Evanston, IL, United States
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Chen E.,Northwestern University | Shalowitz M.U.,NorthShore University Health Systems | Story R.E.,NorthShore University Health Systems | Ehrlich K.B.,Northwestern University | And 4 more authors.
Journal of Allergy and Clinical Immunology | Year: 2017

Background: Previous literature documents associations between low socioeconomic status (SES) and poor health outcomes, including asthma. However, this literature has largely focused on the effects of current family circumstances. Objective: We sought to test an intergenerational hypothesis, that the childhood SES that parents experience will be associated with asthma outcomes in their children, independent of effects of current family SES. Second, we aimed to test whether this association is in part due to difficulties in current parent-child relationships. Methods: This was an observational study, whereby 150 parents were interviewed about their childhood SES and their children (physician-diagnosed asthma, ages 9-17 years) were interviewed about current family stress. Asthma control was assessed by parent report and child report (primary outcome), and blood was collected from children to measure cytokine production relevant to asthma (secondary outcomes). Results: To the degree that parents had lower childhood SES, their offspring showed worse asthma outcomes across multiple indicators. This included lower asthma control scores (parent and child report, Ps < .05), and greater stimulated production of TH2 and TH1 cytokines by PBMCs (Ps < .05). These associations were independent of current family SES. Mediation analyses were consistent with a scenario wherein parents with low childhood SES had current family relationships that were more stressful, and these difficulties, in turn, related to worse asthma control and greater cytokine production in children. Conclusions: These results suggest the potential "long reach" of low SES across generations, and the importance of expanding theories of how the social environment can affect childhood asthma to include characteristics of earlier generations. © 2017 American Academy of Allergy, Asthma & Immunology.


Dubord P.J.,University of British Columbia | MacSai M.S.,University of Chicago | MacSai M.S.,NorthShore University Health Systems | Mannis M.J.,University of California at Davis | And 4 more authors.
Cornea | Year: 2013

PURPOSE: Evidence of the transmission of disease via donor ocular tissue has been demonstrated for adenocarcincoma, rabies, hepatitis B virus, cytomegalovirus, herpes simplex virus, Creutzfeldt-Jakob disease, and a variety of bacterial and fungal infections. METHODS: Although there is no evidence to date of disease transmission for HIV infection, syphilis, hepatitis C, hepatitis A, tuberculosis, HTLV-1 and -2 infection, active leprosy, active typhoid, smallpox, and active malaria, these entities remain contraindications for transplantation for all eye banks nationally and internationally. The potential sources of contamination include infected donors, during the process of removing tissue from cadaveric donors, the processing environment, and contaminated supplies and reagents used during processing. The transmissions of Herpes simplex virus and HSV via corneal graft have been shown to be responsible for primary graft failure. HSV-1 may also be an important cause of PFG. RESULTS: The long latency period of some diseases, the emergence of new infectious disease, and the reemergence of others emphasize the need for long-term record maintenance and effective tracing capabilities. CONCLUSIONS: The standardization of definitions for adverse events and reactions will be necessary to support the prevention and transmission of disease. International classification of a unique identification system for donors will be increasingly important for vigilance and traceability in cross-national exportation of human cells, tissues, and cellular- and tissue-based products. Opportunities for continuous improvement exist as does the need for constant vigilance and surveillance. Copyright © 2013 by Lippincott Williams & Wilkins.


Hong O.,University of California at San Francisco | Fiola L.A.,University of California at San Francisco | Feld J.,NorthShore University Health Systems
Workplace Health and Safety | Year: 2013

Noise-induced hearing loss (NIHL) is a significant occupational health problem in the United States, affecting more than 1 million firefighters. Noise hazards include vehicles, sirens, and power tools. Additionally, firefighters are commonly exposed to ototoxic chemicals. Because the use of hearing protection is not universally required for firefighters, firefighters must be educated about NIHL to ensure they take personal responsibility for hearing loss prevention. This study discusses challenges associated with recruiting firefighters to participate in a randomized, controlled trial testing a web-based hearing protection training program. Successful recruitment strategies included collaboration with key stakeholders, a flexible and convenient computer-based intervention, expansion to multiple recruitment sites, and interactive outreach to potential participants. Future research should use quantitative methods to evaluate and compare the effectiveness of specific recruitment strategies to facilitate firefighter enrollment in research studies. Developing and testing effective hearing protection interventions for firefighters is a crucial first step toward preventing NIHL in this population. Copyright © 2013 American Association of Occupational Health Nurses, Inc.


Drobyshevsky A.,NorthShore University Health Systems | Derrick M.,NorthShore University Health Systems | Luo K.,NorthShore University Health Systems | Zhang L.-Q.,Northwestern University | And 4 more authors.
Stroke | Year: 2012

BACKGROUND AND PURPOSE-: The pattern of antenatal brain injury varies with gestational age at the time of insult. Deep brain nuclei are often injured at older gestational ages. Having previously shown postnatal hypertonia after preterm fetal rabbit hypoxia-ischemia, the objective of this study was to investigate the causal relationship between the dynamic regional pattern of brain injury on MRI and the evolution of muscle tone in the near-term rabbit fetus. METHODS-: Serial MRI was performed on New Zealand white rabbit fetuses to determine equipotency of fetal hypoxia-ischemia during uterine ischemia comparing 29 days gestation (E29, 92% gestation) with E22 and E25. E29 postnatal kits at 4, 24, and 72 hours after hypoxia-ischemia underwent T2- and diffusion-weighted imaging. Quantitative assessments of tone were made serially using a torque apparatus in addition to clinical assessments. RESULTS-: Based on the brain apparent diffusion coefficient, 32 minutes of uterine ischemia was selected for E29 fetuses. At E30, 58% of the survivors manifested hind limb hypotonia. By E32, 71% of the hypotonic kits developed dystonic hypertonia. Marked and persistent apparent diffusion coefficient reduction in the basal ganglia, thalamus, and brain stem was predictive of these motor deficits. CONCLUSIONS-: MRI observation of deep brain injury 6 to 24 hours after near-term hypoxia-ischemia predicts dystonic hypertonia postnatally. Torque-displacement measurements indicate that motor deficits in rabbits progressed from initial hypotonia to hypertonia, similar to human cerebral palsy, but in a compressed timeframe. The presence of deep brain injury and quantitative shift from hypo- to hypertonia may identify patients at risk for developing cerebral palsy. © 2012 American Heart Association, Inc.


Garfield C.F.,Northwestern University | Isacco A.,Chatham University | Bartlo W.D.,NorthShore University Health Systems
International Journal of Men's Health | Year: 2010

A sample of U.S. urban fathers was studied using in-depth qualitative interviews to better understand how having children might influence the fathers' health and health behaviors. Over three-quarters of the men reported positive changes to their health behaviors since becoming fathers. The specific examples cited as positive changes by fathers included; positive changes in diet, increased frequency of exercise and physical activity, taking better care of themselves in general, decreased alcohol use, and less risk-taking behavior. A key shift is also identified in men's perspectives around the transition to fatherhood. Recommendations are provided to clinicians who seek to design interventions that reengage men in the health care system and caring for their health. © 2010 by the Men's Studies Press, LLC. All rights reserved.


Dunlap B.J.,NorthShore University Health Systems | Ferkel R.D.,Southern California Orthopedic Institute | Applegate G.R.,Pacific Advanced Radiology
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose The purpose of this study was to assess a series of lateral inverted osteochondral fractures of the talus. Methods Over a 17-year period, 10 patients with an acute lateral inverted osteochondral fracture of the talus after an inversion injury to the ankle were identified. Diagnosis was made by physical examination, radiographs, magnetic resonance imaging, and/or computed tomography scan. Arthroscopy was initially performed on all patients. All patients had an inverted osteochondral fragment. In 8 of 10 patients the fragment was reattached in an open manner in conjunction with lateral ligament reefing. The fragment was excised in 2 patients. The mean age of the patients was 17.2 years. They were evaluated with the Single Assessment Numeric Evaluation, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, modified Weber score, Berndt and Harty score, and Short Form 36 version 2 score. Physical and radiographic examination was also performed. The mean time to follow-up was 112.3 months (9.3 years). Results The mean American Orthopaedic Foot and Ankle Society score improved from 18.9 preoperatively to 86.9 postoperatively (P ≤.0001). The mean Single Assessment Numeric Evaluation and modified Weber scores were 81.6 and 81.5, respectively. On the Berndt and Harty scale, 6 patients had a good to excellent rating; 3, fair; and 1, poor. The mean Short Form 36 version 2 scores corresponded to national averages for healthy populations. Mean loss of motion for dorsiflexion and plantarflexion was 6.8 and 3.0, respectively, when compared with the contralateral side. All patients showed some osteophyte formation on follow-up radiographs. Conclusions An inverted osteochondral fracture of the lateral talus (lateral, inverted, fracture, talus [LIFT lesion]) can occur after a twisting injury to the ankle. Clinical suspicion should be high, especially in the younger athlete. This injury can be successfully managed with a combined arthroscopic and open approach. Level of Evidence Level IV, therapeutic case series. © 2013 The Arthroscopy Association of North America. Published by Elsevier Inc. All Rights Reserved.


Yin S.,Childrens Memorial Hospital | Wahl M.,University of Illinois at Chicago | Wahl M.,Northshore University Health Systems | Wahl M.,University of Chicago
American Journal of Drug and Alcohol Abuse | Year: 2011

Objectives: We sought to describe the demographics and trends of Coricidin product abuse in children in Illinois and to calculate an approximate total charge to the health-care system. Methods: In this retrospective database review, we identified 652 cases of intentional exposure to Coricidin products among children <18 years old in the Illinois Poison Center database from 2001 to 2006. Demographic, historical, clinical, and outcome data were recorded. Results: The mean (standard deviation) age was 15.7 (1.58) years. A significant increase in exposures occurred during the study period which showed a cyclic nature with peaks in the fall months. Of the patients with disposition data available, 28.6% were admitted to a critical care unit, 15.2% to a noncritical care hospital unit, 6.3% were admitted for inpatient psychiatric care, and 46.4% were evaluated in the emergency department and discharged home. Moderate or major outcomes were reported in 42.7% of cases in which data were available. No deaths were reported. The total approximate hospital charge was $2,119,881.90 or $353,313.65/year. Conclusions: Intentional abuse of Coricidin products reported to the poison center occurred primarily among adolescents and was often associated with significant short-term clinical effects and a clear financial burden to the health-care system. Scientific Significance: This investigation demonstrates that Coricidin product abuse continues to be a problem particularly among adolescents. Parents and clinicians need to continue to be aware of these substances as drugs of abuse and curbing sales to adolescents should be considered. © 2011 Informa Healthcare USA, Inc.


Malik R.D.,University of Chicago | Wang C.E.,NorthShore University Health Systems | Lapin B.,NorthShore University Health Systems | Gerber G.S.,University of Chicago | Helfand B.T.,NorthShore University Health Systems
Prostate Cancer and Prostatic Diseases | Year: 2015

BACKGROUND: The introduction of laser therapies for the management of bladder outlet obstruction in men with BPH has challenged the gold standard treatment, TURP. We sought to compare the changing clinical characteristics of patients undergoing TURP and laser vaporization of the prostate (LVP) over time. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for men who underwent TURP and LVP from 2007 to 2012. Patient demographics, clinical and intraoperative characteristics and 30-day postoperative outcomes were analyzed. RESULTS: In all, 12 645 men met inclusion criteria, of whom 65% underwent TURP and 35% underwent LVP. Overall, men undergoing TURP were more likely to be scheduled as an emergency (3% vs 1%, P < 0.001), have shorter operative times (53 vs 56 min, P < 0.001), longer hospital stays (2.4 vs 1.0 days, P < 0.001), more frequent blood transfusions (2.1% vs 0.6%, P < 0.001) and more postoperative complications including: pneumonia (0.5% vs 0.3%, P = 0.02), septic shock (0.3% vs 0.1%, P = 0.045), and reoperation within 30 days (2.2% vs 1.4%, P = 0.06). However, between 2007 and 2012, there was a significant trend for men undergoing TURP to have increased functional independence (93-96%, P < 0.01) and American Society of Anesthesiology (ASA) Physical Class I categorization (0.6-5.1%, P < 0.001). In contrast, over the same time period, there was a trend for men undergoing LVP to be significantly older (71-73 years, P < 0.001) and have an increased hospital stay (0.50 days to 1.30 days, P = 0.03). CONCLUSIONS: Statistically significant differences in clinical characteristics of patients undergoing TURP and LVP have historically existed. However, since 2007, the characteristics of patients undergoing LVP and TURP have changed significantly. Further studies are required to compare these patient characteristics with specific urologic variables and to evaluate clinically significant changes in these cohorts. © 2015 Macmillan Publishers Limited All rights reserved.


Radosevich A.J.,Northwestern University | Rogers J.D.,Northwestern University | Turzhitsky V.,Northwestern University | Mutyal N.N.,Northwestern University | And 6 more authors.
IEEE Journal on Selected Topics in Quantum Electronics | Year: 2012

Since the early 1980s, the enhanced backscattering (EBS) phenomenon has been well-studied in a large variety of nonbiological materials. Yet, until recently, the use of conventional EBS for the characterization of biological tissue has been fairly limited. In this study, we detail the unique ability of EBS to provide spectroscopic, polarimetric, and depth-resolved characterization of biological tissue using a simple backscattering instrument. We first explain the experimental and numerical procedures used to accurately measure and model the full azimuthal EBS peak shape in biological tissue. Next, we explore the peak shape and height dependencies for different polarization channels and spatial coherence of illumination. We then illustrate the extraordinary sensitivity of EBS to the shape of the scattering phase function using suspensions of latex microspheres. Finally, we apply EBS to biological tissue samples in order to measure optical properties and observe the spatial length scales at which backscattering is altered in early colon carcinogenesis. © 1995-2012 IEEE.


Grant
Agency: Department of Health and Human Services | Branch: | Program: STTR | Phase: Phase II | Award Amount: 1.51M | Year: 2013

DESCRIPTION (provided by applicant): The clinical impact of the 5 million annual surveillance colonoscopies (follow up of previous neoplasia) is remarkably low (gt90% without significant neoplasia). Juxtaposed with this is the alarmingly frequent occurrence of colorectal cancers (CRCs) in between colonoscopies (interval cancers), especially in the proximal colon. The medico-legal and clinical consequences of interval CRCs lead to vast overuse of surveillance colonoscopy engendering unnecessary cost, complications etc. Fecal tests represent an attractive potential adjunct although the typical tests (occult blood, DNA, methylation) have a poor (~10-40%) sensitivity for advanced adenomas, the target of CRC prevention efforts. Our multidisciplinary CRC prevention group has developed a mucus layer fecal colonocyte biophotonics test that allows detection of both field carcinogenesis along with the less abundant tumor products. We have employed our ultrasensitive novel technology, partial wave spectroscopic microscopy (PWS). PWS allows, for the first time, a practical modality to quantify nanoscale architectural colonic epithelial alterations in preclinica models (PNAS, 2008). We have demonstrated that colonocyte PWS analysis has a ~90% accuracy of identifying individuals for colonic advanced adenomas throughout the colon (n=141) (Gastro, 2011). In order for Nanocytomics to commercialize fecal PWS for tailoring colonoscopic screening intervals, we propose to develop a high throughput instrument (phase 1) with milestones of accuracy and speed (lt10 minutes per patient). Phase 2 will involve clinical trials in two common scenarios: 1. Determine whether a patient scheduled for colonoscopy can be safely postponed (n=200 training and 200 testing set) 2. Investigate whether a patient needs to have an expedited colonoscopy (n=250). These will be compared to conventional fecal tests (immunohistochemical and DNA). These studies will be instrumental to bridge the power of PWS to the clinical application off colonoscopic screening interval personalization thus representing a large and well defined commercial opportunity. Furthermore, identification of field carcinogenesis with PWS is a platform with clear applications for average risk CRC screening along with other cancers (lung,ovarian etc). PUBLIC HEALTH RELEVANCE CRCs remain the second leading cause of cancer deaths among Americans. Colonoscopy can prevent CRCs by identifying and removing precursor lesions but this often obligates serial examinations. However, follow up colonoscopies (surveillance) are vastly overused and still allow a significant number of cancers to occur. Our goal is to leverage the remarkable sensitivity of the powerful new technology, PWS to develop a highly accurate minimally intrusive fecal test that could enable personalization of the procedure intervals.

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