Kevin M Kelly - Profile on Academia.edu (original) (raw)

Papers by Kevin M Kelly

Chemical Research in Toxicology, Feb 7, 2019

Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects,... more Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects, including developmental neurotoxicity. Several neurotoxic PCBs are chiral and undergo atropisomeric enrichment in vivo due to atropselective metabolism by cytochrome P450 enzymes. Here we study how the liver-specific deletion of the cytochrome P450 reductase (cpr) gene alters the toxicokinetics of 2,2',3,3',6,6'-hexachlorobiphenyl (PCB 136) in mice. Male and female mice with a liver-specific deletion of cpr (KO) and congenic wild-type (WT) mice were exposed to a single oral dose of racemic PCB 136 (6.63 mg/kg). Levels and chiral signatures of PCB 136 and its hydroxylated metabolites were determined 1 to 48 h after PCB exposure in whole blood. Blood levels of PCB 136 were typically higher in M-WT compared to F-WT mice. At the later time points, F-KO mice had significantly higher PCB 136 levels than F-WT mice.

Journal of Agromedicine, 2020

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on ... more Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents. Methods: Cohorts collected data between 1992-2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD). Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than nonallergic asthma. Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Canadian Prosthetics & Orthotics Journal, 2018

OBJECTIVES The study objectives were to prospectively evaluate treatment results of infants prese... more OBJECTIVES The study objectives were to prospectively evaluate treatment results of infants presenting with isolated deformational brachycephaly following use of a cranial orthosis, and to investigate the role of entrance age on efficacy of treatment. PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32024/24441 How to cite: Kelly K.M, Joganic E, Beals S.P, Riggs J.A, McGuire M.K, Littlefield T.R. A PROSPECTIVE STUDY OF CRANIAL ORTHOTIC TREATMENT OF INFANTS WITH ISOLATED DEFORMATIONAL BRACHYCEPHALY. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32024 Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee.

Chemical Research in Toxicology, 2019

Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects,... more Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects, including developmental neurotoxicity. Several neurotoxic PCBs are chiral and undergo atropisomeric enrichment in vivo due to atropselective metabolism by cytochrome P450 enzymes. Here we study how the liver-specific deletion of the cytochrome P450 reductase (cpr) gene alters the toxicokinetics of 2,2',3,3',6,6'-hexachlorobiphenyl (PCB 136) in mice. Male and female mice with a liver-specific deletion of cpr (KO) and congenic wild-type (WT) mice were exposed to a single oral dose of racemic PCB 136 (6.63 mg/kg). Levels and chiral signatures of PCB 136 and its hydroxylated metabolites were determined 1 to 48 h after PCB exposure in whole blood. Blood levels of PCB 136 were typically higher in M-WT compared to F-WT mice. At the later time points, F-KO mice had significantly higher PCB 136 levels than F-WT mice.

International Journal of Environmental Research and Public Health, Apr 4, 2023

Arsenic and atrazine are two water contaminants of high public health concern in Iowa. The occurr... more Arsenic and atrazine are two water contaminants of high public health concern in Iowa. The occurrence of arsenic and atrazine in drinking water from Iowa's private wells and public water systems was investigated over several decades. In this study, the percentages of detection and violation of regulations were compared over region, season, and water source, and factors affecting the detection and concentration of arsenic and atrazine were analyzed using a mixed-effects model. Atrazine contamination in drinking water was found to vary by region, depending on agricultural usage patterns and hydrogeological features. The annual median atrazine levels of all public water systems were below the drinking water standard of 3 ppb in 2001-2014. Around 40% of public water systems contained arsenic at levels > 1 ppb in 2014, with 13.8% containing arsenic at levels of 5-10 ppb and 2.6% exceeding 10 ppb. This unexpected result highlights the ongoing public health threat posed by arsenic in drinking water in Iowa, emphasizing the need for continued monitoring and mitigation efforts to reduce exposure and associated health risks. Additionally, an atrazine metabolite, desethylatrazine, should be monitored to obtain a complete account of atrazine exposure and possible health effects.

Occupational safety, health, and well-being programs in small Midwest enterprises

Total worker health., 2019

Occupational and Environmental Medicine, 2019

IntroductionConstruction is a hazardous industry, with well-recognized risks of traumatic injury ... more IntroductionConstruction is a hazardous industry, with well-recognized risks of traumatic injury and high physical demands. Other threats to construction workers’ health and well-being occur from work organization and work environment factors, including precarious employment, long commutes, long work hours, and employer policies regarding health and safety. These non-traditional hazards have been associated with injury and illness, psychosocial stress, and unhealthy behaviors including poor diet and smoking. The cumulative impacts of both traditional and non-traditional hazards on the health and well-being of construction workers are largely unknown.MethodsWe conducted annual surveys among apprentice construction workers to identify relationships between four study domains: work organization and environment, health behaviors, health outcomes, and work outcomes.Results963 baseline surveys were completed and returned by apprentice construction workers (90% response rate, mean age 28)....

185. Developing Age-Based Standards for Respirators

AIHce 2001, 2001

Journal of Agromedicine, 2019

Occupational illness, injury, and fatality rates for those working in production agriculture are ... more Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher healthcare costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor selfreported health status was also related to increased injuries, but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Real Iowans Health Survey Questionnaire

Cleft lip and palate research: approaches at the cellular and molecular level

The end of the trail: the genetic bases for deriving the Polynesian peoples from Austronesian-speaking paleopopulations of Melanesian Near Oceania

European Journal of Plastic Surgery, 1991

This study was designed to evaluate the influence of two calcium channel blockers, verapamil and ... more This study was designed to evaluate the influence of two calcium channel blockers, verapamil and nifedipine, on skin flap survival. These agents were selected because they inhibit the passage of calcium through calcium selective channels in the plasma membrane, thereby blocking calcium mediated electromechanical coupling in contractile tissue and resulting in peripheral arterial vasodilation. Three groups of pigs were used in this study. All skin flaps in this study were 3 cm wide and 12 cm long. The first group (10 flaps) served as controls with no pharmacologic manipulations. Pigs in group II (15 flaps) received verapamil (80 mg orally, three times a day) for 7 days postoperatively. Pigs in group III (15 flaps) received nifedipine (10 mg orally, three times a day) for 7 days postoperatively. Statistical analysis of the results demonstrated that both verapamil and nifedipine resulted in significant enhancement of skin flap survival. The increased survival of the skin flaps produced by nifedipine as compared to verapamil was statistically significant.

236. Direct Data Entry Using a Palm-Top Computer in a Large Epidemiologic and Environmental Study

AIHce 2000, 2000

148. International Interlaboratory Comparison of Endotoxin Assays Using Agricultural Dusts

AIHce 1998, 1999

Plagiocephaly: II. Is One Twin at Greater Risk? Multiple-Birth Infants at Higher Risk for Development of Deformational

Plastic and Reconstructive Surgery, 1995

Neurosurgical Focus, 1997

In his paper (Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural ... more In his paper (Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head? Neurosurg. Focus 2(2): Article 3, 1997) Dr. Moss presents results that purport to document combined physiotherapy and repositioning as a nonsurgical, nonorthotic alternative for the treatment of plagiocephaly. Central to his argument are favorable comparisons to measurements published in a study by Ripley, et al.,[3] of dynamic orthotic cranioplasty conducted in our clinic. Moss should be commended for his efforts to explore alternative forms of treatment; however, a careful reading of the manuscript reveals inaccuracies and errors that make comparisons to the study by Ripley, et al., questionable, if not meaningless. From its inception, Moss' plan to compare his measurements with those reported by Ripley, et al., is fraught with problems. In particular, his assertion that his measurements are "a subset of the measurements made during the study of outcomes for patients treated with cranial remodeling headbands" is in error. Our clinic follows the standard anthropometric protocols described by Farkas[1] and Kohler and Salter.[2] To determine cranial vault asymmetry (CVA), our anthropometrist first locates the widest lateral width of the head (eurion-eurion [eu-eu]) by moving the calipers in a plane parallel to the sagittal plane. Once eu-eu is identified, one end of the caliper is anchored and the other end is swept to its ipsilateral frontozygomatic (fz) site. This produces a diagonal measurement across the cranium. The protocol is repeated on the other side of the head. The difference between these diagonal measurements represents the CVA. In contrast, using Dr. Moss' technique, one first obtains the largest measurement between the bulged occipital region and the bossed forehead by rotating the calipers circumferentially around the bossed regions until a maximum is obtained. A similar diagonal measurement is made between the two regions of occipital and frontal flattening. The difference between these measurements produces Moss' CVA.

JPO Journal of Prosthetics and Orthotics, 2003

The recent increase in incidence of deformational plagiocephaly is commonly believed to be associ... more The recent increase in incidence of deformational plagiocephaly is commonly believed to be associated with the American Academy of Pediatrics' "Back to Sleep" campaign. Other factors, however, may contribute to the development of this condition. During the past decade, we have seen a number of infants whose deformities seem to be associated with the extended use of car seats, infant carriers, bouncy seats, and infant swings. Having recognized that notes about usage were being routinely recorded in the margins of our clinical records, we began collecting information on the amount of time infants were spending in these devices. In this report, we describe our findings and document the related cranial deformities. The data and photographs were collected between 1998 and 2000 and reviewed to determine the amount of time children with deformational plagiocephaly spent in these devices. During the three-year study period, 56.6% of the infants spent less than 1.5 hrs, 28.6% spent 1.5 to 4 hrs, and 14.8% spent more than 4 hrs/day in these devices. In addition, 5.7% slept in one of these devices during their first several months of life, frequently because of problems with reflux. These infants often developed an increase in posterior head height and "squaring" or "cornering" of the head. Normal use of car seats, carriers, swings and bouncy seats is not a concern; however, caution is warranted for infants who spend extended periods of time in these devices. The constant pressure these devices apply to the back of the cranium may perpetuate the deformation.

Development of a New Three-Dimensional Cranial Imaging System

Journal of Craniofacial Surgery, 2004

The development of a new three-dimensional (3D) imaging system designed to obtain a digital image... more The development of a new three-dimensional (3D) imaging system designed to obtain a digital image of an infant's cranium is described. This system is intended to replace the manual plaster-casting technique currently used during the process of fabricating cranial remodeling bands. The system uses 18 triangulated digital cameras and the projection of random infrared patterns to capture a 360 degrees image of an infant's cranium instantaneously, including the face and top of the head. Accuracy was calculated by comparing models digitized with this system with the same models digitized with high-precision inspection equipment. Safety was documented under guidelines established by the American Council of Governmental Industrial Hygienists. Images were acquired in 0.008 seconds and processed for viewing in software within 2.5 minutes. Accuracy was calculated to be +/-0.236 mm. Hazard analysis confirmed the system to be safe for direct continuous exposure. The data acquired may be viewed as a point cloud, wire frame, or surface on which a digital photograph (ie, texture) is automatically overlaid. Physical models are created by exporting the digital data to a multiaxis milling machine or stereolithography machine. Quantitative data (linear and surface measurements, curvature, and volumes) can be obtained directly from the digital data. The cranial imaging system is a safe and accurate method of obtaining digital 3D images of an infant's cranium. Along with the obvious clinical and manufacturing benefits, it also has significant potential as a research tool for documenting the natural history and evaluating the treatment of plagiocephaly.

Chemical Research in Toxicology, Feb 7, 2019

Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects,... more Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects, including developmental neurotoxicity. Several neurotoxic PCBs are chiral and undergo atropisomeric enrichment in vivo due to atropselective metabolism by cytochrome P450 enzymes. Here we study how the liver-specific deletion of the cytochrome P450 reductase (cpr) gene alters the toxicokinetics of 2,2',3,3',6,6'-hexachlorobiphenyl (PCB 136) in mice. Male and female mice with a liver-specific deletion of cpr (KO) and congenic wild-type (WT) mice were exposed to a single oral dose of racemic PCB 136 (6.63 mg/kg). Levels and chiral signatures of PCB 136 and its hydroxylated metabolites were determined 1 to 48 h after PCB exposure in whole blood. Blood levels of PCB 136 were typically higher in M-WT compared to F-WT mice. At the later time points, F-KO mice had significantly higher PCB 136 levels than F-WT mice.

Journal of Agromedicine, 2020

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on ... more Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents. Methods: Cohorts collected data between 1992-2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD). Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than nonallergic asthma. Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Canadian Prosthetics & Orthotics Journal, 2018

OBJECTIVES The study objectives were to prospectively evaluate treatment results of infants prese... more OBJECTIVES The study objectives were to prospectively evaluate treatment results of infants presenting with isolated deformational brachycephaly following use of a cranial orthosis, and to investigate the role of entrance age on efficacy of treatment. PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32024/24441 How to cite: Kelly K.M, Joganic E, Beals S.P, Riggs J.A, McGuire M.K, Littlefield T.R. A PROSPECTIVE STUDY OF CRANIAL ORTHOTIC TREATMENT OF INFANTS WITH ISOLATED DEFORMATIONAL BRACHYCEPHALY. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32024 Abstracts were Peer-reviewed by the AOPA 2018 National Assembly Scientific Committee.

Chemical Research in Toxicology, 2019

Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects,... more Exposure to polychlorinated biphenyls (PCBs) has been implicated in adverse human health effects, including developmental neurotoxicity. Several neurotoxic PCBs are chiral and undergo atropisomeric enrichment in vivo due to atropselective metabolism by cytochrome P450 enzymes. Here we study how the liver-specific deletion of the cytochrome P450 reductase (cpr) gene alters the toxicokinetics of 2,2',3,3',6,6'-hexachlorobiphenyl (PCB 136) in mice. Male and female mice with a liver-specific deletion of cpr (KO) and congenic wild-type (WT) mice were exposed to a single oral dose of racemic PCB 136 (6.63 mg/kg). Levels and chiral signatures of PCB 136 and its hydroxylated metabolites were determined 1 to 48 h after PCB exposure in whole blood. Blood levels of PCB 136 were typically higher in M-WT compared to F-WT mice. At the later time points, F-KO mice had significantly higher PCB 136 levels than F-WT mice.

International Journal of Environmental Research and Public Health, Apr 4, 2023

Arsenic and atrazine are two water contaminants of high public health concern in Iowa. The occurr... more Arsenic and atrazine are two water contaminants of high public health concern in Iowa. The occurrence of arsenic and atrazine in drinking water from Iowa's private wells and public water systems was investigated over several decades. In this study, the percentages of detection and violation of regulations were compared over region, season, and water source, and factors affecting the detection and concentration of arsenic and atrazine were analyzed using a mixed-effects model. Atrazine contamination in drinking water was found to vary by region, depending on agricultural usage patterns and hydrogeological features. The annual median atrazine levels of all public water systems were below the drinking water standard of 3 ppb in 2001-2014. Around 40% of public water systems contained arsenic at levels > 1 ppb in 2014, with 13.8% containing arsenic at levels of 5-10 ppb and 2.6% exceeding 10 ppb. This unexpected result highlights the ongoing public health threat posed by arsenic in drinking water in Iowa, emphasizing the need for continued monitoring and mitigation efforts to reduce exposure and associated health risks. Additionally, an atrazine metabolite, desethylatrazine, should be monitored to obtain a complete account of atrazine exposure and possible health effects.

Occupational safety, health, and well-being programs in small Midwest enterprises

Total worker health., 2019

Occupational and Environmental Medicine, 2019

IntroductionConstruction is a hazardous industry, with well-recognized risks of traumatic injury ... more IntroductionConstruction is a hazardous industry, with well-recognized risks of traumatic injury and high physical demands. Other threats to construction workers’ health and well-being occur from work organization and work environment factors, including precarious employment, long commutes, long work hours, and employer policies regarding health and safety. These non-traditional hazards have been associated with injury and illness, psychosocial stress, and unhealthy behaviors including poor diet and smoking. The cumulative impacts of both traditional and non-traditional hazards on the health and well-being of construction workers are largely unknown.MethodsWe conducted annual surveys among apprentice construction workers to identify relationships between four study domains: work organization and environment, health behaviors, health outcomes, and work outcomes.Results963 baseline surveys were completed and returned by apprentice construction workers (90% response rate, mean age 28)....

185. Developing Age-Based Standards for Respirators

AIHce 2001, 2001

Journal of Agromedicine, 2019

Occupational illness, injury, and fatality rates for those working in production agriculture are ... more Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher healthcare costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor selfreported health status was also related to increased injuries, but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual's general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.

Real Iowans Health Survey Questionnaire

Cleft lip and palate research: approaches at the cellular and molecular level

The end of the trail: the genetic bases for deriving the Polynesian peoples from Austronesian-speaking paleopopulations of Melanesian Near Oceania

European Journal of Plastic Surgery, 1991

This study was designed to evaluate the influence of two calcium channel blockers, verapamil and ... more This study was designed to evaluate the influence of two calcium channel blockers, verapamil and nifedipine, on skin flap survival. These agents were selected because they inhibit the passage of calcium through calcium selective channels in the plasma membrane, thereby blocking calcium mediated electromechanical coupling in contractile tissue and resulting in peripheral arterial vasodilation. Three groups of pigs were used in this study. All skin flaps in this study were 3 cm wide and 12 cm long. The first group (10 flaps) served as controls with no pharmacologic manipulations. Pigs in group II (15 flaps) received verapamil (80 mg orally, three times a day) for 7 days postoperatively. Pigs in group III (15 flaps) received nifedipine (10 mg orally, three times a day) for 7 days postoperatively. Statistical analysis of the results demonstrated that both verapamil and nifedipine resulted in significant enhancement of skin flap survival. The increased survival of the skin flaps produced by nifedipine as compared to verapamil was statistically significant.

236. Direct Data Entry Using a Palm-Top Computer in a Large Epidemiologic and Environmental Study

AIHce 2000, 2000

148. International Interlaboratory Comparison of Endotoxin Assays Using Agricultural Dusts

AIHce 1998, 1999

Plagiocephaly: II. Is One Twin at Greater Risk? Multiple-Birth Infants at Higher Risk for Development of Deformational

Plastic and Reconstructive Surgery, 1995

Neurosurgical Focus, 1997

In his paper (Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural ... more In his paper (Nonsurgical, nonorthotic treatment of occipital plagiocephaly: what is the natural history of the misshapen neonatal head? Neurosurg. Focus 2(2): Article 3, 1997) Dr. Moss presents results that purport to document combined physiotherapy and repositioning as a nonsurgical, nonorthotic alternative for the treatment of plagiocephaly. Central to his argument are favorable comparisons to measurements published in a study by Ripley, et al.,[3] of dynamic orthotic cranioplasty conducted in our clinic. Moss should be commended for his efforts to explore alternative forms of treatment; however, a careful reading of the manuscript reveals inaccuracies and errors that make comparisons to the study by Ripley, et al., questionable, if not meaningless. From its inception, Moss' plan to compare his measurements with those reported by Ripley, et al., is fraught with problems. In particular, his assertion that his measurements are "a subset of the measurements made during the study of outcomes for patients treated with cranial remodeling headbands" is in error. Our clinic follows the standard anthropometric protocols described by Farkas[1] and Kohler and Salter.[2] To determine cranial vault asymmetry (CVA), our anthropometrist first locates the widest lateral width of the head (eurion-eurion [eu-eu]) by moving the calipers in a plane parallel to the sagittal plane. Once eu-eu is identified, one end of the caliper is anchored and the other end is swept to its ipsilateral frontozygomatic (fz) site. This produces a diagonal measurement across the cranium. The protocol is repeated on the other side of the head. The difference between these diagonal measurements represents the CVA. In contrast, using Dr. Moss' technique, one first obtains the largest measurement between the bulged occipital region and the bossed forehead by rotating the calipers circumferentially around the bossed regions until a maximum is obtained. A similar diagonal measurement is made between the two regions of occipital and frontal flattening. The difference between these measurements produces Moss' CVA.

JPO Journal of Prosthetics and Orthotics, 2003

The recent increase in incidence of deformational plagiocephaly is commonly believed to be associ... more The recent increase in incidence of deformational plagiocephaly is commonly believed to be associated with the American Academy of Pediatrics' "Back to Sleep" campaign. Other factors, however, may contribute to the development of this condition. During the past decade, we have seen a number of infants whose deformities seem to be associated with the extended use of car seats, infant carriers, bouncy seats, and infant swings. Having recognized that notes about usage were being routinely recorded in the margins of our clinical records, we began collecting information on the amount of time infants were spending in these devices. In this report, we describe our findings and document the related cranial deformities. The data and photographs were collected between 1998 and 2000 and reviewed to determine the amount of time children with deformational plagiocephaly spent in these devices. During the three-year study period, 56.6% of the infants spent less than 1.5 hrs, 28.6% spent 1.5 to 4 hrs, and 14.8% spent more than 4 hrs/day in these devices. In addition, 5.7% slept in one of these devices during their first several months of life, frequently because of problems with reflux. These infants often developed an increase in posterior head height and "squaring" or "cornering" of the head. Normal use of car seats, carriers, swings and bouncy seats is not a concern; however, caution is warranted for infants who spend extended periods of time in these devices. The constant pressure these devices apply to the back of the cranium may perpetuate the deformation.

Development of a New Three-Dimensional Cranial Imaging System

Journal of Craniofacial Surgery, 2004

The development of a new three-dimensional (3D) imaging system designed to obtain a digital image... more The development of a new three-dimensional (3D) imaging system designed to obtain a digital image of an infant's cranium is described. This system is intended to replace the manual plaster-casting technique currently used during the process of fabricating cranial remodeling bands. The system uses 18 triangulated digital cameras and the projection of random infrared patterns to capture a 360 degrees image of an infant's cranium instantaneously, including the face and top of the head. Accuracy was calculated by comparing models digitized with this system with the same models digitized with high-precision inspection equipment. Safety was documented under guidelines established by the American Council of Governmental Industrial Hygienists. Images were acquired in 0.008 seconds and processed for viewing in software within 2.5 minutes. Accuracy was calculated to be +/-0.236 mm. Hazard analysis confirmed the system to be safe for direct continuous exposure. The data acquired may be viewed as a point cloud, wire frame, or surface on which a digital photograph (ie, texture) is automatically overlaid. Physical models are created by exporting the digital data to a multiaxis milling machine or stereolithography machine. Quantitative data (linear and surface measurements, curvature, and volumes) can be obtained directly from the digital data. The cranial imaging system is a safe and accurate method of obtaining digital 3D images of an infant's cranium. Along with the obvious clinical and manufacturing benefits, it also has significant potential as a research tool for documenting the natural history and evaluating the treatment of plagiocephaly.