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1.
Nutrients ; 13(10)2021 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-34684562

RESUMEN

Supplementation of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) may enhance self-regulation (SR) and executive functioning (EF) in children of preschool age. The aim of the Omega Kid Study was to investigate the effect of n-3 LCPUFA supplementation on SR and EF in typically developing preschool-aged children. A double-blind placebo-controlled pilot trial was undertaken, the intervention was 12 weeks and consisted of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day compared to placebo. The HS-Omega-3 Index® was assessed by capillary blood samples at baseline and post-intervention. Seventy-eight children were enrolled and randomised to either the n-3 LCPUFA treatment (n = 39) or placebo (n = 39) group. Post intervention, there was a significant three-fold increase in the HS-Omega-3 Index® in the n-3 LCPUFA group (p < 0.001). There were no improvements in SR or EF outcome variables for the n-3 LCPUFA group post intervention compared to the placebo group determined by linear mixed models. At baseline, there were significant modest positive Spearman correlations found between the HS-Omega-3 index® and both behavioural self-regulation and cognitive self-regulation (r = 0.287, p = 0.015 and r = 0.242, p = 0.015 respectively). Although no treatment effects were found in typically developing children, further research is required to target children with sub-optimal self-regulation who may benefit most from n-3 LCPUFA supplementation.


Asunto(s)
Desarrollo Infantil , Suplementos Dietéticos , Ácidos Grasos Omega-3/farmacología , Autocontrol , Preescolar , Método Doble Ciego , Ingestión de Alimentos , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Placebos
3.
Nutrients ; 13(1)2021 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-33451057

RESUMEN

Self-regulation, the regulation of behaviour in early childhood, impacts children's success at school and is a predictor of health, wealth, and criminal outcomes in adulthood. Self-regulation may be optimised by dietary supplementation of omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs). The aim of the "Omega Kid" study is to investigate the feasibility of a protocol to investigate whether n-3 LCPUFA supplementation enhances self-regulation in preschool-aged children. The protocol assessed involved a double-blind, randomised, placebo-controlled trial of 12 weeks duration, with an intervention of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day (0.3 g EPA and 1.3 g DHA) in a microencapsulated powder compared to placebo. Children (n = 78; 40 boys and 38 girls) aged 3-5 years old were recruited and randomly allocated to the treatment (n = 39) or placebo group (n = 39). The HS-Omega-3 Index® served as a manipulation check on the delivery of either active (n-3 LCPUFAs) or placebo powders. Fifty-eight children (76%) completed the intervention (28-30 per group). Compliance to the study protocol was high, with 92% of children providing a finger-prick blood sample at baseline and high reported-adherence to the study intervention (88%). Results indicate that the protocol is feasible and may be employed in an adequately powered clinical trial to test the hypothesis that n-3 LCPUFA supplementation will improve the self-regulation of preschool-aged children.


Asunto(s)
Desarrollo Infantil/efectos de los fármacos , Suplementos Dietéticos , Ácidos Grasos Omega-3/administración & dosificación , Autocontrol , Biomarcadores/sangre , Preescolar , Electroencefalografía , Función Ejecutiva , Estudios de Factibilidad , Femenino , Humanos , Masculino , Cooperación del Paciente
4.
Front Psychol ; 11: 1382, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32719636

RESUMEN

INTRODUCTION: There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions requires highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes. METHODS: The study will be conducted in Norway 2019-2022 and is designed as a two-arm (intervention, control) cluster randomized controlled trial (RCT) with 7- and 18-months follow-ups. We aim to recruit 60 preschools and 1,200 3- to 5-years-old children to provide sufficient power to detect effect sizes (ESs) between 0.20 and 0.30. The intervention is nested within two levels: the preschool and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of "enriched," meaningful, and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child-level outcomes, including PA, physical fitness, adiposity, motor skills, socioemotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data. DISCUSSION: Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov identifier NCT04048967.

5.
J Pediatr Health Care ; 31(6): 634-647, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28622983

RESUMEN

INTRODUCTION: Our aim was to evaluate cost and acute care utilization related to an organized approach to care coordination and transitional care after major acute care hospitalization for children with medical complexities, including cerebral palsy. METHODS: A retrospective cohort of 32 patients from Ranken Jordan Pediatric Bridge Hospital (RJPBH) who received the Care Beyond the Bedside model was compared with 151 patients receiving standard care elsewhere across Missouri. Claims data (2007-2012) were obtained from MoHealthNet, Missouri's Medicaid program, for all children with moderate to severe cerebral palsy (defined using approximated Gross Motor Function Classification System levels) who had at least one hospital visit during the study period (N = 183). Risk-adjusted linear and Poisson regression models were used to analyze per-member-per-month costs and three indicators of acute care utilization (emergency department visits, readmissions, and inpatient days). RESULTS: RJPBH patients were associated with statistically significant reductions in per-member-per-month costs (-21%), hospital readmissions (-66%), and inpatient days (-57%). DISCUSSION: RJPBH's enhanced interprofessional medical home-like model, including intense care coordination, psychosocial therapy, family and caregiver empowerment, and transitional care, may be keys to reducing cost and unnecessary hospital use for children with medical complexities with cerebral palsy who receive Medicaid.


Asunto(s)
Parálisis Cerebral/economía , Parálisis Cerebral/rehabilitación , Hospitalización/economía , Adolescente , Parálisis Cerebral/terapia , Niño , Preescolar , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Masculino , Medicaid , Planificación de Atención al Paciente , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud/normas , Estudios Retrospectivos , Cuidado de Transición/organización & administración , Cuidado de Transición/normas , Estados Unidos/epidemiología , Adulto Joven
6.
J Anesth ; 29(2): 303-7, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25217117

RESUMEN

Adductor canal catheters preserve quadriceps strength better than femoral nerve catheters and may facilitate postoperative ambulation following total knee arthroplasty. However, the effect of this newer technique on provider workload, if any, is unknown. We conducted a retrospective provider workload analysis comparing these two catheter techniques; all other aspects of the clinical pathway remained the same. The primary outcome was number of interventions recorded per patient postoperatively. Secondary outcomes included infusion duration, ambulation distance, opioid consumption, and hospital length of stay. Adductor canal patients required a median (10-90th percentiles) of 0.0 (0.0-2.6) interventions compared to 1.0 (0.3-3.0) interventions for femoral patients (p < 0.001); 18/23 adductor canal patients (78 %) compared to 2/22 femoral patients (9 %) required no interventions (p < 0.001). Adductor canal catheter infusions lasted 2.0 (1.4-2.0) days compared to 1.5 (1.0-2.7) days in the femoral group (p = 0.016). Adductor canal patients ambulated further [mean (SD)] than femoral patients on postoperative day 1 [24.5 (21.7) vs. 11.9 (14.6) meters, respectively; p = 0.030] and day 2 [44.9 (26.3) vs. 22.0 (22.2) meters, respectively; p = 0.003]. Postoperative opioid consumption and length of stay were similar between groups. We conclude that adductor canal catheters offer both patient and provider benefits when compared to femoral nerve catheters.


Asunto(s)
Anestesia Local/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Catéteres , Nervio Femoral , Personal de Salud/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Muslo , Carga de Trabajo/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Complicaciones Posoperatorias/economía , Estudios Retrospectivos , Resultado del Tratamiento , Caminata
7.
J Anesth ; 29(2): 308-12, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25288506

RESUMEN

An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.


Asunto(s)
Catéteres/efectos adversos , Migración de Cuerpo Extraño/patología , Muslo , Anestesia Local , Artroplastia de Reemplazo de Rodilla , Cadáver , Humanos , Proyectos Piloto
8.
Simul Healthc ; 7(2): 73-80, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22374230

RESUMEN

INTRODUCTION: There has been interest in the use of high-fidelity medical simulation to evaluate performance. We hypothesized that technical and nontechnical performance in the simulated environment is related to other various criterion measures, providing evidence to support the validity of the scores from the performance-based assessment. METHODS: Twelve third-year anesthesia residents participated in a series of 6 short 5-minute scenarios and 1 longer 30-minute scenario. The short scenarios measured technical skills, whereas the longer one focused on nontechnical skills. Two independent raters scored subjects using analytic and holistic ratings. Short scenarios involved acute hemorrhage, blocked endotracheal tube, bronchospasm, hyperkalemia, tension pneumothorax, and unstable ventricular tachycardia. The long scenario concerned management of myocardial ischemia/infarction leading to cardiac arrest. Scores from the simulations were correlated with (a) rankings generated from an Internet-based global ranking instrument that categorized residents based on overall clinical ability and (b) residency board scores. RESULTS: There were moderate correlations between various participant scores from the simulation-based assessment and aggregate rankings based on the global ranking instrument and residency examination scores. CONCLUSIONS: The associations between simulator performance, both for technical and nontechnical skills, and other markers of ability provide some evidence to support the validity of simulation-based assessment scores. Replication studies with larger numbers of residents are warranted.


Asunto(s)
Anestesiología/educación , Competencia Clínica , Educación de Postgrado en Medicina/métodos , Internado y Residencia , Enseñanza/métodos , Adulto , Evaluación Educacional/métodos , Escolaridad , Docentes Médicos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Aprendizaje , Reproducibilidad de los Resultados , Estadística como Asunto , Factores de Tiempo
9.
J Med Chem ; 52(2): 379-88, 2009 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-19143567

RESUMEN

Here, we describe the identification of a clinical candidate via structure-based optimization of a ligand efficient pyrazole-benzimidazole fragment. Aurora kinases play a key role in the regulation of mitosis and in recent years have become attractive targets for the treatment of cancer. X-ray crystallographic structures were generated using a novel soakable form of Aurora A and were used to drive the optimization toward potent (IC(50) approximately 3 nM) dual Aurora A/Aurora B inhibitors. These compounds inhibited growth and survival of HCT116 cells and produced the polyploid cellular phenotype typically associated with Aurora B kinase inhibition. Optimization of cellular activity and physicochemical properties ultimately led to the identification of compound 16 (AT9283). In addition to Aurora A and Aurora B, compound 16 was also found to inhibit a number of other kinases including JAK2 and Abl (T315I). This compound demonstrated in vivo efficacy in mouse xenograft models and is currently under evaluation in phase I clinical trials.


Asunto(s)
Bencimidazoles/farmacología , Inhibidores de Proteínas Quinasas/farmacología , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Urea/análogos & derivados , Animales , Aurora Quinasa A , Aurora Quinasa B , Aurora Quinasas , Bencimidazoles/química , Bencimidazoles/farmacocinética , Línea Celular Tumoral , Cristalografía por Rayos X , Evaluación Preclínica de Medicamentos , Humanos , Ratones , Inhibidores de Proteínas Quinasas/química , Inhibidores de Proteínas Quinasas/farmacocinética , Relación Estructura-Actividad , Urea/química , Urea/farmacocinética , Urea/farmacología
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