100 research outputs found
Sociodemographic Factors influencing Pandemic-Era EHDI Use and Access
Objective: The COVID-19 pandemic impact on Early Hearing Detection and Intervention (EHDI) programs is unknown. This research evaluated sociodemographic factors influencing adherence to EDHI diagnostic testing and the incidence of infant hearing loss during the pandemic.
Method: We evaluated EHDI adherence and incidence of hearing loss in Kentucky before and during the COVID-19 pandemic. Using univariate and multivariate analysis, we evaluated the association of these outcomes to sociodemographic variables.
Results: There were 71,206 births and 1,385 referred infant hearing screening tests during the study period. Infants during the pandemic had a 24% lower odds of hearing testing adherence (OR = 0.76, p = 0.05, 95%CI: 0.57–1). Hispanic infants have 45% lower odds of EHDI adherence (OR = 0.55, p = 0.03, 95%CI: 0.31–0.96) and infants of Swahili speaking families have 90% lower odds of EHDI adherence (OR = 0.10, p = 0.001, 95%CI: 0.02–0.42). Infants of mothers with a high school degree had a higher odds of adherence (OR = 1.50, p = 0.02, 95%CI: 1.06–2.17), presented earlier for testing (p = 0.003, 95%CI: -15.73– -3.32), and had a higher odds of normal hearing (OR = 1.63, p= 0.03, 95%CI: 1.06–2.51).
Conclusion: EHDI adherence is influenced by the COVID-19 pandemic and sociodemographic factors. EHDI programs are encouraged to use this data to promote timely and equitable access and use of diagnostic services
Improving Newborn Hearing Screening Through Collaboration and Communication
Purpose: Hearing loss is the number one birth defect among children. There are significant consequences of delayed diagnosis and failure to obtain timely intervention, particularly for a child’s speech and language development. Design and implementation of successful newborn hearing screening (NHS) programs can be challenging. The purpose of this paper is to demonstrate improved efficiency and effectiveness of a large NHS program through the implementation of a team approach engaging both ambulatory and hospital services.
Methodology: A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to develop an improved NHS program focused on improving patient care. The SWOT analysis outcomes were used to determine several key factors to be implemented, including dedicated technicians solely assigned to the NHS program and purchase of new equipment to improve accuracy and reduce disposable costs. In addition, a two-tiered approach was implemented whereby the dedicated technicians performed initial screenings, with all rescreens performed by an audiologist.
Results: Implementation of the new NHS program demonstrated numerous successes including a significant reduction in the failure rate, improved care coordination, and increased communication between ambulatory and hospital services
Assessment of Factors Involved in Non-Adherence to Infant Hearing Diagnostic Testing
Abstract
Introduction: Delayed diagnosis of pediatric hearing loss can cause delays in cognitive and social development. This study described the sociodemographic factors associated with delayed timing of a final hearing diagnosis after an abnormal newborn hearing screening (NBHS). Methods: Parent-infant dyads were recruited after being referred for further audiologic testing on an abnormal result from the NBHS. Results: Of the 53 participants, 55% (n=29) did not receive a final diagnosis by the recommended 3 months of age. Of those with a delayed diagnosis, 45% (n=13) had their first appointment within 3 months, but a delay was caused by an inconclusive or abnormal auditory brainstem response (ABR), middle ear pathology, or the presence of risk factors requiring additional testing. In a univariate analysis, older parental age (OR: 0.90, 95% CI: [0.82, 0.99]) and more total children in the household ([OR: 0.66, 95% CI: {0.18, 2.49}] for 1 child vs. 2 and [OR: 0.14, 95% CI: {0.03, 0.69}] for 1 children vs. 3 or more) were shown to were shown to significantly increase the odds of a delayed diagnosis, whereas younger infant age at first appointment (OR: 0.95, 95% CI: [0.92, 0.99]) was shown to significantly decrease the odds of a delayed diagnosis. In multivariate analyses, delayed diagnosis was also decreased by younger infant age at the initial appointment (OR=0.94, 95% CI: [0.90, 0.99]). Conclusions: Parental age, number of total children in the household, and timing of first appointment may predict delayed diagnosis. Because many patients with a delayed diagnosis attended an appointment within 3 months, further standardization of the process and targeted interventions for families could improve chances of achieving a diagnosis within the first appointment
Sensory Communication
Contains table of contents on Section 2, an introduction, reports on eleven research projects and a list of publications.National Institutes of Health Grant 5 R01 DC00117National Institutes of Health Grant 5 R01 DC00270National Institutes of Health Contract 2 P01 DC00361National Institutes of Health Grant 5 R01 DC00100National Institutes of Health Contract 7 R29 DC00428National Institutes of Health Grant 2 R01 DC00126U.S. Air Force - Office of Scientific Research Grant AFOSR 90-0200U.S. Navy - Office of Naval Research Grant N00014-90-J-1935National Institutes of Health Grant 5 R29 DC00625U.S. Navy - Office of Naval Research Grant N00014-91-J-1454U.S. Navy - Office of Naval Research Grant N00014-92-J-181
Sensory Communication
Contains table of contents for Section 2, an introduction and reports on twelve research projects.National Institutes of Health Grant 5 R01 DC00117National Institutes of Health Contract 2 P01 DC00361National Institutes of Health Grant 5 R01 DC00126National Institutes of Health Grant R01-DC00270U.S. Air Force - Office of Scientific Research Contract AFOSR-90-0200National Institutes of Health Grant R29-DC00625U.S. Navy - Office of Naval Research Grant N00014-88-K-0604U.S. Navy - Office of Naval Research Grant N00014-91-J-1454U.S. Navy - Office of Naval Research Grant N00014-92-J-1814U.S. Navy - Naval Training Systems Center Contract N61339-93-M-1213U.S. Navy - Naval Training Systems Center Contract N61339-93-C-0055U.S. Navy - Naval Training Systems Center Contract N61339-93-C-0083U.S. Navy - Office of Naval Research Grant N00014-92-J-4005U.S. Navy - Office of Naval Research Grant N00014-93-1-119
Targeting DNA Damage Response and Replication Stress in Pancreatic Cancer
Background and aims:
Continuing recalcitrance to therapy cements pancreatic cancer (PC) as the most lethal malignancy, which is set to become the second leading cause of cancer death in our society. The study aim was to investigate the association between DNA damage response (DDR), replication stress and novel therapeutic response in PC to develop a biomarker driven therapeutic strategy targeting DDR and replication stress in PC.
Methods:
We interrogated the transcriptome, genome, proteome and functional characteristics of 61 novel PC patient-derived cell lines to define novel therapeutic strategies targeting DDR and replication stress. Validation was done in patient derived xenografts and human PC organoids.
Results:
Patient-derived cell lines faithfully recapitulate the epithelial component of pancreatic tumors including previously described molecular subtypes. Biomarkers of DDR deficiency, including a novel signature of homologous recombination deficiency, co-segregates with response to platinum (P < 0.001) and PARP inhibitor therapy (P < 0.001) in vitro and in vivo. We generated a novel signature of replication stress with which predicts response to ATR (P < 0.018) and WEE1 inhibitor (P < 0.029) treatment in both cell lines and human PC organoids. Replication stress was enriched in the squamous subtype of PC (P < 0.001) but not associated with DDR deficiency.
Conclusions:
Replication stress and DDR deficiency are independent of each other, creating opportunities for therapy in DDR proficient PC, and post-platinum therapy
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
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