Publications by authors named "Kayla Brown"

20 Publications

  • Page 1 of 1

Development of a mobile application for acute pain management in U.S. military healthcare.

Appl Nurs Res 2021 Apr 8;58:151393. Epub 2020 Dec 8.

711th Human Performance Wing, Air Force Research Laboratory, En Route Care Research, 2510 5th Street, Bldg 840, Wright-Patterson AFB, OH 45433, United States of America.

One of the most significant challenges faced by the U.S. military health system is effective pain management. In resource-denied environments such as En Route Care (ERC), patient care begins with effective acute pain management and is vital to ensure optimal long-term patient outcomes. An electronic, mobile pain management application (app) called the Bee Better app was developed to address the gaps in acute pain management for patients transported throughout the ERC system. The app enables patients to track self-reported acute pain data, provides education and evidenced-based non-pharmacologic interventions during transport. The Delphi method was used as a novel approach to solicit feedback from subject matter experts to systematically enhance the app development process. In its current state, the app tracks patients' reported pain data and information regarding medication intake and provides educational resources about medications and the flight environment. Optimally in the future, the app will deliver real-time therapeutic pain interventions, integrate with the electronic health record and communicate with providers in real-time during care, enabling better patient-centered pain management in the austere ERC environment. Initial usability scores were above industry standards indicating a potential benefit in using a rigorous process for healthcare app development. These mobile apps may enable increased self-management and autonomy in resource-limited environments and optimize outcomes of acute pain management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.apnr.2020.151393DOI Listing
April 2021

Enteral Nutrition in the Deployed Critical Care Ground and Air Transport Environment: A Narrative Review.

Mil Med 2021 01;186(Suppl 1):311-315

711 Human Performance Wing, Air Force Research Lab.

Introduction: Early and adequate administration of enteral nutrition (EN) improves outcomes in critical care patients. However, the environment where Critical Care Air Transport teams provide patient care poses particular challenges to achieving the same standard of nutritional support readily administered in civilian intensive care units. Providing the highest standard of nutritional care in austere military environments remains the goal for all patients despite inherent challenges. Enteral nutrition, specifically, is not currently a standard of practice in-flight because of concerns for microaspiration and the associated risk of developing ventilator-associated pneumonia. Clinical concern for aspiration combines with the lack of an EN pump approved for use through Safe-to-Fly testing to further decrease the likelihood of initiating EN in trauma patients. Early EN significantly reduces morbidity and mortality risks; therefore, the lack of nutritional support is contrary to established standards of care in civilian intensive care units. Hence, this literature review proposes to provide a clearer understanding of current EN practices as well as any associated risks within the En Route Care system.

Method: A narrative review of literature related to EN in military and civilian flight settings using the PRISMA methodology.

Results: A search using the key terms of critical care, air ambulance, EN, nutritional status, and aspiration returned a total of 51,990 articles. A title review followed by a more targeted abstract analysis by the research team generated 39 articles for full-text review. The full-text review then yielded a total of 10 relevant articles for inclusion in the final synthesis table.

Conclusions: Overall, the consensus of the literature supports that early evaluation and initiation of standard EN feeding protocols on the ground and during transport improves patient outcomes and enhances injury recovery. However, additional research will determine the current number of patients fed in-flight along with the actual risks and benefits of EN in this population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/milmed/usaa309DOI Listing
January 2021

Differences in mother-child and father-child RSA synchrony: Moderation by child self-regulation and dyadic affect.

Dev Psychobiol 2021 Jan 9. Epub 2021 Jan 9.

The Pennsylvania State University, University Park, PA, USA.

Parents and preschoolers show respiratory sinus arrhythmia (RSA) synchrony, but it is unclear how child self-regulation and the dyadic affective climate shape RSA synchrony and how synchrony differs for mothers and fathers. We examined child average RSA, externalizing problems, and dyadic positive affect as moderators of the synchrony of dynamic, within-epoch child and parent RSA reactivity during a challenging task. Mothers (N = 82) and fathers (N = 60) oversampled for familial risk participated with their 3-year-olds. For mothers, when children showed either higher externalizing or lower average RSA, negative RSA synchrony was observed as dynamic coupling of maternal RSA augmentation and child RSA withdrawal, suggesting inadequate support of the child during challenge. However, when children showed both higher externalizing and lower average RSA, indicating greater regulatory difficulties overall, positive synchrony was observed as joint RSA withdrawal. The same patterns were found for father-child RSA synchrony but instead with respect to the moderators of higher externalizing and lower dyadic positive affect. Findings suggest moderators of RSA synchrony differ by parent and shared positive affect plays a robust role in fathers' RSA reactivity and synchrony. Mothers may be more attuned to children's regulatory capacities, whereas fathers may be more influenced by the immediate behavioral context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/dev.22080DOI Listing
January 2021

Seroprevalence of Brucella canis in dogs rescued from South Dakota Indian reservations, 2015-2019.

Prev Vet Med 2020 Nov 23;184:105157. Epub 2020 Sep 23.

Department of Veterinary and Biomedical Sciences, 1155 North Campus Drive, South Dakota State University, Brookings, SD, 57007 USA. Electronic address:

Canine brucellosis, caused by Brucella canis, is an infectious disease with implications for canine as well as human health. The identification of infected dogs originating from and around two South Dakota Indian reservations prompted an examination of the seroprevalence of B. canis in stray or owner-surrendered dogs from these communities. Using results from in-clinic screening tests of 3898 dogs over more than 4 years, we determined an overall apparent B. canis seroprevalence of 6.8% (adjusted estimated true prevalence of 29.4%), with rates declining over time. The apparent rate was similar to other surveys of stray dog populations in the US. Older dogs were significantly more likely to be B. canis-positive than younger dogs, as were reproductively intact dogs versus altered dogs (although this difference was not statistically significant). There were geographic differences in seropositive rates as well, with higher rates found in dogs originating from one reservation compared to other locations. Current diagnostic tests lack sensitivity to effectively identify all B. canis-infected dogs, but results from this study are valuable for investigating differences among risk factors for infection. Because of the potential for B. canis to infect other dogs and people, stray dog populations should be screened for B. canis before those animals are placed in adoptive homes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prevetmed.2020.105157DOI Listing
November 2020

The dynamics of maternal scaffolding vary by cumulative risk status.

J Fam Psychol 2020 Oct 1. Epub 2020 Oct 1.

Department of Psychology, The Pennsylvania State University.

Parental scaffolding, or parenting behaviors that support children's independence and competence, can foster children's self-regulation development. Children facing higher cumulative risk may experience less scaffolding and more directives from parents, but it is unclear how cumulative risk affects the dynamics of parent-child interactions in real time. We examined the role of cumulative risk in mothers' moment-to-moment use of scaffolding and directives in response to preschoolers' off- and on-task behaviors ( = 117). Mothers answered questionnaires about cumulative risk at child age 2.5 years and completed a challenging puzzle task with their preschoolers at age 3 years. Continuous-time multilevel survival analyses revealed differences by cumulative risk in the likelihood of mothers' parenting responses following children's off- and on-task behavioral transitions over the course of the interaction. Specifically, when children went off-task, higher cumulative risk was associated with a lower likelihood of maternal scaffolding, but a comparable likelihood of directives, compared to lower risk mothers. When children got on-task, mothers with higher cumulative risk were less likely to respond with scaffolding and more likely to respond with directives than lower risk mothers. These results suggest that parents at higher risk respond with less scaffolding regardless of child behavior and respond with more directive commands when they may be unnecessary. Findings provide novel, real-time descriptive information about how and when parents experiencing cumulative risk use scaffolding and directive strategies, thus informing microlevel targets for intervention. Implications for the development of self-regulation in children at risk are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/fam0000806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012400PMC
October 2020

The Interpersonal Neurobiology of Child Maltreatment: Parasympathetic Substrates of Interactive Repair in Maltreating and Nonmaltreating Mother-Child Dyads.

Child Maltreat 2019 11 23;24(4):353-363. Epub 2019 Jan 23.

University of Oregon, Eugene, OR, USA.

Children's repair of conflict with parents may be particularly challenging in maltreating families, and early, stressful parent-child interactions may contribute to children's altered neurobiological regulatory systems. To explore neurobiological signatures of repair processes, we examined whether mother and child individual and dyadic respiratory sinus arrhythmia (RSA) covaried with interactive repair differently in maltreating versus nonmaltreating mother-preschooler dyads ( = 101), accounting for whether repair was mother or child initiated. Mother-initiated repair was equally frequent and protective across groups, associated with no change in mother or child RSA at higher levels of repair. But lower levels of mother repair were associated with child RSA withdrawal in nonmaltreating dyads versus child RSA augmentation in maltreating dyads. In maltreating dyads only, higher child-initiated repair was associated with higher mean mother RSA, whereas lower child repair was associated with mother RSA withdrawal. Findings suggest that interactive repair may have a buffering effect on neurobiological regulation but also that maltreating mothers and children show atypical neurobiological response to interpersonal challenges including differences related to children conducting the work of interactive repair that maltreating parents are less able to provide. We conclude by considering the role of maladaptive parent-child relationship processes in the biological embedding of early adversity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1077559518824058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556358PMC
November 2019

Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome.

Pediatr Allergy Immunol Pulmonol 2018 Sep 17;31(3):158-165. Epub 2018 Sep 17.

Division of Immunology, Allergy and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

The prevalence and impact of allergic and immune-mediated food disorders in pediatric acute-onset neuropsychiatric syndrome (PANS) are mostly unknown. We sought to explore the prevalence of atopic dermatitis (AD), asthma, allergic rhinitis (AR), IgE-mediated food allergies (FAs), and other immune-mediated food disorders requiring food avoidance in patients with PANS. In addition, to further understand the extent of food restriction in this population, we investigated the empiric use of dietary measures to improve PANS symptoms. Pediatric patients in a PANS Clinic and Research Program were given surveys regarding their caregiver burdens, allergic and food-related medical history, and whether food elimination resulted in perception of improvement of PANS symptoms. A review of health records was conducted to confirm that all responses in the survey were concordant with documentation of each patient's medical chart. Sixty-nine (ages 4-20 years) of 80 subjects who fulfilled PANS criteria completed the surveys. Thirteen (18.8%) had AD, 11 (15.9%) asthma, 33 (47.8%) AR, 11 (15.9%) FA, 1 (1.4%) eosinophilic gastrointestinal disorders, 1 (1.4%) food protein-induced enterocolitis syndrome, 3 (4.3%) milk protein-induced proctocolitis syndrome, and 3 (4.3%) celiac disease. Thirty subjects (43.5%) avoided foods due to PANS; elimination of gluten and dairy was most common and was associated with perceived improvement of PANS symptoms (by parents). This perceived improvement was not confirmed with objective data. The prevalence of allergic and immune-mediated food disorders in PANS is similar to the general population as reported in the literature, with the exception of AR that appears to be more prevalent in our PANS cohort. More research will be required to establish whether diet or allergies influence PANS symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/ped.2018.0888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6154445PMC
September 2018

Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts.

Cureus 2017 Dec 25;9(12):e1985. Epub 2017 Dec 25.

Medical Oncology, Cancer Treatment Centers of America, Newnan, Ga.

There is an ongoing debate as to the maximum number of brain metastases that can safely and practically be treated with a single course of radiosurgery. Despite evidence of durable local control and favorable overall survival when treating 10 or more brain metastases with radiosurgery alone, some institutions and guidelines still limit radiosurgery to an arbitrary number of metastases. As demonstrated by this case report, the number of lesions is not so important when the patient's life expectancy is otherwise good and body tumors are controllable. In the current era of effective targeted therapies, multi-year survival with brain metastases is increasingly common. Treating 37 brain metastases simultaneously in a five-fraction stereotactic course is technically feasible and in this case, resulted in 100% local and distant control in the brain for 18 months ongoing without any additional brain radiation. We discuss patient selection factors when treating large numbers of brain metastases, and present a possible class solution when using five daily fractions of 6 Gray (Gy) with a single plan and isocenter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.1985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825047PMC
December 2017

Mother-Child Coregulation of Parasympathetic Processes Differs by Child Maltreatment Severity and Subtype.

Child Maltreat 2018 08 11;23(3):211-220. Epub 2018 Jan 11.

2 University of Oregon, Eugene, OR, USA.

Parasympathetic processes appear to underlie maladaptive parent-child interactions in maltreating families, but it is unknown whether parent-child coregulation of respiratory sinus arrhythmia (RSA) differs by child maltreatment severity and subtype. RSA coregulation in maltreating and nonmaltreating mother-child dyads ( N = 146; age 3-5 years) during two dyadic tasks was analyzed using dynamic time series modeling. Nonmaltreating dyads showed positive RSA concordance but maltreating dyads (when examined as one group) did not. However, when examined separately by subtype, physically abusive dyads showed positive concordance and neglectful dyads no concordance, in dyadic RSA. Patterns were further modified by maltreatment severity, which predicted discordant RSA (one partner's RSA predicting decreases in the other's) in both groups. Specifically, higher physical abuse severity predicted lower resting child RSA, declining mother RSA over time, and mother RSA predicting declines in child RSA over time, suggesting a mother-driven dyadic stress response. Higher neglect severity predicted increasing child RSA over time and child RSA predicting declines in mother RSA over time, suggesting a child-driven maternal stress response. These findings show there are distinct patterns of RSA coregulation in nonmaltreating, physically abusive, and neglectful mother-child dyads, which may inform etiology and intervention with respect to stress regulation in maltreating families.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1077559517751672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6026580PMC
August 2018

Response to editor regarding "Improvement of psychiatric symptoms in youth following resolution of sinusitis".

Int J Pediatr Otorhinolaryngol 2018 09 6;112:208-209. Epub 2017 Sep 6.

Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, 700 Welch Road, Suite 125, Palo Alto, CA 94304, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2017.07.047DOI Listing
September 2018

The impact of negative affect on attention patterns to threat across the first 2 years of life.

Dev Psychol 2017 12 12;53(12):2219-2232. Epub 2017 Oct 12.

Department of Psychology, The Pennsylvania State University.

The current study examined the relations between individual differences in attention to emotion faces and temperamental negative affect across the first 2 years of life. Infant studies have noted a normative pattern of preferential attention to salient cues, particularly angry faces. A parallel literature suggests that elevated attention bias to threat is associated with anxiety, particularly if coupled with temperamental risk. Examining the emerging relations between attention to threat and temperamental negative affect may help distinguish normative from at-risk patterns of attention. Infants (N = 145) ages 4 to 24 months (M = 12.93 months, SD = 5.57) completed an eye-tracking task modeled on the attention bias "dot-probe" task used with older children and adults. With age, infants spent greater time attending to emotion faces, particularly threat faces. All infants displayed slower latencies to fixate to incongruent versus congruent probes. Neither relation was moderated by temperament. Trial-by-trial analyses found that dwell time to the face was associated with latency to orient to subsequent probes, moderated by the infant's age and temperament. In young infants low in negative affect longer processing of angry faces was associated with faster subsequent fixation to probes; young infants high in negative affect displayed the opposite pattern at trend. Findings suggest that although age was directly associated with an emerging bias to threat, the impact of processing threat on subsequent orienting was associated with age and temperament. Early patterns of attention may shape how children respond to their environments, potentially via attention's gate-keeping role in framing a child's social world for processing. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/dev0000408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705474PMC
December 2017

Pediatric Acute-Onset Neuropsychiatric Syndrome Response to Oral Corticosteroid Bursts: An Observational Study of Patients in an Academic Community-Based PANS Clinic.

J Child Adolesc Psychopharmacol 2017 Sep 17;27(7):629-639. Epub 2017 Jul 17.

1 Division of Pediatrics, Department of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine , Palo Alto, California.

Background: Sudden-onset severe obsessive-compulsive symptoms and/or severely restrictive food intake with at least two coinciding, similarly debilitating neuropsychiatric symptoms define Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). When associated with Group A Streptococcus, the syndrome is labeled Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). An abnormal immune response to infection and subsequent neuroinflammation is postulated to play an etiologic role. Most patients have a relapsing-remitting course. Treatment outcome data for youth with PANS and PANDAS are limited.

Methods: One hundred seventy-eight consecutive patients were seen in the Stanford PANS clinic between September 1, 2012 and January 15, 2016, of whom 98 met PANS or PANDAS criteria, had a single episode of PANS or relapsing/remitting course, and collectively experienced 403 flares. Eighty-five flares were treated with 102 total courses of oral corticosteroids of either short (4-5 days) or long (5 days-8 weeks) duration. Response to treatment was assessed within 14 days of initiating a short burst of corticosteroids and at the end of a long burst based on clinician documentation and patient questionnaires. Data were analyzed by using multilevel random-effects models.

Results: Patients experienced shorter flares when treated with oral corticosteroids (6.4 ± 5.0 weeks vs. 11.4 ± 8.6 weeks) than when not treated (p < 0.001), even after controlling for presumed confounding variables, including age at flare, weeks since onset of PANS illness, sex, antibiotic treatment, prophylactic antibiotics, previous immunomodulatory treatment, maintenance anti-inflammatory therapy, psychiatric medications, and cognitive behavioral therapy (p < 0.01). When corticosteroids were given for the initial PANS episode, flares tended to be shorter (10.3 ± 5.7 weeks) than when not treated (16.5 ± 9.6 weeks) (p = 0.06). This difference was statistically significant after controlling for the relevant confounding variables listed earlier (p < 0.01). Earlier use of corticosteroids was associated with shorter flare durations (p < 0.001). Longer courses of corticosteroids were associated with a more enduring impact on the duration of neuropsychiatric symptom improvement (p = 0.014).

Conclusion: Corticosteroids may be a helpful treatment intervention in patients with new-onset and relapsing/remitting PANS and PANDAS, hastening symptom improvement or resolution. When corticosteroids are given earlier in a disease flare, symptoms improve more quickly and patients achieve clinical remission sooner. Longer courses of corticosteroids may result in more durable remissions. A double-blind placebo-controlled clinical trial of corticosteroids in PANS is warranted to formally assess treatment efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cap.2016.0139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749576PMC
September 2017

Effect of Early and Prophylactic Nonsteroidal Anti-Inflammatory Drugs on Flare Duration in Pediatric Acute-Onset Neuropsychiatric Syndrome: An Observational Study of Patients Followed by an Academic Community-Based Pediatric Acute-Onset Neuropsychiatric Syndrome Clinic.

J Child Adolesc Psychopharmacol 2017 Sep 11;27(7):619-628. Epub 2017 Jul 11.

1 Division of Pediatrics, Department of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine , Palo Alto, California.

Introduction: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by the sudden onset of severe obsessive-compulsive symptoms and/or eating restriction along with at least two coinciding neuropsychiatric symptoms. When associated with group A Streptococcus, the syndrome is labeled Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). An abnormal immune response to infection and subsequent neuroinflammation is postulated to play an etiologic role. We evaluated the impact of nonsteroidal anti-inflammatory drug (NSAID) treatment on flare duration in PANS/PANDAS.

Methods: Patient inclusion criteria: Patients were included if they had at least one neuropsychiatric deterioration ("flare") that met strict PANS/PANDAS research criteria and for which flare duration could be assessed. Flare inclusion criteria: Any flare that started before October 15, 2016 was included and followed until the flare resolved or until the end of our data collection (November 1, 2016). Flare exclusion criteria: Flares were excluded if they were incompletely resolved, treated with aggressive immunomodulation, or treated with NSAIDs late (>30 days of flare onset). Ninety-five patients met study inclusion criteria and collectively experienced 390 flares that met flare criteria. Data were analyzed using multilevel linear models, adjusting for demographics, disease, and treatment covariates.

Results: NSAID use was associated with a significantly shorter flare duration. Flares not treated with NSAIDs had a mean duration of approximately 12.2 weeks (95% CI: 9.3-15.1). Flares that occurred while the child was on NSAID maintenance therapy were approximately 4 weeks shorter than flares not managed with NSAIDs (95% CI: 1.85-6.24; p < 0.0001). Flares treated with NSAIDs within 30 days of flare onset were approximately 2.6 weeks shorter than flares not managed with NSAIDs (95% CI: 0.43-4.68; p = 0.02). Flares treated prophylactically and those treated early with NSAIDs did not differ in duration (p = 0.26). Among the flares that received NSAID treatment within the first 30 days, earlier intervention was modestly associated with shorter flare durations (i.e., for each day that NSAID treatment was delayed, flare duration increased by 0.18 weeks; 95% CI: 0.03-0.33; p = 0.02), though it was not statistically significant after controlling for covariates (p = 0.06).

Conclusion: NSAIDs given prophylactically or within 30 days of flare onset may shorten neuropsychiatric symptom duration in patients with new-onset and relapsing/remitting PANS and PANDAS. A randomized placebo-control clinical trial of NSAIDs in PANS is warranted to formally assess treatment efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cap.2016.0193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749580PMC
September 2017

Course of Neuropsychiatric Symptoms After Introduction and Removal of Nonsteroidal Anti-Inflammatory Drugs: A Pediatric Observational Study.

J Child Adolesc Psychopharmacol 2017 Sep 11;27(7):652-659. Epub 2017 Jul 11.

1 Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine , Stanford, California.

Objective: Accumulating evidence suggests that anti-inflammatory interventions can modulate neuropsychiatric symptoms. Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is characterized by an abrupt and dramatic onset of obsessive-compulsive (OC) symptoms and/or severely restrictive food intake and at least two coinciding, equally debilitating neuropsychiatric symptoms. When associated with group A Streptococcus, the syndrome is labeled Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). Here, we describe the course of neuropsychiatric symptoms in patients diagnosed with PANS and PANDAS after introduction or removal of nonsteroidal anti-inflammatory drugs (NSAIDs).

Study Design: We reviewed the electronic medical records (EMR) of 218 consecutive patients evaluated in our Stanford PANS Clinic for patients who met strict PANS or PANDAS research criteria and received NSAIDs for arthritis, pain, and/or psychiatric symptoms. We describe neuropsychiatric symptoms that were noted in the EMR before, during, and after NSAIDs were introduced or removed as the sole change in pharmacologic treatment.

Results: Seventy-seven patients were included in the current study. Of the 52 trials in which NSAID addition was the sole change in treatment, 16 (31%) coincided with an improvement in patients' neuropsychiatric symptoms. Of the 57 trials in which removal of NSAID treatment was the sole change in treatment, 20 (35%) coincided with escalation in patients' neuropsychiatric symptoms. Thirty patients (39%) experienced side effects, mainly mild gastrointestinal symptoms, which self-resolved after removal of NSAID, reduction of dose, or change in NSAID.

Conclusions: Improvement in neuropsychiatric symptoms was evident in roughly one-third of NSAID treatment trials. A randomized clinical trial will be necessary to confirm whether NSAIDs are successful in reducing neuropsychiatric symptoms in youth with PANS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cap.2016.0179DOI Listing
September 2017

Palatal Petechiae in the Absence of Group A Streptococcus in Pediatric Patients with Acute-Onset Neuropsychiatric Deterioration: A Cohort Study.

J Child Adolesc Psychopharmacol 2017 Sep 7;27(7):660-666. Epub 2017 Apr 7.

1 Divisions of Pediatric, Department of Allergy, Immunology, and Rheumatology, Palo Alto, California.

Background: Palatal petechiae are 95% specific for streptococcal pharyngitis. Despite this, and despite prior research demonstrating that Group A Streptococcus (GAS) is a common antecedent to pediatric acute-onset neuropsychiatric syndrome (PANS) episodes, we anecdotally observed a low rate of documented GAS in patients with PANS and palatal petechiae. This retrospective chart review was conducted to formally report the rate of palatal petechiae and concurrent GAS in a cohort of patients with PANS and investigate other etiologic factors.

Methods: The clinical notes of 112 patients seen at the Stanford PANS Clinic who met PANS research criteria were reviewed for mention of palatal petechiae. The medical records of patients who demonstrated palatal petechiae on physical examination were reviewed for signs of infection, a clinical history of trauma, and laboratory results that could indicate other causes of petechiae.

Results: Twenty-three patients had documented palatal petechiae on physical examination (ages 5-16, 13/23 [57%] male). Fifteen patients had a rapid GAS test and GAS culture in the Stanford PANS clinic, all with negative results. Evidence of recent GAS infection was found in 8/23 (32%) patients (elevated GAS titers [n = 6] or documentation of a positive rapid GAS test at another facility [n = 2]), one of whom also had potential herpes simplex virus (HSV) infection. One patient had potential HSV infection and recent palatal trauma. No patients had thrombocytopenia. 14/23 (61%) of patients with palatal petechiae had no discernable cause of petechiae. 10/19 (53%) of patients had antihistone antibodies.

Conclusions: Despite the established relationship between palatal petechiae and GAS, no patient with palatal petechiae in our clinic tested positive for GAS and only 32% had evidence of recent GAS. Most did not have an identifiable cause for the palatal lesions. This finding suggests the potential for alternative causes of palatal petechiae or undetectable GAS in our patient population. The high prevalence of palatal petechiae without GAS infection suggests that the pathogenesis of PANS is multifactorial and may involve disruption or inflammation of the microvasculature. Additional research is needed to further elucidate these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cap.2016.0153DOI Listing
September 2017

Maternal anxiety predicts attentional bias towards threat in infancy.

Emotion 2017 08 16;17(5):874-883. Epub 2017 Feb 16.

Department of Psychology, The Pennsylvania State Universit.

Although cognitive theories of psychopathology suggest that attention bias toward threat plays a role in the etiology and maintenance of anxiety, there is relatively little evidence regarding individual differences in the earliest development of attention bias toward threat. The current study examines attention bias toward threat during its potential first emergence by evaluating the relations between attention bias and known risk factors of anxiety (i.e., temperamental negative affect and maternal anxiety). We measured attention bias to emotional faces in infants (N = 98; 57 male) ages 4 to 24 months during an attention disengagement eye-tracking paradigm. We hypothesized that (a) there would be an attentional bias toward threat in the full sample of infants, replicating previous studies; (b) attentional bias toward threat would be positively related to maternal anxiety; and (c) attention bias toward threat would be positively related to temperamental negative affect. Finally, (d) we explored the potential interaction between temperament and maternal anxiety in predicting attention bias toward threat. We found that attention bias to the affective faces did not change with age, and that bias was not related to temperament. However, attention bias to threat, but not attention bias to happy faces, was positively related to maternal anxiety, such that higher maternal anxiety predicted a larger attention bias for all infants. These findings provide support for attention bias as a putative early mechanism by which early markers of risk are associated with socioemotional development. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/emo0000275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519443PMC
August 2017

Improvement of psychiatric symptoms in youth following resolution of sinusitis.

Int J Pediatr Otorhinolaryngol 2017 Jan 31;92:38-44. Epub 2016 Oct 31.

Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA, 94304, USA. Electronic address:

Introduction: Accumulating evidence supports a role for inflammation in psychiatric illness, and the onset or exacerbation of psychiatric symptoms may follow non-CNS infections. Here, we provide the first detailed description of obsessive-compulsive and related psychiatric symptoms arising concurrently with sinusitis.

Methods: We reviewed the charts of 150 consecutive patients evaluated in our Pediatric Acute-onset Neuropsychiatric Syndromes clinic for documented sinusitis as defined by the American Academy of Pediatrics guidelines. Sinusitis treatments, sinonasal imaging, and neuropsychiatric symptoms before, during, and after sinusitis onset were noted. Patients were included in the final review if they had a clear diagnosis of isolated sinusitis (without concurrent illness and/or immunodeficiency), and were evaluated during an episode of sinusitis.

Results: 10/150 (6.6%) patients had isolated sinusitis at the time of their neuropsychiatric deterioration. Eight patients received antibiotics to treat sinusitis, three of whom also received sinus surgery. Neuropsychiatric symptoms improved in all eight patients concurrent with resolution of sinusitis per parent report and clinician assessment. One patient did not follow through with recommended sinus surgery or antibiotics and her psychiatric symptoms persisted. One patient was lost to follow-up.

Conclusions: Improvement of psychiatric symptoms correlated with resolution of sinus disease in this retrospective study. Identification, treatment, and resolution of underlying infections, including sinusitis, may have the potential to change the trajectory of some neuropsychiatric illnesses. Randomized clinical trials are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2016.10.034DOI Listing
January 2017

Multidisciplinary clinic dedicated to treating youth with pediatric acute-onset neuropsychiatric syndrome: presenting characteristics of the first 47 consecutive patients.

J Child Adolesc Psychopharmacol 2015 Feb;25(1):38-47

Stanford PANS Clinic and Research Program at Lucille Packard Children's Hospital, Stanford University School of Medicine , Palo Alto, California.

Background: Abrupt, dramatic onset obsessive-compulsive disorder (OCD) and/or eating restriction with at least two coinciding symptoms (anxiety, mood dysregulation, irritability/aggression/oppositionality, behavioral regression, cognitive deterioration, sensory or motor abnormalities, or somatic symptoms) defines pediatric acute-onset neuropsychiatric syndrome (PANS). Descriptions of clinical data in such youth are limited.

Methods: We reviewed charts of 53 consecutive patients evaluated in our PANS Clinic; 47 met PANS symptom criteria but not all met the requirement for "acute onset." Patients meeting full criteria for PANS were compared with patients who had a subacute/insidious onset of symptoms.

Results: Nineteen of 47 (40%) patients in the study had acute onset of symptoms. In these patients, autoimmune/inflammatory diseases and psychiatric disorders were common in first-degree family members (71% and 78%, respectively). Most acute-onset patients had a relapsing/remitting course (84%), prominent sleep disturbances (84%), urinary issues (58%), sensory amplification (66%), gastrointestinal symptoms (42%), and generalized pain (68%). Inflammatory back pain (21%) and other arthritis conditions (28%) were also common. Suicidal and homicidal thoughts and gestures were common (44% and 17%, respectively) as were violent outbursts (61%). Group A streptococcus (GAS) was the most commonly identified infection at onset (21%) and during flares (74%). Rates of the above-mentioned characteristics did not differ between the acute-onset group and the subacute/insidious-onset groups. Low levels of immunoglobulins were more common in the subacute/insidious-onset group (75%) compared with the acute-onset group (22%), but this was not statistically significant (p=0.06).

Conclusions: In our PANS clinic, 40% of patients had acute onset of symptoms. However, those with and without acute onset of symptoms had similar symptom presentation, rates of inflammatory conditions, somatic symptoms, and violent thoughts and behaviors. GAS infections were the most commonly identified infection at onset and at symptom flares. Because of the wide variety of medical and psychiatric symptoms, youth with PANS may require a multidisciplinary team for adequate care management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/cap.2014.0081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340335PMC
February 2015

Characterization of Fusobacterium isolates from the respiratory tract of white-tailed deer (Odocoileus virginianus).

J Vet Diagn Invest 2014 Mar 3;26(2):213-20. Epub 2014 Mar 3.

1Jason W. Brooks, Animal Diagnostic Laboratory, The Pennsylvania State University, Orchard Road, University Park, PA 16802.

A total of 23 clinical isolates of Fusobacterium spp. were recovered at necropsy over a 2-year period from the respiratory tract of white-tailed deer (Odocoileus virginianus). Isolates were identified as Fusobacterium varium (18/23), Fusobacterium necrophorum subsp. funduliforme (3/23), and Fusobacterium necrophorum subsp. necrophorum (2/23). Using polymerase chain reaction-based detection of virulence genes, all F. necrophorum isolates were positive for the promoter region of the leukotoxin operon and the hemagglutinin-related protein gene, while all F. varium isolates were negative. The presence of the leukotoxin gene in F. necrophorum isolates and the absence of this gene in F. varium isolates were confirmed by Southern hybridization using 2 separate probes. Toxicity to bovine polymorphonuclear leukocytes was observed with all F. necrophorum isolates, but was not observed in any F. varium isolates. Susceptibility to antimicrobials was markedly different for F. varium as compared to F. necrophorum. In summary, no evidence of leukotoxin production was detected in any of the 23 F. varium isolates used in the current study. The data suggests that F. varium, the most common species isolated, may be a significant pathogen in deer with a different virulence mechanism than F. necrophorum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1040638714523613DOI Listing
March 2014

Computer and cell phone access for individuals with mobility impairments: an overview and case studies.

NeuroRehabilitation 2011 ;28(3):183-97

University of Washington, Seattle, WA, USA.

Computers, telephones, and assistive technology hold promise for increasing the independence, productivity, and participation of individuals with disabilities in academic, employment, recreation, and other activities. However, to reach this goal, technology must be accessible to, available to, and usable by everyone. The authors of this article share computer and telephone access challenges faced by individuals with neurological and other impairments, assistive technology solutions, issues that impact product adoption and use, needs for new technologies, and recommendations for practitioners and researchers. They highlight the stories of three individuals with neurological/mobility impairments, the technology they have found useful to them, and their recommendations for future product development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/NRE-2011-0648DOI Listing
August 2011