Skip to main content

James Slaven

Followers

3

Following

2

Public Views

Indiana University

Murray Finkelstein

University of Texas at San Antonio

T.C. Haliç Üniversitesi

United States Geological Survey

Interests

Uploads

Papers by James Slaven

Approximate Negative-Binomial Confidence Intervals: Asbestos Fiber Counts

The negative-binomial distribution is adopted for analyzing asbestos-fiber counts so as to accoun... more The negative-binomial distribution is adopted for analyzing asbestos-fiber counts so as to account for both the sampling errors in capturing only a finite number of fibers as well as the inevitable human variation in identifying and counting sampled fibers. A simple approximation to this distribution is developed for the derivation of quantiles and approximate confidence limits. The success of the approximation depends critically on the use of the Stirling expansion to sufficient order, on exact normalization of the approximating distribution, on reasonable perturbation of quantities from the normal distribution, and on accurately approximating sums by inverse-trapezoidal integration. Accuracy of the approximation developed is checked through simulation and also by comparison to traditional approximate confidence intervals in the specific case that the negative-binomial distribution approaches the Poisson distribution. The resulting statistics are shown to relate directly to early r...

Impact of the COVID-19 Pandemic on Cystic Fibrosis Pulmonary Exacerbations

Proceedings of IMPRS

Background and Hypothesis CF pulmonary exacerbations (PEx) are episodes of decline in res... more Background and Hypothesis CF pulmonary exacerbations (PEx) are episodes of decline in respiratory function that can be triggered by a variety of mechanisms, including respiratory viral infections. The COVID-19 pandemic resulted in school closures and home isolation policies and a potential reduction in exposure to other respiratory viruses. The goal of this project is to study the impact of the COVID-19 pandemic on CF PEx at the Riley Hospital for Children. We hypothesize that the incidence of PEx will be lower during the period of the COVID-19 lockdown from March 1 to May 15 in 2020 compared to the same time interval in 2019. Methods We performed a retrospective chart review of children with CF ages 2-12 (N=80) seen at Riley in 2019 and 2020 and collected data within the following timeframes: January 1 to March 15 2019 and 2020, and March 16 to May 15 2019 and 2020. We collected data on baseline clinical features and details of each PEx event. Data were analyze...

QOL-48. Interdisciplinary Spiritual Care Training in Pediatric Neuro-Oncology

Neuro-Oncology

INTRODUCTION Pediatric neuro-oncology requires attention to not only cancer biology and therapeut... more INTRODUCTION Pediatric neuro-oncology requires attention to not only cancer biology and therapeutics, but also to the suffering of the patient. In addressing patient suffering, consensus guidelines direct attention to the spiritual distress and resources of patients and families. A lack of training has been a key barrier to integrating this aspect of health into patient care. METHODS A neuro-oncologist and a chaplain participated in a train the trainer for the Interprofessional Spiritual Care Education Curriculum (ISPEC) through the George Washington University’s Institute for Spirituality and Health. After the train the trainer, the online curriculum was offered to interdepartmental team members, combined with in-person discussion groups, which met weekly for six sessions. A survey was given before and after the training, and Likert scores were analyzed using the Wilcoxon rank-sum non-parametric test. OUTCOMES: 17 interdisciplinary members participated in the training. These member...

Hyperinflation is Associated with Increased Respiratory Rate and is a More Sensitive Measure of Cystic Fibrosis Lung Disease During Infancy Compared to Forced Expiratory Measures

This a preprint and has not been peer reviewed. Data may be preliminary.

Impact of the COVID-19 Pandemic on Pediatric Cystic Fibrosis Pulmonary Exacerbations

To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PE... more To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PEx) we performed a retrospective review of PEx events at our CF Center and compared the rate of PEx in 2019 vs 2020. Restrictions on social interaction due to the COVID-19 pandemic were associated with a lower rate of PEx at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection in children with CF.

Discordance Between Surrogate Goals of Care and Medical Treatments Received By Hospitalized Older Adults (S769)

Journal of Pain and Symptom Management

Describe the association between parent psychological distress with symptoms and quality of life ... more Describe the association between parent psychological distress with symptoms and quality of life experienced by children undergoing stem cell transplant. Describe a model for collaboration between the primary stem cell transplantation team and pediatric palliative care providers. Original Research Background. Hematopoietic stem cell transplantation (HSCT) is potentially curative for children with life-threatening conditions but can result in a high symptom burden and poor quality of life (QoL). Parents provide extensive care for their children and can experience psychological distress. Research Objectives. To describe the association of parent anxiety, depression, and stress with the symptom burden and QoL among children undergoing HSCT or chimeric-antigen receptor (CAR) T cell therapy Methods. This multisite study employed a longitudinal, repeated measures design. English or Spanishspeaking children ages 2-18 years with any diagnosis and planned HSCT/CAR therapy were eligible. Beck Anxiety and Depression Inventories and the Perceived Stress Scale were administered to parents pre-HSCT/ CAR, and day+30, +60, +90 post-HSCT/CAR. The Memorial Symptom Assessment Scale (MSAS) and Pediatric Quality of Life Cancer Module were administered to children (parent-proxy for younger children) at corresponding timepoints. Descriptive statistics and correlation analyses were used.

Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families

Journal of the International Association of Providers of AIDS Care (JIAPAC)

Background: There are few validated tools to measure stigma, particularly among children living w... more Background: There are few validated tools to measure stigma, particularly among children living with HIV and their families. Methods: This study was nested within a larger study that followed 240 child–caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child–caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. Results: Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. Conclusions: The stigma instrument showed high validity when compared to emotional and beha...

Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

PLOS ONE

Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged ur... more Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safetynet hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%)

Preferred Medication Changes in High Risk Asthma Patients Leads to Increased ED Visits and Hospitalizations

Journal of Allergy and Clinical Immunology

Insurance companies frequently change the preferred inhaled corticosteroid (ICS) for asthma. This... more Insurance companies frequently change the preferred inhaled corticosteroid (ICS) for asthma. This causes gaps in medication utilization as pharmacies, physicians, and patients work to comply with the change. To determine if these changes impacted children with severepersistent asthma, we performed a two year retrospective chart review (2016-2017) of hospitalization and emergency department (ED) visits. METHODS: Hospitalization and ED visits of 98 children (median age 10 years) in our high-risk asthma clinic were reviewed between January 2016 to December 2017. Medication refill history, changes in insurance, and reasons for ED visits/hospitalizations were reviewed. Patients with <2 refills of ICS within 3 months and physician documentation of not taking medication despite continuous ICS access, were labeled ''non-compliant.'' Patients encountering changes in preferred ICS were labeled as ''medication refill issue.'' Data were analyzed using Wilcoxon non-parametric test. RESULTS: In our high-risk asthma patients, a change in preferred ICS was associated with increased rates of ED visits (p50.002) and hospitalizations (p5.009). When examining the reason for the ED visit or hospitalization, we found that ''non-compliant'' patients had more ED visits than patients who were always compliant with medication (p50.002), but they did not have higher hospitalization rates (p50.37). Furthermore, ''medication refill issues'' led to increased ED visits (p<0.001) and hospitalizations (p50.012). CONCLUSIONS: High-risk asthma patients have a higher likelihood of ED visits and hospitalizations when their ICS changes. Working to keep their preferred ICS consistent is crucial in reducing health care costs. Further investigation is needed to determine if non-compliance may be linked with frequent ICS changes.

A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults

Nutrients

A systematic review and meta-analysis determined the effect of restaurant menu labeling on calori... more A systematic review and meta-analysis determined the effect of restaurant menu labeling on calories and nutrients chosen in laboratory and away-from-home settings in U.S. adults. Cochrane-based criteria adherent, peer-reviewed study designs conducted and published in the English language from 1950 to 2014 were collected in 2015, analyzed in 2016, and used to evaluate the effect of nutrition labeling on calories and nutrients ordered or consumed. Before and after menu labeling outcomes were used to determine weighted mean differences in calories, saturated fat, total fat, carbohydrate, and sodium ordered/consumed which were pooled across studies using random effects modeling. Stratified analysis for laboratory and away-from-home settings were also completed. Menu labeling resulted in no significant change in reported calories ordered/consumed in studies with full criteria adherence, nor the 14 studies analyzed with ≤1 unmet criteria, nor for change in total ordered carbohydrate, fat, and saturated fat (three studies) or ordered or consumed sodium (four studies). A significant reduction of 115.2 calories ordered/consumed in laboratory settings was determined when analyses were stratified by study setting. Menu labeling away-from-home did not result in change in quantity or quality, specifically for carbohydrates, total fat, saturated fat, or sodium, of calories consumed among U.S. adults.

Oral Food Challenge Failures Among Foods Eliminated to Treat Atopic Dermatitis

Journal of Allergy and Clinical Immunology

Pre-Operative Nomograms for Predicting Renal Function at 1 Year after Partial Nephrectomy

Journal of endourology, Jul 26, 2017

Partial nephrectomy (PN) reduces the risk of post-operative chronic renal insufficiency (CRI). Ho... more Partial nephrectomy (PN) reduces the risk of post-operative chronic renal insufficiency (CRI). However, some patients still develop CRI after PN, and may eventually require dialysis. Being able to predict renal function before PN helps in counseling patients and managing expectations. We aimed to construct nomograms that predict estimated glomerular filtration rate (eGFR), defined by the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae, at one year after PN, using only pre-operative covariates as predictors. We identified patients who underwent PN in our institution between 2004 and 2016, with known post-operative serum creatinine levels at one year. The pre-operative covariates included patients' demographics, chronic comorbid conditions, tumor characteristics and pre-operative renal status. The endpoints were eGFRs at one year after PN, calculated using the MDRD and the CKD-EPI formulae. We first identifi...

Caspofungin Increases Fungal Chitin and Eosinophil and γδ T Cell-Dependent Pathology in Invasive Aspergillosis

Journal of immunology (Baltimore, Md. : 1950), Jan 31, 2017

The polysaccharide-rich fungal cell wall provides pathogen-specific targets for antifungal therap... more The polysaccharide-rich fungal cell wall provides pathogen-specific targets for antifungal therapy and distinct molecular patterns that stimulate protective or detrimental host immunity. The echinocandin antifungal caspofungin inhibits synthesis of cell wall β-1,3-glucan and is used for prophylactic therapy in immune-suppressed individuals. However, breakthrough infections with fungal pathogen Aspergillus fumigatus are associated with caspofungin prophylaxis. In this study, we report in vitro and in vivo increases in fungal surface chitin in A. fumigatus induced by caspofungin that was associated with airway eosinophil recruitment in neutropenic mice with invasive pulmonary aspergillosis (IA). More importantly, caspofungin treatment of mice with IA resulted in a pattern of increased fungal burden and severity of disease that was reversed in eosinophil-deficient mice. Additionally, the eosinophil granule proteins major basic protein and eosinophil peroxidase were more frequently dete...

Glutathione-S-transferase P1 may predispose children to a decline in pulmonary function after stem cell transplant

Pediatric pulmonology, Jul 2, 2017

Pulmonary complications after hematopoietic stem cell transplant (SCT) are associated with increa... more Pulmonary complications after hematopoietic stem cell transplant (SCT) are associated with increased mortality. Genetic markers for those at risk for pulmonary impairment post-SCT have not been widely investigated. Forty-nine patients were retrospectively selected from a single institution's biorepository with linked clinical data. All subjects performed pre-SCT PFTs. Genotyping was conducted using the Infinium Exome-24 BeadChip. Four single nucleotide polymorphisms (SNPs) were selected (rs1800871, rs1695, rs1800629, rs12477314) and evaluated for association with PFT parameters as change over time from baseline. Associations between SNPs and PFT parameters were assessed and adjusted for the following confounding variables: age, gender, and race. Using the recessive genetic model, patients with one or two minor alleles for the glutathione S-transferase P1 (GSTP1) SNP rs1695 had a lower decline in FEV1 and FEF25-75 at 1-year post-SCT compared to patients who were homozygous for th...

Variations in pollen counts between Indianapolis, IN, and Dayton, OH, in spring 2013 and 2014

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2016

Approximately 20-40 percent of the US population suffers from allergic rhinitis. As pollens contr... more Approximately 20-40 percent of the US population suffers from allergic rhinitis. As pollens contribute significantly to allergic rhinitis, monitoring local pollen counts can help patients and providers better manage this condition (1). Identification of local pollens can help the clinician more accurately select allergens for testing and immunotherapy, and improve advice to sensitized patients on environmental control measures. Certified pollen counting stations can be found on the webpage of the National Allergy Bureau (NAB). Currently, there are 82 NAB stations in the United States, but none in Indiana. The closest station to Indianapolis on the NAB webpage is 120 miles east, in Dayton, Ohio (2). Dayton and Indianapolis are considered to be in the Appalachian floristic province, within the North Atlantic region. Pollen counts in cities in the same region are assumed to be similar (3). Prior work comparing pollen counts between cities eleven kilometers apart found similarities in pollen counts (4). However, pollen counts can be affected by precipitation, temperature, wind, and other environmental factors (5).

Institutional Cost of Unplanned 30-Day Readmission Following Open and Endovascular Surgery

Vascular and endovascular surgery, 2016

Vascular surgical patients have a high rate of readmission, and the cost of readmission for these... more Vascular surgical patients have a high rate of readmission, and the cost of readmission for these patients has not been described. Herein, we characterize and compare institutional index hospitalization and 30-day readmission cost following open and endovascular vascular procedures. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify inpatient open and endovascular procedures at a single institution, from January 2011 through June 2012. Variable and fixed costs for index hospitalization and unplanned 30-day readmissions were obtained using SAP BusinessObjects. Patient characteristics and outcome variables were analyzed using Student t tests or Wilcoxon rank-sum nonparametric tests for continuous variables and Fisher exact tests for categorical variables. One thousand twenty-six inpatient procedures were included in the analysis. There were 605 (59%) open and 421 (41%) endovascular procedures with a 30-day unplanned readmission...

Plasma and Intracellular Concentrations in HIV-infected Patients Requiring Hemodialysis Dosed with Tenofovir Disoproxil Fumarate and Emtricitabine: TDF and FTC in HD

Journal of acquired immune deficiency syndromes (1999), Sep 9, 2016

Oral Food Challenge Failures to Egg, Milk, and Peanut: An Evaluation of Doses, Proportion, and Time

Journal of Allergy and Clinical Immunology, 2016

RATIONALE: Few studies have compared eliciting doses (ED) for failed oral food challenges (OFCs).... more RATIONALE: Few studies have compared eliciting doses (ED) for failed oral food challenges (OFCs). The time to failure (TTF) has also not been compared. The aims of this study were to compare EDs in grams of food consumed, the serving proportions, and TTFs for failed OFCs to egg, milk, and peanut. METHODS: A retrospective chart review analyzed open OFCs to egg, milk, and peanut, performed at an academic pediatric allergy clinic, from 2008-2013. Serving sizes for each food were 12 grams (egg), 16grams (milk), and 10grams (peanut). Median EDs, ED10 (ED for 10% of failures), and TTF (time from first dose ingested to onset of symptoms) were compared. OFCs were offered when milk sIgE was < 1.0 kU/L; egg sIgE was < 0.6 kU/L; and peanut sIgE was < 0.35 kU/L. Extensivelyheated egg and milk OFCs were excluded. Data were analyzed via SAS v9.3 (Cary, NC). RESULTS: There were 51 failures among 185 OFCs (27.6%) (11 milk; 27 egg; 13 peanut). Median doses for failure did not significantly differ (milk 1000mg [60-8000]; egg 1500mg [10-12000]; peanut 1000mg [100-2700]). ED10s did not significantly differ (milk 60mg; egg 100mg; peanut 100mg). Median proportion of a serving did not significantly differ (milk512%; egg 25%; peanut 11%). Median TTF did not significantly differ (milk 60 min [9-219]; egg 121min [9-360]; peanut 120 min [25-199]). CONCLUSIONS: Even when the specific IgE suggests a low risk of reaction, failures still occur, and seem to occur at similar amounts of food exposure, similar proportions of food serving, and similar time frames.

Use of polysomnography to assess safe decannulation in children

Pediatric pulmonology, Aug 25, 2016

Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The ... more Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). ...

Increased prevalence of airway reactivity in children with eosinophilic esophagitis

Pediatric pulmonology, Jan 28, 2015

Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior ... more Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. EoE subjects (n = 33) and healthy controls (n = 37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P = 0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asth...

Approximate Negative-Binomial Confidence Intervals: Asbestos Fiber Counts

The negative-binomial distribution is adopted for analyzing asbestos-fiber counts so as to accoun... more The negative-binomial distribution is adopted for analyzing asbestos-fiber counts so as to account for both the sampling errors in capturing only a finite number of fibers as well as the inevitable human variation in identifying and counting sampled fibers. A simple approximation to this distribution is developed for the derivation of quantiles and approximate confidence limits. The success of the approximation depends critically on the use of the Stirling expansion to sufficient order, on exact normalization of the approximating distribution, on reasonable perturbation of quantities from the normal distribution, and on accurately approximating sums by inverse-trapezoidal integration. Accuracy of the approximation developed is checked through simulation and also by comparison to traditional approximate confidence intervals in the specific case that the negative-binomial distribution approaches the Poisson distribution. The resulting statistics are shown to relate directly to early r...

Impact of the COVID-19 Pandemic on Cystic Fibrosis Pulmonary Exacerbations

Proceedings of IMPRS

Background and Hypothesis CF pulmonary exacerbations (PEx) are episodes of decline in res... more Background and Hypothesis CF pulmonary exacerbations (PEx) are episodes of decline in respiratory function that can be triggered by a variety of mechanisms, including respiratory viral infections. The COVID-19 pandemic resulted in school closures and home isolation policies and a potential reduction in exposure to other respiratory viruses. The goal of this project is to study the impact of the COVID-19 pandemic on CF PEx at the Riley Hospital for Children. We hypothesize that the incidence of PEx will be lower during the period of the COVID-19 lockdown from March 1 to May 15 in 2020 compared to the same time interval in 2019. Methods We performed a retrospective chart review of children with CF ages 2-12 (N=80) seen at Riley in 2019 and 2020 and collected data within the following timeframes: January 1 to March 15 2019 and 2020, and March 16 to May 15 2019 and 2020. We collected data on baseline clinical features and details of each PEx event. Data were analyze...

QOL-48. Interdisciplinary Spiritual Care Training in Pediatric Neuro-Oncology

Neuro-Oncology

INTRODUCTION Pediatric neuro-oncology requires attention to not only cancer biology and therapeut... more INTRODUCTION Pediatric neuro-oncology requires attention to not only cancer biology and therapeutics, but also to the suffering of the patient. In addressing patient suffering, consensus guidelines direct attention to the spiritual distress and resources of patients and families. A lack of training has been a key barrier to integrating this aspect of health into patient care. METHODS A neuro-oncologist and a chaplain participated in a train the trainer for the Interprofessional Spiritual Care Education Curriculum (ISPEC) through the George Washington University’s Institute for Spirituality and Health. After the train the trainer, the online curriculum was offered to interdepartmental team members, combined with in-person discussion groups, which met weekly for six sessions. A survey was given before and after the training, and Likert scores were analyzed using the Wilcoxon rank-sum non-parametric test. OUTCOMES: 17 interdisciplinary members participated in the training. These member...

Hyperinflation is Associated with Increased Respiratory Rate and is a More Sensitive Measure of Cystic Fibrosis Lung Disease During Infancy Compared to Forced Expiratory Measures

This a preprint and has not been peer reviewed. Data may be preliminary.

Impact of the COVID-19 Pandemic on Pediatric Cystic Fibrosis Pulmonary Exacerbations

To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PE... more To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PEx) we performed a retrospective review of PEx events at our CF Center and compared the rate of PEx in 2019 vs 2020. Restrictions on social interaction due to the COVID-19 pandemic were associated with a lower rate of PEx at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection in children with CF.

Discordance Between Surrogate Goals of Care and Medical Treatments Received By Hospitalized Older Adults (S769)

Journal of Pain and Symptom Management

Describe the association between parent psychological distress with symptoms and quality of life ... more Describe the association between parent psychological distress with symptoms and quality of life experienced by children undergoing stem cell transplant. Describe a model for collaboration between the primary stem cell transplantation team and pediatric palliative care providers. Original Research Background. Hematopoietic stem cell transplantation (HSCT) is potentially curative for children with life-threatening conditions but can result in a high symptom burden and poor quality of life (QoL). Parents provide extensive care for their children and can experience psychological distress. Research Objectives. To describe the association of parent anxiety, depression, and stress with the symptom burden and QoL among children undergoing HSCT or chimeric-antigen receptor (CAR) T cell therapy Methods. This multisite study employed a longitudinal, repeated measures design. English or Spanishspeaking children ages 2-18 years with any diagnosis and planned HSCT/CAR therapy were eligible. Beck Anxiety and Depression Inventories and the Perceived Stress Scale were administered to parents pre-HSCT/ CAR, and day+30, +60, +90 post-HSCT/CAR. The Memorial Symptom Assessment Scale (MSAS) and Pediatric Quality of Life Cancer Module were administered to children (parent-proxy for younger children) at corresponding timepoints. Descriptive statistics and correlation analyses were used.

Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families

Journal of the International Association of Providers of AIDS Care (JIAPAC)

Background: There are few validated tools to measure stigma, particularly among children living w... more Background: There are few validated tools to measure stigma, particularly among children living with HIV and their families. Methods: This study was nested within a larger study that followed 240 child–caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child–caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. Results: Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. Conclusions: The stigma instrument showed high validity when compared to emotional and beha...

Early predictors of outcomes of hospitalization for cirrhosis and assessment of the impact of race and ethnicity at safety-net hospitals

PLOS ONE

Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged ur... more Background Safety-net hospitals provide care for racially/ethnically diverse and disadvantaged urban populations. Their hospitalized patients with cirrhosis are relatively understudied and may be vulnerable to poor outcomes and racial/ethnic disparities. Aims To examine the outcomes of patients with cirrhosis hospitalized at regionally diverse safetynet hospitals and the impact of race/ethnicity. Methods A study of patients with cirrhosis hospitalized at 4 safety-net hospitals in 2012 was conducted. Demographic, clinical factors, and outcomes were compared between centers and racial/ethnic groups. Study endpoints included mortality and 30-day readmission. Results In 2012, 733 of 1,212 patients with cirrhosis were hospitalized for liver-related indications (median age 55 years, 65% male). The cohort was racially diverse (43% White, 25% black, 22% Hispanic, 3% Asian) with cirrhosis related to alcohol and viral hepatitis in 635 (87%)

Preferred Medication Changes in High Risk Asthma Patients Leads to Increased ED Visits and Hospitalizations

Journal of Allergy and Clinical Immunology

Insurance companies frequently change the preferred inhaled corticosteroid (ICS) for asthma. This... more Insurance companies frequently change the preferred inhaled corticosteroid (ICS) for asthma. This causes gaps in medication utilization as pharmacies, physicians, and patients work to comply with the change. To determine if these changes impacted children with severepersistent asthma, we performed a two year retrospective chart review (2016-2017) of hospitalization and emergency department (ED) visits. METHODS: Hospitalization and ED visits of 98 children (median age 10 years) in our high-risk asthma clinic were reviewed between January 2016 to December 2017. Medication refill history, changes in insurance, and reasons for ED visits/hospitalizations were reviewed. Patients with <2 refills of ICS within 3 months and physician documentation of not taking medication despite continuous ICS access, were labeled ''non-compliant.'' Patients encountering changes in preferred ICS were labeled as ''medication refill issue.'' Data were analyzed using Wilcoxon non-parametric test. RESULTS: In our high-risk asthma patients, a change in preferred ICS was associated with increased rates of ED visits (p50.002) and hospitalizations (p5.009). When examining the reason for the ED visit or hospitalization, we found that ''non-compliant'' patients had more ED visits than patients who were always compliant with medication (p50.002), but they did not have higher hospitalization rates (p50.37). Furthermore, ''medication refill issues'' led to increased ED visits (p<0.001) and hospitalizations (p50.012). CONCLUSIONS: High-risk asthma patients have a higher likelihood of ED visits and hospitalizations when their ICS changes. Working to keep their preferred ICS consistent is crucial in reducing health care costs. Further investigation is needed to determine if non-compliance may be linked with frequent ICS changes.

A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults

Nutrients

A systematic review and meta-analysis determined the effect of restaurant menu labeling on calori... more A systematic review and meta-analysis determined the effect of restaurant menu labeling on calories and nutrients chosen in laboratory and away-from-home settings in U.S. adults. Cochrane-based criteria adherent, peer-reviewed study designs conducted and published in the English language from 1950 to 2014 were collected in 2015, analyzed in 2016, and used to evaluate the effect of nutrition labeling on calories and nutrients ordered or consumed. Before and after menu labeling outcomes were used to determine weighted mean differences in calories, saturated fat, total fat, carbohydrate, and sodium ordered/consumed which were pooled across studies using random effects modeling. Stratified analysis for laboratory and away-from-home settings were also completed. Menu labeling resulted in no significant change in reported calories ordered/consumed in studies with full criteria adherence, nor the 14 studies analyzed with ≤1 unmet criteria, nor for change in total ordered carbohydrate, fat, and saturated fat (three studies) or ordered or consumed sodium (four studies). A significant reduction of 115.2 calories ordered/consumed in laboratory settings was determined when analyses were stratified by study setting. Menu labeling away-from-home did not result in change in quantity or quality, specifically for carbohydrates, total fat, saturated fat, or sodium, of calories consumed among U.S. adults.

Oral Food Challenge Failures Among Foods Eliminated to Treat Atopic Dermatitis

Journal of Allergy and Clinical Immunology

Pre-Operative Nomograms for Predicting Renal Function at 1 Year after Partial Nephrectomy

Journal of endourology, Jul 26, 2017

Partial nephrectomy (PN) reduces the risk of post-operative chronic renal insufficiency (CRI). Ho... more Partial nephrectomy (PN) reduces the risk of post-operative chronic renal insufficiency (CRI). However, some patients still develop CRI after PN, and may eventually require dialysis. Being able to predict renal function before PN helps in counseling patients and managing expectations. We aimed to construct nomograms that predict estimated glomerular filtration rate (eGFR), defined by the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae, at one year after PN, using only pre-operative covariates as predictors. We identified patients who underwent PN in our institution between 2004 and 2016, with known post-operative serum creatinine levels at one year. The pre-operative covariates included patients' demographics, chronic comorbid conditions, tumor characteristics and pre-operative renal status. The endpoints were eGFRs at one year after PN, calculated using the MDRD and the CKD-EPI formulae. We first identifi...

Caspofungin Increases Fungal Chitin and Eosinophil and γδ T Cell-Dependent Pathology in Invasive Aspergillosis

Journal of immunology (Baltimore, Md. : 1950), Jan 31, 2017

The polysaccharide-rich fungal cell wall provides pathogen-specific targets for antifungal therap... more The polysaccharide-rich fungal cell wall provides pathogen-specific targets for antifungal therapy and distinct molecular patterns that stimulate protective or detrimental host immunity. The echinocandin antifungal caspofungin inhibits synthesis of cell wall β-1,3-glucan and is used for prophylactic therapy in immune-suppressed individuals. However, breakthrough infections with fungal pathogen Aspergillus fumigatus are associated with caspofungin prophylaxis. In this study, we report in vitro and in vivo increases in fungal surface chitin in A. fumigatus induced by caspofungin that was associated with airway eosinophil recruitment in neutropenic mice with invasive pulmonary aspergillosis (IA). More importantly, caspofungin treatment of mice with IA resulted in a pattern of increased fungal burden and severity of disease that was reversed in eosinophil-deficient mice. Additionally, the eosinophil granule proteins major basic protein and eosinophil peroxidase were more frequently dete...

Glutathione-S-transferase P1 may predispose children to a decline in pulmonary function after stem cell transplant

Pediatric pulmonology, Jul 2, 2017

Pulmonary complications after hematopoietic stem cell transplant (SCT) are associated with increa... more Pulmonary complications after hematopoietic stem cell transplant (SCT) are associated with increased mortality. Genetic markers for those at risk for pulmonary impairment post-SCT have not been widely investigated. Forty-nine patients were retrospectively selected from a single institution's biorepository with linked clinical data. All subjects performed pre-SCT PFTs. Genotyping was conducted using the Infinium Exome-24 BeadChip. Four single nucleotide polymorphisms (SNPs) were selected (rs1800871, rs1695, rs1800629, rs12477314) and evaluated for association with PFT parameters as change over time from baseline. Associations between SNPs and PFT parameters were assessed and adjusted for the following confounding variables: age, gender, and race. Using the recessive genetic model, patients with one or two minor alleles for the glutathione S-transferase P1 (GSTP1) SNP rs1695 had a lower decline in FEV1 and FEF25-75 at 1-year post-SCT compared to patients who were homozygous for th...

Variations in pollen counts between Indianapolis, IN, and Dayton, OH, in spring 2013 and 2014

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2016

Approximately 20-40 percent of the US population suffers from allergic rhinitis. As pollens contr... more Approximately 20-40 percent of the US population suffers from allergic rhinitis. As pollens contribute significantly to allergic rhinitis, monitoring local pollen counts can help patients and providers better manage this condition (1). Identification of local pollens can help the clinician more accurately select allergens for testing and immunotherapy, and improve advice to sensitized patients on environmental control measures. Certified pollen counting stations can be found on the webpage of the National Allergy Bureau (NAB). Currently, there are 82 NAB stations in the United States, but none in Indiana. The closest station to Indianapolis on the NAB webpage is 120 miles east, in Dayton, Ohio (2). Dayton and Indianapolis are considered to be in the Appalachian floristic province, within the North Atlantic region. Pollen counts in cities in the same region are assumed to be similar (3). Prior work comparing pollen counts between cities eleven kilometers apart found similarities in pollen counts (4). However, pollen counts can be affected by precipitation, temperature, wind, and other environmental factors (5).

Institutional Cost of Unplanned 30-Day Readmission Following Open and Endovascular Surgery

Vascular and endovascular surgery, 2016

Vascular surgical patients have a high rate of readmission, and the cost of readmission for these... more Vascular surgical patients have a high rate of readmission, and the cost of readmission for these patients has not been described. Herein, we characterize and compare institutional index hospitalization and 30-day readmission cost following open and endovascular vascular procedures. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify inpatient open and endovascular procedures at a single institution, from January 2011 through June 2012. Variable and fixed costs for index hospitalization and unplanned 30-day readmissions were obtained using SAP BusinessObjects. Patient characteristics and outcome variables were analyzed using Student t tests or Wilcoxon rank-sum nonparametric tests for continuous variables and Fisher exact tests for categorical variables. One thousand twenty-six inpatient procedures were included in the analysis. There were 605 (59%) open and 421 (41%) endovascular procedures with a 30-day unplanned readmission...

Plasma and Intracellular Concentrations in HIV-infected Patients Requiring Hemodialysis Dosed with Tenofovir Disoproxil Fumarate and Emtricitabine: TDF and FTC in HD

Journal of acquired immune deficiency syndromes (1999), Sep 9, 2016

Oral Food Challenge Failures to Egg, Milk, and Peanut: An Evaluation of Doses, Proportion, and Time

Journal of Allergy and Clinical Immunology, 2016

RATIONALE: Few studies have compared eliciting doses (ED) for failed oral food challenges (OFCs).... more RATIONALE: Few studies have compared eliciting doses (ED) for failed oral food challenges (OFCs). The time to failure (TTF) has also not been compared. The aims of this study were to compare EDs in grams of food consumed, the serving proportions, and TTFs for failed OFCs to egg, milk, and peanut. METHODS: A retrospective chart review analyzed open OFCs to egg, milk, and peanut, performed at an academic pediatric allergy clinic, from 2008-2013. Serving sizes for each food were 12 grams (egg), 16grams (milk), and 10grams (peanut). Median EDs, ED10 (ED for 10% of failures), and TTF (time from first dose ingested to onset of symptoms) were compared. OFCs were offered when milk sIgE was < 1.0 kU/L; egg sIgE was < 0.6 kU/L; and peanut sIgE was < 0.35 kU/L. Extensivelyheated egg and milk OFCs were excluded. Data were analyzed via SAS v9.3 (Cary, NC). RESULTS: There were 51 failures among 185 OFCs (27.6%) (11 milk; 27 egg; 13 peanut). Median doses for failure did not significantly differ (milk 1000mg [60-8000]; egg 1500mg [10-12000]; peanut 1000mg [100-2700]). ED10s did not significantly differ (milk 60mg; egg 100mg; peanut 100mg). Median proportion of a serving did not significantly differ (milk512%; egg 25%; peanut 11%). Median TTF did not significantly differ (milk 60 min [9-219]; egg 121min [9-360]; peanut 120 min [25-199]). CONCLUSIONS: Even when the specific IgE suggests a low risk of reaction, failures still occur, and seem to occur at similar amounts of food exposure, similar proportions of food serving, and similar time frames.

Use of polysomnography to assess safe decannulation in children

Pediatric pulmonology, Aug 25, 2016

Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The ... more Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. Between 2006 and 2013, patients were identified using a clinical database of decannulation studies. A protocol, finalized in 2005, was implemented for each decannulation attempt. In brief, all patients eligible for decannulation based on physician's assessment undergoes bronchoscopy. Once bronchoscopy findings reveal that the patient's airway is free of significant obstruction, decannulation is conducted in the sleep laboratory. The stoma is covered by an occlusive dressing and respiratory parameters are measured awake and asleep during the day and overnight by polysomnogram (PSG). ...

Increased prevalence of airway reactivity in children with eosinophilic esophagitis

Pediatric pulmonology, Jan 28, 2015

Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior ... more Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. EoE subjects (n = 33) and healthy controls (n = 37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P = 0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asth...