The authors evaluated the validity, reliability, and sensitivity to change of the Delirium Severi... more The authors evaluated the validity, reliability, and sensitivity to change of the Delirium Severity Scale (DSS), a 10-minute assessment consisting of Forward Digit Span and Similarities. Twenty-two older inpatients with delirium but not dementia and 15 control patients were administered the DSS during hospitalization. Scores were significantly inversely correlated with experts' quantitative ratings of severity at all three time-points examined. The DSS showed significant improvement over time (P < 0.001) and significant correlation with improvement in expert ratings (P = 0.026). The DSS shows promise as a valid and reliable measure sensitive to changing symptom severity.
Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess... more Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess an inverse association between meal frequency and childhood obesity with particular focus on breakfast consumption. Methods. Anthropometric data on 4 642 children aged 5 to 6 years were obtained in 5 Bavarian public health offices (Germany) during the obligatory school entry health examination in 2004/2005. An extensive questionnaire on risk factors for childhood obesity was answered by their parents. Obesity was defined according to sex-and age-specific body mass index (BMI) cut-off points, recommended by the International Obesity Task Force. Main exposures were meal frequency and breakfast consumption.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United S... more Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male = 269, female = 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P = 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis. Conclusion: Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health. (HEPATOLOGY 2009.)
Despite absence of clear proof of efficacy, the use of inhaled corticosteroids (ICS) is widesprea... more Despite absence of clear proof of efficacy, the use of inhaled corticosteroids (ICS) is widespread in cystic fibrosis (CF) patients. Therefore, the effect of ICS on lung function and other clinical variables was studied in 27 prepubertal CF children with mild to moderate lung disease. In a prospective double-blind case-controlled study, fluticasone propionate 500 μg or placebo were administered twice daily during 12 months. The mean (standard error of the mean, SEM) patient age was 8.2 (0.6) years in the placebo group and 9.0 (0.5) years in the fluticasone group. The mean (SEM) forced expiratory volume in 1 s (FEV1) was 91% (4%) in the placebo group and 86% (4%) in the fluticasone group. There was no statistically significant difference in the evolution of lung function and the number of respiratory exacerbations between groups. However, longitudinal growth in fluticasone patients was significantly slower than in placebo patients: 3.96 (0.29) cm versus 5.49 (0.38) cm [pANOVA)] over the 12-month study duration. This resulted in a significant change in height standard deviation score (SDS) of –0.38 (0.09) in the fluticasone group versus –0.01 (0.07) in the placebo group (pANOVA). No catch-up growth was noted 1–2 years after discontinuation of inhaled steroids. The use of high-dose ICS in CF patients with mild lung disease may lead to persistent growth impairment.
The authors introduce a minimal-access subtemporal approach for selective resection of the amygda... more The authors introduce a minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with temporal lobe epilepsy and describe seizure and neuropsychological outcomes. Between October 2003 and April 2007, 41 consecutive patients with intractable unilateral nonlesional temporal lobe epilepsy underwent image-guided subtemporal amygdalohippocampectomy. Baseline characteristics, preoperative evaluations, and seizure outcomes were assessed. Eighteen patients underwent pre- and postoperative neuropsychological testing for cognitive functioning, executive functioning, verbal and visual memory, and mood. Important aspects of the subtemporal approach include a low temporal keyhole craniotomy, use of image guidance, preservation of the tentorium, incision in the fusiform gyrus, and subpial, en bloc resection of the hippocampus. There were no deaths and no cases of significant postoperative morbidity. At 1 year, 29 of 36 patients (81%) were without seizures or auras. At 2 years, 17 of 23 (74%) patients were seizure- and aura-free. Detailed neuropsychological testing of language, memory, cognitive functioning, and executive functioning suggested that most patients exhibited either stability or improvement in their scores, regardless of language lateralization. A minimal-access subtemporal approach for amygdalohippocampectomy is an effective treatment for temporal lobe epilepsy yielding encouraging preliminary seizure and neuropsychological outcomes.
Purpose To determine if caring for a child with cancer or a brain tumor affects parental health a... more Purpose To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life. Methods In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress. Results Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents. Conclusions The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.
Journal of Biomaterials Science-polymer Edition, 1999
... KRISTIN M. DEFIFE1, KRIS M. HAGEN3, DAVID L. CLAPPER 3 and JAMES M. ANDERSON1. 2.* 1 Institut... more ... KRISTIN M. DEFIFE1, KRIS M. HAGEN3, DAVID L. CLAPPER 3 and JAMES M. ANDERSON1. 2.* 1 Institute of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA 2 Department of ... T. McPherson, A. Kidane, I. Szleifer and K. Park, Langmuir 14, 176 ( 1998). ...
Photochemical immobilization technology was utilized to covalently couple polymers to silicone ru... more Photochemical immobilization technology was utilized to covalently couple polymers to silicone rubber either at multiple points along a polymer backbone or at the endpoint of an amphiphilic chain. The coating variants then were tested in vitro and in vivo for improvement of desired responses compared to uncoated silicone rubber. All coating variants suppressed the adsorption of fibrinogen and immunoglobulin G, and most also inhibited fibroblast growth by 90-99%. None of the coating variants inhibited monocyte or neutrophil adhesion in vitro. However, the surfaces that supported the highest levels of monocyte adhesion also elicited the lowest secretion of pro-inflammatory cytokines. None of the materials elicited a strong inflammatory response or significantly (p&lt; 0.05) reduced the thickness of the fibrous capsule when implanted subcutaneously in rats. Overall, the most passivating coating variant was an endpoint immobilized polypeptide that reduced protein adsorption, inhibited fibroblast growth by 90%, elicited low cytokine secretion from monocytes, and reduced fibrous encapsulation by 33%. In general, although some coating variants modified the adsorption of proteins and the behavior of leukocytes or fibroblasts in vitro, none abolished the development of a fibrous capsule in vivo.
The authors evaluated the validity, reliability, and sensitivity to change of the Delirium Severi... more The authors evaluated the validity, reliability, and sensitivity to change of the Delirium Severity Scale (DSS), a 10-minute assessment consisting of Forward Digit Span and Similarities. Twenty-two older inpatients with delirium but not dementia and 15 control patients were administered the DSS during hospitalization. Scores were significantly inversely correlated with experts&amp;amp;#39; quantitative ratings of severity at all three time-points examined. The DSS showed significant improvement over time (P &amp;amp;lt; 0.001) and significant correlation with improvement in expert ratings (P = 0.026). The DSS shows promise as a valid and reliable measure sensitive to changing symptom severity.
Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess... more Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess an inverse association between meal frequency and childhood obesity with particular focus on breakfast consumption. Methods. Anthropometric data on 4 642 children aged 5 to 6 years were obtained in 5 Bavarian public health offices (Germany) during the obligatory school entry health examination in 2004/2005. An extensive questionnaire on risk factors for childhood obesity was answered by their parents. Obesity was defined according to sex-and age-specific body mass index (BMI) cut-off points, recommended by the International Obesity Task Force. Main exposures were meal frequency and breakfast consumption.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United S... more Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States. The association between NAFLD and quality of life (QOL) remains unclear. These data are important to estimate the burden of illness in NAFLD. The aim was to report QOL scores of adults with NAFLD and examine the association between NAFLD severity and QOL. QOL data were collected from adults with NAFLD enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network using the Short Form 36 (SF-36) survey, and scores were compared with normative U.S. population scores. Liver biopsy histology was reviewed by a central pathology committee. A total of 713 subjects with NAFLD (male = 269, female = 444) were included. Mean age of subjects was 48.3 years; 61% had definite nonalcoholic steatohepatitis (NASH), and 28% had bridging fibrosis or cirrhosis. Diabetes was present in 27% of subjects. Subjects with NAFLD had worse physical (mean, 45.2) and mental health scores (mean, 47.6) compared with the U.S. population with (mean, 50) and without (physical, 55.8; mental, 52.5) chronic illness. Subjects with NASH reported lower physical health compared with subjects with fatty liver disease without NASH (44.5 versus 47.1, P = 0.02). Subjects with cirrhosis had significantly (P < 0.001) poorer physical health scores (38.4) than subjects with no (47.6), mild (46.2), moderate (44.6), or bridging fibrosis (44.6). Cirrhosis was associated with poorer physical health after adjusting for potential confounders. Mental health scores did not differ between participants with and without NASH or by degree of fibrosis. Conclusion: Adults with NAFLD have a significant decrement in QOL. Treatment of NAFLD should incorporate strategies to improve QOL, especially physical health. (HEPATOLOGY 2009.)
Despite absence of clear proof of efficacy, the use of inhaled corticosteroids (ICS) is widesprea... more Despite absence of clear proof of efficacy, the use of inhaled corticosteroids (ICS) is widespread in cystic fibrosis (CF) patients. Therefore, the effect of ICS on lung function and other clinical variables was studied in 27 prepubertal CF children with mild to moderate lung disease. In a prospective double-blind case-controlled study, fluticasone propionate 500 μg or placebo were administered twice daily during 12 months. The mean (standard error of the mean, SEM) patient age was 8.2 (0.6) years in the placebo group and 9.0 (0.5) years in the fluticasone group. The mean (SEM) forced expiratory volume in 1 s (FEV1) was 91% (4%) in the placebo group and 86% (4%) in the fluticasone group. There was no statistically significant difference in the evolution of lung function and the number of respiratory exacerbations between groups. However, longitudinal growth in fluticasone patients was significantly slower than in placebo patients: 3.96 (0.29) cm versus 5.49 (0.38) cm [pANOVA)] over the 12-month study duration. This resulted in a significant change in height standard deviation score (SDS) of –0.38 (0.09) in the fluticasone group versus –0.01 (0.07) in the placebo group (pANOVA). No catch-up growth was noted 1–2 years after discontinuation of inhaled steroids. The use of high-dose ICS in CF patients with mild lung disease may lead to persistent growth impairment.
The authors introduce a minimal-access subtemporal approach for selective resection of the amygda... more The authors introduce a minimal-access subtemporal approach for selective resection of the amygdala and hippocampus in patients with temporal lobe epilepsy and describe seizure and neuropsychological outcomes. Between October 2003 and April 2007, 41 consecutive patients with intractable unilateral nonlesional temporal lobe epilepsy underwent image-guided subtemporal amygdalohippocampectomy. Baseline characteristics, preoperative evaluations, and seizure outcomes were assessed. Eighteen patients underwent pre- and postoperative neuropsychological testing for cognitive functioning, executive functioning, verbal and visual memory, and mood. Important aspects of the subtemporal approach include a low temporal keyhole craniotomy, use of image guidance, preservation of the tentorium, incision in the fusiform gyrus, and subpial, en bloc resection of the hippocampus. There were no deaths and no cases of significant postoperative morbidity. At 1 year, 29 of 36 patients (81%) were without seizures or auras. At 2 years, 17 of 23 (74%) patients were seizure- and aura-free. Detailed neuropsychological testing of language, memory, cognitive functioning, and executive functioning suggested that most patients exhibited either stability or improvement in their scores, regardless of language lateralization. A minimal-access subtemporal approach for amygdalohippocampectomy is an effective treatment for temporal lobe epilepsy yielding encouraging preliminary seizure and neuropsychological outcomes.
Purpose To determine if caring for a child with cancer or a brain tumor affects parental health a... more Purpose To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life. Methods In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress. Results Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents. Conclusions The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.
Journal of Biomaterials Science-polymer Edition, 1999
... KRISTIN M. DEFIFE1, KRIS M. HAGEN3, DAVID L. CLAPPER 3 and JAMES M. ANDERSON1. 2.* 1 Institut... more ... KRISTIN M. DEFIFE1, KRIS M. HAGEN3, DAVID L. CLAPPER 3 and JAMES M. ANDERSON1. 2.* 1 Institute of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA 2 Department of ... T. McPherson, A. Kidane, I. Szleifer and K. Park, Langmuir 14, 176 ( 1998). ...
Photochemical immobilization technology was utilized to covalently couple polymers to silicone ru... more Photochemical immobilization technology was utilized to covalently couple polymers to silicone rubber either at multiple points along a polymer backbone or at the endpoint of an amphiphilic chain. The coating variants then were tested in vitro and in vivo for improvement of desired responses compared to uncoated silicone rubber. All coating variants suppressed the adsorption of fibrinogen and immunoglobulin G, and most also inhibited fibroblast growth by 90-99%. None of the coating variants inhibited monocyte or neutrophil adhesion in vitro. However, the surfaces that supported the highest levels of monocyte adhesion also elicited the lowest secretion of pro-inflammatory cytokines. None of the materials elicited a strong inflammatory response or significantly (p&lt; 0.05) reduced the thickness of the fibrous capsule when implanted subcutaneously in rats. Overall, the most passivating coating variant was an endpoint immobilized polypeptide that reduced protein adsorption, inhibited fibroblast growth by 90%, elicited low cytokine secretion from monocytes, and reduced fibrous encapsulation by 33%. In general, although some coating variants modified the adsorption of proteins and the behavior of leukocytes or fibroblasts in vitro, none abolished the development of a fibrous capsule in vivo.
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