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Rae C, Furlong W, Jankovic M, Moghrabi A, Naqvi A, Sala A, Samson Y, DePauw S, Feeny D, Barr R. Economic evaluation of treatment for acute lymphoblastic leukaemia in childhood. Eur J Cancer Care (Engl) 2014; 23:779-85. [PMID: 24393150 DOI: 10.1111/ecc.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/27/2022]
Abstract
Berlin-Frankfurt-Munster (BFM) and Dana-Farber Cancer Institute (DFCI) consortia's treatment strategies for acute lymphoblastic leukaemia (ALL) in children are widely used. We compared the health effects and monetary costs of hospital treatments for these two strategies. Parents of children treated at seven centres in Canada, Italy and the USA completed health-related quality of life (HRQL) assessments during four active treatment phases and at 2 years after treatment. Mean HRQL scores were used to calculate quality-adjusted life years (QALYs) for a period of 5 years following diagnosis. Total costs of treatment were determined from variables in administrative databases in a universally accessible and publicly funded healthcare system. Valid HRQL assessments (n = 1200) were collected for 307 BFM and 317 DFCI patients, with costs measured for 66 BFM and 28 DFCI patients. QALYs per patient were <1.0% greater for BFM than DFCI. Median HRQL scores revealed no difference in QALYs. The difference in mean total costs for BFM (US$88 480) and DFCI (US$93 026) was not significant (P = 0.600). This study provides no evidence of superiority for one treatment strategy over the other. Current BFM or DFCI strategies should represent conventional management for the next economic evaluation of treatments for ALL in childhood.
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Barr R, Petrie C, Furlong W, Rothney M, Feeny D. Health-related quality of life during post-induction chemotherapy in children with acute lymphoblastic leukemia in remission. Int J Oncol 2012; 11:333-9. [PMID: 21528219 DOI: 10.3892/ijo.11.2.333] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Using a multi-attribute approach, we and others have reported on the comprehensive health status of survivors of cancer in childhood, after completion of therapy. However, there is a dearth of information about health status and associated health-related quality of life (HRQL) in children and adults with cancer, during the treatment process; a deficit which this study was intended to redress. All children (n=18) receiving 'maintenance' chemotherapy for acute lymphoblastic leukemia (ALL) at a single institution were assessed prospectively through a single cycle of therapy. Patients, family members and health care professionals used global ratings, the health utilities index mark 2 (HUI2) and mark 3 (HUI3) classification systems, and detailed descriptions of temporary states of health, to provide independent assessments of health status at weekly intervals. Utility scores were derived for each comprehensive health state and for single attribute levels of the HUI2 system, and for the temporary health state descriptions. The classification of the subjects into the most appropriate temporary health states was challenging even for older children and some of the parents. The HUI instruments were used much more easily and produced highly comparable information. The most frequently affected attributes were pain, emotion and mobility/ambulation; in that order. The global (p=0.005) and specific morbidity burdens were, as predicted, greatest in the middle of the cycle of chemotherapy, reflecting the toxicity of steroid use. HUI2 global utility scores demonstrated moderate responsiveness with an intra-class correlation coefficient of 0.43. Cyclical administration of therapy, in particular corticosteroids, produces important changes in health status and HRQL in children with ALL. The HUI are valid and responsive systems for quantifying the burden of morbidity during the treatment of cancer in childhood. These are sensitive tools which can be used in a wide array of other circumstances to quantify changes in health status.
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Barr R, Furlong W, Horsman J, Feeny D, Torrance G, Weitzman S. The monetary costs of childhood cancer to the families of patients. Int J Oncol 2012; 8:933-40. [PMID: 21544448 DOI: 10.3892/ijo.8.5.933] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The medical costs of cancer treatment are well described, but there are few reports of expenses incurred by families of children with malignant disease. The objective of this study was to describe the monetary costs borne by families of patients with childhood cancer and to determine whether these costs represent an important component of the burden of illness. Families completed a prospective diary survey about daily expenses incurred during each sample week of therapy. We also undertook a retrospective, cross-sectional questionnaire survey about expenses, incurred during the entire duration of treatment, associated with major or one-time cost items. Seventy families of children treated for high risk acute lymphoblastic leukemia, 19 families of children treated for Wilms' tumor stages 2-5, and 16 families of children treated for neuroblastoma stages 3 and 4 completed diaries or questionnaires detailing the costs resulting from the diseases and their treatment. The mean total expenses (in 1986 Canadian dollars) incurred by families of childhood cancer patients over the entire course of therapy are $26,070 for acute lymphoblastic leukemia? $20,074 for Wilms' tumour, and $10,376 for neuroblastoma. On-going weekly costs rather than major one-time purchases account for the largest share of expenses. Overall, in spite of universal first dollar coverage for medical care in Canada, family-borne costs during the course of these illnesses are at least one-third of the average family's after-tax income.
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Barr R, Pai M, Weitzman S, Feeny D, Furlong W, Rosenbaum P, Torrance G. A multiattribute approach to health-status measurement and clinical management illustrated by an application to brain-tumors in childhood. Int J Oncol 2012; 4:639-48. [PMID: 21566971 DOI: 10.3892/ijo.4.3.639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A comprehensive multi-attribute system was devised to assess global morbidity burden. The system was used to obtain qualitative and quantitative measures of health-status for a case series of survivors of brain tumors in childhood. Health-related quality-of-life scores for each global health-state were calculated from a utility function derived from measures of preferences collected during surveys of a random sample of parents of school age children in the general public (n=194). Global multi-attribute health status (MAHS) utility scores revealed a wide range of severity in morbidity burden. We suggest that the assessment of health-related quality-of-life should become an integral part of clinical management.
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Rae C, Furlong W, Horsman J, Pullenayegum E, Demers C, St-Louis J, Lillicrap D, Barr R. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia 2012; 19:385-91. [PMID: 22994803 DOI: 10.1111/hae.12014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 12/20/2022]
Abstract
von Willebrand disease (VWD) is a bleeding disorder that occurs in up to 1% of the general population. The great majority of females with VWD experience menorrhagia. The morbidity burden in females with VWD may relate to iron deficiency resulting from menorrhagia. To explore relationships between bleeding disorders, menorrhagia, iron deficiency and the outcomes of health-related quality of life (HRQL) and educational attainment. All subjects with VWD, and females with other bleeding disorders, in the Canadian national registry who were more than 12 years of age were eligible for survey. Survey measures included the HEALTH UTILITIES INDEX(®); abridged Clinical History Assessment Tool; socio-demographic questions and serum ferritin. Statistical analyses included testing differences among groups of means using analysis of variance and of proportions using chi-squared test. Significant size differences in mean HRQL scores were detected between VWD females and both females with other bleeding disorders [diff = (-0.08); P = 0.017] and VWD males [diff = (-0.07); P = 0.039]. Mean HRQL scores differed between females with and without menorrhagia (P < 0.001). Mean HRQL scores were not significantly different between females with and without iron deficiency. Educational attainment was not associated with disease group, menorrhagia status or iron status. Females with VWD have a greater morbidity burden than females in the general population, females with other bleeding disorders and males with VWD. Menorrhagia is associated with low HRQL scores in females with bleeding disorders, including VWD. Further investigation should assess how menorrhagia impacts HRQL in females with bleeding disorders.
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Kerr K, Barr R, Loo P, Fyfe N, Nicolson M. 57 Squamous cell and adenocarcinoma ‘lineage’ markers in large cell carcinoma of the lung. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Barr R. Hugh Cooper Barr. West J Med 2011. [DOI: 10.1136/bmj.d2675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barr R, Macdonald H, Stewart A, McGuigan F, Rogers A, Eastell R, Felsenberg D, Glüer C, Roux C, Reid DM. Association between vitamin D receptor gene polymorphisms, falls, balance and muscle power: results from two independent studies (APOSS and OPUS). Osteoporos Int 2010; 21:457-66. [PMID: 19629616 DOI: 10.1007/s00198-009-1019-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY Fall prevention is a key strategy for reducing osteoporotic fractures. We investigated the association between vitamin D receptor (VDR) polymorphisms and reported falls in postmenopausal women. Bsm1 polymorphisms were associated with falls, balance and muscle power measurements. These results may explain some of the excess fracture risk associated with VDR in some studies. INTRODUCTION Fall prevention is a key strategy for reducing osteoporotic fractures. It has been suggested that vitamin D supplementation may reduce the incidence of falls by reducing body sway and increasing muscle power. The vitamin D receptor gene is a well-studied candidate gene for osteoporosis. We investigated the association between VDR polymorphisms and reported falls in postmenopausal women. METHODS Falls data were collected in two separate population cohorts. Five polymorphisms of the VDR gene were analysed (Cdx-2, Fok-1, BsmI, Taq1 and Apa1) in the Aberdeen Prospective Osteoporosis Screening Study (APOSS) cohort. Results found in APOSS were then validated in an independent cohort--the Osteoporosis and Ultrasound (OPUS) study (Bsm1 and Fok1 only), where muscle power and balance were also measured. RESULTS Carriers of the 'B' allele (Bsm1) showed an increased risk for falls. In APOSS, this was statistically significant for visit 3 multiple falls (p = 0.047) and for recurrent falls (p = 0.043). Similar results were found in OPUS for visit 1 falls (p = 0.025) and visit 1 multiple falls (p = 0.015). Bsm1 polymorphisms were also associated with balance and muscle power measurements. CONCLUSIONS In conclusion, these results demonstrate an association between the Bsm1 polymorphism and risk of falling that may explain some of the excess fracture risk associated with VDR in some studies.
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Gupta S, Bonilla M, Fuentes SL, Caniza M, Howard SC, Barr R, Greenberg ML, Ribeiro R, Sung L. Incidence and predictors of treatment-related mortality in paediatric acute leukaemia in El Salvador. Br J Cancer 2009; 100:1026-31. [PMID: 19293804 PMCID: PMC2669993 DOI: 10.1038/sj.bjc.6604895] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Survival rates among children with leukaemia in low-income countries are lower than those in high-income countries. This has been attributed in part to higher treatment-related mortality (TRM). We examined the demographics, treatment, and outcomes of paediatric patients in El Salvador with acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) to determine the incidence, causes, and risk factors for TRM. Two trained data managers collected data prospectively; no patients were excluded. Biological, socioeconomic and nutritional predictors were examined. A total of 469 patients with ALL and 78 patients with AML were included. The 2-year cumulative incidence of TRM was significantly higher among children with AML (35.4±6.4%) than those with ALL (12.5±1.7%; P<0.0001). However, the proportion of deaths attributable to the toxicity of treatment did not differ significantly between AML (25/47, 53.2%) and ALL (55/107, 51.4%; P=0.98). Among children with ALL, low monthly income (P=0.04) and low parental education (P=0.02) significantly increased the risk of TRM. Among children with AML, biological, socioeconomic, and nutritional variables were not associated with TRM. In this low-income country, toxic death significantly contributes to mortality in both ALL and AML. A better understanding of the effect of socioeconomic status on TRM may suggest specific strategies for patients with ALL.
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Sala A, Talsma D, Webber C, Posgate S, Atkinson S, Barr R. Bone mineral status after treatment of malignant lymphoma in childhood and adolescence. Eur J Cancer Care (Engl) 2007; 16:373-9. [PMID: 17587363 DOI: 10.1111/j.1365-2354.2006.00757.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relationship between bone mineral mass and cumulative dose of corticosteroids (CDC) was investigated in 42 children and adolescents treated for Hodgkin disease (HD; n = 22) and non-Hodgkin lymphoma (NHL; n = 20). The median age at the time of the study was 24.1 years for HD survivors and 14.1 years for NHL survivors. Dual-energy X-ray absorptiometry [bone mineral density of the lumbar spine (LS-BMD) expressed as Z-scores] and peripheral quantitative computed tomography at the distal radius [trabecular volumetric BMD (vBMD-trab)] were undertaken. Osteopenia (Z-score < -1.00) was found in 9/22 patients with HD and 10/20 with NHL, while 34% (HD = 6, NHL = 8) had a vBMD-trab below the normal range. The CDC correlated inversely with LS-BMD Z-score (r =-0.41, P = 0.007). There was a statistically significantly higher vBMD-trab in patients who received low (1-4 g/m(2)) compared with high (>or=20 g/m(2)) CDC (P = 0.031). Treatment of malignant lymphoma with high CDC is a risk factor for development of osteopenia.
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Brown S, Belgaumi A, Ajarim D, Kofide A, Al-Saad R, Sabbah R, Ezzat A, Shoukri M, Barr R, Levin A. Loss to follow-up of patients with malignant lymphoma. Eur J Cancer Care (Engl) 2004; 13:180-4. [PMID: 15115474 DOI: 10.1111/j.1365-2354.2004.00461.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Loss to follow-up (LTFU) in cancer patients is a serious problem, yet there is little data on this and on the underlying reasons. Of 144 paediatric and 431 adult patients with lymphoma diagnosed in 1997/1998 at King Faisal Specialist Hospital and Research Center, Riyadh (KFSHRC), 30% and 48.5%, respectively, were LTFU after 4 years (excluding patients known to have died). In 2001-2002, 196 paediatric and adult lymphoma patients at KFSHRC were enrolled in a prospective study in which explanations were obtained in detail for non-attendance at follow-up appointments (No Show). Sixteen months after commencement of the study, 49 patients were No Show, because of patient-based communication problems (20), transportation problems (8), patient not contactable (18), and personal reasons (3). In addition, patients were recorded incorrectly as No Show through hospital/patient communication problems. The No Show patients, especially the 23 who failed to keep a second appointment, are identifiable as potential LTFU during the 3 years in which this cohort will be followed. This study and, we suggest, other studies on LTFU should stimulate interest in this issue, in the predisposing factors, and in strategies to address them.
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Khan F, Elherik K, Bolton-Smith C, Barr R, Hill A, Murrie I, Belch JJF. The effects of dietary fatty acid supplementation on endothelial function and vascular tone in healthy subjects. Cardiovasc Res 2004; 59:955-62. [PMID: 14553835 DOI: 10.1016/s0008-6363(03)00395-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Evaluation of the effects of supplementation of n-3 and n-6 fatty acids on vascular tone and endothelial function in healthy men and women aged 40 to 65 years. METHODS In a double-blind, randomised, placebo controlled study, 173 healthy volunteers took one of six oil supplements for 8 months. Supplements were placebo, oleic acid rich sunflower oil, evening primrose oil, soya bean oil, tuna fish oil, and tuna/evening primrose oil mix. Endothelium-dependent and independent vascular responses were measured in the forearm skin using laser Doppler imaging following iontophoretic applications of acetylcholine and sodium nitroprusside, respectively. RESULTS Acetylcholine, but not sodium nitroprusside responses were significantly improved after tuna oil supplementation (P=0.02). Additionally, there were significant positive correlations between acetylcholine responses and n-3 fatty acid levels in the plasma and erythrocyte membrane phospholipids after tuna oil supplementation. No significant changes in vascular response were seen after supplementation with any of the other oils. CONCLUSIONS Fish oil supplementation has a beneficial effect on endothelial function, even in normal healthy subjects. Modification of the diet by an increase of 6% in eicosapentaenoic acid and 27% in docosahexaenoic acid (equivalent to eating oily fish 2-3 times/week) might have significant beneficial effects on cardiovascular function and health.
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Abstract
This paper summarises the discussions from a meeting held on contrast ultrasound held on 21 October 2000 in Toronto, Canada. The aims of this meeting, supported by ATL/Philips Ultrasound, was to review the current clinical indications for contrast usage in the liver and kidney, arrive at recommendations for use of intravenous contrast agents, and speculate on the future uses. This paper is published to help understand this rapidly evolving field. Consensus points included a recommendation that Levovist in its post-vascular phase was of considerable value in detecting and excluding metastases in the liver, although unlikely realistically to replace CT or MR. Newer agents such as Sonovue, Definity and Sonazoid, suitable for low mechanical index (MI) imaging were also of great value and may have a further role for HCC detection. Equipment manufacturers should strive to keep improving low mechanical index modes for these agents. Promising applications for characterisation included further evaluation of lesions discovered on ultrasound and as a problem solver for CT or MR. To date no contrast agents have received approval from the FDA for radiological applications in the United States. The case for reimbursement for contrast agents was strongly supported by the panel.
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Castillo L, Fluchel M, Dabezies A, Pieri D, Brockhorst N, Barr R. Childhood cancer in Uruguay: 1992-1994. Incidence and mortality. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 37:400-4. [PMID: 11568906 DOI: 10.1002/mpo.1217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The referral of all children with cancer in Uruguay to a single center affords the opportunity to generate population-based incidence and mortality rates in this developing country in Latin America. PROCEDURE All incident cases of cancer in children, 0-14 years of age, were ascertained from a combination of three sources for the period January 1992-December 1994. Diagnoses were grouped according to the International Classification of Childhood Cancer. Information on the size and age distribution of the total population was obtained from national census records. Follow-up was undertaken until December 1999 to afford a minimum interval of 5 years and the determination of mortality rates. RESULTS The average annual incidence was 133.6 cases of cancer per million children per year and the disease distribution was similar to that in industrialized countries, with the exception of a higher rate and younger age distribution for the Hodgkin disease. The overall age-standardized mortality rate from cancer in childhood, at 6.5 per 100,000, was approximately twice that in the United States and Canada. CONCLUSIONS Basic indicators of development suggest that Uruguay is more akin to the countries of North America and Western Europe than to those in the developing world. An opportunity has been identified to improve the outcome for children with cancer in this country.
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Hann M, Baker D, Hayes J, Wagner A, Barr R. Methodological issues in the development of a national database for primary care groups and trusts. HEALTH & SOCIAL CARE IN THE COMMUNITY 2001; 9:286-293. [PMID: 11560744 DOI: 10.1046/j.1365-2524.2001.00309.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
At the National Primary Care Research and Development Centre (NPCRDC) we have constructed a national database for all primary care groups (PCGs) in England. At its core, the database links information about population socio-economic and demographic characteristics to generic health status and to the organisation, resourcing and activities of general practice. In this paper we describe and discuss the problems with linking these data, and with defining the boundaries and the local populations of PCGs, given that they have been established on the basis of administrative expediency rather than geographical coherence. We then consider the implications of these difficulties for needs assessment in primary care groups.
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Barr R. Suing the government. ADVERSE DRUG REACTIONS AND TOXICOLOGICAL REVIEWS 2001; 20:131-2. [PMID: 11668863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Barr R, Vieira A, Rovee-Collier C. Mediated imitation in 6-month-olds: remembering by association. J Exp Child Psychol 2001; 79:229-52. [PMID: 11394928 DOI: 10.1006/jecp.2000.2607] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In two experiments with 72 6-month-olds, we examined whether associating an imitation task with an operant task affects infants' memory for either task. In Experiment 1, infants who imitated target actions that were modeled for 60 s on a hand puppet remembered them for only 1 day. We hypothesized that if infants associated the puppet imitation task with a longer-remembered operant task, then they might remember it longer too. In Experiment 2, infants learned to press a lever to activate a miniature train-a task 6-month-olds remember for 2 weeks-and saw the target actions modeled immediately afterward. These infants successfully imitated for up to 2 weeks, but only if the train memory was retrieved first. A follow-up experiment revealed that the learned association was bidirectional. This is the first demonstration of mediated imitation in 6-month-olds across two very different paradigms and reveals that associations are an important means of protracting memories.
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Stern JW, Fang J, Shusterman S, Pierson G, Barr R, Pawel B, Diller L, Grupp SA. Angiogenesis inhibitor TNP-470 during bone marrow transplant: safety in a preclinical model. Clin Cancer Res 2001; 7:1026-32. [PMID: 11309354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
High-dose therapy with stem cell rescue is a treatment option for patients with advanced solid tumors. Although this approach has promise for some pediatric cancers, especially neuroblastoma, it is limited by the risk of relapse posttransplant as well as concern about possible reinfused tumor cells in autologous stem cell products. Antiangiogenic agents given during and after recovery from high-dose therapy with stem cell rescue may decrease the risk of relapse. TNP-470 is an antiangiogenic agent now in clinical trials. Although it inhibits the growth of bone marrow (BM) colony-forming cells in vitro, no significant hematological toxicity has been seen in Phase I trials. To assess the feasibility of using antiangiogenic agents during the period of posttransplant hematopoietic engraftment, we have developed a model of stem cell transplant in mice. Mice were lethally irradiated and then rescued with stem cells containing a transgene expressed in the hematopoietic lineage. Mice were then treated with TNP-470 or placebo, and assessed for survival, successful engraftment, and kinetics of engraftment. Both treated and control mice demonstrated reliable multilineage engraftment as well as normal lymphoid maturation with no excess mortality in the treated group. WBCs were lower but still within the normal range at d+28 in mice treated with bolus TNP-470, but not in those treated with continuous infusion TNP-470, compared with controls. These data indicate that inhibitors of angiogenesis do not adversely impact engraftment after stem cell transplantation.
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Shusterman S, Grupp SA, Barr R, Carpentieri D, Zhao H, Maris JM. The angiogenesis inhibitor tnp-470 effectively inhibits human neuroblastoma xenograft growth, especially in the setting of subclinical disease. Clin Cancer Res 2001; 7:977-84. [PMID: 11309349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Tumor vascularity is highly correlated with disease outcome in neuroblastoma. Thus, novel therapeutics that target the vascular endothelium are candidates for incorporation into clinical trials. We therefore examined the effect of TNP-470 on human neuroblastoma growth in mouse models reflecting both clinically evident and minimal disease. Mice were inoculated s.c. or by tail vein injection with 10(7) human neuroblastoma-derived CHP-134 cells and treated with TNP-470 (100 mg/kg/dose s.c. three times a week or by continuous infusion) or saline. Treatment was given as a single agent in established xenografts, 10 days after 450 mg/kg of cyclophosphamide, or 12 h after tumor inoculation. Tumor growth rate was markedly inhibited in mice receiving TNP-470 administered alone both s.c. and by continuous infusion with a treatment to control ratio (T:C) at day 16 of 0.3 (P < 0.001) and a T:C at day 30 of 0.4 (P = 0.029) for each dosing method, respectively. TNP-470 also significantly inhibited tumor growth when administered following cyclophosphamide (T:C at day 30 = 0.2, P < 0.001) and inhibited disease establishment when given shortly after xenograft inoculation (T:C at day 30 = 0.1, P < 0.001) or tail vein injection. TNP-470 was shown to directly inhibit angiogenesis by Matrigel assay (P =.010) and to increase the apoptotic index in treated tumors. These data show that TNP-470 is a potent inhibitor of human neuroblastoma growth rate and tumorigenicity. We speculate that TNP-470 may be a useful adjuvant therapy for high-risk neuroblastoma patients, particularly when used in settings of minimal disease status.
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Naafs-Wilstra M, Barr R, Greenberg C, Magrath I, Cardenas F, Chesler M, Masera G, Davis A, Barun K, Morrison H, Petrilli S. Pediatric oncology in developing countries: development of an alliance of stakeholders. MEDICAL AND PEDIATRIC ONCOLOGY 2001; 36:305-9. [PMID: 11452939 DOI: 10.1002/1096-911x(20010201)36:2<305::aid-mpo1069>3.0.co;2-k] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ochsner MG, Knudson MM, Pachter HL, Hoyt DB, Cogbill TH, McAuley CE, Davis FE, Rogers S, Guth A, Garcia J, Lambert P, Thomson N, Evans S, Balthazar EJ, Casola G, Nigogosyan MA, Barr R. Significance of minimal or no intraperitoneal fluid visible on CT scan associated with blunt liver and splenic injuries: a multicenter analysis. THE JOURNAL OF TRAUMA 2000; 49:505-10. [PMID: 11003330 DOI: 10.1097/00005373-200009000-00019] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of ultrasound (U/S) for the evaluation of patients with blunt abdominal trauma is gaining increasing acceptance. Patients who would have undergone computed tomographic (CT) scan may now be evaluated solely with U/S. Solid organ injuries with minimal or no free fluid may be missed by surgeon sonographers. OBJECTIVE The purpose of this study was to describe the incidence and clinical importance of liver and splenic injuries with minimal or no free intraperitoneal fluid visible on CT scan. We hypothesized that these solid organ injuries occur infrequently and are of minor clinical significance. METHODS Patient records and CT scans were reviewed for the presence of and outcome associated with blunt liver and splenic injuries with minimal (<250 mL) or no free fluid detected by an attending radiologist. Data were collected from six major trauma centers during a 4-year period before the introduction of U/S and included demographics, grade of injury (American Association for the Surgery of Trauma scale), need for operative intervention, and outcome. RESULTS A total of 938 patients with liver and splenic injuries were identified. In this group, 11% of liver injuries and 12% of splenic injuries had no free fluid visible on CT scan and could be missed by diagnostic peritoneal lavage or U/S. Of the 938 patients, 267 (28%) met the inclusion criteria; 161 had injury to the spleen and 125 had injury to the liver. In the 267 patients studied, 97% of the injuries were managed nonoperatively. However, 8 patients (3%) required operative intervention for bleeding. Compared with the liver, the spleen was significantly more likely to bleed (p = 0.01), but the grade of splenic injury was not related to the risk for hemorrhage (p = 0.051). CONCLUSION Data from this study suggest that injuries to the liver or spleen with minimal or no intraperitoneal fluid visible on CT scan occur more frequently than predicted but usually are of minimal clinical significance. However, patients with splenic injuries may be missed by abdominal U/S. We found a 5% associated risk of bleeding. Therefore, abdominal U/S should not be used as the sole diagnostic modality in all stable patients at risk for blunt abdominal injury.
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Dyck JR, Berthiaume LG, Thomas PD, Kantor PF, Barr AJ, Barr R, Singh D, Hopkins TA, Voilley N, Prentki M, Lopaschuk GD. Characterization of rat liver malonyl-CoA decarboxylase and the study of its role in regulating fatty acid metabolism. Biochem J 2000; 350 Pt 2:599-608. [PMID: 10947976 PMCID: PMC1221289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In the liver, malonyl-CoA is central to many cellular processes, including both fatty acid biosynthesis and oxidation. Malonyl-CoA decarboxylase (MCD) is involved in the control of cellular malonyl-CoA levels, and functions to decarboxylate malonyl-CoA to acetyl-CoA. MCD may play an essential role in regulating energy utilization in the liver by regulating malonyl-CoA levels in response to various nutritional or pathological states. The purpose of the present study was to investigate the role of liver MCD in the regulation of fatty acid oxidation in situations where lipid metabolism is altered. A single MCD enzyme of molecular mass 50.7 kDa was purified from rat liver using a sequential column chromatography procedure and the cDNA was subsequently cloned and sequenced. The liver MCD cDNA was identical to rat pancreatic beta-cell MCD cDNA, and contained two potential translational start sites, producing proteins of 50.7 kDa and 54.7 kDa. Western blot analysis using polyclonal antibodies generated against rat liver MCD showed that the 50.7 kDa isoform of MCD is most abundant in heart and liver, and of relatively low abundance in skeletal muscle (despite elevated MCD transcript levels in skeletal muscle). Tissue distribution experiments demonstrated that the pancreas is the only rat tissue so far identified that contains both the 50.7 kDa and 54. 7 kDa isoforms of MCD. In addition, transfection of the full-length rat liver MCD cDNA into COS cells produced two isoforms of MCD. This indicated either that both initiating methionines are functionally active, generating two proteins, or that the 54.7 kDa isoform is the only MCD protein translated and removal of the putative mitochondrial targeting pre-sequence generates a protein of approx. 50.7 kDa in size. To address this, we transiently transfected a mutated MCD expression plasmid (second ATG to GCG) into COS-7 cells and performed Western blot analysis using our anti-MCD antibody. Western blot analysis revealed that two isoforms of MCD were still present, demonstrating that the second ATG may not be responsible for translation of the 50.7 kDa isoform of MCD. These data also suggest that the smaller isoform of MCD may originate from intracellular processing. To ascertain the functional role of the 50. 7 kDa isoform of rat liver MCD, we measured liver MCD activity and expression in rats subjected to conditions which are known to alter fatty acid metabolism. The activity of MCD was significantly elevated under conditions in which hepatic fatty acid oxidation is known to increase, such as streptozotocin-induced diabetes or following a 48 h fast. A 2-fold increase in expression was observed in the streptozotocin-diabetic rats compared with control rats. In addition, MCD activity was shown to be enhanced by alkaline phosphatase treatment, suggesting phosphorylation-related control of the enzyme. Taken together, our data demonstrate that rat liver expresses a 50.7 kDa form of MCD which does not originate from the second methionine of the cDNA sequence. This MCD is regulated by at least two mechanisms (only one of which is phosphorylation), and its activity and expression are increased under conditions where fatty acid oxidation increases.
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Barr R, Garcia C, Morré DJ. Touch-Sensitive NADH Oxidase Activity of Pea and Cucumber Tendrils and Soybean Hypocotyl Sections. INTERNATIONAL JOURNAL OF PLANT SCIENCES 2000; 161:387-391. [PMID: 10817974 DOI: 10.1086/314264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/1998] [Revised: 11/01/1999] [Indexed: 05/23/2023]
Abstract
The cell surface reduced nicotinamide adenine dinucleotide (NADH) oxidase activity of soybean stems and of pea and cucumber tendrils responded to touch with a several-fold increase in activity. The increase in NADH oxidase persisted for 20 min or longer, and further touch stimulation during this period did not alter activity. With soybean sections, the specific activities in response to touch approximated those achieved maximally by auxin. Where the NADH oxidase was fully stimulated by 2,4-d, the NADH oxidase failed to respond further to touch. The findings indicate that the NADH oxidase of the plant cell surface is involved in the growth response to touch and in tendril coiling.
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Adams PC, Kertesz AE, McLaren CE, Barr R, Bamford A, Chakrabarti S. Population screening for hemochromatosis: a comparison of unbound iron-binding capacity, transferrin saturation, and C282Y genotyping in 5,211 voluntary blood donors. Hepatology 2000; 31:1160-4. [PMID: 10796893 DOI: 10.1053/he.2000.6984] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Early diagnosis and treatment of hemochromatosis is essential to prevent organ damage. Screening strategies to detect early hemochromatosis include testing for iron overload and/or genetic testing. Voluntary blood donors numbering 5,211 were screened with unbound iron-binding capacity (UIBC), transferrin saturation (TS), and genetic testing for the C282Y mutation of the HFE gene. The study found 16 C282Y homozygotes (1 in 327), 69 compound heterozygotes, 371 simple heterozygotes, and 4,755 normals. There were 5 men and 11 women homozygotes with a mean age of 42, range 28 to 57. Mean UIBC (24 +/- 7 microL) and TS (48% +/- 17%) in homozygotes were significantly different from compound heterozygotes, simple heterozygotes, and normals (ANOVA). Only 3 homozygotes had an elevated serum ferritin. Family studies found an additional 4 iron-loaded homozygotes. Optimal thresholds were < or =28 micromol/L for UIBC and > or =46% for TS. Receiver operating characteristic (ROC) curve analysis showed an area under the curve for UIBC of 0.93 (0. 85-1.0, 95% confidence interval), and for TS of 0.83 (0.7-0.95). Screening with UIBC to preselect those for genotyping is a cost-efficient strategy for population screening for hemochromatosis.
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Hayne H, Boniface J, Barr R. The development of declarative memory in human infants: age-related changes in deferred imitation. Behav Neurosci 2000. [PMID: 10718263 DOI: 10.1037//0735-7044.114.1.77] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In 2 experiments, deferred imitation procedures were used to trace age-related changes in declarative memory by human infants over the first 2 years of life. An adult modeled 3 actions with an object, and infants' ability to reproduce those actions was assessed 24 hr later. Some infants were tested with a new object or in a new context relative to the original demonstration. Changes in the context disrupted the performance of 6-month-olds but had no effect on the performance of 12- and 18-month-olds. Changes in the object disrupted the performance of 6- and 12-month-olds but had no effect on the performance of 18-month-olds. This age-related increase in representational flexibility may account for the decline of childhood amnesia during the 3rd year of life.
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