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Tetarbe M, Chang MR, Barton L, Cayabyab R, Ramanathan R. Economic and Clinical Impact of Using Human Milk-Derived Fortifier in Very Low Birth Weight Infants. Breastfeed Med 2024; 19:114-119. [PMID: 38294868 DOI: 10.1089/bfm.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background: Implementation of exclusive human milk (EHM) feeding defined as mother's own milk or donor human milk fortified with human milk-derived fortifiers can place an economic burden on institutions. Methods: Retrospective study of very low birth weight (VLBW) infants before and after the implementation of EHM feedings. Neonatal demographics and clinical outcomes including necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, late-onset sepsis, days on parenteral nutrition (PN), and length-of-stay were collected. The net cost to the institution was estimated using published data. Results: Sixty-four infants in the pre-EHM period and 57 infants in the post-EHM period were enrolled. Net product acquisition cost in 2020 and 2021 was $884,823. The EHM feeding guideline led to a reduction in the mean length of stay and mean days of PN use by 6.3 and 6.8 days per infant, respectively. This led to a cost saving of $1,813,444 ($31,815 per infant). No significant difference in incidence of short-term morbidities was observed. Combining the cost avoidance from clinical outcomes, the estimated financial impact over 2 years excluding insurance reimbursement was an estimated $ 913,840 ($16,032 per infant). Conclusion: Implementation of EHM-based feeding in VLBW infants is a cost-effective option for neonatal intensive care units that can result in reduced length of stay and days on PN without adversely impacting short-term morbidities.
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Affiliation(s)
- Manas Tetarbe
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Millie Rocio Chang
- CHOC Children's Specialists, Division of Neonatology, Orange, California, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California, USA
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Kohbodi GA, Cayabyab RG, Kibe RN, Ebrahimi M, Barton L, Uzunyan MY, Ramanathan R. Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants. Am J Perinatol 2024. [PMID: 38266754 DOI: 10.1055/s-0044-1779254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics. STUDY DESIGN Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants. RESULTS A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants. CONCLUSION Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants. KEY POINTS · VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance..
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Affiliation(s)
- GoleNaz A Kohbodi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rowena G Cayabyab
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rutuja N Kibe
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mahmoud Ebrahimi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Merujan Y Uzunyan
- Division of Cardiology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
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Chang MR, Tetarbe M, Barton L, Ramanathan R, Cayabyab R. Transient Hypoglycemia and Biochemical Differences in Infants Less Than 1,250 G at Birth Fed Human Milk with Human Milk-Derived Fortifier versus Cow Milk-Derived Fortifier. Am J Perinatol 2023. [PMID: 37657486 DOI: 10.1055/a-2164-7957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Fortification of human milk (HM) with either human milk-derived fortifier (HMDF) or cow milk-derived fortifier (CMDF) is important in preterm infants. The objective is to compare the incidence of hypoglycemia, and biochemical values in infants less than 1,250 g at birth fed HMDF versus CMDF. STUDY DESIGN It is a retrospective cohort study on infants less than 1,250 g at birth who were fed with HMDF or CMDF. Hypoglycemia was defined as blood glucose (BG) level equal to or less than 60 mg/dL within 72 hours of full enteral feeds when off total parenteral nutrition and intravenous fluids. RESULTS Ninety infants were enrolled (HMDF = 61, CMDF = 29). HMDF group had a higher rate of hypoglycemia (46 vs. 24%; p = 0.048) after achievement of full enteral feeding. The median minimum BG was lower (61 vs. 71; p ≤ 0.01), while blood urea nitrogen (12 vs. 6; p ≤ 0.01) and albumin (3.1 vs. 2.7; p ≤ 0.01) were higher in HMDF group compared with CMDF. CONCLUSION At full enteral feedings in infants less than 1,250 g at birth, an HMDF diet may predispose to hypoglycemia needing intervention. Close monitoring of BG levels once off parenteral nutrition is recommended. KEY POINTS · Exclusive human milk (EHM) feeding results in better nutritional indices.. · EHM feeding at higher calorie/ounce improves growth.. · Blood glucose needs to be monitored when off TPN during EHM feeding..
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Affiliation(s)
- Millie R Chang
- Division of Neonatology, CHOC Pediatric Subspecialty Faculty Inc., Orange, California
| | - Manas Tetarbe
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California
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Gaffar S, Siassi B, Cayabyab R, Ebrahimi M, Barton L, Uzunyan M, Ramanathan R. Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants. BMC Pediatr 2023; 23:293. [PMID: 37322472 PMCID: PMC10268431 DOI: 10.1186/s12887-023-04119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. METHODS Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. RESULTS Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months - 3 years). One infant had presumptive resolution because of the presence of flap valve. CONCLUSION No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.
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Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA.
| | - Bijan Siassi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Mahmood Ebrahimi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Merujan Uzunyan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
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Valaiyapathi R, Barton L, Carvalho L, David A, Walji S, Jones B, Cegla J. Lipoprotein apheresis reduces SARS-CoV-2 S protein antibody levels in patients with familial hypercholesterolaemia after vaccination with BNT162b2. Atherosclerosis Plus 2022. [PMCID: PMC9582078 DOI: 10.1016/j.athplu.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Valaiyapathi
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - L. Barton
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - L. Carvalho
- Department of Infection and Immunity, Imperial College Healthcare NHS Trust, London, UK
| | - A. David
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S. Walji
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - B. Jones
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - J. Cegla
- Lipid Clinic, Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Fisk LM, Barton L, Maccarone LD, Jenkins SN, Murphy DV. Seasonal dynamics of ammonia-oxidizing bacteria but not archaea influence soil nitrogen cycling in a semi-arid agricultural soil. Sci Rep 2022; 12:7299. [PMID: 35508560 PMCID: PMC9068766 DOI: 10.1038/s41598-022-10711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
Nitrification, a key pathway of nitrogen (N) loss from agricultural soils, is performed by ammonia-oxidizing bacteria (AOB) and archaea (AOA). We examined the seasonal dynamics (2 years) of ammonia oxidizer gene abundances across a gradient of soil carbon (C) and N in a semi-arid soil after 8 years of tillage and crop residue treatments. AOB was more dominant than AOA in the surface soil, as AOA were undetected in 96% of samples. Seasonal variation in AOB abundance was related to substrate availability; AOB gene copy numbers increased at the end of the growing season (during summer fallow) following higher concentrations in dissolved organic matter soil water. This suggests increased co-location between AOB and substrate resources in pores still filled with water as the soils dried. AOB was however not statistically related to soil ammonium concentrations, soil water content, rainfall or temperature. Organic matter inputs enhanced AOB abundance independent of seasonal variation. AOB abundance was greatest in autumn and immediately preceding the start of the growing season, and coincided with elevated soil nitrate concentrations. The growth of the AOB population is likely to contribute to increased risk of N loss through leaching and/or denitrification at the start of the crop growing season following summer fallow.
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Affiliation(s)
- L M Fisk
- SoilsWest, UWA School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - L Barton
- SoilsWest, UWA School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - L D Maccarone
- SoilsWest, UWA School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - S N Jenkins
- SoilsWest, UWA School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - D V Murphy
- SoilsWest, UWA School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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Davies K, Thomas K, Barton L, Williams C, Aujayeb A, Premchand N. Idiopathic systemic capillary leak syndrome (Clarkson's disease) presenting with recurrent hypovolemic shock. Acute Med 2021; 20:74-77. [PMID: 33749696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 49-year old male with a past medical history of myocardial infarction and compartment syndromes requiring fasciotomies presented on five occasions with hypovolemic shock. We describe his admissions and presumptive diagnoses which required large volumes of intravenous fluids, admission to intensive care for vasopressors and renal replacement therapy. The presentations were always precipitated by a prodrome of fatigue and pre-syncopal episodes. On his last admission, a diagnosis of Idiopathic systemic capillary leak syndrome (ISCLS), also known as Clarkson's Disease, was reached. He is currently receiving high dose intravenous immunoglobulins on a monthly basis.
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Affiliation(s)
- K Davies
- MBChB (Hons) MRes, Clinical Research Fellow in Rheumatology Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - K Thomas
- Advanced Critical Care Practitioner, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - L Barton
- Acute Medicine and Critical Care Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - C Williams
- Haematology Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - A Aujayeb
- Respiratory and Acute Medicine Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
| | - N Premchand
- Acute Medicine and Infectious Diseases Consultant, Northumbria Speciailist Emergency Care Hospital, Cramlington, NE23 6NZ
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Van Winden KR, Bearden A, Kono N, Frederick T, Operskalski E, Stek A, Pandian R, Barton L, Kovacs A. Low Bioactive Vitamin D Is Associated with Pregnancy-Induced Hypertension in a Cohort of Pregnant HIV-Infected Women Sampled Over a 23-Year Period. Am J Perinatol 2020; 37:1446-1454. [PMID: 31365935 PMCID: PMC6992493 DOI: 10.1055/s-0039-1694007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the association of vitamin D insufficiency and risk of pregnancy-induced hypertension (PIH) among human immunodeficiency virus (HIV)-infected pregnant women. STUDY DESIGN This is a retrospective cohort study evaluating the impact of low maternal vitamin D levels on PIH and perinatal outcomes among HIV-infected pregnant women receiving care at an urban HIV center from 1991 to 2014. RESULTS A total of 366 pregnant women were included, of which 11% developed PIH. Lower levels of 25-hydroxyvitamin D (25(OH)D) and bioactive 1,25-dihydroxyvitamin D (1,25(OH)2D) were associated with increased HIV disease activity. 25(OH)D levels were not significantly associated with the incidence of PIH. Higher 1,25(OH)2D levels were associated with reduced incidence of PIH in univariate (odds ratio, OR: 0.87 [95% confidence interval, CI: 0.79-0.95], p = 0.004) and multivariate (OR: 0.88 [95% CI: 0.80-0.97], p = 0.010) analyses. No association was found between 25(OH)D levels and other obstetric outcomes. Lower 1,25(OH)2D levels were associated with group B Streptococcus colonization (OR: 0.92 [95% CI: 0.86-0.99]) and low birth weight (LBW) (OR: 0.90 [95% CI: 0.83-0.98]) on multivariate analysis. Mean 1,25(OH)2D levels were significantly lower in women with preterm delivery and LBW infants. CONCLUSION Lower bioactive vitamin D levels are related to PIH in HIV-infected women. This association may be related to the coexistence of abnormal placental vitamin D metabolism and abnormal placental implantation.
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Affiliation(s)
- Kristi R. Van Winden
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Permanente Medical Group, Oakland, California
| | - Allison Bearden
- Department of Pediatrics, Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Naoko Kono
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Toni Frederick
- Department of Pediatrics, Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Eva Operskalski
- Department of Pediatrics, Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Alice Stek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California,Department of Obstetrics and Gynecology, Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | | | - Lorayne Barton
- Division of Neonatal Medicine, Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Andrea Kovacs
- Department of Pediatrics, Maternal Child and Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
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Uquillas KR, Lee RH, Sardesai S, Chen E, Ihenacho U, Cortessis VK, Barton L. Neonatal hypoglycemia after initiation of late preterm antenatal corticosteroids. J Perinatol 2020; 40:1339-1348. [PMID: 32060360 DOI: 10.1038/s41372-020-0589-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/12/2019] [Accepted: 12/21/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the frequency and severity of neonatal hypoglycemia in pregnancies treated with and without late preterm antenatal corticosteroids. STUDY DESIGN We conducted a retrospective cohort study of late preterm deliveries at LAC + USC (2015-2018). Neonatal outcomes were compared between pregnancies treated with and without corticosteroids. RESULTS 93 pregnancies (39.9%) received corticosteroids and 140 (60.1%) did not. Neonates born to women given corticosteroids were more likely to be hypoglycemic (47.3 vs. 29.3%, ORadj 2.25, padj = 0.01). The mean initial glucose (45.6 mg/dL vs. 51.9 mg/dL, p = 0.01) and glucose nadir (39.1 mg/dL vs. 45.4 mg/dL, p < 0.001) were significantly lower if the neonates received corticosteroids. Neonates admitted to the NICU solely for hypoglycemia were more likely to be born to women treated with corticosteroids (ORadj 4.71, padj = 0.01). CONCLUSION Administration of late preterm corticosteroids was associated with an increased incidence and severity of neonatal hypoglycemia.
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Affiliation(s)
- Kristen R Uquillas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Richard H Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Smeeta Sardesai
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ellison Chen
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ugonna Ihenacho
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Victoria K Cortessis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Bearden A, Van Winden K, Frederick T, Kono N, Operskalski E, Pandian R, Barton L, Stek A, Kovacs A. Low maternal vitamin D is associated with increased risk of congenital and peri/postnatal transmission of Cytomegalovirus in women with HIV. PLoS One 2020; 15:e0228900. [PMID: 32053638 PMCID: PMC7018030 DOI: 10.1371/journal.pone.0228900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background CMV infection of the fetus or neonate can lead to devastating disease, and there are no effective prevention strategies to date. Vitamin D is a potent immunomodulator, supports antiviral immune responses, and plays an important role in placental immunity. Methods Retrospective cohort study to evaluate the impact of low maternal vitamin D on congenital and early postnatal transmission of CMV among HIV-infected, non-breastfeeding women and their HIV exposed but negative infants from an urban HIV clinic. Vitamin D panel was performed on stored maternal plasma obtained near time of delivery. Infant CMV testing at 0–6 months included urine and oral cultures, and/or serum polymerase chain reaction testing. Results Cohort included 340 mother-infant pairs (births 1991–2014). Among 38 infants (11%) with a CMV+ test between 0–6 months, 4.7% (14/300) had congenital CMV transmission (CMV+ test 0–3 weeks), and 7.6% (24/315) had peri/postnatal CMV (CMV+ test >3 weeks-6 months). Women with lower calcitriol (1,25-dihydroxyvitamin D), the active form of vitamin D, were more likely to have an infant with congenital (OR 12.2 [95% CI 1.61–92.2] P = 0.02) and peri/postnatal (OR 9.84 [95% CI 2.63–36.8] P = 0.0007) infections in multivariate analyses, independent of maternal HIV viral load and CD4 count. Conclusion This study demonstrates an association between inadequate maternal calcitriol during pregnancy and increased congenital and early postnatal acquisition of CMV among non-breastfeeding women with HIV and their HIV negative infants.
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Affiliation(s)
- Allison Bearden
- Department of Pediatrics, Division of Infectious Diseases, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
- * E-mail:
| | - Kristi Van Winden
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, and Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Toni Frederick
- Department of Pediatrics, Division of Infectious Diseases, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Naoko Kono
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Eva Operskalski
- Department of Pediatrics, Division of Infectious Diseases, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Raj Pandian
- Pan Laboratories, Irvine, CA, United States of America
| | - Lorayne Barton
- Department of Pediatrics, Division of Neonatology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Alice Stek
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, and Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
| | - Andrea Kovacs
- Department of Pediatrics, Division of Infectious Diseases, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States of America
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Cegla J, Walji S, Neuwirth C, Barton L, Thompson G, Scott J. Three years experience of lomitapide therapy in the uk. ATHEROSCLEROSIS SUPP 2019. [DOI: 10.1016/j.atherosclerosissup.2019.08.014] [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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Abstract
Background Graves’ hyperthyroidism affects 0.2% of pregnant women. Establishing the correct diagnosis and effectively managing Graves’ hyperthyroidism in pregnancy remains a challenge for physicians. Main The goal of this paper is to review the diagnosis and management of Graves’ hyperthyroidism in pregnancy. The paper will discuss preconception counseling, etiologies of hyperthyroidism, thyroid function testing, pregnancy-related complications, maternal management, including thyroid storm, anti-thyroid drugs and the complications for mother and fetus, fetal and neonatal thyroid function, neonatal management, and maternal post-partum management. Conclusion Establishing the diagnosis of Graves’ hyperthyroidism early, maintaining euthyroidism, and achieving a serum total T4 in the upper limit of normal throughout pregnancy is key to reducing the risk of maternal, fetal, and newborn complications. The key to a successful pregnancy begins with preconception counseling.
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Affiliation(s)
- Caroline T Nguyen
- 1Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 204, Los Angeles, Ca 90033 USA
| | - Elizabeth B Sasso
- 2Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, IRD 220, Los Angeles, CA 90033 USA
| | - Lorayne Barton
- 3Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, Ca 90033 USA
| | - Jorge H Mestman
- 4Division of Endocrinology, Diabetes & Metabolism, Department of Medicine and Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1540 Alcazar Street CHP 204, Los Angeles, California 90033 USA
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Biniwale M, Weiner A, Sardesai S, Cayabyab R, Barton L, Ramanathan R. Early postnatal weight gain as a predictor for the development of retinopathy of prematurity. J Matern Fetal Neonatal Med 2017; 32:429-433. [DOI: 10.1080/14767058.2017.1381902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Manoj Biniwale
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Angela Weiner
- Division of Neonatal Medicine, Department of Pediatrics, Sunrise Hospital & Medical Center, Las Vegas, NV, USA
| | - Smeeta Sardesai
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Rowena Cayabyab
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Lorayne Barton
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, LAC + USC Medical Center and Children’s Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, USA
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Sellors A, Melbourne J, Barratt J, Barton L. Assessing the stability and suitability of haematology parameters for diagnosing and monitoring iron deficiency. Int J Lab Hematol 2017; 39:e132-e134. [DOI: 10.1111/ijlh.12702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Sellors
- Department of Haematology; Leicester Royal Infirmary; University Hospitals of Leicester NHS Trust; Leicester UK
| | - J. Melbourne
- Department of Haematology; Leicester Royal Infirmary; University Hospitals of Leicester NHS Trust; Leicester UK
| | - J. Barratt
- Department of Infection, Immunity & Inflammation; UHL NHS Trust; University of Leicester & John Walls Renal Unit; Leicester UK
| | - L. Barton
- Department of Haematology; Leicester Royal Infirmary; University Hospitals of Leicester NHS Trust; Leicester UK
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Jenkins SN, Paredes-Valdivia CA, Waite IS, Ayre J, Moheimani N, Barton L, Abbott LK. Assessing the suitability of microalgae biomass produced from piggery waste as a fertiliser. Anim Prod Sci 2017. [DOI: 10.1071/anv57n12ab051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Van Winden KR, Bearden A, Kono N, Frederick T, Operskalski E, Stek A, Pandian R, Barton L, Kovacs A. 409: Low vitamin D is associated with preterm birth and low birth weight infants in a cohort of pregnant HIV-infected women sampled over a 23-year period. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.667] [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: 11/26/2022]
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Bearden A, Vanwinden K, Kono N, Frederick T, Operskalski E, Stek A, Pandian R, Barton L, Kovacs A. Low Vitamin D Is Associated With Mother-to-Child Transmission of Cytomegalovirus in Women With Human Immunodeficiency Virus. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.13] [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: 11/13/2022] Open
Affiliation(s)
- Allison Bearden
- Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Kristi Vanwinden
- Division of Maternal-Fetal Medicine, University of Southern California, Los Angeles, California
| | - Naoko Kono
- Preventative Medicine, University of Southern California, Los Angeles, California
| | - Toni Frederick
- Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Eva Operskalski
- Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | - Alice Stek
- Division of Maternal-Fetal Medicine, Maternal Child Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
| | | | - Lorayne Barton
- Neonatal Medicine, University of Southern California, Los Angeles, California
| | - Andrea Kovacs
- Pediatrics, Maternal, Child, Adolescent/Adult Center for Infectious Diseases and Virology, University of Southern California, Los Angeles, California
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Kyselova J, Barton L, Bures D, Simunek J. P5042 Comparative analysis of gene expression during postnatal growth in Czech Fleckvieh cattle. J Anim Sci 2016. [DOI: 10.2527/jas2016.94supplement4136x] [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: 11/13/2022] Open
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Abstract
The purpose of this study was to determine the prevalence of pancreatic nodular hyperplasia (NH) and its relation to age in the dog. A total of 101 dogs were enrolled. The pancreas was evaluated by histology and hyperplastic lesions were detected and scored. Age was recorded from the medical records. Correlation of age with inflammation and presence of hyperplastic lesions was evaluated. Of the 101 dogs, 81 (80.2%) had evidence of NH. Twenty-five of the 101 dogs did not have evidence of pancreatic inflammation, necrosis, and/or fibrosis, 17 (68.0%) of which had evidence of NH. Mean ± SD age in dogs with NH was significantly higher compared with dogs without NH (9.5 ± 3.4 years versus 3.4 ± 3.3; p-value < 0.0001). We conclude that NH is a common pathologic lesion in dogs and shows a positive correlation with age regardless of the presence or absence of pancreatic inflammation, necrosis, or fibrosis.
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Affiliation(s)
- S J Newman
- Department of Pathology, College of Veterinary Medicine, University of Tennessee, 2407 River Dr., Knoxville, TN 37996-4542, USA.
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Abstract
Histologic grading schemes for canine inflammatory conditions are sparse, and in the case of the canine pancreas, have not been previously described. In a previous study, we determined that histologic lesions of the exocrine pancreas occurred much more frequently than gross lesions. The intention of the current study was to develop a histologic grading scheme for nonneoplastic lesions following extensive assessment of the exocrine pancreas from dogs presented for necropsy examination. The parameters of the proposed scheme include neutrophilic inflammation, lymphocytic inflammation, pancreatic necrosis, pancreatic fat necrosis, edema, fibrosis, atrophy, and hyperplastic nodules. In this case series, the most common lesion was pancreatic hyperplastic nodules (80.2%), followed by lymphocytic inflammation (52.5%), fibrosis (49.5%), atrophy (46.5%), neutrophilic inflammation (31.7%), pancreatic fat necrosis (25.7%), pancreatic necrosis (16.8%), and edema (9.9%). Only 8 of the 101 animals had no evidence of any of the lesions in any of the sections examined. Fibrosis, atrophy, and/or lymphocytic infiltration most commonly accompanied nodules. Neutrophilic inflammation, when present, was often associated with necrosis (pancreatic necrosis, pancreatic fat necrosis, or both) and occasionally with hyperplastic nodules. The utilization of a grading scheme for exocrine pancreatic lesions will be useful in advancing the classification of exocrine pancreatic disease in the dog, which may lead to multicenter studies of exocrine pancreatic disorders in the dog and in other species.
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Affiliation(s)
- S J Newman
- Department of Pathology, College of Veterinary Medicine, University of Tennessee, Knoxville 37996-4542, USA
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Blue NR, Van Winden KR, Pathak B, Barton L, Opper N, Lane CJ, Ramanathan R, Ouzounian JG, Lee RH. Neonatal Outcomes by Mode of Delivery in Preterm Birth. Am J Perinatol 2015; 32:1292-7. [PMID: 26344006 DOI: 10.1055/s-0035-1562931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We set out to test the hypothesis that infants born vaginally at ≤ 30 weeks gestation have less respiratory distress syndrome (RDS) than those born by cesarean delivery. STUDY DESIGN We conducted a retrospective cohort study of 652 infants born between 24 and 30 (6/7) weeks gestation from March 31, 1996 to May 31, 2014. Comparisons of neonatal outcomes by intended and actual mode of delivery were made using chi-square and t-tests (α = 0.05). Multiple logistic regression was performed to control for confounding variables. RESULTS Neonates born by cesarean delivery were more likely to have RDS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.10-2.90), require intubation (OR, 1.80; 95% CI, 1.12-2.88), and have longer neonatal intensive care unit stay (70.0 ± 37.1 vs. 57.3 ± 40.1 days, p = 0.02). CONCLUSION Compared with cesarean delivery, vaginal delivery is associated with a significant reduction in RDS among infants born at ≤ 30 weeks gestation.
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Affiliation(s)
- Nathan R Blue
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kristi R Van Winden
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bhuvan Pathak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Neisha Opper
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christianne Joy Lane
- Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Richard H Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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22
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Barton L, Wolf B, Rowlings D, Scheer C, Kiese R, Grace P, Stefanova K, Butterbach-Bahl K. Sampling frequency affects estimates of annual nitrous oxide fluxes. Sci Rep 2015; 5:15912. [PMID: 26522228 PMCID: PMC4629121 DOI: 10.1038/srep15912] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/02/2015] [Indexed: 11/20/2022] Open
Abstract
Quantifying nitrous oxide (N2O) fluxes, a potent greenhouse gas, from soils is necessary to improve our knowledge of terrestrial N2O losses. Developing universal sampling frequencies for calculating annual N2O fluxes is difficult, as fluxes are renowned for their high temporal variability. We demonstrate daily sampling was largely required to achieve annual N2O fluxes within 10% of the ‘best’ estimate for 28 annual datasets collected from three continents—Australia, Europe and Asia. Decreasing the regularity of measurements either under- or overestimated annual N2O fluxes, with a maximum overestimation of 935%. Measurement frequency was lowered using a sampling strategy based on environmental factors known to affect temporal variability, but still required sampling more than once a week. Consequently, uncertainty in current global terrestrial N2O budgets associated with the upscaling of field-based datasets can be decreased significantly using adequate sampling frequencies.
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Affiliation(s)
- L Barton
- Soil Biology and Molecular Ecology Group, School of Earth &Environment (M087), UWA Institute of Agriculture, Faculty of Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - B Wolf
- Karlsruhe Institute of Technology, Institute for Meteorology and Climate Research Atmospheric Environmental Research (IMK-IFU), Kreuzeckbahnstr. 19, 82467 Garmisch-Partenkirchen, Germany
| | - D Rowlings
- Institute for Future Environments, Queensland University of Technology, 2 George Street, Brisbane, Queensland 4000, Australia
| | - C Scheer
- Institute for Future Environments, Queensland University of Technology, 2 George Street, Brisbane, Queensland 4000, Australia
| | - R Kiese
- Karlsruhe Institute of Technology, Institute for Meteorology and Climate Research Atmospheric Environmental Research (IMK-IFU), Kreuzeckbahnstr. 19, 82467 Garmisch-Partenkirchen, Germany
| | - P Grace
- Institute for Future Environments, Queensland University of Technology, 2 George Street, Brisbane, Queensland 4000, Australia
| | - K Stefanova
- UWA Institute of Agriculture (M089), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - K Butterbach-Bahl
- Karlsruhe Institute of Technology, Institute for Meteorology and Climate Research Atmospheric Environmental Research (IMK-IFU), Kreuzeckbahnstr. 19, 82467 Garmisch-Partenkirchen, Germany.,International Livestock Research Institute (ILRI), Nairobi, Kenya
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Abstract
OBJECTIVE Our aim was to describe laboratory findings and imaging results for neonatal patients diagnosed with urinary tract infection (UTI). STUDY DESIGN Medical records were reviewed for infants diagnosed with UTI in a single neonatal intensive care unit (NICU) over a 13-year period. RESULTS Of the 8,241 patients admitted to the NICU during the study period, 137 infants were diagnosed with UTI. Imaging was reviewed for 101 patients. Renal pelvis dilation was found in 34% of patients and vesicoureteral reflux was found in 21%. Renal pelvis dilation was not associated with reflux (OR: 0.53 [95% CI: 0.18-1.5]). The sensitivity of urinalysis to detect a positive culture was 76%, and the specificity was 41%. Tests of cure for bacterial infections were uniformly negative. CONCLUSION Renal pelvis dilation was common but not associated with reflux among NICU patients diagnosed with UTI. Diagnostic criteria in this population are not well defined, and guidelines are needed for diagnosis and management of UTIs in NICU patients.
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Affiliation(s)
- Mark F Weems
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Regional One Health and Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel Wei
- Division of Neonatal Medicine, Department of Pediatrics, Keck School of Medicine of USC, LAC + USC Medical Center, University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatal Medicine, Department of Pediatrics, Keck School of Medicine of USC, LAC + USC Medical Center, University of Southern California, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatal Medicine, Department of Pediatrics, Keck School of Medicine of USC, LAC + USC Medical Center, University of Southern California, Los Angeles, California
| | - Linda Vachon
- Department of Radiology, Keck School of Medicine of USC, LAC + USC Medical Center, University of Southern California, Los Angeles, California
| | - Smeeta Sardesai
- Division of Neonatal Medicine, Department of Pediatrics, Keck School of Medicine of USC, LAC + USC Medical Center, University of Southern California, Los Angeles, California
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Chen FH, Dong GH, Zhang DJ, Liu XY, Jia X, An CB, Ma MM, Xie YW, Barton L, Ren XY, Zhao ZJ, Wu XH, Jones MK. Agriculture facilitated permanent human occupation of the Tibetan Plateau after 3600 B.P. Science 2014; 347:248-50. [DOI: 10.1126/science.1259172] [Citation(s) in RCA: 356] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Wei D, Sardesai SR, Barton L. The C in TORCH: a cost-effective alternative to screening small-for-gestational-age infants. Neonatology 2014; 106:24-9. [PMID: 24732345 DOI: 10.1159/000358867] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infants born with birth weights under the 10th percentile for their gestational age are classified as small for gestational age (SGA). TORCH infections are reported to be associated with SGA infants. With the low incidence of infections, screening is likely to be expensive and of low utility. OBJECTIVE The objective of this study was to determine the utility and cost-effectiveness of screening SGA infants with TORCH serology titers, urine cytomegalovirus (CMV) cultures and cranial ultrasounds. METHODS A retrospective review was conducted on all infants admitted to the neonatal intensive care unit (NICU) at Los Angeles County and University of Southern California (LAC+USC) Medical Center from January 2003 to December 2011 with a diagnosis of SGA or intrauterine growth restriction. Birth characteristics such as birth weight, length, head circumference and gestational age were recorded. TORCH titer results, urine CMV results and cranial ultrasound findings were collected. RESULTS Between 2003 and 2011, 232 SGA infants were admitted to the NICU at LAC+USC Medical Center. Of these, 117 infants (50%) had TORCH titer testing performed; there was only 1 positive CMV IgM and 1 positive HSV IgM result. Repeat urine CMV testing was performed on 109 infants (47%), with a total of 296 urine CMV samples collected from these infants; 6 infants had positive results, of whom 3 had repeat positive urine CMV samples. Overall, 149 of the infants had a cranial ultrasound done, none of which were positive for calcifications. CONCLUSIONS TORCH titer testing, urine CMV screening and cranial ultrasound screening are of low yield in screening clinically asymptomatic SGA infants for TORCH infections. Given the low number of positive results, a cost-effective alternative of selective TORCH testing may be limited to infants with additional clinical findings. This study serves as a reminder to periodically examine testing practices and patient population to maximize cost-effectiveness.
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Affiliation(s)
- Daniel Wei
- Division of Neonatal Medicine, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, Los Angeles, Calif., USA
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Hall J, Barton L. Mushroom toxicosis in dogs in general practice causing gastroenteritis, ptyalism and elevated serum lipase activity. J Small Anim Pract 2013; 54:275-9. [DOI: 10.1111/jsap.12036] [Citation(s) in RCA: 5] [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] [Indexed: 12/01/2022]
Affiliation(s)
- J. Hall
- Queen's Veterinary School Hospital; University of Cambridge; Madingley Road Cambridge CB30ES
| | - L. Barton
- Queen's Veterinary School Hospital; University of Cambridge; Madingley Road Cambridge CB30ES
- Vets Now Lincoln; C/O Park View Veterinary Hospital, Hykeham Green; Lincoln Road North Hykeham Lincoln LN6 8NH
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Barton L, Futtermenger J, Gaddi Y, Kang A, Rivers J, Spriggs D, Jenkins PF, Thompson CH, Thomas JS. Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand. Clin Med (Lond) 2012; 12:119-23. [PMID: 22586784 PMCID: PMC4954094 DOI: 10.7861/clinmedicine.12-2-119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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] [Indexed: 11/27/2022]
Abstract
This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.
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Affiliation(s)
- L Barton
- The University of Western Australia
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Rayjada N, Barton L, Chan LS, Plasencia S, Biniwale M, Bui KC. Decrease in incidence of bronchopulmonary dysplasia with erythropoietin administration in preterm infants: a retrospective study. Neonatology 2012; 102:287-92. [PMID: 22922736 DOI: 10.1159/000341615] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. OBJECTIVE To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. METHODS This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. RESULTS Of 478 patients, 297 received EPO before 36 weeks' postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). CONCLUSIONS This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life.
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Affiliation(s)
- Niti Rayjada
- Center for Fetal and Neonatal Medicine and USC Division of Neonatal Medicine, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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Atkinson J, Barton L, Harrison A, Roper N. An effective system to measure and report quality indicators in acute medical units. Acute Med 2012; 11:210-215. [PMID: 23476980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new specialty. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.
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Affiliation(s)
- J Atkinson
- ST6 Acute Medicine, MRCP, Gosforth, Newcastle, UK.
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Zhang D, Chen F, Bettinger RL, Barton L, Ji D, Morgan C, Wang H, Cheng X, Dong G, Guilderson TP, Zhao H. Archaeological records of Dadiwan in the past 60 ka and the origin of millet agriculture. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s11434-010-3097-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Atkinson JM, Barton L, Price CI. Management of acute ischaemic stroke in the acute medical unit. Acute Med 2010; 9:99-103. [PMID: 21597587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Ischaemic stroke is a major cause of death and disability which costs the NHS £2.8 billion/year. Acute stroke care is developing rapidly in line with an increasing evidence base. Intravenous thrombolysis is now recommended by NICE. For this guidance to be effectively implemented stroke must be viewed as a medical emergency by both the public and professionals. Emergency medical services must work in partnership with stroke services to establish systems and protocols which offer high quality acute stroke care. This provides challenges, both in systems design and delivery of clinical care.
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Abstract
OBJECTIVE To determine the causes of neonatal death for extremely-low-birth-weight (ELBW) infants. METHODS All liveborn infants below 1000 g birth weight born from 1994 to 1998 who died and were autopsied were included. Maternal and infant characteristics, placental histology, autopsy material and culture results were obtained. RESULTS A total of 263 ELBW infants were born alive, 104 (40%) died and 44 (42%) were autopsied. Placentas were available for 41 (93%). Infection was the leading cause of death in the autopsied babies (25/44; 57%). Sixteen (64%) of these deaths occurred within the first 48 h and were classified as being due to congenital infections. Twenty-two of 41 (54%) placentas showed evidence of infection. Infection as a cause of death peaked at 22 weeks. Other causes of death were lethal anomalies (20%), respiratory distress and its complications (9%) and immaturity, intraventricular hemorrhage and other conditions (14%). CONCLUSION Congenital infection is the leading cause of death in ELBW infants.
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Affiliation(s)
- J E Hodgman
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA
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Cresswell T, Flowers M, Barton L, Martindale V. Staff opinions on casting material brands: a prospective study. Injury 2008; 39:1467-73. [PMID: 18572172 DOI: 10.1016/j.injury.2008.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/03/2008] [Accepted: 02/08/2008] [Indexed: 02/02/2023]
Abstract
AIM To determine staff opinions on the application of a sample of seven commercially available casting materials. METHODS The casting materials were supplied for an exclusive 6-week period to individual hospital departments for sole use in cast applications. Each time a staff member applied a cast they completed a blinded evaluation form to assess the following features of the material's performance: *ease with which the material unrolled; *ease with which the peg remained central on the roll; *effectiveness with which the POP casts adhered to the gauze; *stringiness of the material; *how well the material moulded; *how well the material set. The staff member also noted whether, based on their experience, they would be happy to use the material on a daily basis or not. RESULTS A total of 638 evaluation forms were completed for the purpose of this study. Of these, 183 related to POP and 455 were synthetic. Significant differences were identified between the application of POP and synthetic casts and also between the different types of material within each of these categories. Of those staff who expressed a preference, 78% said they would be happy to use POP casts on a daily basis compared to 44% happy to use synthetic casts daily. Of those happy to use POP casts 40% were happy to use Cellona, 90% Gypsona and 40% Conforma. Of those happy to use synthetic casts 20% were happy to use Cellacast, 38% Dynacast, 98% Scotchcast and 10% Deltalite. 22% of staff who expressed a preference objected to the daily use of POP casts compared to 56% who objected to synthetic casts. CONCLUSION This study has identified significant differences in application between POP casts and synthetic casts as well as between individual materials within each category. However, staff using casting materials can reach a consensus opinion on the best material to work with. When choosing a casting material, therefore, it is important to consider the application characteristics of the individual material in addition to other factors such as cost and strength. Overall, Gypsona and Scotchcast were the highest scoring materials.
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Affiliation(s)
- T Cresswell
- Department of Orthopaedics, Sheffield Children's Hospital, Western Bank, Sheffield, United Kingdom
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Abstract
OBJECTIVE The objective was to evaluate the postneonatal mortality rate at our institution from 1999 to 2006 as a follow-up to a previous report from our hospital covering 1993 to 1998 and to investigate the causes of death in infants dying in the postneonatal period. STUDY DESIGN We identified all infant deaths before discharge from the nursery aged > or =28 days. Clinical data for all cases and autopsy records where available were reviewed and the cause of death was determined for each infant. RESULT Total nursery deaths for the 7 years were 211, of which 14 (6.6%) occurred after the neonatal period. This represents a decreasing trend from the 12% reported in 1993 to 1998. Causes of death were the complications of prematurity and congenital defects. The five infants whose cause of death was the complications of prematurity had chronic lung disease, four had abdominal surgery for perforation and resection and two had intraventricular hemorrhage (IVH) Gr IV. All infants had multiple organ failure by the time of death and the final event was infection and/or renal failure. The nine congenital defects included two trisomy 21 with complications, one CHARGE association with heart defects, one hypertrophic cardiomyopathy and two others with multiple congenital heart defects. Of the three remaining infants, the anomalies included one with hydranencephaly, one with caudal regression and one with multiple vascular liver tumors. CONCLUSION Along with the general decrease in infant mortality, postneonatal mortality is decreasing as a percentage of nursery deaths. The causes of death include complications of prematurity and congenital defects.
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Affiliation(s)
- A Turlington
- USC Division of Newborn Medicine, Department of Pediatrics, Women's and Children's Hospital, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Pathan SM, Barton L, Colmer TD. Evaluation of a soil moisture sensor to reduce water and nutrient leaching in turfgrass (Cynodon dactylon cv. Wintergreen). ACTA ACUST UNITED AC 2007. [DOI: 10.1071/ea05189] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study evaluated water application rates, leaching and quality of couch grass (Cynodon dactylon cv. Wintergreen) under a soil moisture sensor-controlled irrigation system, compared with plots under conventional irrigation scheduling as recommended for domestic lawns in Perth, Western Australia by the State’s water supplier. The cumulative volume of water applied during summer to the field plots of turfgrass with the sensor-controlled system was 25% less than that applied to plots with conventional irrigation scheduling. During 154 days over summer and autumn, about 4% of the applied water drained from lysimeters in sensor-controlled plots, and about 16% drained from lysimeters in plots with conventional irrigation scheduling. Even though losses of mineral nitrogen via leaching were extremely small (representing only 1.1% of the total nitrogen applied to conventionally irrigated plots), losses were significantly lower in the sensor-controlled plots. Total clippings produced were 18% lower in sensor-controlled plots. Turfgrass colour in sensor-controlled plots was reduced during summer, but colour remained acceptable under both treatments. The soil moisture sensor-controlled irrigation system enabled automatic implementation of irrigation events to match turfgrass water requirements.
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Abstract
OBJECTIVE We sought to determine the contribution of withholding or withdrawing care to neonatal mortality in our hospital over a 10-year period from 1993 through 2002. BACKGROUND Although not initiating or withholding intensive care for certain newborns has been practiced openly for the past 25 years, little information has been published concerning the results of these practices on neonatal mortality. DESIGN AND METHODS All infants who were born in our hospital and remained in the hospital until their death were evaluated for the care they received at the time of birth and near the time of their death. The contribution of not initiating care or withdrawing care to the neonatal mortality rates in our hospital was determined. Information was obtained directly from the patients' charts as well as the neonatal database and monthly neonatal mortality and morbidity review. Other information, if needed, was obtained from the monthly ethics committee reviews of all nursery deaths. Information was collected relating to birth weight, gestational age, diagnosis, time of death, and year of death. Hospital and neonatal unit protocols were evaluated to determine how closely they were followed. RESULTS During the 10-year period, 380 deaths (0.8%) of a total of 47820 live births occurred in our hospital. Care was not initiated or was withdrawn in close to 72% of those deaths; total care until death occurred in 28%. Total care for infants who died over the 10-year period decreased markedly as care not initiated or care withdrawn increased. Most of this increase in not initiating care and in withdrawal of care was in the smaller of the extremely low birth weight infants. CONCLUSIONS The majority of nursery deaths of infants born in our hospital occurred as the result of selected noninitiating of care or as a result of withdrawing care in infants not responding or considered to have a futile outcome. Only slightly more than one quarter of the infants received total care until the time of death.
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Affiliation(s)
- Lorayne Barton
- Division of Newborn Medicine, Department of Pediatrics, Keck School of Medicine, University of Southern California, Women's & Children's Hospital, Los Angeles, California, USA.
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Barton L, Schipper LA, Barkle GF, McLeod M, Speir TW, Taylor MD, McGill AC, van Schaik AP, Fitzgerald NB, Pandey SP. Land application of domestic effluent onto four soil types: plant uptake and nutrient leaching. J Environ Qual 2005; 34:635-643. [PMID: 15758116 DOI: 10.2134/jeq2005.0635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Land application has become a widely applied method for treating wastewater. However, it is not always clear which soil-plant systems should be used, or why. The objectives of our study were to determine if four contrasting soils, from which the pasture is regularly cut and removed, varied in their ability to assimilate nutrients from secondary-treated domestic effluent under high hydraulic loadings, in comparison with unirrigated, fertilized pasture. Grassed intact soil cores (500 mm in diameter by 700 mm in depth) were irrigated (50 mm wk(-1)) with secondary-treated domestic effluent for two years. Soils included a well-drained Allophanic Soil (Typic Hapludand), a poorly drained Gley Soil (Typic Endoaquept), a well-drained Pumice Soil formed from rhyolitic tephra (Typic Udivitrand), and a well-drained Recent Soil formed in a sand dune (Typic Udipsamment). Effluent-irrigated soils received between 746 and 815 kg N ha(-1) and 283 and 331 kg P ha(-1) over two years of irrigation, and unirrigated treatments received 200 kg N ha(-1) and 100 kg P ha(-1) of dissolved inorganic fertilizer over the same period. Applying effluent significantly increased plant uptake of N and P from all soil types. For the effluent-irrigated soils plant N uptake ranged from 186 to 437 kg N ha(-1) yr(-1), while plant P uptake ranged from 40 to 88 kg P ha(-1) yr(-1) for the effluent-irrigated soils. Applying effluent significantly increased N leaching losses from Gley and Recent Soils, and after two years ranged from 17 to 184 kg N ha(-1) depending on soil type. Effluent irrigation only increased P leaching from the Gley Soil. All P leaching losses were less than 49 kg P ha(-1) after two years. The N and P leached from effluent treatments were mainly in organic form (69-87% organic N and 35-65% unreactive P). Greater N and P leaching losses from the irrigated Gley Soil were attributed to preferential flow that reduced contact between the effluent and the soil matrix. Increased N leaching from the Recent Soil was the result of increased leaching of native soil organic N due to the higher hydraulic loading from the effluent irrigation.
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Affiliation(s)
- L Barton
- School of Plant Biology (M084), The University of Western Australia, Nedlands 6009, Western Australia, Australia.
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Chiang C, Hodgman JE, Barton L. 238 THE EFFECT OF INTUBATION ON TIME OF APPEARANCE OF POSITIVE RESPIRATORY CULTURES IN VERY LOW BIRTH WEIGHT INFANTS BETWEEN 450 AND 1250 GRAMS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.237] [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: 11/18/2022]
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Duncan B, Barton L, Edmonds D, Blashill BM. Parental perceptions of the therapeutic effect from osteopathic manipulation or acupuncture in children with spastic cerebral palsy. Clin Pediatr (Phila) 2004; 43:349-53. [PMID: 15118778 DOI: 10.1177/000992280404300406] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.
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Affiliation(s)
- B Duncan
- University of Arizona, Department of Pediatrics, Tucson, AZ 85724, USA
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Holko I, Pavlásek I, Barton L, Kmet V. Comparison of digestive microflora between feedlot cattle with and without infection byCryptosporidium andersoni. Folia Microbiol (Praha) 2004; 49:165-8. [PMID: 15227789 DOI: 10.1007/bf02931393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The influence of cryptosporidial abomasitis on digestive anaerobic microflora in feedlot cattle with spontaneous Cryptosporidium andersoni colonization of abomasum was shown. Significant differences were found after the cultivation of abomasal content. Scopulariopsis brevicaulis was detected in damaged areas of infected abomasum. PCR analysis of ruminal fluid showed no differences between the two animal groups regarding qualitative composition of anaerobic and facultative anaerobic rumen microflora. The concentration of volatile fatty acids (acetate, propionate, butyrate) and ammonia in the rumen content showed that examined metabolic parameters were within normal limits except for ammonia content, which was higher in infected (291 mg/kg) than in healthy animals (203 mg/kg).
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Affiliation(s)
- I Holko
- State Veterinary Institute, 165 03 Prague, Czechia.
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Abstract
OBJECTIVE To investigate causes of death in infants who died after 28 days, beyond the neonatal period but before discharge from the nursery, to establish their clinical courses and causes of death and to attempt to find criteria for earlier identification of these infants. METHODS We identified 30 such infants (12% of nursery deaths) from 1993 through 1998 and conducted a retrospective review of their records including placental pathology and autopsy reports when available. In all, 14 infants who weighed <or = 860 g at birth were matched with survivors. RESULTS The 30 infants divided almost equally into two groups. Of them 15 infants weighing >or = 880 g died of diverse congenital anomalies, including five with nonhemolytic hydrops and four with pulmonary hypoplasia. One infant without congenital anomaly weighed 3290 g. Support for this severely asphyxiated infant was withdrawn after 103 days because of progressive cortical atrophy. The remaining 14, the largest of which weighed 860 g, died of complications of prematurity, which we termed postponed neonatal deaths (PND). They followed a typical course of progressive multiple organ failure. All received assisted ventilation and postnatal steroids, developed chronic lung disease, and were on ventilation at the time of death. Renal insufficiency occurred late in the course. Acute infections and renal failure were the major proximal causes of death. When compared with surviving controls the PND were less likely to have received antenatal steroids and received more inotropic agents for cardiovascular support and more amphotericin for fungal infection; surgery for perforated bowel was confined to the PND. CONCLUSIONS The incidence of postneonatal nursery deaths has not changed in more than 20 years remaining at 11 to 12% of nursery deaths. Congenital anomaly was a prominent cause of death (50%). When infants without congenital anomalies (PND) were compared to surviving controls, no differences were found, which could reliably identify PND early in their course. The only potentially preventable factor was lack of antenatal steroid exposure in the PND.
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Affiliation(s)
- Nathan J Robison
- Division of Neonatology, Department of Pediatrics Keck School of Medicine, Universisty of Southern California Los Angeles County, Los Angeles, CA 90033, USA
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Sweet MP, Hodgman JE, Pena I, Barton L, Pavlova Z, Ramanathan R. Two-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998. Obstet Gynecol 2003; 101:18-23. [PMID: 12517640 DOI: 10.1016/s0029-7844(02)02451-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the neurologic and developmental outcome at 2 years of age in preterm infants with birth weights 600 g or lower. METHOD We conducted a retrospective review from January 1994 through December 1998 for placental histopathology, maternal factors, neonatal intensive care unit course, growth, neurologic/special sense status, and development at 2 years of age corrected for prematurity. RESULTS Of the 104 neonates weighing 600 g or less, 24 survived to nursery discharge (23%). Two infants died of chronic lung disease after discharge, and 21 of the remaining 22 infants (95%) returned for follow-up. Placental pathology was available for 21 (95%); acute inflammation was present in 67%, and other abnormalities occurred in 76%. Mean birth weight was 537 (430-600) g, and mean gestational age was 24 (22-27) weeks. At birth, 55% were below the tenth percentile for birth weight. At nursery discharge and 2 years of age, 94% were below the tenth percentile for weight, length, and head circumference. Nineteen of 21 (90%) infants were abnormal on neurodevelopmental follow-up. Major problems were cerebral palsy, blindness, gastrostomies, and ventriculoperitoneal shunts. CONCLUSION Abnormal placental histology was present in all but one infant, suggesting fetal injury before birth. Only eight of 20 infants with chorioamnionitis were diagnosed clinically, and all infants had a complicated course. We found a high incidence of intrauterine growth restriction and an almost universal pattern of impaired postnatal growth with extremely poor neurodevelopmental outcome at 2 years of age.
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Affiliation(s)
- Matthew P Sweet
- University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA
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Jaworiwsky IS, Long JR, Barton L, Shore SG. Directive effects in bridge cleavage reactions of methyl-substituted boron hydrides. 1. Preparation and nuclear magnetic resonance spectra of 3-methylhexaborane(12), 3-methylpentaborane(11), and 1-methyltetraborane(10). Inorg Chem 2002. [DOI: 10.1021/ic50191a012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- M Hata
- Department of Chemistry, University of Missouri-St. Louis, 8001 Natural Bridge Road, St. Louis, Missouri 63121, USA
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Abstract
Animal slurries and effluents are commonly applied to soil as a source of organic N fertilizer. By increasing inorganic N, applying animal effluents may also increase soil nitrous oxide (N2O) emissions. Our objectives were to (i) determine if dairy farm effluent (DFE) irrigation increased short-term N2O emissions from a surface-drained peat soil and a freely drained mineral soil and (ii) see if this increase could be attributed to increased N availability, increased soil water content, or a combination of both factors. We measured short-term N2O emissions following DFE irrigation in spring and autumn, using closed chambers. Nitrous oxide emissions from DFE-irrigated soils (50 kg N ha(-1), 20-mm hydraulic loading) were compared with soils receiving inorganic nitrogen and water (50 kg N ha(-1), 20 mm), inorganic N only (50 kg N ha(-1)), water only (20 mm), and no treatment. Nitrous oxide emissions increased immediately following DFE irrigation to both soils, and were generally greater than emissions following the application of inorganic fertilizer with water. Increased N20 emissions following DFE irrigation coincided with increased soil water contents and mineral N and CO2 emissions. We suggest that DFE application increased N2O emissions more than inorganic N fertilizer by enhancing denitrification either by increasing C availability and/ or decreasing soil aeration following increased respiration. These findings suggest that the proportion of N applied to the soil and emitted as N2O may at times be greater for organic N fertilizers than inorganic N fertilizers, particularly if the organic N fertilizer contains sufficient available C to enhance denitrification.
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Affiliation(s)
- L Barton
- Landcare Research, Hamilton, New Zealand.
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Bould J, Kennedy JD, Thomas RL, Rath NP, Barton L. The nido-osmaboranes [2,2,2-(CO)(PPh(3))(2)-nido-2-OsB(5)H(9)] and [6,6,6-(CO)(PPh(3))(2)-nido-6-OsB(9)H(13)]. Acta Crystallogr C 2001; 57:1245-7. [PMID: 11706236 DOI: 10.1107/s0108270101012689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2001] [Accepted: 07/26/2001] [Indexed: 11/10/2022] Open
Abstract
The structural characterization of the osmahexaborane 2-carbonyl-2,2-bis(triphenylphosphine)-nido-2-osmahexaborane(9), [Os(B(5)H(9))(C(18)H(15)P)(2)(CO)], (I), a metallaborane analogue of B(6)H(10), confirms the structure proposed from NMR spectroscopy. The structure of the osmadecaborane 6-carbonyl-6,6-bis(triphenylphosphine)-nido-6-osmadecaborane(13), [Os(B(9)H(13))(C(18)H(15)P)(2)(CO)], (IV), is similarly confirmed. The short basal B-B distance of 1.652 (8) A in (I), not bridged by an H atom, mirrors that in the parent hexaborane(10) [1.626 (4) A].
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Affiliation(s)
- J Bould
- Department of Chemistry, University of Missouri-St Louis, St Louis, MO 63121, USA, and School of Chemistry, University of Leeds, Leeds LS2 9JT, England
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Abstract
AIM To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model. BACKGROUND Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community-based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities. METHODS Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes. CONCLUSIONS The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.
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Affiliation(s)
- Y S Kim-Godwin
- School of Nursing, University of North Carolina at Wilmington, North Carolina 28403, USA.
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Abstract
OBJECTIVE To evaluate nursery survival of very low birth weight infants (VLBW) over time, born in the same large inner-city hospital with a predominantly Hispanic population. METHODS All liveborn VLBW infants weighing 500-1500 g at birth were included in four time periods of 2 years' duration during 1982 to 1995. Demographics were collected for the obstetric population. Clinical data were collected including maternal and infant perinatal factors. All infants were assigned a cause of death and infants dying with lethal anomalies were then excluded from further evaluations. RESULTS Overall survival improved progressively (p = 0.0001) with dramatic improvement in survival of infants 500-750 g birth weight (BW) in period 4 (1994-1995). The number of lethal anomalies did not increase but accounted for a larger portion of deaths in period 4. Decreases in other causes of death over time reflected changes in perinatal care. Although the mothers were high-risk, none of the maternal factors evaluated showed any consistent effect on infant survival. Improved labor and delivery care was associated with improvement in Apgar scores, a decrease in intracranial hemorrhage/intraventricular hemorrhage as a cause of death and an improvement in survival between the first two periods. In spite of the increase in Cesarean sections for infants of 500-750 g BW and their improved survival in period 4, no clear advantage for Cesarean section could be demonstrated. The marked improvement seen in period 4 was associated with three changes in care: increased use of maternal steroids, administration of surfactant, and the use of newer ventilatory methods including high-frequency oscillatory ventilation. Although female gender has been reported to confer a protective influence for survival, this was not found in the final period. Black mothers comprised only about 2.5% of the total obstetric population but delivered approximately 10% of the VLBW infants. Despite the increased incidence of small for gestational age (SGA) among black infants, there were no differences in survival between blacks and Hispanics. Mean birth weight and gestational age in both survivors and nonsurvivors decreased significantly over the four time periods. In period 4, 50% survival occurred at a birth weight of 600-700 g and a gestational age of 23 weeks. CONCLUSION Nursery survival improved throughout the period of the study from 1982 to 1995 but especially during period 4 (1994-1995). Improved survival was associated with changes in both maternal and infant care. In infants of BW 500-750 g, gestational age rather than birth weight was more closely associated with survival.
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Affiliation(s)
- A J Teberg
- Departments of Pediatrics and Biostatistics, Division of Newborn Medicine, Keck School of Medicine of the University of Southern California, CA, USA
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