Pediatrics
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Item Open Access Local Economic Inequality and the Primary Care Physician Workforce in North Carolina(2022) Tumin, Dmitry; Nenow, Joseph; Nenow, Andrew; Priest, Allison; Campbell, Kendall M.Item Open Access Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools(2020-08-03) Tumin, DmitryItem Open Access Item Open Access Decrease in heart rate following the administration of sugammadex in adults(2020-10) Tumin, DmitryItem Open Access Scholarly Productivity of Faculty in Primary Care Roles Related to Tenure Versus Non-Tenure Tracks(2020-05-29) Tumin, DmitryItem Open Access Promising insights into the health related quality of life for children with severe obesity(2013) Selewski, David T.; Collier, David N.; MacHardy, Jackie; Gross, Heather E.; Pickens, Edward M.; Cooper, Alan W.; Bullock, Selam; Earls, Marian F.; Pratt, Keeley J.; Scanlon, Kelli; McNeill, Jonathan D.; Messer, Kassandra L.; Lu, Yee; Thissen, David; DeWalt, Darren A.; Gipson, Debbie S.Background Childhood obesity is a growing health concern known to adversely affect quality of life in children and adolescents. The Patient Reported Outcomes Measurement Information System (PROMIS) pediatric measures were developed to capture child self-reports across a variety of health conditions experienced by children and adolescents. The purpose of this study is to begin the process of validation of the PROMIS pediatric measures in children and adolescents affected by obesity. Methods The pediatric PROMIS instruments were administered to 138 children and adolescents in a cross-sectional study of patient reported outcomes in children aged 8–17 years with age-adjusted body mass index (BMI) greater than the 85th percentile in a design to establish known-group validity. The children completed the depressive symptoms, anxiety, anger, peer relationships, pain interference, fatigue, upper extremity, and mobility PROMIS domains utilizing a computer interface. PROMIS domains and individual items were administered in random order and included a total of 95 items. Patient responses were compared between patients with BMI 85 to < 99th percentile versus ≥ 99th percentile. Results 136 participants were recruited and had all necessary clinical data for analysis. Of the 136 participants, 5% ended the survey early resulting in missing domain scores at the end of survey administration. In multivariate analysis, patients with BMI ≥ 99th percentile had worse scores for depressive symptoms, anger, fatigue, and mobility (p < 0.05). Parent-reported exercise was associated with better scores for depressive symptoms, anxiety, and fatigue (p < 0.05). Conclusions Children and adolescents ranging from overweight to severely obese can complete multiple PROMIS pediatric measures using a computer interface in the outpatient setting. In the 5% with missing domain scores, the missing scores were consistently found in the domains administered last, suggesting the length of the assessment is important. The differences in domain scores found in this study are consistent with previous reports investigating the quality of life in children and adolescents with obesity. We show that the PROMIS instrument represents a feasible and potentially valuable instrument for the future study of the effect of pediatric obesity on quality of life.Item Open Access Prenatal diagnosis of a giant intracranial teratoma associated with pulmonary hypoplasia.(East Carolina University, 1993-10) Weyerts, Leah K.; Catanzarite, Val; Jones, Marilyn C.; Mendoza, ArturoWe present a case in which an intracranial tumour replacing all intracranial contents was diagnosed by sonography at 31 weeks' gestation. The patient was delivered by caesarean section and died shortly after delivery. At necropsy, the tumour was found to be a teratoma with no recognisable normal brain tissue present. Additional findings at necropsy included pulmonary and adrenal hypoplasia. The diagnosis and prognosis of intracranial teratomas diagnosed in utero, and the association of this tumour with pulmonary hypoplasia, are discussed. Originally published Journal of Medical Genetics, Vol. 30, No. 10, Oct 1993Item Open Access The agony of agonal respiration: is the last gasp necessary?(East Carolina University, 2002-06) Perkin, R. M.; Resnik, D. B.Gasping respiration in the dying patient is the last respiratory pattern prior to terminal apnoea. The duration of the gasping respiration phase varies; it may be as brief as one or two breaths to a prolonged period of gasping lasting minutes or even hours. Gasping respiration is very abnormal, easy to recognise and distinguish from other respiratory patterns and, in the dying patient who has elected to not be resuscitated, will always result in terminal apnoea. Gasping respiration is also referred to as agonal respiration and the name is appropriate because the gasping breaths appear uncomfortable and raise concern that the patient is suffering and in agony. Enough uncertainty exists about the influence of gasping respiration on patient wellbeing, that it is appropriate to assume that the gasping breaths are burdensome to patients. Therefore, gasping respiration at the end of life should be treated. We propose that there is an ethical basis, in rare circumstances, for the use of neuromuscular blockade to suppress prolonged episodes of agonal respiration in the well-sedated patient in order to allow a peaceful and comfortable death. Originally published Journal of Medical Ethics, Vol. 28, No. 3, June 2002Item Open Access Effect of gender on auditory brainstem response latencies and thresholds to air-and bone-conducted clicks in newborn infants(East Carolina University, 2001) Stuart, Andrew; Yang, Edward Y.Objective: An examination of gender differences in auditory brainstem response (ABR) wave V latencies and thresholds to air-and bone- conducted clicks was undertaken with newborn infants. Design: Two hundred and two full-term newborn infants served as participants (i.e., 103 males and 99 females). Wave V latency measures for air-and bone-conducted click stimuli of 30, 45, and 60 dB nHL and 15 and 30 dB nHL, respectively and thresholds to air-and bone-conducted clicks were determined. Results: Female newborns displayed statistically significant shorter wave V latencies than male newborns for air-conducted click stimuli (p = .0016). There were no significant differences in wave V latencies to bone- conducted click stimuli (p = .11). Females displayed lower ABR thresholds to both air-and bone-conducted stimuli but the differences did not attain statistical significance (p = .054 and p = .18 for air-and bone-conducted stimuli, respectively). Conclusion: The findings of gender disparities in ABR latencies and thresholds to air-conducted clicks may be attributed to either anatomical differences at the periphery or more efficient neural conduction in the auditory nerve and/or brainstem. It was speculated that gender-related Effect of Gender On ABR Latencies and Thresholds 4 differences in bone density or maturation of the skull sutures could affect bone-conducted signal transmission to the cochlea thereby offsetting some inefficiency offered by air-conduction with newborn males. This in turn would minimize gender differences with bone-conducted stimuli.