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1.  Hospital Readmissions for Newly Discharged Pediatric Home Mechanical Ventilation Patients 
Pediatric pulmonology  2011;47(4):409-414.
Summary
Background
Ventilator-dependent children have complex chronic conditions that put them at risk for acute illness and repeated hospitalizations.
Objectives
To determine the 12-month incidence of and risk factors for non-elective readmission in children with chronic respiratory failure (CRF) after initiation on home mechanical ventilation (HMV) via tracheostomy.
Methods
A retrospective cohort study of 109 HMV patients initiated and followed at an university-affiliated children’s hospital between 2003 and 2009. Patient characteristics are presented using descriptive statistics; generalized estimated equations are used to estimate adjusted odds ratios of select predictor variables for readmission.
Results
The 12-month incidence of non-elective readmission was 40%. Close to half of these readmissions occurred within the first 3 months post-index discharge. Pneumonia and tracheitis were the most common reasons for readmission; 64% were pulmonary- or tracheostomy-related. Most demographic and clinical patient characteristics were not statistically associated with non-elective readmissions. Although, a change in the child’s management within 7 days before discharge was associated readmissions shortly after index discharge.
Conclusion
Non-elective readmissions of newly initiated pediatric HMV patients were common and likely multifactorial. Many of these readmissions were airway-related, and some may have been potentially preventable.
doi:10.1002/ppul.21536
PMCID: PMC3694986  PMID: 21901855
readmission; home mechanical ventilation; tracheostomy; child
2.  Longitudinal Assessment of Hemoglobin Oxygen Saturation in Preterm and Term Infants in the First Six Months of Life 
The Journal of pediatrics  2011;159(3):377-383.e1.
Objective
To report longitudinal home recordings of hemoglobin O2 saturation by pulse oximetry (Spo2) during unperturbed sleep in preterm and term infants.
Study design
We recorded continuous pulse oximetry during the first 3 minutes of each hour of monitor use (non-event epochs) for 103 preterm infants born at <1750 g and ≤34 weeks postmenstrual age (PMA), and 99 healthy term infants.
Results
Median baseline Spo2 was approximately 98% for both the preterm and term groups. Episodes of intermittent hypoxemia occurred in 74% of preterm and 62% of term infants. Among infants with intermittent hypoxemia, the number of seconds/hour of monitoring <90% Spo2 was initially significantly greater in the preterm than the term group and declined with age at a similar rate in both groups. The 75th to 95th percentiles for seconds/hour of Spo2 <90% in preterm infants were highest at 36 weeks PMA and progressively decreased until 44 weeks PMA, after which time they did not differ from term infants.
Conclusion
Clinically inapparent intermittent hypoxemia occurs in epochs unperturbed by and temporally unrelated to apnea or bradycardia events, especially in preterm infants at 36 to 44 weeks PMA.
doi:10.1016/j.jpeds.2011.02.011
PMCID: PMC3479632  PMID: 21481418
3.  Mutation of the cytosolic ribosomal protein-encoding RPS10B gene affects shoot meristematic function in Arabidopsis 
BMC Plant Biology  2012;12:160.
Background
Plant cytosolic ribosomal proteins are encoded by small gene families. Mutants affecting these genes are often viable, but show growth and developmental defects, suggesting incomplete functional redundancy within the families. Dormancy to growth transitions, such as the activation of axillary buds in the shoot, are characterised by co-ordinated upregulation of ribosomal protein genes.
Results
A recessive mutation in RPS10B, one of three Arabidopsis genes encoding the eukaryote-specific cytoplasmic ribosomal protein S10e, was found to suppress the excessive shoot branching mutant max2-1. rps10b-1 mildly affects the formation and separation of shoot lateral organs, including the shoot axillary meristems. Axillary meristem defects are enhanced when rps10b-1 is combined with mutations in REVOLUTA, AUXIN-RESISTANT1, PINOID or another suppressor of max2-1, FAR-RED ELONGATED HYPOCOTYL3. In some of these double mutants, the maintenance of the primary shoot meristem is also affected. In contrast, mutation of ALTERED MERISTEM PROGRAMME1 suppresses the rps10b-1axillary shoot defect. Defects in both axillary shoot formation and organ separation were enhanced by combining rps10b-1 with cuc3, a mutation affecting one of three Arabidopsis NAC transcription factor genes with partially redundant roles in these processes. To assess the effect of rps10b-1 on bud activation independently from bud formation, axillary bud outgrowth on excised cauline nodes was analysed. The outgrowth rate of untreated buds was reduced only slightly by rps10b-1 in both wild-type and max2-1 backgrounds. However, rps10b-1 strongly suppressed the auxin resistant outgrowth of max2-1 buds. A developmental phenotype of rps10b-1, reduced stamen number, was complemented by the cDNA of another family member, RPS10C, under the RPS10B promoter.
Conclusions
RPS10B promotes shoot branching mainly by promoting axillary shoot development. It contributes to organ boundary formation and leaf polarity, and sustains max2-1 bud outgrowth in the presence of auxin. These processes require the auxin response machinery and precise spatial distribution of auxin. The correct dosage of protein(s) involved in auxin-mediated patterning may be RPS10B-dependent. Inability of other RPS10 gene family members to maintain fully S10e levels might cause the rps10b-1 phenotype, as we found no evidence for unique functional specialisation of either RPS10B promoter or RPS10B protein.
doi:10.1186/1471-2229-12-160
PMCID: PMC3492191  PMID: 22963533
Shoot branching suppressor; S10e; Axillary bud; Leaf polarity; Lateral organ boundary; Auxin; Strigolactone; CUC; REV
4.  Sleep Fragmentation and Intermittent Hypoxemia Associated with Decreased Insulin Sensitivity in Obese Adolescent Latino Males 
Pediatric research  2012;72(3):293-298.
Background
Although sleep-related breathing disorder (SRBD) has been linked to insulin resistance in adults, this has not been as well established in children. We hypothesized that the severity of SRBD in adolescents was associated with metabolic impairment.
Methods
Polysomnography was performed on obese, Latino males referred for snoring. The frequently sampled intravenous glucose tolerance test (FSIVGTT) was used to assess glucose homeostasis. Total body dual-energy X-ray absorptiometry (DEXA) was used to quantify adiposity.
Results
22 males (mean age 13.4±SD 2.1 years, BMI z-score 2.4±0.3, obstructive apnea hypopnea index (OAHI) 4.1±3.2) were studied. After correcting for age and adiposity in multiple regression models, Log frequency of desaturation (defined as ≥3% drop in oxygen saturation from baseline) negatively correlated with insulin sensitivity. Sleep efficiency was positively correlated with glucose effectiveness (SG-the capacity of glucose to mediate its own disposal). The Log total arousal index was positively correlated with Log homeostasis model assessment (HOMA-IR).
Conclusions
Sleep fragmentation and intermittent hypoxemia are associated with metabolic impairment in obese adolescent Latino males independent of age and adiposity. We speculate that SRBD potentiates the risk for development of metabolic syndrome and type 2 diabetes in the obese adolescent population.
doi:10.1038/pr.2012.73
PMCID: PMC3427473  PMID: 22669298

Results 1-4 (4)