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Cook S, Dunn E, Kornish J, Calderwood L, Campion M, Cusmano-Ozog KP, Tise CG. Molecular testing in newborn screening: VUS burden among true positives and secondary reproductive limitations via expanded carrier screening panels. Genet Med 2024; 26:101055. [PMID: 38146699 DOI: 10.1016/j.gim.2023.101055] [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: 06/23/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE Expanded carrier screening (ECS) gene panels have several limitations, including variable content, current knowledge of disease-causing variants, and differing reporting policies. This study evaluated if the disease-associated variants identified in affected neonates who screened positive by California newborn screening (NBS) for an inherited metabolic disorder (IMD) by tandem mass spectrometry (MS/MS) would likely be reported by ECS gene panels. METHODS Retrospective review of neonates referred by the California Department of Public Health for a positive NBS by multianalyte MS/MS from January 1, 2020 through June 30, 2021. RESULTS One hundred thirty-six neonates screened positive for ≥1 NBS MS/MS indication. Nineteen neonates (14%) were ultimately diagnosed with an IMD, all of whom had abnormal biochemical testing. Eighteen of the 19 underwent molecular testing; 10 (56%) neonates had ≥1 variants of uncertain significance, 9 of whom were of non-White ancestry. ECS panels would have been negative for 56% (20/36) of parents with an affected neonate, 85% (17/20) of whom were of non-White ancestry. CONCLUSION The number of variants of uncertain significance identified in this cohort highlights the need for more diversified variant databases. Due in part to the lack of diversity in currently sequenced populations, genomic sequencing cannot replace biochemical testing for the diagnosis of an IMD.
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Affiliation(s)
- Sabina Cook
- Masters Program in Human Genetics and Genetic Counseling, Stanford University, Stanford, CA
| | - Emily Dunn
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA.
| | | | - Laurel Calderwood
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA; Lucile Packard Children's Hospital, Stanford, CA
| | - MaryAnn Campion
- Masters Program in Human Genetics and Genetic Counseling, Stanford University, Stanford, CA
| | | | - Christina G Tise
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA
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2
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Levit T, Lavoie DCT, Dunn E, Gallo L, Thoma A. Trigger Finger Release Using Wide-Awake Local Anesthesia No Tourniquet Versus Local Anesthesia With a Tourniquet: A Systematic Review and Meta-analysis. Hand (N Y) 2024:15589447231222517. [PMID: 38243708 DOI: 10.1177/15589447231222517] [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] [Indexed: 01/21/2024]
Abstract
Trigger finger release (TFR) is a common hand surgery, historically performed using a tourniquet. Recently, wide-awake local anesthesia no tourniquet (WALANT) has gained popularity due to ostensible advantages such as improved patient pain, satisfaction, lower rate of complications, and decreased cost. This systematic review compares outcomes of WALANT for TFR with local anesthesia with a tourniquet (LAWT). MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched. All English-language peer-reviewed randomized and observational studies assessing TFR in adults were included. Quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Eleven studies (4 randomized controlled trials, 7 observational) including 1233 patients were identified. In the WALANT group, pain on injection was statistically nonsignificantly lower (mean difference [MD]: -1.69 points, 95% confidence interval [CI] = -4.14 to 0.76, P = .18) and postoperative pain was statistically lower in 2 studies. Patient and physician satisfaction were higher and analgesic use was lower in WALANT. There were no significant differences between groups for functional outcomes or rates of adverse events. Preoperative time was longer (MD: 26.43 minutes, 95% CI = 15.36 to 37.51, P < .01), operative time similar (MD: -0.59 minutes, 95% CI = -2.37 to 1.20, P = .52), postoperative time shorter (MD: -27.72 minutes, 95% CI = -36.95 to -18.48, P < .01), and cost lower (MD: -52.2%, 95% CI = -79.9% to -24.5%) in WALANT versus LAWT. The GRADE certainty of evidence of these results ranges from very low to low. This systematic review does not confirm superiority of WALANT over LAWT for TFR due to moderate to high risk of bias of included studies; further robust trials must be conducted.
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Affiliation(s)
- Tal Levit
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Declan C T Lavoie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emily Dunn
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Achilles Thoma
- Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
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3
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Huynh MNQ, Olaiya O, Kim PJ, Chen J, Gallo L, Dunn E, Farrokhyar F, McRae MC, Voineskos S, McRae MH. Comparison of skin grafts versus local flaps for facial skin cancer from the patient perspective: A feasibility study. J Plast Reconstr Aesthet Surg 2024; 88:439-442. [PMID: 38091686 DOI: 10.1016/j.bjps.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 01/02/2024]
Affiliation(s)
- M N Q Huynh
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - O Olaiya
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - P J Kim
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - J Chen
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - L Gallo
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - E Dunn
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - F Farrokhyar
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - M C McRae
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - S Voineskos
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - M H McRae
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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4
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Sidhu SD, Joseph S, Dunn E, Cuffari C. The Utility of Contrast Enhanced Ultrasound and Elastography in the Early Detection of Fibro-Stenotic Ileal Strictures in Children with Crohn's Disease. Pediatr Gastroenterol Hepatol Nutr 2023; 26:193-200. [PMID: 37485027 PMCID: PMC10356970 DOI: 10.5223/pghn.2023.26.4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Crohn's disease (CD) is a chronic, idiopathic bowel disorder that can progress to partial or complete bowel obstruction. At present, there are no reliable diagnostic tests that can readily distinguish between acute inflammatory, purely fibrotic and mixed inflammatory and fibrotic. Our aim is to study the utility of contrast enhanced ultrasound (CEUS) in combination with shear wave elastography (SWE) to differentiate fibrotic from inflammatory strictures in children with obstructive CD of the terminal ileum. Methods Twenty-five (19 male) children between 2016-2021 with CD of the terminal ileum were recruited into the study. Among these patients, 22 had CEUS kinetic measurements of tissue perfusion, including wash-in slope (dB/sec), peak intensity (dB), time to peak intensity (sec), area under the curve (AUC) (dB sec), and SWE. In total, 11 patients required surgery due to bowel obstruction. Histopathologic analysis was performed by a pathologist who was blinded to the CEUS and SWE test results. Results Patients that underwent surgical resection had significantly higher mean area under the curve on CEUS compared to patients responsive to medical therapy (p=0.03). The AUC also correlated with the degree of hypertrophy and the percent fibrosis of the muscularis propria, as determined by histopathologic grading (p<0.01). There was no difference in the mean elastography measurements between these two patient groups. Conclusion CEUS is a useful radiological technique that can help identify pediatric patients with medically refractory obstructive fibrotic strictures of the terminal ileum that should be considered for early surgical resection.
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Affiliation(s)
- Sarah D. Sidhu
- Pediatric Gastroenterology, Hepatology and Nutrition of Florida, Tampa General Hospital, Temple Terrace, FL, USA
| | - Shelly Joseph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emily Dunn
- Department of Pediatric Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carmen Cuffari
- Division of Pediatric Gastroenterology and Nutrition, Children’s National Hospital, Washington DC, USA
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5
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Huynh MNQ, Olaiya O, Kim PJ, Gallo L, Dunn E, Farrokhyar F, McRae MC, Voineskos S, McRae MH. A comparison of skin grafts versus local flaps for facial skin cancer from the patient perspective: protocol for a feasibility study. Jpn J Clin Oncol 2023:7082592. [PMID: 36946321 DOI: 10.1093/jjco/hyad018] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BRIEF ABSTRACT This is a protocol to assess feasibility of conducting a prospective cohort study comparing local flaps versus skin grafts for surgical excision of skin cancer from the face. INTRODUCTION Skin cancer is the most common malignancy worldwide and the face is one of the most common locations of occurrence. Surgical excision is the most popular treatment for small lesions of the face. Defects can be reconstructed using local flaps or skin grafts. There is a paucity of literature evaluating outcomes after skin cancer surgery from the patient's perspective using valid measurement tools. The purpose of this study is to assess the feasibility of conducting a prospective observational cohort study. The primary outcomes include recruitment rates, eligibility rate, compliance of intervention and rate of completion of the primary outcome (FACE-Q scales) at 3 months. Secondary outcomes include examining patient characteristic and FACE-Q score differences between local flaps to skin grafts and adverse events. METHODS AND ANALYSIS This study is a prospective cohort study consisting of an anticipated 30 patients aged ≥18 years. The study population will consist of a consecutive sample of non-melanoma facial skin cancer patients undergoing a skin graft or local flap. Patients will be followed and evaluated with the FACE-Q questionnaire at 2 weeks, 3 months, 6 months and 1 year post-operation. The following criteria will determine success: patients who meet eligibility criteria >70%; recruitment rate >70%; compliance with intervention >90%; rate of completion of full-scale prospective study primary outcome (FACE-Q at 3 months) >80%; retention rate at 6-month follow-up visit >70%. DISCUSSION The findings of this study will be used to guide the sample size calculation for a future, large-scale prospective study.Trial registration: ClinicalTrials.gov (NCT04842279).
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Affiliation(s)
- Minh N Q Huynh
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Oluwatobi Olaiya
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Patrick J Kim
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Emily Dunn
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Matthew C McRae
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Sophocles Voineskos
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
| | - Mark H McRae
- Division of Plastic Surgery, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada
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6
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More R, Dunn E, Dunwell S. Improving radiology: a whole-system opportunity. Clin Radiol 2023; 78:395-400. [PMID: 36935256 DOI: 10.1016/j.crad.2023.01.019] [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] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
In this article, we set out the current context and case for change in radiology in England and how quality-improvement approaches can support the development of sustainable Imaging services and networks to meet the challenges faced now and in the future.
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Affiliation(s)
- R More
- Xytal Health Management Ltd, The Vineyard, Little Norton, Norton Sub Hamdon, Somerset TA14 6TE, UK.
| | - E Dunn
- Xytal Health Management Ltd, The Vineyard, Little Norton, Norton Sub Hamdon, Somerset TA14 6TE, UK
| | - S Dunwell
- Xytal Health Management Ltd, The Vineyard, Little Norton, Norton Sub Hamdon, Somerset TA14 6TE, UK
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7
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Lee JK, Dunn E, Mulvaney O. Ileo-colic Intussusception. AR 2022. [DOI: 10.37549/ar2853] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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8
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Petch S, Clinton S, Roche D, Dunn E. Non-Invasive Prenatal Testing (NIPT) - We Need a National Programme. Ir Med J 2022; 115:636. [PMID: 36300796] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aims The provision of non-invasive prenatal testing (NIPT), a blood test screening for aneuploidy during pregnancy, varies widely internationally. In Ireland, NIPT is available privately, costing over €400. Gobal research on the patient perspective on NIPT shows a strong desire for the test to be provided for free. Attitudes towards NIPT amongst pregnant women in Ireland have not previously been studied. We assessed this in women attending maternity services in our unit. Methods This was a cross-sectional observational study involving a telephone survey. Women were asked about their prior knowledge of NIPT. Women with no prior knowledge were given information about NIPT and asked about their opinion of the test. Results One hundred and twelve (n=112) women participated. Of these, 60% (n=67) had not heard of NIPT, 86% (n=96) believe it should be freely available, and 80% (n=90) said they would avail of the test if it were free. Cost was the main prohibitive factor for those choosing not to have the test. All women wished to be more informed about NIPT. Conclusion Awareness of NIPT amongst women attending maternity services in Ireland may be low, but there is a desire for more information and a more equitable provision of the test.
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Affiliation(s)
- S Petch
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Wexford, Ireland
| | - S Clinton
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Wexford, Ireland
| | - D Roche
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Wexford, Ireland
| | - E Dunn
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Wexford, Ireland
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9
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Ozkaynak M, Voida S, Dunn E. Opportunities and Challenges of Integrating Food Practice into Clinical Decision-Making. Appl Clin Inform 2022; 13:252-262. [PMID: 35196718 PMCID: PMC8866036 DOI: 10.1055/s-0042-1743237] [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: 11/02/2022] Open
Abstract
BACKGROUND Food practice plays an important role in health. Food practice data collected in daily living settings can inform clinical decisions. However, integrating such data into clinical decision-making is burdensome for both clinicians and patients, resulting in poor adherence and limited utilization. Automation offers benefits in this regard, minimizing this burden resulting in a better fit with a patient's daily living routines, and creating opportunities for better integration into clinical workflow. Although the literature on patient-generated health data (PGHD) can serve as a starting point for the automation of food practice data, more diverse characteristics of food practice data provide additional challenges. OBJECTIVES We describe a series of steps for integrating food practices into clinical decision-making. These steps include the following: (1) sensing food practice; (2) capturing food practice data; (3) representing food practice; (4) reflecting the information to the patient; (5) incorporating data into the EHR; (6) presenting contextualized food practice information to clinicians; and (7) integrating food practice into clinical decision-making. METHODS We elaborate on automation opportunities and challenges in each step, providing a summary visualization of the flow of food practice-related data from daily living settings to clinical settings. RESULTS We propose four implications of automating food practice hereinafter. First, there are multiple ways of automating workflow related to food practice. Second, steps may occur in daily living and others in clinical settings. Food practice data and the necessary contextual information should be integrated into clinical decision-making to enable action. Third, as accuracy becomes important for food practice data, macrolevel data may have advantages over microlevel data in some situations. Fourth, relevant systems should be designed to eliminate disparities in leveraging food practice data. CONCLUSION Our work confirms previously developed recommendations in the context of PGHD work and provides additional specificity on how these recommendations apply to food practice.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States,Address for correspondence Mustafa Ozkaynak, PhD University of Colorado, Anschutz Medical Campus, College of NursingCampus Box 288-18 Education 2 North Building, 13120 East, 19th Avenue Room 4314, Aurora, CO 80045United States
| | - Stephen Voida
- Department of Information Science, University of Colorado Boulder, Boulder, Colorado, United States
| | - Emily Dunn
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
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10
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Dunn E, Singh P, Rummel G, Miles S. Remote Fundamentals of Laparoscopic Surgery (FLS) Training in Pre-Clinical Medical Students. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Dunn E, Hakim J, Check R, Arner K, Ridley K, Agresti D, Kelly B, Stankewicz H, Jeanmonod R. 226 Patient Sex and Race as Independent Predictors of HEART Score Documentation by Emergency Medicine Providers. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Mackintosh JA, Glenn L, Barnes H, Dunn E, Bancroft S, Reddy T, Teoh AKY, Troy L, Jo H, Geis M, Glaspole I, Grainge C, Corte TJ, Chambers DC, Hopkins P. Benefits of a virtual interstitial lung disease multidisciplinary meeting in the face of COVID-19. Respirology 2021; 26:612-615. [PMID: 33871150 PMCID: PMC8251432 DOI: 10.1111/resp.14062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 12/23/2022]
Affiliation(s)
- John A Mackintosh
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Laura Glenn
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hayley Barnes
- Department of Respiratory and Sleep Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Emily Dunn
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sandra Bancroft
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Alan K Y Teoh
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Helen Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Monika Geis
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian Glaspole
- Department of Respiratory and Sleep Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher Grainge
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel C Chambers
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Hopkins
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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13
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Manyevitch R, Dunn E, Zaman MH, Maruf MN, Benz K, Clennon EK, Wu WJ, Davis R, Di Carlo HN, Sponseller PD, Stec AA, Gearhart JP. Volumetric and acetabular changes in the bony pelvis associated with primary closure of classic bladder exstrophy. J Pediatr Urol 2020; 16:832.e1-832.e9. [PMID: 32981861 DOI: 10.1016/j.jpurol.2020.08.028] [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: 03/18/2020] [Revised: 06/23/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Repair of classic bladder exstrophy (CBE) is known to alter dimensions of the bony pelvic ring. Pelvic volume and acetabular configuration are additional metrics which merit analysis in the reconstruction process. Advances in magnetic resonance imaging (MRI) allow for precise elucidation of such anatomy in pediatric patients, providing enhanced knowledge of how primary reconstruction may impact factors in pelvic health. METHODS An IRB-approved exstrophy-epispadias database of 1337 patients was reviewed for patients with CBE who had pelvic MRI performed before and after repair. Pelvic MRIs were analyzed by a pediatric radiologist, and three-dimensional volumetric renderings of the true pelvis were calculated. Pre- and post-closure imaging were compared, in addition to imaging from age-matched controls without pelvic pathology. Cartilaginous acetabular index and version angles were also calculated and compared between groups. RESULTS Eighteen patients with post-closure imaging, 14 of whom also had pre-closure imaging, and 23 control patients (ages 0-365 days) were included. The median ages at pre- and post-closure scan were 2 and 178 days, respectively. Osteotomy was performed in 6 (33%) of the closures. The median segmented pelvic volumes were 89 cm3 in the pre-closure group, 105 cm3 in the post-closure group, and 72 cm3 in the control group. At a given age, patients with CBE pre-closure had the largest pelvic volume, and those without bladder exstrophy demonstrated the smallest pelvic volumes (Summary Figure). CBE patients' pelvic volumes were overall lower following repair, relative to age (p = 0.007). Cartilaginous acetabular version angle increased following closure, with acetabular orientation converting from retroversion to anteversion in all cases. However, only acetabular version angles were significantly different between groups. DISCUSSION This study found that pelvic volume significantly decreased relative to age following primary repair of CBE, but that it did not correct to control levels. Similarly, acetabular retroversion that is naturally seen in exstrophy patients was converted to anteversion post-closure but did not become completely normal. Knowledge of these persistent anatomical anomalies may be useful in treatment of future concerns related to exstrophy, such as continence achievement, pelvic organ prolapse, and potential gait disturbances. Lack of significant differences between study groups regarding acetabular index angles can give assurance to providers that hip dysplasia is neither a natural concern nor iatrogenically inflicted through reconstruction. CONCLUSIONS The primary closure of exstrophy results in pelvic volumes and anteverted acetabula that more closely resemble those without bladder exstrophy, compared to pre-closure findings.
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Affiliation(s)
- Roni Manyevitch
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad H Zaman
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Mahir N Maruf
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Karl Benz
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Emily K Clennon
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
| | - Wayland J Wu
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Rachel Davis
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Heather N Di Carlo
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - Paul D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew A Stec
- Division of Urology, Nemours Children's Specialty Care, Jacksonville, FL, USA
| | - John P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
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Affiliation(s)
- Sahar Al Baroudi
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicholas A Jabre
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily Dunn
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Augustine H, Rizvi SA, Dunn E, Murphy J, Retrouvey H, Efanov JI, Steve A, Alhalabi B, Avram R, Voineskos S. Pregnancy and parental leave among plastic surgery residents in Canada: a nationwide survey of attitudes and experiences. Can J Surg 2020. [PMID: 33107817 DOI: 10.1503/cjs.004919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
SUMMARY Small surgical residency programs like plastic surgery can be challenging environments to accommodate parental leave. This study aimed to report the experiences, attitudes and perceived support of Canadian plastic surgery residents, recent graduates and staff surgeons with respect to pregnancy and parenting during training. Residents and staff surgeons were invited via email to participate in an online survey. The results presented here explore experiences of pregnancy and parental leave of current plastic surgery residents and staff surgeons. Residents' and staff surgeons' perceptions of program director support, policies, negative comments and the impact of parental leave on the workload of others were also explored. Although the findings suggest that there may be improvements in the support of program directors, there continues to be a negative attitude in surgical culture toward pregnancy during residency. The perceived confusion of respondents with respect to programspecific policies emphasizes the need for open conversations and standardization of parental leave.
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Affiliation(s)
- Haley Augustine
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Syed Ali Rizvi
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Emily Dunn
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Jessica Murphy
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Helene Retrouvey
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Johnny Ionut Efanov
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Anna Steve
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Becher Alhalabi
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Ronen Avram
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
| | - Sophocles Voineskos
- From the Department of Surgery, Division of Plastic Surgery, McMaster University, Hamilton, Ont. (Augustine, Rizvi, Dunn, Murphy, Avram, Voineskos); the Department of Surgery, Division of Plastic Surgery, University of Montreal, Montreal, Que. (Retrouvey, Efanov); the Department of Surgery, Division of Plastic Surgery, McGill University, Montreal, Que. (Alhalabi); the Division of Plastic Surgery, University of Toronto, Toronto, Ont. (Retrouvey); the Department of Surgery, University of Calgary, Calgary, Alta. (Steve)
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Pancaldi A, Peng L, Rhee DS, Dunn E, Forcucci JA, Belchis D, Pratilas CA. DICER1-associated metastatic abdominopelvic primitive neuroectodermal tumor with an EWSR1 rearrangement in a 16-yr-old female. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a005603. [PMID: 33028642 PMCID: PMC7552927 DOI: 10.1101/mcs.a005603] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
We report a case of a DICER1-associated EWSR1-rearranged malignant primitive neuroectodermal tumor (PNET) arising in a patient with DICER1 tumor predisposition syndrome. A 16-yr-old female with a history of multinodular goiter presented with a widely metastatic abdominal small round blue cell tumor with neuroectodermal differentiation. EWSR1 gene rearrangement was identified in the tumor by fluorescence in situ hybridization (FISH). Genetic analysis revealed biallelic pathogenic DICER1 variation. The patient was treated with an aggressive course of chemotherapy, surgery, and radiation with complete pathologic response. We believe this case to represent a new expression of the DICER1 tumor predisposition syndrome, an entity caused by deleterious germline mutations in the DICER1 gene, encoding a ribonuclease active in the processing of miRNA. Patients with germline mutations in DICER1 develop a diverse group of benign and malignant tumors. Some of these tumors have been noted to have immature neuroepithelium as a component, including the ciliary body medulloepithelioma and the recently described DICER1-associated presacral malignant teratoid neoplasm. To our knowledge, abdominal sarcomas that resemble PNET histology with an EWSR1 rearrangement have not previously been described as a classical expression of the DICER1 syndrome phenotype.
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Affiliation(s)
- Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Lei Peng
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Daniel S Rhee
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA.,Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Jessica A Forcucci
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
| | - Deborah Belchis
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.,Doctor's Community Hospital, Lanham, Maryland 20706, USA
| | - Christine A Pratilas
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
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Franchini E, Dunn E, Takito MY. Reliability and Usefulness of Time-Motion and Physiological Responses in Simulated Judo Matches. J Strength Cond Res 2020; 34:2557-2564. [DOI: 10.1519/jsc.0000000000002727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kruger E, Obasaju P, Dunn E, Lukish J, Goicochea L, Pratilas CA, Rhee DS. Desmoplastic small round cell tumor presenting as an inguinal mass in a 2-year old boy. Journal of Pediatric Surgery Case Reports 2020. [DOI: 10.1016/j.epsc.2020.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Patel P, Young JEM, McRae M, Santos J, Levis C, Gupta MK, Voineskos S, Gallo L, Dunn E, McRae MC. A Retrospective Cohort and Systematic Review of Non-Operative Management of Exposed Calvaria Post-Radiotherapy. Cureus 2020; 12:e8751. [PMID: 32714689 PMCID: PMC7377020 DOI: 10.7759/cureus.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Scalp defects with exposed calvaria that have previously been irradiated present a unique reconstructive challenge. Patients with previously radiated scalp defects often have few reconstructive options due to poor health or personal choice. The aim of this study was to evaluate the results of non-operative management for patients with prior radiotherapy to the scalp who developed exposed calvaria. The outcomes of interest were major and minor complications related to exposed calvaria with a time frame of follow-up of greater than one year or death from any cause. A retrospective chart review was performed to identify patients with prior radiotherapy and surgery for skin cancer to the scalp who subsequently developed exposed calvaria. Data from four surgeons from 2008 to 2019 was collected. Next, a systematic review of PubMed, EMBASE, Cochrane Library, and CINAHL was conducted to identify articles in which non-operative management was utilized for exposed calvaria post-radiotherapy. Nineteen patients were identified who received radiotherapy either before developing recurrent malignancy requiring operation or requiring radiation postoperatively because of close or involved margins and who subsequently developed exposed calvaria. Six of these patients had an additional attempt at local flap or skin grafting that failed. All patients had an American Society of Anesthesiologists score of three or four. All were managed with local wound care. Ten patients had near-complete healing with wound care alone. Eight patients are still alive from one to six years after the presentation. One patient, who remains alive, developed an intracranial abscess requiring long-term antibiotics but was medically compromised by concomitant myelodysplastic syndrome, mantle cell lymphoma on chemotherapy, atrial fibrillation on anticoagulation, and heart failure. Three patients developed new malignancies requiring re-operation with watchful waiting. Two of the three cases resulted in failure to control disease, but control of malignancy occurred in one case with resection of recurrent cancer and exposed bone. The systematic review of the literature yielded three studies that met the inclusion criteria. None of the studies encountered cases of meningitis, encephalitis, or death due to the non-operative treatment of exposed calvaria post radiation. Coverage of the calvaria with well-vascularized tissue is the reconstructive goal in the majority of circumstances. This case series and systematic review found that non-operative management of exposed calvaria post-radiotherapy can be an option for patients who are either not candidates for aggressive surgical treatment or who refuse surgery.
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Affiliation(s)
| | | | - Mark McRae
- Plastic Surgery, McMaster University, Hamilton, CAN
| | - Jenny Santos
- Surgery, Division of Plastic Surgery, McMaster University, Hamilton, CAN
| | - Carolyn Levis
- Surgery, Division of Plastic Surgery, McMaster University, Hamilton, CAN
| | - Michael K Gupta
- Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, CAN
| | | | - Lucas Gallo
- Plastic Surgery, McMaster University, Hamilton, CAN
| | - Emily Dunn
- Surgery, Division of Plastic Surgery, McMaster University, Hamilton, CAN
| | - Matthew C McRae
- Plastic Surgery, St. Joseph's Hospital, McMaster University, Hamilton, CAN
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20
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Gallo L, Wakeham S, Dunn E, Avram R, Thoma A, Voineskos S. The Reporting Quality of Randomized Controlled Trial Abstracts in Plastic Surgery. Aesthet Surg J 2020; 40:335-341. [PMID: 31353409 DOI: 10.1093/asj/sjz199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND When evaluating randomized controlled trials (RCTs), clinicians will often refer to the abstract for an initial assessment of the results and to determine whether a full-text review is warranted. OBJECTIVES This project aims to assess the reporting quality of RCT abstracts published within the top 5 plastic surgery journals utilizing the Consolidated Standards of Reporting Trials (CONSORT) for abstracts checklist. METHODS A computerized database search of OVID MEDLINE was performed. All primary RCTs published within the top 5 plastic surgery journals (by 2016 International Scientific Indexing impact factor) from 2011 to 2018 were included. Two reviewers, blinded to journal and author, independently and in duplicate, scored abstracts employing the 16-item CONSORT for abstracts checklist. RESULTS This review identified 126 RCTs that satisfied the inclusion criteria. Included studies were distributed across 5 journals: Plastic and Reconstructive Surgery (n = 83), JAMA Facial Plastic Surgery (n = 8), Aesthetic Surgery Journal (n = 33), Journal of Reconstructive Microsurgery (n = 2), and the Journal of Hand Surgery-European Volume (n = 0). Mean overall item adherence across all abstracts was 7 (SD ± 2). The most poorly reported items were "trial registration," "method of randomization," and "source of trial funding" and appeared in 4%, 2.4%, and 0% of abstracts, respectively. CONCLUSIONS There is limited adherence to the CONSORT for abstracts checklist among RCT abstracts published within the top 5 plastic surgery journals. Given the reliance of clinicians on abstract reporting, omitting essential trial details can lead to an inaccurate interpretation of trial results and improper application in clinical practice. Active endorsement of the CONSORT for abstracts checklist is required to improve the quality of RCT abstract reporting.
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21
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Oldham C, Canning M, Hayward E, Dunn E. 444 Assessing Admission Medication Prescription Accuracy With the Addition of a Pharmacist to the Cardiac Investigations Unit Clinic. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Davis R, Maruf M, Dunn E, DiCarlo H, Gearhart JP. The role of anatomic pelvic dissection in the successful closure of bladder exstrophy: an aid to success. J Pediatr Urol 2019; 15:559.e1-559.e7. [PMID: 31383518 DOI: 10.1016/j.jpurol.2019.06.025] [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: 03/06/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Classic bladder exstrophy is one of the rarest congenital anomalies compatible with life. Surgical treatment of bladder exstrophy has progressed, but the goal of surgery remains a successful primary bladder closure. Several factors have been identified to decrease the risk of failed closure, including appropriate use of osteotomy and adequate postoperative immobilization and analgesia. However, the role of the radical anatomic pelvic dissection, including dissection of the urogenital diaphragm fibers, in a successful closure has not yet been extensively explored. OBJECTIVE The objective of this study was go examine the role of radical anatomic pelvic dissection, including dissection of the urogenital diaphragm fibers, in patients with classic bladder exstrophy. STUDY DESIGN This was a retrospective study based on an institutional database. METHODS A retrospective review from an institutional approved database of more than 1,300 patients with epispadias-exstrophy complex was performed. The inclusion criteria included patients with classic bladder exstrophy with at least one failed bladder closure and a reclosure at the authors' institution with a single senior surgeon. Data collection included demographics, clinical variables, and status of urogenital diaphragm fibers. Magnetic resonance imaging (MRI) scans, if available, were reviewed with a pediatric radiologist to identify urogenital diaphragm fibers. RESULTS From the database, 93 patients met inclusion criteria. Of these patients, 74 had urogenital diaphragm fibers completely intact at the time of repeat closure, whereas 19 patients did not. There was no association with age or gender and status of urogenital diaphragm fibers. There was no association with osteotomy, the type of primary bladder closure, surgeon subspecialty, and the status of the urogenital fibers. Fourteen patients had at least two prior closures; surprisingly, 11 of these repeat closure patients still had intact urogenital fibers even after two prior closures. DISCUSSION The recent development and application of 3D MRI-guided pelvic dissection in a large group of patients led the authors to investigate whether adequate pelvic floor dissection had been accomplished at primary or secondary closure. Several patients had MRI scans performed before repeat closure in which the urogenital diaphragm fibers were identified to be intact on imaging; this was corroborated with surgical findings. Approximately 80% of patients had their urogenital diaphragm fibers completely intact and, therefore, did not have an adequate pelvic dissection during their primary or secondary bladder closure, putting the success of their previous closures at risk. CONCLUSION Inadequate pelvic diaphragm dissection, defined as intact urogenital diaphragm fibers, demonstrated in a large group of patients with failed exstrophy closure, may be a decisive factor in bladder closure failure. The use of 3D intra-operative image guidance may aid in a safer and more successful pelvic dissection.
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Affiliation(s)
- R Davis
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - M Maruf
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - E Dunn
- Department of Radiology, Pediatrics, Johns Hopkins School of Medicine, Johns Hopkins Children's Center, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - H DiCarlo
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA
| | - J P Gearhart
- Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
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Korotkaya Y, Dunn E, Aybar A, Crino J, Alaish S, Scheimann A. Cecal Duplication Presenting With Hematochezia in an Infant. Clin Pediatr (Phila) 2019; 58:1338-1340. [PMID: 31402694 DOI: 10.1177/0009922819867456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yelena Korotkaya
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Aybar
- Annapolis Pediatric Gastroenterology and Nutrition, Annapolis, MD, USA
| | - Jude Crino
- Department of Obstetrics and Gynecology, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Samuel Alaish
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hu A, Dunn E, Etra J, Nino D, Garcia A, Rhee D. Characteristics of Image Defined Risk Factors on Outcomes for Primary Resection of Neuroblastoma. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Matson L, Dunn E, Haines K, Miller-Smith S, Lee-Stubbs R, Whitten K, Ardinger C, McCarren H, McDonough J. Evaluation of first-line anticonvulsants to treat nerve agent-induced seizures and prevent neuropathology in adult and pediatric rats. Neurotoxicology 2019; 74:203-208. [PMID: 31362008 DOI: 10.1016/j.neuro.2019.07.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 01/28/2023]
Abstract
Risk exists for civilian exposure to nerve agents (NA), and exposure can produce prolonged seizures. Pediatric populations are at greater risk for injury or death due to the central nervous system effects of NAs. To address the need to evaluate the effectiveness of anticonvulsants, pediatric and adult animal models were established to test the effectiveness of anticonvulsant drugs for treating NA-induced seizures in pediatric populations. In this paper, median effective dose (ED50) and neuroprotective effectiveness were determined for the first-line anticonvulsant treatments diazepam and midazolam in pediatric and adult rats against sarin- and VX-induced seizures. Comparisons between treatments were made across postnatal days (PND) 21, 28, and 70 in rats of both sexes. We observed high efficacy and potency of midazolam and diazepam, with low variation in doses across the ages or sexes. These data are important for informing adult and pediatric dosing recommendations for NA-induced seizures.
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Affiliation(s)
- Liana Matson
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA.
| | - Emily Dunn
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Kari Haines
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Stephanie Miller-Smith
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Robyn Lee-Stubbs
- Office of the Commander, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Kimberly Whitten
- Comparative Pathology Department, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Cherish Ardinger
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - Hilary McCarren
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
| | - John McDonough
- Neuroscience Branch, US Army Medical Research Institute of Chemical Defense, 8350 Ricketts Point Road, Aberdeen Proving Ground, MD, 21010, USA
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Farabi SS, Barbour LA, Heiss K, Hirsch NM, Dunn E, Hernandez TL. Obstructive Sleep Apnea Is Associated With Altered Glycemic Patterns in Pregnant Women With Obesity. J Clin Endocrinol Metab 2019; 104:2569-2579. [PMID: 30794722 PMCID: PMC6701202 DOI: 10.1210/jc.2019-00159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/19/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Often unrecognized, obstructive sleep apnea (OSA) worsens over pregnancy and is associated with poorer perinatal outcomes. The association between OSA in late pregnancy and metabolic biomarkers remains poorly understood. We tested the hypothesis that OSA in pregnant women with obesity is positively correlated with 24-hour patterns of glycemia and IR despite controlling for diet. DESIGN Pregnant women (32 to 34 weeks' gestation; body mass index, 30 to 40 kg/m2) wore a continuous glucose monitor for 3 days. OSA was measured in-home by WatchPAT 200™ [apnea hypopnea index (AHI), oxygen desaturation index (ODI; number per hour)]. Fasting blood was collected followed by a 2-hour, 75-g, oral glucose tolerance test to measure IR. Association between AHI and 24-hour glucose area under the curve (AUC) was the powered outcome. RESULTS Of 18 women (29.4 ± 1.4 years of age [mean ± SEM]), 12 (67%) had an AHI ≥5 (mild OSA). AHI and ODI were correlated with 24-hour glucose AUC (r = 0.50 to 0.54; P ≤ 0.03) and mean 24-hour glucose (r = 0.55 to 0.59; P ≤ 0.02). AHI and ODI were correlated with estimated hepatic IR (r = 0.59 to 0.74; P < 0.01), fasting free fatty acids (fFFAs; r = 0.53 to 0.56; P < 0.05), and waking cortisol (r = 0.49 to 0.64; P < 0.05). CONCLUSIONS Mild OSA is common in pregnant women with obesity and correlated with increased glycemic profiles, fFFAs, and estimates of hepatic IR. OSA is a potentially treatable target to optimize maternal glycemia and metabolism, fetal fuel supply, and pregnancy outcomes.
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Affiliation(s)
- Sarah S Farabi
- Office of Nursing Research, Goldfarb School of Nursing, St. Louis, Missouri
- Correspondence and Reprint Requests: Sarah S. Farabi, PhD, Goldfarb School of Nursing, Office of Nursing Research, Mailstop 90-36-697, 4483 Duncan Avenue, St. Louis, Missouri 63110. E-mail:
| | - Linda A Barbour
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristy Heiss
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nicole M Hirsch
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Emily Dunn
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Teri L Hernandez
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Yip P, Stemp J, Dunn E, Vandenberghe H, Konforte D. Discordant findings and error types observed in urine drug screens: An external quality assessment program perspective. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Benz KS, Dunn E, Maruf M, Facciola J, Jayman J, Kasprenski M, Michaud JE, Di Carlo H, Gearhart JP. Novel Anatomical Observations of the Prostate, Prostatic Vasculature and Penile Vasculature in Classic Bladder Exstrophy Using Magnetic Resonance Imaging. J Urol 2018; 200:1354-1361. [DOI: 10.1016/j.juro.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Karl S. Benz
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily Dunn
- Russel H. Morgan Department of Radiology, Division of Pediatric Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mahir Maruf
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James Facciola
- Russel H. Morgan Department of Radiology, Division of Pediatric Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - John Jayman
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew Kasprenski
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jason E. Michaud
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Heather Di Carlo
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John P. Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland
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Rao AD, Ladra M, Dunn E, Kumar R, Rao SS, Sehgal S, Dorafshar AH, Morris CD, Terezakis SA. A Road Map for Important Centers of Growth in the Pediatric Skeleton to Consider During Radiation Therapy and Associated Clinical Correlates of Radiation-Induced Growth Toxicity. Int J Radiat Oncol Biol Phys 2018; 103:669-679. [PMID: 30414451 DOI: 10.1016/j.ijrobp.2018.10.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/31/2018] [Accepted: 10/24/2018] [Indexed: 11/17/2022]
Abstract
With the increasing use of advanced radiation techniques such as intensity modulated radiation therapy, stereotactic radiation therapy, and proton therapy, radiation oncologists now have the tools to mitigate radiation-associated toxicities. This is of utmost importance in the treatment of a pediatric patient. To best use these advanced techniques to mitigate radiation-induced growth abnormalities, the radiation oncologist should be equipped with a nuanced understanding of the anatomy of centers of growth. This article aims to enable the radiation oncologist to better understand, predict, and minimize radiation-mediated toxicities on growth. We review the process of bone development and radiation-induced growth abnormalities and provide an atlas for contouring important growth plates to guide radiation treatment planning. A more detailed recognition of important centers of growth may improve future treatment outcomes in children receiving radiation therapy.
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Affiliation(s)
- Avani D Rao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Emily Dunn
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rahul Kumar
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sandesh S Rao
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shuchi Sehgal
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amir H Dorafshar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Benz K, Dunn E, Solaiyappan M, Kasprenski M, Maruf M, Jayman J, Gearhart J. MP63-08 NOVEL OBSERVATIONS OF FEMALE PELVIC ANATOMY IN CLASSIC BLADDER EXSTROPHY USING THREE-DIMENSIONAL MRI RECONSTRUCTION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2031] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shrot S, Johnson CT, Golden WC, Baschat AA, Bullard JE, Tekes A, Poretti A, Dunn E, Huisman TA. Persistent Extreme Hyperextension of the Fetal Neck: Clinical and Neuroimaging Findings. J Neuroimaging 2018; 28:278-282. [DOI: 10.1111/jon.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Shai Shrot
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of Diagnostic ImagingSheba Medical Center Ramat‐Gan Israel
| | - Clark T. Johnson
- Department of Gynecology & ObstetricsJohns Hopkins University School of Medicine Baltimore MD
| | - W. Christopher Golden
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Ahmet A. Baschat
- Center for Fetal TherapyDepartment of ObstetricsGynecology, and Reproductive SciencesJohns Hopkins University School of Medicine Baltimore MD
| | - Janine E. Bullard
- Division of NeonatologyDepartment of PediatricsJohns Hopkins University School of Medicine Baltimore MD
| | - Aylin Tekes
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Andrea Poretti
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
- Department of NeurogeneticsKennedy Krieger Institute Baltimore MD
| | - Emily Dunn
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
| | - Thierry A.G.M. Huisman
- Section of Pediatric NeuroradiologyDivision of Pediatric Radiology and Pediatric NeuroradiologyDepartment of Radiology and Radiological ScienceJohns Hopkins Hospital Baltimore MD
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Affiliation(s)
| | - Matthew Alvin
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Emily Dunn
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Dunn E, Vos W, De Backer J, Brannan J, Soans B, Grainge C. Functional respiratory imaging demonstrates heterogeneous alterations in airway mechanics and airflow during bronchoconstriction. Imaging 2017. [DOI: 10.1183/1393003.congress-2017.pa802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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35
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Ugezu CH, Mazumdar A, Dunn E, Das A. Harlequin Ichthyosis - A Case Report. Ir Med J 2017; 110:606. [PMID: 29341518] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Harlequin Ichthyosis is a very rare genetic disorder affecting mainly the skin with severe morbidity and mortality. It affects both sexes with incidence of about 1 in 300,000 live births. Autosomal recessive inheritance has been inferred with mutation in ABCA 12 gene identified. Hence, genetic counseling and mutation screening of this gene should be considered in at-risk patients. Death usually occurred in the first 3 months of life due to sepsis, feeding problems and respiratory distress. With improved neonatal care and early introduction of retinoids, its survival rate has increased.
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Affiliation(s)
- C H Ugezu
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Newtown Road. Wexford
| | - A Mazumdar
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Newtown Road. Wexford
| | - E Dunn
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Newtown Road. Wexford
| | - A Das
- Department of Obstetrics and Gynaecology, Wexford General Hospital, Newtown Road. Wexford
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Gemert C, Howell J, Wang J, Stoove M, Cowie B, Allard N, Enright C, Dunn E, Towell V, Hellard M. P63 Knowledge and practices of chronic hepatitis B virus testing by general practitioners in Victoria, 2014–2015. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30804-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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38
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Townsend LK, Islam H, Dunn E, Eys M, Robertson-Wilson J, Hazell TJ. Modified sprint interval training protocols. Part II. Psychological responses. Appl Physiol Nutr Metab 2016; 42:347-353. [PMID: 28177741 DOI: 10.1139/apnm-2016-0479] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sprint-interval training (SIT) is a viable method to improve health and fitness. However, researchers have questioned the utility of SIT because of its strenuous nature. The current study aimed to determine if manipulating the sprint and recovery duration, while maintaining the 1:8 work to rest ratio, could uncover a more favourable SIT protocol. Nine healthy active males (age, 23.3 ± 3.0 years; body mass index, 22.4 ± 2.2 kg·m-2; maximal oxygen consumption, 48.9 ± 5.3 mL·kg-1·min-1) participated in 3 experimental running SIT sessions: (i) 30:240 (4 × 30-s efforts, 240-s recovery), (ii) 15:120 (8 × 15-s efforts, 120-s recovery), (iii) 5:40 (24 × 5-s efforts, 40-s recovery), and (iv) a final behavioural choice follow-up session. Affect, intentions, task self-efficacy, enjoyment, and preference were evaluated. Midway through exercise, affect became more positive for 5:40 compared with 30:240 (p < 0.05) and postexercise affect was greater for both 5:40 (p = 0.014) and 15:120 (p = 0.015) compared with 30:240. Participants expressed greater intentions to perform 5:40 3 and 5 times/week compared with 15:120 and 30:240 (p < 0.05). Participants felt more confident in their ability to perform 5:40 (p = 0.001) and 15:120 (p = 0.008) compared with 30:240. The 5:40 session was also rated as more enjoyable than 15:120 (p = 0.025) and 30:240 (p = 0.026). All participants preferred the 5:40 protocol. These data suggest that shorter sprints with more repetitions are perceived as more enjoyable and lead to greater intentions to engage in SIT.
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Affiliation(s)
- Logan K Townsend
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Hashim Islam
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Emily Dunn
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Mark Eys
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Jennifer Robertson-Wilson
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
| | - Tom J Hazell
- Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada.,Department of Kinesiology and Physical Education, Faculty of Science, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
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Hall DA, Hermanson M, Dunn E, Stebbins G, Merkitch D, Ouyang B, Berry-Kravis E, Jhaveri M. The Corpus Callosum Splenium Sign in Fragile X-Associated Tremor Ataxia Syndrome. Mov Disord Clin Pract 2016; 4:383-388. [PMID: 30363360 DOI: 10.1002/mdc3.12449] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/10/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023] Open
Abstract
Background Hyperintensities in the splenium of the corpus callosum (CCS) have been proposed as a radiographic diagnostic criterion for fragile X-associated tremor ataxia syndrome (FXTAS). Methods Magnetic resonance images from patients with FXTAS and from nonpremutation carriers with movement disorders were viewed by a radiologist who was blinded to gene status, and radiographic criteria for FXTAS were scored. Phenotypic data used for diagnosis of FXTAS also were collected. Results Twenty-two patients with FXTAS and 23 controls were included. Hyperintensity in the CCS (the CCS sign) was more common in men with FXTAS versus controls (87% vs. 40%) but not in women with FXTAS (100% vs. 50% in controls). The CCS sign had higher sensitivity compared with the middle cerebellar peduncle sign (white matter lesions in middle cerebellar peduncle) in both men (0.87 vs. 0.67) and women (1 vs. 0.29) with FXTAS, but it had lower specificity in both men (0.6 vs. 0.8) and women (0.5 vs. 1). Conclusions The CCS sign is common in patients with FXTAS, but it is not significantly more prevalent in women with FXTAS compared with controls. This may be due to small sample sizes in the current study. Other signs, such as brainstem white matter disease, were more common in women with FXTAS and differed from those in men with FXTAS. This finding suggests that additional studies evaluating the diagnostic criteria for FXTAS need to be conducted, ideally with neuropathological confirmation of the disease.
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Affiliation(s)
- Deborah A Hall
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | | | - Emily Dunn
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Glenn Stebbins
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Douglas Merkitch
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Bichun Ouyang
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences Rush University Chicago Illinois USA.,Department of Biochemistry Rush University Chicago Illinois USA.,Department of Pediatrics Rush University Chicago Illinois USA
| | - Miral Jhaveri
- Department of Radiology Rush University Chicago Illinois USA
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Abstract
People tend to mimic the facial expression of others. It has been suggested that this helps provide social glue between affiliated people but it could also aid recognition of emotions through embodied cognition. The degree of facial mimicry, however, varies between individuals and is limited in people with autism spectrum conditions (ASC). The present study sought to investigate the effect of promoting facial mimicry during a facial-emotion-recognition test. In two experiments, participants without an ASC diagnosis had their autism quotient (AQ) measured. Following a baseline test, they did an emotion-recognition test again but half of the participants were asked to mimic the target face they saw prior to making their responses. Mimicry improved emotion recognition, and further analysis revealed that the largest improvement was for participants who had higher scores on the autism traits. In fact, recognition performance was best overall for people who had high AQ scores but also received the instruction to mimic. Implications for people with ASC are explored.
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Affiliation(s)
| | - Emily Dunn
- a School of Psychology , Cardiff University , Cardiff , UK
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Md Yusof M, Cassamoali H, Hawkins T, Rawstron A, Dunn E, Emery P, Vital E. OP0042 Humanised Anti-CD20 Antibodies Improve Depletion and Response in Sle Patients with Resistance To Rituximab: Results from The First 100 Patients at A Single Centre:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.6086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Lander M, Kunz N, Dunn E, Lockard K, O’Shea G, Weaver S, Schweke T, Shullo M, Lagazzi L, Kormos R, Teuteberg J. Substantial Reduction in Driveline Infection Rates with the Modification of Driveline Dressing Protocols. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Humberstone CE, Cormack S, Dunn E, Halperin I, Iverson D, Iredale F, Martin DT. Applying Ratio And Allometric Scaling To Strength Testing In Female Judoka. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478288.56546.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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Drew M, Giles LS, Nasseer AM, Scullion P, Humberstone C, Reale R, Dunican I, Halperin I, Dunn E, Iverson D, Iredale F, Martin DT. Injuries Sustained During an International Judo Training Camp. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000479177.76778.1f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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45
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Reale R, Martin D, Halperin I, Dunn E, Maloney M, Dunican I, Shaw G, Humberstone C, Lee H, Slater G, Burke L. Day-To-Day Reliability of Common Measures of Hydration Status in Australian Judoka. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478284.03181.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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46
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Martin DT, Dunican I, Reale R, Halperin I, Humberstone C, Dunn E, Maloney M, Lee H, Cormack S, Iredale F. Reliability And Validity Of The Single Leg, 3-hop Test In Australian Judoka. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478289.56546.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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47
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Chan SKW, So HC, Hui CLM, Chang WC, Lee EHM, Chung DWS, Tso S, Hung SF, Yip KC, Dunn E, Chen EYH. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med 2015; 45:1181-1193. [PMID: 25233868 DOI: 10.1017/s0033291714002220] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design. METHOD Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed. RESULTS Results suggested that EI patients had reduced suicide rate (χ2 (1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR -0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery. CONCLUSIONS The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.
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Affiliation(s)
- S K W Chan
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - H C So
- Department of Psychiatry,Queen Mary Hospital,Hong Kong
| | - C L M Hui
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - W C Chang
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - E H M Lee
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - D W S Chung
- Department of Psychiatry,Tai Po Hospital,Hong Kong
| | - S Tso
- Department of Psychiatry,Castle Peak Hospital,Hong Kong
| | - S F Hung
- Department of Psychiatry,Kwai Chung Hospital,Hong Kong
| | - K C Yip
- Department of Psychiatry,Kowloon Hospital,Hong Kong
| | - E Dunn
- Department of Psychiatry,Pamela Youde Nethersole Eastern Hospital
| | - E Y H Chen
- Department of Psychiatry,The University of Hong Kong,Hong Kong
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48
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Teuteberg J, McNulty M, Holtz J, Kunz N, Lockard K, Dunn E, Bermudez C, Bhama J, Shullo M, Kormos R, Dew M. Impact of Mechanical Support on Quality of Life Measures Over Time - Is There a Differential Response Based Upon Indication? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Distress tolerance (DT) is a proposed transdiagnostic factor in psychopathology, yet sources of individual differences in DT are largely unknown. The present study examined mindfulness and rumination facets as predictors of persistence on a standardized DT task (mirror tracing). Acting with awareness (a facet of mindfulness) and reflection (a potentially adaptive form of rumination) predicted increased DT. Increased task-induced skin conductance reactivity predicted decreased DT. These results held after controlling for task skill and subjective and heart rate reactivity. Together, these results suggest that teaching skills to promote mindful awareness and reflection hold promise as interventions to enhance DT.
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Feldman G, Zayfert C, Sandoval L, Dunn E, Cartreine JA. Reward responsiveness and anxiety predict performance of Mount Everest climbers. Journal of Research in Personality 2013. [DOI: 10.1016/j.jrp.2012.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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