45 results on '"Duffy LC"'
Search Results
2. Measuring developmental and functional status in children with disabilities.
- Author
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Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Granger CV, Braun S, Ottenbacher, K J, Msall, M E, Lyon, N, Duffy, L C, Granger, C V, and Braun, S
- Published
- 1999
3. Factors associated with rates of participation in WIC by eligible pregnant women.
- Author
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Kahler LR, O'Shea RM, Duffy LC, and Buck GM
- Abstract
The relationship between sociodemographic, biological, and prenatal care characteristics, and participation rates of pregnant women in the Special Supplemental Food Program For Women, Infants, and Children (WIC) was studied by interviewing 200 postpartum patients in a Buffalo, NY, hospital between October 1988 and January 1989. Among the 136 women eligible for the program, 94 (69 percent) participated during their index pregnancies. WIC participation was found to be highly associated with source of prenatal care and having made more frequent prenatal visits. WIC was related to having fewer children and earlier initiation of prenatal care. Multivariate analysis showed that program participation remained highly associated with the source of prenatal care and the number of prenatal visits, when combined with other factors considered, such as age, education, marital status, number of living children, and timing of initial prenatal visit. The results suggest the need for a WIC enrollment effort directed to providers of prenatal care, who would be urged to encourage women to seek early and adequate prenatal care through the program. [ABSTRACT FROM AUTHOR]
- Published
- 1992
4. The stability and equivalence reliability of the functional independence measure for children (WeeFIM).
- Author
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Ottenbacher KJ, Taylor ET, Msall ME, Braun S, Lane SJ, Granger CV, Lyons N, Duffy LC, Ottenbacher, K J, Taylor, E T, Msall, M E, Braun, S, Lane, S J, Granger, C V, Lyons, N, and Duffy, L C
- Published
- 1996
- Full Text
- View/download PDF
5. WeeFIM: normative sample of an instrument for tracking functional independence in children.
- Author
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Msall ME, DiGaudio K, Duffy LC, LaForest S, Braun S, and Granger CV
- Published
- 1994
- Full Text
- View/download PDF
6. The Functional Independence Measure for Children (WeeFIM): conceptual basis and pilot use in children with developmental disabilities.
- Author
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Msall ME, DiGaudio K, Rogers BT, LaForest S, Catanzaro ML, Campbell J, Wilczenski F, and Duffy LC
- Published
- 1994
- Full Text
- View/download PDF
7. Predictors of mortality, morbidity, and disability in a cohort of infants < or = 28 weeks' gestation.
- Author
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Msall ME, Buck GM, Rogers BT, Duffy LC, Mallen SR, and Catanzaro NL
- Published
- 1993
- Full Text
- View/download PDF
8. Perspective: Dietary Biomarkers of Intake and Exposure-Exploration with Omics Approaches.
- Author
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Maruvada P, Lampe JW, Wishart DS, Barupal D, Chester DN, Dodd D, Djoumbou-Feunang Y, Dorrestein PC, Dragsted LO, Draper J, Duffy LC, Dwyer JT, Emenaker NJ, Fiehn O, Gerszten RE, B Hu F, Karp RW, Klurfeld DM, Laughlin MR, Little AR, Lynch CJ, Moore SC, Nicastro HL, O'Brien DM, Ordovás JM, Osganian SK, Playdon M, Prentice R, Raftery D, Reisdorph N, Roche HM, Ross SA, Sang S, Scalbert A, Srinivas PR, and Zeisel SH
- Subjects
- Biomarkers blood, Biomarkers urine, Food, Genomics, Humans, Metagenomics, Nutritional Physiological Phenomena genetics, Nutritional Sciences methods, Nutritional Status, Reproducibility of Results, Biomarkers analysis, Diet, Metabolomics methods
- Abstract
While conventional nutrition research has yielded biomarkers such as doubly labeled water for energy metabolism and 24-h urinary nitrogen for protein intake, a critical need exists for additional, equally robust biomarkers that allow for objective assessment of specific food intake and dietary exposure. Recent advances in high-throughput MS combined with improved metabolomics techniques and bioinformatic tools provide new opportunities for dietary biomarker development. In September 2018, the NIH organized a 2-d workshop to engage nutrition and omics researchers and explore the potential of multiomics approaches in nutritional biomarker research. The current Perspective summarizes key gaps and challenges identified, as well as the recommendations from the workshop that could serve as a guide for scientists interested in dietary biomarkers research. Topics addressed included study designs for biomarker development, analytical and bioinformatic considerations, and integration of dietary biomarkers with other omics techniques. Several clear needs were identified, including larger controlled feeding studies, testing a variety of foods and dietary patterns across diverse populations, improved reporting standards to support study replication, more chemical standards covering a broader range of food constituents and human metabolites, standardized approaches for biomarker validation, comprehensive and accessible food composition databases, a common ontology for dietary biomarker literature, and methodologic work on statistical procedures for intake biomarker discovery. Multidisciplinary research teams with appropriate expertise are critical to moving forward the field of dietary biomarkers and producing robust, reproducible biomarkers that can be used in public health and clinical research., (Published by Oxford University Press on behalf of the American Society for Nutrition 2019.)
- Published
- 2020
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- View/download PDF
9. Omics for Understanding the Gut-Liver-Microbiome Axis and Precision Medicine.
- Author
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Khalsa J, Duffy LC, Riscuta G, Starke-Reed P, and Hubbard VS
- Subjects
- Animals, Drug-Related Side Effects and Adverse Reactions, Humans, Pharmaceutical Preparations metabolism, Precision Medicine, Intestinal Mucosa metabolism, Liver metabolism, Microbiota
- Abstract
Human metabolic disease opens a new view to understanding the contribution of the intestinal microbiome to drug metabolism and drug-induced toxicity in gut-liver function. The gut microbiome, a key determinant of intestinal inflammation, also plays a direct role in chronic inflammation and liver disease. Gut bacterial communities directly metabolize certain drugs, reducing their bioavailability and influencing individual variation in drug response. In addition, some microbiome-produced compounds may affect drug pharmacokinetics and pharmacodynamics via altered expression of metabolizing enzymes and drug transporters or genes coding for drug target proteins, drug response phenotypes, and disease states. Molecular-based high-throughput technologies are providing novel insight about host-gut microbiome interactions, homeostasis, and xenobiotic effects associated with wide variation in efficacy or toxicity in humans. It is envisioned that future approaches to treating and preventing liver disease will benefit from in-depth studies of the liver-microbiome axis. Thus, the microbiome shares a fundamental role in human physiology with various organ systems, and its importance must be considered in the rapid evolution of precision medicine. A new emerging perspective of understanding the effect of the gut microbiome on human response to drugs would be indispensable for developing efficacious, safe, and cost-effective precision therapies., (© 2017, The American College of Clinical Pharmacology.)
- Published
- 2017
- Full Text
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10. Progress and challenges in developing metabolic footprints from diet in human gut microbial cometabolism.
- Author
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Duffy LC, Raiten DJ, Hubbard VS, and Starke-Reed P
- Subjects
- Animals, Congresses as Topic, Humans, Intestinal Mucosa metabolism, Prebiotics adverse effects, Probiotics adverse effects, Biomedical Research trends, Diet adverse effects, Global Health, Intestinal Mucosa microbiology, Metabolomics trends, Microbiology trends, Microbiota
- Abstract
Homo sapiens harbor trillions of microbes, whose microbial metagenome (collective genome of a microbial community) using omic validation interrogation tools is estimated to be at least 100-fold that of human cells, which comprise 23,000 genes. This article highlights some of the current progress and open questions in nutrition-related areas of microbiome research. It also underscores the metabolic capabilities of microbial fermentation on nutritional substrates that require further mechanistic understanding and systems biology approaches of studying functional interactions between diet composition, gut microbiota, and host metabolism. Questions surrounding bacterial fermentation and degradation of dietary constituents (particularly by Firmicutes and Bacteroidetes) and deciphering how microbial encoding of enzymes and derived metabolites affect recovery of dietary energy by the host are more complex than previously thought. Moreover, it is essential to understand to what extent the intestinal microbiota is subject to dietary control and to integrate these data with functional metabolic signatures and biomarkers. Many lines of research have demonstrated the significant role of the gut microbiota in human physiology and disease. Probiotic and prebiotic products are proliferating in the market in response to consumer demand, and the science and technology around these products are progressing rapidly. With high-throughput molecular technologies driving the science, studying the bidirectional interactions of host-microbial cometabolism, epithelial cell maturation, shaping of innate immune development, normal vs. dysfunctional nutrient absorption and processing, and the complex signaling pathways involved is now possible. Substantiating the safety and mechanisms of action of probiotic/prebiotic formulations is critical. Beneficial modulation of the human microbiota by using these nutritional and biotherapeutic strategies holds considerable promise as next-generation drugs, vaccinomics, and metabolic agents and in novel food discovery., (© 2015 American Society for Nutrition.)
- Published
- 2015
- Full Text
- View/download PDF
11. In vivo effects of bifidobacteria and lactoferrin on gut endotoxin concentration and mucosal immunity in Balb/c mice.
- Author
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Griffiths EA, Duffy LC, Schanbacher FL, Qiao H, Dryja D, Leavens A, Rossman J, Rich G, Dirienzo D, and Ogra PL
- Subjects
- Administration, Oral, Analysis of Variance, Animals, Biomarkers, Culture Techniques, Endotoxins analysis, Enzyme-Linked Immunosorbent Assay, Female, Flow Cytometry, Interferon-gamma analysis, Interleukin-6 analysis, Intestinal Mucosa immunology, Intestinal Mucosa microbiology, Limulus Test, Mice, Mice, Inbred BALB C, Pregnancy, Pregnancy, Animal, Probability, Reference Values, Risk Factors, Sensitivity and Specificity, Tumor Necrosis Factor-alpha analysis, Bifidobacterium, Endotoxins metabolism, Immunity, Mucosal physiology, Intestines drug effects, Intestines immunology, Lactoferrin pharmacology
- Abstract
The aim of the present study was to examine the effects of oral supplementation of newborn Balb/c mice with bifidobacteria (B. infantis, B. bifidum) and iron-free apo-lactoferrin (bovine, human) on gut endotoxin concentration and mucosal immunity. Endotoxin concentration was measured in ileocecal filtrates at 7, 14, 21, and 28 days postdelivery by a quantitative limulus amebocyte lysate test. While endotoxin levels in bifidobacteria-fed mice showed a steady rise over time, they were consistently lower than that observed in control animals. Results of lactoferrin supplementation varied depending on the specific time point, but overall by day 28, all treatment groups showed lower intestinal endotoxin concentrations compared to saline fed animals. Neither bifidobacteria nor lactoferrin stimulated an increase in B or T cells, or in cytokine production (IL-6, TNF-alpha, INF-gamma), in Peyer's patches as measured by flow cytometry. Bifidobacteria and lactoferrin were well tolerated as dietary supplements and showed promising potential to reduce gut endotoxin levels.
- Published
- 2004
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12. Improvements in immunization compliance using a computerized tracking system for inner city clinics.
- Author
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Tung Y, Duffy LC, Gyamfi JO, Wojtaszczyk F, Dozier A, Tempfer T, Clark A, Putnam T, and Bonafede R
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Hospitals, Urban, Humans, Infant, Medical Records Systems, Computerized statistics & numerical data, Patient Compliance, Vaccination
- Abstract
Vaccination compliance rates were calculated for 1995 to 2001 for enrolled patients, based on the Centers for Disease Control and Prevention guidelines and age-appropriate vaccine schedules. The results reported here indicate computerized tracking with the Doctor's Pediatric Immunization Program (Dr. PIP) maintained vaccine compliance rates (> 90%) in healthy and immunocompromised children at 2 months and 12 months of age. Instituting the computerized system has yielded nearly optimal results in both indigenous inner-city clinics. Despite the efficient progress made by automated tracking, the results for specific vaccine strategies (Varicella) and target groups (human immunodeficiency virus, high-risk indigent populations) may require on-going and intensive educational efforts to achieve optimization levels.
- Published
- 2003
- Full Text
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13. In vitro growth responses of bifidobacteria and enteropathogens to bovine and human lactoferrin.
- Author
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Griffiths EA, Duffy LC, Schanbacher FL, Dryja D, Leavens A, Neiswander RL, Qiao H, DiRienzo D, and Ogra P
- Subjects
- Animals, Bifidobacterium growth & development, Cattle, Escherichia coli growth & development, Humans, Iron Compounds pharmacology, Lactobacillus acidophilus growth & development, Salmonella typhimurium growth & development, Bifidobacterium drug effects, Escherichia coli drug effects, Lactobacillus acidophilus drug effects, Lactoferrin pharmacology, Salmonella typhimurium drug effects
- Abstract
A series of in vitro experiments was performed to test the ability of bovine and human lactoferrin to influence the growth of the gram-positive probiotic bacteria, Bifidobacterium bifidum, Bifidobacterium infantis, and Lactobacillus acidophilus, as well as the gram-negative enteric bacteria, E. coli O157:H7 and Salmonella typhimurium. None of the lactoferrin preparations stimulated the growth of the tested strains. However, iron-free apo-lactoferrin (bovine and human) and 66% iron-saturated bovine lactoferrin dramatically slowed the growth of E. coli O157:H7 in single culture experiments, while 98% iron-saturated preparations had no effect. In coculture experiments of B. infantis and E. coli, the iron-limited preparations of lactoferrin also slowed the growth of the latter without inhibiting the bifidobacteria. These results suggest that lactoferrin in iron-limited forms may have the potential to be combined with probiotic bacteria in biotherapeutic products, which could help balance human gut microflora and limit the overgrowth of certain enteric microorganisms.
- Published
- 2003
- Full Text
- View/download PDF
14. Immune responses in rhesus rotavirus-challenged BALB/c mice treated with bifidobacteria and prebiotic supplements.
- Author
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Qiao H, Duffy LC, Griffiths E, Dryja D, Leavens A, Rossman J, Rich G, Riepenhoff-Talty M, and Locniskar M
- Subjects
- Animals, Antibodies, Viral blood, Antigens, Viral analysis, Dextrins pharmacology, Drug Synergism, Enzyme-Linked Immunosorbent Assay, Feces virology, Female, Flow Cytometry, Fructose pharmacology, Immunoglobulin A blood, Immunoglobulin G blood, Isomaltose pharmacology, Mice, Mice, Inbred BALB C, Pregnancy, Bifidobacterium immunology, Galactans pharmacology, Oligosaccharides pharmacology, Rotavirus immunology, Rotavirus Infections drug therapy, Rotavirus Infections immunology
- Abstract
Bifidobacterium species (B. bifidum and B. infantis), with or without prebiotic compounds (arabino-galactan, short-chain fructo-oligosaccharide, iso-malto-dextrins), were orally fed to Balb/c pups (n = 192) to evaluate their potential synergistic effects on modulating the course of rhesus rotavirus (RRV) infection, as well as their ability to mediate the associated mucosal and humoral immune responses. Rotavirus-specific IgA and IgG in serum, rotavirus antigen, and specific IgA in feces were measured by ELISA. Mucosal total IgA and IgG levels were determined in Peyer's patches by flow cytometry. Significantly delayed onset (p = 0.001) and early resolution (p < 0.001) of diarrhea were observed in bifidobacteria-treated, RRV-infected mice compared with RRV-infected control mice. Supplementation with prebiotic compounds did not shorten the clinical diarrhea course more than that observed with bifidobacteria treatment alone. Rotavirus-specific IgA in feces was 16-fold elevated on d 5 postinfection in bifidobacteria-treated, RRV-infected mice compared with the RRV-infected alone group. In addition, the level of rotavirus-specific IgA in serum was four-fold higher in bifidobacteria-treated, RRV-infected litters versus mice challenged with RRV alone on 28 and 42 d postinfection. No enhancement of the immune response was found in RRV-infected mice that were treated with both bifidobacteria and prebiotic compounds over those treated with bifidobacteria only. The findings suggest that bifidobacteria may act as an adjuvant by modulating early mucosal and strong humoral rotavirus-specific immune responses, and mitigate severity of rotavirus-induced diarrhea.
- Published
- 2002
- Full Text
- View/download PDF
15. Bacterial toxins and enteral feeding of premature infants at risk for necrotizing enterocolitis.
- Author
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Duffy LC, Zielezny MA, Carrion V, Griffiths E, Dryja D, Hilty M, Cummings J, and Morin F
- Subjects
- Birth Weight, Blood microbiology, Clostridium isolation & purification, Enterobacter isolation & purification, Enterobacteriaceae isolation & purification, Escherichia coli isolation & purification, Feces chemistry, Feces microbiology, Humans, Infant, Newborn, Interleukin-6 analysis, Klebsiella isolation & purification, Lipopolysaccharides analysis, Milk, Human, Risk Factors, Bacterial Toxins analysis, Enteral Nutrition, Enterocolitis, Necrotizing microbiology, Enterocolitis, Necrotizing therapy, Infant, Low Birth Weight, Infant, Premature
- Abstract
Concordance between gram-negative enteric and other toxin-producing bacteria in blood and stool culture, endotoxin (lipopolysaccharide), and interleukin 6 (IL-6) was measured in 60 preterm infants (600-1600 g) as a clinical index in neonatal necrotizing enterocolitis (NEC). Escherichia coli, Klebsiella, Enterobacter, and Clostridium spp, identified by routine bacteriology, were each strongly associated with elevated concentrations of endotoxin (P < 0.01) in stool filtrates with Clostridium spp most strongly associated with NEC disease. Stool filtrate endotoxin (endotoxin units [EU] per gram) measured by a Limulus amebocyte lysate assay was age-dependent. Samples from stage I NEC (61%) and infants with advanced disease (67%) had notably elevated levels of stool endotoxin (>10 ln EU/g) compared with NEC-negative (47%) samples tested. Plasma and stool IL-6 generally tested at the low, nonmeasurable limit of the enzyme-linked immunosorbent assay (ELISA) for NEC-negative (88%) and stage I NEC (93%), although a small proportion of samples (25%) from infants with stage II or II NEC had elevated stool concentrations of IL-6. We conclude that identification of toxin-producing organisms and endotoxin elevations in stool filtrates are more useful than circulating levels of endotoxin in plasma in predicting mucosally limited disease in the gastrointestinal tract. The prognostic value of monitoring stool endotoxin in infants with overgrowth of gram-negative bacteria has implications for therapeutic strategies for patients with early and advanced stages of disease. Monitoring inflammatory cytokines (IL-6) in relation to endotoxin values in stool appears of limited clinical value in controlling this devastating disease in preterm neonates.
- Published
- 2001
- Full Text
- View/download PDF
16. The WeeFIM instrument: its utility in detecting change in children with developmental disabilities.
- Author
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Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Ziviani J, Granger CV, Braun S, and Feidler RC
- Subjects
- Child, Child, Preschool, Female, Humans, Infant, Male, Prospective Studies, Reproducibility of Results, Severity of Illness Index, Activities of Daily Living, Developmental Disabilities diagnosis, Developmental Disabilities rehabilitation
- Abstract
Objective: To examine the utility of the WeeFIM instrument ("WeeFIM") in detecting changes in the functional status of children with disability., Design: Prospective longitudinal design with correlation and responsiveness analysis., Setting: Three facilities providing services to children with developmental disabilities in western New York State., Participants: Two hundred five children (72 girls, 133 boys) with identified medical disabilities receiving special services were administered the WeeFIM. Subjects ranged in age from 11 to 87 months and came from diverse socioeconomic and ethnic backgrounds. Scores for 174 children were available for 3 administrations performed over a 1-year period., Main Outcome Measures: The responsiveness of the WeeFIM instrument was examined using 5 statistical procedures: Reliability Change Index, Proportional Change Index, effect size, standardized response means, and paired t tests., Results: All 5 indexes of responsiveness indicated statistically significant (p < .05) or reliable changes over time. The transfer subscale of the WeeFIM showed a skewed distribution that affected the results for some responsiveness indexes. The advantage, limitations, and assumptions of the responsiveness indexes are described and graphic examples of change over time are presented to validate the responsiveness of the WeeFIM instrument., Conclusion: The WeeFIM instrument showed the ability to document change in functional abilities over a 1-year period in children with chronic disabilities.
- Published
- 2000
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17. Interactions mediating bacterial translocation in the immature intestine.
- Author
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Duffy LC
- Subjects
- Animals, Humans, Infant, Newborn, Infant, Premature, Intestinal Mucosa metabolism, Permeability, Bacterial Translocation physiology, Bifidobacterium metabolism, Intestines microbiology, Mesentery microbiology, Milk, Human, Probiotics therapeutic use
- Abstract
Systemic disease caused by transmucosal passage of enterovirulent bacteria and toxins from the gut lumen into the mesenteric lymph nodes (MLN) is reviewed, with particular concern for bacterial interactions in the developing gut of premature newborns. Anaerobic bacteria are rarely observed to translocate to the MLN. Bifidobacterial strains have been tested for their abilities to adhere to enterocyte-like Caco-2 cells in culture. We have investigated the inhibitory effect of adherent human bifidobacterial strains against colonization by a number of diarrheagenic bacteria (Escherichia coli O157; Salmonella typhimurium) and viruses (murine and rhesus rotavirus), in various in vitro and in vivo models. The phagocytic cell (macrophage) may be a key factor in bacterial translocation (BT). Human breast milk contains abundant bioactive substances (immunologic, nutritional) that provide protective effects through inhibition of bacterial overgrowth and BT. New biotherapeutic therapies that stimulate beneficial anaerobic microflora (Lactobacillus, Bifidobacterium) are promising avenues of research to combat BT in disease treatment.
- Published
- 2000
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18. Perspectives on bifidobacteria as biotherapeutic agents in gastrointestinal health.
- Author
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Duffy LC, Leavens A, Griffiths E, and Dryja D
- Subjects
- Animals, Bacterial Translocation physiology, Enteral Nutrition, Humans, Intestines microbiology, Permeability, Bifidobacterium growth & development, Bifidobacterium physiology, Biological Therapy trends, Gastrointestinal Diseases therapy, Infections therapy
- Published
- 1999
- Full Text
- View/download PDF
19. Bacterial toxins and enteral feeding of premature infants at risk for necrotizing enterocolitis.
- Author
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Duffy LC, Zielezny MA, Carrion V, Griffiths E, Dryja D, Hilty M, Cummings J, and Morin F 3rd
- Abstract
Bacterial translocation and enteral feeding are factors implicated in neonatal necrotizing enterocolitis (NEC) in the preterm infant. A cohort of 60 preterm low birth-weight (LBW) infants (600-1,600 g at birth) consecutively admitted to the neonatal intensive care unit (NICU; N = 183) were prospectively followed to evaluate the role of bacterial endotoxins (lipopolysaccharides) and enteral feeding in the development of NEC. Stage I NEC was identified in 14/60 (23%) infants. In all, 15% (9/60) of infants followed, which represented roughly 5% of higher risk, LBW infants admitted to the NICU, progressed to Stage II or III NEC disease. Infants not enterally fed (nothing by mouth [NPO]) were at greatest risk of developing NEC. No infant who was breast milk fed progressed to Stage II or III NEC. The protective effect of breast milk was most evident when compared with the combined group of NPO or formula-feeding infants per person-week at risk (RR = .15, P < .04). Toxin-producing bacteria and endotoxin levels in stool filtrates predicted early and advanced stages of NEC disease. Cytokine concentrations (interleukin-6 [IL-6]) in stool appeared of limited value in reflecting mucosally limited disease in the gastrointestinal tract. Overgrowth of toxin-producing bacteria and their toxin products may adversely affect gut barrier function; monitoring endotoxin concentrations in stool filtrates may be most clinically useful in NPO and formula-fed infants identified at risk of developing NEC. Am. J. Hum. Biol. 10:211-219, 1998. © 1998 Wiley-Liss, Inc., (Copyright © 1998 Wiley-Liss, Inc.)
- Published
- 1998
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20. Interrater agreement and stability of the Functional Independence Measure for Children (WeeFIM): use in children with developmental disabilities.
- Author
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Ottenbacher KJ, Msall ME, Lyon NR, Duffy LC, Granger CV, and Braun S
- Subjects
- Child, Child, Preschool, Humans, Infant, Observer Variation, Activities of Daily Living, Disability Evaluation, Disabled Persons, Health Status Indicators
- Abstract
Objective: Examination of the interrater agreement and stability of ratings obtained using the Functional Independence Measure for Children (WeeFIM) in a sample of children with developmental disabilities., Design: A relational design was used in which two sets of WeeFIM scores were collected under four conditions: same rater-short interval; same rater-long interval; different rater-short interval; and different rater-long interval., Setting: WeeFIM scores were collected in outpatient developmental rehabilitation centers, school programs, and the children's homes., Participants: Data were collected for 205 children ranging in age from 11 to 87 months. All children had a medical diagnosis of disability and were receiving habilitative-educational intervention or follow-along services including neurodevelopmental surveillance., Instrument: The WeeFIM instrument examines basic daily living and functional skills in children from birth to 7 years of age. The WeeFIM is modeled after the Functional Independence Measure (FIM) for adults and includes 18 items in the following subscales: self-care, sphincter control, transfers, locomotion, communication, and social cognition., Results: Kappa values for items ranged from .44 to .82. Intraclass correlation coefficients (ICC) for the six subscales ranged from .73 to .98. Total WeeFIM ICC values were greater than .95 for all analyses., Conclusions: The WeeFIM ratings for the 205 children with developmental disabilities participating in this investigation were consistent across raters and time.
- Published
- 1997
- Full Text
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21. Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media.
- Author
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Duffy LC, Faden H, Wasielewski R, Wolf J, and Krystofik D
- Subjects
- Acute Disease, Adult, Age Factors, Analysis of Variance, Child Day Care Centers, Cohort Studies, Colony Count, Microbial, Female, Humans, Infant, Infant Food adverse effects, Infant, Newborn, Logistic Models, Male, Nasopharynx microbiology, Proportional Hazards Models, Recurrence, Risk Factors, Breast Feeding, Otitis Media prevention & control, Otitis Media with Effusion prevention & control
- Abstract
Objective: We followed a cohort (N = 306) of infants at well-baby visits in two suburban pediatric practices to assess the relation of exclusive breastfeeding, and other environmental exposures, to episodes of acute otitis media (AOM) and otitis media with effusion (OME)., Methods: Detailed prospective information about the exclusiveness of breastfeeding, parental smoking, day care attendance, and family history was obtained at scheduled clinic visits. Tympanometric and otoscopic examinations were used in the diagnosis of otitis media (OM). Nasopharyngeal cultures were performed at 1-6 months, and at 8, 10, 12, 15, 18, and 24 months of age to detect colonization with middle-ear pathogens., Results: Between 6 and 12 months of age, cumulative incidence of first OM episodes increased from 25% to 51% in infants exclusively breastfed and from 54% to 76% in infants formula-fed from birth. Peak incidence of AOM and OME episodes was inversely related to rates of breastfeeding beyond 3 months of age. A twofold elevated risk of first episodes of AOM or OME was observed in exclusively formula-fed infants compared with infants exclusively breast-fed for 6 months. In the logistic regression analysis, formula-feeding was the most significant predictor of AOM and OME episodes, although age at colonization with middle-ear pathogens and day care (outside the home) were significant competing risk factors. A hazard health model suggested additionally that breastfeeding, even for short durations (3 months), reduced onset of OM episodes in infancy., Conclusions: Modifiable factors in the onset of AOM and OME episodes during the first 2 years of life include early age at colonization (=3 months of age), day care outside the home, and not being breastfed.
- Published
- 1997
- Full Text
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22. Concordance of bacterial cultures with endotoxin and interleukin-6 in necrotizing enterocolitis.
- Author
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Duffy LC, Zielezny MA, Carrion V, Griffiths E, Dryja D, Hilty M, Rook C, and Morin F 3rd
- Subjects
- Feces chemistry, Feces microbiology, Humans, Infant, Newborn, Infant, Premature, Diseases metabolism, Limulus Test, Endotoxins analysis, Enterocolitis, Pseudomembranous metabolism, Enterocolitis, Pseudomembranous microbiology, Gram-Negative Bacteria isolation & purification, Infant, Premature, Diseases microbiology, Interleukin-6 metabolism
- Abstract
Concordance between gram-negative enteric and other toxin-producing bacteria in blood and stool culture, endotoxin (lipopolysaccharide), and interleukin-6 (IL-6) was measured in 60 preterm infants (600-1600 g) as a clinical index in neonatal necrotizing enterocolitis (NEC). E. coli, Klebsiella, Enterobacter, and Clostridium spp., identified by routine bacteriology, were each strongly associated with elevated concentrations of endotoxin (P < 0.01) in stool filtrates, with Clostridium spp. most strongly associated with NEC disease. Stool filtrate endotoxin (EU/g) measured by a Limulus amebocyte lysate assay was age dependent. Samples from stage I NEC (61%) and infants with advanced disease (67%) had notably elevated levels of stool endotoxin (> 10 ln EU/g) compared to NEC-negative (47%) samples tested. Plasma and stool IL-6 generally tested at the low, nonmeasurable limit of the ELISA for NEC-negative (88%) and stage I NEC (93%), although a small proportion of samples (25%) from infants with stage II or III NEC had elevated stool concentrations of IL-6. We conclude that identification of toxin-producing organisms and endotoxin elevations in stool filtrates are more useful than circulating levels of endotoxin in plasma in predicting mucosally limited disease in the gastrointestinal tract. The prognostic value of monitoring stool endotoxin in infants with overgrowth of gram-negative bacteria has implications for therapeutic strategies in patients with early and advanced stages of disease. Monitoring inflammatory cytokines (IL-6) in relation to endotoxin values in stool appears of limited clinical value in controlling this devastating disease in preterm neonates.
- Published
- 1997
- Full Text
- View/download PDF
23. Content analysis of prime-time television medical news. A pediatric perspective.
- Author
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Prabhu NP, Duffy LC, and Stapleton FB
- Subjects
- Adult, Child, Humans, New York, Parents education, Surveys and Questionnaires, Attitude, Child Welfare, Parents psychology, Pediatrics education, Physicians psychology, Television standards
- Abstract
Objectives: To assess child health news broadcasts by a major regional television station and to evaluate the attitudes of parents and pediatricians about the context and value of television news reports., Design: Videotaping 6 months of consecutive evening news telecasts (Monday and Friday). Self-administered surveys given to a convenience sample of parents and mailed to community pediatricians., Setting: Local and national newscasts of prime-time coverage by a major metropolitan television station., Participants: One hundred forty-four members of the Buffalo (NY) Pediatric Society and 87 parents of children in the outpatient or inpatient departments of The Children's Hospital, Buffalo., Results: Pediatric issues were presented in 15% of local and 21% of national medical news stories. Adult-specific issues were addressed in 48% of local and 33% of national medical news reports. Local pediatric news reports focused on behavior (22%) and major illnesses (22%); national pediatric news concentrated on nutrition (30%), allergy (21%), and major illnesses (21%). Seventy percent of local and 85% of national pediatric news reports referenced an informative source. Fifty-one (59%) of the 87 parents and 69 (48%) of the 144 pediatricians consider television news to be an effective means of increasing awareness of child health issues. Parents and physicians recommended pediatric emergencies, safety, disease prevention, and adolescent issues as important areas of emphasis for television news. Fifty-one percent of the parents (44) and 48% of the pediatricians (69) believed that television reports increase knowledge of how to access local health resources., Conclusions: Television news reports are important sources of child health information. Pediatric topics on local and national news programs often do not focus on topics considered of highest priority by parents and pediatricians. Greater awareness by pediatricians of the potential value of television news as a tool for public health education is warranted.
- Published
- 1996
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24. Pulmonary surfactant maintains patency of conducting airways in the rat.
- Author
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Enhorning G, Duffy LC, and Welliver RC
- Subjects
- Animals, Rats, Rats, Wistar, Airway Resistance physiology, Pulmonary Surfactants physiology, Pulmonary Ventilation physiology
- Abstract
The hypothesis was tested that after extrusion of the liquid columns that often block the lumen of conducting airways, the latter will remain open because of well-functioning pulmonary surfactant preventing the liquid columns from returning. The extirpated lungs of 22 Wistar rats were studied. Via a tracheal tube a very fine catheter (PE 10) was inserted and advanced until it pierced the pleura. It was extracted until only 2 mm remained in the lung parenchyma. A pressure transducer measured the resistance that met a steady flow of air through the series of tubes: the PE 10 tube, the conducting airway of the lung, and the tracheal tube. The airway resistance was studied for 240 s after three airway flushings, two with saline solution and one with calf lung surfactant extract (CLSE), 3 mg/ml. The pressure recording showed that a low pressure, indicating airway patency, occurred for only 31 +/- 8 s (mean +/- SEM) after the first saline flush, and for 26 +/- 8 s after the second. After the CLSE flush the airway remained open for 174 +/- 12 s, which indicated a significantly reduced resistance (p < 0.0001). The results imply that well-functioning pulmonary surfactant is required for a low airway resistance.
- Published
- 1995
- Full Text
- View/download PDF
25. Sepsis syndrome and associated sequelae in patients at high risk for gram-negative sepsis.
- Author
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Conboy K, Welage LS, Walawander CA, Duffy LC, Welliver RC, Zielezny MA, DiPiro JT, Raebel MA, and Grasela TH
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Bacteremia epidemiology, Community-Acquired Infections drug therapy, Community-Acquired Infections epidemiology, Cross Infection drug therapy, Cross Infection epidemiology, Female, Gram-Negative Bacterial Infections complications, Gram-Negative Bacterial Infections drug therapy, Hospitalization, Humans, Incidence, Male, Middle Aged, Population Surveillance, Prospective Studies, Respiratory Tract Infections drug therapy, Respiratory Tract Infections epidemiology, Risk Factors, Systemic Inflammatory Response Syndrome complications, United States epidemiology, Urinary Tract Infections complications, Urinary Tract Infections epidemiology, Gram-Negative Bacterial Infections epidemiology, Systemic Inflammatory Response Syndrome epidemiology
- Abstract
We conducted a prospective surveillance study of 80 hospitals across the United States to determine the incidence of sepsis syndrome and its associated sequelae in hospitalized patients over age 18 years who were administered antibiotics for suspected or documented gram-negative infection. A sample of 1754 hospitalized patients were followed from onset of antimicrobial therapy to discharge or death. Mortality rates (MR) varied depending on the suspected source of sepsis syndrome. For patients in whom the syndrome was associated with community-acquired urinary tract infections, mortality was 20% (relative risk [RR] = 0.51, p < 0.05), for those with trauma 20.6% (RR = 0.51, p < 0.05), and patients with nosocomial respiratory tract infections 57.1% (RR = 1.66, p < 0.05). More than two complications occurred in 65.2% of patients under age 60 years (MR 31%), 40.8% of those age 60-80 (MR 42%), and 35.6% of patients older than 80 years (MR 33.3%, p > 0.05). Various patient populations had significant differences in both the incidence of the syndrome and its complications, and consequent mortality. Perhaps morbidity as well as mortality should be used as outcomes when testing the efficacy of innovative therapies for sepsis.
- Published
- 1995
26. Microalbuminuria in an adolescent cohort with insulin-dependent diabetes mellitus.
- Author
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Quattrin T, Waz WR, Duffy LC, Sheldon MW, Campos SP, Albini CH, and Feld LG
- Subjects
- Adolescent, Albuminuria urine, Cohort Studies, Diabetes Mellitus, Type 1 urine, Diabetic Nephropathies urine, Female, Humans, Kidney Function Tests, Male, Reference Values, Risk Factors, Serum Albumin analysis, Albuminuria diagnosis, Diabetes Mellitus, Type 1 diagnosis, Diabetic Nephropathies diagnosis
- Abstract
To document the incidence of microalbuminuria in children and adolescents with longstanding insulin-dependent diabetes mellitus (IDDM) and to compare the clinical characteristics and determinant risk factors of those with and without microalbuminuria, 135 adolescent patients with IDDM for 5 years or longer were evaluated. The study population was divided on the basis of microalbumin excretion into normal (< 20 micrograms/min), incipient (20-200 micrograms/min), and overt (> 200 micrograms/min) nephropathy groups. There were 106 patients in the normal group, 24 patients in the incipient group, and five in the overt nephropathy group. Glycosylated hemoglobin, cholesterol concentration, and glomerular filtration rate (GFR) were analyzed. The incidence of incipient and overt nephropathy was 17.8% and 3.7%, respectively. Mean cholesterol concentration in the incipient and overt nephropathy groups (208 +/- 39 mg/dL [5.4 +/- 1.0 mmol/L]) and 227 +/- 49 mg/dL [5.9 +/- 1.3 mmol/L], respectively) was significantly higher than the normal group (186 +/- 37 mg/dL [4.8 +/- 0.9 mmol/L] P < 0.05). Similarly, systolic and diastolic blood pressures were significantly higher in the incipient and overt nephropathy groups compared to the normal group. This study confirms the high incidence of incipient and overt nephropathy in adolescents with IDDM early in the course of the disease.
- Published
- 1995
- Full Text
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27. Reduction of virus shedding by B. bifidum in experimentally induced MRV infection. Statistical application for ELISA.
- Author
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Duffy LC, Zielezny MA, Riepenhoff-Talty M, Dryja D, Sayahtaheri-Altaie S, Griffiths E, Ruffin D, Barrett H, and Ogra PL
- Subjects
- Animals, Antigens, Viral analysis, Bifidobacterium virology, Enzyme-Linked Immunosorbent Assay, Female, Gastroenteritis therapy, Intestines virology, Mice, Mice, Inbred BALB C, Rotavirus immunology, Rotavirus isolation & purification, Rotavirus Infections therapy, Bifidobacterium physiology, Gastroenteritis virology, Rotavirus Infections virology, Virus Shedding
- Abstract
The protective effect of a human strain of Bifidobacterium bifidum (B. bifidum) against murine group A rotavirus (MRV) was examined in the intestines of BALB/c infected mice. In experiments designed to determine whether B. bifidum mediated MRV shedding during diarrheal disease, pregnant dams (and their expected litters) were randomly assigned to the following groups: (1) mice infected with MRV alone; (2) B. bifidum-treated + MRV-infected mice; (3) B. bifidum-treated controls; and (4) saline control animals. An enzyme-linked immunosorbent assay (ELISA) for the detection of group A rotavirus was used to measure virus protein. The sensitivity of the MRV antigen detector ELISA was determined by serially diluting the rotavirus antigen in test samples. Antigen was detected in dilution ranges of 1:256-1:4096 during the acute phase and 1:16-1:512 in the recovery phase of MRV clinical disease, in the samples tested. Treatment with B. bifidum significantly reduced shedding of MRV antigen (P < 0.009) on days 2-10 postinoculation. The reduction in shedding of virus protein corresponded well with delayed onset of acute diarrhea (P < 0.02). Closer examination of tissue cross sections under electron microscopy revealed that the B. bifidum-ingested strain adhered to the epithelium of the small intestine. These results suggest that priming the intestine with B. bifidum is effective against experimental MRV challenge and confirmed the potential usefulness of this detector ELISA for studying the kinetics of group A rotavirus infection in animals and humans.
- Published
- 1994
- Full Text
- View/download PDF
28. Perfluorocarbon-associated gas exchange in gastric aspiration.
- Author
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Nesti FD, Fuhrman BP, Steinhorn DM, Papo MC, Hernan LJ, Duffy LC, Fisher JE, Leach CL, Paczan PR, and Burak BA
- Subjects
- Analysis of Variance, Animals, Hemodynamics physiology, Pneumonia, Aspiration physiopathology, Prospective Studies, Random Allocation, Respiratory Function Tests, Single-Blind Method, Swine, Time Factors, Fluorocarbons pharmacology, Pulmonary Gas Exchange drug effects, Respiratory Distress Syndrome physiopathology
- Abstract
Objectives: To test whether perfluorocarbon-associated gas exchange (gas ventilation of the perfluorocarbon-liquid filled lung) could support oxygenation better than conventional positive pressure breathing in a piglet model of gastric aspiration-induced adult respiratory distress syndrome (ARDS)., Design: Prospective, randomized, blinded, controlled study., Setting: A critical care research laboratory in a university medical school., Subjects: Fourteen healthy piglets., Interventions: Under alpha-chloralose anesthesia and metocurine iodide neuromuscular blockade, 14 piglets underwent tracheostomy; central venous, systemic and pulmonary arterial catheterizations; and volume-regulated continuous positive-pressure breathing. Homogenized gastric aspirate (1 mL/kg) titrated to pH of 1.0 was instilled into the tracheostomy tube of each subject at 0 min to induce ARDS. Hemodynamics, lung mechanics, and gas exchange were evaluated every 30 mins for 6 hrs. Seven piglets were treated at 60 mins by tracheal instillation of perflubron, a volume selected to approximate normal functional residual capacity, and were supported by perfluorocarbon-associated gas exchange without modifying ventilatory settings. Perflubron was added to the trachea every hour to replace evaporative losses., Measurements and Main Results: There was a significant difference in oxygenation over time when tested by repeated-measures analysis of variance (F test = 8.78, p < .01). On further analysis, the differences were not significant from baseline to 2.5 hrs but became increasingly significant from 2.5 to 6 hrs after injury (p < .05) in the inflammatory phase of gastric aspiration-induced ARDS. Histologic evidence for ARDS in the treated group 6 hrs after injury was lacking., Conclusions: In the piglet model, perfluorocarbon-associated gas exchange with perflubron facilitates oxygenation in the acute phase of gastric aspiration-induced inflammatory ARDS when compared with conventional positive-pressure breathing. Histologic and physiologic data suggest that perfluorocarbon-associated gas exchange with perflubron might prevent ARDS if instituted after aspiration in the time window before the acute inflammatory process is manifest.
- Published
- 1994
- Full Text
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29. Effectiveness of Bifidobacterium bifidum in mediating the clinical course of murine rotavirus diarrhea.
- Author
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Duffy LC, Zielezny MA, Riepenhoff-Talty M, Dryja D, Sayahtaheri-Altaie S, Griffiths E, Ruffin D, Barrett H, Rossman J, and Ogra PL
- Subjects
- Administration, Oral, Animals, Antibodies, Viral blood, Antigens, Viral isolation & purification, Diarrhea immunology, Diarrhea virology, Evaluation Studies as Topic, Female, Gastroenteritis immunology, Gastroenteritis prevention & control, Gastroenteritis virology, Immunoglobulin G blood, Male, Mice, Mice, Inbred BALB C, Peyer's Patches immunology, Peyer's Patches virology, Pregnancy, Random Allocation, Rotavirus immunology, Rotavirus isolation & purification, Rotavirus Infections immunology, Rotavirus Infections virology, Bifidobacterium physiology, Diarrhea prevention & control, Rotavirus Infections prevention & control
- Abstract
Human Bifidobacterium sp strain bifidum (B. bifidum) was administered to BALB/c lactating mice (n = 58) and their litters (n = 327 pups) to evaluate the ingested strain's adherent properties and ability to inhibit murine rotavirus (MRV) infection. ELISA and anaerobic bacteriologic techniques were used to measure MRV shedding and colonization of Bifidobacterium in the small intestine. At 13-16 d gestation, pregnant dams (and their expected litters) were randomly assigned to one of four experimental groups: 1) normal controls; 2) B. bifidum-treated only; 3) MRV-infected only; and 4) B. bifidum-treated + MRV-infected dams and litters. During the acute phase of diarrhea, 80% of small-intestine cultures in B. bifidum-treated litters were positive for the ingested B. bifidum strain compared with 24% of fecal cultures. Examination of tissue cross sections under electron microscopy revealed the ingested B. bifidum strain survived passage through the upper gastrointestinal tract and adhered to the small-intestine epithelium. After the administration of the high dose of virus, diarrhea developed in all pups, but onset was significantly delayed in B. bifidum-treated + MRV-infected litters compared with litters infected with MRV only (p < 0.02). B. bifidum-treated+MRV-infected pups demonstrated a significant reduction in MRV shedding compared with litters challenged with MRV only at d 2 to 10 after inoculation (p < 0.009). More direct studies are needed to assess mechanisms by which this anaerobe can alter the course of MRV infection at the level of gut epithelium.
- Published
- 1994
- Full Text
- View/download PDF
30. Prognostic value of sonography in childhood nephrotic syndrome.
- Author
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Gershen RS, Brody AS, Duffy LC, and Springate JE
- Subjects
- Adolescent, Biopsy, Child, Child, Preschool, Female, Glucocorticoids therapeutic use, Humans, Infant, Kidney diagnostic imaging, Kidney drug effects, Kidney pathology, Male, Nephrotic Syndrome drug therapy, Nephrotic Syndrome pathology, Prognosis, Retrospective Studies, Ultrasonography, Nephrotic Syndrome diagnostic imaging
- Abstract
This retrospective case review of 43 children with primary nephrotic syndrome was designed to evaluate the relationship among renal ultrasound findings at presentation, subsequent corticosteroid responsiveness and histological diagnoses. Fifty-one percent of patients had abnormal sonograms; nephromegaly was present in 42% and increased renal echogenicity in 35%. There was no relationship between nephromegaly and either response to corticosteroids or specific glomerular lesions causing nephrosis. Although the presence of echogenic kidneys did not denote a particular type of renal disease, it was significantly more frequent in corticosteroid-resistant than in corticosteroid-responsive patients (62% vs. 18%, P < 0.05). We conclude that increased renal echogenicity at time of presentation is a possible indicator of corticosteroid resistance in children with primary nephrotic syndrome.
- Published
- 1994
- Full Text
- View/download PDF
31. Family pesticide and childhood brain cancer.
- Author
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Duffy LC, Cole P, and Lamm SH
- Subjects
- Child, Environmental Exposure adverse effects, Humans, Research Design, Brain Neoplasms chemically induced, Pesticides adverse effects
- Published
- 1994
- Full Text
- View/download PDF
32. Effectiveness of Bifidobacterium bifidum in experimentally induced MRV infection: dietary implications in formulas for newborns.
- Author
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Duffy LC, Zielezny MA, Riepenhoff-Talty M, Dryja D, Sayahtaheri-Altaie S, Griffiths E, Ruffin D, Barrett H, Rossman J, and Ogra PL
- Subjects
- Animals, Antigens, Viral analysis, Bacterial Adhesion, Bifidobacterium isolation & purification, Disease Models, Animal, Enzyme-Linked Immunosorbent Assay, Female, Gastroenteritis prevention & control, Humans, Infant, Newborn, Intestine, Small microbiology, Intestine, Small ultrastructure, Mice, Mice, Inbred BALB C, Microscopy, Electron, Pregnancy, Rotavirus immunology, Rotavirus Infections immunology, Bifidobacterium physiology, Food, Formulated, Infant Food, Rotavirus Infections prevention & control
- Abstract
The protective effect of a human strain of Bifidobacterium bifidum (B. bifidum) against murine Group A rotavirus (MRV) was examined in the intestines of BALB/c infected mice. In experiments designed to determine whether B. bifidum mediated MRV shedding during diarrheal disease, pregnant dams (and their expected litters) were randomly assigned to the following groups: 1. Mice infected with MRV alone; 2. B. bifidum treated + MRV infected mice; 3. B. bifidum treated controls; 4. Saline control animals. An enzyme-linked immunosorbent assay (ELISA) for the detection of group A rotavirus was used to measure virus protein. Treatment with B. bifidum significantly reduced shedding of MRV antigen (P < 0.009) days 2-10 post-inoculation. The reduction in shedding of virus protein corresponded well with delayed onset of acute diarrhea (P < 0.02). Closer examination of tissue cross-sections under electron microscopy revealed that the B. bifidum ingested strain adhered to the epithelium of the small intestine. In further experiments, adherent properties of the ingested strain were related to enhancement, although nonsignificant, in immunoglobulin secreting cell responses in Peyer's patch lymphocytes. These results suggest that priming the intestine with B. bifidum is effective against experimental MRV challenge. Closer examination of B. bifidum and related growth factors in suckling neonates on gut physiology and enhancement of local immune responses has potential dietary implications in formulas for newborns.
- Published
- 1993
33. Functional status of extremely preterm infants at kindergarten entry.
- Author
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Msall ME, Rogers BT, Buck GM, Mallen S, Catanzaro NL, and Duffy LC
- Subjects
- Activities of Daily Living, Blindness diagnosis, Blindness physiopathology, Cerebral Palsy diagnosis, Cerebral Palsy physiopathology, Disability Evaluation, Female, Follow-Up Studies, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Diseases diagnosis, Intellectual Disability diagnosis, Intellectual Disability physiopathology, Male, Disabled Persons classification, Infant, Premature, Diseases physiopathology
- Abstract
Functional status was formally assessed in 149 of 153 surviving members of an extremely preterm (< or = 28 weeks) birth cohort born at one tertiary center between 1983 and 1986. The children were observed in the completion of motor, speech and self-care tasks, and administered either the Vineland Daily Living Skills Scale (VDLS) or the Functional Independence Measure for children (WeeFIM). 31 children had major neurodevelopmental impairment. Only 5 per cent were considered to have severe functional limitation. The prevalence of functional limitation varied by definition: 11 children were limited using the WeeFIM instrument and 35 using the VDLS instrument. These findings suggest that the majority of extremely preterm children are functional at kindergarten entry, but will require continuous monitoring of academic skills.
- Published
- 1993
- Full Text
- View/download PDF
34. Blood culture results as determinants in the organism identification of bacterial meningitis.
- Author
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Coant PN, Kornberg AE, Duffy LC, Dryja DM, and Hassan SM
- Subjects
- Adolescent, Anti-Bacterial Agents administration & dosage, Child, Child, Preschool, Diagnosis, Differential, Humans, Infant, Infant, Newborn, Latex Fixation Tests, Meningitis, Bacterial cerebrospinal fluid, Meningitis, Bacterial diagnosis, Meningitis, Bacterial drug therapy, Meningitis, Haemophilus diagnosis, Retrospective Studies, Sensitivity and Specificity, Spinal Puncture, Staining and Labeling, Time Factors, Blood microbiology, Meningitis, Bacterial microbiology
- Abstract
The diagnosis of bacterial meningitis depends on a lumbar puncture (LP). Sometimes, antibiotics are administered before a LP that is delayed owing to prior need for computerized tomography (CT) scan, technical problems, inability to obtain consent, or an unstable patient. We examined the accuracy of blood culture, cerebrospinal fluid (CSF) Gram's stain, and antigen detection by latex for organism identification of meningitis. All patients admitted to the Children's Hospital of Buffalo between January 1, 1984 and December 31, 1989 and having a CSF culture diagnosis of bacterial meningitis had their charts retrospectively reviewed. Patients excluded from the study were those with neural tube defects or CSF catheters, those admitted directly to the Intensive Care Nursery (ICN), those whose positive CSF cultures were determined to be a contaminant, those whose medical records were not found, or those older than 16 years. We analyzed a total of 178 patients with positive CSF cultures and the confirmed diagnosis of bacterial meningitis. Of 169 patients who had a blood culture performed, 86% had the organism responsible for meningitis recovered by this test, with the highest yield of 91% occurring in the 2.5-month to 24-month age group. Blood culture identified the bacteria in 94% of those patients with Haemophilus influenzae meningitis, and this yield increased to 100% when patients who had been pretreated with antibiotics were excluded. The combination of blood culture, CSF Gram's stain, and/or latex agglutination identified the causative bacteria in 92% of patients with meningitis. Blood culture, CSF Gram's stain, and latex agglutination are useful in identifying the organism causing pediatric meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1992
- Full Text
- View/download PDF
35. Parents' developmental perceptions and expectations for their high-risk infants.
- Author
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Rogers BT, Booth LJ, Duffy LC, Hassan MB, McCormick P, Snitzer J, and Zorn WA
- Subjects
- Brain Damage, Chronic diagnosis, Child, Preschool, Developmental Disabilities diagnosis, Female, Humans, Infant, Infant, Newborn, Infant, Premature, Diseases diagnosis, Intensive Care, Neonatal, Language Development Disorders diagnosis, Language Development Disorders psychology, Male, Neurologic Examination, Neuropsychological Tests, Psychomotor Disorders diagnosis, Psychomotor Disorders psychology, Attitude, Brain Damage, Chronic psychology, Developmental Disabilities psychology, Infant, Premature, Diseases psychology, Parents psychology
- Abstract
This study examines the relationship between developmental outcomes of high-risk infants and parental perceptions and expectations. Parents of 209 consecutive high-risk infants were asked to provide their development interpretations and expectations before their infants received standard developmental assessments between April and October 1989. Moderate correlations between parents and professional assessments of motor and language skills were noted (p less than .05 to p less than .01). Most agreements occurred when infants were assessed as normal by professionals. Disagreements were common and occurred in all areas of development. These mismatches were not associated with gestational age at birth, neonatal complications, poverty, or estimates of parental experience. Professionals should take seriously any expressed developmental concerns by parents of high-risk infants. Expressed developmental concerns, however, cannot be relied on for developmental screening of high-risk infants.
- Published
- 1992
- Full Text
- View/download PDF
36. Relevance of major stress events as an indicator of disease activity prevalence in inflammatory bowel disease.
- Author
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Duffy LC, Zielezny MA, Marshall JR, Byers TE, Weiser MM, Phillips JF, Calkins BM, Ogra PL, and Graham S
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Male, Personality Inventory, Prospective Studies, Risk Factors, Sick Role, Colitis, Ulcerative psychology, Crohn Disease psychology, Life Change Events, Psychophysiologic Disorders psychology
- Abstract
The impact of psychological stress in recurrence of inflammatory bowel disease (IBD) is unclear. Why some patients with ulcerative colitis (UC) or Crohn's disease (CD) have unrelenting relapses whereas other IBD patients experience long periods of quiescent disease remains an enigma. The authors examined the risk of exposure to major stress events in clinical episodes of IBD. They followed up on 124 persons in a prospective study that monitored behavioral and biological characteristics for a period of 6 months. Stress-exposed subjects demonstrated increased risk of clinical episodes of disease when compared with unexposed subjects (RR = 2.6, 95% CI: 1.3-4.9). Elevated effect measures were highest for the domain of health-related stress (RR = 3.8, 95% CI: 1.5-9.9). In the multiple regression analysis, major stress events remained the most significant indicator of disease activity in the presence of the covariables considered. Only 7% of the variation in disease activity was uniquely attributed to stress. Baseline activity was the other notable indicator of subsequent disease activity in the study sample. All variables considered together explained 52% of the variance observed and implicated factors of potential clinical importance in monitoring recurrence of the disease.
- Published
- 1991
- Full Text
- View/download PDF
37. Should corticosteroids be used in the treatment of bacterial meningitis? Pro and con.
- Author
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Kornberg AE, Welliver RC, Duffy LC, and Stapleton FB
- Subjects
- Adrenal Cortex Hormones adverse effects, Animals, Hearing Disorders etiology, Hearing Disorders prevention & control, Humans, Meningitis, Bacterial complications, Adrenal Cortex Hormones therapeutic use, Meningitis, Bacterial drug therapy
- Published
- 1991
38. Multiple minor malformations as a marker for prenatal etiology of cerebral palsy.
- Author
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Coorssen EA, Msall ME, and Duffy LC
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Brain Damage, Chronic congenital, Brain Damage, Chronic etiology, Cerebral Palsy etiology, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Risk Factors, Abnormalities, Multiple etiology, Cerebral Palsy congenital
- Abstract
A consecutive series of 137 patients with cerebral palsy living in institutions and aged between 18 and 30 years was examined for minor malformations, using a modified Weighted Anomaly Score. After examination, the patients were divided into two groups, based on whether their cerebral palsy was prenatal or postnatal in onset. A further subset of prenatal-onset patients with unidentified etiology was also analysed. Both the prenatal group with known etiology and the subgroup with unknown etiology had significantly more minor malformations than the postnatal group. These results suggest that multiple minor malformations may indicate prenatal etiology of cerebral palsy.
- Published
- 1991
- Full Text
- View/download PDF
39. Effect of prior immunity on the shedding of virulent revertant virus in feces after oral immunization with live attenuated poliovirus vaccines.
- Author
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Ogra PL, Faden HS, Abraham R, Duffy LC, Sun M, and Minor PD
- Subjects
- Antibodies, Viral biosynthesis, Humans, Infant, Nasopharynx immunology, Neutralization Tests, Poliovirus classification, Poliovirus genetics, Poliovirus isolation & purification, RNA, Viral analysis, Vaccines, Inactivated standards, Feces microbiology, Poliovirus pathogenicity, Poliovirus Vaccine, Inactivated standards, Poliovirus Vaccine, Oral standards
- Abstract
Groups of infants were immunized with one or two doses of orally inoculated live attenuated Sabin poliovirus vaccine (OPV group) or with one or two doses of enhanced-potency inactivated poliovirus vaccine (EIPV) administered parenterally followed by one or two doses of OPV (EIPV-OPV group). The fecal specimens from both groups were tested for poliovirus shedding 1-2 months after OPV. The virus isolates were examined for nucleic acid sequences in the 5' noncoding regions (bases 480, 481, and 472 for serotypes 1, 2, and 3, respectively) to determine whether the viruses shed represented nonattenuated revertants, attenuated parent vaccine strains (nonrevertants), or both. In the OPV group, 4 of the 6 virus isolates recovered 30-60 days after the first immunization dose and 1 of the 3 isolates obtained after the second dose were found to be nonrevertants (parent vaccine strain). In contrast, 11 of the 12 isolates in the EIPV-OPV group were of the nonvaccine revertant virus types. The frequency for reversion appeared to differ for different poliovirus serotypes. However, all revertant type 3 isolates were recovered from subjects previously immunized with EIPV.
- Published
- 1991
- Full Text
- View/download PDF
40. Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease.
- Author
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Duffy LC, Zielezny MA, Marshall JR, Weiser MM, Phillips JF, Byers TE, Calkins BM, Graham S, and Ogra PL
- Subjects
- Acute Disease, Adult, Female, Humans, Inflammatory Bowel Diseases etiology, Male, Middle Aged, Recurrence, Risk Factors, Stress, Physiological diagnosis, Stress, Physiological epidemiology, Surveys and Questionnaires, Time Factors, Inflammatory Bowel Diseases epidemiology, Stress, Physiological complications
- Abstract
We followed a cohort of 124 subjects with a history of inflammatory bowel disease to ascertain risk estimates for clinically active disease associated with exposure to recent stress events. We calculated risk estimates for three lag models (-1, 0, + 1 month). The data indicated a strong association between stress exposures and new clinical episodes of disease (RR = 2.9, 95% Cl: 2.0-4.1), most apparent in the immediate period (lag = 0). Risk estimates were also elevated for extended episodes of disease in subjects under stress compared with unexposed subjects. These results underscore the importance of monitoring stress exposures in prevention and treatment of recurrent disease.
- Published
- 1991
- Full Text
- View/download PDF
41. Cigarette smoking and risk of clinical relapse in patients with Crohn's disease.
- Author
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Duffy LC, Zielezny MA, Marshall JR, Weiser MM, Byers TE, Phillips JF, Ogra PL, and Graham S
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Risk Factors, Crohn Disease etiology, Smoking adverse effects
- Abstract
Risk of clinical relapse among cigarette smokers and nonsmokers was examined in a cohort of 74 adult Crohn's disease (CD) patients who were identified and followed at monthly intervals for six months. We measured clinical activity by a weighted symptom index used previously. Relapse at any point during the study was defined by the index score exceeding 150. Approximately 50% of nonsmokers experienced clinical relapse during the study period. Current smokers experienced a relapse risk 1.6 times that of nonsmokers (P less than .01). The risk estimates correspond to mean overall clinical activity scores of 142 +/- 34 for smokers compared to 119 +/- 26 for nonsmokers. Adjustment for confounding effects did not substantially alter the association shown between cigarette use and clinical relapse. We observed no increase in the likelihood of relapse among former smokers. The statistically significant finding that current smoking increases the risk of relapse for CD patients is of clinical importance, given the high prevalence of smoking (42%) among CD patients in this sample.
- Published
- 1990
42. Vasoactive intestinal peptide as a laboratory supplement to clinical activity index in inflammatory bowel disease.
- Author
-
Duffy LC, Zielezny MA, Riepenhoff-Talty M, Byers TE, Marshall J, Weiser MM, Graham S, and Ogra PL
- Subjects
- Adult, Colitis, Ulcerative diagnosis, Colitis, Ulcerative physiopathology, Crohn Disease diagnosis, Crohn Disease physiopathology, Female, Follow-Up Studies, Humans, Immunoassay, Male, Sex Factors, Colitis, Ulcerative blood, Crohn Disease blood, Vasoactive Intestinal Peptide blood
- Abstract
Circulating levels of vasoactive intestinal peptide (VIP) in plasma were measured in gauging activity in inflammatory bowel disease (IBD). One hundred-fifteen adult IBD patients were studied cross-sectionally and prospectively, 48 with ulcerative colitis (UC) and 67 with Crohn's disease (CD). Sequential samples of plasma were assayed for VIP by specific radioimmunoassay. Sixty males and 55 females, ranging in age from 22 to 76 years were studied over six months. The results revealed a strong, positive association between VIP levels and clinical activity, both at baseline (r = 0.38, P less than 0.001) and follow-up (r = .41, P less than 0.001). The ability of the VIP immunoassay to gauge clinical activity was also evaluated where VIP concentrations above 30 pg/ml were defined as abnormal. At baseline, sensitivity (specificity) was found to be 81% (55%). The predictive value of a positive (negative) test was 57% (80%). These estimates did not differ at follow-up. Examination of paired plasma samples from intermittently active patients revealed nearly twofold increases (P less than 0.05) in VIP concentration during active periods of disease. The data suggest that plasma VIP levels may be a valuable laboratory parameter in gauging activity in inflammatory bowel disease.
- Published
- 1989
- Full Text
- View/download PDF
43. The effects of infant feeding on rotavirus-induced gastroenteritis: a prospective study.
- Author
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Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea LJ, Zielezny M, and Ogra PL
- Subjects
- Adolescent, Adult, Enzyme-Linked Immunosorbent Assay, Female, Gastroenteritis microbiology, Humans, Infant, Microscopy, Electron, New York, Prospective Studies, Risk, Rotavirus analysis, Virion analysis, Bottle Feeding, Breast Feeding, Gastroenteritis etiology, Rotavirus Infections epidemiology
- Abstract
The relationship between feeding method and risk of rotavirus infection was studied by following a cohort of 197 infants from low income households through the winter diarrhea season of 1983-84. Fecal specimens were systematically collected and tested for the presence of rotavirus particles by electron microscopy, confirmed by ELISA. The attack rates of rotavirus gastroenteritis were similar for breast-fed and bottle-fed infants (20 per cent, 17 per cent, respectively); however, the clinical course of rotavirus gastroenteritis was quite different. Infants who were breast-fed had illnesses which were characterized by milder symptoms of shorter duration. Of the 10 breast-fed infants who acquired rotavirus gastroenteritis, nine (90 per cent) were classified as mild illnesses while of the 25 bottle-fed infants who acquired rotavirus gastroenteritis, only nine (36 per cent) were classified as having mild illnesses. These data suggest that factors associated with breast-feeding, although not affecting rotavirus infection rates, may moderate the clinical course of rotavirus gastroenteritis.
- Published
- 1986
- Full Text
- View/download PDF
44. Postpartum immunization with rubella virus vaccine and antibody response in breast-feeding infants.
- Author
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Krogh V, Duffy LC, Wong D, Rosenband M, Riddlesberger KR, and Ogra PL
- Subjects
- Breast Feeding, Female, Humans, Infant, Newborn, Pregnancy, Rubella prevention & control, Rubella virus immunology, Vaccination, Vaccines, Attenuated, Antibodies, Viral biosynthesis, Immunity, Maternally-Acquired, Postpartum Period immunology, Rubella immunology, Rubella Vaccine immunology
- Abstract
Women who were susceptible to rubella, whether they had elected to breast-feed or formula-feed their infants, received immunization with subcutaneously administered rubella antibody 27/3 live, attenuated rubella virus vaccine in the postpartum period. The breast-fed or formula-fed infants of these mothers who had been immunized subsequently received active immunization with the rubella antibody 27/3 vaccine at 15 to 18 months of age. A second group of naturally immune women who were seropositive for rubella did not receive immunization after childbirth. However, infants of naturally immune mothers who did not receive immunization received immunization with the rubella vaccine and served as controls. Seroconversion for rubella antibody developed in over 94% of susceptible women who were seronegative for rubella after postpartum immunization. The infants of these mothers had no rubella antibody activity in the cord blood; however, 13% of such infants exhibited rubella antibody in serum at 6 months of age. On the other hand, 44% of breast-fed infants of naturally immune mothers (controls) demonstrated rubella antibody activity at 6 months of age. Subsequent immunization with rubella vaccine in breast-fed infants whose mothers had received postpartum immunization resulted in a serum antibody response that was similar to the response observed in the formula-fed infants or the infants of naturally immune mothers who had not received immunization. These data suggest that early neonatal exposure to the rubella virus in breast milk does not enhance or suppress subsequent responses to current programs of rubella vaccination in early childhood.
- Published
- 1989
45. Modulation of rotavirus enteritis during breast-feeding. Implications on alterations in the intestinal bacterial flora.
- Author
-
Duffy LC, Riepenhoff-Talty M, Byers TE, La Scolea LJ, Zielezny MA, Dryja DM, and Ogra PL
- Subjects
- Bifidobacterium growth & development, Bifidobacterium isolation & purification, Bottle Feeding, Feces microbiology, Humans, Infant, Prospective Studies, Rotavirus isolation & purification, Breast Feeding, Enteritis etiology, Intestines microbiology, Rotavirus Infections etiology
- Abstract
A cohort of 197 infants was followed up prospectively for a single rotavirus (RV) season, 1983 to 1984, to examine the effect of long-term feeding method on RV infection. The feeding classification distinguished breast vs formula milk intake over the long term, for at least 18 weeks from birth (approximately four months). During the follow-up period, relative numbers of RV particles in feces were compared by electron microscopy, and positive specimens were confirmed by an enzyme-linked immunosorbent assay. There was no apparent difference in the infection rates of rotavirus enteritis in breast-fed (20%) as compared with bottle-fed (17%) infants. However, clinical manifestation of illness was milder in breast-fed infants. Among the breast-fed subjects, fecal flora identified by bacterial cultures, biochemical reaction, and gas-liquid chromatography revealed a significant growth of bifidobacteria lasting as long as the period of lactation. Colonization by this organism above the detection level of log 10(5)/mL was not observed in the feces of bottle-fed infants. These data suggest that alterations in enteric flora induced by breast-feeding may be correlates of intraluminal events, mediated by human milk, that modulate the clinical course of RV gastroenteritis.
- Published
- 1986
- Full Text
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