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Background & Aims: Patients with acute liver failure (ALF) awaiting liver transplantation (LT) may develop multiorgan failure, but organ failure does not impact waitlist prioritization. The aim of this study was to examine the impact of organ failure on waitlist mortality risk and post LT outcomes in patients with ALF. Methods: We studied adults waitlisted for ALF in the United Network for Organ Sharing (UNOS) database (2002–2019). Organ failures were defined using a previously described Chronic Liver Failure modified sequential organ failure score assessment adapted to UNOS data. Regression analyses of the primary endpoints, 30‐day waitlist mortality (Competing risk), and post‐LT mortality (Cox‐proportional hazards), were performed. Latent class analysis (LCA) was used to determine the organ failures most closely associated with 30‐day waitlist mortality. Results: About 3212 adults with ALF were waitlisted, for hepatotoxicity (41%), viral (12%) and unspecified (36%) etiologies. The median number of organ failures was three (interquartile range 1–3). Having ≥3 organ failures (vs. ≤2) was associated with a sub hazard ratio (HR) of 2.7 (95%CI 2.2–3.4)) and a HR of 1.5 (95%CI 1.1–2.5)) for waitlist and post‐LT mortality, respectively. LCA identified neurologic and respiratory failure as most impactful on 30‐day waitlist mortality. The odds ratios for both organ failures (vs. neither) were higher for mortality 4.5 (95% CI 3.4–5.9) and lower for delisting for spontaneous survival.5 (95%CI.4–.7) and LT.6 (95%CI.5–.7). Conclusion: Cumulative organ failure, especially neurologic and respiratory failure, significantly impacts waitlist and post‐LT mortality in patients with ALF and may inform risk‐prioritized allocation of organs. [ABSTRACT FROM AUTHOR]

Background and Aims: Little is known about the clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis (mAH) as compared to severe alcohol‐associated hepatitis (sAH). Therefore, we aimed to describe the clinical characteristics and risk factors associated with mortality in hospitalized mAH patients. Methods: Patients hospitalized with alcohol‐associated hepatitis (AH) from 1 January 2010 to 31 December 2020 at a large US healthcare system [11 hospitals, one liver transplant centre] were retrospectively analysed for outcomes. Primary outcome was 90‐day mortality. AH and mAH were defined according to NIAAA Alcoholic Hepatitis Consortia and Model for End‐stage Liver Disease Score ≤ 20 respectively. Multivariable Cox regression analysis was performed to identify independent risk factors associated with 90‐day mortality. Results: 1504 AH patients were hospitalized during the study period, of whom 39% (n = 590) had mAH. Compared to sAH patients, mAH patients were older (50 vs. 48 years, p < 0.001) and less likely to have underlying cirrhosis (74% vs. 83%, p < 0.001). There were no differences between the two groups for median alcohol intake g/day (mAH 140.0 vs. sAH 112.0, p = 0.071). The cumulative proportion surviving at 90 days was 88% in mAH versus 62% in sAH (p < 0.001). On multivariable analysis, older age [HR 1.03 (95% CI 1.00–1.06), p = 0.020], corticosteroid use [HR 1.80 (95% CI 1.06–3.06), p = 0.030] and acute kidney injury (AKI) [HR 2.43 (95% CI 1.33–4.47), p = 0.004] were independently associated with 90‐day mortality. Conclusions: mAH carries a 12% mortality rate at 90 days. Age, AKI and corticosteroid use were associated with an increased risk for 90‐day mortality. Avoidance of corticosteroids and strategies to reduce the risk of AKI could improve outcomes in mAH patients. [ABSTRACT FROM AUTHOR]

Objectives: Frailty is a clinical syndrome characterized by decreased physiologic reserve that diminishes the ability to respond to stressors such as acute illness. Veterans Health Administration (VA) emergency departments (ED) are the primary venue of care for Veterans with acute illness and represent key sites for frailty recognition. As questionnaire‐based frailty instruments can be cumbersome to implement in the ED, we examined two administratively derived frailty scores for use among VA ED patients. Methods: This national retrospective cohort study included all VA ED visits (2017–2020). We evaluated two administratively derived scores: the Care Assessment Needs (CAN) score and the VA Frailty Index (VA‐FI). We categorized all ED visits across four frailty groups and examined associations with outcomes of 30‐day and 90‐day hospitalization and 30‐day, 90‐day, and 1‐year mortality. We used logistic regression to assess the model performance of the CAN score and the VA‐FI. Results: The cohort included 9,213,571 ED visits. With the CAN score, 28.7% of the cohort were classified as severely frail; by VA‐FI, 13.2% were severely frail. All outcome rates increased with progressive frailty (p‐values for all comparisons < 0.001). For example, for 1‐year mortality based on the CAN score frailty was determined as: robust, 1.4%; prefrail, 3.4%; moderately frail, 7.0%; and severely frail, 20.2%. Similarly, for 90‐day hospitalization based on VA‐FI, frailty was determined as prefrail, 8.3%; mildly frail, 15.3%; moderately frail, 29.5%; and severely frail, 55.4%. The c‐statistics for CAN score models were higher than for VA‐FI models across all outcomes (e.g., 1‐year mortality, 0.721 vs. 0.659). Conclusions: Frailty was common among VA ED patients. Increased frailty, whether measured by CAN score or VA‐FI, was strongly associated with hospitalization and mortality and both can be used in the ED to identify Veterans at high risk for adverse outcomes. Having an effective automatic score in VA EDs to identify frail Veterans may allow for better targeting of scarce resources. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to assess the impact of an emergency department (ED) deprescribing intervention for geriatric adults. We hypothesized that pharmacist‐led medication reconciliation for at‐risk aging patients would increase the 60‐day case rate of primary care provider (PCP) deprescribing of potentially inappropriate medications (PIMs). Methods: This was a retrospective, before‐and‐after intervention pilot study conducted at an urban Veterans Affairs ED. In November 2020, a protocol utilizing pharmacists to perform medication reconciliations for patients 75 years or older who screened positive using an Identification of Seniors at Risk tool at triage was implemented. Reconciliations focused on identifying PIMs and providing deprescribing recommendations to patients' PCPs. A preintervention group was collected between October 2019 and October 2020, and a postintervention group was collected between February 2021 to February 2022. The primary outcome compared case rates of PIM deprescribing in the preintervention group to the postintervention group. Secondary outcomes include per‐medication PIM deprescribing rate, 30‐day PCP follow‐up visits, 7‐ and 30‐day ED visits, 7‐ and 30‐day hospitalizations, and 60‐day mortality. Results: A total of 149 patients were analyzed in each group. Both groups were similar in age and sex, with an average age of 82 years and 98% male. The case rate of PIM deprescribing at 60 days was 11.1% preintervention compared to 57.1% postintervention (p < 0.001). Preintervention, 91% of PIMs remained unchanged at 60 days compared to 49% (p < 0.05) postintervention. Regardless of PIM identification, the 30‐day primary care follow‐up rate increased postintervention: 31.5% and 55.7% (p < 0.0001), respectively. There was no improvement in 7‐ or 30‐day subsequent ED visits, hospitalization, or mortality. Conclusions: Pharmacist‐led medication reconciliation in high‐risk geriatric patients was associated with an increase both in the rate of PIM deprescribing and in post‐ED primary care engagement. [ABSTRACT FROM AUTHOR]

Study Objective: Dexmedetomidine is titrated to achieve sedation in the pediatric and cardiovascular intensive care units (PICU and CVICU). In adults, dexmedetomidine response has been associated with an ADRA2A polymorphism (rs1800544); CC genotype is associated with an increased sedative response compared with GC and GG. To date, this has not been studied in children. Design: We conducted a pilot study to determine whether ADRA2A genotype is associated with dexmedetomidine dose in children. Measurements and Main Results: Forty intubated PICU or CVICU patients who received dexmedetomidine as a continuous infusion for at least 2 days were genotyped for ADRA2A with a custom‐designed TaqMan® Assay. Ten (25%) subjects were wildtype (GG), 15 (37.5%) were heterozygous (GC), and 15 (37.5%) were homozygous (CC) variant. The maximum dexmedetomidine doses (mCg/kg/h) were not different between genotype groups CC (1, 0.3–1.2), GC (1, 0.3–1.3), and GG (0.8, 0.3–1.2), (p = 0.37); neither were mean dexmedetomidine doses for these respective genotype groups 0.68 (0.24–1.07), 0.72 (0.22–0.98), 0.58 (0.3–0.94), (p = 0.67). Conclusions: These findings did not confirm the results from adult studies where ADRA2A polymorphisms correlate with dexmedetomidine response, therefore highlighting the need for pediatric studies to validate PGx findings in adults prior to implementation in pediatrics. [ABSTRACT FROM AUTHOR]

Background & Aims: Guidelines recommend albumin as the plasma‐expander of choice for acute kidney injury (AKI) in cirrhosis. However, the impact of these recommendations on patient outcomes remains unclear. We aimed to determine the practice‐patterns and outcomes associated with albumin use in a large, nationwide‐US cohort of hospitalized cirrhotics with AKI. Methods: A retrospective cohort study was performed in hospitalized cirrhotics with AKI using Cerner‐Health‐Facts database from January 2009 to March 2018. 6786 were included for analysis on albumin‐practice‐patterns, and 4126 had available outcomes data. Propensity‐score‐adjusted model was used to determine the association between albumin use, AKI‐recovery and in‐hospital survival. Results: Median age was 61‐years (60% male, 70% white), median serum‐creatinine was 1.8 mg/dL and median Model for End‐stage Liver Disease Sodium (MELD‐Na) score was 24. Albumin was given to 35% of patients, of which 50% received albumin within 48‐hours of AKI‐onset, and 17% received appropriate weight‐based dosing. Albumin was used more frequently in patients with advanced complications of cirrhosis, higher MELD‐Na scores and patients admitted to urban‐teaching hospitals. After propensity‐matching and multivariable adjustment, albumin use was not associated with AKI‐recovery (odds ratio [OR] 0.70, 95% confidence‐interval [CI]: 0.59‐1.07, P =.130) or in‐hospital survival (OR 0.76 [95% CI: 0.46‐1.25], P =.280), compared with crystalloids. Findings were unchanged in subgroup analyses of patients with varying cirrhosis complications and disease severity. Conclusions: USA hospitalized patients with cirrhosis and AKI frequently do not receive intravenous albumin, and albumin use was not associated with improved clinical outcomes. Prospective randomised trials are direly needed to evaluate the impact of albumin in cirrhotics with AKI. [ABSTRACT FROM AUTHOR]

Children admitted to the pediatric intensive care unit (PICU) often require multiple medications to achieve comfort and sedation. Although starting doses are available, these medications are typically titrated to the desired effect. Both oversedation and undersedation are associated with adverse events. The aim of this retrospective study was to evaluate cumulative medication burden necessary to achieve comfort in patients in the PICU and determine relevant predictors of medication needs. In order to account for all of the sedative medications, z‐scores were used to assess the population average dose of each medication and compare each patient day to this population average. Sedation regimens for 130 patients in the PICU were evaluated. Mean overall infusion rates of fentanyl, morphine, and hydromorphone were 1.67 ± 0.81 µg/kg/hour, 0.12 ± 0.08 mg/kg/hour, and 17.84 ± 13.4 µg/kg/hour, respectively. The mean infusion rate of dexmedetomidine was 0.59 ± 0.28 µg/kg/hour, and midazolam was 0.14 ± 0.1 mg/kg/hour. Summation z‐sores were used to rank the amount of sedation medication needed to achieve comfort for each individual patient for his/her PICU stay in relation to the entire sample. Patient age, weight, and length of mechanical ventilation were all significant predictors of sedation requirement. This study will provide data necessary to develop a model of cumulative medication burden needed to achieve appropriate sedation in this population. This descriptive model in appropriately ranking patients based on sedative needs is the first step in exploring potential genetic factors that may provide an insight into homing in on the appropriate sedation regimen. [ABSTRACT FROM AUTHOR]

Background and objective: Asthma is characterized by airway hyperreactivity and airway inflammation. We previously demonstrated that adults with mild well‐controlled asthma exhibited a marked decrease in airway reactivity (PC20 increased >2‐fold) after using nocturnal continuous positive airway pressure (CPAP) for 1 week. If CPAP produces a similar suppression of airway reactivity in children with moderate–severe asthma, who require chronic use of corticosteroids, then this non‐pharmacological therapy might provide a beneficial alternative or supplemental therapy in these subjects. Methods: Children aged 8–17 years with moderate–severe asthma were treated with 4 weeks of nocturnal CPAP (8–10 cm H2O) or sham CPAP (<2 cm H2O). Adherence was monitored with a modem installed in the equipment or by memory cards. Airway reactivity, assessed by methacholine bronchial challenge, was measured prior to and following treatment. Results: The percentage of subjects adherent to treatment was similar in both groups (19/27 CPAP vs 19/28 sham, ~70%). There was a tendency for PC20 to increase with treatment in both groups (3.0–5.3 mg/mL CPAP vs 3.2 to 4.3 mg/mL sham, P = 0.083); however, the change did not differ significantly between groups (P = 0.569). Conclusion: We found that the 4‐week treatment with nocturnal CPAP did not produce a twofold suppression of airway reactivity in children with moderate–severe asthma. We compared 4 weeks of nocturnal continuous positive airway pressure (CPAP) versus sham to suppress airway reactivity and inflammation in children with moderate–severe asthma. There were no significant differences between treatments. The treatment effect in children with moderate–severe asthma was smaller than previously reported in adults with mild well‐controlled asthma. See related Editorial [ABSTRACT FROM AUTHOR]

OBJECTIVE: Describe the implementation and effects of Mobile Acute Care for Elders (MACE) consultation at a Veterans Affairs Medical Center (VAMC). DESIGN: Retrospective cohort analysis. INTERVENTION: Veterans aged 65 or older who were admitted to the medicine service between October 1, 2012, and September 30, 2014, were screened for geriatric syndromes via review of medical records within 48 hours of admission. If the screen was positive, the MACE team offered the admitting team a same‐day consultation involving comprehensive geriatric assessment and ongoing collaboration with the admitting team and supportive services to implement patient‐centric recommendations for geriatric syndromes. RESULTS: Veterans seen by MACE (n = 421) were compared with those with positive screens but without consultation (n = 372). The two groups did not significantly differ in age, comorbidity, sex, or race. All outcomes (30‐day readmission, 30‐day mortality, readmission costs) were in the expected direction for patients receiving MACE but did not reach statistical significance. Patients receiving MACE had lower odds of 30‐day readmission (11.9% vs 14.8%; odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.54‐1.25; p =.360) and 30‐day mortality (5.5% vs 8.6%; OR = 0.64; CI = 0.36‐1.12; p =.115), and they had lower 30‐day readmission costs (MACE $15,502; CI = $12,242‐$19,631; comparison = $18,335; CI = $14,641‐$22,962; p =.316) than those who did not receive MACE after adjusting for age and Charlson Comorbidity Index. CONCLUSION: Our MACE consultation model for older veterans with geriatric syndromes leverages the limited supply of clinicians with expertise in geriatrics. Although not statistically significant in this study of 793 subjects, MACE patients had lower odds of 30‐day readmission and mortality, and lower readmission costs. J Am Geriatr Soc 67:818–824, 2019. [ABSTRACT FROM AUTHOR]

Fibromyalgia ( FM) is typically associated with the experience of diffuse pain and physical impairment. Depression also commonly co-exists in patients with FM and has been correlated with pain intensity and physical functioning. Previous research suggests an association between pain intensity and physical functioning; however, the direct causal relationship between improvements in pain intensity and in functioning is not observed in many FM patients. This may suggest that another factor such as depression is mediating this relationship. The present work examined mediating role of depression. Two hundred sixteen patients with FM completed measures of pain intensity, depression, and physical function as part of a larger longitudinal study. Assessments were completed at baseline, 12, 24, and 36 weeks. Longitudinal mediational analyses indicated that depression is a partial mediator of the relationship between pain intensity and physical functioning at all four assessment points. Beta coefficients for the path from pain to physical functioning ranged from 0.18 to 0.36, with attenuated path coefficients ranging 0.03-0.08, still showing significant but decreased associations when depression was added as a mediator. Clinical implication includes the importance of treating comorbid depression in patients with FM early in the course of treatment to prevent engagement in the cycle of disability. [ABSTRACT FROM AUTHOR]

Background: Traditional medication adherence measures do not account for the pharmacokinetic (PK) properties of the drugs, potentially misrepresenting true therapeutic exposure. Methods: In a population of HIV-infected Kenyan children on antiretroviral therapy including nevirapine (NVP), we used a one-compartment model with previously established PK parameters and Medication Event Monitoring Systems (MEMS®)- recorded dosing times to estimate the mean plasma concentration of NVP (Cp) in individual patients during 1 month of follow-up. Intended NVP concentration (Cp') was calculated under a perfectly followed dosing regimen and frequency. The ratio between the two (R = Cp/Cp') characterized the patient's NVP exposure as compared to intended level. Smaller R values indicated poorer adherence. We validated R by evaluating its association with MEMS®-defined adherence, CD4%, and spotcheck NVP plasma concentrations assessed at 1 month. Results: In data from 152 children (82 female), children were mean age 7.7 years (range 1.5-14.9) and on NVP an average of 2.2 years. Mean MEMS® adherence was 79%. The mean value of R was 1.11 (SD 0.37). R was positively associated with MEMS® adherence (p < 0.0001), and lower-than-median R values were significantly associated with lower NVP drug concentrations (p = 0.0018) and lower CD4% (p = 0.0178), confirming a smaller R value showed poorer adherence. Conclusion: The proposed adherence measures, R, captured patient drug-taking behaviours and PK properties. [ABSTRACT FROM AUTHOR]

Outcomes of kidney re-transplant recipients ( RTR) were compared to primary recipients ( FTR) from paired donor kidneys. Organ Procurement and Transplantation Network (OPTN) database was used to identify deceased donors (n = 6266) who donated one kidney to an RTR and the mate kidney to an FTR between January 2000 to December 2010. As compared to FTR, RTR were younger (45 vs. 52 yr, p < 0.001) and had higher proportion of plasma reactive antibody >80 (25% vs 7%, p < 0.001). There were higher 0 mismatches in RTR (19% vs. 16%, p < 0.001). There were more pre-emptive transplants in RTR (24% vs. 21%, p = 0.002). Delayed graft function (28% vs. 25%, p = 0.007) was higher in RTR. Patient survival was similar in FTR and RTR groups at one, three, and five yr (95.7%, 90.2%, and 82.5% vs. 95.2%, 89.8% and 82.7%). Allograft survival rates were higher in FTR group compared to RTR group at one, three, and five yr (91.1%, 82.4%, and 70.9% vs. 87.8%, 77.4%, and 66.1% p < 0.001). Death-censored allograft survival rates were higher in FTR group at one, three, and five yr (91.3%, 82.7% and 71.4% vs. 88%, 77.7% and 66.5% p < 0.001). In today's era of modern immunosuppression, graft survival in RTR has improved but remains inferior to FTR when controlling for donor factors. [ABSTRACT FROM AUTHOR]

The roles of glycemic control, diabetes management, diabetes care responsibility, living independently of parents, and time since high school graduation in predicting diabetes-related quality of life (DQOL) were examined in 184 emerging adults with type 1 diabetes. Data were collected at graduation and 1 year later. Analyses controlling for selected covariates were completed using generalized linear mixed models. Better diabetes management was associated with more positive responses on all four dimensions of DQOL. Impact and worry of DQOL were greater in the presence of depressive symptoms, and life satisfaction was lower. DQOL life satisfaction was lower in those living independently of parents. Young women reported poorer diabetes-related health status than did young men. Time since graduation was not linked to DQOL. Further research is needed on ways to improve DQOL in conjunction with diabetes management and on ways that families can support DQOL when youth live independently. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Chlamydia trachomatis urogenital serovars D-K are intracellular bacterial pathogens that replicate almost exclusively in human reproductive tract epithelium. In the C. muridarum mouse model for human Chlamydia genital tract infections CD4 T helper type 1 cell responses mediate protective immunity while CD8 T-cell responses have been associated with scarring and infertility. Scarring mediated by CD8 T cells requires production of tumour necrosis factor- α ( TNF- α); however, TNF- α is associated with protective immunity mediated by CD4 T cells. The latter result suggests that TNF- α in-and-of itself may not be the sole determining factor in immunopathology. CD8 T cells mediating immunopathology presumably do something in addition to producing TNF- α that is detrimental during resolution of genital tract infections. To investigate the mechanism underlying CD8 immunopathology we attempted to isolate Chlamydia-specific CD8 T-cell clones from mice that self-cleared genital tract infections. They could not be derived with antigen-pulsed irradiated naive splenocytes; instead derivation required use of irradiated immune splenocyte antigen-presenting cells. The Chlamydia-specific CD8 T-cell clones had relatively low cell surface CD8 levels and the majority were not restricted by MHC class Ia molecules. They did not express Plac8, and had varying abilities to terminate Chlamydia replication in epithelial cells. Two of the five CD8 clones produced interleukin-13 ( IL-13) in addition to IL-2, TNF- α, IL-10 and interferon- γ. IL-13-producing Chlamydia-specific CD8 T cells may contribute to immunopathology during C. muridarum genital tract infections based on known roles of TNF- α and IL-13 in scar formation. [ABSTRACT FROM AUTHOR]

A simulation study was conducted to provide a more thorough account of measurement error associated with interval sampling methods. A computer program simulated the application of momentary time sampling, partial-interval recording, and whole-interval recording methods on target events randomly distributed across an observation period. The simulation yielded measures of error for multiple combinations of observation period, interval duration, event duration, and cumulative event duration. The simulations were conducted up to 100 times to yield measures of error variability. Although the present simulation confirmed some previously reported characteristics of interval sampling methods, it also revealed many new findings that pertain to each method's inherent strengths and weaknesses. The analysis and resulting error tables can help guide the selection of the most appropriate sampling method for observation-based behavioral assessments. [ABSTRACT FROM AUTHOR]

Introduction: High levels of adherence to antiretroviral therapy (ART) are central to HIV management. The objective of this study was to compare multiple measures of adherence and investigate factors associated with adherence among HIV-infected children in western Kenya. Methods: We evaluated ART adherence prospectively for six months among HIV-infected children aged ≤14 years attending a large outpatient HIV clinic in Kenya. Adherence was reported using caregiver report, plasma drug concentrations and Medication Event Monitoring Systems (MEMS®). Kappa statistics were used to compare adherence estimates with MEMS®. Logistic regression analyses were performed to assess the association between child, caregiver and household characteristics with dichotomized adherence (MEMS® adherence ≥90% vs. <90%) and MEMS® treatment interruptions of ≥48 hours. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: Among 191 children, mean age at baseline was 8.2 years and 55% were female. Median adherence by MEMS® was 96.3% and improved over the course of follow-up (p<0.01), although 49.5% of children had at least one MEMS® treatment interruption of ≥48 hours. Adherence estimates were highest by caregiver report, and there was poor agreement between MEMS® and other adherence measures (Kappa statistics 0.04–0.37). In multivariable logistic regression, only caregiver-reported missed doses in the past 30 days (OR 1.25, 95% CI 1.14–1.39), late doses in the past seven days (OR 1.14, 95% CI 1.05–1.22) and caregiver-reported problems with getting the child to take ART (OR 1.10, 95% CI 1.01–1.20) were significantly associated with dichotomized MEMS® adherence. The caregivers reporting that ART made the child sick (OR 1.12, 95% CI 1.01–1.25) and reporting difficulties in the community that made giving ART more difficult (e.g. stigma) (OR 1.14, 95% CI 1.02–1.27) were significantly associated with MEMS® treatment interruptions in multivariable logistic regression. Conclusions: Non-adherence in the form of missed and late doses, treatment interruptions of more than 48 hours and sub-therapeutic drug levels were common in this cohort. Adherence varied significantly by adherence measure, suggesting that additional validation of adherence measures is needed. Few factors were consistently associated with non-adherence or treatment interruptions. [ABSTRACT FROM AUTHOR]

Background We aimed to examine the association of objectively measured and self-reported sleep duration with carotid artery intima media thickness (IMT) among 257 police officers, a group at high risk for cardiovascular disease (CVD). Methods Sleep duration was estimated using actigraphic data and through self-reports. The mean maximum IMT was the average of the largest 12 values scanned bilaterally from three angles of the near and far wall of the common carotid, bulb, and internal carotid artery. Linear and quadratic regression models were used to assess the association of sleep duration with IMT. Results Officers who had fewer than 5 or 8 hr or more of objectively measured sleep duration had significantly higher maximum IMT values, independent of age. Self-reported sleep duration was not associated with either IMT measure. Conclusion Attainment of sufficient sleep duration may be considered as a possible strategy for atherosclerosis prevention among police officers. Am. J. Ind. Med. 56:1341-1351, 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between long-term maintenance of moderate to vigorous physical activity (MVPA) and clinical outcomes in fibromyalgia (FM).Methods: Patients with FM (n = 170) received individualized exercise prescriptions and completed baseline and followup physical activity assessments using the Community Health Activities Model Program for Seniors questionnaire at weeks 12, 24, and 36. The primary outcome was the change in the Fibromyalgia Impact Questionnaire-Physical Impairment (FIQ-PI) score. The secondary outcomes included improvements in overall well-being (FIQ total score), pain severity ratings, and depression.Results: Using a threshold increase in MVPA of ≥10 metabolic equivalent hours/week above usual activities, 27 subjects (15.9%) increased and sustained (SUS-PA), 68 (40%) increased but then declined (UNSUS-PA), and 75 (44.1%) did not achieve (LO-PA) this benchmark. Compared to LO-PA subjects, both SUS-PA and UNSUS-PA subjects reported greater improvement in FIQ-PI (P < 0.01) and FIQ total score (P < 0.05). Additionally, the SUS-PA group reported greater improvement in pain severity compared to the LO-PA group (P < 0.05). However, there were no significant group differences between SUS-PA and UNSUS-PA for any primary or secondary outcome measure.Conclusion: Increased participation in MVPA for at least 12 weeks improved physical function and overall well-being in patients with FM. Although sustained physical activity was not associated with greater clinical benefit compared with unsustained physical activity, these findings also suggest that performing greater volumes of physical activity is not associated with worsening pain in FM. Future research is needed to determine the relationship between sustained MVPA participation and subsequent improvement in patient outcomes. [ABSTRACT FROM AUTHOR]

Background With the growing numbers of liver transplant recipients, it is increasingly important to understand the risks of de novo malignancy after liver transplantation. Aim To characterize the incidence of de novo malignancy after liver transplantation compared with a control non-transplant population. Methods We studied 534 Indiana state residents undergoing liver transplantation at our center between 1997 and 2004, followed through August 2010. The incidence and predictors of malignancy were determined. The standardized incidence ratio ( SIR) of cancer in our cohort was compared with age-, gender-, and period-matched state population using the Indiana State Cancer Registry. Results After a mean follow-up of 5.7 ± 3.2 yr, 73 patients (13.7%) developed 80 cancers, with five- and 10-yr incidence rates of 11.7% and 24.8%, respectively. These included 24 (30%) skin, 16 (20%) hematologic, and 40 (50%) solid tumors. The most common solid cancers were aerodigestive. Compared with matched state population, liver transplant recipients had significantly higher incidence of all cancers ( SIR: 3.1, 95% CI [Confidence interval]: 2.9-3.2), skin (melanoma) ( SIR: 5.8, 95% CI: 4.7-7.0), hematologic ( SIR: 7.1, 95% CI: 6.3-8.0), and solid ( SIR: 2.7, 95% CI: 2.5-2.8) tumors. Conclusion There is a significantly increased risk of de novo malignancies after liver transplantation, highlighting the need for surveillance strategies in this population. [ABSTRACT FROM AUTHOR]

Rowan CM, Hege KM, Speicher RH, Goodman M, Perkins SM, Slaven JE, Westenkirchner DF, Haut PR, Nitu ME. Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation. Abstract: The mortality in the ICU for pediatric HSCT recipients remains high. Early pulmonary complications continue to be an obstacle to the survival. We hypothesize OI is a predictor for mortality in critically ill pediatric HSCT recipients. Retrospective review of pediatric HSCT recipients between 2002 and 2010 who required intensive care during the same hospital admission as their transplant. Twenty-eight patients accounted for 31 ICU admissions. Twenty-six (84%) admissions required mechanical ventilation. Ten (38%) mechanically ventilated admissions were placed on HFOV. Mortality of those mechanically ventilated was 70%. An OI ≥ 20 at any point during ventilation was associated with 94% mortality, while an OI ≥ 25 had 100% mortality. There was a significant association between maximum OI at any point during mechanical ventilation and ICU mortality, with the odds of dying increasing by 13% for each unit increase of max OI (OR = 1.13, 95% CI = 1.01-1.26, p = 0.03). An OI of 20 had a sensitivity of 0.89 and specificity of 0.83 for predicting mortality. OI has a strong association with ICU mortality among pediatric stem cell recipients. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the link between adiposity measures and oxidative stress biomarkers glutathione (GSH), GSH peroxidase (GSH-PX), vitamin C, thiobarbituric acid reactive substances (TBARS) and thiobarbituric acid reactive substances (TBARS) among police officers in Buffalo, New York. GSH was associated with waist circumference and waist-to-hip ratio. GSH-PX was associated with body mass index (BMI) and waist-to-height ratio. No relationships were found between TEAC, TBARS and oxidative stress score with any measure.

Background Influenza virus was used to characterize the efficacy of a cyclone-based, two-stage personal bioaerosol sampler for the collection and size fractionation of aerosolized viral particles. Methods A Collison single-jet nebulizer was used to aerosolize the attenuated FluMist® vaccine into a calm-air settling chamber. Viral particles were captured with bioaerosol samplers that utilize 2 microcentrifuge tubes to collect airborne particulates. The first tube (T1) collects particles greater than 1.8 μm in diameter, while the second tube (T2) collects particles between 1.0 and 1.8 μm, and the back-up filter (F) collects submicron particles. Following aerosolization, quantitative PCR was used to detect and quantify H1N1 and H3N2 influenza strains. Results Based on qPCR results, we demonstrate that aerosolized viral particles were efficiently collected and separated according to aerodynamic size using the two-stage bioaerosol sampler. Most viral particles were collected in T2 (1-1.8 μm) and on the back-up filter (< 1 μm) of the bioaerosol sampler. Furthermore, we found that the detection of viral particles with the two-stage sampler was directly proportional to the collection time. Consequently, viral particle counts were significantly greater at 40 minutes in comparison to 5, 10 and 20 minute aerosol collection points. Conclusions Due to a lack of empirical data, aerosol transmission of influenza is often questioned. Using FluMist®, we demonstrated that a newly developed bioaerosol sampler is able to recover and size fractionate aerosolized viral particles. This sampler should be an important tool for studying viral transmission in clinical settings and may significantly contribute towards understanding the modes of influenza virus transmission. [ABSTRACT FROM AUTHOR]

Introduction: There are few data on adherence and low‐cost measurement tools for children living with HIV. We collected prospective data on adherence to antiretroviral therapy (ART) among a multinational cohort of children to evaluate an adherence questionnaire. Methods: We enrolled 319 children ages 0 to 16 years on ART in Kenya (n = 110), South Africa (n = 109) or Thailand (n = 100). Children were followed up for six months of adherence monitoring between March 2015 and August 2016 using Medication Event Monitoring Systems (MEMS®) with at least one viral load measure. At month 3 and 6, children or their caregivers were administered a 10‐item adherence questionnaire. Repeated measures analyses were used to compare responses on questionnaire items to external adherence criteria: MEMS® dichotomized adherence (≥90% of doses taken vs. <90%), 48‐hour MEMS® treatment interruptions and viral suppression (<1000 copies/mL). Items associated with outcomes (p < 0.10) were coefficient‐weighted to calculate a total adherence score, which was tested in multivariate regression against MEMS® and viral suppression outcomes. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Results: Mean child age was 11 years and 54% were female. Children from Thailand (median age 14 years) were significantly older compared to Kenya (10 years) and South Africa (10 years). Prevalence of viral suppression was 97% in Thailand, 81% in South Africa and 69% in Kenya, while the prevalence of MEMS® adherence ≥90% was 57% in Thailand, 58% in South Africa and 40% in Kenya. Across sites, child‐reported adherence using the questionnaire was significantly associated with dichotomized MEMS® adherence (OR 1.8, 95% CI 1.4 to 2.4), 48‐hour treatment interruptions (OR 0.41, 95% CI 0.3 to 0.6), and viral suppression (OR 3.4, 95% CI 1.7 to 6.7). We did find, however, that different cut‐points for the adherence score may be context‐specific. For example, MEMS® non‐adherent children in Kenya had a lower adherence score (0.98) compared to South Africa (1.77) or Thailand (1.58). Conclusions: We found suboptimal adherence to ART was common by multiple measures in this multi‐country cohort of children. The short‐form questionnaire demonstrated reasonable validity to screen for non‐adherence in these diverse settings. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Associations of objectively measured and self-reported sleep duration with carotid artery intima media thickness among police officers" in the 2013 issue is presented.