Binocular indirect ophthalmoscopy (BIO) is the gold standard for retinopathy of prematurity (ROP) screening, however, associated use of an eyelid speculum results in significant infant stress. Handheld optical coherence tomography (OCT) may identify ROP severity biomarkers and is non-contact. We performed a prospective, observational study to compare vital signs measured during BIO and OCT to identify whether OCT has an advantage in lowering cardiorespiratory impact of screening. This study included 16 premature infants screened for ROP, recruited between April 2019 and February 2020. Each infant underwent BIO and OCT at least 30 minutes apart, alternating the order at each consecutive screening session. Infants who were too unstable were excluded from the study. Vital signs were obtained 1 minute before, 1 and 2 minutes into, and 15 minutes after the examination. Vital sign deviations from baseline were compared for each infant between the two imaging modalities using a paired linear mixed model to adjust for multiple imaging sessions.This study included 26 examinations among 16 infants (62.5% female, mean gestational age 285.86±2.82 weeks, mean birth weight 1058.25±289.00 grams) with 9 infants at ROP stage 1, 4 at ROP stage 2, and 1 at ROP stage 3. BIO duration was significantly shorter than OCT (4.4 vs.10.8 minutes, P<0.001). Vital signs increase from baseline were significantly greater for BIO compared to OCT for heart rate at 1 minute (18.81±20.75 vs. 0.00±22.82 beats per minute, P=0.04), diastolic blood pressure at 2 minutes (41.22±31.69 vs. 28.19±25.84 mmHg, P=0.04), mean arterial pressure at 2 minutes (46.83±34.83 vs. 36.99±20.08 mmHg, P=0.04), and systolic blood pressure at 15 minutes (10.85±10.55 vs. -5.12±13.53 mmHg, P=0.04). OCT resulted in significantly lower impact on heart rate and blood pressure compared to BIO. The ability to screen for ROP using OCT may benefit overall health for these vulnerable premature infants. 

Antiseizure medications (ASM) may contribute to adverse fetal outcomes in pregnant women with epilepsy (WWE). Folate processing (methylenetetrahydrofolate reductase, MTHFR) gene abnormalities are common in women with epilepsy and depression. The enzyme product of this gene is a component of the metabolic pathway that makes folate bioavailable through methylation, critical for maintaining adequate serum folate levels. Folate is known to be crucial for fetal development, namely in the prevention of spina bifida and other neural tube defects (NTDs). The teratogenesis of some ASM in combination with genetic polymorphisms put WWE at higher risk for infertility, miscarriage, and/or major fetal malformations. L-methylfolate supplements may bypass deficiencies in the MTHFR-mediated folate metabolism pathway, yet their use in WWE during gestation or on fetal development is not well studied. We hypothesized that supplementation with L-methylfolate and methylcobalamin (methylated B12) may support better perinatal and fetal outcomes in pregnant WWE. We examined pregnancy histories of three WWE who supplemented with either folate or L-methylfolate and methylcobalamin (methylated B12) during pregnancies. Their pregnancy outcomes (both in conception and gestation) as well as mood stability improved with supplementation. L-methylfolate and methylcobalamin supplementation merits further study in WWE who have MTHFR mutations, fertility, recurrent miscarriage and/or depression histories.

Pigs often have an anterior crossbite (underbite), where the maxillary incisors (upper anterior teeth) are positioned behind the mandibular incisors (lower anterior teeth) instead of in front as found in a normal dental relationship. In humans, when this condition is severe, proper feeding, speaking, and breathing can be impeded. An anterior crossbite can occur due to dental and/or skeletal malformations. Retro-inclination of the maxillary incisors or excessive pro-inclination of the mandibular incisors are dental contributors to this problem, whereas excessive growth of the mandible (lower jaw) or deficient growth of the maxilla (upper jaw) are skeletal causes. Pigs are a novel model for anterior crossbites in humans, yet it is unclear which dental or skeletal condition is the primary cause in pigs. Therefore, it is necessary to characterize this condition in pigs to translate this model to humans effectively. The purpose of this project is to determine if improper inclination of the incisors, mandibular prognathism, or maxillary retrognathism is the primary cause of anterior crossbites in pigs. A total of 150 pig skulls (120 dry skulls and 30 CT images) were included in this study. The angle of inclination of maxillary and mandibular incisors, length of the mandible, and length of the maxilla (estimated by the length of the hard palate) were measured in dry skulls using a metric protractor and ruler to the nearest degree or mm. The same measurements were taken on CT images using ImageJ software. Measurements will be compared between normal and affected pigs using t-tests and correlated to the severity of anterior crossbite using Pearson correlations. Based on the data I have acquired, I expect that the primary cause of anterior crossbites in pigs is maxillary retrognathism, also termed maxillary hypoplasia, and thus serves as a model for this specific condition in humans.

Asthma is the most prevalent chronic childhood condition in the United States. Comprehensive preventative care is necessary to address symptoms that may increase the risk of complications due to respiratory infections, air quality degradation, and seasonal changes. Social determinants of health (SDOH) and environmental conditions dictate the control of a patent’s asthma, indicated by asthma control test (ACT) values. Patients experience allergens, air quality levels, and respiratory infections differently given their locality and access to medical resources. Simulation modeling is an effective tool to investigate the consequences of these factors on pediatric patient health and the response of the healthcare delivery system. We developed an agent-based discrete event simulation model that can evaluate early intervention strategies which are intended to mitigate exacerbation of asthma symptoms, specifically those caused by one or more social determinant conditions. SDOH, environmental conditions, emergency department visits, and prescribed medication are modeled and affect patient ACT scores. Several case studies were used to evaluate the model and examine patient population responses to care strategies. Populations of 500 pediatric asthma patients were simulated over 12-month periods. Patient responses to environmental changes and preemptive medical care reflected those seen in the healthcare literature. The model can be used to compare patient response (e.g., ACT) and medical treatment plans with respect to SDOH and environmental conditions. Users can edit patient model parameters and integrate additional environmental and care submodels to compare the effects of these preemptive care strategies for pediatric asthma patients.

The purpose of this project is to determine if there are compensatory changes to the height and width of the skull as a result of midfacial hypoplasia (MFH) in pigs. Secondarily, this research aims to determine if the ability to respirate may be impacted because of changes in the anatomy of the airway. MFH is a malformation of the face in which the upper jaw, cheekbones, and eye sockets grow less than the rest of the face, often resulting in a “bug-eyed” appearance and/or an “underbite”. In severe cases, MFH can cause dental crowding and airway obstruction. By gaining a better understanding of the causes and consequences of midfacial hypoplasia, there can be better progress in the prevention and treatment of this sometimes life-threatening malformation. Methods: This project utilized 158 skulls, including 132 dry skulls which were hand measured using a metric ruler, and the remaining 26 skulls are in CT scan format. These skulls are being measured using the program AVIZO. Out of the 158 skulls, 68 have MFH. Each pig skull provides a series of 6 measurements. To determine if there are changes to the height and width of the skull, I measured the snout height and width, and calvarial height and width. To determine if the airway is affected, I measured the choanal height and width. Using the measurements from the total of 158 skulls, I plan to compare normal pigs to pigs with MFH by using t-tests and by correlating the measurements based on the severity of MFH using Excel. The results from this project will render insight to the causes and consequences of this malformation.