Suzanne Hudson

Overweight teens at increased risk for weight gain while using depot medroxyprogesterone acetate.

STUDY OBJECTIVE To determine if factors such as body mass index (BMI), race, and age are associated with weight gain in adolescents receiving depot medroxyprogesterone acetate (DMPA). DESIGN/SETTING Retrospective chart review at three rural health department family planning clinics and a university-based adolescent clinic in rural eastern North Carolina. PARTICIPANTS Adolescent females, aged 12-19, who used either oral contraceptive pills (OCPs) or DMPA consistently for the first year of use. MAIN OUTCOME MEASURE Weight change at one year. RESULTS A total of 239 adolescent females were included in the analysis; 117 were DMPA users and 122 were OCP users. The mean weight gain for the DMPA group was 8.9 lbs. compared with 4.79 lbs. in the OCP group (P =.002). The change in BMI from baseline was greater among the DMPA group (1.51 +/- 1.94) than the OCP group (.75 +/- 1.65), P =.001. After adjusting for age, race, and contraceptive method, initial BMI was associated with weight gain (P =.009). CONCLUSIONS Adolescent females using DMPA gained significantly more weight over one year than those girls using OCPs. Adolescent females who are overweight at the initiation of DMPA may be more likely to have significant weight gain during the first year of use.

Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital

OBJECTIVES we evaluated the effect of implementation of an electronic medical record (EMR) on the use of antimicrobial agents and on the rates of infections with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). METHODS this was a retrospective, observational study conducted between 1 January 2005 and 31 December 2009. Antimicrobial drug use, rates of nosocomial C. difficile infection (CDI) and MRSA infection, the number of medical charts reviewed and number of antimicrobial recommendations made and accepted were compared before and after implementing the EMR utilizing interrupted time-series analysis. RESULTS compared with the 10 quarters prior to implementing the EMR, there was a 36.6% increase in the number of charts reviewed (P < 0.0001), a 98.1% increase in the number of antimicrobial recommendations made (P < 0.0001) and a 124% increase in the number of recommendations accepted (P < 0.0001). There was a 28.8% decrease in the use of 41 commonly used antibacterial agents (P < 0.0001). Nosocomial CDI decreased by 18.7% (P = 0.07) and nosocomial MRSA infections decreased by 45.2% (P < 0.0001) following implementation of the EMR. CONCLUSIONS adoption of an EMR facilitated a significant increase in chart reviews and antimicrobial recommendations, which resulted in a sustained decrease in antimicrobial use. There were decreased nosocomial infections with MRSA and a trend towards decreasing CDIs following implementation of the EMR.

Evaluation Criteria for Discrete Confidence Intervals: Beyond Coverage and Length

Confidence intervals for discrete distributions are often evaluated only by coverage and expected length. We discuss two additional criteria, p-confidence and p-bias. The choice of these criteria is motivated by the interpretation of a confidence interval as being the set of parameter values not rejected by a hypothesis test. Using these additional criteria we compare a number of equal-tailed confidence intervals for the binomial distribution. It is shown that methods that produce superior intervals, as measured by coverage and length, need not perform well in terms of p-confidence and p-bias. Coxs measuring device example is discussed to motivate the need for criteria beyond coverage and length.

Racial Variations in Velopharyngeal and Craniometric Morphology in Children: An Imaging Study.

PURPOSE The purpose of this study is to examine craniometric and velopharyngeal anatomy among young children (4-8 years of age) with normal anatomy across Black and White racial groups. METHOD Thirty-two healthy children (16 White and 16 Black) with normal velopharyngeal anatomy participated and successfully completed the magnetic resonance imaging scans. Measurements included 11 craniofacial and 9 velopharyngeal measures. RESULTS Two-way analysis of covariance was used to determine the effects of race and sex on velopharyngeal measures and all craniometric measures except head circumference. Head circumference was included as a covariate to control for overall cranial size. Sex did not have a significant effect on any of the craniometric measures. Significant racial differences were demonstrated for face height. A significant race effect was also observed for mean velar length, velar thickness, and velopharyngeal ratio. CONCLUSION The present study provides separate craniofacial and velopharyngeal values for young Black and White children. Data from this study can be used to examine morphological variations with respect to race and sex.

Prevalence of CYP3A5 Genomic Variances and Their Impact on Tacrolimus Dosing Requirements among Kidney Transplant Recipients in Eastern North Carolina

To assess the prevalence of CYP3A5 genomic variances and their impact on tacrolimus (TAC) dosing requirements among kidney transplant recipients in eastern North Carolina, we conducted a single‐center retrospective cohort study at a large tertiary care medical center. A total of 162 adults who received a kidney transplant between March 1, 2013, and February 28, 2015, and received oral TAC as part of their maintenance immunosuppression were enrolled. Of these patients, 85 patients expressed a genotype with a CYP3A5*1 variant (CYP3A5*1 group), and 77 patients expressed genotypes with other CYP3A5 variants (nonexpressor group). All patients were followed for 1 year posttransplantation. The primary end point was the TAC total daily dose (TDD) required to achieve the first therapeutic trough level based on the presence or absence of the CYP3A5*1 variant. The prevalence of different CYP3A5 variants across race/ethnicities in the study cohort was determined by CYP3A5 genotyping for each patient. The CYP3A5*1 and nonexpressor groups did not differ significantly with respect to sex, mean age, or mean weight. The CYP3A5*1 group was largely African American (93%, p≤0.0005) compared with other race/ethnicities. Among the CYP3A5*1 expressors compared with nonexpressors, the mean TAC TDD in milligrams at the first therapeutic TAC level was significantly higher (12 vs 8 mg/day, p≤0.001). Similarly, the mean TAC TDD in milligrams/kilogram was 50% greater among CYP3A5*1 expressors (0.15 vs 0.1 mg/kg/day, p≤0.0005). The predominant genotypic variants were CYP3A5*3/*3 (33%), CYP3A5*1/*3 (20%), and CYP3A5*1/*1 (19%). This study illustrates the prevalence of the CYP3A5*1 variant among African‐American kidney transplant recipients and the effect of this gene expression on the TAC TDD. Patients with the CYP3A5*1 variant require higher TAC doses, on average, to achieve desirable drug levels. In addition, this study provides transplant clinicians with insight and support to dose TAC more aggressively in African‐American kidney transplant recipients who may be at higher risk for both toxicities as well as poor clinical outcomes related to inadequate immunosuppression.

NEW RESULTS FOR A CLASS OF UNIVARIATE DISTRIBUTIONS

ABSTRACT Several new results are presented for a class of univariate distributions for which the maximum likelihood estimate of the population mean is the sample mean. It is shown that the convolution of any two such distributions also belongs to this class of functions. It is also shown that the marginal distribution for the sample mean captures all of the Fisher information for the population mean contained in the full distribution. Parameters orthogonal to the mean are found for special cases of these distributions. If the distribution is conditioned on the sample mean, the conditional distribution depends on the parameters only through parameters orthogonal to the mean.

A 14-year longitudinal study of the impact of clean indoor air legislation on state smoking prevalence, USA, 1997–2010

While clean indoor air legislation at the state level is an evidence-based recommendation, only limited evidence exists regarding the impact of clean indoor air policies on state smoking prevalence. Using state smoking prevalence data from 1997 to 2010, a repeated measures observational analysis assessed the association between clean indoor air policies (i.e., workplace, restaurant, and bar) and state smoking prevalence while controlling for state cigarette taxes and year. The impacts from the number of previous years with any clean indoor air policy, the number of policies in effect during the current year, and the number of policies in effect the previous year were analyzed. Findings indicate a smoking prevalence predicted decrease of 0.13 percentage points (p=0.03) for each additional year one or more clean indoor air policies were in effect, a predicted decrease of 0.12 percentage points (p=0.09) for each policy in effect in the current year, and a predicted decrease of 0.22 percentage points (p=0.01) for each policy in effect in the previous year on the subsequent year. Clean indoor air policies show measurable associations with reductions in smoking prevalence within a year of implementation above and beyond taxes and time trends. Further efforts are needed to diffuse clean indoor air policies across states and provinces that have not yet adopted such policies.

Impact of CYP3A5 genomic variances on clinical outcomes among African American kidney transplant recipients

Little is known about the impact of CYP3A5 polymorphisms on transplantation outcomes among African American (AA) kidney transplant recipients (KTRs). To assess this issue, clinical outcomes were compared between AA CYP3A5*1 expressers and nonexpressers. This retrospective cohort study analyzed AA KTRs. Biopsy‐proven acute rejection (BPAR), delayed graft function (DGF), glomerular filtration rate (GFR), infections, and tacrolimus dosing requirements were examined in 106 immunologically high‐risk AA kidney transplant patients over a 2‐year follow‐up period. In CYP3A5*1 expressers compared to nonexpressers, the incidence of BPAR was significantly higher in the first 6 months (13% vs 0%; P = .016) compared to 24 months (13% vs 7%; P = .521). Tacrolimus total daily dose at first therapeutic level was significantly higher in CYP3A5*1 expressers (12 mg/day) compared to nonexpressers (8 mg/day; P < .001). Compared to CYP3A5*1 nonexpressers, DGF incidence was significantly higher among CYP3A5*1 expressers (27.6% vs 6.7%; P = .006). By contrast, median GFR was significantly higher in CYP3A5*1 expressers compared to nonexpressers (54.5 mL/min vs 50.0 mL/min; P = .003) at 24 months. The findings from this retrospective study suggest that AAs with CYP3A5*1 expression require 50% more tacrolimus and have an increased incidence of DGF and acute rejection.

Simulation Study of Conditional, Bootstrap, and t Confidence Intervals in Linear Regression

Abstract Two resampling procedures, the bootstrap (BS) and the conditional confidence interval (CCI), are compared with the standard t-interval for the slope parameter in simple linear regression with an error term that is not necessarily normal. The type of bootstrap confidence intervals computed are the widely used bias-corrected and accelerated (BC a ) intervals. The CCIs are found by an efficient method for inverting permutation tests. Normal, highly skewed, and heavy-tailed error distributions are considered. While the CCI and BC a intervals have similar asymptotic properties, for a moderate number of cases, the confidence intervals obtained from the CCI and BC a behave differently in terms of accuracy, power, length, and correctness. Across all conditions, the CCI is the most accurate interval and has very good power. The t-intervals are also very accurate across most of the conditions we studied, and have coverage closer to the nominal value than the BC a intervals.