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Consult Questions: Communication is key. Acad Pediatr 2024:S1876-2859(24)00163-3. [PMID: 38796058 DOI: 10.1016/j.acap.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
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Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes. Anaesthesia 2023; 78:1365-1375. [PMID: 37531295 PMCID: PMC10952313 DOI: 10.1111/anae.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/04/2023]
Abstract
Postoperative systemic inflammation is strongly associated with surgical outcomes, but its relationship with patient-centred outcomes is largely unknown. Detection of excessive inflammation and patient and surgical factors associated with adverse patient-centred outcomes should inform preventative treatment options to be evaluated in clinical trials and current clinical care. This retrospective cohort study analysed prospectively collected data from 3000 high-risk, elective, major abdominal surgery patients in the restrictive vs. liberal fluid therapy for major abdominal surgery (RELIEF) trial from 47 centres in seven countries from May 2013 to September 2016. The co-primary endpoints were persistent disability or death up to 90 days after surgery, and quality of recovery using a 15-item quality of recovery score at days 3 and 30. Secondary endpoints included: 90-day and 1-year all-cause mortality; septic complications; acute kidney injury; unplanned admission to intensive care/high dependency unit; and total intensive care unit and hospital stays. Patients were assigned into quartiles of maximum postoperative C-reactive protein concentration up to day 3, after multiple imputations of missing values. The lowest (reference) group, quartile 1, C-reactive protein ≤ 85 mg.l-1 , was compared with three inflammation groups: quartile 2 > 85 mg.l-1 to 140 mg.l-1 ; quartile 3 > 140 mg.l-1 to 200 mg.l-1 ; and quartile 4 > 200 mg.l-1 to 587 mg.l-1 . Greater postoperative systemic inflammation had a higher adjusted risk ratio (95%CI) of persistent disability or death up to 90 days after surgery, quartile 4 vs. quartile 1 being 1.76 (1.31-2.36), p < 0.001. Increased inflammation was associated with increasing decline in risk-adjusted estimated medians (95%CI) for quality of recovery, the quartile 4 to quartile 1 difference being -14.4 (-17.38 to -10.71), p < 0.001 on day 3, and -5.94 (-8.92 to -2.95), p < 0.001 on day 30. Marked postoperative systemic inflammation was associated with increased risk of complications, poor quality of recovery and persistent disability or death up to 90 days after surgery.
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Seasonal variability in body mass index change among children enrolled in the Pediatric Obesity Weight Evaluation Registry: A step in the right direction. Pediatr Obes 2023; 18:e13012. [PMID: 36811325 PMCID: PMC10150645 DOI: 10.1111/ijpo.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Research has shown children disproportionately gain excess weight over the summer months (vs. school months), with stronger effects for children with obesity. However, the question has not been investigated among children receiving care in paediatric weight management (PWM) programs. OBJECTIVE To test for seasonal variability in weight change among youth with obesity in PWM care enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). METHOD Longitudinal evaluation of a prospective cohort from 2014 to 2019 among youth in 31 PWM programs. Change in percentage of the 95th percentile for BMI (%BMIp95) was compared by quarter. RESULTS Participants (N = 6816) were primarily ages 6-11 (48%), female (54%), 40% non-Hispanic White, 26% Hispanic and 17% Black, and 73% had severe obesity. Children were enrolled on average 424.9 ± 401.5 days. Participants reduced their %BMIp95 every season, but compared with Quarter 3 (July-September), reductions were significantly greater in Q1 (Jan-March, b = -0.27, 95%CI -0.46, -0.09), Q2 (April-June, b = -0.21, CI -0.40, -0.03), and Q4 (October-December, b = -0.44, CI -0.63, -0.26). CONCLUSION AND RELEVANCE Across 31 clinics nationwide, children reduced their %BMIp95 every season, but reductions were significantly smaller during the summer quarter. While PWM successfully mitigated excess weight gain during every period, summer remains a high-priority time.
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Experiences that matter in bipolar disorder: a qualitative study using the capability, comfort and calm framework. Int J Bipolar Disord 2023; 11:13. [PMID: 37079153 PMCID: PMC10119352 DOI: 10.1186/s40345-023-00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND When assessing the value of an intervention in bipolar disorder, researchers and clinicians often focus on metrics that quantify improvements to core diagnostic symptoms (e.g., mania). Providers often overlook or misunderstand the impact of treatment on life quality and function. We wanted to better characterize the shared experiences and obstacles of bipolar disorder within the United States from the patient's perspective. METHODS We recruited 24 individuals diagnosed with bipolar disorder and six caretakers supporting someone with the condition. Participants were involved in treatment or support services for bipolar disorder in central Texas. As part of this qualitative study, participants discussed their everyday successes and obstacles related to living with bipolar disorder during personalized, open-ended interviews. Audio files were transcribed, and Nvivo software processed an initial thematic analysis. We then categorized themes into bipolar disorder-related obstacles that limit the patient's capability (i.e., function), comfort (i.e., relief from suffering) and calm (i.e., life disruption) (Liu et al., FebClin Orthop 475:315-317, 2017; Teisberg et al., MayAcad Med 95:682-685, 2020). We then discuss themes and suggest practical strategies that might improve the value of care for patients and their families. RESULTS Issues regarding capability included the struggle to maintain identity, disruptions to meaningful employment, relationship loss and the unpredictable nature of bipolar disorder. Comfort related themes included the personal perception of diagnosis, social stigma and medication issues. Calm themes included managing dismissive doctors, finding the right psychotherapist and navigating financial burdens. CONCLUSIONS Qualitative data from patients with bipolar disorder helps identify gaps in care or practical limitations to treatment. When we listen to these individuals, it is clear that treatments must also address the unmet psychosocial impacts of the condition to improve patient care, capability and calm.
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Interplay Between Adiposity and Clinical Measurements of Lower Extremity Neuromuscular Performance in Children. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Enhanced Concentric Torque After Eccentric Loading is A Positive Contributor to Dynamic Balance In Children. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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On Differentiating Multiple Types of ULF Magnetospheric Waves in Response to Solar Wind Periodic Density Structures. JOURNAL OF GEOPHYSICAL RESEARCH. SPACE PHYSICS 2022; 127:e2021JA030144. [PMID: 35859722 PMCID: PMC9285707 DOI: 10.1029/2021ja030144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/13/2022] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
Identifying the nature and source of ultra-low frequencies (ULF) waves (f ⪅ 4 mHz) at discrete frequencies in the Earth's magnetosphere is a complex task. The challenge comes from the simultaneous occurrence of externally and internally generated waves, and the ability to robustly identify such perturbations. Using a recently developed robust spectral analysis procedure, we study an interval that exhibited in magnetic field measurements at geosynchronous orbit and in-ground magnetic observatories both internally supported and externally generated ULF waves. The event occurred on 9 November 2002 during the interaction of the magnetosphere with two interplanetary shocks that were followed by a train of 90 min solar wind periodic density structures. Using the Wang-Sheeley-Arge model, we mapped the source of this solar wind stream to an active region and a mid-latitude coronal hole just prior to crossing the Heliospheric current sheet. In both the solar wind density and magnetospheric field fluctuations, we separated broad power increases from enhancements at specific frequencies. For the waves at discrete frequencies, we used the combination of satellite and ground magnetometer observations to identify differences in frequency, polarization, and observed magnetospheric locations. The magnetospheric response was characterized by: (a) forced breathing by periodic solar wind dynamic pressure variations below ≈1 mHz, (b) a combination of directly driven oscillations and wave modes triggered by additional mechanisms (e.g., shock and interplanetary magnetic field discontinuity impact, and substorm activity) between ≈1 and 4 mHz, and (c) largely triggered modes above ≈4 mHz.
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Laryngeal complications after tracheal intubation and tracheostomy. BJA Educ 2021; 21:250-257. [PMID: 34178381 DOI: 10.1016/j.bjae.2021.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
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Effects of Lactanase on the plasma lactate response to intense exercise in horses. COMPARATIVE EXERCISE PHYSIOLOGY 2020. [DOI: 10.3920/cep200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A commonly held belief is that lactate production during exercise limits performance via fatigue. The current study aimed to assess the effects of a supplement marketed as performance enhancing (Lactanase®) on equine exercise performance and plasma lactate concentrations. Lactanase was expected to alter exercise performance and plasma lactate. Eight healthy, unfit Standardbred horses (four geldings and four mares, 9±3 years, 489±33 kg, mean ± standard error) were administered Lactanase (5 doses of 25 g) top-dressed on a commercial pelleted ration or unsupplemented pellets (Control) in a cross-over design experiment. Doses were administered over a four-day period and horses performed a graded exercise test on the fourth day following the final dose of either Lactanase or control. Blood samples (20 ml) were obtained via jugular catheter 30 min prior to exercise, immediately prior to exercise, in the last 10 s of each incremental exercise step, and 5 and 60 min post-exercise. Samples were frozen at -80 °C until further analysis. Data were analysed using a two-way repeated measures ANOVA. Statistically different means were separated using Student-Newman-Keuls and Dunnetts. No differences (P>0.05) in total run time were observed following Lactanase administration. Plasma lactate increased (P<0.05) when horses reached a speed of 7 m/s and remained elevated through 60 min post-exercise. There was no effect (P>0.05) of Lactanase on the plasma lactate response during exercise. Similarly, supplementation did not affect (P>0.05) plasma glucose or total protein at any time point. Exercise did increase plasma total protein (P<0.05), but it returned to baseline levels by 60 min post-exercise. Plasma glucose was elevated (P<0.05) post-exercise. These results indicate Lactanase administration does not alter the lactate response or the total run time to fatigue during intense incremental exercise in horses.
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Gynecologic oncology postoperative patient discharge experience in the time of enhanced recovery after surgery (ERAS) and opioid epidemic. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Data on the modulatory effects of a single bolus dexamethasone on the surface marker expression of various leucocyte subsets. Data Brief 2020; 32:106117. [PMID: 32904373 PMCID: PMC7452708 DOI: 10.1016/j.dib.2020.106117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/29/2023] Open
Abstract
Dexamethasone is frequently administered to surgical patients for anti-emetic prophylaxis. We have examined the immunomodulatory effects of a single bolus of dexamethasone on circulating peripheral blood mononuclear cells (PBMCs) in the same 10 healthy male volunteers, previously used in our investigation on early in vivo effects of a single anti-emetic dose of dexamethasone on innate immune cell gene expression and activation [1]. Blood samples were drawn at baseline, 2 h, 4 h and 24 h. Immune cell phenotypes were examined with flow cytometry. In this data article the expression strength of markers involved in immune activation and immunosuppression as well as maturation, migration, cell death and responsiveness to signalling on monocyte and cDC subsets, as well as NK cells, CD4+ and CD8+ T cells and regulatory T cells (Treg) are presented. These data improve our understanding of the immunomodulatory effects of the glucocorticoid dexamethasone in-vivo, which may be important for the optimisation of treatment regimens as well as the evaluation of new indications for glucocorticoid treatment.
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Intussusception in 2 Children With Severe Acute Respiratory Syndrome Coronavirus-2 Infection. J Pediatric Infect Dis Soc 2020; 9:504-506. [PMID: 32770243 PMCID: PMC7454795 DOI: 10.1093/jpids/piaa096] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
We note that intussusception was likely associated with severe acute respiratory syndrome coronavirus-2 infection in 2 infants in Wuhan and London. The intussusception was reduced by enemas in Wuhan; the outcome was fatal. The intussusception was not reduced by enemas in London and required surgery; the outcome was favorable.
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Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia 2020; 75:1659-1670. [PMID: 32396986 PMCID: PMC7272992 DOI: 10.1111/anae.15120] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2020] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme's 'Safe Tracheostomy Care' workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol-generating procedures and risks to staff; insertion procedures; and management following tracheostomy.
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Density function theory (DFT) calculated infrared absorption spectra for nitrosamines. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2019; 80:1967-1974. [PMID: 32144228 DOI: 10.2166/wst.2020.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Absorption spectra within the infrared (IR) range of frequencies for nitrosamines in water are calculated using density function theory (DFT). Calculated in this study, are the IR spectra of C2H6N2O, C4H10N2O, C6H14N2O, C4H8N2O, C3H8N2O, and C8H18N2O. DFT calculated absorption spectra corresponding to vibration excited states of these molecules in continuous water background can be correlated with additional information obtained from laboratory measurements. The DFT software Gaussian was used for the calculations of excited states presented here. This case study provides proof of concept, viz., that such DFT calculated spectra can be used for their practical detection in environmental samples. Thus, DFT calculated spectra may be used to construct templates, for spectral-feature comparison, and thus detection of spectral-signature features associated with target materials.
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Duration of trans-laryngeal intubation before tracheostomy is associated with laryngeal injury when assessed using Fibreoptic Endoscopic Evaluation of Swallow. Br J Anaesth 2019. [DOI: 10.1016/j.bja.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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From smartphone to bed-side: exploring the use of social media to disseminate recommendations from the National Tracheostomy Safety Project to front-line clinical staff. Anaesthesia 2019; 75:227-233. [PMID: 31250430 DOI: 10.1111/anae.14747] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/27/2022]
Abstract
Traditional methods used to disseminate educational resources to front-line healthcare staff have several limitations. Social media may increase the visibility of these resources among targeted groups and communities. Our project aimed to disseminate key clinical messages from the National Tracheostomy Safety Project to those caring for patients with tracheostomies or laryngectomies. We commissioned an external media company to design educational material and devise a marketing strategy. We developed videos to communicate recommendations from the safety project and used Facebook, Twitter, YouTube and LinkedIn to deliver these to our target users. We recorded 629,270 impressions over a paid 12-week campaign. Our YouTube channel registered more than a five-fold increase in views and watch time during the campaign as compared with the previous year. Around two-thirds of views across all platforms were from peer-to-peer sharing. We spent £4140 on social media advertising, with each view and click costing £0.02 and £0.67, respectively. This intelligence-led approach using social media is an effective and efficient method to disseminate knowledge on the principles of safe tracheostomy care to front-line clinical staff. Similar strategies may be effective for other patient safety topics, especially when targeting groups that do not use medical journals or other traditional means of dissemination.
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Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER. J Pediatr 2019; 208:57-65.e4. [PMID: 30853195 DOI: 10.1016/j.jpeds.2018.12.049] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US. STUDY DESIGN This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling. RESULTS We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were -1.88 (IQR, -5.8 to 1.4), -2.50 (IQR, -7.4 to 1.8), -2.86 (IQR, -8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors. CONCLUSIONS Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02121132.
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Public perceptions of equine welfare classification and subsequent use. J Equine Vet Sci 2019. [DOI: 10.1016/j.jevs.2019.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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Helios Observations of Quasiperiodic Density Structures in the Slow Solar Wind at 0.3, 0.4, and 0.6 AU. JOURNAL OF GEOPHYSICAL RESEARCH. SPACE PHYSICS 2019; 124:837-860. [PMID: 32908809 PMCID: PMC7477809 DOI: 10.1029/2018ja026182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/09/2019] [Indexed: 06/11/2023]
Abstract
Following previous investigations of quasiperiodic plasma density structures in the solar wind at 1 AU, we show using the Helios1 and Helios2 data their first identification in situ in the inner heliosphere at 0.3, 0.4, and 0.6 AU. We present five events of quasiperiodic density structures with time scales ranging from a few minutes to a couple of hours in slow solar wind streams. Where possible, we locate the solar source region of these events using photospheric field maps from the Mount Wilson Observatory as input for the Wang-Sheeley-Arge model. The detailed study of the plasma properties of these structures is fundamental to understanding the physical processes occurring at the origin of the release of solar wind plasma. Temperature changes associated with the density structures are consistent with these periodic structures developing in the solar atmosphere as the solar wind is formed. One event contains a flux rope, suggesting that the solar wind was formed as magnetic reconnection opened up a previously closed flux tube at the Sun. This study highlights the types of structures that Parker Solar Probe and the upcoming Solar Orbiter mission will observe, and the types of data analyses these missions will enable. The data from these spacecrafts will provide additional in situ measurements of the solar wind properties in the inner heliosphere allowing, together with the information of the other interplanetary probes, a more comprehensive study of solar wind formation.
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Using the 6-minute walk test to predict disability-free survival after major surgery. Br J Anaesth 2019; 122:111-119. [DOI: 10.1016/j.bja.2018.08.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
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Targeted Reforms in Health Care Financing to Improve the Care of Adolescents and Young Adults. Pediatrics 2018; 142:peds.2018-2998. [PMID: 30455343 DOI: 10.1542/peds.2018-2998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Significant changes have occurred in the commercial and government insurance marketplace after the passage of 2 federal legislation acts, the Patient Protection and Affordable Care Act of 2010 and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. Despite the potential these 2 acts held to improve the health care of adolescents and young adults (AYAs), including the financing of care, there are barriers to achieving this goal. In the first quarter of 2016, 13.7% of individuals 18 to 24 years of age still lacked health insurance. Limitations in the scope of benefits coverage and inadequate provider payment can curtail access to health care for AYAs, particularly care related to sexual and reproductive health and mental and behavioral health. Some health plans impose financial barriers to access because they require families to absorb high cost-sharing expenses (eg, deductibles, copayments, and coinsurance). Finally, challenges of confidentiality inherent in the billing and insurance claim practices of some health insurance plans can discourage access to health care in the absence of other obstacles and interfere with provision of confidential care. This policy statement summarizes the current state of impediments that AYA, including those with special health care needs, face in accessing timely and appropriate health care and that providers face in serving these patients. These impediments include limited scope of benefits, high cost sharing, inadequate provider payment, and insufficient confidentiality protections. With this statement, we aim to improve both access to health care by AYAs and providers' delivery of developmentally appropriate health care for these patients through the presentation of an overview of the issues, specific recommendations for reform of health care financing for AYAs, and practical actions that pediatricians and other providers can take to advocate for appropriate payments for providing health care to AYAs.
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EXPLORING THE CAREGIVING EXPERIENCE OF LATINO AND NON-HISPANIC WHITE CAREGIVERS ACROSS FOUR AGE COHORTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
For many teenagers, obtaining a driver's license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15-19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.
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Post-intubation laryngeal injury is not associated with significantly worse secretion management when assessed by fibreoptic endoscopic evaluation of swallow. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2018.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Optimizing blood management in gynecologic cancer patients undergoing laparotomy. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The early in-vivo effects of a single anti-emetic dose of dexamethasone on innate immune cell gene expression and activation in healthy volunteers. Anaesthesia 2018; 73:955-966. [DOI: 10.1111/anae.14306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
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30
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Collaborative national consensus and prioritisation of tracheostomy quality improvements in the United Kingdom. Br J Anaesth 2018. [DOI: 10.1016/j.bja.2017.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Is this resectable? Validation and refinement of a CT model to predict residual disease and surgical complexity in advanced ovarian cancer. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reducing blood transfusion rates in gynecologic oncology patients through application of bundled interventions. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study. BMJ Open 2017; 7:e014634. [PMID: 28420662 PMCID: PMC5541438 DOI: 10.1136/bmjopen-2016-014634] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/20/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Against a background of failure to prevent neonatal invasive early-onset group B Streptococcus infections (GBS) in our maternity unit using risk-based approach for intrapartum antibiotic prophylaxis, we introduced an antenatal GBS carriage screening programme to identify additional women to target for prophylaxis. OBJECTIVES To describe the implementation and outcome of an antepartum screening programme for prevention of invasive early-onset GBS infection in a UK maternity unit. DESIGN Observational study of outcome of screening programme (intervention) with comparison to historical controls (preintervention). SETTING Hospital and community-based maternity services provided by Northwick Park and Central Middlesex Hospitals in North West London. PARTICIPANTS Women who gave birth between March 2014 and December 2015 at Northwick Park Hospital. METHODS Women were screened for GBS at 35-37 weeks and carriers offered intrapartum antibiotic prophylaxis. Screening programme was first introduced in hospital (March 2014) and then in community (August 2014). Compliance was audited by review of randomly selected case records. Invasive early-onset GBS infections were defined through GBS being cultured from neonatal blood, cerebrospinal fluid or sterile fluids within 0-6 days of birth. MAIN OUTCOME Incidence of early-onset GBS infections. RESULTS 6309 (69%) of the 9098 eligible women were tested. Screening rate improved progressively from 42% in 2014 to 75% in 2015. Audit showed that 98% of women accepted the offer of screening. Recto-vaginal GBS carriage rate was 29.4% (1822/6193). All strains were susceptible to penicillin but 11.3% (206/1822) were resistant to clindamycin. Early onset GBS rate fell from 0.99/1000 live births (25/25276) in the prescreening period to 0.33/1000 in the screening period (Rate Ratio=0.33; p=0.08). In the subset of mothers actually screened, the rate was 0.16/1000 live births (1/6309), (Rate Ratio=0.16; p<0.05). CONCLUSIONS Our findings confirm that an antenatal screening programme for prevention of early-onset GBS infection can be implemented in a UK maternity setting and is associated with a fall in infection rates.
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Abstract
Youth in the criminal justice system commonly suffer from multiple medical and psychological health problems. Because they likely live in lower socioeconomic environments, the medical care they receive through the justice system might be their only recent medical care and can result in the discovery of health problems or chronic illnesses that must be managed while in the system and beyond. We describe the case of an adolescent diagnosed with a serious chronic disease during his time in an urban detention center to illustrate how health workers and justice staff must use a team approach in caring for this vulnerable population of children. Barriers to appropriate care, including social and systems-level challenges, are discussed. The lessons learned in this case can be applied more broadly to other vulnerable youth populations, including those in foster care and impoverished communities where the primary care pediatrician (or other assigned pediatric specialist) is both the leader of the medical team and an advocate for quality care.
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Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial. Br J Anaesth 2016; 117:801-811. [DOI: 10.1093/bja/aew338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022] Open
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Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice. Vet Rec 2016; 179:515-520. [PMID: 27856985 PMCID: PMC5256232 DOI: 10.1136/vr.103862] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Numerous professional bodies have questioned whether traditional input-based continuing professional development (CPD) schemes are effective at measuring genuine learning and improving practice performance and patient health. The most commonly used type of long-established CPD activities, such as conferences, lectures and symposia, have been found to have a limited effect on improving practitioner competence and performance, and no significant effect on patient health outcomes. Additionally, it is thought that the impact of many CPD activities is reduced when they are undertaken in isolation outside of a defined structure of directed learning. In contrast, CPD activities which are interactive, encourage reflection on practice, provide opportunities to practice skills, involve multiple exposures, help practitioners to identify between current performance and a standard to be achieved, and are focused on outcomes, are the most effective at improving practice and patient health outcomes.
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Review of Outcomes, Practices and Reimbursement: A Comparison of Hysterectomy for Benign and Malignant Conditions Using the National Surgical Quality Improvement Program Database. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Utility of a targeted NGS oncology assay for circulating tumor DNA in a multi-histology clinical setting. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw380.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Impact of sentinel node approach to endometrial cancer on fellowship training. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.08.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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P109 Cumulative exposure to racial discrimination across time and domains: exploring racism’s long term impact on the mental health of ethnic minority people in the UK. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Twenty-nine inferior phrenic artery embolizations were performed in 20 patients with primary or metastatic hepatic neoplasms. All patients had interruption of their hepatic arteries by previous infusion of chemotherapy, hepatic arterial embolization or surgical ligation. In one patient, bilateral pleural effusions developed following embolization of the inferior phrenic artery. No other severe complications occurred. Inferior phrenic artery embolization is a safe procedure and permits the continuation of transcatheter treatment of hepatic neoplasms.
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Abstract
Sixty-seven patients had hilar cholangiocarcinomas which were divided into 3 types based on tumor morphology as observed on cholangiography and CT. The pathology, vascularity, and pattern of tumor spread of these types were compared. Most of the infiltrative tumors (n = 44) were scirrhous adenocarcinomas, which on CT showed poor or no contrast enhancement with frequent lymph node metastases and liver atrophy. At angiography, there was vascular encasement in 52%, in rare cases neovascularity, and tumor stain. The exophytic type (n = 19) was divided into 2 subgroups depending on the main location of the tumor. The nodular subtype (n = 16) was mainly inside the liver and somewhat hypervascular similar to peripheral cholangiocarcinoma, often with intrahepatic metastases. The periductal subtype (n = 3) was hypovascular, similar to the infiltrative cholangiocarcinoma, and had a tendency to spread along the portal vein. The intraductal type (n = 4) was observed as a filling defect on cholangiography. CT revealed an intraluminal low density mass. Histologically, they were papillary adenocarcinomas. The radiologic types of hilar cholangiocarcinoma showed different characteristics with regard to pathologic findings, vascularity, and pattern of spread.
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20: Transdermal light neuromodulation: First investigation of optogenetics in the urinary tract. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Disrupted nitric oxide signaling due to GUCY1A3 mutations increases risk for moyamoya disease, achalasia and hypertension. Clin Genet 2016; 90:351-60. [PMID: 26777256 DOI: 10.1111/cge.12739] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/23/2022]
Abstract
Moyamoya disease (MMD) is a progressive vasculopathy characterized by occlusion of the terminal portion of the internal carotid arteries and its branches, and the formation of compensatory moyamoya collateral vessels. Homozygous mutations in GUCY1A3 have been reported as a cause of MMD and achalasia. Probands (n = 96) from unrelated families underwent sequencing of GUCY1A3. Functional studies were performed to confirm the pathogenicity of identified GUCY1A3 variants. Two affected individuals from the unrelated families were found to have compound heterozygous mutations in GUCY1A3. MM041 was diagnosed with achalasia at 4 years of age, hypertension and MMD at 18 years of age. MM149 was diagnosed with MMD and hypertension at the age of 20 months. Both individuals carry one allele that is predicted to lead to haploinsufficiency and a second allele that is predicted to produce a mutated protein. Biochemical studies of one of these alleles, GUCY1A3 Cys517Tyr, showed that the mutant protein (a subunit of soluble guanylate cyclase) has a significantly blunted signaling response with exposure to nitric oxide (NO). GUCY1A3 missense and haploinsufficiency mutations disrupt NO signaling leading to MMD and hypertension, with or without achalasia.
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Wastewater treatment in a compact intensified wetland system at the Badboot: a floating swimming pool in Belgium. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:12870-12878. [PMID: 25369915 DOI: 10.1007/s11356-014-3726-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/14/2014] [Indexed: 06/04/2023]
Abstract
The Badboot (Dutch for swimming pool boat) is a floating swimming pool located in the city center of Antwerp in Belgium. The overall design consists of a recycled ferry boat that serves as a restaurant and next to that a newly built ship that harbours an Olympic size swimming pool, sun decks, locker rooms with showers, and a party space. A major design goal of the project was to make the ship as environmentally friendly as possible. To avoid discharge of contaminated waste water in the Antwerp docks, the ship includes onsite treatment of wastewater in a compact constructed wetland. The treatment wetland system was designed to treat wastewater from visitor locker rooms, showers, toilets, two bars, and the wastewater from the restaurant kitchen. Due to the limited space on board the ship, only 188 m(2) could be allocated to a wetland treatment system. As a result, part of the design included intensification of the wetland treatment process through the use of Forced Bed Aeration, which injects small quantities of air in a very uniform grid pattern throughout the wetland with a mechanical air compressor. The system was monitored between August 2012 and March 2013 (with additional sampling in the autumn of 2014). Flows and loads to the wetland were highly variable, but removal efficiency was extremely high; 99.5 % for chemical oxygen demand (COD), 88.6 % for total nitrogen and 97.2 % for ammonia. The treatment performance was assessed using a first-order, tanks-in-series model (the P-k-C* model) and found to be roughly equivalent to similar intensified wetlands operating in Germany. However, treatment performance was substantially better than data reported on passive wetlands, likely as a result of intensification. Even with mechanically assisted aeration, the total oxygen delivered to the treatment wetlands was insufficient to support conventional nitrification and denitrification, so it is likely that alternate nitrogen removal pathways, such as anammox, are operating in the wetland.
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Refusal of recommended chemotherapy for ovarian cancer: Risk factors and outcomes, a National Cancer Database study. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fibroblast growth factor-21, body composition, and insulin resistance in pre-pubertal and early pubertal males and females. Clin Endocrinol (Oxf) 2015; 82:550-6. [PMID: 25039824 PMCID: PMC4289452 DOI: 10.1111/cen.12552] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/10/2014] [Accepted: 07/07/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Accumulating evidence derived primarily from animal models suggests that fibroblast growth factor-21 (FGF-21) may affect the musculoskeletal system via effects on the capacity of tissues to respond to insulin. A proportion of musculoskeletal properties and underpinnings of promoting/preventing insulin resistance are established early in the pubertal transition. Thus, the objective of this study was to test the hypothesis that insulin resistance and/or obesity will promote greater FGF-21 concentration which will be inversely associated with musculoskeletal parameters [lean mass and bone mineral content (BMC)] in pre-/early pubertal children. Given the sexual dimorphic nature of musculoskeletal development of fat mass accrual, differences by obesity status and sex were also investigated. DESIGN Cross-sectional. PATIENTS Children ages 7-12 years (n = 69, 38% male, 48% non-Hispanic black, 45% obese). MEASUREMENTS Fasting FGF-21, glucose and insulin measures were obtained. An estimate of insulin resistance was derived using the homoeostatic model assessment of insulin resistance (HOMA-IR). Body composition (BMC, lean mass and fat mass) was assessed by DXA. Multivariate regression analysis was used to evaluate the influence of FGF-21 on BMC, lean mass and HOMA-IR as dependent variables. Obesity status was established based on BMI z-score. RESULTS FGF-21 concentrations did not differ by obesity status or by sex. There was an inverse association between FGF-21 and BMC among nonobese individuals (P = 0·01) and an inverse association between FGF-21 and lean mass among females (P = 0·02), which were both independent of fat mass. FGF-21 was inversely associated with HOMA-IR in males, but not females (P = 0·04). CONCLUSIONS The existence of relationships of FGF-21 with musculoskeletal parameters and insulin resistance raises the possibility of crosstalk between these systems. These findings suggest that circulating FGF-21 may differ in its association with bone, lean mass and insulin resistance depending on sex and weight status.
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