Clinical Decision Supports in Electronic Health Records to Promote Childhood Obesity-Related Care: Results from a 2015 Survey of Healthcare Providers

( Megan R. Harrison ),( Elizabeth A. Lundeen ),( Brook Belay ),( Alyson B. Goodman ) 한국임상영양학회 2019 Clinical Nutrition Research Vol.8 No.4

Obesity-related clinical decision support tools in electronic health records (EHRs) can improve pediatric care, but the degree of adoption of these tools is unknown. DocStyles 2015 survey data from US pediatric healthcare providers (n = 1,156) were analyzed. Multivariable logistic regression identified provider characteristics associated with three EHR functionalities: automatically calculating body mass index (BMI) percentile (AUTO), displaying BMI trajectory (DISPLAY), and flagging abnormal BMIs (FLAG). Most providers had EHRs (88%). Of those with EHRs, 90% reporting having AUTO, 62% DISPLAY, and 54% FLAG functionalities. Only provider age was associated with all three functionalities. Compared to providers aged > 54 years, providers < 40 years had greater odds for: AUTO (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.58-5.70), DISPLAY (aOR, 2.07; 95% CI, 1.38-3.12), and FLAG (aOR, 1.67; 95% CI, 1.14-2.44). Future investigations can elucidate causes of lower adoption of EHR functions that display growth trajectories and flag abnormal BMIs.

Modulation of the host immune response by respiratory syncytial virus proteins

Megan E. Schmidt,Steven M. Varga 한국미생물학회 2017 The journal of microbiology Vol.55 No.3

Respiratory syncytial virus (RSV) causes severe respiratory disease in both the very young and the elderly. Nearly all individuals become infected in early childhood, and reinfec-tions with the virus are common throughout life. Despite its clinical impact, there remains no licensed RSV vaccine. RSV infection in the respiratory tract induces an inflammatory response by the host to facilitate efficient clearance of the virus. However, the host immune response also contributes to the respiratory disease observed following an RSV infec-tion. RSV has evolved several mechanisms to evade the host immune response and promote virus replication through interactions between RSV proteins and immune components. In contrast, some RSV proteins also play critical roles in ac-tivating, rather than suppressing, host immunity. In this re-view, we discuss the interactions between individual RSV pro-teins and host factors that modulate the immune response and the implications of these interactions for the course of an RSV infection.

Biosynthesis of Veratrum californicum specialty chemicals in Camelina sativa seed

Megan M. Augustin,Ashutosh K. Shukla,Courtney M. Starks,Mark O’Neil‑Johnson,Linna Han,Cynthia K. Holland,Toni M. Kutchan 한국식물생명공학회 2017 Plant biotechnology reports Vol.11 No.1

Economically feasible systems for heterologous production of complex secondary metabolites originating from difficult to cultivate species are in demand since Escherichia coli and Saccharomyces cerevisiae are not always suitable for expression of plant and animal genes. An emerging oilseed crop, Camelina sativa, has recently been engineered to produce novel oil profiles, jet fuel precursors, and small molecules of industrial interest. To establish C. sativa as a system for the production of medicinally relevant compounds, we introduced four genes from Veratrum californicum involved in steroid alkaloid biosynthesis. Together, these four genes produce verazine, the hypothesized precursor to cyclopamine, a medicinally relevant steroid alkaloid whose analogs are currently being tested for cancer therapy in clinical trials. The future supply of this potential cancer treatment is uncertain as V. californicum is slow-growing and not amendable to cultivation. Moreover, the complex stereochemistry of cyclopamine results in low-yield syntheses. Herein, we successfully engineered C. sativa to synthesize verazine, as well as other V. californicum secondary metabolites, in seed. In addition, we have clarified the stereochemistry of verazine and related V. californicum metabolites.

Transitional and Developmental Challenges for Chinese Social Policy

Megan Blaxland, Karen Fisher and Xiaoyuan Shang 한국사회복지학회 2015 Asian Social Work and Policy Review Vol.9 No.1

This special issue explores the social policy challenges faced by China as it navigates a period of rapid social and economic change. While China has benefited from significant growth and new wealth in recent years, there are many sections of Chinese society that continue to live in poverty. The authors in this special issue provide thoughtful and creative responses to difficult policy questions with the aim of reducing poverty and expanding and improving social and community services.

Demographics of dogs and cats with oral tumors presenting to teaching hospitals: 1996–2017

Megan Cray,Laura E. Selmic,Audrey Ruple 대한수의학회 2020 Journal of Veterinary Science Vol.21 No.5

Background: Oral neoplasia has been reported to account for 6–7% of all canine cancer and 3% of all feline cancers. To the authors' knowledge the last epidemiologic analysis of general oral cancer in dogs and cats was published in 1976. Objectives: The goal of this study was to report contemporary demographic information regarding oral tumors in dogs and cats. Methods: Information was collected from cats or dogs diagnosed with oral neoplasia from the Veterinary Medical Data Base. Medical records representing cases that presented to one of 26 veterinary teaching hospitals from January 1, 1996 through December 31, 2017 were included. Results: A total of 1,810 dogs and 443 cats were identified. A total of 962 cases (53.6%) of canine oral tumors were classified as malignant and 455 cases as benign (25.4%). The majority of feline oral tumors were classified as malignant (257 cases, 58.1%) and only a few benign (11 cases, 2.5%). The incidence of oral tumors was calculated to be 4.9 per 1,000 dogs (0.5%) and 4.9 per 1,000 cats (0.5%). Conclusions: This incidence of oral tumors is considerably higher than previously reported in both dogs and cats. These results provide valuable information for generation of hypotheses for future investigations of breed-based and pathology-based oral neoplastic studies.

A preliminary investigation of differences in acoustic startle responses between school-age children who do and do not stutter

Megan Kate Selman,Brent Andrew Gregg 한국언어재활사협회 2020 Clinical Archives of Communication Disorders Vol.5 No.2

Purpose: It is theorized that stuttering emerges as the result of an interaction between constitutional and environmental factors and that constitutional factors in persistent stuttering may include an emotionally-reactive temperament. The purpose of this pilot study is to examine the reactive/“sensitive” temperament characteristic of children who stutter relative to children who do not stutter, as evidenced by the acoustic startle response and scores on the following subscales of a temperament measure: anger/frustration, fear, inhibitory control, and shyness. Methods: Twenty seven school-age children participated in this study. There were thirteen children who stutter (CWS) and fourteen normally-fluent children. Participants were between the ages of 8:0 and 14:0. Each child participated in an acoustic startle response task, and caregivers completed a standardized temperament/personality assessment on their child. Results: Results indicated that CWS do not demonstrate statistically significant higher levels of physiological reactivity, as measured by mean normalized RMS amplitude of startle response scores, compared to their fluent peers. Further, there was no statistically significant correlation between subscale scores on standardized temperament/personality assessments. Conclusions: Improving on methodologies of past studies, the present investigation employed epidemiologically-sound groups, as well as clearly-delineated and replicable EMG procedures, normalization of EMG data, and neurophysiological measures of temperament combined with caregiver temperament questionnaire. Findings are in contradiction to several studies that have reported higher levels of trait anxiety or “nervousness” in adults who stutter.

INSTABILITY OF THE BETTI SEQUENCE FOR PERSISTENT HOMOLOGY AND A STABILIZED VERSION OF THE BETTI SEQUENCE

MEGAN JOHNSON,JUNG JAE HUN(정재훈) 한국산업응용수학회 2021 Journal of the Korean Society for Industrial and A Vol.25 No.4

Topological Data Analysis (TDA), a relatively new field of data analysis, has proved very useful in a variety of applications. The main persistence tool from TDA is persis- tent homology in which data structure is examined at many scales. Representations of persis- tent homology include persistence barcodes and persistence diagrams, both of which are not straightforward to reconcile with traditional machine learning algorithms as they are sets of intervals or multisets. The problem of faithfully representing barcodes and persistent diagrams has been pursued along two main avenues: kernel methods and vectorizations. One vectoriza- tion is the Betti sequence, or Betti curve, derived from the persistence barcode. While the Betti sequence has been used in classification problems in various applications, to our knowledge, the stability of the sequence has never before been discussed. In this paper we show that the Betti sequence is unstable under the 1-Wasserstein metric with regards to small perturbations in the barcode from which it is calculated. In addition, we propose a novel stabilized version of the Betti sequence based on the Gaussian smoothing seen in the Stable Persistence Bag of Words for persistent homology. We then introduce the normalized cumulative Betti sequence and provide numerical examples that support the main statement of the paper.

The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature

Megan Fracol,Robert Dorfman,Lindsay Janes,Swati Kulkarni,Kevin Bethke,Nora Hansen,John Kim 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.6

We report a case of a 51 years old female with a 25 pack year smoking history who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed right breast cancer. The patient reported herself as a non-smoker despite significant e-cigarette use, with resulting significant mastectomy skin flap necrosis and breast reconstruction failure. Little is known about the physiologic effect of e-cigarettes on wound healing and tissue perfusion. To this end, we provide an updated review of the impact of e-cigarettes on surgical outcomes. PubMed, Ovid MEDLINE, and PRS GO were searched for the terms “e-cigarette”, “electronic cigarette”, “e-cig”, “electronic nicotine delivery system”, “vaping”, “surgery”, “surgical”, “peri-operative”, “operate”, “operative”, and “wound healing”. Abstract review of all articles was performed. 123 articles returned that contained both variants of e-cigarettes and surgery as keywords. Of those, manual assessment returned three articles which were found to be relevant to e-cigarette use in the surgical patient. No articles were found that compared perioperative complications in e-cigarette versus traditional cigarette users in humans. In conclusion, our case report depicts the potential dangers associated with e-cigarette use in the surgical patient. There is a public misconception that e-cigarettes are healthier than traditional cigarettes and as such their use may go unreported by patients. Early evidence suggests e-cigarettes may induce some of the same physiologic changes as traditional cigarettes, and may have a significant deleterious effect on wound healing.

Regulation of Osteoblast Metabolism by Wnt Signaling

Megan C. Moorer,Ryan C. Riddle 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.3

Wnt/β-catenin signaling plays a critical role in the achievement of peak bone mass, affecting the commitment of mesenchymal progenitorsto the osteoblast lineage and the anabolic capacity of osteoblasts depositing bone matrix. Recent studies suggest that thisevolutionarily-conserved, developmental pathway exerts its anabolic effects in part by coordinating osteoblast activity with intermediarymetabolism. These findings are compatible with the cloning of the gene encoding the low-density lipoprotein related receptor-5(LRP5) Wnt co-receptor from a diabetes-susceptibility locus and the now well-established linkage between Wnt signaling and metabolism. In this article, we provide an overview of the role of Wnt signaling in whole-body metabolism and review the literature regardingthe impact of Wnt signaling on the osteoblast’s utilization of three different energy sources: fatty acids, glucose, and glutamine. Special attention is devoted to the net effect of nutrient utilization and the mode of regulation by Wnt signaling. Mechanisticstudies indicate that the utilization of each substrate is governed by a unique mechanism of control with β-catenin-dependent signalingregulating fatty acid β-oxidation, while glucose and glutamine utilization are β-catenin-independent and downstream of mammaliantarget of rapamycin complex 2 (mTORC2) and mammalian target of rapamycin complex 1 (mTORC1) activation, respectively. The emergence of these data has provided a new context for the mechanisms by which Wnt signaling influences bone development.

The Perceptions and Effects of Sleep Deprivation in a Department of Anesthesiology

Megan Sanders,Helen Perrie,Juan Scribante, 대한수면학회 2018 sleep medicine research Vol.9 No.1

Background and ObjectiveaaSleep deprivation has multiple pathophysiological, psychological and cognitive effects. The effects of sleep deprivation on anesthetists have been recognized both within and outside of the workplace. This study investigated the perceived effects of sleep deprivation on anesthetists. To document the longest time spent without sleep due to work schedule, to describe the perceptions of the effects of sleep deprivation and the degree of sleepiness and daytime fatigue symptoms using the Epworth Sleepiness Scale (ESS) and to describe measures taken by anesthetists to overcome sleepiness. MethodsaaA prospective, contextual, descriptive research design was followed for the study. A convenience sample of anesthetists completed a questionnaire regarding perceptions and effects of sleep deprivation and the ESS. Data were descriptively analyzed. ResultsaaThe mean [standard deviation (SD)] longest time spent without sleep due to work schedule was 31 (9.1) hours and all anesthetists felt that they had insufficient sleep due to work schedule, with 61 (57%) stating this occurred 1 to 2 nights per week. Effects of sleep deprivation included effects on academic development, feeling tired at work, difficulty in concentrating at work and feeling stressed or irritable. Dozing off in theatre both during a night call and a day shift at different frequencies were reported. Other effects on family and social life were described. The mean (SD) ESS score was 11.5 (4.4). ConclusionsaaAnesthetists reported perceptions of inadequate sleep and the subsequent effects both at work and at home. Further research to determine the extent of sleep deprivation amongst anesthetists in South Africa is suggested.