A sizeable proportion of elementary schoolchildren sleep less than the recommended 9 hours. Across the age range, decreases in sleep time and, in ethnic minorities, increasingly delayed bedtimes suggest emerging sleep restriction in preadolescents. Observed ethnic differences in sleep behavior highlight the need for better understanding of the social and environmental influences encouraging these sleep patterns.
A 15-year-old boy with hypoplastic left heart syndrome experienced plastic bronchitis 9 years after completion of a nonfenestrated lateral tunnel Fontan. Despite cardiac catheterization with coil embolization of collateral vessels and initiation of a pulmonary toilet regimen, including aerosolized tissue plasminogen activator, he continued to expectorate large acellular-mucinous casts. Finally, after optimization of cardiac function with the addition of carvedilol, the expectorated casts decreased in number. This report reviews pathophysiology of plastic bronchitis cast formation and therapy in the context of this late presentation after Fontan.
In studies that use electronic health record data, imputation of important data elements such as Glycated hemoglobin (A1c) has become common. However, few studies have systematically examined the validity of various imputation strategies for missing A1c values. We derived a complete dataset using an incident diabetes population that has no missing values in A1c, fasting and random plasma glucose (FPG and RPG), age, and gender. We then created missing A1c values under two assumptions: missing completely at random (MCAR) and missing at random (MAR). We then imputed A1c values, compared the imputed values to the true A1c values, and used these data to assess the impact of A1c on initiation of antihyperglycemic therapy. Under MCAR, imputation of A1c based on FPG 1) estimated a continuous A1c within ± 1.88% of the true A1c 68.3% of the time; 2) estimated a categorical A1c within ± one category from the true A1c about 50% of the time. Including RPG in imputation slightly improved the precision but did not improve the accuracy. Under MAR, including gender and age in addition to FPG improved the accuracy of imputed continuous A1c but not categorical A1c. Moreover, imputation of up to 33% of missing A1c values did not change the accuracy and precision and did not alter the impact of A1c on initiation of antihyperglycemic therapy. When using A1c values as a predictor variable, a simple imputation algorithm based only on age, sex, and fasting plasma glucose gave acceptable results.
To evaluate the association of vitamin D level with incident rheumatoid arthritis (RA) in a patient population using electronic health records (EHR). Case-control study with data extracted from EHR from 1/1/2001 to 12/31/2012 in the Geisinger Health System (GHS). Incident RA was defined as International Classification of Disease-9 code 714.0 twice by a GHS rheumatologist. Patients were identified at time of RA diagnoses and were matched 1:5 for age and gender with non-RA controls. Vitamin D levels were identified and extracted prior to RA diagnosis. The subjects were followed retrospectively with regard to their vitamin D levels; the most recent value of vitamin D prior to the RA diagnosis was used in the analysis. Vitamin D levels were treated both as continuous and categorical with two different cutoff values, 30 and 20 ng/ml. The association between vitamin D and RA was presented as the odds ratios with 95 % confidence intervals (OR, 95 % CI) from a conditional logistic regression model adjusting for obesity and smoking status. A total of 270 patients with incident RA and 1,341 matched controls were identified. The RA patients were 83.3 % female with median age at RA diagnosis of 62 years. The adjusted OR (95 % CI) for the association of vitamin D levels with incident RA compared with controls was 1.00 (0.99, 1.01), 0.98 (0.75, 1.29) and 1.12 (0.80, 1.57) for continuous, <30 and <20 ng/ml vitamin D levels, respectively. Subgroup analysis according to gender or rheumatoid factor positivity yielded similar results. In this patient population, vitamin D levels were not associated with the development of RA.
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