The Childrens Mercy Hospitals And Clinics

Kansas City, MO, United States

The Childrens Mercy Hospitals And Clinics

Kansas City, MO, United States
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Barnes C.S.,Childrens Mercy Hospital | Barnes C.S.,The Childrens Mercy Hospitals and Clinics | Horner W.E.,UL Environment | Kennedy K.,Childrens Mercy Hospital | And 8 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2016

Awareness of the relationship of fungi to asthma in indoor air is very old and well documented. There is substantial evidence that mold and dampness exacerbate asthma in sensitized individuals. Many governmental and nongovernmental organizations around the world have issued guidelines to the effect that the elimination of moisture intrusion and the removal of moldy items from living space can improve respiratory health. The process of home assessment for moisture and mold presence is discussed along with factors that can be used to guide fungal exposure reduction efforts. An approach to the assessment process itself is outlined, and common causes of moisture and mold damage are described. Points that should be included in a report resulting from a home assessment and rudimentary elements of report interpretation are discussed. Emphasis is that interpretation of sampling for moisture and fungal presence should be provided by the person performing the assessment. We conclude that multifaceted remediation contributes to fungal allergen avoidance. The use of an indoor environmental professional to generate evaluation reports and remediation activities can be a valuable contribution to an overall allergen avoidance strategy. © 2016 American Academy of Allergy, Asthma & Immunology.


Zheng X.,Northwestern University | Lee S.,Northwestern University | Selvarangan R.,The Childrens Mercy Hospitals And Clinics | Qin X.,Seattle Childrens Hospital | And 9 more authors.
Emerging Infectious Diseases | Year: 2015

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is highly prevalent in Asia and is now being reported from Europe. Few data on MRMP are available in the United States. Using genotypic and phenotypic methods, we detected high-level MRMP in 13.2% of 91 M. pneumoniae–positive specimens from 6 US locations. © 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.


Williams P.B.,Childrens Mercy Hospital | Williams P.B.,University of Missouri - Kansas City | Barnes C.S.,Childrens Mercy Hospital | Barnes C.S.,The Childrens Mercy Hospitals and Clinics | And 11 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2016

Exposure to fungi and their products is practically ubiquitous, yet most of this is of little consequence to most healthy individuals. This is because there are a number of elaborate mechanisms to deal with these exposures. Most of these mechanisms are designed to recognize and neutralize such exposures. However, in understanding these mechanisms it has become clear that many of them overlap with our ability to respond to disruptions in tissue function caused by trauma or deterioration. These responses involve the innate and adaptive immune systems usually through the activation of nuclear factor kappa B and the production of cytokines that are considered inflammatory accompanied by other factors that can moderate these reactivities. Depending on different genetic backgrounds and the extent of activation of these mechanisms, various pathologies with resulting symptoms can ensue. Complicating this is the fact that these mechanisms can bias toward type 2 innate and adaptive immune responses. Thus, to understand what we refer to as allergens from fungal sources, we must first understand how they influence these innate mechanisms. In doing so it has become clear that many of the proteins that are described as fungal allergens are essentially homologues of our own proteins that signal or cause tissue disruptions. © 2016 American Academy of Allergy, Asthma & Immunology.


Baxi S.N.,Boston Childrens Hospital | Portnoy J.M.,Childrens Mercy Hospital | Portnoy J.M.,University of Missouri - Kansas City | Larenas-Linnemann D.,Hospital Medica Sur | And 10 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2016

Fungi are ubiquitous microorganisms that are present in outdoor and indoor environments. Previous research has found relationships between environmental fungal exposures and human health effects. We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma. These are important issues because they provide a rationale for interventions that might be considered for homes and buildings in which there is increased fungal exposure. In addition to rhinitis and asthma, fungus exposure is associated with a number of other illnesses including allergic bronchopulmonary mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis. Additional research is necessary to establish causality and evaluate interventions for fungal- and dampness-related health effects. © 2016 American Academy of Allergy, Asthma & Immunology.


Platt A.M.,The Childrens Mercy Hospitals and Clinics | Egan A.M.,University of Missouri - Kansas City | Berquist M.J.,The Childrens Mercy Hospitals and Clinics | Dreyer M.L.,University of Missouri - Kansas City | And 2 more authors.
Journal of Pediatric Health Care | Year: 2013

Introduction: The purpose of this study was to examine the incidence and severity of depression and health-related quality of life (HRQoL) in youth with insulin resistance (IR) who are overweight/obese and to examine the impact on making lifestyle changes. Method: New patients presenting for treatment in an IR clinic were screened for depression and HRQoL and reassessed twice during a 1-year treatment period. Metabolic and growth parameters were obtained for each participant. Results: Elevated symptoms of depression were reported in 51% of the sample, and these symptoms were stable over time. Approximately 10% of these youth reported moderate or severe symptoms of depression. HRQoL scores indicated a good quality of life overall with slight improvement in some areas over time. Depression scores were not associated with demographic variables or metabolic parameters. Discussion: More than 50% of adolescents with IR and obesity reported elevated symptoms of depression. These results provide sufficient evidence for the need to conduct routine screening of depression for all youth with IR so that appropriate mental health referrals can be made. © 2013 National Association of Pediatric Nurse Practitioners.


Hughes S.S.,The Childrens Mercy Hospitals and Clinics | Welsh H.I.,The Childrens Mercy Hospitals and Clinics | Safina N.P.,The Childrens Mercy Hospitals and Clinics | Bejaoui K.,Prevention Genetics | Ardinger H.H.,The Childrens Mercy Hospitals and Clinics
American Journal of Medical Genetics, Part A | Year: 2014

CHARGE syndrome is an autosomal dominant malformation syndrome associated with mutations in CHD7. The condition is typically sporadic with few familial cases reported. The diagnosis of CHARGE syndrome is based on a combination of major and minor criteria comprised of structural and functional abnormalities, most of which are part of the original CHARGE acronym, although additional anomalies have been added. To date, family history has not been considered in the diagnostic criteria. Here we report a family with a previously unreported missense mutation in exon 31 of CHD7, in which family history played a role in the diagnosis of CHARGE syndrome. Given the tremendous phenotypic variability and the dominant nature of CHARGE syndrome, we propose that family history be included as a major diagnostic criterion. A positive family history would include any individual with an apparently isolated unilateral major CHARGE anomaly or someone with a few of the minor features. Our cases support this proposal; had family history not been considered in this case, CHD7 testing might not have been pursued, leading to incomplete medical follow-up and erroneous genetic counseling. Additionally, with the increased incidence of orofacial clefting in this family, as well as in the literature, we suggest that cleft lip and/or palate be added to the major diagnostic criteria for CHARGE syndrome. © 2013 Wiley Periodicals, Inc.


Rinaldi R.,The Childrens Mercy Hospitals and Clinics | Patel A.,Kansas City Bone and Joint
PM and R | Year: 2013

The large degree of clinical heterogeneity within each of the major categories of inherited neuropathies can lead to difficulties in making correct diagnoses based on clinical findings alone. The observation of key clinical findings coupled with electrophysiological findings and understanding of inheritance patterns, should allow the clinician to make judicious use of genetic testing to confirm the clinical diagnosis. An understanding of the clinical and electrophysiological nature of these disorders, as well as an understanding of how to clinically distinguish the inherited conditions from acquired conditions, is imperative to this process. © 2013 by the American Academy of Physical Medicine and Rehabilitation.


O'Brien Jr. J.E.,The Childrens Mercy Hospitals and Clinics | Marshall J.A.,The Childrens Mercy Hospitals and Clinics | Young A.R.,The Childrens Mercy Hospitals and Clinics | Handley K.M.,The Childrens Mercy Hospitals and Clinics | Lofland G.K.,The Childrens Mercy Hospitals and Clinics
Annals of Thoracic Surgery | Year: 2010

Background: There are limited data available on the outcomes of single-ventricle patients who have undergone a nonfenestrated extracardiac Fontan procedure. This study examined the clinical experience of a large cohort of patients from a single institution who received this procedure. Methods: A retrospective data set of 145 patients who underwent a nonfenestrated extracardiac Fontan procedure from July 1997 to September 2008 was reviewed. Results: The hospital survival was 94.5%. Takedown of the Fontan conduit was necessary in 4 patients (2.8%), and 3 of these 4 patients were also operative deaths. Although female sex (p = 0.048), cardiopulmonary bypass time (p = 0.002), and aortic cross-clamp time (p = 0.007) were found to be significant in the univariate analysis, only sex (p = 0.035; odds ratio, 3.869; 95% confidence limits, 1.097 to 13.644) and cardiopulmonary bypass time in minutes (p = 0.001; odds ratio, 1.023; 95% confidence limits, 1.009 to 1.037) were found to be significant in the multivariate analysis for hospital survival. The late survival was 95.6% (131 of 137 patients) with a mean follow-up of 3.3 years (range, 0.0 to 10.8 years). The freedom from Fontan failure was 92% at 1 year, 89% at 5 years, and 82% at 10 years. Stepwise logistic regression found cardiopulmonary bypass time (p = 0.003; odds ratio, 1.023; 95% confidence limits, 1.008 to 1.039) to be a significant risk factor for late survival. Conclusions: The nonfenestrated extracardiac Fontan procedure can be successfully used in the palliation of single-ventricle patients. © 2010 The Society of Thoracic Surgeons.


O'Brien Jr. J.E.,The Childrens Mercy Hospitals and Clinics | Marshall J.A.,The Childrens Mercy Hospitals and Clinics | Tarrants M.L.,The Childrens Mercy Hospitals and Clinics | Stroup R.E.,The Childrens Mercy Hospitals and Clinics | Lofland G.K.,The Childrens Mercy Hospitals and Clinics
Annals of Thoracic Surgery | Year: 2010

Background: Intraoperative hyperglycemia has been found to be associated with a higher incidence of postoperative infections in the adult cardiac surgery population. The goal of this study was to determine the association of intraoperative hyperglycemia and postoperative bacteremia in the pediatric population. Methods: A retrospective chart review of all cardiac surgical cases for patients 18 years of age or younger requiring cardiopulmonary bypass support between June 2002 and July 2007 yielded 1,132 total cases representing 992 unique patients. Patient demographic and clinical data of interest were collected. Descriptive statistics and regression analyses were performed to investigate the hypothesized relationship between glucose levels and infection rates. Results: From the 992 patient records examined, 15 patients exhibited a bacteremia within 14 days of surgery (1.5%). The association between the highest glucose during cardiopulmonary bypass and bacteremia reached statistical significance when the glucose level reached 175 mg/dL (χ2 = 4.59, 1 degree of freedom; p = 0.032). A patient was more than three times as likely to have a postoperative bacteremia when the glucose level reached this amount or exceeded it (odds ratio, 3.3, 95% confidence interval, 1.04 to 10.39). Ten of the 15 (66.7%) postoperative infections occurred in patients with peak bypass glucose levels of at least 175 mg/dL. Conclusions: Intraoperative hyperglycemia was found to be associated with a higher risk of postoperative bacteremia in the pediatric cardiac surgery population. © 2010 The Society of Thoracic Surgeons.


Abdel-Rahman S.M.,The Childrens Mercy Hospitals and Clinics | Ridge A.L.,The Childrens Mercy Hospitals and Clinics
Open Medical Devices Journal | Year: 2012

There exist a number of pediatric health care settings wherein time and/or resource constraints do not permit care providers to reliably assess children's weight. This study describes the development and validation of a pediatric weight estimation strategy that addresses the limitations of currently available weight estimation methods. Demographic and anthropometric data on children 2 months to 16 years of age were extracted from the National Health and Nutrition Examination Survey. Datasets were randomly assigned into a method development set (n=17,328) and a method validation set (n=1,938). Humeral length and mid-upper arm circumference were used to develop a weight estimation method. The predictive performance of this method was evaluated and compared with the performance of 13 previously published weight estimation methods. We also developed a measurement device that performs both measurements simultaneously requiring simple addition and no external references to arrive at the weight estimate. The method developed in this study (Mercy method) outperformed the 13 other published methods when evaluated by goodness-of-fit (r2=0.98 vs. 0.69 to 0.87; slope=0.97 vs. 0.43 to 0.96; intercept 0.9 vs. 3.1 to 11.8), mean error (-0.40 kg vs.-10.88 to 2.23), mean percentage error (-0.46% vs. -16.84 to 3.51), root mean square error (3.65 kg vs. 3.42 to 16.96) and percentage of children in agreement within 10% of actual weight (79% vs. 17.8 to 45.3). The Mercy method represents a significant improvement over existing age-based, length-based and habitus-based weight estimation strategies. © Abdel-Rahman and Ridge; Licensee Bentham Open.

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