Rhonda Szczesniak

Rhonda Szczesniak
Cincinnati Children's Hospital Medical Center | CCHMC · Department of Pediatrics

About

103
Publications
9,735
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2,006
Citations
Citations since 2017
52 Research Items
1807 Citations
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Introduction
Skills and Expertise

Publications

Publications (103)
Article
Background: Youth with CF and pulmonary exacerbation (PEx) often experience weight loss, then rapid weight gain. Little is known about body composition and its relationship to functional outcomes during this critical period. Methods: Twenty CF youth experiencing PEx were assessed on the day following admission and 7-17 days later at discharge fo...
Article
Objective: Despite evidence-based guidelines, antibiotics prescribed for uncomplicated skin and soft tissue infections can involve inappropriate microbial coverage. Our aim was to evaluate the appropriateness of antibiotic prescribing practices for mild nonpurulent cellulitis in a pediatric tertiary academic medical center over a 1-year period. M...
Article
In omics experiments, estimation and variable selection can involve thousands of proteins/genes observed from a relatively small number of subjects. Many regression regularization procedures have been developed for estimation and variable selection in such high-dimensional problems. However, approaches have predominantly focused on linear regressio...
Article
Full-text available
Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellit...
Article
Full-text available
In the attention-deficit hyperactivity disorder (ADHD) study, children are prescribed different stimulant medications. The height measurements are recorded longitudinally along with the medication time. Differences among the patients are captured by the parameters suggested the Superimposition by Translation and Rotation (SITAR) model using three s...
Article
Full-text available
Women with pre-gestational diabetes have a high rate of large for gestational age (LGA) babies compared to women without diabetes. In particular, there is a high rate of asymmetric LGA defined as ponderal index (PI) > 90th percentile for gestational age. We examined the association of birth weight and PI, with body mass index (BMI) and obesity stat...
Article
Many longitudinal studies often require jointly modeling a biomarker and an event outcome, in order to provide more accurate inference and dynamic prediction of disease progression. Cystic fibrosis (CF) studies have illustrated the benefits of these models, primarily examining the joint evolution of lung-function decline and survival. We propose a...
Article
Many longitudinal studies often require jointly modeling a biomarker and an event outcome, in order to provide more accurate inference and dynamic prediction of disease progression. Cystic fibrosis (CF) studies have illustrated the benefits of these models, primarily examining the joint evolution of lung‐function decline and survival. We propose a...
Article
Introduction: Natural, social, and constructed environments play a critical role in the development and exacerbation of respiratory diseases. However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders. Areas Covered...
Preprint
Full-text available
Background: Beginning at a young age, children with cystic fibrosis (CF) embark on demanding care regimens that pose challenges to parents. We examined the extent to which clinical, demographic and psychosocial features inform patterns of adherence to pulmonary therapies and how these patterns can be used to develop clinical personas, defined as as...
Preprint
Full-text available
Background: Beginning at a young age, children with cystic fibrosis (CF) embark on demanding care regimens that pose challenges to parents. We examined the extent to which clinical, demographic and psychosocial features inform patterns of adherence to pulmonary therapies and how these patterns can be used to develop clinical personas, defined as as...
Preprint
Full-text available
Background: Beginning at a young age, children with cystic fibrosis (CF) embark on demanding care regimens that pose challenges to parents. We examined the extent to which clinical, demographic and psychosocial features inform patterns of adherence to pulmonary therapies and how these patterns can be used to develop clinical personas, defined as as...
Preprint
Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a mu...
Preprint
Full-text available
Growth curve modeling should ideally be flexible, computationally feasible and allow for the inclusion of co-variates for better predictability and mechanistic explanations. The original shape invariant growth curve model, motivated by epidemiological research on the evolution of pubertal heights over time, fits the underlying shape function for he...
Article
Full-text available
Spiritual struggles (SSs) are distressing spiritual thoughts associated with poorer health outcomes. This study’s purpose was to test feasibility, acceptability, and fidelity of an intervention to decrease SS of parents of children with CF. Parents screening positive for SS were enrolled and were randomized to intervention or attention-control cond...
Preprint
Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbation (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a mul...
Preprint
Full-text available
Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a mu...
Preprint
Full-text available
Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a mu...
Article
Introduction: The methods to identify important variables among a large number of variables is critical to produce stable models that generate accurate predictions. This work is motivated by CF proteomic data that includes 5011 protein isoforms from 88 patients. The goal is to develop a variable selection model to identify a handful set of predicti...
Article
Full-text available
OBJECTIVES/SPECIFIC AIMS: This study aims to first describe the unique cytokine profile and TGFbeta levels of young children with CF, then understand the pathologic effects of TGFbeta on lung function in a CF animal model. These powerful translational studies linking observations in clinical disease with a transgenic mouse model allow us a unique o...
Article
Full-text available
The clinical course of cystic fibrosis lung disease is marked by acute drops of lung function, defined clinically as rapid decline. As such, lung function is monitored routinely through pulmonary function testing, producing hundreds of measurements over the lifespan of an individual patient. Point-of-care technologies aimed at improving detection o...
Article
Background: Cystic fibrosis (CF) is an inherited, chronic, progressive condition affecting around 10,000 individuals in the UK and over 70,000 worldwide. Survival in CF has improved considerably over recent decades and it is important to provide up-to-date information on patient prognosis. Methods: The UK Cystic Fibrosis Registry is a secure cen...
Article
Full-text available
PurposeTo quantify HRQOL of TGN patients using the PedsQL 4.0 generic core scales, and to compare reported HRQOL of TGN adolescents with published data from comparison populations. Methods Transgender children and adolescents (N = 142; 68% natal females) ages 6–23 years (M = 15.9, SD = 3.7) attending an outpatient clinic for TGN care at an academic...
Article
A two-level Gaussian process (GP) joint model is proposed to improve personalized prediction of medical monitoring data. The proposed model is applied to jointly analyze multiple longitudinal biomedical outcomes, including continuous measurements and binary outcomes, to achieve better prediction in disease progression. At the population level of th...
Article
Full-text available
Cystic fibrosis is a chronic lung disease which requires frequent patient monitoring to maintain lung function over time and minimize onset of acute respiratory events known as pulmonary exacerbations. From the clinical point of view it is important to characterize the association between key biomarkers such as $FEV_1$ and time-to first exacerbatio...
Article
Full-text available
Background: Cystic fibrosis (CF) is the most common inherited disease in Caucasians, affecting around 10,000 individuals in the UK today. Prognosis has improved considerably over recent decades with ongoing improvements in treatment and care. Providing up-to-date survival predictions is important for patients, clinicians and health services planni...
Article
Full-text available
Background Epidemiologic surveillance of lung function is key to clinical care of individuals with cystic fibrosis, but lung function decline is nonlinear and often impacted by acute respiratory events known as pulmonary exacerbations. Statistical models are needed to simultaneously estimate lung function decline while providing risk estimates for...
Conference Paper
Full-text available
Slowing cystic fibrosis (CF) lung disease progression is crucial to survival, but point-of-care technologies aimed at early detection-and possibly prevention-of rapid lung function decline are limited. This proof-of-principle study leverages a rich national patient registry and follow-up data on a local CF cohort to build an algorithm and prototype...
Article
Modern environmental and climatological studies produce multiple outcomes at high spatial resolutions. Multivariate spatial modeling is an established means to quantify cross-correlation among outcomes. However, existing models typically suffer from poor computational efficiency and lack the flexibility to simultaneously estimate auto- and cross-co...
Article
Full-text available
Objective Spiritual struggle (SS) is associated with poorer health outcomes including depression. The study's main objectives were to characterize change in depression over time, examine longitudinal associations between SS and depression, and determine the extent to which experiencing SS at baseline was predictive of developing depression at follo...
Article
Full-text available
Background Expansion of CFTR modulators to patients with rare/undescribed mutations will be facilitated by patient-derived models quantifying CFTR function and restoration. We aimed to generate a personalized model system of CFTR function and modulation using non-surgically obtained nasal epithelial cells (NECs). Methods NECs obtained by curettage...
Article
Objective: More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider's response to any EHR alert. The primary goal was to evaluate the effects of alert burden on...
Article
Rationale: Individuals with cystic fibrosis are at risk for prolonged drops in lung function, clinically termed rapid decline, during discreet periods of the disease. Objectives: To identify phenotypes of rapid pulmonary decline and determine how these phenotypes are related to patient characteristics. Methods: A longitudinal cohort study of c...
Article
Study objectives: The assessment of pharyngeal collapsibility is difficult to perform in children under normal sleep. An alternative is to perform the assessment under an anesthetic, such as dexmedetomidine (DEX), that induces non-rapid eye movement (NREM) sleep. The objectives of this study were to compare critical closing airway pressure (Pcrit)...
Article
Study Objectives: To describe a dynamic three-dimensional (3D) computed tomography (CT) technique for the upper airway and compare the required radiation dose to that used for common clinical studies of a similar anatomical area, such as for subjects undergoing routine clinical facial CT. Methods: Dynamic upper-airway CT was performed on eight subj...
Article
Full-text available
Aim. To examine the gestational glycemic profile and identify specific times during pregnancy that variability in glucose levels, measured by change in velocity and acceleration/deceleration of blood glucose fluctuations, is associated with delivery of a large-for-gestational-age (LGA) baby, in women with type 1 diabetes. Methods. Retrospective ana...
Article
Background: Adequate nutrition is essential for growth in children with cystic fibrosis (CF). The new CF Foundation Clinical Practice Guidelines bring attention to monitoring macronutrient intake as well as total energy. Methods: Dietary intake of 75 preschool children with CF and pancreatic insufficiency was examined and compared to the Clinica...
Article
Full-text available
Background: Forced expiratory volume in 1s (FEV1) is an established marker of cystic fibrosis (CF) disease progression that is used to capture clinical course and evaluate therapeutic efficacy. The research community has established FEV1 surveillance data through a variety of observational data sources such as patient registries, and there is a gr...
Article
Background: Progressive, restrictive, respiratory insufficiency is the major cause of morbidity and mortality in Congenital Muscular Dystrophy (CMD). Nocturnal hypoventilation precedes daytime alveolar hypoventilation, and if untreated, may lead to respiratory failure and cor pulmonale. CMD consensus care guidelines recommend screening for respira...
Data
The Supplementary Material contains relevant SAS code for the methodology described in the article.
Article
Full-text available
Background: The dawn of precision medicine and CFTR modulators require more detailed assessment of lung structure in cystic fibrosis (CF) clinical studies. Various imaging markers have emerged and are measurable, but clarity is needed to identify what markers should count for clinical studies. High-resolution chest computed tomography (CT) scoring...
Article
Full-text available
Studies of religious/spiritual behavior frequently rely on self-reported questionnaire data, which is susceptible to bias. The Daily Phone Diary (DPD) was developed to minimize bias in reporting activities and behavior across a 24-hour period. A cross-sectional study of 126 parents of children with cystic fibrosis was used to establish the validity...
Article
Study objectives: To describe a dynamic three-dimensional (3D) computed tomography (CT) technique for the upper airway and compare the required radiation dose to that used for common clinical studies of a similar anatomical area, such as for subjects undergoing routine clinical facial CT. Methods: Dynamic upper-airway CT was performed on eight s...
Article
Full-text available
p> Background: Previous small-sample studies have examined the effect of gastronomy (g-) tube placement on weight, height, and lung function in adolescent patients with cystic fibrosis (CF), but there are no RCTs to date reporting efficacy. The goal of this study was to implement a dynamic prediction model to 1) understand the role of rapid lung fu...
Article
Full-text available
Rationale: Refractory lung function decline in association with recurrent pulmonary exacerbations is a common, yet poorly explained finding in CF. We reviewed clinically-indicated lung biopsy specimens obtained during a period of persistent decline to investigate histopathologic mechanisms of pulmonary deterioration during adolescence and early ad...
Article
Rationale: Recent advancements in magnetic resonance imaging (MRI) have been made that improve our ability to assess pulmonary structure and function in cystic fibrosis (CF) patients. A non-ionizing imaging modality that can be used as a serial monitoring tool throughout life can positively impact patient care and outcomes. Objectives: The purpo...
Article
Objectives: Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications. Materials and Methods: We created an order and alert ana...
Article
Full-text available
Objective To identify phenotypes of type 1 diabetes control and associations with maternal/neonatal characteristics based on blood pressure (BP), glucose, and insulin curves during gestation, using a novel functional data analysis approach that accounts for sparse longitudinal patterns of medical monitoring during pregnancy. Methods We performed a...
Article
Full-text available
Semiparametric mixed models are increasingly popular for statistical analysis of medical device studies in which long sequences of repeated measurements are recorded. Monitoring these sequences at different periods over time on the same individual, such as before and after an intervention, results in nested repeated measures (NRM). Covariance model...
Article
Purpose: To further validate the ability of ultrashort echo-time (UTE) magnetic resonance imaging (MRI) in quantifying lung density in patients diagnosed with chronic obstructive pulmonary disease (COPD) and to develop an MRI-based emphysema index (EI). Materials and methods: Ten subjects clinically diagnosed with COPD (5M/5F, age 62.6 ± 8.5 yea...
Article
Background: Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery. Objectives: To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults wit...
Article
Full-text available
Objective: Adolescent cystic fibrosis (CF) treatment adherence is a significant multidimensional issue. Using the Theory of Reasoned Action (TRA), this study examined the role of spiritual factors in adherence. METHODS: Forty-five 11-19-year-olds diagnosed with CF completed questionnaires concerning psychosocial, spiritual, and adherence-related c...
Article
Full-text available
Metabolomics is the comprehensive study of small molecule metabolites in biological systems. By assaying and analyzing thousands of metabolites in biological samples, it provides a whole picture of metabolic status and biochemical events happening within an organism and has become an increasingly powerful tool in the disease research. In metabolomi...
Article
Full-text available
Lower airway biomarkers of restored cystic fibrosis transmembrane conductance regulator (CFTR) function are limited. We hypothesized that fractional excretion of nitric oxide (FENO), typically low in CF patients, would demonstrate reproducibility during CFTR-independent therapies, and increase during CFTR-specific intervention (ivacaftor) in patien...
Article
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The potential to characterize nonlinear progression over time is now possible in many health conditions due to advancements in medical monitoring and more frequent data collection. It is often of interest to investigate differences between experimental groups in a study or identify the onset of rapid changes in the response of interest using medica...
Article
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Decannulation readiness is approached in several ways and is tailored to the individual patient. While microlaryngoscopy and bronchoscopy evaluate airway patency at all levels, polysomnography assesses sleep-related upper airway physiology. There are limited data in the literature on the utility of these tools. Thus, the main objectives of this stu...
Article
Objectives To investigate whether vitamin D status and vitamin D insufficiency were associated with CF pulmonary exacerbations in our local CF Center. Methods Data was used for patients ages 6–18 years during the years 2000–2010 from our local CF database. Models were created to investigate the association of Vitamin D 25-OH levels and IV exacerba...
Article
Full-text available
Evidence-based treatments that achieve optimal energy intake and improve growth in preschool-aged children with cystic fibrosis (CF) are a critical need. To test whether behavioral and nutritional treatment (intervention) was superior to an education and attention control treatment in increasing energy intake, weight z (WAZ) score, and height z (HA...
Article
Full-text available
Cystic fibrosis is a progressive disease requiring a complex, time-consuming treatment regimen. Nonadherence may contribute to an acceleration of the disease process. Spirituality influences some parental healthcare behaviors and medical decision-making. We hypothesized that parents of children with cystic fibrosis, when classified into groups base...
Article
Highly skewed count data with excess zeros challenge the application of conventional statistical methods. Additional problems arise from repeated zero-inflated measures. Longitudinal zero-inflated Poisson (ZIP-mixed) models are mixtures of logistic and Poisson models that accommodate excess zeros and repeated counts. We compared a ZIP-mixed model w...
Article
Full-text available
The aim of this study is to assess insulin secretion in pediatric cystic fibrosis (CF) patients with exocrine pancreatic sufficiency. Glucose and insulin responses during an oral glucose tolerance test (OGTT) were measured in 146 CF patients. Patients were divided into exocrine sufficient (CF-PS) and insufficient (CF-PI) groups based on pancreatic...