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Michelle A. Miller - One of the best experts on this subject based on the ideXlab platform.
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Congenital and acquired brain Injury. 1. Brain Injury: Epidemiology and pathophysiology
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Brian D. Greenwald, Derek M. Burnett, Michelle A. MillerAbstract:UNLABELLED This self-directed learning module highlights recent advances in the understanding of brain Injury pathophysiology, Epidemiology. severity scales, and treatment interventions to minimize brain Injury in adults and children. It is part of the chapter on congenital and acquired brain Injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, brain Injury Epidemiology is summarized, and differences in between brain Injury in pediatric and elderly persons are highlighted. Underlying physiologic and chemical mechanisms for secondary brain Injury are reviewed, along with strategies and research to minimize this Injury. Contemporary understanding of the mechanisms and treatments of brain Injury in preterm infants is also discussed. Classification of brain Injury severity provides a way to stratify this heterogeneous group. OVERALL ARTICLE OBJECTIVE (a) To summarize brain Injury Epidemiology and prevention strategies across the age spectrum, (b) to review the pathophysiology of pediatric and adult brain Injury, and (c) to classify brain Injury by severity scales.
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1. Brain Injury: Epidemiology and pathophysiology☆
Archives of Physical Medicine and Rehabilitation, 2003Co-Authors: Brian D. Greenwald, Derek M. Burnett, Michelle A. MillerAbstract:Abstract Greenwald BD, Burnett DM, Miller MA. Congenital and acquired brain Injury. 1. Brain Injury: Epidemiology and pathophysiology. Arch Phys Med Rehabil 2003;84 Suppl 1:S3-7. This self-directed learning module highlights recent advances in the understanding of brain Injury pathophysiology, Epidemiology, severity scales, and treatment interventions to minimize brain Injury in adults and children. It is part of the chapter on congenital and acquired brain Injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, brain Injury Epidemiology is summarized, and differences in between brain Injury in pediatric and elderly persons are highlighted. Underlying physiologic and chemical mechanisms for secondary brain Injury are reviewed, along with strategies and research to minimize this Injury. Contemporary understanding of the mechanisms and treatments of brain Injury in preterm infants is also discussed. Classification of brain Injury severity provides a way to stratify this heterogeneous group. Overall Article Objective: (a) To summarize brain Injury Epidemiology and prevention strategiesacross the age spectrum, (b) to review the pathophysiology of pediatric and adult brain Injury, and (c) to classify brain Injury by severity scales.
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Congenital and acquired brain Injury. 1. Brain Injury: Epidemiology and pathophysiology.
Archives of physical medicine and rehabilitation, 2003Co-Authors: Brian D. Greenwald, Derek M. Burnett, Michelle A. MillerAbstract:This self-directed learning module highlights recent advances in the understanding of brain Injury pathophysiology, Epidemiology. severity scales, and treatment interventions to minimize brain Injury in adults and children. It is part of the chapter on congenital and acquired brain Injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, brain Injury Epidemiology is summarized, and differences in between brain Injury in pediatric and elderly persons are highlighted. Underlying physiologic and chemical mechanisms for secondary brain Injury are reviewed, along with strategies and research to minimize this Injury. Contemporary understanding of the mechanisms and treatments of brain Injury in preterm infants is also discussed. Classification of brain Injury severity provides a way to stratify this heterogeneous group. (a) To summarize brain Injury Epidemiology and prevention strategies across the age spectrum, (b) to review the pathophysiology of pediatric and adult brain Injury, and (c) to classify brain Injury by severity scales.
David J Askenazi - One of the best experts on this subject based on the ideXlab platform.
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The Association of Intraventricular Hemorrhage and Acute Kidney Injury in Premature Infants from the Assessment of the Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) Study.
Neonatology, 2019Co-Authors: Christine Stoops, David T. Selewski, Louis Boohaker, Brian Sims, Russell Griffin, David J AskenaziAbstract:Background: Acute kidney Injury (AKI) and intraventricular hemorrhage (IVH) are common in premature infants. We previously demonstrated that infants with AKI have a higher hazards ratio to develop grade ≥2 IVH when controlling for confounders. However, that single-center study was unable to show an overall association. Objectives: To test the hypothesis that infants diagnosed with AKI have an increased risk of IVH independent of variables associated with both AKI and IVH, we performed a study on 825 infants from the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study (a 24-center multinational retrospective cohort). Method: A neonatal modified KDIGO definition of AKI was used based on serum creatinine (SCr) and/or urine output criteria. Baseline SCr was defined as the lowest previous value. IVH was diagnosed with head ultrasounds. Results: AKI was documented in 22.2% (183/825) of infants and IVH in 14.3% (118/825). Infants with AKI (n = 183) were more likely to have IVH (26.8%, 49/183) than those without AKI (n= 642) who had IVH (10.7%, 69/642, p < 0.0001). After controlling for 5-min Apgar score, vasopressor support within the first week of age, and gestational age, infants with AKI had 1.6 times higher adjusted odds to develop any grade IVH (95% CI 1.04–2.56). Furthermore, infants of gestational age of 22–28 weeks had 1.9 times higher adjusted odds to develop IVH (OR 1.87, 95% CI 1.08–3.23). Conclusions: We present the first multicenter evaluation of the association between AKI and IVH in premature infants showing a significant independent association between AKI and IVH. Development of strategies to reduce AKI may also reduce IVH.
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Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN].
Pediatric research, 2018Co-Authors: Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L KentAbstract:Hypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age. Diagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age. Of the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney Injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation. Neonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.
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Correction: Incidence of neonatal hypertension from a large multicentre study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN].
Pediatric Research, 2018Co-Authors: Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L KentAbstract:Hypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age. Diagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age. Of the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney Injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation. Neonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.
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Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study.
Frontiers in pediatrics, 2016Co-Authors: Jennifer G. Jetton, David J Askenazi, Alison L Kent, Ronnie Guillet, Lynn Dill, Judd Jacobs, David T. Selewski, Carolyn Abitbol, Fredrick J Kaskel, Maroun J. MhannaAbstract:INTRODUCTION: Acute kidney Injury (AKI) affects ~30% of hospitalized neonates. Critical to advancing our understanding of neonatal AKI is collaborative research among neonatologists and nephrologists. The Neonatal Kidney Collaborative (NKC) is an international, multidisciplinary group dedicated to investigating neonatal AKI. The AWAKEN study (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates) was designed to describe the Epidemiology of neonatal AKI, validate the definition of neonatal AKI, identify primary risk factors for neonatal AKI, and investigate the contribution of fluid management to AKI events and short term outcomes. METHODS and ANALYSIS: The NKC was established with at least one pediatric nephrologist and neonatologist from 24 institutions from 4 countries (USA, Canada, Australia, India). A Steering Committee and four subcommittees were created. The database subcommittee oversaw the development of the web-based database (MediData Rave™) that captured all NICU admissions from 1/1/14-3/31/14. Inclusion and exclusion criteria were applied to eliminate babies with a low likelihood of AKI. Data collection includes: 1) baseline demographic information; 2) daily physiologic parameters and care received during the first week of life; 3) weekly “snapshots”; 4) discharge information including growth parameters, final diagnoses, discharge medications and need for renal replacement therapy; and 5) all serum creatinine values. ETHICS and DISSEMINATION: AWAKEN was proposed as human subjects research. The study design allowed for a waiver of informed consent/parental permission. NKC investigators will disseminate data through peer-reviewed publications and educational conferences. DISCUSSION: The purpose of this publication is to describe the formation of the NKC, the establishment of the AWAKEN cohort and database, future directions and a few “lessons learned”. The AWAKEN database includes ~325 unique variables and >4 million discrete data points. AWAKEN will be the largest, most inclusive neonatal AKI study to date. In addition to validating the neonatal AKI definition and identifying risk factors for AKI, this study will uncover variations in practice patterns related to fluid provision, renal function monitoring, and involvement of pediatric nephrologists during hospitalization. The AWAKEN study will position the NKC to achieve the long-term goal of improving the lives, health and well-being of newborns at risk for kidney disease.
Hassan Abolghasem Gorji - One of the best experts on this subject based on the ideXlab platform.
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Injury Epidemiology in Iran: a systematic review.
Journal of injury & violence research, 2016Co-Authors: Saber Azami-aghdash, Homayoun Sadeghi-bazargani, Hosein Shabaninejad, Hassan Abolghasem GorjiAbstract:Background: Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the Epidemiology of injuries in Iran through a systematic review. Methods: Required data were collected searching the following key words and their Persian equivalents; trauma, Injury, accident, Epidemiology, prevalence, Pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts. Results: Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. Males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%), followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents. Conclusions: The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).
Jess F. Kraus - One of the best experts on this subject based on the ideXlab platform.
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A journey to and through Injury Epidemiology
Injury epidemiology, 2014Co-Authors: Jess F. KrausAbstract:This brief commentary describes key events in the development of Dr. Jess Kraus’s professional career in Injury Epidemiology from the 1950s to the 2000s. It highlights the interactions with Dr. William Haddon Jr. and other researchers that were instrumental to his contributions to the field of Injury Epidemiology.
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Methodological issues in motorcycle Injury Epidemiology
Accident; analysis and prevention, 2008Co-Authors: Mau Roung Lin, Jess F. KrausAbstract:Motorcycle riders are over 30 times more likely than car occupants to die in a traffic crash. While this fact is well known, specific issues of methodology in epidemiological motorcycle-Injury research have been rarely researched. To facilitate more-valid research on motorcycle injuries, this article evaluates the current state of our knowledge on how we measure the population at risk of Injury, completeness of case finding and identification, validity of crash/Injury data sources, and completeness of information on important exposures such as alcohol consumption, helmet status, crash severity, and crash speeds, as well as problems of existing Injury severity scales and statistical analyses for correlated Injury data.
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A systematic review of brain Injury Epidemiology in Europe.
Acta neurochirurgica, 2005Co-Authors: F. Tagliaferri, C. Compagnone, M. Korsic, F. Servadei, Jess F. KrausAbstract:Background. The world’s literature on traumatic brain Injury (TBI) grows annually including new reports on epidemiologic findings from many regions. With the wide variety of reports emphasizing various factors it is useful to compile these findings, hence the objective of this report. Thus, we describe epidemiological factors from European studies largely published in the last 20 years.
Alison L Kent - One of the best experts on this subject based on the ideXlab platform.
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Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN].
Pediatric research, 2018Co-Authors: Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L KentAbstract:Hypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age. Diagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age. Of the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney Injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation. Neonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.
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Correction: Incidence of neonatal hypertension from a large multicentre study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN].
Pediatric Research, 2018Co-Authors: Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L KentAbstract:Hypertension occurs in up to 3% of neonates admitted to the Neonatal Intensive Care Unit (NICU), and is a potentially under-recognized condition. The aim of this study was to examine the incidence of documented and undiagnosed hypertension from the 24-center Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database, and to assess risk factors for hypertension according to gestational age. Diagnosed hypertension was documented if an infant had a discharge diagnosis of hypertension and/or discharged on antihypertensive medications. Undiagnosed hypertension was defined when infants did not have a diagnosis of hypertension, but >50% of the lowest mean, diastolic and systolic blood pressure recordings were >95th percentile for gestational age. Of the 2162 neonates enrolled in the study, hypertension was documented in 1.8%. An additional 3.7% were defined as having undiagnosed hypertension. There was a significant correlation with neonatal hypertension and acute kidney Injury (AKI). Additional risk factors for neonatal hypertension were hyperbilirubinaemia, Caucasian race, outborn, vaginal delivery, and congenital heart disease. Protective factors were small for gestational age, multiple gestations, and steroids for fetal maturation. Neonatal hypertension may be an under-recognized condition. AKI and other risk factors predispose infants to hypertension.
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Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study.
Frontiers in pediatrics, 2016Co-Authors: Jennifer G. Jetton, David J Askenazi, Alison L Kent, Ronnie Guillet, Lynn Dill, Judd Jacobs, David T. Selewski, Carolyn Abitbol, Fredrick J Kaskel, Maroun J. MhannaAbstract:INTRODUCTION: Acute kidney Injury (AKI) affects ~30% of hospitalized neonates. Critical to advancing our understanding of neonatal AKI is collaborative research among neonatologists and nephrologists. The Neonatal Kidney Collaborative (NKC) is an international, multidisciplinary group dedicated to investigating neonatal AKI. The AWAKEN study (Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates) was designed to describe the Epidemiology of neonatal AKI, validate the definition of neonatal AKI, identify primary risk factors for neonatal AKI, and investigate the contribution of fluid management to AKI events and short term outcomes. METHODS and ANALYSIS: The NKC was established with at least one pediatric nephrologist and neonatologist from 24 institutions from 4 countries (USA, Canada, Australia, India). A Steering Committee and four subcommittees were created. The database subcommittee oversaw the development of the web-based database (MediData Rave™) that captured all NICU admissions from 1/1/14-3/31/14. Inclusion and exclusion criteria were applied to eliminate babies with a low likelihood of AKI. Data collection includes: 1) baseline demographic information; 2) daily physiologic parameters and care received during the first week of life; 3) weekly “snapshots”; 4) discharge information including growth parameters, final diagnoses, discharge medications and need for renal replacement therapy; and 5) all serum creatinine values. ETHICS and DISSEMINATION: AWAKEN was proposed as human subjects research. The study design allowed for a waiver of informed consent/parental permission. NKC investigators will disseminate data through peer-reviewed publications and educational conferences. DISCUSSION: The purpose of this publication is to describe the formation of the NKC, the establishment of the AWAKEN cohort and database, future directions and a few “lessons learned”. The AWAKEN database includes ~325 unique variables and >4 million discrete data points. AWAKEN will be the largest, most inclusive neonatal AKI study to date. In addition to validating the neonatal AKI definition and identifying risk factors for AKI, this study will uncover variations in practice patterns related to fluid provision, renal function monitoring, and involvement of pediatric nephrologists during hospitalization. The AWAKEN study will position the NKC to achieve the long-term goal of improving the lives, health and well-being of newborns at risk for kidney disease.