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Sarah B Cairo, Indrajit Majumdar, Aurora Pryor, Alan Posner, Carroll M Harmon, David H Rothstein
Obesity in pediatric patients is rising with nearly one third of children in the USA classified as overweight and up to 16-18% of the adolescent population obese with at least one comorbid condition. Consequently, bariatric procedures in this population have increased without consistent recommendations for follow-up and transition to adult providers. This review describes the known and potential long-term consequences of bariatric surgery in pediatric patients, reviews the current literature on transitions of care for adolescent patients with chronic illnesses...
February 9, 2018: Obesity Surgery
Rebecca B Harmon, Gina DeGennaro, Meg Norling, Christine Kennedy, Dorrie Fontaine
In 2005 the American Association of Critical Care Nurses defined six Healthy Work Environment (HWE) standards for the clinical setting (AACN, 2005), which were reaffirmed and expanded in 2016 (AACN, 2016). These clinical standards were adapted for use in the academic setting by Fontaine, Koh, and Carroll in 2012. The intention of this article is threefold: to present a revised version of the academic workplace standards which are appropriate for all School of Nursing (SON) employees, staff as well as faculty; to proposes the addition of a seventh standard, self-care, which provides the foundation for all standards; and to describe the continuing implementation of these seven standards at the University of Virginia School of Nursing (UVA SON)...
January 2018: Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing
Marc P Michalsky, Thomas H Inge, Todd M Jenkins, Changchun Xie, Anita Courcoulas, Michael Helmrath, Mary L Brandt, Carroll M Harmon, Mike Chen, John B Dixon, Elaine M Urbina
BACKGROUND AND OBJECTIVES: Severely obese adolescents harbor numerous cardiovascular disease risk factors (CVD-RFs), which improve after metabolic and bariatric surgery (MBS). However, predictors of change in CVD-RFs among adolescents have not yet been reported. METHODS: The Teen-Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected anthropometric and health status data on 242 adolescents undergoing MBS at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after Roux-en-Y gastric bypass and vertical sleeve gastrectomy were examined...
February 2018: Pediatrics
Sarah B Cairo, David H Rothstein, Carroll M Harmon
Imperforate anus, a variant of anorectal malformation (ARM), is a common congenital anomaly requiring surgical attention in the newborn period. It may present with a variety of anatomic configurations, largely dependent on the presence and location of a fistula. The location (or characteristics) of a fistula, which usually lies between the gastrointestinal tract and the genitourinary tract or perineum, is often used in determining the type and timing of operative management. This article discusses the work-up and management, modes of treatment and their postoperative outcomes, and continued controversy regarding the use of minimally invasive surgical approaches to ARM...
December 2017: Clinics in Perinatology
Sarah B Cairo, Benjamin Tabak, Carroll M Harmon, Kathryn D Bass
Anastomotic stricture is a common complication following repair of esophageal atresia (EA). Many factors are thought to contribute to stricture formation and a variety of management techniques have been developed. In this case report, we describe the treatment of a recurrent anastomotic stricture following repair of long-gap esophageal atresia. Porcine bladder extracellular matrix (ECM) was mounted on a stent and delivered endoscopically to the site of recurrent stricture. An appropriate positioning was confirmed using direct endoscopic visualization and intra-operative fluoroscopy...
September 2017: Pediatric Surgery International
David B Sarwer, Rebecca J Dilks, Jacqueline C Spitzer, Robert I Berkowitz, Thomas A Wadden, Renee H Moore, Jesse L Chittams, Mary L Brandt, Mike K Chen, Anita P Courcoulas, Carroll M Harmon, Michael A Helmrath, Marc P Michalsky, Stavra A Xanthakos, Meg H Zeller, Todd M Jenkins, Thomas H Inge
BACKGROUND: A growing number of studies suggest that bariatric surgery is safe and effective for adolescents with severe obesity. However, surprisingly little is known about changes in dietary intake and eating behavior of adolescents who undergo bariatric surgery. OBJECTIVE: Investigate changes in dietary intake and eating behavior of adolescents with obesity who underwent bariatric surgery (n = 119) or lifestyle modification (LM) (n = 169). SETTING: University-based health systems METHODS: A prospective investigation of 288 participants (219 female and 69 male) prior to bariatric surgery or LM and again 6, 12, and 24 months (surgery patients only) after treatment...
December 2017: Obesity Surgery
Yingkui Yang, Min Chen, George Ventro, Carroll M Harmon
The melanocortin-1 receptor (MC1R) is a subtype of the melanocortin receptor family and NDP-α-MSH is a non-selective agonist for MC1R. The core sequence of NDP-α-MSH, His-Phe-Arg-Trp, is important for ligand binding and biological activities at the melanocortin receptor subtypes (MCRs). A recent study indicates that Trp(9) in NDP-α-MSH plays an important role in ligand selectivity. Deletion of Trp(9) in NDP-α-MSH (des-Trp(9)-NDP-α-MSH) resulted in loss of agonist activity at MC4R, although remains agonist activity at MC1R...
October 15, 2017: Molecular and Cellular Endocrinology
George J Ventro, Yingkui Yang, Min Chen, Carroll M Harmon
PURPOSE: Parenteral nutrition associated liver disease (PNALD) develops in a subset of children receiving parenteral nutrition for intestinal failure. Omegaven™ is an omega-3 fatty acid (Ω3FA) lipid emulsion high in docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) that can lessen PNALD. Inflammatory cytokines (IL-1, TNF-α, TGF-β) are elevated in PNALD and can decrease paraoxonase 1 protein expression (PON1). We sought to determine the effect of Omegaven™, EPA, and DHA on inflammatory cytokines TNF-α, IL-1, and TGF-β via ERK1/2 and p-Smad2/3 signaling pathways as well as the changes in intracellular PON1 protein expression as a potential mechanism explaining the protective effects of Omegaven™ and Ω3FA...
June 2017: Journal of Pediatric Surgery
Arianne T Train, Carroll M Harmon, David H Rothstein
BACKGROUND: Although disparities in access to minimally invasive surgery are thought to exist in pediatric surgical patients in the United States, hospital-level practice patterns have not been evaluated as a possible contributing factor. METHODS: Retrospective cohort study using the Kids' Inpatient Database, 2012. Odds ratios of undergoing a minimally invasive compared to open operation were calculated for six typical pediatric surgical operations after adjustment for multiple patient demographic and hospital-level variables...
February 2, 2017: Journal of Pediatric Surgery
N Paul, A Corsi, A Obertelli, P Doornenbal, G Authelet, H Baba, B Bally, M Bender, D Calvet, F Château, S Chen, J-P Delaroche, A Delbart, J-M Gheller, A Giganon, A Gillibert, M Girod, P-H Heenen, V Lapoux, J Libert, T Motobayashi, M Niikura, T Otsuka, T R Rodríguez, J-Y Roussé, H Sakurai, C Santamaria, N Shimizu, D Steppenbeck, R Taniuchi, T Togashi, Y Tsunoda, T Uesaka, T Ando, T Arici, A Blazhev, F Browne, A M Bruce, R Carroll, L X Chung, M L Cortés, M Dewald, B Ding, F Flavigny, S Franchoo, M Górska, A Gottardo, A Jungclaus, J Lee, M Lettmann, B D Linh, J Liu, Z Liu, C Lizarazo, S Momiyama, K Moschner, S Nagamine, N Nakatsuka, C Nita, C R Nobs, L Olivier, Z Patel, Zs Podolyák, M Rudigier, T Saito, C Shand, P-A Söderström, I Stefan, R Orlandi, V Vaquero, V Werner, K Wimmer, Z Xu
The first measurement of the low-lying states of the neutron-rich ^{110}Zr and ^{112}Mo was performed via in-beam γ-ray spectroscopy after one proton removal on hydrogen at ∼200  MeV/nucleon. The 2_{1}^{+} excitation energies were found at 185(11) keV in ^{110}Zr, and 235(7) keV in ^{112}Mo, while the R_{42}=E(4_{1}^{+})/E(2_{1}^{+}) ratios are 3.1(2), close to the rigid rotor value, and 2.7(1), respectively. These results are compared to modern energy density functional based configuration mixing models using Gogny and Skyrme effective interactions...
January 20, 2017: Physical Review Letters
Kavita Nadendla, Amelia Sutton, David Kelly, Reed Dimmitt, Linda Wilkinson, Carroll Harmon, Colin Martin
OBJECTIVE: To review a case of quintuplets with all babies developing necrotizing enterocolitis. METHODS: A retrospective study of preterm quintuplets all developing necrotizing enterocolitis. Clinical outcomes were reviewed. RESULTS: Quintuplets were born at 24 weeks gestation. Each baby developed NEC and was treated. One baby died. Currently the remaining 4 infants are on full enteral nutrition. CONCLUSION: Further studies are needed to better understand this emerging population of multiple birth pregnancy and the frequency of NEC development...
2016: Fetal and Pediatric Pathology
David H Rothstein, Carroll M Harmon
Biliary disease in children has changed over the past few decades, with a marked rise in incidence-perhaps most related to the parallel rise in pediatric obesity-as well as a rise in cholecystectomy rates. In addition to stone disease (cholelithiasis), acalculous causes of gallbladder pain such as biliary dyskinesia, also appear to be on the rise and present diagnostic and treatment conundrums to surgeons.
August 2016: Seminars in Pediatric Surgery
Neha R Santucci, Paul E Hyman, Carroll M Harmon, Julie H Schiavo, Sunny Z Hussain
Cholecystectomy rates for biliary dyskinesia in children are rising in the United States, but not in other countries. Biliary dyskinesia is a validated functional gallbladder disorder in adults, requiring biliary colic in the diagnosis. In contrast, most studies in children require upper abdominal pain, absent gallstones on ultrasound, and an abnormal gallbladder ejection fraction (GBEF) on cholecystokinin-stimulated cholescintigraphy for diagnosis. We aimed to systematically review existing literature in biliary dyskinesia in children, determine the validity and reliability of diagnostic criteria, GBEF, and to assess outcomes following cholecystectomy...
February 2017: Journal of Pediatric Gastroenterology and Nutrition
Justin R Ryder, Nicholas M Edwards, Resmi Gupta, Jane Khoury, Todd M Jenkins, Sharon Bout-Tabaku, Marc P Michalsky, Carroll M Harmon, Thomas H Inge, Aaron S Kelly
IMPORTANCE: Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. OBJECTIVE: To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. DESIGN, SETTING, AND PARTICIPANTS: The Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers...
September 1, 2016: JAMA Pediatrics
Colin D Gause, Grace Hsiung, Ben Schwab, Matthew Clifton, Carroll M Harmon, Katherine A Barsness
BACKGROUND: Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. MATERIALS AND METHODS: After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years...
August 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
George Ventro, Min Chen, Yingkui Yang, Carroll M Harmon
BACKGROUND: Growing evidence suggests that omega 3 fatty acid containing lipid emulsions have a beneficial effect on parenteral nutrition associated liver disease (PNALD). However, the cellular and molecular mechanisms responsible for this effect are unclear. In this study, we investigated whether Omegaven™ fish oil emulsion could inhibit lipopolysaccharidase (LPS) mediated liver damage. METHODS: We examined the effects of Omegaven™ and LPS alone and synergistically on hepatic paraoxonase 1 (PON1), a potent antioxidant protein, ERK1/2 activity, and TLR4 regulation...
June 2016: Journal of Pediatric Surgery
Robert M Dorman, Kaveh Vali, Carroll M Harmon, Mario Zaritzky, Kathryn D Bass
We describe the treatment of a patient with long-gap esophageal atresia with an upper pouch fistula, mircogastria and minimal distal esophageal remnant. After 4.5 months of feeding via gastrostomy, a proximal fistula was identified by bronchoscopy and a thoracoscopic modified Foker procedure was performed reducing the gap from approximately 7-5 cm over 2 weeks of traction. A second stage to ligate the fistula and suture approximate the proximal and distal esophagus resulted in a gap of 1.5 cm. IRB and FDA approval was then obtained for endoscopic placement of 10-French catheter mounted magnets in the proximal and distal pouches promoting a magnetic compression anastomosis (magnamosis)...
May 2016: Pediatric Surgery International
Elizabeth Ford, John A Carroll, Helen E Smith, Donia Scott, Jackie A Cassell
BACKGROUND: Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality...
September 2016: Journal of the American Medical Informatics Association: JAMIA
Thomas H Inge, Anita P Courcoulas, Todd M Jenkins, Marc P Michalsky, Michael A Helmrath, Mary L Brandt, Carroll M Harmon, Meg H Zeller, Mike K Chen, Stavra A Xanthakos, Mary Horlick, C Ralph Buncher
BACKGROUND: Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. METHODS: We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis...
January 14, 2016: New England Journal of Medicine
Jacob T Good, Daniel B Holland, Ian A Finneran, P Brandon Carroll, Matthew J Kelley, Geoffrey A Blake
We present the design and capabilities of a high-resolution, decade-spanning ASynchronous OPtical Sampling (ASOPS)-based TeraHertz Time-Domain Spectroscopy (THz-TDS) instrument. Our system employs dual mode-locked femtosecond Ti:Sapphire oscillators with repetition rates offset locked at 100 Hz via a Phase-Locked Loop (PLL) operating at the 60th harmonic of the ∼80 MHz oscillator repetition rates. The respective time delays of the individual laser pulses are scanned across a 12.5 ns window in a laboratory scan time of 10 ms, supporting a time delay resolution as fine as 15...
October 2015: Review of Scientific Instruments
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