Publications by authors named "Grace Park"

86 Publications

Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives.

Aging Med (Milton) 2021 Mar 21;4(1):4-11. Epub 2021 Jan 21.

Health Sciences and Innovation Surrey Memorial Hospital Fraser Health Surrey British Columbia Canada.

Background: Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID-19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health.

Methods: Two focus groups enrolled home-living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in-home care for frail older adults were administered at audio-recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software.

Results: The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology-based supports and suggested that telehealth / health-monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty.

Conclusions: The integrated perspectives provided an updated understanding of what older adults and practitioners value in home-living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.
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http://dx.doi.org/10.1002/agm2.12144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954833PMC
March 2021

Two novel loci underlie natural differences in Caenorhabditis elegans abamectin responses.

PLoS Pathog 2021 Mar 15;17(3):e1009297. Epub 2021 Mar 15.

Molecular Biosciences, Northwestern University, Evanston, Illinois, United States of America.

Parasitic nematodes cause a massive worldwide burden on human health along with a loss of livestock and agriculture productivity. Anthelmintics have been widely successful in treating parasitic nematodes. However, resistance is increasing, and little is known about the molecular and genetic causes of resistance for most of these drugs. The free-living roundworm Caenorhabditis elegans provides a tractable model to identify genes that underlie resistance. Unlike parasitic nematodes, C. elegans is easy to maintain in the laboratory, has a complete and well annotated genome, and has many genetic tools. Using a combination of wild isolates and a panel of recombinant inbred lines constructed from crosses of two genetically and phenotypically divergent strains, we identified three genomic regions on chromosome V that underlie natural differences in response to the macrocyclic lactone (ML) abamectin. One locus was identified previously and encodes an alpha subunit of a glutamate-gated chloride channel (glc-1). Here, we validate and narrow two novel loci using near-isogenic lines. Additionally, we generate a list of prioritized candidate genes identified in C. elegans and in the parasite Haemonchus contortus by comparison of ML resistance loci. These genes could represent previously unidentified resistance genes shared across nematode species and should be evaluated in the future. Our work highlights the advantages of using C. elegans as a model to better understand ML resistance in parasitic nematodes.
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http://dx.doi.org/10.1371/journal.ppat.1009297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993787PMC
March 2021

Neutrophil dysfunction in cystic fibrosis.

J Cyst Fibros 2021 Feb 13. Epub 2021 Feb 13.

Massachusetts General Hospital, Mucosal Immunology and Biology Research Center, Boston, MA, United States; Harvard Medical School, Department of Pediatrics, Boston, MA, United States.

Background: Excessive neutrophil inflammation is the hallmark of cystic fibrosis (CF) airway disease. Novel technologies for characterizing neutrophil dysfunction may provide insight into the nature of these abnormalities, revealing a greater mechanistic understanding and new avenues for CF therapies that target these mechanisms.

Methods: Blood was collected from individuals with CF in the outpatient clinic, CF individuals hospitalized for a pulmonary exacerbation, and non-CF controls. Using microfluidic assays and advanced imaging technologies, we characterized 1) spontaneous neutrophil migration using microfluidic motility mazes, 2) neutrophil migration to and phagocytosis of Staphylococcal aureus particles in a microfluidic arena, 3) neutrophil swarming on Candida albicans clusters, and 4) Pseudomonas aeruginosa-induced neutrophil transepithelial migration using micro-optical coherence technology (µOCT).

Results: Participants included 44 individuals: 16 Outpatient CF, 13 Hospitalized CF, and 15 Non-CF individuals. While no differences were seen with spontaneous migration, CF neutrophils migrated towards S. aureus particles more quickly than non-CF neutrophils (p < 0.05). CF neutrophils, especially Hospitalized CF neutrophils, generated significantly larger aggregates around S. aureus particles over time. Hospitalized CF neutrophils were more likely to have dysfunctional swarming (p < 0.01) and less efficient clearing of C. albicans (p < 0.0001). When comparing trans-epithelial migration towards Pseudomonas aeruginosa epithelial infection, Outpatient CF neutrophils displayed an increase in the magnitude of transmigration and adherence to the epithelium (p < 0.05).

Conclusions: Advanced technologies for characterizing CF neutrophil function reveal significantly altered migratory responses, cell-to-cell clustering, and microbe containment. Future investigations will probe mechanistic basis for abnormal responses in CF to identify potential avenues for novel anti-inflammatory therapeutics.
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http://dx.doi.org/10.1016/j.jcf.2021.01.012DOI Listing
February 2021

Symptoms upon postural change and orthostatic hypotension in adolescents with concussion.

Brain Inj 2021 Jan 17;35(2):226-232. Epub 2021 Jan 17.

UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.

: Concussion is associated with dysautonomia, altered blood pressure (BP) control, and may cause Orthostatic Hypotension (OH). We measured prevalence of OH using the 1-minute supine-to-standing OH Test in adolescents with concussion and controls.: Adolescents within 10 days of injury (Concussion Group, n = 297, 15.0 ± 1.7 years, 59% male) were compared with controls (Control Group, n = 214, 15.0 ± 1.5 years, 58% male).: BP, heart rate (HR), and complaints of lightheadedness/dizziness were measured after 2-minute supine and 1-minute standing. Control Group was assessed once. Concussion Group was assessed twice; (1) initial visit (mean 6.0 ± 3 days-since-injury) and (2) after clinical recovery (mean 46.3 ± 42 days-since-injury).: Initial visit; Concussion Group reported feeling lightheaded/dizzy on postural change more often than the Control Group (37% vs 4%,  < .001) but did not differ in meeting standard OH criteria (3% vs 5%,  = .32). Experiencing symptoms did not correlate with meeting OH criteria, but correlated with abnormal vestibulo-ocular reflex. After clinical recovery; Concussion Group did not differ in experiencing lightheaded/dizziness on postural change than controls (4%,  = .65).: Adolescents commonly experience orthostatic intolerance after concussion without meeting the standard criteria for OH.
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http://dx.doi.org/10.1080/02699052.2021.1871951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033637PMC
January 2021

Are non-abstinent reductions in World Health Organization drinking risk level a valid treatment target for alcohol use disorders in adolescents with ADHD?

Addict Behav Rep 2020 Dec 5;12:100312. Epub 2020 Nov 5.

Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Introduction: Abstinence from drinking represents the primary treatment target for alcohol use disorders (AUD) in youth, but few adolescents who engage in problematic drinking seek treatment. A reduction in World Health Organization (WHO) drinking risk level has been established as valid and reliable non-abstinent treatment target for AUD in adults but remains unstudied in youth.

Methods: The present study used data from the NIDA-CTN-0028 trial to examine associations between reductions in WHO drinking risk level and changes in global functioning and attention-deficit hyperactivity disorder (ADHD) symptoms during treatment in a sample of adolescents (ages 13-18 years) with ADHD and comorbid substance use disorder (SUD) (n = 297, 61% with AUD) receiving a 16-week intervention that combined ADHD pharmacotherapy (OROS-methylphenidate vs. placebo) and drug-focused cognitive-behavioral therapy.

Results: Shifts in drinking risk level during treatment were highly variable in adolescents treated for ADHD/SUD, and influenced by AUD diagnostic status. In the total sample, 15% of participants had a 2-level or greater reduction in WHO drinking risk level, with 59% and 24% showing no change or an increase in risk-level during treatment respectively. Achieving at least a 2-level change in WHO drinking risk level during treatment was associated with greater reduction in ADHD symptoms and better functional outcomes.

Conclusions: These findings parallel the adult AUD literature and provide preliminary support for the use 2-level reductions in WHO risk levels for alcohol use as a clinically valid non-abstinent treatment outcome for youth with ADHD and comorbid AUD.
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http://dx.doi.org/10.1016/j.abrep.2020.100312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752731PMC
December 2020

Organismal Fructose Metabolism in Health and Non-Alcoholic Fatty Liver Disease.

Biology (Basel) 2020 Nov 18;9(11). Epub 2020 Nov 18.

Department of Biological Chemistry, University of California Irvine, Irvine, CA 92697, USA.

NAFLD has alarmingly increased, yet FDA-approved drugs are still lacking. An excessive intake of fructose, especially in liquid form, is a dietary risk factor of NAFLD. While fructose metabolism has been studied for decades, it is still controversial how fructose intake can cause NAFLD. It has long been believed that fructose metabolism solely happens in the liver and accordingly, numerous studies have investigated liver fructose metabolism using primary hepatocytes or liver cell lines in culture. While cultured cells are useful for studying detailed signaling pathways and metabolism in a cell-autonomous manner, it is equally important to understand fructose metabolism at the whole-body level in live organisms. In this regard, recent in vivo studies using genetically modified mice and stable isotope tracing have tremendously expanded our understanding of the complex interaction between fructose-catabolizing organs and gut microbiota. Here, we discuss how the aberrant distribution of fructose metabolism between organs and gut microbiota can contribute to NAFLD. We also address potential therapeutic interventions of fructose-elicited NAFLD.
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http://dx.doi.org/10.3390/biology9110405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698815PMC
November 2020

Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children.

BMC Med Res Methodol 2020 09 11;20(1):228. Epub 2020 Sep 11.

Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA.

Background: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions.

Methods: A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic.

Results: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens.

Conclusions: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
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http://dx.doi.org/10.1186/s12874-020-01110-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483494PMC
September 2020

Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses.

J Pediatr 2020 12 20;227:45-52.e5. Epub 2020 Aug 20.

Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.

Objectives: As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical.

Study Design: Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified.

Results: A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed.

Conclusions: This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.
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http://dx.doi.org/10.1016/j.jpeds.2020.08.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438214PMC
December 2020

Establishment of a Pediatric COVID-19 Biorepository: Unique Considerations and Opportunities for Studying the Impact of the COVID-19 Pandemic on Children.

Res Sq 2020 Aug 10. Epub 2020 Aug 10.

Massachusetts General Hospital.

: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples in a standardized manner to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. : A broad study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. : Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. : Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility, and, immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
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http://dx.doi.org/10.21203/rs.3.rs-42030/v1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430592PMC
August 2020

Defining the characteristics of intermediate care models including transitional care: an international Delphi study.

Aging Clin Exp Res 2020 Nov 19;32(11):2399-2410. Epub 2020 May 19.

Jefe de Servicio de Geriatría Hospital Universitario de Getafe, Getafe, Spain.

Background: Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions.

Aim: To identify and define the characteristics of intermediate care models.

Methods: A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted.

Results: Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models.

Discussion: There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination.

Conclusions: This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.
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http://dx.doi.org/10.1007/s40520-020-01579-zDOI Listing
November 2020

A Computerized Frailty Assessment Tool at Points-of-Care: Development of a Standalone Electronic Comprehensive Geriatric Assessment/Frailty Index (eFI-CGA).

Front Public Health 2020 31;8:89. Epub 2020 Mar 31.

Health Sciences and Innovation, Surrey Memorial Hospital, Surrey, BC, Canada.

Frailty is characterized by loss of biological reserves and is associated with an increased risk of adverse health outcomes. Frailty can be operationalized using a Frailty Index (FI) based on the accumulation of health deficits; items under health evaluation in the well-established Comprehensive Geriatric Assessment (CGA) have been used to generate an FI-CGA. Traditionally, constructing the FI-CGA has relied on paper-based recording and manual data processing. As this can be time-consuming and error-prone, it limits widespread uptake of this proven type of frailty assessment. Here, we report the development of an electronic tool, the eFI-CGA, for use on personal computers by frontline healthcare providers, to collect CGA data and automate FI-CFA calculation. The ultimate goal is to support early identification and management of frailty at points-of-care, and make uptake in Electronic Medical Records (EMR) feasible and transparent. An electronic CGA (eCGA) form was implemented to operate on Microsoft's WinForms platform and coded using C# programming language. Users complete the eCGA form, from which items under the CGA evaluation are automatically retrieved and processed to output an eFI-CGA score. A user-friendly interface and secured data saving methods were implemented. The software was debugged and tested using systematically designed simulation data, addressing different logic, syntax, and application errors, and then tested with clinical assessment. The user manual and manual scoring were used as ground truth to compare eFI-CGA input and automated eFI score calculations. Frontline health-provider user feedback was incorporated to improve the end-user experience. The Standalone eFI-CGA software tool was developed and optimized for use on personal computers. The user interface adapted the design of paper-based CGA form to facilitate familiarity for clinical users. Compared to known scores, the software tool generated eFI-CGA scores with 100% accuracy to four decimal places. The eFI-CGA allowed secure data storage and retrieval of multiple types, including user input, completed eCGA form, coded items, and calculated eFI-CGA scores. It also permitted recording of actions requiring clinical follow-up, facilitating care planning. Application bugs were identified and resolved at various stages of the implementation, resulting in efficient system performance. Accurate, robust, and reliable computerized frailty assessments are needed to promote effective frailty assessment and management, as a key tool in health care systems facing up to frailty. Our research has enabled the delivery of the standalone eFI-CGA software technology to empower effective frailty assessment and management by various healthcare providers at points-of-care, facilitating integrated care of older adults.
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http://dx.doi.org/10.3389/fpubh.2020.00089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137764PMC
March 2020

Neurosensory Screening and Symptom Provocation in Pediatric Mild Traumatic Brain Injury.

J Head Trauma Rehabil 2020 Jul/Aug;35(4):270-278

The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico (Drs Mayer, Stephenson, Hanlon, and Phillips, Messrs Wertz, Dodd, and Shaff, and Mss Robertson-Benta and Pabbathi Reddy); Departments of Psychiatry and Behavioral Sciences (Dr Mayer), Psychology (Drs Mayer and Campbell), Neurology (Drs Mayer and Phillips), and Emergency Medicine (Mr Oglesbee and Dr Park), University of New Mexico, Albuquerque; Department of Epidemiology and Biostatistics, University of Arizona, Tucson (Dr Bedrick); Center for Injury Research and Prevention, Department of Pediatrics (Drs Master, Grady, and Arbogast), and Division of Orthopedic Surgery (Drs Master and Grady), The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada (Dr Zemek); Department of Psychology (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), University of Calgary, Calgary, Alberta, Canada; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee (Dr Meier); Departments of Cell Biology, Neurobiology and Anatomy (Dr Meier) and Biomedical Engineering (Dr Meier), Medical College of Wisconsin, Milwaukee; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Mannix); and UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York (Dr Leddy).

Objective: To evaluate diagnostic/prognostic implications of neurosensory testing during the subacute stage in patients with pediatric mild traumatic brain injury (pmTBI).

Setting: Recruitment from pediatric emergency department and urgent care clinics, assessment in a controlled environment.

Participants: In total, 146 pmTBI patients evaluated 7.4 ± 2.3 days and approximately 4 months postinjury; 104 age/sex-matched healthy controls (HCs) at equivalent time points.

Design: Prospective cohort study.

Main Measures: Neurosensory examination based on sequence of 10 established tests of vestibular-ocular, oculomotor, vestibulospinal, and visual functioning.

Results: The amount of symptom provocation (positive change from pretest symptomatology) was significantly increased in pmTBI relative to HCs on every subtest 1 week postinjury, as were deficits in monocular accommodative amplitude and King-Devick Test errors. However, symptom provocation did not meaningfully alter diagnostic sensitivity/specificity relative to more easily obtained pretest symptom ratings. Evidence of clinically significant symptom provocation 1 week postinjury improved sensitivity (Δ = +12.9%) of identifying patients with persistent postconcussive symptoms 4 months postinjury on an independent symptom measure.

Conclusions: The diagnostic sensitivity/specificity of neurosensory testing in acutely concussed youth may be limited at 1 week postinjury as a function of natural recovery occurring in most emergency department cohorts. Neurosensory screening may have greater utility for identifying patients who experience delayed recovery.
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http://dx.doi.org/10.1097/HTR.0000000000000560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335318PMC
July 2021

Comparison of Methods for Classifying Persistent Post-Concussive Symptoms in Children.

J Neurotrauma 2020 07 12;37(13):1504-1511. Epub 2020 Mar 12.

Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA.

Pediatric mild traumatic brain injury (pmTBI) has received increased public scrutiny over the past decade, especially regarding children who experience persistent post-concussive symptoms (PPCS). However, several methods for defining PPCS exist in clinical and scientific literature, and even healthy children frequently exhibit non-specific, concussive-like symptoms. Inter-method agreement (six PPCS methods), observed misclassification rates, and other psychometric properties were examined in large cohorts of consecutively recruited adolescent patients with pmTBI ( = 162) 1 week and 4 months post-injury and in age/sex-matched healthy controls (HC;  = 117) at equivalent time intervals. Six published PPCS methods were stratified into Simple Change (e.g., , 10th revision [ICD-10]) and Standardized Change (e.g., reliable change indices) algorithms. Among HC, test-retest reliability was fair to good across the 4-month assessment window, with evidence of bias (i.e., higher symptom ratings) during retrospective relative to other assessments. Misclassification rates among HC were higher (>30%) for Simple Change algorithms, with poor inter-rater reliability of symptom burden across HC and their parents. A 49% spread existed in terms of the proportion of pmTBI patients "diagnosed" with PPCS at 4 months, with superior inter-method agreement among standardized change algorithms. In conclusion, the self-reporting of symptom burden is only modestly reliable in typically developing adolescents over a 4-month period, with additional evidence for systematic bias in both adolescent and parental ratings. Significant variation existed for identifying pmTBI patients who had "recovered" (i.e., those who did not meet individual criteria for PPCS) from concussion across the six definitions, representing a considerable challenge for estimating the true incidence rate of PPCS in published literature. Although relatively straightforward to obtain, current findings question the utility of the most commonly used Simple Change scores for diagnosis of PPCS in clinical settings.
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http://dx.doi.org/10.1089/neu.2019.6805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307699PMC
July 2020

Persistent alterations in cerebrovascular reactivity in response to hypercapnia following pediatric mild traumatic brain injury.

J Cereb Blood Flow Metab 2020 12 5;40(12):2491-2504. Epub 2020 Jan 5.

The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.

Much attention has been paid to the effects of mild traumatic brain injury (mTBI) on cerebrovascular reactivity in adult populations, yet it remains understudied in pediatric injury. In this study, 30 adolescents (12-18 years old) with pediatric mTBI (pmTBI) and 35 age- and sex-matched healthy controls (HC) underwent clinical and neuroimaging assessments during sub-acute (6.9 ± 2.2 days) and early chronic (120.4 ± 11.7 days) phases of injury. Relative to controls, pmTBI reported greater initial post-concussion symptoms, headache, pain, and anxiety, resolving by four months post-injury. Patients reported increased sleep issues and exhibited deficits in processing speed and attention across both visits. In grey-white matter interface areas throughout the brain, pmTBI displayed increased maximal fit/amplitude of a time-shifted end-tidal CO regressor to blood oxygen-level dependent response relative to HC, as well as increased latency to maximal fit. The alterations persisted through the early chronic phase of injury, with maximal fit being associated with complaints of ongoing sleep disturbances during post hoc analyses but not cognitive measures of processing speed or attention. Collectively, these findings suggest that deficits in the speed and degree of cerebrovascular reactivity may persist longer than current conceptualizations about clinical recovery within 30 days.
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http://dx.doi.org/10.1177/0271678X19896883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820694PMC
December 2020

Radiologic common data elements rates in pediatric mild traumatic brain injury.

Neurology 2020 01 23;94(3):e241-e253. Epub 2019 Oct 23.

From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada.

Objective: The nosology for classifying structural MRI findings following pediatric mild traumatic brain injury (pmTBI) remains actively debated. Radiologic common data elements (rCDE) were developed to standardize reporting in research settings. However, some rCDE are more specific to trauma (probable rCDE). Other more recently proposed rCDE have multiple etiologies (possible rCDE), and may therefore be more common in all children. Independent cohorts of patients with pmTBI and controls were therefore recruited from multiple sites (New Mexico and Ohio) to test the dual hypothesis of a higher incidence of probable rCDE (pmTBI > controls) vs similar rates of possible rCDE on structural MRI.

Methods: Patients with subacute pmTBI (n = 287), matched healthy controls (HC; n = 106), and orthopedically injured (OI; n = 71) patients underwent imaging approximately 1 week postinjury and were followed for 3-4 months.

Results: Probable rCDE were specific to pmTBI, occurring in 4%-5% of each sample, rates consistent with previous large-scale CT studies. In contrast, prevalence rates for incidental findings and possible rCDE were similar across groups (pmTBI vs OI vs HC). The prevalence of possible rCDE was also the only finding that varied as a function of site. Possible rCDE and incidental findings were not associated with postconcussive symptomatology or quality of life 3-4 months postinjury.

Conclusion: Collectively, current findings question the trauma-related specificity of certain rCDE, as well how these rCDE are radiologically interpreted. Refinement of rCDE in the context of pmTBI may be warranted, especially as diagnostic schema are evolving to stratify patients with structural MRI abnormalities as having a moderate injury.
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http://dx.doi.org/10.1212/WNL.0000000000008488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108809PMC
January 2020

Incorporation of Mindfulness Exercises to Reduce Anxiety During Urodynamic Testing: A Randomized Single-Blind Controlled Pilot Trial.

J Altern Complement Med 2020 Jan 25;26(1):74-75. Epub 2019 Sep 25.

Brooke Army Medical Center, Fort Sam Houston, TX.

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http://dx.doi.org/10.1089/acm.2018.0447DOI Listing
January 2020

Emerging investigator series: characterization of silver and silver nanoparticle interactions with zinc finger peptides.

Environ Sci Nano 2019 Aug 19;6(8):2367-2378. Epub 2019 Jul 19.

Department of Chemistry & Biochemistry Santa Clara University Santa Clara, CA 95053, USA.

In biological systems, chemical and physical transformations of engineered silver nanomaterials (AgENMs) are mediated, in part, by proteins and other biomolecules. Metalloprotein interactions with AgENMs are also central in understanding toxicity and antimicrobial and resistance mechanisms. Despite their readily available thiolate and amine ligands, zinc finger (ZF) peptides have thus far escaped study in reaction with AgENMs and their Ag(I) oxidative dissolution product. We report spectroscopic studies that characterize AgENM and Ag(I) interactions with two ZF peptides that differ in sequence, but not in metal binding ligands: the ZF consensus peptide CP-CCHC and the C-terminal zinc finger domain of HIV-1 nucleocapsid protein p7 (NCp7_C). Both ZF peptides catalyze AgENM (10 and 40 nm, citrate coated) dissolution and agglomeration, two important AgENM transformations that impact bioreactivity. AgENMs and their oxidative dissolution product, Ag(I)(), mediate changes to ZF peptide structure and metalation as well. Spectroscopic titrations of Ag(I) into apo-ZF peptides show an Ag(I)-thiolate charge transfer band, indicative of Ag(I)-ZF binding. Fluorescence studies of the Zn(II)-NCp_7 complex indicate that the Ag(I) also effectively competes with the Zn(II) to drive Zn(II) displacement from the ZFs. Upon interaction with AgENMs, Zn(II) bound ZF peptides show a secondary structural change in circular dichroism spectroscopy toward an apo-like structure. The results suggest that Ag(I) and AgENMs may alter ZF protein function within the cell.
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http://dx.doi.org/10.1039/C9EN00065HDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746224PMC
August 2019

Proactive inhibition deficits with normal perfusion after pediatric mild traumatic brain injury.

Hum Brain Mapp 2019 12 28;40(18):5370-5381. Epub 2019 Aug 28.

Emergency Medicine, University of New Mexico, Albuquerque, New Mexico.

Although much attention has been generated in popular media regarding the deleterious effects of pediatric mild traumatic brain injury (pmTBI), a paucity of empirical evidence exists regarding the natural course of biological recovery. Fifty pmTBI patients (12-18 years old) were consecutively recruited from Emergency Departments and seen approximately 1 week and 4 months post-injury in this prospective cohort study. Data from 53 sex- and age-matched healthy controls (HC) were also collected. Functional magnetic resonance imaging was obtained during proactive response inhibition and at rest, in conjunction with independent measures of resting cerebral blood flow. High temporal resolution imaging enabled separate modeling of neural responses for preparation and execution of proactive response inhibition. A priori predictions of failed inhibitory responses (i.e., hyperactivation) were observed in motor circuitry (pmTBI>HC) and sensory areas sub-acutely and at 4 months post-injury. Paradoxically, pmTBI demonstrated hypoactivation (HC>pmTBI) during target processing, along with decreased activation within prefrontal cognitive control areas. Functional connectivity within motor circuitry at rest suggested that deficits were limited to engagement during the inhibitory task, whereas normal resting cerebral perfusion ruled out deficits in basal perfusion. In conclusion, current results suggest blood oxygen-level dependent deficits during inhibitory control may exceed commonly held beliefs about physiological recovery following pmTBI, potentially lasting up to 4 months post-injury.
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http://dx.doi.org/10.1002/hbm.24778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864901PMC
December 2019

Étude en population de la fréquence de navigation et de contact pour soins palliatifs avant le décès de patients atteints de cancer.

Can Oncol Nurs J 2019 1;29(1):25-33. Epub 2019 Feb 1.

Programme de soins du cancer de la Nouvelle-Écosse, Régie de la santé de la Nouvelle-Écosse, Halifax, Nouvelle-Écosse.

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http://dx.doi.org/10.5737/236880762912533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516242PMC
February 2019

Population surveillance of navigation frequency and palliative care contact before death among cancer patients.

Can Oncol Nurs J 2019 1;29(1):17-24. Epub 2019 Feb 1.

Nova Scotia Cancer Care Program, Nova Scotia Health Authority, Halifax, NS.

Cancer patient navigation in Canada began in 2002 in Nova Scotia with oncology nurses providing support to patients from diagnosis up to and including end of life. This novel study was carried out to determine navigation frequency and palliative care contact rates, and variations in these rates among adults who were diagnosed with cancer, navigated, and then died between 2011 and 2014. Among the 2,532 study subjects, 56.7% were navigated for more than one month and 30.6% had palliative care contact reported. Variations were observed by geographic area, cancer stage, time from diagnosis to death, and whether the person died of cancer. Further study of the role of navigation is advised for persons at end of life.
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http://dx.doi.org/10.5737/236880762911724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6516249PMC
February 2019

Practice Patterns in Pharmacological and Non-Pharmacological Therapies for Children with Mild Traumatic Brain Injury: A Survey of 15 Canadian and United States Centers.

J Neurotrauma 2019 10 17;36(20):2886-2894. Epub 2019 Jun 17.

Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI. The survey, developed by a panel of pediatric mTBI experts, consisted of a 10-item survey instrument regarding providers' perception of common pediatric mTBI symptoms and mTBI interventions. Surveys were distributed electronically to a convenience sample of local experts at each center. Frequencies and percentages (with confidence intervals [CI]) were determined for survey responses. One hundred and seven respondents (71% response rate) included specialists in pediatric Emergency Medicine, Sports Medicine, Neurology, Neurosurgery, Neuropsychology, Neuropsychiatry, Physical and Occupational Therapy, Physiatry/Rehabilitation, and General Pediatrics. Respondents rated headache as the most prevalently reported symptom after pediatric mTBI, followed by cognitive problems, dizziness, and irritability. Of the 65 (61%; [95% CI: 51,70]) respondents able to prescribe medications, non-steroidal anti-inflammatory medications (55%; [95% CI: 42,68]) and acetaminophen (59%; [95% CI: 46,71]) were most commonly recommended. One in five respondents reported prescribing amitriptyline for headache management after pediatric mTBI, whereas topiramate (8%; [95% CI: 3,17]) was less commonly reported. For cognitive problems, methylphenidate (11%; [95% CI: 4,21]) was used more commonly than amantadine (2%; [95% CI: 0,8]). The most common non-pharmacological interventions were rest ("always" or "often" recommended by 83% [95% CI: 63,92] of the 107 respondents), exercise (59%; [95%CI: 49,69]), vestibular therapy (42% [95%CI: 33,53]) and cervical spine exercises (29% [95%CI: 21,39]). Self-reported utilization for common pediatric mTBI interventions varied widely across our Canadian and United States consortium. Future effectiveness studies for pediatric mTBI are urgently needed to advance the evidence-based care.
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http://dx.doi.org/10.1089/neu.2018.6290DOI Listing
October 2019

Immune reconstitution in ART treated, but not untreated HIV infection, is associated with abnormal beta cell function.

PLoS One 2018 24;13(5):e0197080. Epub 2018 May 24.

Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.

HIV infection has been associated with increased diabetes risk, but prior work has mostly focused on insulin resistance, as opposed to beta cell effects, or included patients on antiretroviral therapies (ART) directly linked to metabolic toxicity. In this analysis, we measured markers of glucose homeostasis and beta cell function, stress, and death in fasting sera from a cross section of HIV+ individuals off ART (n = 43), HIV+ individuals on ART (n = 23), and HIV- controls (n = 39). Markers included glucose, HOMA%S, HOMA%B, proinsulin:C-peptide ratio (PI:C ratio), and circulating preproinsulin (INS) DNA. We performed multiple linear regressions with adjustments for age, sex, race, BMI, and smoking status. Compared to HIV- controls, HIV+ participants off ART exhibited similar beta cell function and insulin sensitivity, without increases in markers of beta cell stress or death. Specifically, in HIV+ participants with CD4 counts <350 cells/μL, PI:C ratios were lower than in HIV- controls (p<0.01), suggesting a reduction in intrinsic beta cell stress among this group. By contrast, HIV+ participants on ART had higher fasting glucose (p<0.0001) and lower HOMA%B (p<0.001) compared to HIV- controls. Among the entire HIV+ population, higher HIV RNA correlated with lower fasting glucose (r = -0.57, p<0.001), higher HOMA%B (r = 0.40, p = 0.001), and lower PI:C ratios (r = -0.42, p<0.001), whereas higher CD4 counts correlated with higher PI:C ratios (r = 0.2, p = 0.00499). Our results suggest that HIV seropositivity in the absence of ART does not worsen beta cell function or glucose homeostasis, but immune reconstitution with ART may be associated with worsened beta cell function.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197080PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967701PMC
August 2018

Neurosensory Deficits Vary as a Function of Point of Care in Pediatric Mild Traumatic Brain Injury.

J Neurotrauma 2018 05 20;35(10):1178-1184. Epub 2018 Mar 20.

5 Division of Orthopedic Surgery, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.

Neurosensory abnormalities are frequently observed following pediatric mild traumatic brain injury (pmTBI) and may underlie the expression of several common concussion symptoms and delay recovery. Importantly, active evaluation of neurosensory functioning more closely approximates real-world (e.g., physical and academic) environments that provoke symptom worsening. The current study determined whether symptom provocation (i.e., during neurosensory examination) improved classification accuracy relative to pre-examination symptom levels and whether symptoms varied as a function of point of care. Eighty-one pmTBI were recruited from the pediatric emergency department (PED; n = 40) or outpatient concussion clinic (n = 41), along with matched (age, sex, and education) healthy controls (HC; n = 40). All participants completed a brief (∼ 12 min) standardized neurosensory examination and clinical questionnaires. The magnitude of symptom provocation upon neurosensory examination was significantly higher for concussion clinic than for PED patients. Symptom provocation significantly improved diagnostic classification accuracy relative to pre-examination symptom levels, although the magnitude of improvement was modest, and was greater in the concussion clinic. In contrast, PED patients exhibited worse performance on measures of balance, vision, and oculomotor functioning than the concussion clinic patients, with no differences observed between both samples and HC. Despite modest sample sizes, current findings suggest that point of care represents a critical but highly under-studied variable that may influence outcomes following pmTBI. Studies that rely on recruitment from a single point of care may not generalize to the entire pmTBI population in terms of how neurosensory deficits affect recovery.
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http://dx.doi.org/10.1089/neu.2017.5340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953216PMC
May 2018

Acute toxicity of Corexit EC9500A and assessment of dioctyl sulfosuccinate as an indicator for monitoring four oil dispersants applied to diluted bitumen.

Environ Toxicol Chem 2018 05 15;37(5):1309-1319. Epub 2018 Feb 15.

Pacific & Yukon Laboratory for Environmental Testing, Science & Technology Branch, Pacific Environmental Science Centre, Environment & Climate Change Canada, North Vancouver, British Columbia, Canada.

The present study investigated oil dispersant toxicity to fish species typical of the cooler regions of Canada, together with less well-documented issues pertaining to oil dispersant monitoring. The oil dispersant toxicity of Corexit EC9500A was assessed for the freshwater fish species rainbow trout and the seawater species coho, chinook, and chum, with a final median lethal concentration (LC50) acute lethality range between 35.3 and 59.8 mg/L. The LC50 range was calculated using confirmed 0-h dispersant concentrations that were justified by fish mortality within the first 24 h of exposure and by variability of the dispersant indicator dioctyl sulfosuccinate (DOSS) used to monitor concentrations at later time points. To investigate DOSS as an oil dispersant indicator in the environment, microcosm systems were prepared containing Corexit EC9500A, Finasol OSR52, Slickgone NS, and Slickgone EW dispersants together with diluted bitumen. The DOSS indicator recovery was found to be stable for up to 13 d at 5 °C, 8 d at 10 °C, but significantly less than 8 d at ≥15 °C. After 3 d at temperatures ≥15 °C, the DOSS indicator recovery became less accurate and was dependent on multiple environmental factors including temperature, microbial activity, and aeration, with potential for loss of solvents and stabilizers. A final assessment determined DOSS to be a discrepant indicator for long-term monitoring of oil dispersant in seawater. Environ Toxicol Chem 2018;37:1309-1319. © 2018 SETAC.
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http://dx.doi.org/10.1002/etc.4065DOI Listing
May 2018

Defining and characterizing sustained remission in patients with rheumatoid arthritis.

Clin Rheumatol 2018 Apr 9;37(4):885-893. Epub 2017 Dec 9.

Amgen Inc., Thousand Oaks, CA, USA.

The objective of this study is to characterize stability and clinical features of patients with rheumatoid arthritis (RA) in sustained remission. Combination therapy with methotrexate and tumor necrosis factor inhibitors (TNFi) has increased remission rates in RA but optimal regimens to maintain remission are unknown. We describe Study of Etanercept And Methotrexate in Combination or as Monotherapy in Subjects with Rheumatoid Arthritis (SEAM-RA) and data from a run-in period of longitudinal observation. Patients in Simplified Disease Activity Index (SDAI) remission (score ≤ 3.3) receiving etanercept and methotrexate were screened and had to maintain remission over 3 run-in visits/24 weeks before randomization to combination therapy or withdrawal of etanercept or methotrexate. Baseline characteristics were examined for predictive factors for maintaining remission. As of November 2016, 141 patients have enrolled; of these, 64 have been randomized, 34 were ineligible after run-in, and 43 are in run-in period; 70% have completed run-in. Enrolled and randomized patients, respectively, had mean (standard deviation [SD]) disease duration 11.0 (8.6) and 12.6 (9.7) years; mean (SD) duration of etanercept use 4.2 (3.8) and 4.9 (4.2) years; mean (SD) methotrexate dose 15.9 (4.8) and 15.5 (4.9) mg/week; and mean (SD) SDAI scores 1.5 (0.9) and 1.4 (0.8). At enrollment, 73% and 63% were in Boolean remission based on 28 joints and 66/68 joints, respectively. No enrollment characteristic predicted successful completion of run-in. Two-thirds of patients considered to be in remission at enrollment sustained remission through 24 weeks. Baseline characteristics of enrolled patients and those who completed run-in were comparable.
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http://dx.doi.org/10.1007/s10067-017-3923-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880849PMC
April 2018

Reversing Frailty Levels in Primary Care Using the CARES Model.

Can Geriatr J 2017 Sep 28;20(3):105-111. Epub 2017 Sep 28.

Department of Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS.

Background: The purpose of this manuscript was to evaluate the effectiveness of the Community Actions and Resources Empowering Seniors (CARES) model in measuring and mitigating frailty among community-dwelling older adults.

Methods: The CARES model is based on a goal-oriented multidisciplinary primary care plan which combines a comprehensive geriatric assessment (CGA) with health coaching. A total of 51 older adults (82 ± 7 years; 33 females) participated in the pilot phase of this initiative. Frailty was measured using the Clinical Frailty Scale (CFS) and the Frailty Index (FI-CGA) at baseline and at six-month follow-up.

Results: The FI-CGA at follow-up (0.21 ± 0.08) was significantly lower than the FI-CGA at baseline (0.24 ± 0.08), suggesting an average reduction of 1.8 deficits. Sixty-one per cent of participants improved their FI-CGA and 38% improved CFS categories. Participants classified as vulnerable/frail at baseline were more responsive to the intervention compared to non-frail participants.

Conclusion: Pilot data showed that it is feasible to assess frailty in primary care and that the CARES intervention might have a positive effect on frailty, a promising finding that requires further investigations. General practitioners who participate in the CARES model can now access their patients' FI-CGA scores at point of service through their electronic medical records.
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http://dx.doi.org/10.5770/cgj.20.274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624254PMC
September 2017

Detection of urine DNA markers for monitoring recurrent hepatocellular carcinoma.

Hepatoma Res 2017 6;3:105-111. Epub 2017 Jun 6.

The Baruch S. Blumberg Institute, Doylestown, PA 18902, USA.

Aim: This study aimed to explore the potential of detecting hepatocellular carcinoma (HCC)-associated DNA markers, mutations and aberrant methylation of and genes, for monitoring HCC recurrence. HCC remains a leading cause of death worldwide, with one of the fastest growing incidence rates in the US. While treatment options are available and new ones emerging, there remains a poor prognosis of this disease mostly due to its late diagnosis and high recurrence rate. Although there are no specific guidelines addressing how HCC recurrence should be monitored, recurrence is usually monitored by serum-alpha fetal protein and imaging methods such as magnetic resonance imaging (MRI). However, early detection of recurrent HCC remains limited, particularly at the site of treated lesion.

Methods: Here, the authors followed 10 patients that were treated for a primary HCC, and monitored for months or years later. At these follow-up visits, urine was collected and tested retrospectively for 3 DNA biomarkers that associate with HCC development.

Results: This 10-patient study compared detection of urine DNA markers with MRI for monitoring HCC recurrence. Five patients were confirmed by MRI for recurrence, and all 5 had detectable DNA biomarkers up to 9 months before recurrence confirmation by MRI.

Conclusion: Overall, this suggests that detection of HCC-associated DNA markers in urine could provide a promising tool to complement detection of recurrent HCC by imaging.
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http://dx.doi.org/10.20517/2394-5079.2017.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546802PMC
June 2017

Randomized single-blinded clinical trial on effects of nursery songs for infants and young children's anxiety before and during head CT.

Am J Emerg Med 2016 Mar 21;34(3):663. Epub 2015 Dec 21.

Department of Music, University of New Mexico, Albuquerque, NM; Department of Internal Medicine, University of New Mexico, Albuquerque, NM.

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http://dx.doi.org/10.1016/j.ajem.2015.12.049DOI Listing
March 2016