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Matteini A.M.,Johns Hopkins Institutions | Matteini A.M.,Johns Hopkins University | Walston J.D.,Johns Hopkins Institutions | Bandeen-Roche K.,Johns Hopkins Institutions | And 6 more authors.
Journal of Nutrition, Health and Aging | Year: 2010

Objective: This project was designed to follow-up prior evidence that demonstrated a significant association between vitamin B12 transport and metabolism and the frailty syndrome in community-dwelling older women. The cross-sectional relationship between genetic variants within six candidate genes along this pathway with serum methylmalonic acid (MMA) levels and frailty was evaluated in this same population of older women. Methods: Baseline measures were collected prior to folate fortification from 326 women in the Women's Health and Aging Studies I and II. Odds ratios and statistical tests were estimated for single SNP and haplotype via linear regression models for serum MMA, a marker for available vitamin B12, and in logistic regression models for frailty. Results: Fifty-six SNPs from CBS, MTHFR, MTR, MTRR, TCN1 and TCN2 genes were genotyped. Several SNPs in MTHFR, MTR and MTRR demonstrated a modest association to elevated MMA, while SNPs in TCN2 showed significant association to the frailty syndrome. TCN2 polymorphisms, particularly one SNP reported to be in perfect LD with functional variant Pro259Arg, were significantly associated with increased odds of frailty, after adjustment for age, presence of cardiovascular disease and elevated MMA (OR = 2.25, p-value = 0.009). Conclusions: Using MMA as a marker for vitamin B12, these results suggest that TCN2 gene variants may lead to decreased vitamin B 12 availability, leading to reduced energy metabolism, ultimately contributing to frailty pathology. Further studies to determine the biological role of functional TCN2 polymorphisms in frailty are needed. The Journal of Nutrition, Health and Aging©.


Kelen G.D.,Johns Hopkins Institutions | Kelen G.D.,Johns Hopkins University | Catlett C.L.,Johns Hopkins Institutions | Catlett C.L.,Johns Hopkins University | And 2 more authors.
Annals of Emergency Medicine | Year: 2012

Study objective: Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011. Methods: Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed. Results: Of 9,360 search "hits," 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), "euthanizing" an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%). Conclusion: Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of event represents a significant challenge to hospital security and effective deterrence practices because most perpetrators proved determined and a significant number of shootings occur outside the hospital building. Copyright © 2012 by the American College of Emergency Physicians.


Yang D.,Sun Yat Sen University | Grant M.C.,Johns Hopkins Institutions | Stone A.,Sun Yat Sen University | Wu C.L.,Sun Yat Sen University | Wick E.C.,Johns Hopkins Institutions
Annals of Surgery | Year: 2016

Background: The clinical benefits of intraoperative low tidal volume (LTV) mechanical ventilation with concomittent positive end expiratory pressure (PEEP) and intermittent recruitment maneuvers - termed "protective lung ventilation" (PLV) - have not been investigated systematically in otherwise healthy patients undergoing general anesthesia. Methods: Our group performed a meta-analysis of 16 studies (n = 1054) comparing LTV (n = 521) with conventional lung ventilation (n = 533) for associated postoperative incidence of atelectasis, lung infection, acute lung injury (ALI), and length of hospital stay. A secondary analysis of 3 studies comparing PLV (n = 248) with conventional lung ventilation (n = 247) was performed. Results: Although intraoperative LTV ventilation was associated with a decreased incidence of postoperative lung infection (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.16-0.68; P = 0.003) compared with a conventional strategy, no difference was noted between groups in incidence of postoperative ALI (OR=0.38; 95% CI, 0.10-1.52; P=0.17) or atelectasis (OR = 0.86; 95% CI, 0.26-2.81; P = 0.80). Analysis of trials involving protective ventilation (LTV + PEEP + recruitment maneuvers) showed a statistically significant reduction in incidence of postoperative lung infection (OR = 0.21; 95% CI, 0.09-0.50; P = 0.0003), atelectasis (OR = 0.36; 95% CI, 0.20-0.64; P = 0.006), and ALI (OR = 0.15; 95% CI, 0.04-0.61; P = 0.008) and length of hospital stay (Mean Difference=-2.08; 95% CI, -3.95 to -0.21; P = 0.03) compared with conventional ventilation. Conclusions: Intraoperative LTV ventilation in conjunction with PEEP and intermittent recruitment maneuvers is associated with significantly improved clinical pulmonary outcomes and reduction in length of hospital stay in otherwise healthy patients undergoing general surgery. Providers should consider application of all the 3 elements for a comprehensive protective ventilation strategy. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Safer D.J.,Johns Hopkins Institutions
Journal of Child and Adolescent Psychopharmacology | Year: 2011

Objective: This review aims to detail specific psychotropic medication treatment differences in adverse drug events (ADEs) between children, adolescents, and adults. Method: A thorough data-based search of ADEs was made, augmented by findings from approved and updated U.S. Food and Drug Administration (FDA) drug labels, controlled clinical trial reports, and from FDA information on ADEs at scheduled public hearings. Results: Children were found to generally exhibit more ADEs to psychotropic medication than adolescents and adults. These ADEs primarily include altered growth velocity, rash, vomiting, dystonia, tics, affect lability, activation, metabolic blood test abnormalities, sedation, sialorrhea, and electrocardiogram irregularities. Conclusion: Children have more biological vulnerabilities than older individuals, which could account for their greater rate of ADEs to psychotropic medication treatment. © Copyright 2011, Mary Ann Liebert, Inc.


Kelen G.D.,Johns Hopkins University | Kelen G.D.,Johns Hopkins Institutions | Sauer L.,Johns Hopkins University | Sauer L.,Johns Hopkins Institutions | And 3 more authors.
Disaster Medicine and Public Health Preparedness | Year: 2015

Background Critically insufficient pediatric hospital capacity may develop during a disaster or surge event. Research is lacking on the creation of pediatric surge capacity. A system of reverse triage, with early discharge of hospitalized patients, has been developed for adults and shows great potential but is unexplored in pediatrics. Methods We conducted an evidence-based modified-Delphi consensus process with 25 expert panelists to derive a disposition classification system for pediatric inpatients on the basis of risk tolerance for a consequential medical event (CME). For potential validation, critical interventions (CIs) were derived and ranked by using a Likert scale to indicate CME risk should the CI be withdrawn or withheld for early disposition. Results Panelists unanimously agreed on a 5-category risk-based disposition classification system. The panelists established upper limit (mean) CME risk for each category as <2% (interquartile range [IQR]: 1-2%); 7% (5-10%), 18% (10-20%), 46% (20-65%), and 72% (50-90%), respectively. Panelists identified 25 CIs with varying degrees of CME likelihood if withdrawn or withheld. Of these, 40% were ranked high risk (Likert scale mean ≥7) and 32% were ranked modest risk (≤3). Conclusions The classification system has potential for an ethically acceptable risk-based taxonomy for pediatric inpatient reverse triage, including identification of those deemed safe for early discharge during surge events. © Society for Disaster Medicine and Public Health, Inc. 2015.


PubMed | Johns Hopkins Institutions
Type: Journal Article | Journal: Journal of child and adolescent psychopharmacology | Year: 2011

This review aims to detail specific psychotropic medication treatment differences in adverse drug events (ADEs) between children, adolescents, and adults.A thorough data-based search of ADEs was made, augmented by findings from approved and updated U.S. Food and Drug Administration (FDA) drug labels, controlled clinical trial reports, and from FDA information on ADEs at scheduled public hearings.Children were found to generally exhibit more ADEs to psychotropic medication than adolescents and adults. These ADEs primarily include altered growth velocity, rash, vomiting, dystonia, tics, affect lability, activation, metabolic blood test abnormalities, sedation, sialorrhea, and electrocardiogram irregularities.Children have more biological vulnerabilities than older individuals, which could account for their greater rate of ADEs to psychotropic medication treatment.


PubMed | Johns Hopkins Institutions
Type: Journal Article | Journal: Annals of emergency medicine | Year: 2012

Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011.Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed.Of 9,360 search hits, 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), euthanizing an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officers gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%).Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of event represents a significant challenge to hospital security and effective deterrence practices because most perpetrators proved determined and a significant number of shootings occur outside the hospital building.


News Article | November 10, 2016
Site: www.prweb.com

John Fuller, Ed.D., a nationwide diversity practitioner, has presented hundreds of cultural awareness sessions and facilitated race relations dialogues to thousands of participants in nearly every state. In “America’s Diversity Meltdown: Challenging Diversity Education and Its Epic Failure to Improve Race Relations” (published by Archway Publishing), Fuller offers readers a behind-the-scenes look at how the genesis of diversity education required “us versus them” themes that essentially created the “white elephant in the room” in every classroom and, how mostly repackaged curriculum exists but with the same theme today. In his book, Fuller, a white male, offers an open discourse about white male privilege, communities of color, identities, affirmative action and divisive rhetoric. He reveals how over 30-plus years of mostly mandatory diversity training provided by businesses, communities and the federal government have failed to improve what he calls is the caldera of negative race relations that is not being discussed in classrooms. Fuller strives to replace the current approach with the mindset of “it is all about us” through meaningful and action-oriented dialogue. Fuller offers practical recommendations that would overhaul current failed diversity education and create new pathways to success that include his “Gateway to Race Relations World Café Dialogue.” Fuller says, “Small keys can open large doors and my book may hold the small key that opens the large door to revive Dr. Martin Luther King’s crucial national conversation on race relations which he started but never continued after his assassination.” “America’s Diversity Meltdown” By John Fuller, Ed.D. Hardcover | 5.5 x 8.5 in | 166 pages | ISBN 9781480833326 Softcover | 5.5 x 8.5 in | 166 pages | ISBN 9781480833319 E-Book | 166 pages | ISBN 9781480833333 Available at Amazon and Barnes & Noble About the Author John Fuller, Ed.D., is a diversity champion with over 26 years of diversity and EEO (Equal Employment Opportunity) experience. Currently the Chief Employee Engagement Educator with the Department of Veterans Affairs, he was the former Director of Workforce Diversity and EEO for Johns Hopkins Hospital. He holds a Doctor of Education, Master of Science in Business Ethics, Master of Science in Community Leadership and Master of Arts in Education. He is a retired U.S. Army Major and was a U.S. Marine Corps Sergeant during the Vietnam-era, with over 22 combined years of active duty military and numerous military awards. Fuller is a recipient of the prestigious Johns Hopkins Institutions' Martin Luther King Community Service Award in recognition for his extensive community service contributions and involvement. He is married to his wife Christine of 35 years and they have two children, Stephanie and David, and one granddaughter, Jane. For more information, readers may visit http://www.challengingdiversity.com. Simon & Schuster, a company with nearly ninety years of publishing experience, has teamed up with Author Solutions, LLC, the leading self-publishing company worldwide, to create Archway Publishing. With unique resources to support books of all kind, Archway Publishing offers a specialized approach to help every author reach his or her desired audience. For more information, visit archwaypublishing.com or call 888-242-5904.

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