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Wilmington, DE, United States

Chan S.,DuPont Company | Hossain J.,Nemours Biomedical Research | Hossain J.,University of Delaware | Di Pentima M.C.,Vanderbilt University
Pediatric Infectious Disease Journal

Background: We evaluated the performance of two consecutive antimicrobial stewardship interventions on vancomycin use. Methods: Prospective audit with intervention and real time feedback to providers were implemented in April 2004. In February 2009, the institutional vancomycin policy was modified requiring preauthorization by the pediatric infectious diseases clinician on-call. Monthly vancomycin use was calculated as doses administered per 1000 patient-days. Results: After 5 years of prospective-audit vancomycin use declined from 378 doses administered/1000 patient-days to 208 doses administered/1000 patient-days (45%). Following the implementation of preauthorization, vancomycin use decreased by an additional 16% in the subsequent 4 years. When compared with the trend of vancomycin use with prospective-audit, the trend of vancomycin use after the implementation of the restriction policy increased by 3.9 doses per month (SE: 1.51, P=0.012) during the subsequent 51 months. Conclusions: Implementation of preauthorization didn't significantly reduce the use of vancomycin beyond the accomplishments by prospective-audit and feedback by a team of an infectious disease pharmacist and physician. © 2015 Wolters Kluwer Health, Inc. Source

Kumar S.,Mayo Medical School | Hossain J.,Nemours Biomedical Research | Aguirre R.,Illinois College | Sriram S.,Mayo Medical School | Babu Balagopal P.,Mayo Medical School
Journal of Clinical Endocrinology and Metabolism

Context: Spexin is a novel peptide that is implicated in obesity and related energy homeostasis in animals and adult humans. Little is known about its role in children. Objective: The aim of the current study was to determine the potential role of Spexin in obese children and explore its relationships with various cardiometabolic risk factors. Design and Participants: This was a cross-sectional study composed of 69 children (51 obese and 18 normal weight; age 15.3-0.26 y). Outcome Measures: Spexin was measured using a specific enzyme-linked immunosorbent assay. Leptin, total and high-molecular-weight adiponectin, IL-6, high-sensitivity C-reactive protein, glucose, and insulin were also measured. Mann-Whitney U test, Pearson and Spearman rank correlations, logistic regression, and cluster analysis were used for the analysis and interpretation of the data. Results: Spexin levels were significantly lower in obese vs normal-weight children, median(IQR) (0.33 ng/mL [0.27-0.44] vs 0.42 ng/mL [0.33-0.55]; P <.024), but did not correlate with other adipokines and/or insulin and glucose levels. Ordinal categorical variables of Spexin showed a strictly reverse association of obesity with the level of Spexin. Cluster analysis of Spexin and body mass index z score resulted in splitting the participants into normal-weight and obese-weight groups with high accuracy. Conclusions: Lower circulating levels of Spexin in obese children compared with their normalweight counterparts and the ability to discriminate obese and normal-weight groups based on Spexin concentration enabled us to suggest a potential role for this novel peptide in childhood obesity. The clinical significance of these findings needs additional investigation. © 2016 by the Endocrine Society. Source

Mills T.,Northeastern University | Mills T.,University of Alberta | Bunnell H.T.,Nemours Biomedical Research | Patel R.,Northeastern University
AAC: Augmentative and Alternative Communication

Text-to-speech options on augmentative and alternative communication (AAC) devices are limited. Often, several individuals in a group setting use the same synthetic voice. This lack of customization may limit technology adoption and social integration. This paper describes our efforts to generate personalized synthesis for users with profoundly limited speech motor control. Existing voice banking and voice conversion techniques rely on recordings of clearly articulated speech from the target talker, which cannot be obtained from this population. Our VocaliD approach extracts prosodic properties from the target talker's source function and applies these features to a surrogate talker's database, generating a synthetic voice with the vocal identity of the target talker and the clarity of the surrogate talker. Promising intelligibility results suggest areas of further development for improved personalization. © 2014 International Society for Augmentative and Alternative Communication. Source

Merianda T.T.,Drexel University | Vuppalanchi D.,Indiana University | Yoo S.,Nemours Biomedical Research | Blesch A.,University of Heidelberg | And 2 more authors.
Journal of Cell Science

Many neuronal mRNAs are transported from cell bodies into axons and dendrites. Localized translation of the mRNAs brings autonomy to these processes that can be vast distances from the cell body. For axons, these translational responses have been linked to growth and injury signaling, but there has been little information about local function of individual axonally synthesized proteins. In the present study, we show that axonal injury increases levels of the mRNA encoding neural membrane protein 35 (NMP35) in axons, with a commensurate decrease in the cell body levels of NMP35 mRNA. The 3' untranslated region (3'UTR) of NMP35 is responsible for this localization into axons. Previous studies have shown that NMP35 protein supports cell survival by inhibiting Fas-ligand-mediated apoptosis; however, these investigations did not distinguish functions of the locally generated NMP35 protein. Using axonally targeted versus cell-body-restricted NMP35 constructs, we show that NMP35 supports axonal growth, and overexpression of an axonally targeted NMP35 mRNA is sufficient to increase axonal outgrowth. © 2013. Source

Muthukumar P.K.,Carnegie Mellon University | Black A.W.,Carnegie Mellon University | Bunnell H.T.,Nemours Biomedical Research
Proceedings of the Annual Conference of the International Speech Communication Association, INTERSPEECH

Every parametric speech synthesizer requires a good excitation model to produce speech that sounds natural. In this paper, we describe efforts toward building one such model using the Liljencrants-Fant (LF) model. We used the Iterative Adaptive Inverse Filtering technique to derive an initial estimate of the glottal flow derivative (GFD). Candidate pitch periods in the estimated GFD were then located and LF model parameters estimated using a gradient descent optimization algorithm. Residual energy in the GFD, after subtracting the fitted LF signal, was then modeled by a 4-term LPC model plus energy term to extend the excitation model and account for source information not captured by the LF model. The ClusterGen speech synthesizer was then trained to predict these excitation parameters from text so that the excitation model could be used for speech synthesis. ClusterGen excitation predictions were further used to reinitialize the excitation fitting process and iteratively improve the fit by including modeled voicing and segmental influences on the LF parameters. The results of all of these methods have been confirmed both using listening tests and objective metrics. Copyright © 2013 ISCA. Source

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