements in the udenafil group versus the placebo group in oxygen consumption (+33±185 [3.2%] versus -9±193 [-0.9%] mL/min, P=0.012), ventilatory equivalents of carbon dioxide (-0.8 versus -0.06, P=0.014), and work rate (+3.8 versus +0.34 W, P=0.021). There was no difference in change of myocardial performance index, the natural log of the reactive hyperemia index, or serum brain-type natriuretic peptide level. CONCLUSIONS In the FUEL trial, treatment with udenafil (87.5 mg twice daily) was not associated with an improvement in oxygen consumption at peak exercise but was associated with improvements in multiple measures of exercise performance at the ventilatory anaerobic threshold. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02741115.
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Affiliation(s)
- David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Victor Zak
- New England Research Institutes, Watertown, MA (V.Z.)
| | - Bryan H Goldstein
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Kurt R Schumacher
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Jonathan Rhodes
- Department of Cardiology, Children's Hospital Boston, MA (J.R.)
| | - Daniel J Penny
- Division of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (D.J.P.)
| | - Christopher J Petit
- Emory University School of Medicine, Children's Healthcare of Atlanta, GA (C.J.P.)
| | - Salil Ginde
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Shaji C Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City (S.C.M.)
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon-Si, South Korea (S.-H.K.)
| | - Gi Beom Kim
- Seoul National University School of Medicine, Seoul National University Children's Hospital, South Korea (G.B.K.)
| | - Todd T Nowlen
- Heart Center, Phoenix Children's Hospital, AZ (T.T.N.)
| | - Michael V DiMaria
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (M.V.D.)
| | - Benjamin P Frischhertz
- Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN (B.P.F.)
| | - Jonathan B Wagner
- Divisions of Cardiology and Clinical Pharmacology, Children's Mercy Kansas City, MO (J.B.W.)
| | - Kimberly E McHugh
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston (K.E.M.)
| | - Brian W McCrindle
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Ontario (B.W.M.)
| | - Amanda J Shillingford
- Nemours Cardiac Center, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE (A.J.S.)
| | - Arash A Sabati
- Los Angeles Children's Hospital, Division of Cardiology, CA (A.A.S.)
| | - Anji T Yetman
- Children's Hospital and Medical Center, University of Nebraska, Omaha (A.T.Y.)
| | - Anitha S John
- Division of Cardiology, Children's National Health System, Washington, DC (A.S.J.)
| | - Marc E Richmond
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY (M.E.R.)
| | - Matthew D Files
- Division of Cardiology, Seattle Children's Hospital, WA (M.D.F.)
| | - R Mark Payne
- Division of Cardiology, Riley Hospital for Children, Indianapolis, IN (R.M.P.)
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada (A.S.M.)
| | | | | | - Kevin D Hill
- Duke Children's Pediatric and Congenital Heart Center, Durham, NC (K.D.H.)
| | - Ruchira Garg
- Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (R.G.)
| | - Jeffrey P Jacobs
- Johns Hopkins All Children's Hospital, Department of Surgery, St Petersburg, FL (J.P.J.)
| | - Michelle S Hamstra
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Stacy Woyciechowski
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Kathleen A Rathge
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - Michael G McBride
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
| | - Peter C Frommelt
- Division of Cardiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee (S.G., P.C.F.)
| | - Mark W Russell
- Division of Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI (K.R.S., M.W.R.)
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, OH (B.H.G., M.S.H., K.A.R., E.M.U.)
| | - James L Yeager
- Consultant to Mezzion Pharma Co Ltd, Mezzion Pharma Co Ltd, Seoul, South Korea (J.L.Y.)
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Mario P Stylianou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.P., M.P.S., G.D.P.)
| | - Stephen M Paridon
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, PA (D.J.G., S.W., M.G.M., S.M.P.)
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5
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Vargas LA, Dyar DA, Davis CK, Dummer KB. Prenatal Detection of Anomalous Right Coronary Artery with an Interarterial Course. ACTA ACUST UNITED AC 2019; 4:63-65. [PMID: 32337391 PMCID: PMC7175794 DOI: 10.1016/j.case.2019.10.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Abnormal right coronary artery origin and course are demonstrated by FE. Color flow Doppler is essential for visualizing fetal coronary artery anatomy. Color-compare images help identify coronary artery origin and course.
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Affiliation(s)
- Lisa A Vargas
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
| | - Dan A Dyar
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California
| | - Christopher K Davis
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California.,Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Kirsten B Dummer
- Division of Cardiology, Rady Children's Hospital San Diego, San Diego, California.,Division of Cardiology, Department of Pediatrics, University of California, San Diego, San Diego, California
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6
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Longmuir PE, Brothers JA, de Ferranti SD, Hayman LL, Van Hare GF, Matherne GP, Davis CK, Joy EA, McCrindle BW. Promotion of Physical Activity for Children and Adults With Congenital Heart Disease. Circulation 2013; 127:2147-59. [DOI: 10.1161/cir.0b013e318293688f] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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7
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Tedjasaputra V, Sá RC, Arai TJ, Holverda S, Theilmann RJ, Chen WT, Wagner PD, Davis CK, Kim Prisk G, Hopkins SR. The heterogeneity of regional specific ventilation is unchanged following heavy exercise in athletes. J Appl Physiol (1985) 2013; 115:126-35. [PMID: 23640585 DOI: 10.1152/japplphysiol.00778.2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heavy exercise increases ventilation-perfusion mismatch and decreases pulmonary gas exchange efficiency. Previous work using magnetic resonance imaging (MRI) arterial spin labeling in athletes has shown that, after 45 min of heavy exercise, the spatial heterogeneity of pulmonary blood flow was increased in recovery. We hypothesized that the heterogeneity of regional specific ventilation (SV, the local tidal volume over functional residual capacity ratio) would also be increased following sustained exercise, consistent with the previously documented changes in blood flow heterogeneity. Trained subjects (n = 6, maximal O2 consumption = 61 ± 7 ml·kg(-1)·min(-1)) cycled 45 min at their individually determined ventilatory threshold. Oxygen-enhanced MRI was used to quantify SV in a sagittal slice of the right lung in supine posture pre- (preexercise) and 15- and 60-min postexercise. Arterial spin labeling was used to measure pulmonary blood flow in the same slice bracketing the SV measures. Heterogeneity of SV and blood flow were quantified by relative dispersion (RD = SD/mean). The alveolar-arterial oxygen difference was increased during exercise, 23.3 ± 5.3 Torr, compared with rest, 6.3 ± 3.7 Torr, indicating a gas exchange impairment during exercise. No significant change in RD of SV was seen after exercise: preexercise 0.78 ± 0.15, 15 min postexercise 0.81 ± 0.13, 60 min postexercise 0.78 ± 0.08 (P = 0.5). The RD of blood flow increased significantly postexercise: preexercise 1.00 ± 0.12, 15 min postexercise 1.15 ± 0.10, 45 min postexercise 1.10 ± 0.10, 60 min postexercise 1.19 ± 0.11, 90 min postexercise 1.11 ± 0.12 (P < 0.005). The lack of a significant change in RD of SV postexercise, despite an increase in the RD of blood flow, suggests that airways may be less susceptible to the effects of exercise than blood vessels.
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Affiliation(s)
- Vince Tedjasaputra
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
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8
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Davis CK, Denman SE, Sly LI, McSweeney CS. Development of a colorimetric colony-screening assay for detection of defluorination by micro-organisms. Lett Appl Microbiol 2011; 53:417-23. [PMID: 21767280 DOI: 10.1111/j.1472-765x.2011.03123.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To develop a colorimetric colony-screening assay to facilitate the isolation of micro-organisms capable of defluorination. METHODS AND RESULTS A metal-dye chelate, zirconium-xylenol orange was used to detect fluoride ions released from a fluorinated substrate through microbial metabolism. Depolymerised zirconium reagent gave the greatest visual contrast for the presence of fluoride compared to more polymerised forms of zirconium reagent. The sensitivity of the assay was greatest when the molar ratio of depolymerised zirconium to xylenol orange was 1:2. Using depolymerised zirconium and xylenol orange (150 and 300 nmol l(-1) respectively), the assay could detect a fluoride application spot (5 mmol l(-1)) containing 50 nmoles of fluoride ions. Most media constituents were well tolerated by the assay, although phosphate ions needed to be restricted to 0.1 g l(-1) and some proteins digest to between 1 and 5 g l(-1). A microbial enrichment culture growing on solidified medium containing 20 mmol l(-1) fluoroacetate was screened using the assay, and defluorinating bacteria belonging to the genus Burkholderia isolated. CONCLUSIONS A method was developed that is sensitive, rapid and reliable for detecting defluorination by micro-organisms growing on solidified medium. SIGNIFICANCE AND IMPACT OF THE STUDY This method can be used to facilitate the isolation of micro-organisms capable of defluorination.
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Affiliation(s)
- C K Davis
- CSIRO Livestock Industries, Queensland Bioscience Precinct, St Lucia, Qld, Australia
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Abstract
Academic teaching hospitals and their networks can best serve patients and other stakeholders by achieving critical mass and scope of clinical services, teaching and research. Successful hospital reconfigurations are associated with a convincing case and majority clinician buy-in. The inscrutable political decision to relocate services away from a major teaching hospital campus and into a merged Queensland Children's Hospital was determined without broad stakeholder consultation or a transparent and accountable business case. This compromised process poses a significant and enduring risk to patient care and Queensland's paediatric, perinatal, adolescent and obstetric academic teaching hospital services. As the proposed major stakeholder in Australia's public hospitals and medical workforce training, the federal government should review this decision using an effective methodology incorporating relevant criteria. National guidelines are needed to ensure best practice in the future planning and auditing of major health care projects. The medical profession is responsible for ensuring that health care policy complies with reliable evidence and good practice.
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Affiliation(s)
- Christopher K Davis
- Department of Geriatric Medicine, Prince Charles Hospital, Brisbane, QLD, Australia.
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Irving BA, Davis CK, Brock DW, Weltman JY, Swift D, Barrett EJ, Gaesser GA, Weltman A. Effect of exercise training intensity on abdominal visceral fat and body composition. Med Sci Sports Exerc 2009; 40:1863-72. [PMID: 18845966 DOI: 10.1249/mss.0b013e3181801d40] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED The metabolic syndrome is a complex clustering of metabolic defects associated with physical inactivity, abdominal adiposity, and aging. PURPOSE To examine the effects of exercise training intensity on abdominal visceral fat (AVF) and body composition in obese women with the metabolic syndrome. METHODS Twenty-seven middle-aged obese women (mean +/- SD; age = 51 +/- 9 yr and body mass index = 34 +/- 6 kg x m(-2)) with the metabolic syndrome completed one of three 16-wk aerobic exercise interventions: (i) no-exercise training (Control): seven participants maintained their existing levels of physical activity; (ii) low-intensity exercise training (LIET): 11 participants exercised 5 d x wk(-1) at an intensity < or = lactate threshold (LT); and (iii) high-intensity exercise training (HIET): nine participants exercised 3 d x wk(-1) at an intensity > LT and 2 d x wk(-1) < or = LT. Exercise time was adjusted to maintain caloric expenditure (400 kcal per session). Single-slice computed tomography scans obtained at the L4-L5 disc space and midthigh were used to determine abdominal fat and thigh muscle cross-sectional areas. Percent body fat was assessed by air displacement plethysmography. RESULTS HIET significantly reduced total abdominal fat (P < 0.001), abdominal subcutaneous fat (P = 0.034), and AVF (P = 0.010). There were no significant changes observed in any of these parameters within the Control or the LIET conditions. CONCLUSIONS The present data indicate that body composition changes are affected by the intensity of exercise training with HIET more effectively for reducing total abdominal fat, subcutaneous abdominal fat, and AVF in obese women with the metabolic syndrome.
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Affiliation(s)
- Brian A Irving
- Department of Human Services, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
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Irving BA, Weltman JY, Patrie JT, Davis CK, Brock DW, Swift D, Barrett EJ, Gaesser GA, Weltman A. Effects of exercise training intensity on nocturnal growth hormone secretion in obese adults with the metabolic syndrome. J Clin Endocrinol Metab 2009; 94:1979-86. [PMID: 19318453 PMCID: PMC2690422 DOI: 10.1210/jc.2008-2256] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Abdominal adiposity is associated with reduced spontaneous GH secretion, and an increased incidence of the metabolic syndrome, type 2 diabetes, and cardiovascular disease. Exercise training increases GH secretion, induces abdominal visceral fat loss, and has been shown to improve the cardiometabolic risk factor profile. However, little is known about the effects of endurance training intensity on spontaneous GH release in obese individuals. OBJECTIVE Our objective was to examine the effects of 16 wk endurance training on spontaneous 12-h overnight GH secretion in adults with the metabolic syndrome. DESIGN AND SETTING This randomized, controlled exercise intervention was conducted at the University of Virginia. PARTICIPANTS A total of 34 adults with the metabolic syndrome (mean +/- sem: age: 49.1 +/- 1.8 yr) participated. INTERVENTION Participants were randomized to one of three groups for 16 wk: no exercise training (control), low-intensity exercise training, or high-intensity training. MAIN OUTCOME MEASURE Change in nocturnal integrated GH area under the curve (AUC) was calculated. RESULTS Both exercise training conditions augmented within-group nocturnal GH AUC pretrain to post-training (low-intensity exercise training approximately (upward arrow) 49%, P < 0.05; and high-intensity training approximately (upward arrow) 65%, P < 0.01), and these changes were also greater than the changes in the control group (P < 0.01). The change in nocturnal GH AUC was inversely associated with the change in fat mass across the entire sample (r = -0.34; P = 0.051; n=34) but was not significantly associated with the change in abdominal visceral fat (r = 0.02; P = 0.920; n = 34). CONCLUSIONS Sixteen wk of supervised exercise training in adults with the metabolic syndrome increases spontaneous nocturnal GH secretion independent of exercise training intensity.
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Affiliation(s)
- Brian A Irving
- Department of Human Services, Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, Virginia 22908, USA
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Davis CK, Cummings MW, Gurka MJ, Gutgesell HP. Frequency and degree of change of peak transvalvular pressure gradient determined by two Doppler echocardiographic examinations in newborns and children with valvular congenital aortic stenosis. Am J Cardiol 2008; 101:393-5. [PMID: 18237607 DOI: 10.1016/j.amjcard.2007.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 08/24/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
Abstract
The natural history of congenital aortic stenosis (AS) has been described predominantly using data derived from catheterization studies. Because of the inherent selection bias of many of these studies, this study was conducted to determine the course of valvular AS using data from serial echocardiograms, for which this bias is less pervasive. The medical records of 103 patients (mean age 3.3+/-3.8 years at time of diagnosis) with congenital AS were examined, and data from the initial and most recent echocardiograms before any intervention on the aortic valve were recorded. The average change in gradient for the entire study population was +1 mm Hg/patient-year. Forty percent (8 of 20) of patients diagnosed in the newborn period (<2 months) required intervention before 6 months of age, compared with 11% (9 of 83) of those diagnosed after the newborn period who required intervention at any time during the study period (p<0.01). Patients diagnosed at >or=1 year of age were less likely to have acute increases in gradient or need intervention; those older patients whose gradients progressed more rapidly were more likely to have significant (more than mild) aortic insufficiency than those whose gradients did not progress (55% vs 28%, p<0.05). In conclusion, congenital AS is usually a slowly progressive disease. Risk factors for more rapid gradient progression include diagnosis as a neonate and the development of significant aortic insufficiency.
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Swift DL, Irving BA, Brock DW, Davis CK, Barrett EJ, Gaesser GA, Weltman A. Heart rate recovery does not predict endothelial function in obese women. Obe Metab 2007; 3:101-105. [PMID: 22545071 PMCID: PMC3338316] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of the present study was to examine the relationship between heart rate recovery (HR(REC)) and endothelial function in obese women with the metabolic syndrome. The metabolic syndrome has been associated with increased cardiometabolic risk including endothelial dysfunction. However, measurement of endothelial function via flow-mediated dilation (FMD) requires expensive equipment and qualified medical personnel, and therefore may be impractical in some healthcare settings. Heart rate recovery (HR(REC)) has predictive utility with respect to endothelial function in individuals with suspected coronary artery disease and individuals with the metabolic syndrome also have elevated risk for developing coronary artery disease. Thirty-one obese, sedentary women (age: 47.7±11.2 yr, mean±SD) who met the International Diabetes Federation criteria for the metabolic syndrome underwent a brachial artery ultrasound to determine FMD and nitroglycerine-mediated dilation (NTG). HR(REC) was assessed during 5 min of active recovery following a standardized VO(2 Peak) treadmill protocol. Results revealed that the %FMD was not correlated to HR(REC) when examined across all participants (r= 0.067, p=0.72). However, this relationship was significant in participants with impaired FMD (n=16, %FMD<6%) (r=0.71, p=0.002). Although HR(REC) may be a significant correlate of FMD in women with the metabolic syndrome and with prevalent endothelial dysfunction, it was not a significant correlate across all women with the metabolic syndrome. The present data do not support the use of HR(REC) as a possible screening tool for endothelial dysfunction in obese women with the metabolic syndrome.
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Affiliation(s)
- Damon L. Swift
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
| | - Brian A. Irving
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, VA, USA
| | - David W. Brock
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, VA, USA
| | - Christopher K. Davis
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Department of Pediatrics, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Eugene J. Barrett
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center, University of Virginia, Charlottesville, VA, USA
| | - Glenn A. Gaesser
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center, University of Virginia, Charlottesville, VA, USA
| | - Arthur Weltman
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center, University of Virginia, Charlottesville, VA, USA
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Irving BA, Davis CK, Brock DW, Weltman JY, Swift D, Barrett EJ, Gaesser GA, Weltman A. The metabolic syndrome, hypertriglyceridemic waist, and cardiometabolic risk factor profile in obese women. Obe Metab 2007; 3:50-57. [PMID: 21857883 PMCID: PMC3157146] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The hypertriglyceridemic waist (HTGW) and metabolic syndrome (MS) are associated with increased cardiometabolic risk. We evaluated the impact of the HTGW on cardiometabolic risk factors in obese women diagnosed with the MS. Thirty-six abdominally obese women with the MS as defined by the International Diabetes Federation (IDF) [(mean (SD); age 49 (11) y, ht 165 (6) cm, wt 95 (16) kg] participated. The HTGW was defined as follows: a waist circumference ≥80 cm and triglycerides ≥1.7 mM. Unpaired t-tests and Analysis of Covariance (ANCOVA) were employed to detect mean differences between women with MS plus or minus HTGW. Women with the MS plus HTGW had higher total cholesterol (16%, p=0.015), VLDL-cholesterol (97%, p<0.001), non-HDL-cholesterol (16%, p=0.002), insulin (40%, p=0.043), and abdominal visceral fat (24%, p=0.100), and lower total HDL-cholesterol (6%, p=0.024), HDL(3) (11%, p=0.031) and Quantitative Insulin Sensitivity Check Index (QUICKI) (5%, p=0.068) compared with women with the MS minus HTGW. Thus, the presence of the HTGW was accompanied by a worsened cardiometabolic risk factor profile in these obese women with the MS. In particular, women with the MS plus HTGW were more insulin resistant compared to women with the MS minus HTGW. In conclusion, the presence of the HTGW in obese women with the MS exacerbates insulin resistance and cardiometabolic risk factors.
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Affiliation(s)
- Brian A. Irving
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, VA, USA
| | - Christopher K. Davis
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Department of Pediatrics, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - David W. Brock
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville, VA, USA
| | - Judy Y. Weltman
- General Clinical Research Center (GCRC), University of Virginia, Charlottesville, VA, USA
| | - Damon Swift
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
| | - Eugene J. Barrett
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center (GCRC), University of Virginia, Charlottesville, VA, USA
| | - Glenn A. Gaesser
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center (GCRC), University of Virginia, Charlottesville, VA, USA
| | - Arthur Weltman
- Department of Human Services, University of Virginia, Charlottesville, VA, USA
- Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
- General Clinical Research Center (GCRC), University of Virginia, Charlottesville, VA, USA
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Weltman A, Irving BA, Swift D, Davis CK, Rodriguez J, Rutkowski J, Frick K, Barrett EJ, Gaesser GA. Exercise-Induced Weight Loss and Biological/Behavioral Compensation in Women with the Metabolic Syndrome (MS). Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273197.73366.aa] [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: 11/21/2022]
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Davis CK, Irving BA, Brock DW, Gaesser GA, Barrett EJ, Weltman A. Exercise TVaining-Induced Changes in Skeletal Muscle Microvasculature Assessed by Contrast Enhanced Ultrasound. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000274697.21792.2c] [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: 11/21/2022]
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Irving BA, Swift D, Davis CK, Barrett EJ, Gaesser GA, Weltman A. Effects of Exercise Training Intensity on Cardiometabolic Risk in Women with the Metabolic Syndrome with or without Hypertension. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273305.12652.88] [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: 11/21/2022]
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Irving BA, Weltman JY, Brock DW, Davis CK, Gaesser GA, Weltman A. NIH ImageJ and Slice-O-Matic computed tomography imaging software to quantify soft tissue. Obesity (Silver Spring) 2007; 15:370-6. [PMID: 17299110 DOI: 10.1038/oby.2007.573] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare reliability and limits of agreement of soft tissue cross-sectional areas obtained using Slice-O-Matic and NIH ImageJ medical imaging software packages. RESEARCH METHODS AND PROCEDURES Abdominal and midthigh images were obtained using single-slice computed tomography. Two trained investigators analyzed each computed tomography image in duplicate. Adipose tissue and skeletal muscle cross-sectional areas (centimeters squared) were calculated using standard Hounsfield unit ranges (adipose tissue: -190 to -30 and skeletal muscle: -29 to 150). Regions of interest included abdominal total area, total fat area, subcutaneous fat area, visceral fat area (AVF), and right and left thigh total area, fat area, and skeletal muscle area. RESULTS For all images, intra-investigator coefficients of variation ranged from 0.2% to 3.4% and from 0.4% to 5.6% and inter-investigator coefficients of variation ranged from 0.9% to 4.8% and 0.2% to 2.6% for Slice-O-Matic and NIH ImageJ, respectively, with intra- and inter-investigator coefficients of reliability of R(2) = 0.99. Mean AVF values for investigators A and B ranged from 168 to 170 cm(2) using Slice-O-Matic and NIH ImageJ. Bland-Altman analyses revealed that Slice-O-Matic and NIH ImageJ results were comparable. The mean differences (95% confidence intervals) between the AVF cross-sectional areas obtained using the Slice-O-Matic and NIH ImageJ medical imaging software were +2.5 cm(2) (-5.7, +10.8 cm(2)) or +1.4% (-3.4%, +6.4%). DISCUSSION These findings show that both the Slice-O-Matic and NIH ImageJ medical imaging software systems provide reliable measurements of adipose tissue and skeletal muscle cross-sectional areas.
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Affiliation(s)
- Brian A Irving
- Department of Human Services, University of Virginia, Charlottesville, VA 22904, USA
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Brock DW, Davis CK, Irving BA, Rodriguez J, Barrett EJ, Weltman A, Taylor AG, Gaesser GA. A high-carbohydrate, high-fiber meal improves endothelial function in adults with the metabolic syndrome. Diabetes Care 2006; 29:2313-5. [PMID: 17003313 DOI: 10.2337/dc06-0917] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 02/03/2023]
Affiliation(s)
- David W Brock
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
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Irving BA, Rutkowski J, Brock DW, Davis CK, Barrett EJ, Gaesser GA, Weltman A. Comparison of Borg- and OMNI-RPE as Markers of the Blood Lactate Response to Exercise. Med Sci Sports Exerc 2006; 38:1348-52. [PMID: 16826034 DOI: 10.1249/01.mss.0000227322.61964.d2] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the utility of the Borg (6-20) and adult OMNI walk/run (0-10) ratings of perceived exertion (RPE) scales as markers of the blood lactate response to exercise. METHODS Thirty-six (26 females and 10 males) individuals with the metabolic syndrome (mean+/-SEM: age, 45.8+/-2.0 yr; height, 168.4+/-1.3 cm; weight, 100.4+/-3.6 kg) completed a continuous peak oxygen uptake (VO2peak)/lactate threshold (LT) treadmill protocol. VO2 (mL.kg.min), blood lactate concentration (BLC, mM), and heart rate (bpm) were measured at the end of each stage. RPE were assessed at 2:15 and 2:45 of each 3-min stage using both RPE scales presented in a counterbalanced order. Participants were read standardized instructions specific to each scale. The LT and BLC of 2.5 and 4.0 mM were determined from the blood lactate-velocity relationship. RESULTS The mean Borg, OMNI, and standardized (to the Borg scale) OMNI-RPE values at the LT and BLC of 2.5 mM, 4.0 mM, and peak ranged from 10.1 to 16.9, 3.1 to 8.2, and 9.9 to 17.1, respectively. No differences were observed between Borg and standardized OMNI-RPE at any exercise intensity. The correlation within and between Borg- and OMNI-RPE and the velocities associated with LT, BLC of 2.5 mM, 4.0 mM, and peak ranged from r=0.82 to 0.93 (P<0.01). Mean differences (95% CI) between the Borg- and standardized OMNI-RPE at LT, and BLC of 2.5 mM, 4.0 mM, and peak were 0.27 (-2.26, 2.80), -0.48 (-3.14, 2.18), -0.29 (-2.92, 2.35), and 0.10 (-1.65, 1.84), respectively. CONCLUSION Both the Borg and OMNI walk/run scales demonstrate predictive utility as markers of the blood lactate response to incremental exercise in individuals with the metabolic syndrome.
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Affiliation(s)
- Brian A Irving
- Department of Human Services, Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22904, USA
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Sawyer BJ, Blessinger JR, Davis CK, Irving BA, Weltman A, Gaesser GA. Walking and Running Economy are Weakly Inversely Correlated to Maximal Oxygen Consumption In Healthy Males and Females. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gaesser GA, Clark BR, Parker BE, Olowin AB, Richardson NT, Blessinger JR, Sawyer BJ, Davis CK, Welk GJ, Irving BA. Validation Of An Integrated Heart Rate/Physical Activity Monitor. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-03189] [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: 11/21/2022]
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Irving BA, Rutkowski JJ, Brock DW, Davis CK, Gaesser GA, Weltman A. Ratings Of Perceived Exertion And The Blood Lactate Response To Exercise. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-00066] [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: 11/21/2022]
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Kaufman SS, Lyden ER, Brown CR, Iverson AK, Davis CK, Sudan DL, Fox IJ, Horslen SP, Shaw BW, Langnas AN. Disaccharidase activities and fat assimilation in pediatric patients after intestinal transplantation. Transplantation 2000; 69:362-5. [PMID: 10706043 DOI: 10.1097/00007890-200002150-00009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intestinal transplantation has become an accepted therapy for short bowel syndrome and other types of intestinal failure. In order to assess digestive capabilities and feeding practices in a group of 22 pediatric patients after intestinal transplantation, we assessed mucosal disaccharidase activities and assimilation of total dietary lipid and vitamin E. Twelve of the patients had undergone contemporaneous liver transplantation. METHODS Mucosal biopsies were assayed for disaccharidase activities between 15 and 412 days after transplantation in 7 of the 22 when all were receiving some enteral nutrition and were free of rejection. Coefficients of lipid absorption were determined in those patients receiving total enteral feeding (two-thirds polymeric/one-third elemental) between 43 and 1032 days after transplantation; oral vitamin E tolerance tests were done at about the same time. RESULTS Activities of lactase, sucrase, maltase, and palatinase consistently exceeded reference ranges (P<0.05). Mean coefficient of lipid absorption equaled 86+/-12% and was not influenced by duration of time after transplantation. No patient required dietary lipid restriction. No significant absorption of vitamin E was demonstrated until 160 days after transplantation. Vitamin E absorption did correlate with length of time elapsed after surgery (r=0.64, P<0.0011). CONCLUSIONS The results of this investigation show that, in the absence of histologic or clinical indications of allograft rejection, pediatric intestinal transplant recipients do not have primary disaccharidase deficiencies. Similarly, absorption of usual dietary lipid content is adequate once weaning from parenteral nutrition is complete. In contrast, early assimilation of vitamin E is poor. Vitamin E absorption subsequently improves, but the mechanism is obscure.
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Affiliation(s)
- S S Kaufman
- Department of Pediatrics, Creighton University and University of Nebraska Medical Center, Omaha, USA.
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Whitehouse MW, Turner AG, Davis CK, Roberts MS. Emu oil(s): A source of non-toxic transdermal anti-inflammatory agents in aboriginal medicine. Inflammopharmacology 1998; 6:1-8. [PMID: 17638122 DOI: 10.1007/s10787-998-0001-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/1997] [Accepted: 04/23/1997] [Indexed: 10/23/2022]
Abstract
The 'oil' obtained from emu fat can be a very effective inhibitor of chronic inflammation in rats when applied dermally (with a skin penetration enhancer). Assays for this activity using the adjuvant-induced arthritis model have shown: i. Considerable variability in potency of some commercial oil samples; ii. Little or no correlation of activity with colour or linolenic acid (18:3) content of the oil; iii. Relative stability of some active oils (to heat, ageing at room temperature); iv. The bulk of the anti-inflammatory activity was present in a low triglyceride fraction; and v. Potential arthritis-suppressant/immunoregulant activity of these active fractions. These studies point to the need for more rigid quality control before considering such a (now proven) traditional medicine as a complementary therapy.Repeated applications of selected oils did not induce any of the more prominent side-effects associated with NSAIDs (e.g. platelet inhibition, gastrotoxicity) or certain anti-arthritic drugs (proteinuria, leukopenia).
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Affiliation(s)
- M W Whitehouse
- Department of Medicine, University of Queensland, Princess Alexandra Hospital, 4102, Brisbane, Queensland
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Burczynski FJ, Pond SM, Davis CK, Johnson LP, Weisiger RA. Calibration of albumin-fatty acid binding constants measured by heptane-water partition. Am J Physiol 1993; 265:G555-63. [PMID: 8214076 DOI: 10.1152/ajpgi.1993.265.3.g555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Most measurements of binding affinity of albumin for long-chain fatty acids are based on heptane-water partition. In this method, equilibrium partition of fatty acid between heptane and an albumin-containing buffer is calibrated using the partition ratio between heptane and buffer in the absence of protein. In the current study, we used a variety of techniques to examine potential problems with this approach. Hydrophobic impurities in commercial [3H]palmitate preparations were incompletely removed by standard purification techniques. These impurities contributed from 5% of the total radioactivity in the heptane phase at low albumin concentrations (5 microM) to 62% at higher albumin concentrations (500 microM), thus confounding determination of binding affinity. These were identified by gas chromatography/mass spectroscopy as radio-labeled glycerol monopalmitate and monostearate. When albumin was not present, the partition ratio was similar to values reported by others. However, our results varied by a factor of four (265-1,119) depending on how the solutions were prepared. Although a true equilibrium partition must not depend on starting conditions, the partition ratio after 24-72 h was > 2x as large when tracer [3H]palmitate was added to the heptane phase than when it was added to the aqueous phase. Results also depended on the relative volumes of heptane and buffer used, approaching a maximum of 1,445 +/- 112 for very low heptane/buffer volume ratios. Much of this variability was due to hydrophilic impurities in [3H]palmitate, which ranged from 0.2 to 1.2% in commercial lots down to 0.1-0.5% after alkaline ethanol extraction and < 0.05% after thin-layer chromatography (TLC).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F J Burczynski
- Department of Medicine, University of California, San Francisco 94143-0538
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Davis CK. Deemed status for CHAP. A new standard for health care. Nurs Health Care 1992; 13:294-5. [PMID: 1630709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The board chair of the Community Health Accreditation Program (CHAP) reflects on the implications of federal recognition of CHAP. In challenging the status quo, CHAP has shown that a voluntary, consumer-based alternative can protect the public and promote excellence.
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Pond SM, Davis CK, Bogoyevitch MA, Gordon RA, Weisiger RA, Bass L. Uptake of palmitate by hepatocyte suspensions: facilitation by albumin? Am J Physiol 1992; 262:G883-94. [PMID: 1590397 DOI: 10.1152/ajpgi.1992.262.5.g883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Albumin-dependent uptake of unbound [3H]palmitic acid by hepatocytes isolated from female rat livers was studied and the experimental results compared with the predictions of a noncompartmental diffusion-reaction theory for the cellular uptake of protein-bound ligands. The outright theoretical predictions involve values for the parameters of the system, some newly measured (hepatocyte radii and the rate constant for the dissociation of palmitate-albumin complex) and some taken from the literature (diffusion coefficients and the equilibrium association constant for the palmitate-albumin complex). The measured unbound clearance of [3H]palmitic acid, defined as the initial uptake velocity divided by the unbound [3H]palmitic acid concentration in the medium, was enhanced 6.6-fold as the concentration of human serum albumin was increased from approximately 5 to 480 microM. This enhancement factor was predicted by the theory, according to which the enhancement reflects codiffusion of bound ligand across the unstirred layer adjacent to the cell membrane and, therefore, an increased delivery of unbound ligand to the cell surface. In contrast, the absolute magnitude of the unbound clearance was consistent with the theory only for the lowest published value for the equilibrium association constant, 15 microM-1. For higher published values (62 and 94 microM-1), the magnitude of the unbound clearance observed experimentally was severalfold higher than that predicted by the theory. If in fact the association constant exceeds 30 microM-1, the data would imply that an albumin-dependent facilitation mechanism exists which enhances the availability of palmitate to the cell over and above the enhancement predicted by the diffusion-reaction theory.
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Affiliation(s)
- S M Pond
- Department of Medicine, University of Queensland, Brisbane, Australia
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Davis CK. A vision for U.S. health care and nursing: an interview with Carolyne K. Davis. Interview by Sally Burrows-Hudson. ANNA J 1991; 18:165-70. [PMID: 2025047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Casey JT, Cleverley WO, Davis CK, King JG, Korman IB, Lang HL, Mortimer JD, Roberts EC. 1991 outlook: progress will require partnerships, improved productivity--roundtable discussion. Mod Healthc 1991; 21:32-4, 36, 38-40. [PMID: 10108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
To address the myriad problems and challenges in the next year, the operative word will be partnership. That's according to members of Modern Healthcare's editorial advisory board in their discussion of the healthcare industry in 1991. The experts see the need for hospitals, physicians and the business community to team up to control costs, solve staffing woes and take initial steps toward healthcare reform.
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Davis CK. An interview with Carolyne K. Davis. Interview by Barbara J. Barnum. Nurs Health Care 1990; 11:460-2. [PMID: 2250795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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King JG, O'Leary RW, Korman IB, Davis CK, Penkhus ML, Roberts C, Cathcart HR, Lachner BJ, Coile RC. The outlook for healthcare and hospitals in 1990. Roundtable discussion. Mod Healthc 1990; 20:38-9, 42, 44 passim. [PMID: 10103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Davis CK. Carolyne Davis. Interview by C.R. Shelton. N J Healthc 1989; 2:7-9. [PMID: 10304439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Arnwine DL, Cathcart HR, Coile RC, Davis CK, Galvin JM, King JG, Lachner BJ, Roberts C, Washington JW. Challenges for '89. Interview by Clark Bell. Mod Healthc 1989; 19:28-30, 34, 36. [PMID: 10291277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK, Abbey FB. Keeping score alters the game. New techniques for measuring the quality of health-care services could revolutionize those services themselves. Health Manage Q 1988; 11:6-9. [PMID: 10303621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. The nursing shortage. Carolyne Davis speaks out. Nurs Health Care 1988; 9:354-9. [PMID: 3173792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Davis CK, Orsolits M, Abbey FB. The PRO's role in monitoring quality of care. Trustee 1987; 40:8-10. [PMID: 10282898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK, Powell PD. The health agenda facing the 100th Congress: budget, PPS, elderly are among chief concerns. Rev Fed Am Health Syst 1987; 20:16-21. [PMID: 10311963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. An interview with Carolyne K. Davis, Ph.D.. Interview by Roy Parker. Comput Healthc 1986; 7:32-4. [PMID: 10277443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. Health-care reforms: what can we expect? Nurs Econ 1986; 4:10-1, 49. [PMID: 3633019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Davis CK. The future of health care: four critical variables. Mass Nurse 1985; 54:3, 5. [PMID: 3849659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Davis CK. The future of reimbursement: a government official answers key questions. Cost Containment 1985; 7:3-6. [PMID: 10273652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. HCFA's Davis praises PPS, predicts strong future for medical record profession. Interview by Jill Callahan Dennis, RRA. J Am Med Rec Assoc 1985; 56:17-9. [PMID: 10273660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. The impact of prospective payment on clinical research. JAMA 1985; 253:686-7. [PMID: 3918186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Davis CK. Where money and medicine meet: a conversation with HCFA administrator Carolyne K. Davis. Interview by John K. Iglehart. Health Aff (Millwood) 1985; 4:72-81. [PMID: 3930378 DOI: 10.1377/hlthaff.4.2.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Stolp-Smith SC, Dalston JW, Davis CK. The chief administrative officer of the academic health center--a post of growing impact on both higher education and health services delivery. J Health Adm Educ 1984; 2:3-25. [PMID: 10266595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. HCFA is not imposing quotas on PROs, administrator says. Rev Fed Am Hosp 1984; 17:50-1. [PMID: 10273635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Davis CK. Carolyne K. Davis: expanding the profession's influence. Focus Crit Care 1984; 11:56-7. [PMID: 6567554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Davis CK. The status of reimbursement policy and future projections. ANA Publ 1984:17-23. [PMID: 6428255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Davis CK. The federal role in changing health care financing. Part II: prospective payment and its impact on nursing. Nurs Econ 1983; 1:98-104, 146. [PMID: 6415496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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