Cincinnati Childrens Hospital Medical Center Cincinnati

Cincinnati, Ohio, United States

Cincinnati Childrens Hospital Medical Center Cincinnati

Cincinnati, Ohio, United States
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Thomson K.E.,University of Utah | Modi A.C.,Cincinnati Childrens Hospital Medical Center Cincinnati | Glauser T.A.,Cincinnati Childrens Hospital Medical Center Cincinnati | Rausch J.R.,Cincinnati Childrens Hospital Medical Center Cincinnati | Steve White H.,University of Utah
Epilepsia | Year: 2017

Objective: Nonadherence to prescribed dosing regimens is a significant problem in the treatment of pediatric and adult chronic epilepsy, and can result in severe consequences to patient outcomes. In this first-of-kind preclinical study, the impact of nonadherence on seizure control was studied by simulating human patterns of nonadherence in an animal epilepsy model. Methods: In study 1, three different patterns of nonadherence were modeled in newly diagnosed epileptic rats treated with carbamazepine: perfect adherence (100% of pellets contained carbamazepine), variable nonadherence (50% of pellets contained carbamazepine with different dosing patterns between animals), and complete nonadherence (0% of pellets contained carbamazepine). In study 2, a cohort of newly diagnosed epileptic rats were subjected to a "drug holiday" nonadherence paradigm, that is, a 2-week on (100%), 2-week off (0%), and 2-week on (100%) carbamazepine paradigm. Results: In the first experiment, the 100% (0.3 ± 0.2 SD convulsive seizures per day) adherent cohort demonstrated better seizure control than either the 0% (1.1 ± 0.8 SD) or 50% (0.8 ± 0.6 SD) adherent cohorts, which had similar levels of seizure control. In the second study, poor seizure control was exhibited during the second 2 weeks; that is, the drug holiday epoch; however, this did not negatively affect restoration of seizure control upon reinstatement of CBZ. Significance: The results from this pilot investigation suggest that nonadherence to carbamazepine is associated with significant negative but reversible effects on seizure control in an animal model of epilepsy. Furthermore, these results demonstrate that animal studies of nonadherence can yield potentially important and translatable insights into the consequences of nonadherence on seizure control. © 2017 International League Against Epilepsy.

PubMed | Norwegian Institute of Public Health, Cornell College, Cincinnati Childrens Hospital Medical Center Cincinnati, Kaiser Permanente and 3 more.
Type: | Journal: Autism research : official journal of the International Society for Autism Research | Year: 2016

This study reports on the initial validation of the Autism Symptom Interview (ASI), School-Age, a brief (15-20 min) phone interview derived from questions from the Autism Diagnostic Interview-Revised (ADI-R). The ASI, School-Age was administered by interviewers with minimal training to parents of children ages 5 to 12 who had all been previously identified with (or referred for assessment of) ASD or another neurodevelopmental disorder. Children then underwent a comprehensive assessment to determine a best-estimate clinical diagnosis of ASD (n=159) or non-ASD (e.g. language disorder, intellectual disability, ADHD; n=130). Clinicians who conducted the assessments were blind to ASI results. ROC analyses compared ASI scores to clinical diagnosis. Due to the small number of participants with non-ASD diagnoses who were classified as nonverbal (i.e. not yet using phrases on a daily basis), it was not possible to assess sensitivity and specificity of the nonverbal algorithm in this sample. The verbal algorithm yielded a sensitivity of 0.87 (95% CI=0.81-0.92) and a specificity of 0.62 (95% CI=0.53-0.70). When used in conjunction with the Autism Diagnostic Observation Schedule (ADOS), sensitivity and specificity were 0.82 (95% CI=0.74-0.88) and 0.92 (95% CI=0.86-0.96), respectively. Internal consistency and test-retest reliability were both excellent. Particularly for verbal school age children, the ASI may serve as a useful tool to more quickly ascertain or classify children with ASD for research or clinical triaging purposes. Additional data collection is underway to determine the utility of the ASI in children who are younger and/or nonverbal. Autism Res 2016. 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Glueck C.J.,Jewish Hospital of Cincinnati | Morrison J.A.,Cincinnati Childrens Hospital Medical Center | Wang P.,Jewish Hospital of Cincinnati | Woo J.G.,Cincinnati Childrens Hospital Medical Center | Woo J.G.,Cincinnati Childrens Hospital Medical Center Cincinnati
Metabolism: Clinical and Experimental | Year: 2013

Objective We determined whether simple, clinical information on late and early menarche could help identify adult women with metabolic syndrome (MetS) and oligomenorrhea. Materials/Methods We carried out a 26-year prospective follow-up of 272 suburban schoolgirls from ages 5-22 to 30-46. Results Early menarche (≤ 10 years, 5.2% of girls) and late menarche (≥ 16 years, 6.7% of girls) were both associated with oligomenorrhea (≥ 42 days) in adulthood, 29% and 11%, vs. 5% for normal menarche (11-15 years), p =.004. Early menarche was characterized by high childhood BMI (LS mean ± SE: 21.2 ± 1.0 kg/m2) and by high childhood and adult MetS (15%, 36%). Girls with late menarche had the lowest childhood BMI (18.1 ± 1.0), no childhood MetS, and the highest adult MetS (47%). Increasing age at menarche was associated with uniformly decreasing childhood BMI and MetS, but with a U-shaped pattern of BMI (p =.05), MetS (p =.008), and oligomenorrhea (p =.02) in adulthood. Change to MetS from median ages 13 to 38 was associated with early-late menarche (OR = 3.11, 95% CI 1.37-7.07, p =.007). MetS in adulthood was associated with childhood MetS (OR = 8.03, 95% CI 2.57-25.08, p =.0003) and with early-late menarche (OR = 3.43, 95% CI 1.44-8.15, p =.005). Conclusions Menarche age had a curvilinear ('U' shaped) relationship with MetS and oligomenorrhea in adulthood. Late menarche and early menarche are risk factors for adult oligomenorrhea, MetS, and cardiometabolic abnormalities. Girls with early (≤ age 10) and with late menarche (≥ 16) represent a group at high risk for adult cardiometabolic abnormalities and oligomenorrhea that is easily identifiable by physicians. © 2013 Elsevier Inc.

PubMed | Cincinnati Childrens Hospital Medical Center Cincinnati, Ford Motor Company, Indiana University, University of Illinois at Chicago and 3 more.
Type: | Journal: Cardiology in the young | Year: 2016

There is a known high prevalence of genetic and clinical syndrome diagnoses in the paediatric cardiac population. These disorders often have multisystem effects, which may have an important impact on neurodevelopmental outcomes. Taken together, these facts suggest that patients and families may benefit from consultation by genetic specialists in a cardiac neurodevelopmental clinic.This study assessed the burden of genetic disorders and utility of genetics evaluation in a cardiac neurodevelopmental clinic.A retrospective chart review was conducted of patients evaluated in a cardiac neurodevelopmental clinic from 6 December, 2011 to 16 April, 2013. All patients were seen by a cardiovascular geneticist with genetic counselling support.A total of 214 patients were included in this study; 64 of these patients had a pre-existing genetic or syndromic diagnosis. Following genetics evaluation, an additional 19 were given a new clinical or laboratory-confirmed genetic diagnosis including environmental such as teratogenic exposures, malformation associations, chromosomal disorders, and single-gene disorders. Genetic testing was recommended for 112 patients; radiological imaging to screen for congenital anomalies for 17 patients; subspecialist medical referrals for 73 patients; and non-genetic clinical laboratory testing for 14 patients. Syndrome-specific guidelines were available and followed for 25 patients with known diagnosis. American Academy of Pediatrics Red Book asplenia guideline recommendations were given for five heterotaxy patients, and family-based cardiac screening was recommended for 23 families affected by left ventricular outflow tract obstruction.Genetics involvement in a cardiac neurodevelopmental clinic is helpful in identifying new unifying diagnoses and providing syndrome-specific care, which may impact the patients overall health status and neurodevelopmental outcome.

Painter E.,Cincinnati Childrens Hospital Medical Center | Rausch J.R.,University of Cincinnati | Rausch J.R.,Cincinnati Childrens Hospital Medical Center Cincinnati | Modi A.C.,Cincinnati Childrens Hospital Medical Center | Modi A.C.,University of Cincinnati
Epilepsy and Behavior | Year: 2014

Having a child diagnosed with a chronic pediatric illness is a major stressor for families that can alter their daily lives. The primary study aim was to use Daily Phone Diaries (DPDs), a cued-recall procedure to track parents through their activities over a 24-hour period, to assess the activity patterns of a group of caregivers with a child diagnosed with new-onset epilepsy (group with NOE; n. = 30) and a group of matched comparisons (comparison group; n. = 29). The time caregivers spent in sleep and recreation was evaluated over the first 5.5. months after diagnosis. Caregivers of children with NOE spent significantly more time in recreation inside the home, while the comparison group spent significantly more time in recreation outside the home. These data suggest that families with children with NOE reallocate their time post-diagnosis from recreation outside to inside the home, which raises concerns about the overall adaptation of the family to the diagnosis and presents a critical opportunity for health-care teams to intervene and support families with children with NOE. © 2013.

Ragsdale J.R.,Cincinnati Childrens Hospital Medical Center Cincinnati
The journal of pastoral care & counseling : JPCC | Year: 2012

Nineteen newly certified Association for Clinical Pastoral Education (ACPE) Associate Supervisors were interviewed to determine how they learned to do Clinical Pastoral Education (CPE) supervision. Grounded theory was the qualitative research method used in gathering and analyzing data for this IRB approved study. The emerging theory, Mutually Engaged Supervisory Processes, includes nine processes: Discerning Vocation, Feedback, Support, Supervisory Practices and Identity, Theory, Increased Awareness, Shift in Personhood, Offering Presence, and Owning Authority. Member checks confirmed the trustworthiness of the results.

PubMed | Cincinnati Childrens Hospital Medical Center Cincinnati
Type: | Journal: Frontiers in human neuroscience | Year: 2015

Fourteen healthy children (13.8 2.2 years, range 10-16; M:F = 5:9) received 30 Hz intermittent theta burst transcranial magnetic stimulation (iTBS) with a stimulation intensity of 70% of resting motor threshold (RMT) with a total of 300 (iTBS300) pulses. All volunteers were free of neurologic, psychiatric and serious medical illnesses, not taking any neuropsychiatric medications, and did not have any contraindications to transcranial magnetic stimulation. Changes in the mean amplitudes of motor-evoked potentials from baseline following iTBS were expressed as a ratio and assessed from 1 to 10 min (BLOCK1) and 1-30 min (BLOCK2) using repeated-measures analysis of variance. All 14 subjects completed iTBS300 over the dominant primary motor cortex (M1) without any clinically reported adverse events. ITBS300 produced significant M1 facilitation [F (5, 65) = 3.165, p = 0.01] at BLOCK1 and trend level M1 facilitation at BLOCK2 [F (10, 129) = 1.69, p = 0.089]. Although iTBS300 (stimulation duration of 92 s at 70% RMT) delivered over M1 in typically developed children was well-tolerated and produced on average significant facilitatory changes in cortical excitability, the post-iTBS300 neurophysiologic response was variable in our small sample. ITBS300-induced changes may represent a potential neuroplastic biomarker in healthy children and those with neuro-genetic or neuro-psychiatric disorders. However, a larger sample size is needed to address safety and concerns of response variability.

PubMed | Cincinnati Childrens Hospital Medical CenterCincinnati and Cincinnati Childrens Hospital Medical Center Cincinnati
Type: | Journal: Frontiers in physiology | Year: 2016

The primary cilium is a ubiquitous, microtubule-based organelle that cells utilize to transduce molecular signals. Ciliopathies are a group of diseases that are caused by a disruption in the structure or function of the primary cilium. Over 30% of all ciliopathies are primarily defined by their craniofacial phenotypes, which typically include midfacial defects, cleft lip/palate, micrognathia, aglossia, and craniosynostosis. The frequency and severity of craniofacial phenotypes in ciliopathies emphasizes the importance of the cilium during development of the craniofacial complex. Molecularly, many ciliopathic mutants, including the avian

PubMed | Cincinnati Childrens Hospital Medical Center Cincinnati
Type: | Journal: Frontiers in neuroscience | Year: 2015

Sound modulation is a critical temporal cue for the perception of speech and environmental sounds. To examine auditory cortical responses to sound modulation, we developed an acoustic change stimulus involving amplitude modulation (AM) of ongoing noise. The AM transitions in this stimulus evoked an acoustic change complex (ACC) that was examined parametrically in terms of rate and depth of modulation and hemispheric symmetry.Auditory cortical potentials were recorded from 64 scalp electrodes during passive listening in two conditions: (1) ACC from white noise to 4, 40, 300 Hz AM, with varying AM depths of 100, 50, 25% lasting 1 s and (2) 1 s AM noise bursts at the same modulation rate. Behavioral measures included AM detection from an attend ACC condition and AM depth thresholds (i.e., a temporal modulation transfer function, TMTF).The N1 response of the ACC was large to 4 and 40 Hz and small to the 300 Hz AM. In contrast, the opposite pattern was observed with bursts of AM showing larger responses with increases in AM rate. Brain source modeling showed significant hemispheric asymmetry such that 4 and 40 Hz ACC responses were dominated by right and left hemispheres respectively.N1 responses to the ACC resembled a low pass filter shape similar to a behavioral TMTF. In the ACC paradigm, the only stimulus parameter that changes is AM and therefore the N1 response provides an index for this AM change. In contrast, an AM burst stimulus contains both AM and level changes and is likely dominated by the rise time of the stimulus. The hemispheric differences are consistent with the asymmetric sampling in time hypothesis suggesting that the different hemispheres preferentially sample acoustic time across different time windows.The ACC provides a novel approach to studying temporal processing at the level of cortex and provides further evidence of hemispheric specialization for fast and slow stimuli.

PubMed | Cincinnati Childrens Hospital Medical Center Cincinnati
Type: Journal Article | Journal: Brain and behavior | Year: 2015

Dyslexia is characterized by slow, inaccurate reading. Previous studies have shown that the Reading Acceleration Program (RAP) improves reading speed and accuracy in children and adults with dyslexia and in typical readers across different orthographies. However, the effect of the RAP on the neural circuitry of reading has not been established. In the current study, we examined the effect of the RAP training on regions of interest in the neural circuitry for reading using a lexical decision task during fMRI in children with reading difficulties and typical readers.Children (8-12 years old) with reading difficulties and typical readers were studied before and after 4 weeks of training with the RAP in both groups.In addition to improvements in oral and silent contextual reading speed, training-related gains were associated with increased activation of the left hemisphere in both children with reading difficulties and typical readers. However, only children with reading difficulties showed improvements in reading comprehension, which were associated with significant increases in right frontal lobe activation.Our results demonstrate differential effects of the RAP on neural circuits supporting reading in both children with reading difficulties and typical readers and suggest that the intervention may stimulate use of typical neural circuits for reading and engage compensatory pathways to support reading in the developing brain of children with reading difficulties.

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