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Article ; Online: Autonomic dysfunction in adult-onset alexander disease: a case report and review of the literature.

Spritzer, Scott D / Zarkou, Srijana / Ireland, Stephen P / Carter, Jonathon L / Goodman, Brent P

Clinical autonomic research : official journal of the Clinical Autonomic Research Society

2013 Volume 23, Issue 6, Page(s) 333–338

Abstract: Background: Alexander disease (AxD) is an astrogliopathy, resulting from a mutation in the glial ...

Abstract	Background: Alexander disease (AxD) is an astrogliopathy, resulting from a mutation in the glial fibrillary astrocytic protein gene. Different clinical subtypes have been described, including infantile, juvenile, and adult onset, based upon the age at which symptoms begin. Patients with the adult-onset form, develop a progressive, spastic paraparesis, palatal myoclonus, ataxia, and bulbar weakness. Autonomic nervous system (ANS) dysfunction has been reported as a potential manifestation of adult-onset AxD, but has not been well characterized. Objective: We report a case of adult-onset AxD with symptomatic orthostatic hypotension (OH) and heat intolerance that underwent formal autonomic testing. In addition, a comprehensive literature search was conducted to review the frequency and pattern of autonomic dysfunction in this patient population. Results: A 51-year-old patient was diagnosed with AxD at the age of 47, following an 8-year history of vertigo, intermittent diplopia, and sleep disturbance. The patient developed symptoms of OH, erectile dysfunction, and heat intolerance soon after his diagnosis. Autonomic testing demonstrated OH on tilt-table testing (47 mmHg decrease in BP with 18 BPM heart rate increment) with absent late phase II and IV responses during the Valsalva maneuver, severe cardiovagal impairment, and preserved postganglionic sympathetic sudomotor function. These findings were interpreted as being consistent with central autonomic failure. The most common autonomic symptoms reported in other AxD cases include constipation, urinary incontinence, and sphincter dysfunction. To our knowledge, this is the first report of formal autonomic testing in AxD. Conclusion: Signs and symptoms of ANS impairment can occur in patients with AxD, and can include orthostatic hypotension and bowel/bladder dysfunction. Autonomic testing in our patient suggests impairment in central autonomic pathways.
MeSH term(s)	Age of Onset ; Alexander Disease/complications ; Alexander Disease/physiopathology ; Autonomic Nervous System Diseases/etiology ; Autonomic Nervous System Diseases/physiopathology ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2013-08-08
Publishing country	Germany
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1080007-4
ISSN	1619-1560 ; 0959-9851
ISSN (online)	1619-1560
ISSN	0959-9851
DOI	10.1007/s10286-013-0205-y
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 3270: Show issues

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Article ; Online: Response to the letter: "Utility of electroencephalography in toxin-induced seizure".

Sidlak, Alexander M / Dibble, Brent / Schultz, Brian

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2024

Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Letter
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14918
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Zs.A 4479: Show issues

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Article ; Online: Private Equity-Acquired Physician Practices And Market Penetration Increased Substantially, 2012-21.

Abdelhadi, Ola / Fulton, Brent D / Alexander, Laura / Scheffler, Richard M

Health affairs (Project Hope)

2024 Volume 43, Issue 3, Page(s) 354–362

Abstract: Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms' penetration at the physician level into local markets and the impact on health care quality and prices. However, limited knowledge ...

Abstract	Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms' penetration at the physician level into local markets and the impact on health care quality and prices. However, limited knowledge exists about the extent of PE firms' control in local markets. By linking data on PE acquisitions to physician data and using full-time-equivalent physicians as the base of assessment, we estimated the local market share of each PE firm within ten physician specialties at the Metropolitan Statistical Area (MSA) level. PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021. Single PE firms had significant market share, exceeding 30 percent in 108 MSA specialty markets and exceeding 50 percent in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.
MeSH term(s)	United States ; Humans ; Physicians ; Health Personnel ; Administrative Personnel ; Medicine ; Quality of Health Care
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2023.00152
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Zs.A 2118: Show issues

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Article ; Online: Utility of electroencephalography in toxin-induced seizures.

Sidlak, Alexander M / Dibble, Brent / Schultz, Brian

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2024 Volume 31, Issue 3, Page(s) 249–255

Abstract: Introduction: Toxin-induced seizures differ from seizures occurring in epilepsy and have a high rate of complications. Electroencephalography (EEG) is routinely obtained when there is concern for nonconvulsive status epilepticus (NCSE). The purpose of ... ...

Abstract	Introduction: Toxin-induced seizures differ from seizures occurring in epilepsy and have a high rate of complications. Electroencephalography (EEG) is routinely obtained when there is concern for nonconvulsive status epilepticus (NCSE). The purpose of this study was to characterize the typical findings after toxin-induced seizures, assess the rate of epileptiform discharges and NCSE, and identify any changes in management resulting from EEG. Methods: Patients older than 16 years who had an EEG during hospitalization for drug-induced seizure or seizure-like activity were included. We reviewed 10 years of data (2013-2022) across our hospital system (four community hospitals and one academic center). Patients with a history of seizures and those with cardiac arrest prior to EEG were excluded. The primary outcome was incidence of epileptiform discharges on EEG. The secondary outcome was number of antiseizure medications (ASM) added after EEG. Results: A total of 256 encounters were screened with 83 patient encounters included. A total of 53% (44/83) of EEGs showed some degree of generalized slowing. A total of 2.4% (2/83) of cases had epileptiform activity on EEG. No cases of nonconvulsive status were identified. No ASM was started in the two cases where epileptiform discharges were identified. Conclusions: During usual care of toxin-induced seizures, epileptiform discharges are uncommon.
MeSH term(s)	Humans ; Seizures/drug therapy ; Electroencephalography/methods ; Status Epilepticus/drug therapy ; Status Epilepticus/epidemiology ; Incidence ; Retrospective Studies
Language	English
Publishing date	2024-02-22
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14834
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Zs.A 4479: Show issues

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Article ; Online: Intracranial pressure monitoring during stereoelectroencephalography implantation: a technical note.

Nagahama, Yasunori / Alexander, Allyson L / O'Neill, Brent R

Journal of neurosurgery. Pediatrics

2022 Volume 29, Issue 4, Page(s) 454–457

Abstract: Stereoelectroencephalography (SEEG) has become increasingly employed as a critical component of epilepsy workups for patients with drug-resistant epilepsy when information from noninvasive studies is not conclusive and sufficient to guide epilepsy ... ...

Abstract	Stereoelectroencephalography (SEEG) has become increasingly employed as a critical component of epilepsy workups for patients with drug-resistant epilepsy when information from noninvasive studies is not conclusive and sufficient to guide epilepsy surgery. Although exceedingly rare, clinically significant hemorrhagic complications can be caused during SEEG implantation procedures. Intracranial hemorrhage (ICH) can be difficult to recognize due to the minimally invasive nature of SEEG. The authors describe their technique using a commercially available intraparenchymal intracranial pressure (ICP) monitor as a method for early intraoperative detection of ICH during SEEG implantation. Between May 2019 and July 2021, 18 pediatric patients underwent SEEG implantation at a single, freestanding children's hospital with the use of an ICP monitor during the procedure. No patients experienced complications resulting from this technique. The authors have relayed their rationale for ICP monitor use during SEEG, the technical considerations, and the safety profile. In addition, they have reported an illustrative case in which the ICP monitor proved crucial in early detection of ICH during SEEG implantation.
MeSH term(s)	Child ; Drug Resistant Epilepsy/diagnostic imaging ; Drug Resistant Epilepsy/etiology ; Drug Resistant Epilepsy/surgery ; Electrodes, Implanted/adverse effects ; Electroencephalography/methods ; Humans ; Intracranial Pressure ; Retrospective Studies ; Stereotaxic Techniques
Language	English
Publishing date	2022-01-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2021.12.PEDS21490
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Uk I Zs.135 -Pediatrics-: Show issues

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Article ; Online: When acute SARS-CoV-2 infection was a blessing in disguise! Unexpected diagnosis and clinical course of hepatopulmonary syndrome in a teenager.

Mull, Eric S / Ronau, Rachel / Adler, Brent / Kirkby, Stephen / Nathan, Jaimie D / Weymann, Alexander / Shenoy, Archana / Paul, Grace R

Pediatric pulmonology

2024

Language	English
Publishing date	2024-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.27002
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Zs.A 2143: Show issues

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Article ; Online: Analysis of rising cases of adolescent opioid use presentations to the emergency department and their management.

Sidlak, Alexander / Dibble, Brent / Dhaliwal, Mannet / Bottone, Paul / Marino, Ryan / Henry, Linda / Howell, John

Drug and alcohol dependence

2024 Volume 258, Page(s) 111136

Abstract: Objective: We sought to answer the question of how adolescents (ages 12-17 years old) with opioid-related presentations are currently managed in the ED. The two main outcomes were the proportion of visits where naloxone and buprenorphine were both used ... ...

Abstract	Objective: We sought to answer the question of how adolescents (ages 12-17 years old) with opioid-related presentations are currently managed in the ED. The two main outcomes were the proportion of visits where naloxone and buprenorphine were both used and prescribed, and the rate of revisits to the emergency department in the six months following ED presentation. Methods: This was a multi-center retrospective cross-sectional study. We studied patients presenting to the ED who were 12-17 years old with an opioid-related presentation. Results: Two-hundred and thirty-one patients were identified out of 571 encounters screened. Of these presentations, 77/231 (33%) were girls and 154/231 (67%) were boys. The majority of patients were Latino (64%; n=147); 26% were white (n=59), 6% were middle eastern or Arab (14), and 4% were black (10). Incidence of opioid use disorder per 100,000 presentations increased by 2800% from 2014 to 2022 (21/100,000 +/- 10 [2014] to 600/100,000 +/- 50 [2022]). A plurality of cases was related to opioid withdrawal (42%; 97). On discharge from the ED, 29% of patients received naloxone. For patients in withdrawal, 4% received a prescription for buprenorphine. Twenty-nine percent of patients had a return to the ED in the six months following initial visit. Conclusions: Adolescent opioid-related presentations to the ED are rapidly increasing. Increasing ED presentations, compounded by a high 6-month revisit rate, pose a management challenge amid limited outpatient resources for this population. Opioid agonist therapy and naloxone are not routinely provided. Increasing the use of both are two ways to improve the quality of care for this population.
Language	English
Publishing date	2024-02-29
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2024.111136
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Zs.A 1310: Show issues

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Article ; Online: Open-source five degree of freedom motion platform for investigating fish-robot interaction

Brent Utter / Alexander Brown

HardwareX, Vol 7, Iss , Pp - (2020)

2020

Abstract: This paper presents the design, construction, operation, and validation of a robotic gantry platform specifically designed for studying fish-robot interaction. The platform has five degrees of freedom to manipulate the three-dimensional position, yaw ... ...

Abstract	This paper presents the design, construction, operation, and validation of a robotic gantry platform specifically designed for studying fish-robot interaction. The platform has five degrees of freedom to manipulate the three-dimensional position, yaw angle, and the pitch of a lure. Additionally, it has a four-conductor slip ring that allows power and data to be transmitted to the lure for the operation of fins and other actuators that increase realism or act as stimuli to focal fish during an ethorobotic experiment. The design is open-source, low-cost, and includes purpose-built electronics, software, and hardware to make it extensible and customizable for a number of applications with varying requirements.
Keywords	Open-source hardware ; Ethorobotics ; Robotics ; Mechatronics ; Fish-robot interaction ; Science (General) ; Q1-390
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Maturational dyssynchrony in benign B-cell precursors following lymphocyte depleting chemotherapy: A potential pitfall for B-lymphoblastic leukemia minimal/measurable residual disease (MRD) flow cytometry analysis.

Placek, Alexander / Lockhart, Brian / Miller, Karin P / Wertheim, Gerald B / Maude, Shannon L / Wood, Brent L / Kovach, Alexandra E

Cytometry. Part B, Clinical cytometry

2024 Volume 106, Issue 2, Page(s) 138–141

MeSH term(s)	Humans ; Flow Cytometry ; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid ; Neoplasm, Residual
Language	English
Publishing date	2024-01-21
Publishing country	United States
Document type	Letter
ZDB-ID	2099657-3
ISSN	1552-4957 ; 1552-4949 ; 0196-4763
ISSN (online)	1552-4957
ISSN	1552-4949 ; 0196-4763
DOI	10.1002/cyto.b.22161
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Zs.A 1688: Show issues

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Article ; Online: Increasing number and shifting demographics of adolescent opioid use disorder presentations to the emergency department.

Sidlak, Alexander M / Howell, John M / Henry, Linda / Dibble, Brent

The American journal of emergency medicine

2023 Volume 73, Page(s) 79–82

Abstract: Introduction: Opioid use has been increasing in adolescents; however, lacking are data describing sex, ethnicity, and age groups most affected. We identified and characterized the trend in the adolescent population who presented to the emergency ... ...

Abstract	Introduction: Opioid use has been increasing in adolescents; however, lacking are data describing sex, ethnicity, and age groups most affected. We identified and characterized the trend in the adolescent population who presented to the emergency departments (ED) of a large hospital system. Methods: We obtained data directly from the electronic medical record for patients aged 12-21 years from January 2014 to December 2022. We identified opioid-related visits by primary diagnosis. Trends were compared amongst age groups and by sex and reported ethnicity. Results: Opioid-related presentations increased in all age groups and were significantly increased in adolescents aged 13-17 years compared to patients aged 18-21 years (1700% [range: 1000-3300%] v 400% [200-800%]; p = 0.02). Adolescents presenting to the ED with opioid-related primary diagnoses were more likely to be Hispanic and male in our region. Discussion: Over the last two years (2021-22) there was a significant increase in opioid-related presentations to our hospital system amongst adolescents and an acceleration post-COVID. In 2022, emergency department presentations shifted to younger teenagers and from white young adults to Hispanic adolescents. The increased number of cases posed management problems in the ED given the lack of outpatient treatment options. Conclusion: Opioid-related ED presentations are increasing in adolescents with post-COVID increases in male, Hispanic, and younger patients in our region. Pathways for outpatient treatment need to be developed for adolescents with OUD.
Language	English
Publishing date	2023-08-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.08.011
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