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Železnik M, Vipotnik Vesnaver T, Neubauer D, Soltirovska Šalamon A. Neurological findings and a brief review of the current literature in a severe case of Aicardi-Gutières syndrome due to IFIH1 mutation. Neuropediatrics 2024. [PMID: 38714209 DOI: 10.1055/a-2321-0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Aicardi-Goutières syndrome (AGS) is a rare genetic early-onset progressive encephalopathy with variable clinical manifestations. The IFIH1 mutation has been confirmed to be responsible for type I interferon (IFN) production and activation of the Janus kinase (JAK) signaling pathway. We herein stress neurological observations and neuroimaging findings in a severe case report of an infant with AGS type 7 due to an IFIH1 mutation who was diagnosed in first month of life. We also review neurological characteristics of IFIH1 mutations through recent literature.
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Affiliation(s)
| | | | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, Chair of Paediatrics, University of Ljubljana, Ljubljana, Slovenia
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2
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Peganc Nunčič K, Neubauer D, Oražem Mrak J, Perković Benedik M, Mahne U, Bizjak N, Rener Primec Z, Šuštar N, Butenko T, Vrščaj E, Osredkar D. Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography. Front Pediatr 2024; 12:1362918. [PMID: 38725985 PMCID: PMC11079286 DOI: 10.3389/fped.2024.1362918] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
Background and objectives In children requiring electroencephalography (EEG), sleep recording can provide crucial information. As EEG recordings during spontaneous sleep are not always possible, pharmacological sleep-inducing agents are sometimes required. The aim of the study was to evaluate safety and efficacy of melatonin (Mel) and dexmedetomidine (Dex; intranasal and sublingual application) for sleep induction prior to EEG. Methods In this prospective randomized study, 156 consecutive patients aged 1-19 years were enrolled and randomized by draw into melatonin group (Mel; n = 54; dose: 0.1 mg/kg), dexmedetomidine (Dex) sublingual group (DexL; n = 51; dose: 3 mcg/kg) or dexmedetomidine intranasal group (DexN; n = 51; dose: 3 mcg/kg). We compared the groups in several parameters regarding efficacy and safety and also carried out a separate analysis for a subgroup of patients with complex behavioral problems. Results Sleep was achieved in 93.6% of participants after the first application of the drug and in 99.4% after the application of another if needed. Mel was effective as the first drug in 83.3% and Dex in 99.0% (p < 0.001); in the subgroup of patients with complex developmental problems Mel was effective in 73.4% and Dex in 100% (p < 0.001). The patients fell asleep faster after intranasal application of Dex than after sublingual application (p = 0.006). None of the patients had respiratory depression, bradycardia, desaturation, or hypotension. Conclusions Mel and Dex are both safe for sleep induction prior to EEG recording in children. Dex is more effective compared to Mel in inducing sleep, also in the subgroup of children with complex behavioral problems. Clinical Trial Registration Dexmedetomidine and Melatonin for Sleep Induction for EEG in Children, NCT04665453.
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Affiliation(s)
- Katja Peganc Nunčič
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Neubauer
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Oražem Mrak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Urška Mahne
- Department of Pediatric Intensive Care, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neli Bizjak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zvonka Rener Primec
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Šuštar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tita Butenko
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eva Vrščaj
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
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Nanetti L, Kearney M, Boesch S, Stovickova L, Ortigoza-Escobar JD, Macaya A, Gomez-Andres D, Roze E, Molnar MJ, Wolf NI, Darling A, Vasco G, Bertini E, Indelicato E, Neubauer D, Haack TB, Sagi JC, Danti FR, Sival D, Zanni G, Kolk A, Boespflug-Tanguy O, Schols L, van de Warrenburg B, Vidailhet M, Willemsen MA, Buizer AI, Orzes E, Ripp S, Reinhard C, Moroni I, Mariotti C. Child-to-adult transition: a survey of current practices within the European Reference Network for Rare Neurological Diseases (ERN-RND). Neurol Sci 2024; 45:1007-1016. [PMID: 37853291 DOI: 10.1007/s10072-023-07101-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Transition from child-centered to adult-centered healthcare is a gradual process that addresses the medical, psychological, and educational needs of young people in the management of their autonomy in making decisions about their health and their future clinical assistance. This transfer is challenging across all chronic diseases but can be particularly arduous in rare neurological conditions. AIM To describe the current practice on the transition process for young patients in centers participating in the European Reference Network for Rare Neurological Diseases (ERN-RND). METHODS Members of the ERN-RND working group developed a questionnaire considering child-to-adult transition issues and procedures in current clinical practice. The questionnaire included 20 questions and was sent to members of the health care providers (HCPs) participating in the network. RESULTS Twenty ERN-RND members (75% adult neurologists; 25% pediatricians; 5% nurses or study coordinators) responded to the survey, representing 10 European countries. Transition usually occurs between 16 and 18 years of age, but 55% of pediatric HCPs continue to care for their patients until they reach 40 years of age or older. In 5/20 ERN-RND centers, a standardized procedure managing transition is currently adopted, whereas in the remaining centers, the transition from youth to adult service is usually assisted by pediatricians as part of their clinical practice. CONCLUSIONS This survey demonstrated significant variations in clinical practice between different centers within the ERN-RND network. It provided valuable data on existing transition programs and highlighted key challenges in managing transitions for patients with rare neurological disorders.
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Affiliation(s)
- Lorenzo Nanetti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy
| | - Mary Kearney
- Patient Advocate at the European Reference Network Representing Individuals With Ataxia, and Neurology Research Fellow at the National Ataxia Centre, Tallaght University, Dublin, Ireland
| | - Sylvia Boesch
- Center for Rare Movement Disorders, Department of Neurology, Innsbruck, Austria
| | - Lucie Stovickova
- Centre of Hereditary Ataxias, Department of Pediatric Neurology, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic
| | | | - Alfons Macaya
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Gomez-Andres
- Pediatric Neurology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, and Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Emmanuel Roze
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Maria-Judit Molnar
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Nicole I Wolf
- Amsterdam Leukodystrophy Center, Department of Child Neurology, Emma's Children's Hospital, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Cellular & Molecular Mechanisms, Amsterdam, The Netherlands
| | - Alejandra Darling
- Pediatric Neurology Department, Institut de Recerca Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Gessica Vasco
- Research Unit of Neurorehabilitation, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | | | - David Neubauer
- UMCL, Children's Hospital Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics University of Tübingen, Tübingen, Germany
| | - Judit C Sagi
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
- Department of Paediatrics, Semmelweis University, Dept. of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Federica R Danti
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Deborah Sival
- Department of Paediatric Neurology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ginevra Zanni
- Unit of Neuromuscular and Neurodegenerative Disease, IRCCS Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Anneli Kolk
- Tartu University Hospital Children's Clinic, Department of Pediatrics and Neurology, Tartu, Estonia
| | - Odile Boespflug-Tanguy
- APHP, Université Paris Cité, INSERM UMR1141, Hôpital Robert Debré, Service de Neuropédiatrie, Centre de Reference LEUKOFRANCE, Paris, France
| | - Ludger Schols
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, and German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Bart van de Warrenburg
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie Vidailhet
- Sorbonne University, INSERM, CNRS, Paris Brain Institute, APHP Salpêtrière Hospital, Paris, France
| | - Michèl A Willemsen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Emma Children's Hospital, Amsterdam, Vrije Universiteit, Amsterdam, Amsterdam Movement Science, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Enrico Orzes
- Osservatorio Malattie Rare - Rarelab S.R.L., Rome, Italy
| | - Sophie Ripp
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Carola Reinhard
- Centre for Rare Diseases and Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy.
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Schotland H, Wickwire E, Aaronson RM, Dawson SC, Khosla S, Lee-Iannotti JK, Leu RM, Lewin DS, McCrae CS, Neubauer D, Ong JC, Heffron TM, Whittington C, Martin JL. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med 2024; 20:455-459. [PMID: 37942936 PMCID: PMC11019205 DOI: 10.5664/jcsm.10922] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
Challenges exist in access to high-quality care for insomnia disorder. After the recent publication of a clinical practice guideline on behavioral and psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a 1-day virtual Insomnia Summit in September 2022 to discuss improving care for patients with insomnia disorder. Fifty participants representing a variety of organizations (eg, medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the event. Videos highlighting patient perspectives on insomnia and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions, each with 3 to 4 brief, topical presentations by content experts. Breakout groups were used to brainstorm and prioritize issues in each thematic area. Top barriers to care for insomnia disorder include limited access, limited awareness of treatment options, low perceived value of insomnia treatment, and an insufficient number of trained clinicians. Top facilitators of high-quality care include education and awareness, novel care models to increase access, expanding the insomnia patient care workforce, incorporating research into practice, and increasing reimbursement for psychotherapies. Priorities for the future include increasing awareness among patients and providers, increasing the number of skilled behavioral sleep medicine providers, increasing advocacy efforts to address insurance issues (eg, billing, reimbursement, and performance measures), and working collaboratively with multidisciplinary organizations to achieve common goals. These priorities highlight that goals set to improve accessible, high-quality care for insomnia disorder will require sustained, coordinated efforts to increase awareness, improve reimbursement, and grow the necessary skilled health care workforce. CITATION Schotland H, Wickwire E, Aaronson RM, et al. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med. 2024;20(3):455-459.
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Affiliation(s)
| | - Emerson Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Spencer C. Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | - Joyce K. Lee-Iannotti
- Department of Internal Medicine, Department of Neurology, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
| | - Roberta M. Leu
- Division of Pulmonology and Sleep, Department of Pediatrics, Emory University, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Christina S. McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - David Neubauer
- Sleep Disorders Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason C. Ong
- Nox Health, Inc, Alpharetta, Georgia
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jennifer L. Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
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Štajer K, Kovač N, Šikonja J, Mlinarič M, Bertok S, Brecelj J, Debeljak M, Kovač J, Markelj G, Neubauer D, Rus R, Žerjav Tanšek M, Drole Torkar A, Zver A, Battelino T, Jiménez Torres R, Grošelj U. Clinical and genetic characteristics of a patient with phosphoribosyl pyrophosphate synthetase 1 deficiency and a systematic literature review. Mol Genet Metab Rep 2023; 36:100986. [PMID: 37670898 PMCID: PMC10475845 DOI: 10.1016/j.ymgmr.2023.100986] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 09/07/2023] Open
Abstract
Phosphoribosylpyrophosphate synthetase 1 (PRS-I) is an enzyme involved in nucleotide metabolism. Pathogenic variants in the PRPS1 are rare and PRS-I deficiency can manifest as three clinical syndromes: X-linked non-syndromic sensorineural deafness (DFN2), X-linked Charcot-Marie-Tooth neuropathy type 5 (CMTX5) and Arts syndrome. We present a Slovenian patient with PRS-I enzyme deficiency due to a novel pathogenic variant - c.424G > A (p.Val142Ile) in the PRPS1 gene, who presented with gross motor impairment, severe sensorineural deafness, balance issues, ataxia, and frequent respiratory infections. In addition, we report the findings of a systemic literature review of all described male cases of Arts syndrome and CMTX5 as well as intermediate phenotypes. As already proposed by other authors, our results confirm PRS-I deficiency should be viewed as a phenotypic continuum rather than three separate syndromes because there are multiple reports of patients with an intermediary clinical presentation.
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Affiliation(s)
- Katarina Štajer
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neja Kovač
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jaka Šikonja
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Mlinarič
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Bertok
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Brecelj
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maruša Debeljak
- Laboratory of Genetics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Kovač
- Laboratory of Genetics, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gašper Markelj
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurologyx, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Rina Rus
- Department of Nephrology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mojca Žerjav Tanšek
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Drole Torkar
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Aleksandra Zver
- Unit for Pulmonary Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rosa Jiménez Torres
- La Paz University Hospital Health Research Institute (FIBHULP), IdiPaz, Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Spain
| | - Urh Grošelj
- Department of Endocrinology, Diabetes, and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Troha Gergeli A, Škofljanec A, Neubauer D, Paro Panjan D, Kodrič J, Osredkar D. Corrigendum: Prognostic value of various diagnostic methods for long-term outcome of newborns after hypoxic-ischemic encephalopathy treated with hypothermia. Front Pediatr 2023; 11:1226835. [PMID: 37425275 PMCID: PMC10327817 DOI: 10.3389/fped.2023.1226835] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.856615.].
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Affiliation(s)
- Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreja Škofljanec
- Pediatric Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Health Institution Zdravje, Ljubljana, Slovenia
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Paro Panjan
- Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jana Kodrič
- Unit of Child Psychiatry of the University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Rose K, Grant-Kels JM, Striano P, Oishi T, Neubauer D, Ettienne EB. "Pediatric" Drug Studies Might Be the Largest Abuse in Medical Research in History. It Is Time for Lawyers to Step In. J Law Med 2023; 30:131-154. [PMID: 37271955] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A new type of research has emerged with United States and European Union pediatric laws that request/demand separate clinical studies for vaccines and drugs in minors less than 18 years of age. Physiologically, minors mature before their 18th birthday. Medicine treats the body, not the administrative status. Many "pediatric" studies are performed in minors that bodily are no longer children, which makes them pointless. Traditional malpractice litigation in clinical research involves patients that were harmed in clinical studies. In the new type of "pediatric" studies, drugs known to work in humans are retested, pretending that "children" are uniquely different, which is incorrect. Minors are not another species. Patients are not treated at all (placebo group) or below standard-of-care (comparison to outdated treatment). Pediatric laws are the law, but not a free pass for harming patients. Where "pediatric" studies violate accepted norms of medical practice, lawyers should be aware of this challenge at the interface of medicine and law.
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Riehen, Switzerland
| | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, "G. Gaslini" Institute, Genova, Italy
| | - Tanjinatus Oishi
- Howard University College of Pharmacy, Washington DC, United States
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Childrens' Hospital, Ljubljana, Slovenia
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Milaščević D, Wright FV, Milošević M, Neubauer D. Measuring advanced motor skills in children with cerebral palsy: development of normative data and percentile curves for the Challenge-20 assessment. Int J Rehabil Res 2022; 45:329-335. [PMID: 36083590 DOI: 10.1097/mrr.0000000000000546] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Challenge-20 is an assessment of advanced motor skills of children with cerebral palsy. The purpose of this study was to develop age-related norms and percentile curves for the Challenge-20 with typically developing children ( n = 150, 7 through 11 years), and compare Challenge-20 scores of independently ambulatory children with CP, Gross Motor Function Classification System level I ( n = 135) and II ( n = 56) to these age norms. Younger TD children (7 years) scored lowest, and older children (11 years) scored highest on the Challenge-20 , showing similar developmental trajectories. Challenge-20 scores of 15% of children in GMFCS level I were situated above the lower 2.5th percentile curve of the typically developing children's Challenge-20 growth curve, that is, overlapping into the typically developing child zone. The Challenge-20 is sensitive to the progression of advanced gross motor skills in typically developing children. Children with cerebral palsy, GMFCS I follow similar, albeit lower, Challenge score trajectory to that of typically developing children, and in some cases come close to lower level abilities of typically developing children. The reference values with typically developing children extend the Challenge-20 's utility when assessing advanced gross motor skill of independently ambulatory children with cerebral palsy for physiotherapy intervention and physical activity planning and open the door to re-thinking more about advanced gross motor interventions for children with cerebral palsy in GMFCS levels I and II given their potential to progress along the developmental trajectory.
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Affiliation(s)
- Darko Milaščević
- University of Ljubljana, PhD Candidate at Interdisciplinary Doctoral Study in Biomedicine - Neuroscience, School of Medicine, Ljubljana, Slovenia
| | - F Virginia Wright
- Holland Bloorview Kids Rehabilitation Hospital/Bloorview Research Institute, Toronto, Ontario, Canada
| | - Milan Milošević
- University of Zagreb, School of Medicine, School of Public Health "Andrija Štampar", Department of Environmental Health, Occupational and Sports Medicine, Zagreb, Croatia
| | - David Neubauer
- University of Ljubljana, Medical Faculty and University Medical Centre Ljubljana, Children's Hospital, Department of Child, Adolescent & Developmental Neurology, Ljubljana, Slovenia
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9
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Kelesidis GA, Neubauer D, Fan LS, Lohmann U, Pratsinis SE. Enhanced Light Absorption and Radiative Forcing by Black Carbon Agglomerates. Environ Sci Technol 2022; 56:8610-8618. [PMID: 35652563 PMCID: PMC9228049 DOI: 10.1021/acs.est.2c00428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 05/19/2023]
Abstract
The climate models of the Intergovernmental Panel on Climate Change list black carbon (BC) as an important contributor to global warming based on its radiative forcing (RF) impact. Examining closely these models, it becomes apparent that they might underpredict significantly the direct RF for BC, largely due to their assumed spherical BC morphology. Specifically, the light absorption and direct RF of BC agglomerates are enhanced by light scattering between their constituent primary particles as determined by the Rayleigh-Debye-Gans theory interfaced with discrete dipole approximation and recent relations for the refractive index and lensing effect. The light absorption of BC is enhanced by about 20% by the multiple light scattering between BC primary particles regardless of the compactness of their agglomerates. The resulting light absorption agrees very well with the observed absorption aerosol optical depth of BC. ECHAM-HAM simulations accounting for the realistic BC morphology and its coatings reveal high direct RF = 3-5 W/m2 in East, South Asia, sub-Sahara, western Africa, and the Arabian peninsula. These results are in agreement with satellite and AERONET observations of RF and indicate a regional climate warming contribution by 0.75-1.25 °C, solely due to BC emissions.
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Affiliation(s)
- Georgios A. Kelesidis
- Particle
Technology Laboratory, Institute of Energy and Process Engineering,
Department of Mechanical and Process Engineering, ETH Zürich, Sonneggstrasse 3, CH-8092 Zürich, Switzerland
| | - David Neubauer
- Institute
of Atmospheric and Climate Science, Department of Environmental Systems
Science, ETH Zürich, Universitaetstrasse 16, CH-8092 Zürich, Switzerland
| | - Liang-Shih Fan
- Department
of Chemical and Biomolecular Engineering, The Ohio State University, 140 West 19th Avenue, Columbus, Ohio 43210, United States
| | - Ulrike Lohmann
- Institute
of Atmospheric and Climate Science, Department of Environmental Systems
Science, ETH Zürich, Universitaetstrasse 16, CH-8092 Zürich, Switzerland
| | - Sotiris E. Pratsinis
- Particle
Technology Laboratory, Institute of Energy and Process Engineering,
Department of Mechanical and Process Engineering, ETH Zürich, Sonneggstrasse 3, CH-8092 Zürich, Switzerland
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10
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Lepola P, Kindred M, Giannuzzi V, Glosli H, Dehlinger-Kremer M, Dalrymple H, Neubauer D, Boylan GB, Conway J, Dewhurst J, Hoffman D. Informed consent and assent guide for paediatric clinical trials in Europe. Arch Dis Child 2022; 107:582-590. [PMID: 34853000 PMCID: PMC9125378 DOI: 10.1136/archdischild-2021-322798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical trial sponsors spend considerable resources preparing informed consent (IC) and assent documentation for multinational paediatric clinical trial applications in Europe due to the limited and dispersed patient populations, the variation of national legal and ethical requirements, and the lack of detailed guidance. The aim of this study was to design new easy-to-use guide publicly available on European Medicines Agency's, Enpr-EMA website for all stakeholders. METHODS Current EU legal, ethical and regulatory guidance for paediatric clinical trials were collated, analysed and divided into 30 subject elements in two tables. The European Network of Young Person's Advisory Group reviewed the data and provided specific comments. A three-level recommendation using 'traffic light' symbols was designed for four age groups of children, according to relevance and the requirements. RESULTS A single guide document includes two tables: (1) general information and (2) trial-specific information. In the age group of 6-9 years old, 92% of the trial-specific subject elements can be or should be included in the IC discussion. Even in the youngest possible age group (2-5 years old children), the number of elements considered was, on average, 52%. CONCLUSION The EU Clinical Trial Regulation (2014) does not contain specific requirements exclusively for paediatric clinical trials. This work is the first to extensively collate all the current legal, regulatory and ethical documentation on the IC process, together with input from adolescents. This guide may increase the ethical standards in paediatric clinical trials.
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Affiliation(s)
- Pirkko Lepola
- University of Helsinki and Helsinki University Hospital, Department of Children and Adolescents, Helsinki, Finland
| | - Maxine Kindred
- Portfolio Delivery Operations, Janssen Research & Development, High Wycombe, Buckinghamshire, UK
| | - Viviana Giannuzzi
- Research Department, Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Bari, Italy
| | - Heidi Glosli
- Paediatric Clinical Trial Ward, Oslo University Hospital, Oslo, Norway
| | | | - Harris Dalrymple
- Center for Pediatric Clinical Developmen, ICON plc, Dublin, Ireland
| | - David Neubauer
- Department of Child, Adolesecent & Developmental Neurology, University Medical Centre Ljubljana, Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Geraldine B Boylan
- Department of Paediatrics and Child Health, Neonatal Brain Research Group, Cork University Maternity Hospital, Cork, Ireland
| | - Jean Conway
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
| | - Jo Dewhurst
- Center for Pediatric Clinical Developmen, ICON plc, Dublin, Ireland
| | - Diane Hoffman
- Retired from work, Janssen Research and Development LLC, Raritan, New Jersey, USA
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11
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Višnjar T, Maver A, Writzl K, Maloku O, Bergant G, Jaklič H, Neubauer D, Fogolari F, Pečarič Meglič N, Peterlin B. Biallelic ATOH1 Gene Variant in Siblings With Pontocerebellar Hypoplasia, Developmental Delay, and Hearing Loss. Neurol Genet 2022; 8:e677. [PMID: 35518571 PMCID: PMC9067583 DOI: 10.1212/nxg.0000000000000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/09/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives To report on the novel association of biallelic variant in atonal basic helix-loop-helix transcription factor 1 (ATOH1) gene and pontocerebellar hypoplasia (PCH), severe global developmental delay, intellectual disability, and hearing loss in a family with 2 affected siblings. Methods A detailed clinical assessment and exome sequencing of peripheral blood sample were performed. Segregation analysis with Sanger sequencing and structural modeling of the variant was performed to support the pathogenicity of the variant. Results A homozygous missense variant (NM_005172.1:c.481C>G) in the ATOH1 gene was identified in the proband and his affected sister. The segregation analysis subsequently confirmed its segregation with an apparently recessive PCH in this family. ATOH1 encodes for the atonal basic helix-loop-helix (bHLH) transcription factor 1, a core transcription factor in the developing cerebellum, brainstem, and dorsal spinal cord, and in the ear. The identified variant results in the p.(Arg161Gly) amino acid substitution in the evolutionarily conserved DNA-binding bHLH domain of the ATOH1 protein. Biallelic missense variants in this domain were previously reported to result in disordered cerebellar development and hearing loss in animal models. In silico homology modeling revealed that p.Arg161Gly in ATOH1 protein probably disrupts a salt bridge with DNA backbone phosphate and increases the flexibility of the bHLH helix-both of which together affect the binding capability of the bHLH domain to the DNA. Discussion Based on the sequencing results and evidence from structural modeling of the identified variant, as well as with previous reports of ATOH1 gene disruption, we conclude that ATOH1 may represent a novel candidate gene associated with the phenotype of PCH, global developmental delay, and hearing loss in humans.
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Affiliation(s)
- Tanja Višnjar
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Aleš Maver
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Karin Writzl
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Ornela Maloku
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Gaber Bergant
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Helena Jaklič
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - David Neubauer
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Federico Fogolari
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Nuška Pečarič Meglič
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
| | - Borut Peterlin
- Clinical Institute of Genomic Medicine (T.V., A.M., K.W., G.B., H.J., B.P.), University Medical Centre Ljubljana, Slovenia; Medical Faculty (K.W., D.N.), University of Ljubljana, Slovenia; Division of Paediatrics (D.N.), Department of Child, Adolescent & Developmental Neurology, University Medical Centre Ljubljana, Slovenia; Clinical Institute of Radiology (N.P.M.), University Medical Centre Ljubljana, Slovenia; and Department of Mathematics (O.M., F.F.), Informatics and Physics, University of Udine, Italy
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12
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Salzmann M, Ferrachat S, Tully C, Münch S, Watson‐Parris D, Neubauer D, Siegenthaler‐Le Drian C, Rast S, Heinold B, Crueger T, Brokopf R, Mülmenstädt J, Quaas J, Wan H, Zhang K, Lohmann U, Stier P, Tegen I. The Global Atmosphere-aerosol Model ICON-A-HAM2.3-Initial Model Evaluation and Effects of Radiation Balance Tuning on Aerosol Optical Thickness. J Adv Model Earth Syst 2022; 14:e2021MS002699. [PMID: 35860306 PMCID: PMC9285428 DOI: 10.1029/2021ms002699] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 06/15/2023]
Abstract
The Hamburg Aerosol Module version 2.3 (HAM2.3) from the ECHAM6.3-HAM2.3 global atmosphere-aerosol model is coupled to the recently developed icosahedral nonhydrostatic ICON-A (icon-aes-1.3.00) global atmosphere model to yield the new ICON-A-HAM2.3 atmosphere-aerosol model. The ICON-A and ECHAM6.3 host models use different dynamical cores, parameterizations of vertical mixing due to sub-grid scale turbulence, and parameter settings for radiation balance tuning. Here, we study the role of the different host models for simulated aerosol optical thickness (AOT) and evaluate impacts of using HAM2.3 and the ECHAM6-HAM2.3 two-moment cloud microphysics scheme on several meteorological variables. Sensitivity runs show that a positive AOT bias over the subtropical oceans is remedied in ICON-A-HAM2.3 because of a different default setting of a parameter in the moist convection parameterization of the host models. The global mean AOT is biased low compared to MODIS satellite instrument retrievals in ICON-A-HAM2.3 and ECHAM6.3-HAM2.3, but the bias is larger in ICON-A-HAM2.3 because negative AOT biases over the Amazon, the African rain forest, and the northern Indian Ocean are no longer compensated by high biases over the sub-tropical oceans. ICON-A-HAM2.3 shows a moderate improvement with respect to AOT observations at AERONET sites. A multivariable bias score combining biases of several meteorological variables into a single number is larger in ICON-A-HAM2.3 compared to standard ICON-A and standard ECHAM6.3. In the tropics, this multivariable bias is of similar magnitude in ICON-A-HAM2.3 and in ECHAM6.3-HAM2.3. In the extra-tropics, a smaller multivariable bias is found for ICON-A-HAM2.3 than for ECHAM6.3-HAM2.3.
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Affiliation(s)
- M. Salzmann
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - S. Ferrachat
- Institute of Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - C. Tully
- Institute of Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - S. Münch
- Institute of Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - D. Watson‐Parris
- Atmospheric, Oceanic and Planetary PhysicsDepartment of PhysicsUniversity of OxfordOxfordUK
| | - D. Neubauer
- Institute of Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | | | - S. Rast
- Max Planck Institute for MeteorologyHamburgGermany
| | - B. Heinold
- Leibniz Institute for Tropospheric ResearchLeipzigGermany
| | - T. Crueger
- Max Planck Institute for MeteorologyHamburgGermany
| | - R. Brokopf
- Max Planck Institute for MeteorologyHamburgGermany
| | - J. Mülmenstädt
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
- Now at Pacific Northwest National LaboratoryRichlandWAUSA
| | - J. Quaas
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - H. Wan
- Pacific Northwest National LaboratoryRichlandWAUSA
| | - K. Zhang
- Pacific Northwest National LaboratoryRichlandWAUSA
| | - U. Lohmann
- Institute of Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - P. Stier
- Atmospheric, Oceanic and Planetary PhysicsDepartment of PhysicsUniversity of OxfordOxfordUK
| | - I. Tegen
- Leibniz Institute for Tropospheric ResearchLeipzigGermany
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13
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Rose K, Ettienne EB, Grant-Kels JM, Striano P, Neubauer D, Tanjinatus O. Neurology's vital role in preventing unnecessary and potentially harmful pediatric studies. Expert Rev Neurother 2022; 22:209-219. [PMID: 35213279 DOI: 10.1080/14737175.2022.2045953] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory authorities recognize two human populations: adults and children defined as <18 years. For drug approval, they demand separate studies. But humans mature slowly during puberty. The 18th birthday is an administrative limit that does not correspond to a physiological change. Separate drug approval before/after the 18th birthday reflects the children-are-therapeutic-orphans concept that emerged after 1962. The Food and Drug Administration (FDA) has backed away from this concept for antiepileptic drugs, but sticks to it in other areas. In contrast, the European Medicines Agency (EMA) is continuously expanding its demand for "pediatric" studies. Parents hesitate increasingly to let their children participate in questionable studies. AREAS COVERED Neurologists challenge the children-are-therapeutic-orphans mantra. Young patients do not need separate proof of efficacy & safety, but appropriate dosing recommendations. Minors should be treated as human beings, instead of being abused in questionable studies. EXPERT OPINION Young patients with multiple sclerosis and other neurological diseases deserve studies with therapeutic intentions. "Pediatric" careers have emerged in academia, regulatory authorities, and pharmaceutical companies. Institutional Review Boards/ Ethics Committees should suspend questionable "pediatric" studies and reject newly submitted ones. The medical professions should distance themselves from questionable "pediatric" research that reflects massive conflicts of interest.
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Affiliation(s)
- Klaus Rose
- Klausrose Consulting, Riehen, Switzerland
| | | | - Jane M Grant-Kels
- Dermatology Department, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, "G. Gaslini" Institute, Genova, Italy
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
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14
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Troha Gergeli A, Škofljanec A, Neubauer D, Paro Panjan D, Kodrič J, Osredkar D. Prognostic Value of Various Diagnostic Methods for Long-Term Outcome of Newborns After Hypoxic-Ischemic Encephalopathy Treated With Hypothermia. Front Pediatr 2022; 10:856615. [PMID: 35463898 PMCID: PMC9021608 DOI: 10.3389/fped.2022.856615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prediction of outcome in newborns with hypoxic-ischemic encephalopathy (HIE) has been modulated by hypothermia treatment (HT). We assessed the predictive value of diagnostic methods commonly used in neonates with HIE for short-term neurodevelopmental outcome and long-term neurological outcome. MATERIALS AND METHODS This longitudinal cohort study followed up 50 term newborns who underwent HT after HIE between July 2006 and August 2015, until preschool age. We estimated sensitivity and specificity for short-term neurodevelopmental outcome at 18 months and long-term neurological outcome at five years based on Amiel-Tison Neurological Assessment (ATNA), electroencephalography (EEG), and magnetic resonance imaging (MRI) performed in the neonatal period. RESULTS The accuracy of all neonatal methods tested was higher for long-term neurological outcome compared to the predictive accuracy for short-term neurodevelopmental outcome at 18-24 months. Sensitivity and specificity in predicting unfavorable long-term neurological outcome were: MRI (sensitivity 1.0 [95%CI 0.96-1.0]; specificity 0.91 [95%CI 0.86-1.0]), EEG (sensitivity 0.94 [95%CI 0.71-1.0]; specificity 1.0 [95% CI 0.89-1.0]), and ATNA (sensitivity 0.94 [95%CI 0.71-1.0]; specificity 0.91 [95%CI 0.76-0.98]). CONCLUSION MRI is a powerful predictor of long-term neurological outcome when performed in the first week after HIE in HT treated infants, as are EEG and ATNA performed in the second or third week postnatally.
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Affiliation(s)
- Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andreja Škofljanec
- Pediatric Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Health Institution Zdravje, Ljubljana, Slovenia
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Darja Paro Panjan
- Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jana Kodrič
- Unit of Child Psychiatry of the University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Center for Developmental Neuroscience, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Rose K, Grant-Kels JM, Ettienne EB, Tanjinatus O, Striano P, Neubauer D. Comment on: A review of the experience with pediatric written requests issued for oncology drug products. Pediatr Blood Cancer 2021; 68:e28972. [PMID: 33619883 DOI: 10.1002/pbc.28972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Riehen, Switzerland
| | - Jane M Grant-Kels
- Department of Dermatology, UConn Health, Farmington, Connecticut, USA
| | - Earl B Ettienne
- College of Pharmacy, Howard University, Washington, District of Columbia, USA
| | - Oishi Tanjinatus
- College of Pharmacy, Howard University, Washington, District of Columbia, USA
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, 'G. Gaslini' Institute, University of Genova, Genova, Italy
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
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16
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Arnaud C, Ehlinger V, Delobel-Ayoub M, Klapouszczak D, Perra O, Hensey O, Neubauer D, Hollódy K, Virella D, Rackauskaite G, Greitane A, Himmelmann K, Ortibus E, Dakovic I, Andersen GL, Papavasiliou A, Sellier E, Platt MJ, Krägeloh-Mann I. Trends in Prevalence and Severity of Pre/Perinatal Cerebral Palsy Among Children Born Preterm From 2004 to 2010: A SCPE Collaboration Study. Front Neurol 2021; 12:624884. [PMID: 34093391 PMCID: PMC8173253 DOI: 10.3389/fneur.2021.624884] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Received: 12/03/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Aim: To report on prevalence of cerebral palsy (CP), severity rates, and types of brain lesions in children born preterm 2004 to 2010 by gestational age groups. Methods: Data from 12 population-based registries of the Surveillance of Cerebral Palsy in Europe network were used. Children with CP were eligible if they were born preterm (<37 weeks of gestational age) between 2004 and 2010, and were at least 4 years at time of registration. Severity was assessed using the impairment index. The findings of postnatal brain imaging were classified according to the predominant pathogenic pattern. Prevalences were estimated per 1,000 live births with exact 95% confidence intervals within each stratum of gestational age: ≤27, 28–31, 32–36 weeks. Time trends of both overall prevalence and prevalence of severe CP were investigated using multilevel negative binomial regression models. Results: The sample comprised 2,273 children. 25.8% were born from multiple pregnancies. About 2-thirds had a bilateral spastic CP. 43.5% of children born ≤27 weeks had a high impairment index compared to 37.0 and 38.5% in the two other groups. Overall prevalence significantly decreased (incidence rate ratio per year: 0.96 [0.92–1.00[) in children born 32–36 weeks. We showed a decrease until 2009 for children born 28–31 weeks but an increase in 2010 again, and a steady prevalence (incidence rate ratio per year = 0.97 [0.92–1.02] for those born ≤27 weeks. The prevalence of the most severely affected children with CP revealed a similar but not significant trend to the overall prevalence in the corresponding GA groups. Predominant white matter injuries were more frequent in children born <32 weeks: 81.5% (≤27 weeks) and 86.4% (28–31 weeks), compared to 63.6% for children born 32–36 weeks. Conclusion: Prevalence of CP in preterm born children continues to decrease in Europe excepting the extremely immature children, with the most severely affected children showing a similar trend.
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Affiliation(s)
- Catherine Arnaud
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France.,Clinical Epidemiology Unit, University Hospital of Toulouse, Toulouse, France
| | - Virginie Ehlinger
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Malika Delobel-Ayoub
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Dana Klapouszczak
- UMR 1027 SPHERE Team, Inserm, Toulouse 3 Paul Sabatier University, Toulouse, France.,Childhood Disability Registry in Haute-Garonne, University Hospital of Toulouse, Toulouse, France
| | - Oliver Perra
- School of Nursing & Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, United Kingdom
| | | | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Katalin Hollódy
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Daniel Virella
- Neonatology Intensive Care Unit/Research Center, Central Lisbon Hospital, Lisbon, Portugal
| | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kate Himmelmann
- Department of Pediatrics, Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ivana Dakovic
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Guro L Andersen
- The Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Elodie Sellier
- Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, TIMC-IMAG, Grenoble, France.,Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, France
| | - Mary Jane Platt
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Inge Krägeloh-Mann
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital, Eberhard Karls Universität Tübingen, Tübingen, Germany
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17
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Rose K, Grant-Kels JM, Striano P, Neubauer D, Tanjinatus O, Etienne EB. Warp speed for COVID-19 drugs and vaccines - time to re-consider how we use the term 'children'. Clin Infect Dis 2021; 74:168-169. [PMID: 33949656 PMCID: PMC8135891 DOI: 10.1093/cid/ciab399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Klaus Rose
- Klausrose Consulting, Basel, Switzerland
| | - Jane M Grant-Kels
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | | | - Earl B Etienne
- College of Pharmacy, Howard University, Washington, D.C, USA
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18
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Rose K, Grant-Kels JM, Ettienne EB, Tanjinatus O, Striano P, Neubauer D. COVID-19 and Treatment and Immunization of Children-The Time to Redefine Pediatric Age Groups is Here. Rambam Maimonides Med J 2021; 12:RMMJ.10433. [PMID: 33780329 PMCID: PMC8092959 DOI: 10.5041/rmmj.10433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Children are infected with coronavirus disease 2019 (COVID-19) as often as adults, but with fewer symptoms. During the first wave of the COVID-19 pandemic, multisystem inflammatory syndrome (MIS) in children (MIS-C), with symptoms similar to Kawasaki syndrome, was described in young minors testing positive for COVID-19. The United States (US) Centers for Disease Control and Prevention (CDC) defined MIS-C as occurring in <21-year-olds, triggering hundreds of PubMed-listed papers. However, postpubertal adolescents are no longer children biologically; the term MIS-C is misleading. Furthermore, MIS also occurs in adults, termed MIS-A by the CDC. Acute and delayed inflammations can be triggered by COVID-19. The 18th birthday is an administrative not a biological age limit, whereas the body matures slowly during puberty. This blur in defining children leads to confusion regarding MIS-C/MIS-A. United States and European Union (EU) drug approval is handled separately for children, defined as <18-year-olds, ascribing non-existent physical characteristics up to the 18th birthday. This blur between the administrative and the physiological meanings for the term child is causing flawed demands for pediatric studies in all drugs and vaccines, including those against COVID-19. Effective treatment of all conditions, including COVID-19, should be based on actual physiological need. Now, the flawed definition for children in the development of drugs and vaccines and their approval is negatively impacting prevention and treatment of COVID-19 in minors. This review reveals the necessity for redefining pediatric age groups to rapidly establish recommendations for optimal prevention and treatment in minors.
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Riehen, Switzerland
- To whom correspondence should be addressed. E-mail:
| | | | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, ‘G. Gaslini’ Institute, Genova, Italy
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children’s Hospital, Ljubljana, Slovenia
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19
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Rose K, Tanjinatus O, Grant-Kels JM, Ettienne EB, Striano P, Neubauer D. Minors and a Dawning Paradigm Shift in "Pediatric" Drug Development. J Clin Pharmacol 2021; 61:736-739. [PMID: 33368372 DOI: 10.1002/jcph.1806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Riehen, Switzerland
| | | | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Childrens' Hospital, Ljubljana, Slovenia
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20
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Mulder PA, van Balkom IDC, Landlust AM, Priolo M, Menke LA, Acero IH, Alkuraya FS, Arias P, Bernardini L, Bijlsma EK, Cole T, Coubes C, Dapia I, Davies S, Di Donato N, Elcioglu NH, Fahrner JA, Foster A, González NG, Huber I, Iascone M, Kaiser AS, Kamath A, Kooblall K, Lapunzina P, Liebelt J, Lynch SA, Maas SM, Mammì C, Mathijssen IB, McKee S, Mirzaa GM, Montgomery T, Neubauer D, Neumann TE, Pintomalli L, Pisanti MA, Plomp AS, Price S, Salter C, Santos-Simarro F, Sarda P, Schanze D, Segovia M, Shaw-Smith C, Smithson S, Suri M, Tatton-Brown K, Tenorio J, Thakker RV, Valdez RM, Van Haeringen A, Van Hagen JM, Zenker M, Zollino M, Dunn WW, Piening S, Hennekam RC. Development, behaviour and sensory processing in Marshall-Smith syndrome and Malan syndrome: phenotype comparison in two related syndromes. J Intellect Disabil Res 2020; 64:956-969. [PMID: 33034087 PMCID: PMC8957705 DOI: 10.1111/jir.12787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 10/31/2019] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ultrarare Marshall-Smith and Malan syndromes, caused by changes of the gene nuclear factor I X (NFIX), are characterised by intellectual disability (ID) and behavioural problems, although questions remain. Here, development and behaviour are studied and compared in a cross-sectional study, and results are presented with genetic findings. METHODS Behavioural phenotypes are compared of eight individuals with Marshall-Smith syndrome (three male individuals) and seven with Malan syndrome (four male individuals). Long-term follow-up assessment of cognition and adaptive behaviour was possible in three individuals with Marshall-Smith syndrome. RESULTS Marshall-Smith syndrome individuals have more severe ID, less adaptive behaviour, more impaired speech and less reciprocal interaction compared with individuals with Malan syndrome. Sensory processing difficulties occur in both syndromes. Follow-up measurement of cognition and adaptive behaviour in Marshall-Smith syndrome shows different individual learning curves over time. CONCLUSIONS Results show significant between and within syndrome variability. Different NFIX variants underlie distinct clinical phenotypes leading to separate entities. Cognitive, adaptive and sensory impairments are common in both syndromes and increase the risk of challenging behaviour. This study highlights the value of considering behaviour within developmental and environmental context. To improve quality of life, adaptations to environment and treatment are suggested to create a better person-environment fit.
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Affiliation(s)
- P A Mulder
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - I D C van Balkom
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - A M Landlust
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
| | - M Priolo
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - L A Menke
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - I H Acero
- Genetics Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F S Alkuraya
- Saudi Human Genome Project, King Abdulaziz City for Science and Technology, and Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - P Arias
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - L Bernardini
- Cytogenetics Unit, Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - E K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Coubes
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Dapia
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - S Davies
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - N Di Donato
- Institute for Clinical Genetics, TU Dresden, Dresden, Germany
| | - N H Elcioglu
- Department of Pediatric Genetics, Marmara University Medical School, Istanbul and Eastern Mediterranean University, Mersin, Turkey
| | - J A Fahrner
- McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Foster
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - N G González
- Unit Hospital Universitario Central de Asturias, Oviedo, Spain
| | - I Huber
- Sørland Hospital, Kristiansand, Norway
| | - M Iascone
- Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A-S Kaiser
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - A Kamath
- Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - K Kooblall
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - J Liebelt
- South Australian Clinical Genetics Services, Women's and Children's Hospital, North Adelaide, Australia
| | - S A Lynch
- UCD Academic Centre on Rare Diseases, School of Medicine and Medical Sciences, University College Dublin, and Clinical Genetics, Temple Street Children's University Hospital, Dublin, Ireland
| | - S M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - C Mammì
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - I B Mathijssen
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S McKee
- Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - G M Mirzaa
- Center for Integrative Brain Research, Seattle Children's Research Institute, and Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T Montgomery
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Neubauer
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - T E Neumann
- Mitteldeutscher Praxisverbund Humangenetik, Halle, Germany
| | - L Pintomalli
- Unità Operativa di Genetica Medica, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - M A Pisanti
- Medical Genetic and Laboratory Unit, "Antonio Cardarelli" Hospital, Naples, Italy
| | - A S Plomp
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Netherlands
| | - S Price
- Department of Clinical Genetics, Northampton General Hospital NHS Trust, Northampton, UK
| | - C Salter
- Wessex Clinical Genetics Service, Princess Ann Hospital, Southampton, UK
| | - F Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - P Sarda
- Département de Génétique Médicale, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Schanze
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Segovia
- CENAGEM, Centro Nacional de Genética, Buenos Aires, Argentina
| | - C Shaw-Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - S Smithson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - M Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Tatton-Brown
- Division of Genetics and Epidemiology, Institute of Cancer Research, London and South West Thames Regional Genetics Service, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - J Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, and CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
| | - R V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - R M Valdez
- Genetics Unit, Hospital Militar Central "Cirujano Mayor Dr. Cosme Argerich", Buenos Aires, Argentina
| | - A Van Haeringen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - J M Van Hagen
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, Netherlands
| | - M Zenker
- Institute of Human Genetics, University Hospital Magdeburg, Magdeburg, Germany
| | - M Zollino
- Department of Laboratory Medicine, Institute of Medical Genetics, Catholic University, Rome, Italy
| | - W W Dunn
- Department of Occupational Therapy Education, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - S Piening
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - R C Hennekam
- Autism Team Northern-Netherlands, Jonx Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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21
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Gosar D, Tretnjak V, Bregant T, Neubauer D, Derganc M. Reduced white-matter integrity and lower speed of information processing in adolescents with mild and moderate neonatal hypoxic-ischaemic encephalopathy. Eur J Paediatr Neurol 2020; 28:205-213. [PMID: 32665198 DOI: 10.1016/j.ejpn.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/18/2019] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Studies have shown that adolescents with moderate hypoxic-ischaemic encephalopathy (HIE) may have specific cognitive deficits, especially reduced speed of information processing. The aim of our study was to confirm these earlier findings find out whether the degree of impairment in speed of information processing correlates with the degree of white-matter impairment as measured by diffusion tensor imaging (DTI). METHODS Thirty-three participants (mean age 18y 5mo, SD 12mo; 19 male) with mild or moderate HIE and 32 neurotypical adolescents (mean age 17y 10mo, SD 12mo, 18 male) completed a comprehensive neuropsychological battery measuring short-term memory, inhibition, speed of information processing, long-term visual and verbal memory. Fourteen participants also underwent structural MRI and DTI scans. RESULTS After controlling for age, gender and maternal education we found a significant effect of HIE on speed of information processing (F(2, 64) = 3.51, p < .037, η2 = 0.115), but not on other neuropsychological domains. Using tract-based spatial statistics we were also able to confirm a correlation between the degree of impairment in this cognitive domain and fractional anisotropy in several white-matter tracts. CONCLUSIONS The long-term cognitive outcome of moderate HIE includes reduced speed of information processing and is in part mediated by reduced integrity of major white-matter tracts.
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Affiliation(s)
- David Gosar
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia.
| | - Vali Tretnjak
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Tina Bregant
- Centre for Education and Rehabilitation of Physically Handicapped Children and Adolescents - CIRIUS Kamnik, Slovenia
| | - David Neubauer
- University Children's Hospital, University Medical Centre Ljubljana, Department of Child, Adolescent and Developmental Neurology, Ljubljana, Slovenia
| | - Metka Derganc
- University Medical Centre Ljubljana, Department of Paediatric Surgery and Intensive Care, Ljubljana, Slovenia
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22
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Abstract
AbstractSeparate pediatric studies for antiepileptic drugs (AEDs) emerged with general separate drug approval in children and were defined by the U.S. Food and Drug Administration (FDA) as <17 years and by the European Union (EU) as <18 years. These administrative age limits are necessary in pediatrics, but they correspond variably with the physiological maturity of young patients and are not helpful for therapeutic decisions or as study inclusion criteria. AEDs are often effective for partial onset seizures (POS) in 2 to 17-year-olds as well as in ≥18-year-olds, if dosed correctly. Separate pediatric AED studies assume no difference between the legal and the physiological meaning of the word “child.” While the FDA now accepts efficacy of AEDs in POS in children ≥2 years, the EU still requires separate “pediatric” studies. For retigabine it waived all pediatric studies after having required 20 such studies over several years. We feel the current regulation creates a situation where many studies in children are done unnecessarily; we question the ethics of such an approach, which in our view, is morally wrong. Critical publications contributed to the FDA's shift of opinion for AEDs in POS but did not address the blur of different meanings of the word “child.”
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Affiliation(s)
- Klaus Rose
- Klausrose Consulting, Riehen, Switzerland
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Childrens' Hospital, Ljubljana, Slovenia
| | - Jane M. Grant-Kels
- Department of Dermatology, UConn Health, Farmington, Connecticut, United States
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23
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Rose K, Grant-Kels JM, Neubauer D, Fumi L. Comment on: Mumme M, et al. Tissue engineering for paediatric patients. Swiss Med Wkly. 2019.149.w20032. Swiss Med Wkly 2020; 150:w20239. [DOI: 10.4414/smw.2020.20239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Riehen, Switzerland
CEO
- Basel
- SWITZERLAND
- +41 61 312 0510
| | | | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, Ljubljana, Slovenia
| | - Lucio Fumi
- Wyfold Medical Consultancy, The Innovation Centre, Howbery Park, Oxford, UK
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24
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Troha Gergeli A, Neubauer D, Golli T, Butenko T, Loboda T, Maver A, Osredkar D. Prevalence and genetic subtypes of congenital myasthenic syndromes in the pediatric population of Slovenia. Eur J Paediatr Neurol 2020; 26:34-38. [PMID: 32070632 DOI: 10.1016/j.ejpn.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 11/03/2019] [Revised: 01/08/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
AIM Congenital myasthenic syndromes (CMS) are rare, genetically and phenotypically diverse disorders of neuromuscular transmission. Data on prevalence among children are scarce. Whole exome sequencing facilitated discovery of novel CMS mutations and enabled targeted treatment. Our aim was to identify the prevalence, genetic subtypes and clinical characteristics of CMS in pediatric population of Slovenia. METHODS In this observational, national, cross-sectional study, medical records were retrospectively reviewed. Children with genetically confirmed CMS, referred over a 19 - year period (2000-2018) to the University Medical Centre, Ljubljana, Slovenia, were included in the study. Genetic and phenotypic characteristics were collected and prevalence of CMS in children was calculated. RESULTS Eight children with a confirmed genetic mutation in 5 different genes (CHRNE, CHRND, RAPSN, CHAT, MUSK) causative of the CMS were identified. Calculated prevalence of genetically confirmed CMS was 22.2 cases per 1.000.000 children at the end of 2018. INTERPRETATION The prevalence of genetically confirmed CMS in Slovenian children at the end of 2018 exceeds previously reported prevalence by more than two-fold, which suggests that prevalence in the literature is likely to be underestimated. Two extremely rarely detected mutations in MUSK and CHRND gene were detected and patient's clinical descriptions add important information on genotype-phenotype correlation.
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Affiliation(s)
- Anja Troha Gergeli
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Tanja Golli
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Tita Butenko
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Tanja Loboda
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Aleš Maver
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
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25
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Mülmenstädt J, Nam C, Salzmann M, Kretzschmar J, L’Ecuyer TS, Lohmann U, Ma PL, Myhre G, Neubauer D, Stier P, Suzuki K, Wang M, Quaas J. Reducing the aerosol forcing uncertainty using observational constraints on warm rain processes. Sci Adv 2020; 6:eaaz6433. [PMID: 32523991 PMCID: PMC7259935 DOI: 10.1126/sciadv.aaz6433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Global climate models (GCMs) disagree with other lines of evidence on the rapid adjustments of cloud cover and liquid water path to anthropogenic aerosols. Attempts to use observations to constrain the parameterizations of cloud processes in GCMs have failed to reduce the disagreement. We propose using observations sensitive to the relevant cloud processes rather than only to the atmospheric state and focusing on process realism in the absence of aerosol perturbations in addition to the process susceptibility to aerosols. We show that process-sensitive observations of precipitation can reduce the uncertainty on GCM estimates of rapid cloud adjustments to aerosols. The feasibility of an observational constraint depends on understanding the precipitation intensity spectrum in both observations and models and also on improving methods to compare the two.
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Affiliation(s)
- Johannes Mülmenstädt
- Institute of Meteorology, Universität Leipzig, Leipzig, Germany
- Atmospheric Sciences & Global Change Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Christine Nam
- Institute of Meteorology, Universität Leipzig, Leipzig, Germany
| | - Marc Salzmann
- Institute of Meteorology, Universität Leipzig, Leipzig, Germany
| | - Jan Kretzschmar
- Institute of Meteorology, Universität Leipzig, Leipzig, Germany
| | - Tristan S. L’Ecuyer
- Department of Atmospheric and Oceanic Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ulrike Lohmann
- Institute of Atmospheric and Climate Science, ETH Zürich, Zürich, Switzerland
| | - Po-Lun Ma
- Atmospheric Sciences & Global Change Division, Pacific Northwest National Laboratory, Richland, WA, USA
| | - Gunnar Myhre
- CICERO Center for International Climate Research, Oslo, Norway
| | - David Neubauer
- Institute of Atmospheric and Climate Science, ETH Zürich, Zürich, Switzerland
| | - Philip Stier
- Department of Physics, University of Oxford, Oxford, UK
| | - Kentaroh Suzuki
- Atmosphere and Ocean Research Institute, University of Tokyo, Tokyo, Japan
| | - Minghuai Wang
- School of Atmospheric Sciences, Nanjing University, Nanjing, China
| | - Johannes Quaas
- Institute of Meteorology, Universität Leipzig, Leipzig, Germany
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Himmelmann K, Påhlman M, Andersen GL, Vik T, Virella D, Horridge K, Neubauer D, Arnaud C, Rackauskaite G, de la Cruz J. Access to Intrathecal Baclofen Treatment for Children with Cerebral Palsy in European Countries: An SCPE Survey Reveals Important Differences. Neuropediatrics 2020; 51:129-134. [PMID: 32120427 DOI: 10.1055/s-0040-1701659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM The aim is to study access to intrathecal baclofen (ITB) for children with cerebral palsy (CP) in Europe, as an indicator of access to advanced care. METHODS Surveys were sent to CP registers, clinical networks, and pump manufacturers. Enquiries were made about ITB treatment in children born in 1990 to 2005 by sex, CP type, level of gross motor function classification system (GMFCS) and age at the start of treatment. Access to ITB was related to the country's gross domestic product (GDP) and % GDP spent on health. RESULTS In 2011 population-based data from Sweden, Norway, England, Portugal, Slovenia, and Denmark showed that 114 (3.4%) of 3,398 children with CP were treated with ITB, varying from 0.4 to 4.7% between centers. The majority of the children were at GMFCS levels IV-V and had bilateral spastic CP. In Sweden, dyskinetic CP was the most commonly treated subtype. Boys were more often treated with ITB than girls (p = 0.014). ITB was reported to be available for children with CP in 25 of 43 countries. Access to ITB was associated with a higher GDP and %GDP spent on health (p < 0.01). Updated information from 2019 showed remaining differences between countries in ITB treatment and sex difference in treated children was maintained. CONCLUSION There is a significant difference in access to ITB for children with CP across Europe. More boys than girls are treated. Access to ITB for children with CP is associated with GDP and percent of GDP spent on health in the country.
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Affiliation(s)
- Kate Himmelmann
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Påhlman
- Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Guro L Andersen
- The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tönsberg, Norway
| | - Torstein Vik
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel Virella
- The Cerebral Palsy Registry of Portugal, Área da Mulher, Criança e Adolescência, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Karen Horridge
- Paediatric Department, Sunderland Royal Hospital, Sunderland, United Kingdom.,The North of England Collaborative Cerebral Palsy Survey, Regional Maternity Survey Office, Public Health England, Newcastle upon Tyne, United Kingdom
| | - David Neubauer
- Department of Pediatric Neurology, University Children's Hospital, Ljubljana, Slovenia
| | - Catherine Arnaud
- UMR 1027 Inserm U, Toulouse III University, Toulouse, France.,Clinical epidemiology Unit, University Hospital, Toulouse, France
| | - Gija Rackauskaite
- Child and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Javier de la Cruz
- Clinical Research Unit, Imas12-Ciberesp, Hospital 12 Octubre, Madrid, Spain
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Bellouin N, Quaas J, Gryspeerdt E, Kinne S, Stier P, Watson‐Parris D, Boucher O, Carslaw KS, Christensen M, Daniau A, Dufresne J, Feingold G, Fiedler S, Forster P, Gettelman A, Haywood JM, Lohmann U, Malavelle F, Mauritsen T, McCoy DT, Myhre G, Mülmenstädt J, Neubauer D, Possner A, Rugenstein M, Sato Y, Schulz M, Schwartz SE, Sourdeval O, Storelvmo T, Toll V, Winker D, Stevens B. Bounding Global Aerosol Radiative Forcing of Climate Change. Rev Geophys 2020; 58:e2019RG000660. [PMID: 32734279 PMCID: PMC7384191 DOI: 10.1029/2019rg000660] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 05/04/2023]
Abstract
Aerosols interact with radiation and clouds. Substantial progress made over the past 40 years in observing, understanding, and modeling these processes helped quantify the imbalance in the Earth's radiation budget caused by anthropogenic aerosols, called aerosol radiative forcing, but uncertainties remain large. This review provides a new range of aerosol radiative forcing over the industrial era based on multiple, traceable, and arguable lines of evidence, including modeling approaches, theoretical considerations, and observations. Improved understanding of aerosol absorption and the causes of trends in surface radiative fluxes constrain the forcing from aerosol-radiation interactions. A robust theoretical foundation and convincing evidence constrain the forcing caused by aerosol-driven increases in liquid cloud droplet number concentration. However, the influence of anthropogenic aerosols on cloud liquid water content and cloud fraction is less clear, and the influence on mixed-phase and ice clouds remains poorly constrained. Observed changes in surface temperature and radiative fluxes provide additional constraints. These multiple lines of evidence lead to a 68% confidence interval for the total aerosol effective radiative forcing of -1.6 to -0.6 W m-2, or -2.0 to -0.4 W m-2 with a 90% likelihood. Those intervals are of similar width to the last Intergovernmental Panel on Climate Change assessment but shifted toward more negative values. The uncertainty will narrow in the future by continuing to critically combine multiple lines of evidence, especially those addressing industrial-era changes in aerosol sources and aerosol effects on liquid cloud amount and on ice clouds.
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Affiliation(s)
- N. Bellouin
- Department of MeteorologyUniversity of ReadingReadingUK
| | - J. Quaas
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - E. Gryspeerdt
- Space and Atmospheric Physics GroupImperial College LondonLondonUK
| | - S. Kinne
- Max Planck Institute for MeteorologyHamburgGermany
| | - P. Stier
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - D. Watson‐Parris
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - O. Boucher
- Institut Pierre‐Simon Laplace, Sorbonne Université/CNRSParisFrance
| | - K. S. Carslaw
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - M. Christensen
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - A.‐L. Daniau
- EPOC, UMR 5805, CNRS‐Université de BordeauxPessacFrance
| | - J.‐L. Dufresne
- Laboratoire de Météorologie Dynamique/IPSL, CNRS, Sorbonne Université, Ecole Normale Supérieure, PSL Research University, Ecole PolytechniqueParisFrance
| | - G. Feingold
- NOAA ESRL Chemical Sciences DivisionBoulderCOUSA
| | - S. Fiedler
- Max Planck Institute for MeteorologyHamburgGermany
- Now at Institut für Geophysik und MeteorologieUniversität zu KölnKölnGermany
| | - P. Forster
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - A. Gettelman
- National Center for Atmospheric ResearchBoulderCOUSA
| | - J. M. Haywood
- CEMPSUniversity of ExeterExeterUK
- UK Met Office Hadley CentreExeterUK
| | - U. Lohmann
- Institute for Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | | | - T. Mauritsen
- Department of MeteorologyStockholm UniversityStockholmSweden
| | - D. T. McCoy
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - G. Myhre
- Center for International Climate and Environmental Research‐Oslo (CICERO)OsloNorway
| | - J. Mülmenstädt
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - D. Neubauer
- Institute for Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - A. Possner
- Department of Global EcologyCarnegie Institution for ScienceStanfordCAUSA
- Now at Institute for Atmospheric and Environmental SciencesGoethe UniversityFrankfurtGermany
| | | | - Y. Sato
- Department of Applied Energy, Graduate School of Engineering, Nagoya UniversityNagoyaJapan
- Now at Faculty of Science, Department of Earth and Planetary SciencesHokkaido UniversitySapporoJapan
| | - M. Schulz
- Climate Modelling and Air Pollution Section, Research and Development DepartmentNorwegian Meteorological InstituteOsloNorway
| | - S. E. Schwartz
- Brookhaven National Laboratory Environmental and Climate Sciences DepartmentUptonNYUSA
| | - O. Sourdeval
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
- Laboratoire d'Optique AtmosphériqueUniversité de LilleVilleneuve d'AscqFrance
| | - T. Storelvmo
- Department of GeosciencesUniversity of OsloOsloNorway
| | - V. Toll
- Department of MeteorologyUniversity of ReadingReadingUK
- Now at Institute of PhysicsUniversity of TartuTartuEstonia
| | - D. Winker
- NASA Langley Research CenterHamptonVAUSA
| | - B. Stevens
- Max Planck Institute for MeteorologyHamburgGermany
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Calamandrei G, Ricceri L, Meccia E, Tartaglione AM, Horvat M, Tratnik JS, Mazej D, Špirić Z, Prpić I, Vlašić-Cicvarić I, Neubauer D, Kodrič J, Stropnik S, Janasik B, Kuraś R, Mirabella F, Polańska K, Chiarotti F. Pregnancy exposome and child psychomotor development in three European birth cohorts. Environ Res 2020; 181:108856. [PMID: 31706595 DOI: 10.1016/j.envres.2019.108856] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
Characterization of the exposome, the totality of all environmental factors that one is exposed to from conception onwards, has been recommended to better evaluate the role of environmental influences on developmental programming and life-course vulnerability to major chronic diseases. In the framework of the Health and Environment-wide Associations based on Large population Surveys (HEALS) project we considered the pregnancy exposome exploiting two databases (PHIME and REPRO_PL) that include birth cohorts from three EU countries (Croatia, Slovenia and Poland). The databases contained information on several chemical exposures, socio-demographic, lifestyle and health related factors from conception to child birth, and neuropsychological scores assessed by the Bayley Scales of Infant and Toddler Development in the first two years of life. Our main goal was to assess consistency of environmental influences on neurodevelopment, if any, across European countries differing for geographical, socio-demographic characteristics and levels of chemical exposures to metals such as lead (Pb), mercury (Hg), cadmium (Cd) and trace elements, including micronutrients such as zinc (Zn) and selenium (Se). To this aim, we first selected variables common to the different databases, then applied univariate and multivariate regression analyses to identify factors linked to neurodevelopment, and finally performed meta-analysis to detect potential heterogeneity among cohorts and pooled estimates. Significant differences in exposure levels among the three sub-cohorts were observed as for Hg and Se; exposure levels under study were relatively low and within the range described in existing EU biomonitoring studies. The univariate analyses did not show any common pattern of association as only in the Polish cohort chemical exposure had an impact on neuropsychological outcome. In the meta-analysis, some consistent trends were evident, relative to the adverse influence of Pb on children's language and cognition and the positive influence of Se on language abilities. The effects of the neurotoxic metal Hg positively influenced the motor scores in the Polish cohorts, while it decreased the motor scores in the Slovenia and Croatian sub-cohorts. The only socio-demographic factor consistently associated to the outcome among cohorts was child's sex, with females performing better than males on cognitive and language scores. These findings point to the need of harmonizing existing cohorts or creating prospective study designs that facilitate comparisons in the exposome over time, places and kind of environmental exposures.
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Affiliation(s)
- Gemma Calamandrei
- Centre for Behavioral Sciences and Mental Health, National Institute of Health (ISS), Rome, Italy.
| | - Laura Ricceri
- Centre for Behavioral Sciences and Mental Health, National Institute of Health (ISS), Rome, Italy
| | - Ettore Meccia
- Department of Environment and Primary Prevention, National Institute of Health (ISS), Rome, Italy
| | - Anna Maria Tartaglione
- Centre for Behavioral Sciences and Mental Health, National Institute of Health (ISS), Rome, Italy
| | - Milena Horvat
- Department of Environmental Sciences, Jožef Stefan Institute (JSI), Ljubljana, Slovenia
| | - Janja Snoj Tratnik
- Department of Environmental Sciences, Jožef Stefan Institute (JSI), Ljubljana, Slovenia
| | - Darja Mazej
- Department of Environmental Sciences, Jožef Stefan Institute (JSI), Ljubljana, Slovenia
| | | | - Igor Prpić
- University Hospital Centre Rijeka, Centre for Clinical, Health and Organizational Psychology, Rijeka, Croatia
| | - Inge Vlašić-Cicvarić
- University Hospital Centre Rijeka, Centre for Clinical, Health and Organizational Psychology, Rijeka, Croatia
| | - David Neubauer
- Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Slovenia
| | - Jana Kodrič
- Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Slovenia
| | - Staša Stropnik
- Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, University Medical Centre Ljubljana, Slovenia
| | - Beata Janasik
- Department of Biological and Environmental Monitoring, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Renata Kuraś
- Department of Biological and Environmental Monitoring, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Fiorino Mirabella
- Centre for Behavioral Sciences and Mental Health, National Institute of Health (ISS), Rome, Italy
| | - Kinga Polańska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland
| | - Flavia Chiarotti
- Centre for Behavioral Sciences and Mental Health, National Institute of Health (ISS), Rome, Italy
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29
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Gryspeerdt E, Mülmenstädt J, Gettelman A, Malavelle FF, Morrison H, Neubauer D, Partridge DG, Stier P, Takemura T, Wang H, Wang M, Zhang K. Surprising similarities in model and observational aerosol radiative forcing estimates. Atmos Chem Phys 2020; 20:613-623. [PMID: 33204244 PMCID: PMC7668122 DOI: 10.5194/acp-20-613-2020] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The radiative forcing from aerosols (particularly through their interaction with clouds) remains one of the most uncertain components of the human forcing of the climate. Observation-based studies have typically found a smaller aerosol effective radiative forcing than in model simulations and were given preferential weighting in the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report (AR5). With their own sources of uncertainty, it is not clear that observation-based estimates are more reliable. Understanding the source of the model and observational differences is thus vital to reduce uncertainty in the impact of aerosols on the climate. These reported discrepancies arise from the different methods of separating the components of aerosol forcing used in model and observational studies. Applying the observational decomposition to global climate model (GCM) output, the two different lines of evidence are surprisingly similar, with a much better agreement on the magnitude of aerosol impacts on cloud properties. Cloud adjustments remain a significant source of uncertainty, particularly for ice clouds. However, they are consistent with the uncertainty from observation-based methods, with the liquid water path adjustment usually enhancing the Twomey effect by less than 50%. Depending on different sets of assumptions, this work suggests that model and observation-based estimates could be more equally weighted in future synthesis studies.
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Affiliation(s)
- Edward Gryspeerdt
- Space and Atmospheric Physics Group, Imperial College London, London, UK
| | | | | | - Florent F. Malavelle
- College of Engineering Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- Met Office, Fitzroy Road, Exeter, UK
| | - Hugh Morrison
- National Center for Atmospheric Research, Boulder, USA
| | - David Neubauer
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Daniel G. Partridge
- College of Engineering Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Philip Stier
- Atmospheric, Oceanic and Planetary Physics, Department of Physics, University of Oxford, Oxford, UK
| | - Toshihiko Takemura
- Research Institute for Applied Mathematics, Kyushu University, Fukuoka, Japan
| | - Hailong Wang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, USA
| | - Minghuai Wang
- Institute for Climate and Global Change Research, Nanjing University, Nanjing, China
- School of Atmospheric Sciences, Nanjing University, Nanjing, China
- Collaborative Innovation Center of Climate Change, Nanjing, China
| | - Kai Zhang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, USA
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Abstract
United States (US) and European Union (EU) laws attempt to counterbalance the presumed discrimination of children in drug treatment and drug development. The US Food and Drug Administration (FDA)-rewarded pediatric studies with antidepressants triggered in 2004 an FDA black-box warning of suicidality in young patients. Fewer antidepressants were prescribed, and the number of completed suicides of young persons increased. The dilemma between this warning and the need to adequately treat young depressed patients remains unsolved. We analyzed the history of drug development, the evolving view of diseases in young patients, US/EU pediatric laws, and pediatric studies triggered by FDA/European Medicines Agency (EMA) in depression and other diseases on the background of developmental pharmacology; financial, institutional, and other interests; and the literature. The FDA/EMA define children administratively, not physiologically, as <17 (FDA)/<18 years old (EMA). But young persons mature physiologically well before their 17th/18th birthday. Depression occurs in young persons, has special characteristics, but is not fundamentally different from adult depression. Young persons are not another species. Regulatory requirements for "pediatric" studies focus on "pediatric" labels. Many "pediatric" studies, including those in depression, lacked and lack medical sense and harm patients by placebo treatment although effective drugs exist. The FDA has partially abandoned separate "pediatric" efficacy studies, but not in psychiatry. Clinicians, parents, institutional review boards, and ethics committees should become aware of questionable "pediatric" studies, should re-evaluate ongoing ones, consider to suspend them, and to reject new ones. The concept of separate "pediatric" drug approval needs to be abandoned.
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Riehen, Switzerland
- To whom correspondence should be addressed: E-mail:
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, Ljubljana, Slovenia
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Trdin A, Snoj Tratnik J, Mazej D, Fajon V, Krsnik M, Osredkar J, Prpić I, Špirić Z, Petrović O, Marc J, Neubauer D, Kodrič J, Kobal AB, Barbone F, Falnoga I, Horvat M. Mercury speciation in prenatal exposure in Slovenian and Croatian population - PHIME study. Environ Res 2019; 177:108627. [PMID: 31421448 DOI: 10.1016/j.envres.2019.108627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
In recent years, several studies have addressed the issue of prenatal exposure to methylmercury (MeHg); however, few have actually analysed MeHg blood concentrations. Our study population included mothers and their new-borns from Slovenia (central region; N = 584) and Croatia (coastal region; N = 234). We have measurements of total Hg (THg) and MeHg in maternal hair, maternal peripheral blood, and cord blood. Cord blood Hg concentrations were low to moderate (median THg = 1.84 ng/g and MeHg = 1.69 ng/g). The proportion of THg as MeHg (%MeHg) in maternal and cord blood varied between 4% and 100% (coefficient of variation, CV = 32%) and between 8% and 100% (CV = 20%), respectively. Our data shows that variability of %MeHg was higher at lower blood THg levels. Concentrations of MeHg in maternal blood and cord blood were highly correlated (Rs = 0.943), in the case of inorganic Hg correlation was significant but weaker (Rs = 0.198). MeHg levels in maternal blood and cord blood were positively associated with seafood intake, maternal age, and negatively associated with pre-pregnancy BMI. Additionally, MeHg in maternal blood was positively associated with plasma selenium levels, and cord blood MeHg was negatively associated with parity. The results of multiple linear regression models showed that speciation analysis provides more defined estimation of prenatal exposure in association modelling. Associations between Hg exposure and cognitive performance of children (assessed using Bayley Scales of Infant and Toddler development) adjusted for maternal or child Apolipoprotein E genotypes showed higher model R2 and lower p-values when adjusted for MeHg compared to THg. This study demonstrates that Hg speciation improves the association between exposure and possible negative health effects.
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Affiliation(s)
- Ajda Trdin
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Janja Snoj Tratnik
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Darja Mazej
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Vesna Fajon
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia
| | - Mladen Krsnik
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Joško Osredkar
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Igor Prpić
- Department of Paediatrics, University Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Oleg Petrović
- Department of Obstetrics and Gynaecology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Janja Marc
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - David Neubauer
- Department of Child, Adolescent, and Developmental Neurology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jana Kodrič
- Department of Child, Adolescent, and Developmental Neurology, Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfred B Kobal
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Fabio Barbone
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ingrid Falnoga
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Milena Horvat
- Department of Environmental Sciences, Jožef Stefan Institute, Ljubljana, Slovenia; Jožef Stefan International Postgraduate School, Ljubljana, Slovenia.
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Abstract
BACKGROUND United States (US) and European Union (EU) legislation attempts to counterbalance the presumed discrimination in pediatric drug treatment and development. METHODS We analyzed the history of drug development, US/EU pediatric laws, and pediatric studies required by US/EU regulatory authorities and reviewed relevant literature. RESULTS The US and EU definitions of a child are defined administratively (rather than physiologically) as being aged <17 years and <18 years, respectively. However, children mature physiologically well before their seventeenth or eighteenth birthdays. The semantic blur for these differing definitions may indicate certain conflicts of interest. CONCLUSIONS Pediatric healthcare today is better than ever. Regulatory-related requirements for "pediatric" studies focus on labeling. Most of these studies lack medical usefulness and may even harm "pediatric" patients through administration of placebo and/or substandard treatment, despite the resultant publications, networking, patent extensions, and strengthened regulatory standing. Clinicians, parents, and ethics committees should be aware of these issues. New rules are needed to determine new pharmaceutical dose estimates in prepubescent patients, and when/how to clinically confirm them. Internet-based structures to divulge this information should be established between drug developers, clinicians, and regulatory authorities. A prerequisite for the rational use of pharmaceuticals in children would be to correct the flawed concept that children are discriminated against in drug treatment and development, and to abandon separate "pediatric" drug approval processes.
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Affiliation(s)
- Klaus Rose
- klausrose Consulting, Pediatric Drug Development & More, Riehen, Switzerland
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, Ljubljana, Slovenia
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Fanourgakis GS, Kanakidou M, Nenes A, Bauer SE, Bergman T, Carslaw KS, Grini A, Hamilton DS, Johnson JS, Karydis VA, Kirkevåg A, Kodros JK, Lohmann U, Luo G, Makkonen R, Matsui H, Neubauer D, Pierce JR, Schmale J, Stier P, Tsigaridis K, van Noije T, Wang H, Watson-Parris D, Westervelt DM, Yang Y, Yoshioka M, Daskalakis N, Decesari S, Gysel-Beer M, Kalivitis N, Liu X, Mahowald NM, Myriokefalitakis S, Schrödner R, Sfakianaki M, Tsimpidi AP, Wu M, Yu F. Evaluation of global simulations of aerosol particle and cloud condensation nuclei number, with implications for cloud droplet formation. Atmos Chem Phys 2019; 19:8591-8617. [PMID: 33273898 PMCID: PMC7709872 DOI: 10.5194/acp-19-8591-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A total of 16 global chemistry transport models and general circulation models have participated in this study; 14 models have been evaluated with regard to their ability to reproduce the near-surface observed number concentration of aerosol particles and cloud condensation nuclei (CCN), as well as derived cloud droplet number concentration (CDNC). Model results for the period 2011-2015 are compared with aerosol measurements (aerosol particle number, CCN and aerosol particle composition in the submicron fraction) from nine surface stations located in Europe and Japan. The evaluation focuses on the ability of models to simulate the average across time state in diverse environments and on the seasonal and short-term variability in the aerosol properties. There is no single model that systematically performs best across all environments represented by the observations. Models tend to underestimate the observed aerosol particle and CCN number concentrations, with average normalized mean bias (NMB) of all models and for all stations, where data are available, of -24% and -35% for particles with dry diameters > 50 and > 120nm, as well as -36% and -34% for CCN at supersaturations of 0.2% and 1.0%, respectively. However, they seem to behave differently for particles activating at very low supersaturations (< 0.1 %) than at higher ones. A total of 15 models have been used to produce ensemble annual median distributions of relevant parameters. The model diversity (defined as the ratio of standard deviation to mean) is up to about 3 for simulated N3 (number concentration of particles with dry diameters larger than 3 nm) and up to about 1 for simulated CCN in the extra-polar regions. A global mean reduction of a factor of about 2 is found in the model diversity for CCN at a supersaturation of 0.2% (CCN0.2) compared to that for N3, maximizing over regions where new particle formation is important. An additional model has been used to investigate potential causes of model diversity in CCN and bias compared to the observations by performing a perturbed parameter ensemble (PPE) accounting for uncertainties in 26 aerosol-related model input parameters. This PPE suggests that biogenic secondary organic aerosol formation and the hygroscopic properties of the organic material are likely to be the major sources of CCN uncertainty in summer, with dry deposition and cloud processing being dominant in winter. Models capture the relative amplitude of the seasonal variability of the aerosol particle number concentration for all studied particle sizes with available observations (dry diameters larger than 50, 80 and 120 nm). The short-term persistence time (on the order of a few days) of CCN concentrations, which is a measure of aerosol dynamic behavior in the models, is underestimated on average by the models by 40% during winter and 20% in summer. In contrast to the large spread in simulated aerosol particle and CCN number concentrations, the CDNC derived from simulated CCN spectra is less diverse and in better agreement with CDNC estimates consistently derived from the observations (average NMB -13% and -22% for updraft velocities 0.3 and 0.6 ms-1, respectively). In addition, simulated CDNC is in slightly better agreement with observationally derived values at lower than at higher updraft velocities (index of agreement 0.64 vs. 0.65). The reduced spread of CDNC compared to that of CCN is attributed to the sublinear response of CDNC to aerosol particle number variations and the negative correlation between the sensitivities of CDNC to aerosol particle number concentration (∂N d/∂N a) and to updraft velocity (∂N d/∂w). Overall, we find that while CCN is controlled by both aerosol particle number and composition, CDNC is sensitive to CCN at low and moderate CCN concentrations and to the updraft velocity when CCN levels are high. Discrepancies are found in sensitivities ∂N d/∂N a and ∂N d/∂w; models may be predisposed to be too "aerosol sensitive" or "aerosol insensitive" in aerosol-cloud-climate interaction studies, even if they may capture average droplet numbers well. This is a subtle but profound finding that only the sensitivities can clearly reveal and may explain inter-model biases on the aerosol indirect effect.
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Affiliation(s)
- George S. Fanourgakis
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, 70013, Greece
| | - Maria Kanakidou
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, 70013, Greece
| | - Athanasios Nenes
- Laboratory of Atmospheric Processes and their Impacts, School of Architecture, Civil & Environmental Engineering, École Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland
- Institute of Chemical Engineering Sciences, Foundation for Research and Technology (FORTH/ICE-HT), Hellas, 26504, Patras, Greece
| | - Susanne E. Bauer
- NASA Goddard Institute for Space Studies, New York, NY, USA
- Center for Climate Systems Research, Columbia University, New York, NY, USA
| | - Tommi Bergman
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, the Netherlands
| | - Ken S. Carslaw
- School of Earth and Environment, University of Leeds, UK
| | | | - Douglas S. Hamilton
- Department of Earth and Atmospheric Sciences, Atkinson Center for a Sustainable Future, Cornell University, Ithaca, NY, USA
| | | | - Vlassis A. Karydis
- Department of Atmospheric Chemistry, Max Planck Institute for Chemistry, Mainz, Germany
- Forschungszentrum Jülich, Inst Energy & Climate Res IEK-8, 52425 Jülich, Germany
| | - Alf Kirkevåg
- Norwegian Meteorological Institute, Oslo, Norway
| | - John K. Kodros
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado, USA
| | - Ulrike Lohmann
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Gan Luo
- Climate Atmospheric Sciences Research Center , of the State University of New York at Albany, Albany, 12203, New York, USA
| | - Risto Makkonen
- Climate System Research, Finnish Meteorological Institute, P.O. Box 503, 00101 Helsinki, Finland
- Institute for Atmospheric and Earth System Research/Physics, University of Helsinki, P.O. Box 64, 00014 Helsinki, Finland
| | - Hitoshi Matsui
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - David Neubauer
- Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Jeffrey R. Pierce
- Department of Atmospheric Science, Colorado State University, Fort Collins, Colorado, USA
| | - Julia Schmale
- Laboratory of Atmospheric Chemistry, Paul Scherrer Institute, Villigen, Switzerland
| | - Philip Stier
- Atmospheric, Oceanic & Planetary Physics, Department of Physics, University of Oxford, Oxford OX1 2JD, UK
| | - Kostas Tsigaridis
- NASA Goddard Institute for Space Studies, New York, NY, USA
- Center for Climate Systems Research, Columbia University, New York, NY, USA
| | - Twan van Noije
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, the Netherlands
| | - Hailong Wang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - Duncan Watson-Parris
- Atmospheric, Oceanic & Planetary Physics, Department of Physics, University of Oxford, Oxford OX1 2JD, UK
| | - Daniel M. Westervelt
- NASA Goddard Institute for Space Studies, New York, NY, USA
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY 10964, USA
| | - Yang Yang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, Washington, USA
| | | | - Nikos Daskalakis
- Laboratory for Modeling and Observation of the Earth System (LAMOS) Institute of Environmental Physics (IUP), University of Bremen, Bremen, Germany
| | - Stefano Decesari
- Institute of Atmospheric Sciences and Climate, National Research Council of Italy, Via Piero Gobetti, 101, 40129 Bologna, Italy
| | - Martin Gysel-Beer
- Laboratory of Atmospheric Chemistry, Paul Scherrer Institute, Villigen, Switzerland
| | - Nikos Kalivitis
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, 70013, Greece
| | - Xiaohong Liu
- Department of Atmospheric Science, University of Wyoming, Laramie, Wyoming, USA
| | - Natalie M. Mahowald
- Department of Earth and Atmospheric Sciences, Atkinson Center for a Sustainable Future, Cornell University, Ithaca, NY, USA
| | - Stelios Myriokefalitakis
- Institute for Environmental Research and Sustainable Development (IERSD), National Observatory of Athens, Penteli, Greece
| | - Roland Schrödner
- Centre for Environmental and Climate Research, Lund University, Lund, Sweden
| | - Maria Sfakianaki
- Environmental Chemical Processes Laboratory, Department of Chemistry, University of Crete, Heraklion, 70013, Greece
| | - Alexandra P. Tsimpidi
- Department of Atmospheric Chemistry, Max Planck Institute for Chemistry, Mainz, Germany
| | - Mingxuan Wu
- Department of Atmospheric Science, University of Wyoming, Laramie, Wyoming, USA
| | - Fangqun Yu
- Climate Atmospheric Sciences Research Center , of the State University of New York at Albany, Albany, 12203, New York, USA
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Rose K, Neubauer D, Grant-Kels JM. Questionable Industry-Sponsored Postneonatal Pediatric Studies in Slovenia. Curr Ther Res Clin Exp 2019; 90:86-91. [PMID: 31388360 PMCID: PMC6677645 DOI: 10.1016/j.curtheres.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND US and EU pediatric laws promote industry-sponsored pediatric studies, based on the therapeutic orphans concept that claims discrimination of children in drug treatment and drug development. OBJECTIVE We investigated the medical validity of international pediatric studies with centers in Slovenia, an EU member state, and challenge their medical utility. METHODS We analyzed international industry-sponsored pediatric studies with centers in Slovenia, listed in www.ClinicalTrials.gov, for their medical value. RESULTS Most pediatric studies triggered by the US Food and Drug Administration and by the European Medicines Agency were/are without medical or scientific value. They were/are formally and regulatorily justified, but lack medical sense and thus were/are unethical. Several even harm children and/or adolescents with serious diseases by exposing them to placebo or substandard treatment. CONCLUSIONS Pediatric studies triggered by US and EU regulatory demands are a serious abuse of nonneonatal children and adolescents in Slovenia and worldwide. They are medically redundant at best and often deter patients from effective innovative personalized therapy. They also exclude young patients from reasonable studies. Institutional review boards/ethics committees should be alerted, should critically review all ongoing pediatric studies, should suspend those found to be questionable, and should reject newly submitted questionable ones.
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Affiliation(s)
- Klaus Rose
- Pediatric Drug Development & More, klausrose Consulting, Riehen, Switzerland
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Childrens' Hospital, Ljubljana, Slovenia
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Kemmler R, Hübner R, Löhle A, Neubauer D, Voloshenko I, Schoop LM, Dressel M, Pronin AV. Free-carrier dynamics in Au 2Pb probed by optical conductivity measurements. J Phys Condens Matter 2018; 30:485403. [PMID: 30418951 DOI: 10.1088/1361-648x/aae7b1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We measured the optical reflectivity of the Dirac material Au2Pb in a broad frequency range (30-48 000 cm-1) for temperatures between 9 and 300 K. The optical conductivity, computed from the reflectivity, is dominated by free-carrier contributions from topologically trivial bulk bands at all temperatures. The temperature-independent total plasma frequency of these carriers is [Formula: see text] eV. Overall, optical response of Au2Pb is typically metallic with no signs of localization and bad-metal behavior.
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Affiliation(s)
- R Kemmler
- 1. Physikalisches Institut, Universität Stuttgart, 70569 Stuttgart, Germany
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Labordena M, Neubauer D, Folini D, Patt A, Lilliestam J. Blue skies over China: The effect of pollution-control on solar power generation and revenues. PLoS One 2018; 13:e0207028. [PMID: 30462670 PMCID: PMC6248963 DOI: 10.1371/journal.pone.0207028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022] Open
Abstract
Air pollution is the single most important environmental health risk, causing about 7 million premature deaths annually worldwide. China is the world's largest emitter of anthropogenic air pollutants, which causes major negative health consequences. The Chinese government has implemented several policies to reduce air pollution, with success in some but far from all sectors. In addition to the health benefits, reducing air pollution will have side-benefits, such as an increase in the electricity generated by the solar photovoltaic panels via an increase in surface solar irradiance through a reduction of haze and aerosol-impacted clouds. We use the global aerosol-climate model ECHAM6-HAM2 with the bottom-up emissions inventory from the Community Emission Data System and quantify the geographically specific increases in generation and economic revenue to the Chinese solar photovoltaic fleet as a result of reducing or eliminating air pollution from the energy, industrial, transport, and residential and commercial sectors. We find that by 2040, the gains will be substantial: the projected solar photovoltaic fleet would produce between 85-158 TWh/year of additional power in clean compared to polluted air, generating US$6.9-10.1 billion of additional annual revenues in the solar photovoltaic sector alone. Furthermore, we quantify the cost of adopting best-practice emission standards in all sectors and find that the revenue gains from the increased solar photovoltaic generation could offset up to about 13-17% of the costs of strong air pollution control measures designed to reach near-zero emissions in all sectors. Hence, reducing air pollution in China will not only have clear health benefits, but the side-effect of increased solar power generation would also offset a sizeable share of the costs of air pollution control measures.
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Affiliation(s)
- Mercè Labordena
- Climate Policy Research Group, Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland
| | - David Neubauer
- Atmospheric Physics Research Group, Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Doris Folini
- Climate and Water Cycle Group, Institute for Atmospheric and Climate Science, ETH Zurich, Zurich, Switzerland
| | - Anthony Patt
- Climate Policy Research Group, Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland
| | - Johan Lilliestam
- Renewable Energy Policy Group, Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland
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Hadjipanayis A, Crawley FP, Stiris T, Neubauer D, Michaud PA. Child trafficking in Europe: what is the paediatrician's role? : A statement by the European Academy of Paediatrics. Eur J Pediatr 2018; 177:1419-1423. [PMID: 29946856 DOI: 10.1007/s00431-018-3190-2] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Child trafficking is among the most lucrative criminal activities in the world and growing rapidly. Poverty, natural disasters, armed conflicts and, in particular, migration put vulnerable children at high risk of trafficking. Accurate statistics on child trafficking are not available due to its illegal nature. Moreover, trafficking may not be consistently recorded and reported by European countries, mainly because of different perceptions as to who is considered a victim of trafficking. Around 4000-5000 children were identified as presumed victims of trafficking in European Union countries from 2013 to 2014; this is an underestimate of the problem because many victims go unrecognised. Trafficking is linked with issues, such as forced marriage, begging, labour or domestic servitude, slavery and prostitution as well as sexual abuse and child pornography. It may also involve the use of children as soldiers or for criminal activities, such as theft and drug smuggling. Child trafficking also involves the removal of organs and the selling neonates, infants, and children for adoption. Child victims of trafficking should be promptly identified in order to provide them with the necessary care as well as to prosecute the traffickers and stop their illegal activity. Healthcare professionals should be appropriately trained to keep a careful eye out for any signs of trafficking in children. CONCLUSION The European Academy of Paediatrics calls on our governments, intergovernmental organisations, paediatricians, and healthcare professionals to collaborate so as to improve the identification and healthcare of victims and to contribute to the disbanding and prosecution of child traffickers by reporting such situations. What is Known: • Child trafficking is a fast growing and among the most lucrative criminal activities in the world. • Poverty, natural disasters, armed conflicts and in particular migration put vulnerable children at high risk of trafficking. What is New: • Child trafficking is an underestimated and often ignored issue, with around 4000-500children identified as presumed victims in European Union countries from 2013 to 2014. • The European Academy of Paediatrics strongly encourages Paediatricians to identify victims as well as provide them with adequate health care and support; it calls on governments, intergovernmental organisations, and fellow compatriots to act within the full extent of the law to identify, disband, and prosecute child traffickers.
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Affiliation(s)
- Adamos Hadjipanayis
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus. .,Medical School, European University of Cyprus, Nicosia, Cyprus. .,European Academy of Paediatrics, Brussels, Belgium.
| | - Francis P Crawley
- European Academy of Paediatrics, Brussels, Belgium.,Good Clinical Practice Alliance - Europe (GCPA), Brussels, Belgium
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium.,Department of Neonatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - David Neubauer
- European Academy of Paediatrics, Brussels, Belgium.,Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
| | - Pierre-André Michaud
- European Academy of Paediatrics, Brussels, Belgium.,Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland
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Sa M, Hacohen Y, Alderson L, Chong WKK, Anderson G, Jacques TS, Neubauer D, Szczepanik E, Lim M, Kaliakatsos M. Immunotherapy-responsive childhood neurodegeneration with systemic and central nervous system inflammation. Eur J Paediatr Neurol 2018; 22:882-888. [PMID: 29759327 DOI: 10.1016/j.ejpn.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 08/09/2017] [Revised: 04/03/2018] [Accepted: 04/22/2018] [Indexed: 11/25/2022]
Abstract
Subacute neuroregression in association with raised neopterin and overexpression of interferon stimulated genes (ISGs) could indicate a type 1 interferonopathy. Here we describe a novel immunotherapy-responsive, clinico-immunological and imaging phenotype with evidence of innate immune activation. Three children (patient 1: 22-month-old boy; patient 2: 5-year-old girl; patient 3: 4-year-old girl) presented with asymmetric bilateral mixed dystonia and spasticity, regression in language (expressive more than receptive) and bulbar symptoms with no evidence of seizures. Symptoms evolved over several weeks to months. Brain MRI changes mimicked cerebral atrophy, initially asymmetric. CSF revealed raised neopterins. Blood RNA assay showed abnormal overexpression of ISGs and transient raised alanine aminotransferase (ALT). Importantly, all three children were treated with intravenous methylprednisolone and immunoglobulin with significant and sustained improvement in their motor and language function, and normalisation of imaging. Immune-mediated encephalitis can masquerade as subacute neuroregression.
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Affiliation(s)
- Mario Sa
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Yael Hacohen
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Lucy Alderson
- Physiotherapy Department, Great Ormond Street Hospital or Children, London, United Kingdom
| | - W K Kling Chong
- Paediatric Neuroradiology, Great Ormond Street Hospital or Children, London, United Kingdom
| | - Glenn Anderson
- Department of Histopathology, Great Ormond Street for Children NHS Trust, London, United Kingdom
| | - Thomas S Jacques
- Department of Histopathology, Great Ormond Street for Children NHS Trust, London, United Kingdom; Developmental Biology and Cancer Program, UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - David Neubauer
- Department of Child, Adolescent & Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia
| | - Elzbieta Szczepanik
- Clinic of Neurology of Children and Adolescents, Institute of Mother and Child, Warsaw, Poland
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital @ Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Marios Kaliakatsos
- Paediatric Neurology, Great Ormond Street Hospital for Children, London, United Kingdom.
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Barbone F, Rosolen V, Mariuz M, Parpinel M, Casetta A, Sammartano F, Ronfani L, Vecchi Brumatti L, Bin M, Castriotta L, Valent F, Little DL, Mazej D, Snoj Tratnik J, Miklavčič Višnjevec A, Sofianou K, Špirić Z, Krsnik M, Osredkar J, Neubauer D, Kodrič J, Stropnik S, Prpić I, Petrović O, Vlašić-Cicvarić I, Horvat M. Prenatal mercury exposure and child neurodevelopment outcomes at 18 months: Results from the Mediterranean PHIME cohort. Int J Hyg Environ Health 2018; 222:9-21. [PMID: 30057028 DOI: 10.1016/j.ijheh.2018.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 02/16/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Neurotoxicity due to acute prenatal exposure to high-dose of mercury (Hg) is well documented. However, the effect of prenatal exposure to low Hg levels on child neurodevelopment and the question about "safety" of fish-eating during pregnancy remain controversial. International comparisons of Hg concentrations in mother-child biological samples and neurodevelopmental scores embedded in birth cohort studies may provide useful evidence to explore this issue. MATERIALS AND METHODS The Mediterranean (Italy, Slovenia, Croatia, and Greece) cohort study included 1308 mother-child pairs enrolled in the Public Health Impact of long-term, low-level, Mixed Element exposure in a susceptible population EU Sixth Framework Programme (PHIME). Maternal hair and venous blood, cord blood and breast milk samples were collected, and total Hg (THg) levels were measured. Demographic and socioeconomic information, lifestyles and nutritional habits were collected through questionnaires at different phases of follow-up. Children at 18 months of age underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Multivariate linear and logistic regressions were performed, for each country, to assess the association between THg and BSID-III scores, obtaining adjusted β coefficients and odds ratios (ORs). These values were used to conduct a meta-analysis, to explore possible heterogeneity among countries and to obtain combined estimates of the association between THg exposure and BSID-III scores. RESULTS Median THg (ng/g) was: 704 in maternal hair, 2.4 in maternal blood, 3.6 in cord blood, and 0.6 in breast milk. THg concentrations were highest in Greece and lowest in Slovenia. BSID-III neurodevelopmental scores were higher in Croatia and Slovenia. The meta-analysis of multivariate linear models found an overall positive association between language composite score and receptive communication scaled score and increasing THg in maternal hair (n = 1086; β = 0.55; 95%CI: 0.05-1.05 and n = 1075; β = 0.12; 95%CI: 0.02-0.22, respectively). The meta-analysis of logistic regression models showed that the overall adjusted OR between THg in cord blood and suboptimal gross motor score was borderline significant (n = 882; OR = 1.03; 95%CI: 1.00-1.07). Heterogeneity was found across the four sub-cohorts for language composite score in maternal blood, and for fine motor scaled score in cord blood and breast milk. Language composite score and THg concentrations in maternal venous blood were positively related (n = 58; β = 4.29; CI95% (-0.02, 8.60)) in Croatia and an increase of 1 ng/g of THg in maternal venous blood was associated with a reduced risk for children to fall in the lowest quintile of language score by 31% (n = 58; OR = 0.69; CI 95%: 0.37, 1.01). The comparison of β coefficients obtained by multiple linear regression model showed an inverse association between fine motor score and THg concentrations in cord blood for Croatia (n = 54; β = -0.53; CI 95%: -1.10, 0.04) and Slovenia (n = 225; β = -0.25; CI 95%: -0.49, -0.01). In Slovenia THg level in breast milk was associated with suboptimal fine motor performance (n = 195; OR = 5.25; CI 95%: 1.36, 21.10). CONCLUSIONS This study showed an inverse relation between THg levels and developmental motor scores at 18 months, although the evidence was weak and partially internally and externally inconsistent. No evidence of detrimental effects of THg was found for cognitive and language outcomes at these concentrations and age.
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Affiliation(s)
- Fabio Barbone
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.
| | - Valentina Rosolen
- Department of Medical Area, University of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Marika Mariuz
- Department of Medical Area, University of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Maria Parpinel
- Department of Medical Area, University of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Anica Casetta
- Department of Medical Area, University of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Francesca Sammartano
- Department of Medical Area, University of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.
| | - Liza Vecchi Brumatti
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.
| | - Maura Bin
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", via dell'Istria, 65/1, 34137, Trieste, Italy.
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology Academic Hospital of Udine, via Colugna 50, 33100, Udine, Italy.
| | - Francesca Valent
- Institute of Hygiene and Clinical Epidemiology Academic Hospital of Udine, via Colugna 50, 33100, Udine, Italy.
| | - D'Anna Latesha Little
- Azienda per I'Assistenza Sanitaria n. 5 Friuli Occidentale, via Piave 54 33170 Pordenone (PN), Italy.
| | - Darja Mazej
- Jozef Stefan Institute, Jamova 39 SI-1000, Ljubljana, Slovenia.
| | - Janja Snoj Tratnik
- Jozef Stefan Institute, Jamova 39 SI-1000, Ljubljana, Slovenia; International Postgraduate School Jozef Stefan, Jamova 39 SI-1000, Ljubljana, Slovenia.
| | | | - Katia Sofianou
- Institute of Child Health, "Aghia Sophia" Children's Hospital, Thivon & Papadiamantopoulou, Goudi, 115 27, Athens, Greece.
| | - Zdravko Špirić
- Green Infrastructure Ltd., Fallerovo Setaliste 22, 10.000, Zagreb, Croatia.
| | | | | | | | - Jana Kodrič
- University Medical Centre Ljubljana, Slovenia.
| | | | - Igor Prpić
- The Clinical Hospital Center of Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | - Oleg Petrović
- The Clinical Hospital Center of Rijeka, Krešimirova 42, 51000, Rijeka, Croatia.
| | | | - Milena Horvat
- Jozef Stefan Institute, Jamova 39 SI-1000, Ljubljana, Slovenia; International Postgraduate School Jozef Stefan, Jamova 39 SI-1000, Ljubljana, Slovenia.
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Mazur A, Caroli M, Radziewicz-Winnicki I, Nowicka P, Weghuber D, Neubauer D, Dembiński Ł, Crawley FP, White M, Hadjipanayis A. Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement. Acta Paediatr 2018; 107:568-576. [PMID: 29164673 DOI: 10.1111/apa.14136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 06/04/2017] [Revised: 07/17/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022]
Abstract
This study reviewed the link between social media and the growing epidemic of childhood obesity in Europe. A task force from the European Academy of Paediatrics and the European Childhood Obesity Group searched published literature and developed a consensus statement. It found that there was evidence of a strong link between obesity levels across European countries and childhood media exposure and that parents and society needed a better understanding of the influence of social media on dietary habits. CONCLUSION Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.
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Affiliation(s)
- Artur Mazur
- Medical Faculty; University of Rzeszów; Rzeszów Poland
- European Childhood Obesity Group; Brindisi Italy
| | - Margherita Caroli
- European Childhood Obesity Group; Brindisi Italy
- Paediatrician - Nutritionist; Brindisi Italy
| | | | - Paulina Nowicka
- European Childhood Obesity Group; Brindisi Italy
- Division of Pediatrics; Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Food, Nutrition and Dietetics; Uppsala University; Uppsala Sweden
| | - Daniel Weghuber
- European Childhood Obesity Group; Brindisi Italy
- Department of Pediatrics; Paracelsus Medical University; Salzburg Austria
| | - David Neubauer
- University Children's Hospital Ljubljana; Ljubljana Slovenia
| | - Łukasz Dembiński
- Department of Paediatric Gastroenterology and Nutrition; The Medical University of Warsaw; Warsaw Poland
| | | | - Martin White
- Our Ladys Childrens Hospital Crumlin; Dublin 12 Ireland
| | - Adamos Hadjipanayis
- School of Medicine; European University Cyprus; Engomi Cyprus
- Paediatric Department; Larnaca General Hospital; Larnaca Cyprus
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Abstract
PURPOSE Refractory epilepsies in children present a major burden for patients and their families. Cannabidiol (CBD) has been suggested as a potential treatment for refractory epilepsies. The aim of this study was to evaluate the effectiveness of add-on therapy with CBD for the treatment of refractory childhood epilepsies. METHOD Patients with childhood-onset refractory epilepsy, treated at the tertiary epilepsy center of the University Children's Hospital Ljubljana, Slovenia, were included in the study. Add-on therapy with CBD was initiated once the child's epilepsy was categorized as pharmacoresistant to other antiepileptic drugs/therapies. The dosage of CBD was gradually increased to at least 8mg/kg/day. The effect of CBD treatment was evaluated by the reduction in seizure burden and presence of side effects (positive and negative). Serial electroencephalography was performed in some children. RESULTS Sixty-six patients were included in the analysis. Thirty-two (48.5%) patients had a more than 50% improvement regarding seizure burden, 14 of whom (21.2%) became seizure-free. None of the patients reported worsening of seizure frequency, but CBD had no effect in 15 (22.7%) patients. Some patients reported less vigorous seizures, shorter duration of seizures, shorter time to recovery, and other positive side effects of CBD treatment. Adverse effects were reported in 5/66 children. CONCLUSIONS In our cohort of patients, CBD was found to have potential benefits as add-on therapy for refractory childhood epilepsies, mainly by reducing seizure burden.
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Affiliation(s)
- David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia.
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Schultz MG, Stadtler S, Schröder S, Taraborrelli D, Franco B, Krefting J, Henrot A, Ferrachat S, Lohmann U, Neubauer D, Siegenthaler-Le Drian C, Wahl S, Kokkola H, Kühn T, Rast S, Schmidt H, Stier P, Kinnison D, Tyndall GS, Orlando JJ, Wespes C. The Chemistry Climate Model ECHAM6.3-HAM2.3-MOZ1.0. ACTA ACUST UNITED AC 2017. [DOI: 10.5194/gmd-2017-191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The chemistry climate model ECHAM-HAMMOZ contains a detailed representation of tropospheric and stratospheric reactive chemistry and state-of-the-art parametrisations of aerorols using either a modal scheme (M7) or a bin scheme (SALSA). This article describes and evaluates the model version ECHAM6.3-HAM2.3-MOZ1.0 with a focus on the tropospheric gas-phase chemistry. A ten-year model simulation was performed to test the stability of the model and provide data for its evaluation. The comparison to observations concentrates on the year 2008 and includes total column observations of ozone (O<sub>3</sub>) and carbon monoxide (CO) from Infrared Atmospheric Sounding Interferometer (IASI) and Ozone Monitoring Instrument (OMI), Microwave Limb Sounder (MLS) observations of temperature, nitric acid (HNO<sub>3</sub>), chlorine monoxide (ClO), and O<sub>3</sub> for the evaluation of polar stratospheric processes, an ozone sonde climatology, surface ozone observations from the Tropospheric Ozone Assessment Report (TOAR) database, and surface CO data from the Global Atmosphere Watch network. Global budgets of ozone, hydroxide (OH), nitrogen oxides (NO<sub>x</sub>), aerosols, clouds, and radiation are analyzed and compared to the literature. ECHAM-HAMMOZ performs well in many aspects. However, in the base simulation, lightning NO<sub>x</sub> emissions are very low, and the impact of the heterogeneous reaction of HNO<sub>3</sub> on dust and seasalt aerosol is too strong. Sensitivity simulations with increased lightning NOx or modified heterogeneous chemistry deteriorate the comparison with observations and yield excessively large ozone budget terms and too much OH. We hypothesize that this is an impact of potential issues with tropical convection in the ECHAM model.
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Crawley FP, Hoyer P, Mazur A, Siderius L, Grosek S, Stiris T, Neubauer D. Health, integrity, and doping in sports for children and young adults. A resolution of the European Academy of Paediatrics. Eur J Pediatr 2017; 176:825-828. [PMID: 28365828 DOI: 10.1007/s00431-017-2894-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 11/27/2022]
Abstract
The European Academy of Paediatrics (EAP) is dedicated to promoting healthy lifestyles for children from birth into young adulthood. Physical exercise and leisure are essential to the development of healthy bodies, strong minds, and social skills. All children, without regard to their physical or mental capacities, should be provided with the time, the leadership, the facilities, and the equipment needed to exercise through sports while enjoying playing, even competing, in an environment appropriate to their capacities and aspirations. During exercise and sports, children should be assured of a safe and an appropriate environment that protects and promotes their human rights. Top sports that engage the best competitive athletes in an age group, in a region, in a country, or in the world should provide role models and even dreams for all children. These top sports, however, are also most usually surrounded by large political, economic, and/or business interests where only the best can compete while at times exacting a too high physical and/or psychological cost for those who have survived the cut, made the grade. Alongside this more and more children are being raised in environments with fewer open spaces as well as inside a media and digital culture making significantly less room for the enjoyment of physical exercise and leisure. Children's diets have also been changed dramatically by a significant intake of calorierich foods, which often have little nutritional value and which even a child's high metabolism rates not able to burn off efficiently. Conclusion With this Resolution, the EAP is calling for a renewed look at the role of sports and leisure in the lives of children and, by implication, at the way we structure, finance, and promote sports in Europe. The EAP is also asking that this Resolution be adopted by all organizers of sports involving children and young adults in Europe (and beyond), be that on the playground, in schools, in clubs, or in professional sporting organizations. The EAP would like that every child, throughout his or her childhood years and into young adulthood, can fully participate in sports in a safe environment where winning is playing and playing is winning.
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Affiliation(s)
| | - Peter Hoyer
- University Children's Hospital, Essen, Germany
| | - Artur Mazur
- Medical Faculty University of Rzeszów, Rzeszów, Poland
| | | | - Stefan Grosek
- Division of Surgery, Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
| | - David Neubauer
- University Children's Hospital Ljubljana, Ljubljana, Slovenia.
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Gryspeerdt E, Quaas J, Ferrachat S, Gettelman A, Ghan S, Lohmann U, Morrison H, Neubauer D, Partridge DG, Stier P, Takemura T, Wang H, Wang M, Zhang K. Constraining the instantaneous aerosol influence on cloud albedo. Proc Natl Acad Sci U S A 2017; 114:4899-4904. [PMID: 28446614 PMCID: PMC5441736 DOI: 10.1073/pnas.1617765114] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Much of the uncertainty in estimates of the anthropogenic forcing of climate change comes from uncertainties in the instantaneous effect of aerosols on cloud albedo, known as the Twomey effect or the radiative forcing from aerosol-cloud interactions (RFaci), a component of the total or effective radiative forcing. Because aerosols serving as cloud condensation nuclei can have a strong influence on the cloud droplet number concentration (Nd ), previous studies have used the sensitivity of the Nd to aerosol properties as a constraint on the strength of the RFaci. However, recent studies have suggested that relationships between aerosol and cloud properties in the present-day climate may not be suitable for determining the sensitivity of the Nd to anthropogenic aerosol perturbations. Using an ensemble of global aerosol-climate models, this study demonstrates how joint histograms between Nd and aerosol properties can account for many of the issues raised by previous studies. It shows that if the anthropogenic contribution to the aerosol is known, the RFaci can be diagnosed to within 20% of its actual value. The accuracy of different aerosol proxies for diagnosing the RFaci is investigated, confirming that using the aerosol optical depth significantly underestimates the strength of the aerosol-cloud interactions in satellite data.
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Affiliation(s)
- Edward Gryspeerdt
- Institute for Meteorology, Universität Leipzig, 04109 Leipzig, Germany;
- Space and Atmospheric Physics Group, Imperial College London, London SW7 2AZ, United Kingdom
| | - Johannes Quaas
- Institute for Meteorology, Universität Leipzig, 04109 Leipzig, Germany
| | - Sylvaine Ferrachat
- Institute for Atmospheric and Climate Science, ETH Zurich, 8092 Zurich, Switzerland
| | | | - Steven Ghan
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, WA 99352
| | - Ulrike Lohmann
- Institute for Atmospheric and Climate Science, ETH Zurich, 8092 Zurich, Switzerland
| | - Hugh Morrison
- National Center for Atmospheric Research, Boulder, CO 80305
| | - David Neubauer
- Institute for Atmospheric and Climate Science, ETH Zurich, 8092 Zurich, Switzerland
| | - Daniel G Partridge
- Department of Environmental Science and Analytical Chemistry, Stockholm University, SE-106 91 Stockholm, Sweden
- Bert Bolin Centre for Climate Research, Stockholm University, SE-106 91 Stockholm, Sweden
- Department of Mathematics, University of Exeter, Exeter EX4 4QF, United Kingdom
| | - Philip Stier
- Atmospheric, Oceanic, and Planetary Physics, Department of Physics, University of Oxford, Oxford OX1 3PU, United Kingdom
| | - Toshihiko Takemura
- Research Institute for Applied Mathematics, Kyushu University, Fukuoka 816-8580, Japan
| | - Hailong Wang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, WA 99352
| | - Minghuai Wang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, WA 99352
- Institute for Climate and Global Change Research, Nanjing University, 210023 Nanjing, China
- School of Atmospheric Sciences, Nanjing University, 210023 Nanjing, China
- Collaborative Innovation Center of Climate Change, 210023 Nanjing, China
| | - Kai Zhang
- Atmospheric Sciences and Global Change Division, Pacific Northwest National Laboratory, Richland, WA 99352
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Snoj Tratnik J, Falnoga I, Trdin A, Mazej D, Fajon V, Miklavčič A, Kobal AB, Osredkar J, Sešek Briški A, Krsnik M, Neubauer D, Kodrič J, Stropnik S, Gosar D, Lešnik Musek P, Marc J, Jurkovič Mlakar S, Petrović O, Vlašić-Cicvarić I, Prpić I, Milardović A, Radić Nišević J, Vuković D, Fišić E, Špirić Z, Horvat M. Prenatal mercury exposure, neurodevelopment and apolipoprotein E genetic polymorphism. Environ Res 2017; 152:375-385. [PMID: 27616663 DOI: 10.1016/j.envres.2016.08.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/21/2016] [Accepted: 08/30/2016] [Indexed: 05/20/2023]
Abstract
The aim of the present study was to evaluate the association between prenatal exposure to mercury (Hg) and neurodevelopment of the child, taking into account genetic polymorphism of apolipoprotein E (Apoe) and other relevant confounders. Six hundred and one mother-child pairs were recruited from the central Slovenia region and 243 from Rijeka, on the Croatian coast of the northern Adriatic. The total Hg in cord blood, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) assessment at 18 months of age and Apoe genotyping was performed on 361 children; 237 of them were from Slovenia and 124 from Croatia. The results showed negative association between low-to-moderate Hg exposure in children with normal neurodevelopmental outcome and cognitive and fine motor scores at 18 months of age as assessed by Bayley III. The Hg-related decrease in cognitive score was observed only in children carrying at least one Apoe ε4 allele, while the decrease in fine motor scores was independent of the Apoe genotype. Adjusting for selenium (Se) and lead (Pb) levels, a positive association between Se and the language score and a negative association between Pb and the motor score was observed, but not in the subgroup of children carrying the ε4 allele.
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Affiliation(s)
- Janja Snoj Tratnik
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia; 'Jožef Stefan' International Postgraduate School, Ljubljana, Slovenia
| | - Ingrid Falnoga
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Ajda Trdin
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia; 'Jožef Stefan' International Postgraduate School, Ljubljana, Slovenia
| | - Darja Mazej
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Vesna Fajon
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia; 'Jožef Stefan' International Postgraduate School, Ljubljana, Slovenia
| | - Ana Miklavčič
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia
| | - Alfred B Kobal
- Ex-Department of Occupational Health, Idrija Mercury Mine, Idrija, Slovenia
| | - Joško Osredkar
- University Medical Centre Ljubljana, Clinical Institute of Clinical Chemistry and Biochemistry, Ljubljana, Slovenia
| | - Alenka Sešek Briški
- University Medical Centre Ljubljana, Clinical Institute of Clinical Chemistry and Biochemistry, Ljubljana, Slovenia
| | - Mladen Krsnik
- University Medical Centre Ljubljana, Clinical Institute of Clinical Chemistry and Biochemistry, Ljubljana, Slovenia
| | - David Neubauer
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Slovenia
| | - Jana Kodrič
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Slovenia
| | - Staša Stropnik
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Slovenia
| | - David Gosar
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Slovenia
| | - Petra Lešnik Musek
- University Medical Centre Ljubljana, Division of Paediatrics, Department of Child, Adolescent and Developmental Neurology, Slovenia
| | - Janja Marc
- University in Ljubljana, Faculty of Pharmacy, Slovenia
| | | | - Oleg Petrović
- University Hospital Centre Rijeka, Department of Paediatrics, Rijeka, Croatia
| | | | - Igor Prpić
- University Hospital Centre Rijeka, Department of Paediatrics, Rijeka, Croatia
| | - Ana Milardović
- University Hospital Centre Rijeka, Department of Paediatrics, Rijeka, Croatia
| | | | - Danijela Vuković
- University Hospital Centre Rijeka, Department of Paediatrics, Rijeka, Croatia
| | - Elizabeta Fišić
- University Hospital Centre Rijeka, Department of Paediatrics, Rijeka, Croatia
| | | | - Milena Horvat
- 'Jožef Stefan' Institute, Department of Environmental Sciences, Ljubljana, Slovenia; 'Jožef Stefan' International Postgraduate School, Ljubljana, Slovenia.
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Lepola P, Needham A, Mendum J, Sallabank P, Neubauer D, de Wildt S. Informed consent for paediatric clinical trials in Europe. Arch Dis Child 2016; 101:1017-1025. [PMID: 27226526 PMCID: PMC5136704 DOI: 10.1136/archdischild-2015-310001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Paediatric clinical trials are often conducted as multinational trials. Informed consent or assent is part of the ethics committee approval for clinical trials. The consent requirements vary between countries due to national laws and regulations, which are not harmonised in Europe. These discrepancies can present challenges for paediatric clinical trials. The aim of this study was to assemble these consent and assent requirements across the European Economic Area. The collated national requirements have not been publicly available before, despite a real need for this data. METHODS National consent and assent requirements for paediatric clinical trials were analysed and collated for 25 European Union Member States and 2 European Free Trade Association countries until the end of 2014. The data were retrieved from existing databases and through communication with the competent authorities and selected ethics committees. Results from a literature search for international or national guidelines, declarations and conventions and academic societies' publications served as comparison material. RESULTS Consent and assent requirements are heterogeneous across these countries. We compiled our findings in 'The Informed Consent and Assent Tool Kit', a table including 27 national consent and assent requirements listed by individual country. CONCLUSIONS Wide variation in paediatric consents and assents presents challenges for multinational paediatric trials in Europe. The toolkit is available for all those involved in paediatric clinical trials and ethics committees, providing a new platform for proactive feedback on informed consent requirements, and may finally lead to a needed harmonisation process, including uniform standards accepted across Europe.
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Affiliation(s)
- Pirkko Lepola
- Finnish Investigators Network for Pediatric Medicines, Clinical Research Institute Helsinki University Central Hospital Ltd,Helsinki, Finland,Tampere Center for Child Health Research, 33014 University of Tampere, Tampere, Finland
| | - Allison Needham
- The Hospital for Sick Children Research Institute, Toronto, Canada
| | | | | | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital/University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Saskia de Wildt
- Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands
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Radsel A, Osredkar D, Neubauer D. Health-related quality of life in children and adolescents with cerebral palsy. Zdr Varst 2016; 56:1-10. [PMID: 28289457 PMCID: PMC5329779 DOI: 10.1515/sjph-2017-0001] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/15/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction In a cross-sectional cohort study, health-related quality of life of Slovenian children and adolescents with cerebral palsy was examined, and factors associated with it have been identified. Methods Caregivers of 122 children and adolescents with cerebral palsy were addressed to fill out proxy versions of HRQoL questionnaires (DISABKIDS generic and cerebral palsy module). Children and adolescents without cognitive deficit were asked to fill out the self-report versions. Results Ninety-one families of 43 children (the mean age is 10 years, 6 months, SD 1.2; 26 males and 17 females) and 48 adolescents (the mean age is 14 years, SD 0.9; 23 males and 25 females) completed proxyreports. Forty-eight individuals were able to self-report (26 children and 22 adolescents). Health-related quality of life was perceived as good. Self-reporting participants scored higher than their caregivers (mean score 75.6, SD 15.9 versus mean 72.3, SD 17.9; p=0.048). Adolescents scored lower than children in all domains (mean score 69.4, SD 19.4 versus mean 80.8, SD 10.0; p=0.01). Higher age (p<0.001), pain (p<0.001) and disturbed sleep (p=0.002) were strong predictors of worse health-related quality of life. Social Inclusion and Independence domains received the lowest scores. Conclusions Slovenian children and adolescents with cerebral palsy have a good health-related quality of life, with Social Inclusion and Independence being the weakest domains. Children reported higher scores than adolescents or their caretakers. Pain was the strongest predictor of poor health-related quality of life.
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Affiliation(s)
- Anja Radsel
- University Medical Centre Ljubljana, University Children's Hospital, Department of Child, Adolescent and Developmental Neurology, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Damjan Osredkar
- University Medical Centre Ljubljana, University Children's Hospital, Department of Child, Adolescent and Developmental Neurology, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - David Neubauer
- University Medical Centre Ljubljana, University Children's Hospital, Department of Child, Adolescent and Developmental Neurology, Bohoriceva 20, 1525 Ljubljana, Slovenia
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48
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Sauer PJJ, Nicholson A, Neubauer D. Age determination in asylum seekers: physicians should not be implicated. Eur J Pediatr 2016; 175:299-303. [PMID: 26385241 DOI: 10.1007/s00431-015-2628-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 08/04/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Pieter J J Sauer
- Department of Paediatrics, Beatrix Children Hospital/UMCG, Hanzeplein 1, 9700RB, Groningen, The Netherlands.
| | - Alf Nicholson
- Department of Paediatrics, Children's University Hospital, Dublin 1, Ireland.
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital, Ljubljana, Slovenia.
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Slaats GG, Isabella CR, Kroes HY, Dempsey JC, Gremmels H, Monroe GR, Phelps IG, Duran KJ, Adkins J, Kumar SA, Knutzen DM, Knoers NV, Mendelsohn NJ, Neubauer D, Mastroyianni SD, Vogt J, Worgan L, Karp N, Bowdin S, Glass IA, Parisi MA, Otto EA, Johnson CA, Hildebrandt F, van Haaften G, Giles RH, Doherty D. MKS1 regulates ciliary INPP5E levels in Joubert syndrome. J Med Genet 2016; 53:62-72. [PMID: 26490104 PMCID: PMC5060087 DOI: 10.1136/jmedgenet-2015-103250] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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] [Received: 05/06/2015] [Accepted: 09/23/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Joubert syndrome (JS) is a recessive ciliopathy characterised by a distinctive brain malformation 'the molar tooth sign'. Mutations in >27 genes cause JS, and mutations in 12 of these genes also cause Meckel-Gruber syndrome (MKS). The goals of this work are to describe the clinical features of MKS1-related JS and determine whether disease causing MKS1 mutations affect cellular phenotypes such as cilium number, length and protein content as potential mechanisms underlying JS. METHODS We measured cilium number, length and protein content (ARL13B and INPP5E) by immunofluorescence in fibroblasts from individuals with MKS1-related JS and in a three-dimensional (3D) spheroid rescue assay to test the effects of disease-related MKS1 mutations. RESULTS We report MKS1 mutations (eight of them previously unreported) in nine individuals with JS. A minority of the individuals with MKS1-related JS have MKS features. In contrast to the truncating mutations associated with MKS, all of the individuals with MKS1-related JS carry ≥ 1 non-truncating mutation. Fibroblasts from individuals with MKS1-related JS make normal or fewer cilia than control fibroblasts, their cilia are more variable in length than controls, and show decreased ciliary ARL13B and INPP5E. Additionally, MKS1 mutant alleles have similar effects in 3D spheroids. CONCLUSIONS MKS1 functions in the transition zone at the base of the cilium to regulate ciliary INPP5E content, through an ARL13B-dependent mechanism. Mutations in INPP5E also cause JS, so our findings in patient fibroblasts support the notion that loss of INPP5E function, due to either mutation or mislocalisation, is a key mechanism underlying JS, downstream of MKS1 and ARL13B.
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Affiliation(s)
- Gisela G. Slaats
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Hester Y. Kroes
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Glen R. Monroe
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ian G. Phelps
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Karen J. Duran
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonathan Adkins
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Division of Integrated Cancer Genomics, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Sairam A. Kumar
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Dana M. Knutzen
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Nine V. Knoers
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nancy J. Mendelsohn
- Department of Medical Genetics, Children’s Hospitals & Clinics of Minnesota, Minneapolis, MN, USA
| | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Julie Vogt
- West Midlands Regional Genetics Service, Birmingham Women’s Hospital, Birmingham, UK
| | - Lisa Worgan
- Department of Clinical Genetics, Liverpool Hospital, Liverpool, Australia
| | - Natalya Karp
- Medical Genetics Program, Department of Pediatrics, London Health Science Centre, University of Western Ontario, London, Ontario, Canada
| | - Sarah Bowdin
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian A. Glass
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Melissa A. Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Edgar A. Otto
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Colin A. Johnson
- Section of Ophthalmology and Neuroscience, Leeds Institutes of Molecular Medicine, University of Leeds, Leeds, UK
| | - Friedhelm Hildebrandt
- Division of Nephrology, Boston Children’s Hospital, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Gijs van Haaften
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rachel H. Giles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children’s Research Institute, Seattle, WA, USA
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Shen XM, Brengman J, Neubauer D, Sine SM, Engel AG. Investigation of Congenital Myasthenia Reveals Functional Asymmetry of Invariant Acetylcholine Receptor (AChR) Cys-loop Aspartates. J Biol Chem 2015; 291:3291-301. [PMID: 26698174 DOI: 10.1074/jbc.m115.683995] [Citation(s) in RCA: 8] [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] [Received: 08/05/2015] [Indexed: 11/06/2022] Open
Abstract
We identify two heteroallelic mutations in the acetylcholine receptor δ-subunit from a patient with severe myasthenic symptoms since birth: a novel δD140N mutation in the signature Cys-loop and a mutation in intron 7 of the δ-subunit gene that disrupts splicing of exon 8. The mutated Asp residue, which determines the disease phenotype, is conserved in all eukaryotic members of the Cys-loop receptor superfamily. Studies of the mutant acetylcholine receptor expressed in HEK 293 cells reveal that δD140N attenuates cell surface expression and apparent channel gating, predicting a reduced magnitude and an accelerated decay of the synaptic response, thus reducing the safety margin for neuromuscular transmission. Substituting Asn for Asp at equivalent positions in the α-, β-, and ϵ-subunits also suppresses apparent channel gating, but the suppression is much greater in the α-subunit. Mutant cycle analysis applied to single and pairwise mutations reveals that αAsp-138 is energetically coupled to αArg-209 in the neighboring pre-M1 domain. Our findings suggest that the conserved αAsp-138 and αArg-209 contribute to a principal pathway that functionally links the ligand binding and pore domains.
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Affiliation(s)
- Xin-Ming Shen
- From the Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota 55905,
| | - Joan Brengman
- From the Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota 55905
| | - David Neubauer
- the Department of Pediatric Neurology, University Children's Hospital, Ljubljana 1525, Slovenia, and
| | - Steven M Sine
- From the Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota 55905, the Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota 55905
| | - Andrew G Engel
- From the Department of Neurology and Neuromuscular Research Laboratory, Mayo Clinic, Rochester, Minnesota 55905
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