Publications by authors named "Victoria Evans"

19 Publications

  • Page 1 of 1

Seizure frequency, quality of life, behavior, cognition, and sleep in pediatric patients enrolled in a prospective, open-label clinical study with cannabidiol.

Epilepsy Behav 2021 Sep 21;124:108325. Epub 2021 Sep 21.

Department of Child Health, University of Missouri, Columbia, MO 65201, USA; Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA; Department of Pediatrics, University of Florida, Gainesville, FL 32611, USA.

Objective: To evaluate the effects of oral pharmacological cannabidiol (CBD) on seizures, side effects, quality of life, behavior, mood, and sleep in children with drug-resistant epilepsy (DRE) during a phase II, prospective, open-label clinical study.

Methods: During a phase II expanded access program (EAP) study to evaluate the safety and efficacy of using cannabidiol (CBD) for the long-term treatment of children with drug-resistant epilepsy, secondary outcome measures were also performed, including quality of life (QOLCE), behavior (aberrant behavior checklist ABC), and sleep (children's sleep habit questionnaire, CSHQ). Participants between the ages of 2 and 16 years of age with drug-resistant epilepsy (n = 35) were included in this EAP. Primary outcomes included change in parent-recorded seizure frequency relative to baseline, as well as the safety and tolerability over the course of 24 months of CBD treatment. Secondary outcomes observed in the first 12 months included changes in child behavior, and cognitive function, and sleep quality.

Results: The median change in overall seizure frequency decreased from baseline (n = 33) by -61.3% ([n = 33], Inter Quartile Range (IQR): 43-88%) at month 3, -62.9% at month 6 ([n = 29], IQR: 48-92%), -74.7% at month 12 ([n = 29], IQR: 64-96%), and finally -83.7% ([n = 28], IQR: 68-100%) at the conclusion of 24 months of treatment. Seven (20%) of the 35 patients enrolled withdrew from treatment and observation by month 24: 2 failed inclusion criteria at baseline, 4 due to lack of treatment efficacy, and 1 was lost to follow-up. The 12-month recording of secondary measures revealed a significant improvement in Irritability (-39.4%, [n = 28], ABC), Hyperactivity (-45.4%, [n = 28], ABC), Cognition in Quality of Life (+14.2%, [n = 28], QOLCE), Behavioral function (+14.7%, [n = 28], QOLCE), General Health (+14.7%, [n = 28], QOLCE), Sleep duration (-33.9%, [n = 28], CSHQ), Daytime sleepiness (-23.8%, [n = 28], CSHQ), and nocturnal arousals (-36.2%, [n = 28], CSHQ).

Significance: The results of this phase II open-label study demonstrate that pharmacological CBD significantly reduces seizure frequency, and improves QOL, behavior deficits, and sleep disruption, in children with drug-resistant epilepsy. The results also suggest that CBD is efficacious in controlled seizures over a 2-year period in childhood DRE.
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http://dx.doi.org/10.1016/j.yebeh.2021.108325DOI Listing
September 2021

Rock 'n' knoll in the mouth: A man with a lump on the hard palate.

Aust J Gen Pract 2020 12;49(12):845-846

BSc (Hons), MBChB, FRACGP, Senior General Practitioner, Arafura Medical Clinics, NT.

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http://dx.doi.org/10.31128/AJGP-02-20-5234DOI Listing
December 2020

Nutritional challenges in children with primary immunodeficiencies undergoing hematopoietic stem cell transplant.

Clin Nutr 2020 09 19;39(9):2832-2841. Epub 2019 Dec 19.

Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Australia.

Nutritional profile and management of patients with primary immunodeficiencies (PID) undergoing hematopoietic stem cell transplant (HSCT) has not been described in the literature. We aim to report the nutritional challenges and practices peculiar to this population before and after HSCT and suggest clinical pathways for their management. We conducted a single-centre retrospective study. Inclusion criteria were children aged less than 20 years with a diagnosis of PID who have undergone HSCT at the Royal Children's Hospital Melbourne since April 2014 with a minimal follow-up of 1 year. Nutritional parameters were collected in the pre-transplant period, at conditioning, and at 1, 3, 6 and 12 months post-HSCT. Descriptive analysis were used. Between April 2014 and December 2018, 27 children received 31 HSCT. Before transplant, 33% had a weight and/or height ≤ -2 standard deviations (SD). Forty percent required nutritional support before transplant: 33% had enteral nutrition (EN) while 7% required long-term parenteral nutrition (PN) due to intestinal failure. After transplant, although most children were started on EN, 82% required PN with a mean duration of 67 days. Mean time to full oral diet was 154 days. Pre-transplant mean weight and height were -0.57 SD and -0.88 SD respectively. After a decrease in anthropometric parameters the first 3 months post-transplant, progressive catch up was noticeable for weight (-0.27 SD) with no catch up for height at 1 year (-0.93 SD). Our work highlights the nutritional challenges and specificities of children with PID in the peri-transplant period. An approach to nutrition assessment and management in the pre- and post-transplant period is proposed.
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http://dx.doi.org/10.1016/j.clnu.2019.12.015DOI Listing
September 2020

Indications and Patterns of Use for Parenteral Nutrition in Pediatric Oncology.

JPEN J Parenter Enteral Nutr 2020 05 22;44(4):632-638. Epub 2019 Jul 22.

Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.

Background: Children with cancer are at risk of treatment related gastrointestinal toxicity and malnutrition. Intestinal dysfunction may preclude or limit use of enteral nutrition, and parenteral nutrition (PN) may be required. Published indications for PN use in children with cancer are generally nonspecific. We sought to describe patterns of use, indications, and frequency of PN prescription in children with cancer and propose indicators to guide appropriate PN use.

Methods: Retrospective chart review of children with cancer receiving inpatient PN in a tertiary referral pediatric hospital over 12 months was performed using electronic medical record search and paper records. Data were summarized using descriptive statistics.

Results: PN was prescribed to 88 patients in 111 episodes. Total use (2377 days) represented 24% of annual inpatient days in all children with cancer. Primary clinical indications were mucositis (40%), feed intolerance (29%), postoperative (16%), or "other" (15%), (including nasogastric tube refusal (n = 6)). Patients with hematological cancer had longer median episodes (19 vs 12.5 days) and earlier commencement of PN after diagnosis (50 vs 80 days) than children with nonhematological cancer. Most PN episodes longer than 28 days were in children with hematopoietic stem cell transplant (HSCT).

Conclusion: Inpatient PN use is common in childhood cancer. Indications include mucositis, feed intolerance, and surgical management. Patterns of use are influenced by cancer diagnosis and treatment, with greater use in children with hematological cancer and HSCT. Improved understanding and specific indications may guide appropriate PN prescription and minimize unnecessary risk, cost, and inconsistency in care.
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http://dx.doi.org/10.1002/jpen.1685DOI Listing
May 2020

Parent Training for Feeding Problems in Children With Autism Spectrum Disorder: Initial Randomized Trial.

J Pediatr Psychol 2019 03;44(2):164-175

University of Rochester.

Objective: Many children with autism spectrum disorder (ASD) have feeding and mealtime problems. To address these, we conducted a pilot randomized trial of a new 11-session, individually delivered parent training program that integrated behavioral strategies and nutritional guidance (PT-F).

Methods: Forty-two young children (age: 2 to 7-11 years) with ASD and feeding problems were assigned to 11 sessions of PT-F intervention over 20 weeks or a waitlist control. Outcomes included attendance, parent satisfaction, therapist fidelity, and preliminary assessments of child and parent outcomes.

Results: Of the 21 PT-F families, attendance was high (85%) as was parent satisfaction (94% would recommend to others). Treatment fidelity was also high (97%-therapist integrity; 94%-parent adherence). Compared with waitlist, children whose parents participated in PT-F showed significantly greater reductions on the two parent-completed primary outcomes (Brief Autism Mealtime Behavior Inventory-Revised; Twald = -2.79; p = .003; About Your Child's Eating; Twald = -3.58; p = .001). On the independent evaluator-completed secondary eating outcome, the Clinical Global Impression-Improvement, 48.8% of the participants in PT-F were rated as "responders" compared with 0% in waitlist (p = .006). General child disruptive behavior outcomes decreased more in PT-F but not significantly. Parent outcomes of caregiver stress showed nonsignificant trends favoring PT-F with moderate to small effect sizes.

Conclusions: This trial provides evidence for feasibility, satisfaction, and fidelity of implementation of PT-F for feeding problems in young children with ASD. Feeding outcomes also appeared favorable and lends support for conducting a larger efficacy trial.
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http://dx.doi.org/10.1093/jpepsy/jsy063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365095PMC
March 2019

Vascular Ehlers-Danlos Syndrome: An Unusual Cause of Chronic Intestinal Failure in a Child.

J Pediatr Gastroenterol Nutr 2019 Jan;68(1):e14-e15

Clinical Nutrition Unit, Department of Gastroenterology and Clinical Nutrition.

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http://dx.doi.org/10.1097/MPG.0000000000002074DOI Listing
January 2019

Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors.

Sleep Med 2018 04 1;44:61-66. Epub 2018 Feb 1.

Marcus Autism Center, Children's Healthcare of Atlanta & Emory University, USA.

Background And Purpose: Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances.

Participants And Methods: One hundred and seventy-seven children with complete data out of 180 (mean age 4.7) with ASD participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into "poor sleepers" (upper quartile on the total score of the CSHQ-ASD) and "good sleepers" (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress.

Results: The two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress.

Conclusions: The finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.
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http://dx.doi.org/10.1016/j.sleep.2018.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853135PMC
April 2018

Assessment of Sleep in Children with Autism Spectrum Disorder.

Children (Basel) 2017 Aug 8;4(8). Epub 2017 Aug 8.

Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.

Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD.
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http://dx.doi.org/10.3390/children4080072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575594PMC
August 2017

Use of electronic nicotine delivery systems and recent initiation of smoking among US youth.

Int J Public Health 2016 Mar 1;61(2):237-41. Epub 2016 Feb 1.

Fay W. Boozman College of Public Health, Little Rock, AR, USA.

Objectives: We assessed whether the prevalence of recent (within a year) initiation of cigarette smoking was associated with reports of ever using electronic delivery systems (ENDS) in the National Youth Tobacco Survey (NYTS) and whether the association varied by age.

Methods: Weighted cross-sectional analysis of use of ENDS, cigarette smoking, age at interview and age at initiation of smoking collected systematically through the 2011-2013 NYTS cycles.

Results: In multivariate analyses those who ever used ENDS were twice as likely as nonusers of ENDS to have tried cigarette smoking in the last year (multivariate PR: 2.3; 95 % CI 1.9, 2.7). This average hid significant variations by age: a 4.1-fold increase (95 %; 2.6, 6.4) among those 11-13 years of age, compared to a smaller increase among those 16-18 years: 1.4-fold (95 % CI 1.1, 1.8).

Conclusions: Use of ENDS by adolescents was associated with initiation of cigarette smoking in the last year. This association was stronger in younger adolescents.
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http://dx.doi.org/10.1007/s00038-015-0783-7DOI Listing
March 2016

Aseptic non-touch technique and catheter-related bloodstream infection in children receiving parenteral nutrition at home.

United European Gastroenterol J 2015 Aug;3(4):393-8

Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Objectives: Parenteral nutrition (PN) at home is an acceptable form of delivering long-term PN for children with intestinal failure. Catheter-related bloodstream infection (CRBSI) is one of the serious complications of long-term PN and can lead to increasing morbidity and mortality. Using aseptic non-touch technique (ANTT) was proven to decrease the incidence of CRBSI in hospital patients. In this study we aimed to review the incidence of CRBSI in children receiving PN at home in our institution using the ANTT and a simplified training programme for parents and carers.

Methods: We retrospectively collected clinical and microbiological data on all children with intestinal failure (IF) who were on treatment with PN at home under our specialist IF rehabilitation service between November 2012 and November 2013.

Results: Thirty-five children were included, 16 of whom did not have any infection recorded during the study period. The overall CRBSI rate was 1.3 infections per 1000 line-days, with Staphylococcus being the commonest organism. Twenty-one children did not require catheter change and the overall catheter changes were 1.8 per 1000 line-days.

Conclusion: In this article, we report a low incidence of CRBSI in a single institution by using the principle of ANTT for accessing central venous catheters combined with a simplified, nurse-led, two-week standardised training programme for parents of children going home on PN.
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http://dx.doi.org/10.1177/2050640615576444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528206PMC
August 2015

Eosinophilic gastrointestinal disease and inflammatory bowel disease in children: is it a disease continuum?

Eur J Gastroenterol Hepatol 2015 Jan;27(1):20-3

Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Eosinophilic gastrointestinal disease (EGID) and inflammatory bowel disease (IBD) are two distinct disorders that share some clinical manifestations but have different diagnostic criteria. In this article, we reviewed the clinical data of three children with EGID who later developed IBD. This study is a retrospective case note review that was conducted between 2007 and 2012. EGID seems to precede IBD in some subsets of children in whom the diagnosis of IBD may take a few years to fully develop.
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http://dx.doi.org/10.1097/MEG.0000000000000230DOI Listing
January 2015

The effectiveness of 4 weeks of fundamental movement training on functional movement screen and physiological performance in physically active children.

J Strength Cond Res 2015 Jan;29(1):254-61

1Sport and Wellbeing, Student Services, Teesside University, Middlesbrough, United Kingdom; and 2Sport and Exercise, School of Social Sciences and Law, Teesside University, Middlesbrough, United Kingdom.

The effectiveness of fundamental movement training interventions in adolescents is not fully understood. The Functional Movement Screen (FMS) may provide means of evaluating the effectiveness of such programs alongside traditional tests of physiological performance. Twenty-two children completed the FMS, plank, side plank, sit and reach, and multistage fitness test. Participants were pair matched by total FMS score and assigned to control or intervention. The intervention group received a weekly 4 × 30-minute training sessions with an emphasis on movement quality, whereas the control group was involved in generic multisport activity. A smallest worthwhile effect of 0.2 between-participant SDs was set a priori for all measures except total FMS score for which a change of 1 unit was chosen. When compared with the control, our intervention had a likely trivial effect for FMS score (0.2 Arbitrary Units [AU], 90% confidence limits ±1.2 AU), a very likely small beneficial effect for plank score (87 ± 55%), but a possibly small harmful effect for side plank score (-22 ± 49%). A likely trivial effect was observed for the sit and reach test (0.3 ± 15%), whereas the effect of the training intervention on predicted (Equation is included in full-text article.)was unclear (-0.3 ± 11%). Unexpectedly, generic multisport activity enhanced both side plank and sit and reach test performances in the control group. These results demonstrated that short-term interventions might affect specific isolated components of fitness but not FMS performance.
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http://dx.doi.org/10.1519/JSC.0000000000000602DOI Listing
January 2015

Association of single nucleotide polymorphisms of interleukins-1β, -6, and -12B with contact lens keratitis susceptibility and severity.

Ophthalmology 2012 Jul 11;119(7):1320-7. Epub 2012 Apr 11.

Brien Holden Vision Institute, Australia.

Purpose: To investigate whether single nucleotide polymorphisms (SNPs) in interleukin (IL)-1β, IL-6, and IL-12β are associated with the susceptibility and severity of contact lens-related keratitis.

Design: Retrospective, case control study.

Participants: One hundred twelve cases of keratitis and 225 controls were recruited from studies conducted at Moorfields Eye Hospital and in Australia during 2003 through 2005.

Methods: Buccal swab samples were collected on Whatman FTA cards and were mailed by post for analysis. IL-1β (-31), IL-6 (-174, -572, -597), and IL-12B (3'+1158) genotypes were analyzed with pyrosequencing and analyzed using a regression model for susceptibility (sterile, microbial keratitis, controls) and severity. Statistical significance was set at 0.05.

Main Outcome Measures: The relative risk of developing contact lens-related keratitis and more severe forms of the disease based on allele, genotype, and haplotype associations.

Results: Carriers of IL-6 SNPs were more likely to experience moderate and severe events compared with those with nonmutated genotypes (-174 heterozygous: odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-8.3; homozygous: OR, 6.4; 95% CI, 1.4-28.4; -174/-597: OR, 4.1; 95% CI, 1.6-11.0). More severe keratitis and microbial keratitis were less likely to occur in wearers with the nonmutated IL-6 haplotype (severity OR, 0.4 [95% CI, 0.2-0.7]; microbial OR, 0.6 [95% CI, 0.4-0.9]). Wearers carrying an IL-12B SNP had an increased risk of sterile keratitis (OR, 9.7; 95% CI, 1.2-76.9) compared with controls.

Conclusions: The IL-6 SNPs are known to reduce protein expression of this cytokine and thus ocular immune defense, and carriers of these SNPs were more likely to experience more severe and microbial keratitis, suggesting that IL-6 decreases the severity and susceptibility of contact lens-related keratitis. Carriers of a functional SNP of IL-12B that is known to increase IL-12 expression and stability are more likely to experience sterile keratitis, suggesting that this is associated with the intense inflammatory reaction that occurs in this condition.
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http://dx.doi.org/10.1016/j.ophtha.2012.01.031DOI Listing
July 2012

Comparison of ocular comfort, vision, and SICS during silicone hydrogel contact lens daily wear.

Eye Contact Lens 2012 Jan;38(1):2-6

Brien Holden Vision Institute, Sydney, NSW, Australia.

Objectives: The aim of this study was to investigate the relationship between solution-induced corneal staining (SICS) and silicone hydrogel contact lens comfort and vision.

Methods: A retrospective analysis of a series of open-label studies were conducted with 24 groups of approximately 40 participants, each wearing 1 of 6 silicone hydrogel contact lenses with 1 of 4 lens care products bilaterally for 3 months of daily wear. The presence of SICS and subjective ocular ratings were collected at 2 weeks and at 1 and 3 months.

Results: A total of 1,051 participants were enrolled. The participants with SICS rated significantly less favorably than did the participants without SICS for comfort during the day (7.9±1.7 vs. 8.5±1.4, P=0.03), comfort at the end of the day (6.6±2.1 vs. 7.4±1.9, P=0.03), overall dryness (7.4±1.9 vs. 8.0±1.7, P=0.04), dryness at the end of the day (6.7±2.2 vs. 7.5±2.1, P=0.01), feelings of burning and stinging (8.5±2.0 vs. 8.9±1.8, P=0.02), and overall vision (8.2±1.6 vs. 8.7±1.3, P<0.001).

Conclusions: The participants with SICS had lower subjective comfort and vision compared with those who did not experience SICS.
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http://dx.doi.org/10.1097/ICL.0b013e318239df9fDOI Listing
January 2012

A qualitative analysis of immunization programs with sustained high coverage, 2000-2005.

J Public Health Manag Pract 2010 Jan-Feb;16(1):E9-17

National Center for Immunization and Respiratory Diseases, Immunization Services Division, Health Services Research and Evaluation Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Despite record-high immunization coverage nationally, there is considerable variation across state and local immunization programs, which are responsible for the implementation of vaccine recommendations in their jurisdictions. The objectives of this study were to describe activities of state and local immunization programs that sustained high coverage levels across several years and to identify common themes and practical examples for sustaining childhood vaccination coverage rates that could be applied elsewhere. We conducted 95 semi-structured key informant interviews with internal staff members and external partners at the 10 immunization programs with the highest sustained childhood immunization coverage from 2000 to 2005, as measured by the National Immunization Survey. Interview transcripts were analyzed qualitatively using a general inductive approach. Common themes across the 10 programs included maintaining a strong program infrastructure, using available data to drive planning and decision making, a commitment to building and sustaining relationships, and a focus on education and communication. Given the challenges of an increasingly complex immunization system, the lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs.
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http://dx.doi.org/10.1097/PHH.0b013e3181c7e053DOI Listing
May 2012

Qualitative analysis of immunization programs with most improved childhood vaccination coverage from 2001 to 2004.

J Public Health Manag Pract 2010 Jan-Feb;16(1):E1-8

National Center for Immunization and Respiratory Diseases, Immunization Services Division, Health Services Research and Evaluation Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

State and urban immunization programs are responsible for the implementation of comprehensive programs to vaccinate populations within their geographic area. Given the variability in immunization coverage rates between geographic areas, the purpose of this two-phase study was to first identify the state and urban areas that achieved the highest increases in coverage, and then those with the highest sustained coverage, between two designated periods, and to interview key program staff members and their community counterparts to capture their perspectives on what factors may have contributed to increasing and sustaining high rates. In this article, we describe phase 1, in which we visited the seven sites that achieved the largest increases in coverage from 2001 to 2004. Results describe outcomes from the 71 semistructured key informant interviews with internal staff and external partners at the site's immunization programs. Interview transcripts were analyzed qualitatively, using a general inductive approach. Common challenges encountered among the seven sites included increasing reluctance among parents and overcoming barriers to accessing care. Common strategies to address these and other challenges included collecting and using data on immunization coverage, developing communication and education efforts, and continuously reaching out and collaborating with immunization partners. Lessons learned from these programs may help inform others who are working to improve childhood immunization delivery and coverage in their own programs.
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http://dx.doi.org/10.1097/PHH.0b013e3181b0b8bcDOI Listing
May 2012

Contact lens-related adverse events and the silicone hydrogel lenses and daily wear care system used.

Arch Ophthalmol 2009 Dec;127(12):1616-23

BOptom, Institute for Eye Research, Level 3, Rupert Myers Building, University of New South Wales, Sydney, NSW 2052, Australia.

Objective: To investigate the incidence of adverse events related to the use of varying silicone hydrogel contact lens and lens solution combinations.

Methods: Individuals with myopia (N = 558) participated in 1 or more of approximately 40-participant trials in a matrix of 20 silicone hydrogel contact lens and lens-solution combinations. Visits were at baseline, 2 weeks, 1 month, and 3 months. The mean study completion rate was 90% of the expected participant-months (final data set: 840 lens-solution combinations and 2271 participant-months). Adverse events were reported as the first occurrence of each type per 100 participant-months for each lens-solution combination.

Results: The rate of all corneal infiltrative events (CIEs) was 3.1 per 100 participant-months (range, 0-10.5), and the rate of symptomatic CIEs was 1.7 per 100 participant-months (range, 0-10.5), including 1 case of microbial keratitis (0.04 per 100 participant-months). Rates for CIEs differed substantially among solution groups, with hydrogen peroxide having the lowest rate (0.6 per 100 participant-months; range, 0-0.9). The rate was 0.8 per 100 participant-months (range, 0-8.0) for superior epithelial arcuate lesions, which varied by lens type, 0.04 per 100 participant-months (1 case only) for corneal erosion, and 0.4 per 100 participant-months (range, 0-2.0) for contact lens papillary conjunctivitis, which was modified by type of solution. The rate of solution-induced corneal staining for all lens-solution combinations was 4.7 per 100 participant-months (range, 0-23) and varied significantly based on lens-solution combination (P < .001).

Conclusions: The frequency of adverse events varied with silicone hydrogel contact lens and lens solution combinations, with hydrogen peroxide having the lowest incidence of CIEs and solution-induced corneal staining, indicating that lens material and design, type of solution, and solution-lens interactions are likely contributing factors in this mode of lens wear.
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http://dx.doi.org/10.1001/archophthalmol.2009.313DOI Listing
December 2009

Grading of corneal and conjunctival staining in the context of other dry eye tests.

Cornea 2003 Oct;22(7):640-50

Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK.

Purpose: To describe the Oxford Scheme for grading ocular surface staining in dry eye and to discuss optimization of stain detection using various dyes and filters. Also, to propose a sequence of testing for dry eye diagnosis.

Methods: The grading of corneal and conjunctival staining is described, using the Oxford Scheme, including biomicroscopy, optical filters, illumination conditions, and the characteristics of and instillation techniques used for, selected clinical dyes.

Results: A series of panels, labeled A-E, in order of increasing severity, reproducing the staining patterns encountered in dry eye, are used as a guide to grade the degree of staining seen in the patient. The amount of staining seen in each panel, represented by punctate dots, increases by 0.5 of the log of the number of dots between panels B to E. The use of the vital dyes fluorescein, lissamine green, and rose Bengal is described; fluorescein and lissamine green, used in conjunction with appropriate absorption filters, are recommended for use in clinical trials. The placement of staining in relation to the sequence of other diagnostic tests is discussed.

Conclusions: The monitoring and assessment of corneal and conjunctival staining can be greatly enhanced by the use of a grading scale, controlled instillation of dyes, and standard evaluation techniques. This is of particular benefit in clinical trials, where ocular surface staining is commonly employed as an outcome measure
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http://dx.doi.org/10.1097/00003226-200310000-00008DOI Listing
October 2003

Menopause, hormone replacement therapy and tear function.

Adv Exp Med Biol 2002 ;506(Pt B):1029-33

Cooperative Research Centre for Eye Research and Technology, The University of New South Wales, Kensington, NSW, Australia.

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http://dx.doi.org/10.1007/978-1-4615-0717-8_145DOI Listing
May 2003
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