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Grosse SD, Cuthbert C, Gaffney M, Gaviglio A, Hinton CF, Kellar-Guenther Y, Kemper AR, McKasson S, Ojodu J, Riley C, Singh S, Sontag MK, Shapira SK. Progress in expanding newborn screening in the United States. Am J Hum Genet 2023; 110:1015-1016. [PMID: 37267896 PMCID: PMC10257000 DOI: 10.1016/j.ajhg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 05/05/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carla Cuthbert
- Division of Laboratory Services, Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcus Gaffney
- Division of Laboratory Services, Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Gaviglio
- Division of Laboratory Services, Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA; Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Cynthia F Hinton
- Division of Laboratory Services, Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Alex R Kemper
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah McKasson
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sikha Singh
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Marci K Sontag
- Center for Public Health Innovation, CI International, Littleton, CO, USA
| | - Stuart K Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Liu T, Ouyang L, Walker WO, Wiener JS, Woodward J, Castillo J, Wood HM, Tanaka ST, Adams R, Smith KA, O'Neil J, Williams TR, Ward EA, Bowman RM, Riley C. Education and employment as young adults living with spina bifida transition to adulthood in the USA: A study of the National Spina Bifida Patient Registry. Dev Med Child Neurol 2023; 65:821-830. [PMID: 36385606 PMCID: PMC10415865 DOI: 10.1111/dmcn.15456] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
AIM To describe the education and employment transition experience of young adults with spina bifida (YASB) and investigate factors associated with employment. METHOD We queried education and employment data from the US National Spina Bifida Patient Registry from 2009 to 2019. We applied generalized estimating equations models to analyze sociodemographic and disease-related factors associated with employment. RESULTS A total of 1909 participants (850 males, 1059 females) aged 18 to 26 years contributed 4379 annual visits. Nearly 84% had myelomeningocele and, at last visit, the median age was 21 years (mean 21 years 5 months, SD 2 years 10 months). A total of 41.8% had at least some post-high school education, and 23.9% were employed. In a multivariable regression model, employment was significantly associated with education level, lower extremity functional level, bowel continence, insurance, and history of non-shunt surgery. This large, national sample of YASB demonstrated low rates of post-secondary education attainment and employment and several potentially modifiable factors associated with employment. INTERPRETATION Specific sociodemographic, medical, and functional factors associated with employment are important for clinicians to consider when facilitating transition for YASB into adulthood. Additional research is needed to understand the impact of cognitive functioning and social determinants of health on transition success in YASB. WHAT THIS PAPER ADDS There were low education attainment and employment rates in a large sample of young adults with spina bifida. Specific sociodemographic, medical, and functional factors are associated with employment. Some employment-associated factors, such as continence and self-management skills, are modifiable.
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Affiliation(s)
- Tiebin Liu
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - Lijing Ouyang
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - William O. Walker
- Division of Developmental Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - John S. Wiener
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jason Woodward
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan Castillo
- Division of Developmental Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Hadley M. Wood
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Stacy T. Tanaka
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Adams
- University of Texas Southwestern Medical Center; Scottish Rite for Children, Dallas, Texas, USA
| | - Kathryn A. Smith
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph O'Neil
- Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Tonya R. Williams
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - Elisabeth A. Ward
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
- Universal Consulting Services, Inc, Consultant to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin M. Bowman
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Catharine Riley
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
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3
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Paramsothy P, Wang Y, Cai B, Conway KM, Johnson NE, Pandya S, Ciafaloni E, Mathews KD, Romitti PA, Howard JF, Riley C. Selected clinical and demographic factors and all-cause mortality among individuals with Duchenne muscular dystrophy in the Muscular Dystrophy Surveillance, Tracking, and Research Network. Neuromuscul Disord 2022; 32:468-476. [PMID: 35597713 PMCID: PMC9214635 DOI: 10.1016/j.nmd.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/08/2023]
Abstract
Population-based estimates of survival among individuals with Duchenne muscular dystrophy (DMD) living in the United States are lacking. It is also unclear whether the association between glucocorticoid use and all-cause mortality persists in the context of other common treatments (cardiac medication, cough-assist, bilevel positive airway pressure, and scoliosis surgery) observed to delay mortality. Among 526 individuals identified by the Muscular Dystrophy Surveillance, Tracking, and Research Network, the estimated median survival time from birth was 23.7 years. Current glucocorticoid users had a lower hazard of mortality than non-users. Individuals who ever had scoliosis surgery had a lower hazard of mortality than individuals who did not have scoliosis surgery. Individuals who ever used cough assist had a lower hazard of mortality than individuals who never used cough assist. Non-Hispanic Black individuals had a higher hazard of mortality than non-Hispanic White individuals. No differences in hazards of mortality were observed between ever versus never use of cardiac medication and ever versus never use of bilevel positive airway pressure. The glucocorticoid observation is consistent with the 2018 Care Considerations statement that glucocorticoid use continues in the non-ambulatory phase. Our observations may inform the clinical care of individuals living with DMD.
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Affiliation(s)
- Pangaja Paramsothy
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS S106-3, 4770 Buford Hwy, Chamblee, GA 30341-3717, United States of America
| | - Yinding Wang
- McKing Consulting Corporation Consultant to Centers for Disease Control and Prevention, 2900 Chamblee Tucker Rd. Building 10, Ste. 100. Atlanta, GA 30341, United States of America
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 460, Columbia, SC 29208, United States of America
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, 145 N Riverside Drive, CPHB, Iowa City, IA 52242, United States of America
| | - Nicholas E. Johnson
- Department of Neurology, Virginia Commonwealth University, 1101 East Marshall St., Richmond, VA 23059, United States of America
| | - Shree Pandya
- Department of Neurology, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, United States of America
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, United States of America
| | - Katherine D. Mathews
- Departments of Pediatrics and Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Dr. , Iowa City, IA 52242, United States
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, 145 N Riverside Drive, CPHB, Iowa City, IA 52242, United States of America
| | - James F. Howard
- Department of Neurology, The University of North Carolina at Chapel Hill, CB#7025, Houpt Building, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States
| | - Catharine Riley
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS S106-3, 4770 Buford Hwy, Chamblee, GA 30341-3717, United States of America
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4
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Loloi J, Matloubieh J, Riley C, Melendez D, Watts K, Maria P. Hypertension and Low Cholesterol as Risk Factors for Infection after Penile Prosthesis Surgery. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Romero L, Carneiro PB, Riley C, Clark H, Uy R, Park M, Mawokomatanda T, Bombard JM, Hinckley A, Skapik J. Building capacity of community health centers to overcome data challenges with the development of an agile COVID-19 public health registry: a multistate quality improvement effort. J Am Med Inform Assoc 2021; 29:80-88. [PMID: 34648005 PMCID: PMC8524633 DOI: 10.1093/jamia/ocab233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic, federally qualified health centers rapidly mobilized to provide SARS-CoV-2 testing, COVID-19 care, and vaccination to populations at increased risk for COVID-19 morbidity and mortality. We describe the development of a reusable public health data analytics system for reuse of clinical data to evaluate the health burden, disparities, and impact of COVID-19 on populations served by health centers. Materials and Methods The Multistate Data Strategy engaged project partners to assess public health readiness and COVID-19 data challenges. An infrastructure for data capture and sharing procedures between health centers and public health agencies was developed to support existing capabilities and data capacities to respond to the pandemic. Results Between August 2020 and March 2021, project partners evaluated their data capture and sharing capabilities and reported challenges and preliminary data. Major interoperability challenges included poorly aligned federal, state, and local reporting requirements, lack of unique patient identifiers, lack of access to pharmacy, claims and laboratory data, missing data, and proprietary data standards and extraction methods. Discussion Efforts to access and align project partners’ existing health systems data infrastructure in the context of the pandemic highlighted complex interoperability challenges. These challenges remain significant barriers to real-time data analytics and efforts to improve health outcomes and mitigate inequities through data-driven responses. Conclusion The reusable public health data analytics system created in the Multistate Data Strategy can be adapted and scaled for other health center networks to facilitate data aggregation and dashboards for public health, organizational planning, and quality improvement and can inform local, state, and national COVID-19 response efforts.
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Affiliation(s)
- Lisa Romero
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Pedro B Carneiro
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Hollie Clark
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Raymonde Uy
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
| | - Michael Park
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Tebitha Mawokomatanda
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Jennifer M Bombard
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Julia Skapik
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
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Farr SL, Riley C, Van Zutphen AR, Brei TJ, Leedom VO, Kirby RS, Pabst LJ. Prevention and awareness of birth defects across the lifespan using examples from congenital heart defects and spina bifida. Birth Defects Res 2021; 114:35-44. [PMID: 34921598 DOI: 10.1002/bdr2.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Sherry L Farr
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
| | - Alissa R Van Zutphen
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Timothy J Brei
- Seattle Children's Hospital, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA.,Spina Bifida Association of America, Arlington, Virginia, USA
| | - Vinita Oberoi Leedom
- Division of Population Health Surveillance, South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura J Pabst
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia, USA
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7
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Lichstein J, Riley C, Keehn A, Lyon M, Maiese D, Sarkar D, Scott J. Children with genetic conditions in the United States: Prevalence estimates from the 2016-2017 National Survey of Children's Health. Genet Med 2021; 24:170-178. [PMID: 34906507 DOI: 10.1016/j.gim.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Estimating the overall prevalence of genetic conditions among children in the United States and the burden of these conditions on children and their families has been challenging. The redesigned National Survey of Children's Health provides an opportunity to examine the prevalence and burden. METHODS We used the combined 2016-2017 National Survey of Children's Health to estimate the prevalence of genetic conditions among children aged 0 to 17 years (N = 71,522). Bivariate analyses were used to assess differences in sociodemographic characteristics, health-related characteristics, and health care utilization between children with and without genetic conditions. RESULTS In 2016-2017, the prevalence of children aged 0 to 17 years with a reported genetic condition was approximately 0.039, roughly equating to 2.8 million children. A greater percentage of children with genetic conditions had a physical (50.9% vs 24.8%), mental (27.9% vs 5.8%), or behavioral/developmental/intellectual condition (55.6% vs 14.4%) than children without a genetic condition. Furthermore, they used more care and had more unmet health needs (7.6% vs 2.9%). CONCLUSION This study provides an estimate of the overall prevalence of children living with genetic conditions in the United States based on a nationally representative sample. It also highlights the physical, mental, and behavioral health needs among children with genetic conditions and their unmet health care needs.
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Affiliation(s)
- Jesse Lichstein
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD.
| | - Catharine Riley
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Alisha Keehn
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Megan Lyon
- American College of Medical Genetics and Genomics, Bethesda, MD
| | - Deborah Maiese
- American College of Medical Genetics and Genomics, Bethesda, MD
| | - Deboshree Sarkar
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Joan Scott
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
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Romero L, Pao LZ, Clark H, Riley C, Merali S, Park M, Eggers C, Campbell S, Bui C, Bolton J, Le X, Fanfair RN, Rose M, Hinckley A, Siza C. Health Center Testing for SARS-CoV-2 During the COVID-19 Pandemic - United States, June 5-October 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1895-1901. [PMID: 33332299 PMCID: PMC7745953 DOI: 10.15585/mmwr.mm6950a3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Do TQN, Riley C, Paramsothy P, Ouyang L, Bolen J, Grosse SD. Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006-2011. Am J Intellect Dev Disabil 2020; 125:103-108. [PMID: 32058813 PMCID: PMC7305836 DOI: 10.1352/1944-7558-125.2.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Using national data, we examined emergency department (ED) encounters during 2006-2011 for which a diagnosis code for fragile X syndrome (FXS) was present (n = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.
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Affiliation(s)
- Thuy Quynh N Do
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Catharine Riley
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Pangaja Paramsothy
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Lijing Ouyang
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Julie Bolen
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
| | - Scott D Grosse
- Thuy Quynh N. Do, Catharine Riley, Pangaja Paramsothy, Lijing Ouyang, Julie Bolen, and Scott D. Grosse, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
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Goldstein S, Hartzell-Cushanick R, Riley C, Kim N, Goldstein I. 003 Two-Arm, Prospective, Open-Label, Pilot Study of Flibanserin versus Flibanserin and Sex Therapy in Pre- and Postmenopausal Women with HSDD. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nash R, Riley C, Paramsothy P, Gilbertson K, Raspa M, Wheeler A, Dziuban EJ, Peacock G. A Description of the Educational Setting Among Individuals With Fragile X Syndrome. Am J Intellect Dev Disabil 2019; 124:57-76. [PMID: 30715925 PMCID: PMC6442477 DOI: 10.1352/1944-7558-124.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children with fragile X syndrome (FXS) display wide-ranging intellectual and behavioral abilities that affect daily life. We describe the educational setting of students with FXS and assess the relationships between school setting, co-occurring conditions, and functional ability using a national survey sample ( n = 982). The majority of students with FXS in this sample have formal individualized education plans, spend part of the day outside regular classrooms, and receive modifications when in a regular classroom. Males with FXS and certain co-occurring conditions (autism, aggression, and self-injurious behavior) are more likely to spend the entire day outside regular classrooms, compared to males without these co-occurring conditions. Students who spend more time in regular classrooms are more likely to perform functional tasks without help.
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Affiliation(s)
- Rebecca Nash
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Catharine Riley
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Pangaja Paramsothy
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Kendra Gilbertson
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Melissa Raspa
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Anne Wheeler
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Eric J Dziuban
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Georgina Peacock
- Rebecca Nash, Emory University Rollins School of Public Health; Catharine Riley and Pangaja Paramsothy, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Kendra Gilbertson, ORISE, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Melissa Raspa and Anne Wheeler, RTI International; and Eric J. Dziuban and Georgina Peacock, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
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Parasuraman SR, Anglin TM, McLellan SE, Riley C, Mann MY. Health Care Utilization and Unmet Need Among Youth With Special Health Care Needs. J Adolesc Health 2018; 63:435-444. [PMID: 30078509 DOI: 10.1016/j.jadohealth.2018.03.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine unmet health needs and health care utilization among youth with special health care needs (YSHCN). METHODS We analyzed data among youth aged 12-17 years using the 2016 National Survey of Children's Health. We conducted descriptive analyses comparing YSHCN with non-YSHCN, and bivariate and multivariable analyses examining associations between dependent and independent measures. Six dependent variables represented unmet needs and utilization. Adjusted analyses controlled for sociodemographic and health measures. RESULTS A total of 5,862 individuals were identified as YSHCN, and nearly 70% had three or more comorbid conditions. Over 90% used medical care, preventive care, or dental care in the past 12 months, while 8% reported having unmet health needs (compared with 2.8% of non-YSHCN). Using a typology of qualifying criteria for special health care needs, we found that YSHCN with increasing complexity of needs were more likely to report unmet health needs, use of mental health care services, and emergency department use, compared with YSHCN using medication only to manage their conditions. All YSHCN living in households below 400% federal poverty level were less likely to utilize nearly all types of health care examined, with the exception of mental health care use, compared with those at or above 400% federal poverty level. CONCLUSIONS Differences in complexity of needs, race/ethnicity, and poverty status highlight existing gaps in health care utilization and persistent unmet health needs among YSHCN. Efforts should focus on strengthening coordinated systems of care that optimally meet the needs of YSHCN so they may thrive in their families and communities.
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Affiliation(s)
- Sarika Rane Parasuraman
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Trina M Anglin
- Adolescent Health Branch, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Sarah E McLellan
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Catharine Riley
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
| | - Marie Y Mann
- Division of Services for Children with Special Health Needs, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland.
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13
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Affiliation(s)
- C Riley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Andrzejowski
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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14
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Skuli SJ, Bantug ET, Zafman N, Riley C, Ruck JM, Sheng J, Smith KC, Snyder CF, Smith KL, Stearns V, Wolff AC. Abstract P6-12-21: Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-12-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Survivorship care plans (SCPs) are strongly recommended for all breast cancer survivors to address sequelae of cancer care, plan cancer surveillance and screening, and encourage health promotion and care coordination. Ongoing studies are evaluating the impact of SCPs in cancer survivor populations and the role of survivorship visits (SVs) as an intervention. Here we describe characteristics and outcomes of patients who participated in SVs at Johns Hopkins (JH).
Methods: We retrospectively reviewed the charts of patients who participated in a SV with one of two nurse practitioners ˜1-3 months after completion of locoregional therapy and initial systemic therapy, as referred by their JH breast cancer provider. We collected patient demographics, comorbidity status, tumor characteristics, treatments received, and responses to GAD7 (generalized anxiety disorder 7-item), PHQ9 (patient health questionnaire-9), and a symptom questionnaire. Characteristics of SV participants were compared to analytical breast cancer cases from the JH Cancer Registry (JHCR 2010-2015), matched for stage.
Results: 87 women (stages I-III) who participated in a SV in 2010-2016 were identified. Compared to patients in the JHCR (n=2,942), the SV cohort was younger (age ≤50, 43% v 34%, p=0.14), more likely to be African American (33% v 22%, p=0.04), and more likely to have a higher TNM stage (I, 26% v 49%; II, 48% v 37%; III, 25% v 15%, p<0.001), node-positive status (60% v 33%, p<0.001), hormone receptor-negative disease (44% v 18%, p<0.001), and HER2-positive disease (38% v 14%, p<0.001). The SV cohort was also more likely to receive chemotherapy (94% v 43%, p<0.001) and undergo radiation therapy (78% v 54%, p<0.001). The SV cohort had a higher recurrence event rate than the JHCR cohort (11.5% v 8.0%) and a shorter median follow-up (886 v 1292 days), suggestive of a higher risk profile. In the SV cohort, a comparison of comorbidities at breast cancer diagnosis versus time of SV visit identified a significant increase in the prevalence of peripheral neuropathy (9% v 73%, p<.001), anemia (15% v 50%, p<.001), lymphedema (0% v 28%, p<.001), anxiety (15% v 38%, p<.001), and depression (13% v 29%, p<.001). Patients in the SV cohort were overweight at diagnosis (body mass index, median 29 [IQR 24, 32]). At the time of the SV, patients reported symptoms of sleep difficulty (53%), numbness or tingling (46%), weight changes (45%), muscle aches (44%), and pain (37%).
Conclusions: Patients who participated in SVs had high-risk cancers and, compared to baseline, a higher frequency of comorbidities that are potentially associated with breast cancer and its treatment. These data can inform future breast cancer survivorship care models as they describe a population that may be at greater risk for worse cancer and non-cancer outcomes, and that might benefit more from interventions like SCPs and SVs. Ongoing studies are identifying optimal target populations, appropriate timing of such interventions, and informative measures of patient-centered outcomes.
Funding: Komen Maryland/Komen Scholar SAC110053 (ACW).
Citation Format: Skuli SJ, Bantug ET, Zafman N, Riley C, Ruck JM, Sheng J, Smith KC, Snyder CF, Smith KL, Stearns V, Wolff AC. Breast cancer survivors undergoing survivorship visits at Johns Hopkins are a high-risk population [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-21.
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Affiliation(s)
- SJ Skuli
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - ET Bantug
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - N Zafman
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - C Riley
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - JM Ruck
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - J Sheng
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - KC Smith
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - CF Snyder
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - KL Smith
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - V Stearns
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - AC Wolff
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Wheeler A, Raspa M, Hagerman R, Mailick M, Riley C. Implications of the FMR1 Premutation for Children, Adolescents, Adults, and Their Families. Pediatrics 2017; 139:S172-S182. [PMID: 28814538 PMCID: PMC5621635 DOI: 10.1542/peds.2016-1159d] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Given the nature of FMR1 gene expansions, most biological mothers, and often multiple other family members of children with fragile X syndrome (FXS), will have a premutation, which may increase individual and family vulnerabilities. This article summarizes important gaps in knowledge and notes potential implications for pediatric providers with regard to developmental and medical risks for children and adolescents with an FMR1 premutation, including possible implications into adulthood. METHODS A structured electronic literature search was conducted on FMR1 pre- and full mutations, yielding a total of 306 articles examined. Of these, 116 focused primarily on the premutation and are included in this review. RESULTS Based on the literature review, 5 topic areas are discussed: genetics and epidemiology; phenotypic characteristics of individuals with the premutation; implications for carrier parents of children with FXS; implications for the extended family; and implications for pediatricians. CONCLUSIONS Although the premutation phenotype is typically less severe in clinical presentation than in FXS, premutation carriers are much more common and are therefore more likely to be seen in a typical pediatric practice. In addition, there is a wide range of medical, cognitive/developmental, and psychiatric associated features that individuals with a premutation are at increased risk for having, which underscores the importance of awareness on the part of pediatricians in identifying and monitoring premutation carriers and recognizing the impact this identification may have on family members.
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Affiliation(s)
- Anne Wheeler
- RTI International, Research Triangle Park, North Carolina;
| | - Melissa Raspa
- RTI International, Research Triangle Park, North Carolina
| | - Randi Hagerman
- MIND Institute, University of California at Davis, Sacramento, California
| | - Marsha Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin; and
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
OBJECTIVES The purpose of this systematic literature review is to describe what is known about fragile X syndrome (FXS) and to identify research gaps. The results can be used to help inform future public health research and provide pediatricians with up-to-date information about the implications of the condition for individuals and their families. METHODS An electronic literature search was conducted, guided by a variety of key words. The search focused on 4 areas of both clinical and public health importance: (1) the full mutation phenotype, (2) developmental trajectories across the life span, (3) available interventions and treatments, and (4) impact on the family. A total of 661 articles were examined and 203 were included in the review. RESULTS The information is presented in the following categories: developmental profile (cognition, language, functional skills, and transition to adulthood), social-emotional profile (cooccurring psychiatric conditions and behavior problems), medical profile (physical features, seizures, sleep, health problems, and physiologic features), treatment and interventions (educational/behavioral, allied health services, and pharmacologic), and impact on the family (family environment and financial impact). Research gaps also are presented. CONCLUSIONS The identification and treatment of FXS remains an important public health and clinical concern. The information presented in this article provides a more robust understanding of FXS and the impact of this complex condition for pediatricians. Despite a wealth of information about the condition, much work remains to fully support affected individuals and their families.
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Affiliation(s)
- Melissa Raspa
- RTI International, Research Triangle Park, North Carolina; and
| | | | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common known inherited form of intellectual disability. Early identification is an important step in linking FXS individuals with appropriate and timely medical and social services. Newborn screening (NBS) is 1 approach that has been used for other conditions to facilitate early identification. METHODS A literature review was conducted to identify issues, barriers, challenges, and approaches to addressing challenges related to NBS for FXS. Search terms included: fragile X syndrome, FMR1, newborn screening, screening, and genetic testing. To supplement the literature review, 9 key informant interviews were conducted. Information gathered through these interviews supplemented what was identified in the literature. Information from both the literature review and supplemental interviews was reviewed by 3 researchers who discussed and came to consensus on thematic areas and categorization of issues. RESULTS The barriers and challenges related to NBS for FXS identified in the literature and by experts and stakeholders are categorized into 5 thematic areas: public health burden, treatment, timing, screening/testing methodologies, and translating results. Summaries of these issues and barriers are provided, along with potential approaches to addressing them. CONCLUSIONS The issues and barriers described in this article highlight limited areas of knowledge that need be addressed to improve our understanding of FXS and the potential benefit of NBS. The landscape of NBS for FXS could be influenced by a series of research findings over time or a larger breakthrough that demonstrates an effective targeted treatment that has to be implemented early in life.
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Affiliation(s)
- Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne Wheeler
- RTI International, Research Triangle Park, North Carolina
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18
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Sherman SL, Kidd SA, Riley C, Berry-Kravis E, Andrews HF, Miller RM, Lincoln S, Swanson M, Kaufmann WE, Brown WT. FORWARD: A Registry and Longitudinal Clinical Database to Study Fragile X Syndrome. Pediatrics 2017; 139:S183-S193. [PMID: 28814539 PMCID: PMC5621599 DOI: 10.1542/peds.2016-1159e] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Advances in the care of patients with fragile X syndrome (FXS) have been hampered by lack of data. This deficiency has produced fragmentary knowledge regarding the natural history of this condition, healthcare needs, and the effects of the disease on caregivers. To remedy this deficiency, the Fragile X Clinic and Research Consortium was established to facilitate research. Through a collective effort, the Fragile X Clinic and Research Consortium developed the Fragile X Online Registry With Accessible Research Database (FORWARD) to facilitate multisite data collection. This report describes FORWARD and the way it can be used to improve health and quality of life of FXS patients and their relatives and caregivers. METHODS FORWARD collects demographic information on individuals with FXS and their family members (affected and unaffected) through a 1-time registry form. The longitudinal database collects clinician- and parent-reported data on individuals diagnosed with FXS, focused on those who are 0 to 24 years of age, although individuals of any age can participate. RESULTS The registry includes >2300 registrants (data collected September 7, 2009 to August 31, 2014). The longitudinal database includes data on 713 individuals diagnosed with FXS (data collected September 7, 2012 to August 31, 2014). Longitudinal data continue to be collected on enrolled patients along with baseline data on new patients. CONCLUSIONS FORWARD represents the largest resource of clinical and demographic data for the FXS population in the United States. These data can be used to advance our understanding of FXS: the impact of cooccurring conditions, the impact on the day-to-day lives of individuals living with FXS and their families, and short-term and long-term outcomes.
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Affiliation(s)
- Stephanie L. Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia;,Address correspondence to Stephanie L. Sherman, PhD, Department of Human Genetics, Emory University School of Medicine, 615 Michael St, Whitehead Building, Suite 301, Atlanta, GA 303022. E-mail:
| | - Sharon A. Kidd
- National Fragile X Foundation, Washington, District of Columbia
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics,,Neurological Sciences, and,Biochemistry, Rush University Medical Center, Chicago, Illinois
| | - Howard F. Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Sharyn Lincoln
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Mark Swanson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walter E. Kaufmann
- Department of Neurology, Boston Children’s Hospital, Boston Massachusetts;,Center for Translational Research, Greenwood Genetic Center, Greenwood, South Carolina; and
| | - W. Ted Brown
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York
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19
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Kaufmann WE, Kidd SA, Andrews HF, Budimirovic DB, Esler A, Haas-Givler B, Stackhouse T, Riley C, Peacock G, Sherman SL, Brown WT, Berry-Kravis E. Autism Spectrum Disorder in Fragile X Syndrome: Cooccurring Conditions and Current Treatment. Pediatrics 2017; 139:S194-S206. [PMID: 28814540 PMCID: PMC5619699 DOI: 10.1542/peds.2016-1159f] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Individuals with fragile X syndrome (FXS) are frequently codiagnosed with autism spectrum disorder (ASD). Most of our current knowledge about ASD in FXS comes from family surveys and small studies. The objective of this study was to examine the impact of the ASD diagnosis in a large clinic-based FXS population to better inform the care of people with FXS. METHODS The study employed a data set populated by data from individuals with FXS seen at specialty clinics across the country. The data were collected by clinicians at the patient visit and by parent report for nonclinical and behavioral outcomes from September 7, 2012 through August 31, 2014. Data analyses were performed by using χ2 tests for association, t tests, and multiple logistic regression to examine the association between clinical and other factors with ASD status. RESULTS Half of the males and nearly 20% of females met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for current ASD. Relative to the FXS-only group, the FXS with ASD (FXS+ASD) group had a higher prevalence of seizures (20.7% vs 7.6%, P < .001), persistence of sleep problems later in childhood, increased behavior problems, especially aggressive/disruptive behavior, and higher use of α-agonists and antipsychotics. Behavioral services, including applied behavior analysis, appeared to be underused in children with FXS+ASD (only 26% and 16% in prekindergarten and school-age periods, respectively) relative to other populations with idiopathic ASD. CONCLUSIONS These findings confirm among individuals with FXS an association of an ASD diagnosis with important cooccurring conditions and identify gaps between expected and observed treatments among individuals with FXS+ASD.
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Affiliation(s)
- Walter E. Kaufmann
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Greenwood Genetic Center, Greenwood, South Carolina;,Address correspondence to Walter E. Kaufmann, MD, Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Cir, Greenwood, SC 29646. E-mail:
| | - Sharon A. Kidd
- National Fragile X Foundation, Washington, District of Columbia
| | - Howard F. Andrews
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | | | - Amy Esler
- University of Minnesota, Minneapolis, Minnesota
| | | | | | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Georgina Peacock
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie L. Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - W. Ted Brown
- New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York; and
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, and Biochemistry, Rush University Medical Center, Chicago, Illinois
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Affiliation(s)
- Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marsha Mailick
- Waisman Center, University of Wisconsin, Madison, Wisconsin
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois,Department of Biochemistry, Rush University Medical Center, Chicago, Illinois
| | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Spies L, Garner SL, Faucher M, Hastings-Tolsma M, Riley C, Millenbruch J, Prater L, Conroy S. A model for upscaling global partnerships and building nurse and midwifery capacity. Int Nurs Rev 2017; 64:331-344. [DOI: 10.1111/inr.12349] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L.A. Spies
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - S. L. Garner
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - M.A. Faucher
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - M. Hastings-Tolsma
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
- University of Johannesburg; Johannesburg South Africa
| | - C. Riley
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - J. Millenbruch
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - L. Prater
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
| | - S.F. Conroy
- Baylor University Louise Herrington School of Nursing; Dallas TX USA
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22
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Holmström MO, Hjortsø MD, Ahmad SM, Met Ö, Martinenaite E, Riley C, Straten P, Svane IM, Hasselbalch HC, Andersen MH. The JAK2V617F mutation is a target for specific T cells in the JAK2V617F-positive myeloproliferative neoplasms. Leukemia 2016; 31:495-498. [PMID: 27761006 DOI: 10.1038/leu.2016.290] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- M O Holmström
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark.,Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - M D Hjortsø
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - S M Ahmad
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Ö Met
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - E Martinenaite
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - C Riley
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - P Straten
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - I M Svane
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - H C Hasselbalch
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - M H Andersen
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Abstract
Despite the complexity of much modern apparatus the responsibility for inventing new equipment still rests with the scientist. A high level of practical skill is not necessary, but working models play a valuable part. The instrument industry has an equally essential part to play in converting an innovation into a viable commercial product and must take great financial risks in doing so.
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Affiliation(s)
- C Riley
- Royal Sussex County Hospital, Brighton
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24
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Kumar J, Fraser FW, Riley C, Ahmed N, McCulloch DR, Ward AC. Granulocyte colony-stimulating factor receptor signalling via Janus kinase 2/signal transducer and activator of transcription 3 in ovarian cancer. Br J Cancer 2016; 113:1642-3. [PMID: 26625223 PMCID: PMC4705898 DOI: 10.1038/bjc.2015.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
BACKGROUND Iron deficiency is a prevalent health problem in India affecting women and newborns. Delayed umbilical cord clamping at birth is a safe and effective means for increasing serum iron levels in newborns up to 6 months of age. AIM The study aim was to increase the utilization of delayed cord clamping in a group of midwives working in Hyderabad, India. METHODS A single group pre- and post-test design was used to evaluate knowledge, beliefs and practice before and after a delayed cord clamping intervention including follow-up at 10 months after the original intervention. The intervention included lectures and simulation. RESULTS Results show significant increases in knowledge and positive beliefs about the practice of delayed cord clamping. Simulation was effective for eliciting important feedback related to learning. LIMITATIONS Results represent a small group of midwives working with a non-profit foundation in Southern India. Language discordancy and cultural norms in this group of midwives may have influenced results. CONCLUSIONS Knowledge, beliefs and practice related to delayed cord clamping were all significantly improved after the intervention. The Knowledge to Action framework using simulation is an effective cross-cultural method for implementing education about evidence-based practice. Midwives are invested in learning practices that promote public health. IMPLICATIONS FOR NURSING AND HEALTH POLICY Changing institutional policy may have limitations without first considering normative practice. Using simulation combined with institutional health policy appears to result in significant uptake of practice change. Qualitative studies exploring the interconnections between cultural norms and decision making may be informative about promoting practice change particularly in this setting. Upscaling midwifery has been recommended to improve maternal and child health in India.
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Affiliation(s)
- M A Faucher
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - C Riley
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | - L Prater
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
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Ouyang L, Grosse SD, Riley C, Bolen J, Bishop E, Raspa M, Bailey DB. A comparison of family financial and employment impacts of fragile X syndrome, autism spectrum disorders, and intellectual disability. Res Dev Disabil 2014; 35:1518-27. [PMID: 24755230 PMCID: PMC4491950 DOI: 10.1016/j.ridd.2014.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/25/2014] [Accepted: 04/01/2014] [Indexed: 05/17/2023]
Abstract
This study compares the family financial and employment impacts of having a child with fragile X syndrome (FXS), autism spectrum disorder (ASD), or intellectual disabilities (ID). Data from a 2011 national survey of families of children with FXS were matched with data from the National Survey of Children with Special Health Care Needs 2009-2010 to form four analytic groups: children with FXS (n=189), children with special health care needs with ASD only (n=185), ID only (n=177), or both ASD and ID (n=178). Comparable percentages of parents of children with FXS (60%) and parents of children with both ASD and ID (52%) reported that their families experienced a financial burden as a result of the condition, both of which were higher than the percentages of parents of children with ASD only (39%) or ID only (29%). Comparable percentages of parents of children with FXS (40%) and parents of children with both ASD and ID (46%) reported quitting employment because of the condition, both of which were higher than the percentages of parents of children with ID only (25%) or ASD only (25%). In multivariate analyses controlling for co-occurring conditions and functional difficulties and stratified by age, adjusted odds ratios for the FXS group aged 12-17 years were significantly elevated for financial burden (2.73, 95% CI 1.29-5.77), quitting employment (2.58, 95% CI 1.18-5.65) and reduced hours of work (4.34, 95% CI 2.08-9.06) relative to children with ASD only. Among children aged 5-11 years, the adjusted odds ratios for the FXS group were elevated but statistically insignificant for financial burden (1.63, 95% CI 0.85-3.14) and reducing hours of work (1.34, 95% CI 0.68-2.63) relative to children with ASD only. Regardless of condition, co-occurring anxiety or seizures, limits in thinking, reasoning, or learning ability, and more irritability were significantly associated with more caregiver financial and employment impacts. Proper management of anxiety or seizures and functional difficulties of children with FXS or other developmental disabilities may be important in alleviating adverse family caregiver impacts.
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Affiliation(s)
- Lijing Ouyang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Catharine Riley
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Julie Bolen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, United States
| | - Ellen Bishop
- RTI International, Research Triangle Park, NC, United States
| | - Melissa Raspa
- RTI International, Research Triangle Park, NC, United States
| | - Donald B Bailey
- RTI International, Research Triangle Park, NC, United States
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Ward MJ, Thirdborough SM, Mellows T, Riley C, Harris S, Suchak K, Webb A, Hampton C, Patel NN, Randall CJ, Cox HJ, Jogai S, Primrose J, Piper K, Ottensmeier CH, King EV, Thomas GJ. Tumour-infiltrating lymphocytes predict for outcome in HPV-positive oropharyngeal cancer. Br J Cancer 2014; 110:489-500. [PMID: 24169344 PMCID: PMC3899750 DOI: 10.1038/bjc.2013.639] [Citation(s) in RCA: 280] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/28/2013] [Accepted: 09/12/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC) is associated with improved survival compared with HPV-negative disease. However, a minority of HPV-positive patients have poor prognosis. Currently, there is no generally accepted strategy for identifying these patients. METHODS We retrospectively analysed 270 consecutively treated OPSCC patients from three centres for effects of clinical, pathological, immunological, and molecular features on disease mortality. We used Cox regression to examine associations between factors and OPSCC death, and developed a prognostic model for 3-year mortality using logistic regression analysis. RESULTS Patients with HPV-positive tumours showed improved survival (hazard ratio (HR), 0.33 (0.21-0.53)). High levels of tumour-infiltrating lymphocytes (TILs) stratified HPV-positive patients into high-risk and low-risk groups (3-year survival; HPV-positive/TIL(high)=96%, HPV-positive/TIL(low)=59%). Survival of HPV-positive/TIL(low) patients did not differ from HPV-negative patients (HR, 1.01; P=0.98). We developed a prognostic model for HPV-positive tumours using a 'training' cohort from one centre; the combination of TIL levels, heavy smoking, and T-stage were significant (AUROC=0·87). This model was validated on patients from the other centres (detection rate 67%; false-positive rate 5.6%; AUROC=0·82). INTERPRETATION Our data suggest that an immune response, reflected by TIL levels in the primary tumour, has an important role in the improved survival seen in most HPV-positive patients, and is relevant for the clinical evaluation of HPV-positive OPSCC.
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Affiliation(s)
- M J Ward
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Department of Otolaryngology—Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - S M Thirdborough
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - T Mellows
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - C Riley
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - S Harris
- Department of Medical Statistics, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - K Suchak
- Department of Cellular Pathology, Bart's and The London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK
| | - A Webb
- Department of Oral and Maxillofacial Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - C Hampton
- Macmillan Head, Neck and Thyroid Specialist Nurse Team, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - N N Patel
- Department of Otolaryngology—Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - C J Randall
- Department of Otolaryngology—Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - H J Cox
- Department of Otolaryngology—Head and Neck Surgery, Poole NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK
| | - S Jogai
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - J Primrose
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - K Piper
- Department of Cellular Pathology, Bart's and The London School of Medicine and Dentistry, Garrod Building, Turner Street, Whitechapel, London E1 2AD, UK
| | - C H Ottensmeier
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- NIHR Experimental Cancer Medicine Centre Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - E V King
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Department of Otolaryngology—Head and Neck Surgery, Poole NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK
- NIHR Experimental Cancer Medicine Centre Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - G J Thomas
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- NIHR Experimental Cancer Medicine Centre Southampton, Tremona Road, Southampton SO16 6YD, UK
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Thermenos H, Whitfield-Gabrieli S, Seidman L, Kuperberg G, Juelich R, Divatia S, Riley C, Jabbar G, Shenton M, Kubicki M, Manschreck T, Keshavan M, DeLisi L. Altered language network activity in young people at familial high-risk for schizophrenia. Schizophr Res 2013; 151:229-37. [PMID: 24176576 PMCID: PMC3987706 DOI: 10.1016/j.schres.2013.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Abnormalities in language and language neural circuitry are observed in schizophrenia (SZ). Similar, but less pronounced language deficits are also seen in young first-degree relatives of people with SZ, who are at higher familial risk (FHR) for the disorder than the general population. The neural underpinnings of these deficits in people with FHR are unclear. METHODS Participants were 43 people with FHR and 32 comparable controls. fMRI scans were collected while participants viewed associated and unrelated word pairs, and performed a lexical decision task. fMRI analyses conducted in SPM8 examined group differences in the modulation of hemodynamic activity by semantic association. RESULTS There were no group differences in demographics, IQ or behavioral semantic priming, but FHR participants had more schizotypal traits than controls. Controls exhibited the expected suppression of hemodynamic activity to associated versus unrelated word pairs. Compared to controls, FHR participants showed an opposite pattern of hemodynamic modulation to associated versus unrelated word pairs, in the left inferior frontal gyrus (IFG), right superior and middle temporal gyrus (STG) and the left cerebellum. Group differences in activation were significant, FWE-corrected for multiple comparisons (p<0.05). Activity within the IFG during the unrelated condition predicted schizotypal symptoms in FHR participants. CONCLUSIONS FHR for SZ is associated with abnormally increased neural activity to semantic associates within an inferior frontal/temporal network. This might increase the risk of developing unusual ideas, perceptions and disorganized language that characterize schizotypal traits, potentially predicting which individuals are at greater risk to develop a psychotic disorder.
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Affiliation(s)
- H.W. Thermenos
- Harvard Medical School, Boston, MA, USA,Massachusetts Mental Health Center Division of Public Psychiatry, Boston, MA, USA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Corresponding author at: Athinoula A. Martinos Center for Biomedical Imaging, Building 149, 2nd Floor (Room 2602E), 13th Street, Charlestown, MA 02129, USA. Tel.: +1 617 726 6043; fax: +1 617 726 4078. (H.W. Thermenos)
| | - S. Whitfield-Gabrieli
- McGovern Institute for Brain Research and Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - L.J. Seidman
- Harvard Medical School, Boston, MA, USA,Massachusetts Mental Health Center Division of Public Psychiatry, Boston, MA, USA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - G. Kuperberg
- Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Tufts University, Department of Psychology, Medford, MA, USA
| | - R.J. Juelich
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S. Divatia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - C. Riley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - G.A. Jabbar
- Harvard Medical School, Boston, MA, USA,VA Boston Healthcare System, Brockton, MA 02301, USA
| | - M.E. Shenton
- Harvard Medical School, Boston, MA, USA,VA Boston Healthcare System, Brockton, MA 02301, USA,Department of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - M. Kubicki
- Harvard Medical School, Boston, MA, USA,Department of Psychiatry and Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - T. Manschreck
- Harvard Medical School, Boston, MA, USA,Corrigan Mental Health Center, Fall River, MA, USA
| | - M.S. Keshavan
- Harvard Medical School, Boston, MA, USA,Massachusetts Mental Health Center Division of Public Psychiatry, Boston, MA, USA,Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - L.E. DeLisi
- Harvard Medical School, Boston, MA, USA,VA Boston Healthcare System, Brockton, MA 02301, USA
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Abstract
After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. Anaesthesia poses certain challenges in the identification of valid outcome indicators sensitive to variations in anaesthetic care. Metrics collected during the immediate post-anaesthetic recovery period, such as patient temperature, patient-reported quality of recovery, and pain and nausea, provide potentially useful information for the anaesthetist, yet this information is not routinely fed back. Reviews of the effects of feeding back performance data to healthcare providers suggest that this may result in small to moderate positive effects upon outcomes and professional practice, with stronger effects where feedback is integrated within a broader quality improvement strategy. The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.
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Affiliation(s)
- J Benn
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK.
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30
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Azevedo C, Riley C. A Mother-Daughter Pair with Neuromyelitis Optica Spectrum Disorder (P07.063). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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31
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Lim R, Riley C, Barker G, Rice GE, Lappas M. Human labour is associated with decreased cytoplasmic FoxO4. Placenta 2011; 33:52-9. [PMID: 22112832 DOI: 10.1016/j.placenta.2011.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 10/06/2011] [Accepted: 10/07/2011] [Indexed: 12/11/2022]
Abstract
Forkhead box O (FoxO) proteins function primarily as transcription factors in the nucleus where they bind to their cognate DNA targeting sequences. FoxO regulated genes include those involved in cellular stress responses, inflammation and apoptosis; all of which are involved in the processes of human labour and delivery. We have previously identified Forkhead box O4 (FoxO4) proteins in human gestational tissues; there is, however, no data is available on the role of FoxO4 in the processes of human labour and delivery. Thus the aim of this study was to determine the effect of (i) human labour, preterm chorioamnionitis and pro-inflammatory stimuli on the expression of FoxO4 in human placenta and fetal membranes; and (ii) FoxO4 knockdown by siRNA on the expression of pro-labour mediators. Quantitative RT-PCR (qRT-PCR), immunohistochemistry and/or Western blotting was used to analyse the expression of FoxO4 (n = 6 per group). Human labour and preterm chorioamnionitis significantly decreased cytoplasmic FoxO4 expression in placenta and/or choriodecidua. Knockdown of FoxO4 mRNA and protein in JEG-3 cells using siRNA was associated with decreased COX-2 mRNA expression concomitant with lower PGF(2α) secretion. However, in BeWo cells, siRNA inhibition of FoxO4 was not associated with inflammation, oxidative stress or apoptosis. In summary, human term labour and chorioamnionitis is characterised by lower FoxO4 mRNA and/or protein expression in placenta and/or choriodecidua. Although the exact role of FoxO4 in human pregnancy remains to be fully elucidated, our data demonstrate that it can regulate COX-2 expression and subsequent prostaglandin expression.
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Affiliation(s)
- R Lim
- Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
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32
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Michael A, Riley C, Bokaee S, Denyer M, Pandha HS, Annels NE. EN2: A candidate antigen for the development of targeted therapies in ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Lappas M, Lim R, Riley C, Menon R, Permezel M. Expression and localisation of FoxO3 and FoxO4 in human placenta and fetal membranes. Placenta 2010; 31:1043-50. [PMID: 20934750 DOI: 10.1016/j.placenta.2010.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 02/04/2023]
Abstract
Forkhead box O (FoxO) proteins regulate inflammation, extracellular matrix (ECM) remodelling and apoptosis. We have previously identified FoxO1 proteins in human gestational tissues, and demonstrated a link between FoxO1 and rupture of fetal membranes. There is, however, no data available on the expression and localisation of FoxO3 and FoxO4 in human intrauterine tissues. Thus the aim of this study was to characterise the localisation and expression of FoxO3 and FoxO4 in (i) human placenta and fetal membranes before term spontaneous labour onset, and (ii) supracervical site (SCS) and distal site (DS) fetal membranes from non-labouring women. Immunohistochemistry, Western blotting and quantitative RT-PCR (qRT-PCR) was used to localise and quantitate FoxO3 and FoxO4 protein and mRNA expressions. Cytoplasmic and nuclear FoxO3 was localised in the syncytiotrophoblast layer, chorionic trophoblasts, amnion epithelium and decidua. Cytoplasmic FoxO4 was localised in the syncytiotrophoblasts and chorionic trophoblasts. No or very little FoxO4 protein and mRNA was present in amnion epithelium. The intensity and extent of staining of FoxO3 and FoxO4 was greater in fetal membranes obtained from the SCS compared to DS. Presence of FoxO3 and FoxO4 are expected to contribute to apoptosis and/or cell cycle regulation associated with fetal membrane rupture.
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Affiliation(s)
- M Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital forWomen, 163 Studley Road, Heidelberg 3084,Victoria, Australia.
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35
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Lappas M, Lim R, Riley C, Rice GE, Permezel M. Localisation and expression of FoxO1 proteins in human gestational tissues. Placenta 2009; 30:256-62. [PMID: 19150739 DOI: 10.1016/j.placenta.2008.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 12/11/2008] [Accepted: 12/13/2008] [Indexed: 10/21/2022]
Abstract
In non-gestational tissues, emerging data indicate that the FoxO1 family of Forkhead transcription factors play diverse roles in many cellular processes coordinating programs of gene expression that regulate apoptosis, oxidative stress resistance, and immune cell homeostasis. Successful outcome of human parturition rely on many of these processes, however there is no data available on FoxO1 proteins in human intrauterine tissues, nor their role in pregnancy complications such as pre-eclampsia. Thus the aim of this study was (i) to characterises the localisation and expression of FoxO1, acetylated (ac)-FoxO1 and phosphorylated (p)-FoxO1 in human placenta and fetal membranes obtained from term Caesarean sections (n=5); and (ii) to compare the expression of FoxO1 proteins in term placental samples from normal and pre-eclamptic pregnancies (n=5 per group). In placenta, weak FoxO1 staining was localised to the syncytiotrophoblast layer, whereas ac-FoxO1 and p-FoxO1 staining was mainly localised in the syncytiotrophoblasts and cytotrophoblasts. In fetal membranes, FoxO1, ac-FoxO1 and p-FoxO1 were localised to the trophoblast layer of the chorion, amnion epithelium and decidual cells. Quantitative RT-PCR (qRT-PCR) analysis showed a 6-fold and 12-fold higher mRNA expression in the choriodecidua compared to placenta and amnion, respectively. In both amnion and choriodecidua, FoxO1 protein expression was higher in the cytoplasmic fractions than in the nuclear fractions. On the otherhand, ac-FoxO1 and p-FoxO1 protein expression was higher in the nuclear fractions for all three tissues. There was no difference in the mRNA or protein expression of FoxO1 proteins in placental samples from normal and pre-eclamptic term pregnancies. The exact role of FoxO1 proteins in human pregnancy are unknown, however the finding that they are expressed in human gestational tissues warrants further research into their function in these tissues.
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Affiliation(s)
- M Lappas
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Level 4/163 Studley Road, Heidelberg 3084, Victoria, Australia.
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McGuire S, Hoogeveen J, Bacchia P, Johnstone P, Khew C, Lee B, Marchant H, Morris K, Riley C, Smith K, Kruger E, Tennant M. The presenting complaints of low income adults for emergency dental care: an analysis of 35,000 episodes in Victoria, Australia. Community Dent Health 2008; 25:143-147. [PMID: 18839719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study examined the mix of presenting problems faced by a large diverse dental service treating low-income Australian adults and provides a basis for communities to understand and manage demand for dental services. DESIGN A retrospective analysis in a state-wide multi-centre dental health service. Data for all patients (in all public adult dental clinics in the state of Victoria during May-Aug 2005) who used the emergency services in a 12 week period were recorded and analysed. A triage question tree was developed and embedded into a neural network based computer triage tool. RESULTS Approximately 52% of low income adults presenting for emergency treatment required treatment on the day of triage. The main problem was with natural teeth (89.6%). Of those with natural teeth problems, 41.3% had pain disturbing their sleep patterns and 14.7% had experienced a swelling. Metropolitan patients accessed the services 2.3 times more than rural patients. CONCLUSION These data clearly highlight that there is significant opportunity to reduce nearly 48% of on-day demand for emergency dental care through the application of appropriately clinical based triage.
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Abstract
The advanced energy initiative to reduce the nation's future demand for oil has resulted in the definition of a number of pathways for the development of the bio-renewables industry. This paper gives an overview of the pathways which could lead to both ethanol and other types of bio-products. The methods that would be used for cellulose conversion also apply to adding value for the co-products of ethanol production. Process milestones and pathways for research that would enable corn dry mill operations to improve are described. A corn dry mill improvement pathway is outlined, and introduces the topics that are covered in this particular special volume.
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Affiliation(s)
- C Schell
- Navarro Research and Engineering, Inc., US DOE Golden Field Office, 1617 Cole Boulevard, Golden, CO 80401, United States
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Mahadevan D, Garewal H, Riley C, Zhu Y, Engelhardt K, Cooke L, Nagle R, Saldanha J, Von Hoff D. Humanized anti-CEACAM6 PEGylated scFv: A promising novel therapy for pancreatic cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3042 Background: Novel Therapies for pancreatic cancer (PC) based on biological insight are urgently needed. CEACAM6, a member of the carcinoembryonic antigen (CEA) family, is a cell surface oncogene on PC cells. It is a glycoprotein composed of 3 Ig-like domains (Mr ∼35.2kD) and is linked to the plasma membrane via a glycophospholipid linked anchor. It is over-expressed on ≥95% PC patients’ found irrespective of stage of disease and represents a target for antibody therapy. Methods: Murine anti-CEACAM6 monoclonal antibody (Mab) 13–1 was humanized by a structure-based approach and single chain variable fragments (scFv) designed consisting of a Gly/Ser-linker which includes a cysteine residue for PEGylation. Murine scFv and 4 humanized scFv fragments (Version.1, 2, 7, 8) were bacterially expressed, purified, PEGylated and evaluated for activity alone or in combination with gemcitabine in human PC cell lines and mouse xenograft tumors. Cell viability, apoptosis and in-cell Westerns were done for efficacy and binding. Mouse xenograft tumors were treated with scFv or PEGylated scFv or combination with gemcitabine. Tumors (treated Vs untreated) were analyzed by immunohistochemistry for Ki-67, CD31, CEACAM6 and Caspase 3 Results: Mab 13–1, murine and 4 humanized scFvs’ were cytotoxic to CEACAM6 expressing PC cells (BxPC-3, HPAF-2) and not to PC cells that lack CEACAM6 (CaPan-2) with increased PARP-cleavage that was dose dependent (IC50=10μg/mL). Western blotting of culture media and serum from xenograft mice showed that CEACAM6 is not shed. In-cell Western confirmed humanized V.7 to be the best binder (KD=1–10μg/mL) confirming protein-protein interaction studies performed in silico with homology models of murine and humanized scFvs’ and CEACAM6. The murine scFv alone or the humanized scFV (V.8) in combination with gemcitabine delayed tumor growth by >50%. This tumor reduction correlated well with the immunohistochemical markers of response. Conclusions: We have demonstrated that CEACAM6 is a clinically relevant target in PC and that a PEGylated humanized scFv is a novel effective therapy alone and/or in combination with gemcitabine. Humanized scFv V.7 is undergoing mouse xenograft evaluation and expect will be the most effective agent to take forward into clinical development. No significant financial relationships to disclose.
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Affiliation(s)
| | - H. Garewal
- University of Arizona Cancer Center, Tucson, AZ
| | - C. Riley
- University of Arizona Cancer Center, Tucson, AZ
| | - Y. Zhu
- University of Arizona Cancer Center, Tucson, AZ
| | | | - L. Cooke
- University of Arizona Cancer Center, Tucson, AZ
| | - R. Nagle
- University of Arizona Cancer Center, Tucson, AZ
| | - J. Saldanha
- University of Arizona Cancer Center, Tucson, AZ
| | - D. Von Hoff
- University of Arizona Cancer Center, Tucson, AZ
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Mahadevan D, Cooke L, Riley C, Swart R, Simons B, Della Croce K, Wisner L, Iorio M, Shakalya K, Garewal H, Nagle R, Bearss D. A novel tyrosine kinase switch is a mechanism of imatinib resistance in gastrointestinal stromal tumors. Oncogene 2007; 26:3909-19. [PMID: 17325667 DOI: 10.1038/sj.onc.1210173] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
KIT or alpha-platelet-derived growth factor receptor (alpha-PDGFR) activating mutations are the pathogenic mechanisms that characterize gastrointestinal stromal tumors (GIST). Despite excellent responses to imatinib mesylate (IM), patients are relapsing. We developed an IM-resistant GIST cell line (GIST-R) from the IM-sensitive GIST882 cell line (GIST-S) by growing these cells in IM. Gene expression profiling (GEP) of GIST-S, GIST-R cells and two IM resistant GIST patients demonstrated that KIT is downregulated implying a major role in IM resistance. Instead, GIST-R cells have acquired IM resistance by overexpressing the oncogenic receptor tyrosine kinase - AXL - in a 'kinase switch'. Further, the two IM resistant GIST patients express AXL and not c-Kit, seen by immunohistochemistry (IHC). Real time reverse transcriptase-polymerase chain reaction and Western blotting of the GIST-S and GIST-R cells confirmed the switch from Kit to AXL. In GIST-R, AXL is tyrosine phosphorylated and its ligand growth-arrest-specific gene 6 is overexpressed implying autocrine activation. The kinase switch is associated with a morphological change from spindle to epithelioid. Molecular modeling of the kinase domain of mutant c-Kit (V654A) and AXL showed no binding to IM but efficient binding to MP470, a novel c-Kit/AXL kinase inhibitor. MP470 synergizes with docetaxel (taxotere) and is cytotoxic to GIST cells.
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Affiliation(s)
- D Mahadevan
- Arizona Cancer Center, Tucson, AZ 85724, USA.
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Vortmeyer AO, Tran MGB, Zeng W, Gläsker S, Riley C, Tsokos M, Ikejiri B, Merrill MJ, Raffeld M, Zhuang Z, Lonser RR, Maxwell PH, Oldfield EH. Evolution of VHL tumourigenesis in nerve root tissue. J Pathol 2006; 210:374-82. [PMID: 16981244 DOI: 10.1002/path.2062] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Haemangioblastomas are the key central nervous system manifestation of von Hippel-Lindau (VHL) disease, which is caused by germline mutation of the VHL gene. We have recently shown that 'tumour-free' spinal cord from patients with VHL disease contains microscopic, poorly differentiated cellular aggregates in nerve root tissue, which we descriptively designated 'mesenchymal tumourlets'. Here we have investigated spinal cord tissue affected by multiple tumours. We show that a small subset of mesenchymal tumourlets extends beyond the nerve root to form proliferative VHL-deficient mesenchyme and frank haemangioblastoma. We thus demonstrate that tumourlets present potential, but true precursor material for haemangioblastoma. We further show that intraradicular tumourlets consist of scattered VHL-deficient cells with activation of HIF-2alpha and HIF-dependent target proteins including CAIX and VEGF, and are associated with an extensive angiogenic response. In contrast, activation of HIF-1alpha was only observed in the later stages of tumour progression. In addition, ultrastructural examination reveals gradual transition from poorly differentiated VHL-deficient cells into vacuolated cells with a 'stromal' cell phenotype. The evolution of frank haemangioblastoma seems to involve multiple steps from a large pool of precursor lesions.
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Affiliation(s)
- A O Vortmeyer
- Surgical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland 20892, USA.
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Affiliation(s)
- C Riley
- The Stephen Ralli Memorial Laboratory, The Royal Sussex County Hospital, Brighton, and St Francis Hospital, Haywards Heath, Sussex
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Barr J, Wilson B, Gordon M, Rah M, Riley C, Kollbaum P, Zadnik K. Estimation of the incidence and factors predictive of corneal scarring in the collaborative longitudinal evaluation of keratoconus (CLEK) study. Am J Ophthalmol 2006. [DOI: 10.1016/j.ajo.2006.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The water utility companies in the UK are regulated by the economic regulator to ensure that they do not abuse their monopoly powers and operate under high efficiency targets to minimise costs to their customers. The requirements for improved environmental performance are set by the Environment Agency and, once agreed, incorporated in a five-year plan. Prior to the Water Framework Directive the companies had little choice but to meet a rigorous programme to achieve higher discharge standards as end-of-pipe solutions. The catchment-based approach of the WFD, coupled with the requirement to achieve 'good status' for receiving waters and the requirement for stakeholder involvement, has introduced much needed flexibility into the process which is expected to lead to better and more cost effective solutions to water quality problems.
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Affiliation(s)
- C Riley
- Mersey Basin Campaign, Fourways House, 57 Hilton Street, Manchester, M1 2EJ, UK.
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Ahmed N, Riley C, Oliva K, Rice G, Quinn M. Ascites induces modulation of alpha6beta1 integrin and urokinase plasminogen activator receptor expression and associated functions in ovarian carcinoma. Br J Cancer 2005. [PMID: 15798771 DOI: 10.1038/sj.bjc.6602495].] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Interactions between cancer cells and the surrounding medium are not fully understood. In this study, we demonstrate that ascites induces selective changes in the expression of integrins and urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) in ovarian cancer cells. We hypothesise that this change of integrin and uPA/uPAR expression triggers signalling pathways responsible for modulating phenotype-dependent functional changes in ovarian cancer cells. Human ovarian surface epithelial (HOSE) cell lines and epithelial ovarian cancer cell lines were treated with ascites for 48 h. Ascites induced upregulation of alpha6 integrin, without any change in the expression of alphav, beta1 and beta4 integrin subunits. Out of the four ovarian cancer cell lines studied, ascites induced enhancement in the expression of uPA/uPAR in the more invasive OVCA 433 and HEY cell lines without any change in the noninvasive OVHS1 and moderately invasive PEO.36 cell lines. On the other hand, no change in the expression of alpha6 integrin or uPAR, in response to ascites, was observed in HOSE cells. In response to ascites, enhancement in proliferation and in adhesion was observed in all four ovarian cancer cell lines studied. In contrast, no significant increase in proliferation or adhesion by ascites was observed in HOSE cells. Ascites-induced expression of uPA/uPAR correlated with the increased invasiveness of HEY and OVCA 433 cell lines but was not seen in OVHS1, PEO.36 and HOSE cell lines. Upregulation of alpha6 integrin and uPA/uPAR correlated with the activation of Ras and downstream Erk pathways. Ascites-induced activation of Ras and downstream Erk can be inhibited by using inhibitory antibodies against alpha6 and beta1 integrin and uPAR, consistent with the inhibition of proliferation, adhesion and invasive functions of ovarian cancer cell lines. Based on these findings, we conclude that ascites can induce selective upregulation of integrin and uPA/uPAR in ovarian cancer cells and these changes may modulate the functions of ovarian carcinomas.
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Affiliation(s)
- N Ahmed
- Gynaecological Cancer Research Centre, Royal Women's Hospital, Melbourne, Australia.
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45
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Ahmed N, Riley C, Oliva K, Rice G, Quinn M. Ascites induces modulation of alpha6beta1 integrin and urokinase plasminogen activator receptor expression and associated functions in ovarian carcinoma. Br J Cancer 2005; 92:1475-85. [PMID: 15798771 PMCID: PMC2362012 DOI: 10.1038/sj.bjc.6602495] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Interactions between cancer cells and the surrounding medium are not fully understood. In this study, we demonstrate that ascites induces selective changes in the expression of integrins and urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) in ovarian cancer cells. We hypothesise that this change of integrin and uPA/uPAR expression triggers signalling pathways responsible for modulating phenotype-dependent functional changes in ovarian cancer cells. Human ovarian surface epithelial (HOSE) cell lines and epithelial ovarian cancer cell lines were treated with ascites for 48 h. Ascites induced upregulation of alpha6 integrin, without any change in the expression of alphav, beta1 and beta4 integrin subunits. Out of the four ovarian cancer cell lines studied, ascites induced enhancement in the expression of uPA/uPAR in the more invasive OVCA 433 and HEY cell lines without any change in the noninvasive OVHS1 and moderately invasive PEO.36 cell lines. On the other hand, no change in the expression of alpha6 integrin or uPAR, in response to ascites, was observed in HOSE cells. In response to ascites, enhancement in proliferation and in adhesion was observed in all four ovarian cancer cell lines studied. In contrast, no significant increase in proliferation or adhesion by ascites was observed in HOSE cells. Ascites-induced expression of uPA/uPAR correlated with the increased invasiveness of HEY and OVCA 433 cell lines but was not seen in OVHS1, PEO.36 and HOSE cell lines. Upregulation of alpha6 integrin and uPA/uPAR correlated with the activation of Ras and downstream Erk pathways. Ascites-induced activation of Ras and downstream Erk can be inhibited by using inhibitory antibodies against alpha6 and beta1 integrin and uPAR, consistent with the inhibition of proliferation, adhesion and invasive functions of ovarian cancer cell lines. Based on these findings, we conclude that ascites can induce selective upregulation of integrin and uPA/uPAR in ovarian cancer cells and these changes may modulate the functions of ovarian carcinomas.
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Affiliation(s)
- N Ahmed
- Gynaecological Cancer Research Centre, Royal Women's Hospital, Melbourne, Australia.
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46
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Ahmed N, Riley C, Oliva K, Rice G, Quinn M. Ascites induces modulation of alpha6beta1 integrin and urokinase plasminogen activator receptor expression and associated functions in ovarian carcinoma. Br J Cancer 2005. [PMID: 15798771 DOI: 10.1038/sj.bjc.6602495]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Interactions between cancer cells and the surrounding medium are not fully understood. In this study, we demonstrate that ascites induces selective changes in the expression of integrins and urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) in ovarian cancer cells. We hypothesise that this change of integrin and uPA/uPAR expression triggers signalling pathways responsible for modulating phenotype-dependent functional changes in ovarian cancer cells. Human ovarian surface epithelial (HOSE) cell lines and epithelial ovarian cancer cell lines were treated with ascites for 48 h. Ascites induced upregulation of alpha6 integrin, without any change in the expression of alphav, beta1 and beta4 integrin subunits. Out of the four ovarian cancer cell lines studied, ascites induced enhancement in the expression of uPA/uPAR in the more invasive OVCA 433 and HEY cell lines without any change in the noninvasive OVHS1 and moderately invasive PEO.36 cell lines. On the other hand, no change in the expression of alpha6 integrin or uPAR, in response to ascites, was observed in HOSE cells. In response to ascites, enhancement in proliferation and in adhesion was observed in all four ovarian cancer cell lines studied. In contrast, no significant increase in proliferation or adhesion by ascites was observed in HOSE cells. Ascites-induced expression of uPA/uPAR correlated with the increased invasiveness of HEY and OVCA 433 cell lines but was not seen in OVHS1, PEO.36 and HOSE cell lines. Upregulation of alpha6 integrin and uPA/uPAR correlated with the activation of Ras and downstream Erk pathways. Ascites-induced activation of Ras and downstream Erk can be inhibited by using inhibitory antibodies against alpha6 and beta1 integrin and uPAR, consistent with the inhibition of proliferation, adhesion and invasive functions of ovarian cancer cell lines. Based on these findings, we conclude that ascites can induce selective upregulation of integrin and uPA/uPAR in ovarian cancer cells and these changes may modulate the functions of ovarian carcinomas.
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Affiliation(s)
- N Ahmed
- Gynaecological Cancer Research Centre, Royal Women's Hospital, Melbourne, Australia.
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Riley C, Hutter-Paier B, Windisch M, Doppler E, Moessler H, Wronski R. A peptide preparation protects cells in organotypic brain slices against cell death after glutamate intoxication. J Neural Transm (Vienna) 2005; 113:103-10. [PMID: 15843866 DOI: 10.1007/s00702-005-0302-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2005] [Accepted: 03/12/2005] [Indexed: 01/20/2023]
Abstract
Cerebrolysin has been shown to have neurotrophic and neuroprotective potential similar to NGF or BDNF. In the present study organotypic brain slices were utilized to determine the neuroprotective effects of Cerebrolysin, in a glutamate lesion paradigm mimicking a key event in ischemia. The study focused on the effects of Cerebrolysin on both necrotic and apoptotic cell death. Two specific DNA intercalating dyes were used to distinguish the type of cell death. The drug effect was evaluated both microscopically and quantitatively before, 24 hours after and then again 8 days after the lesion. Cerebrolysin was added either before and after the lesion or after the lesion only. The most pronounced effect was seen with the drug added both prior to and after the glutamate lesioning. A treatment after the lesion only also counteracted necrosis and apoptosis. The results render the drug relevant for treating acute as well as chronic neurodegenerative diseases.
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Affiliation(s)
- C Riley
- JSW-Research, Institute of Experimental Pharmacology, Graz, Austria
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Zhang GY, Ahmed N, Riley C, Oliva K, Barker G, Quinn MA, Rice GE. Enhanced expression of peroxisome proliferator-activated receptor gamma in epithelial ovarian carcinoma. Br J Cancer 2005; 92:113-9. [PMID: 15583697 PMCID: PMC2361744 DOI: 10.1038/sj.bjc.6602244] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The peroxisome proliferator-activated receptors (PPARs) belong to a subclass of nuclear hormone receptor that executes important cellular transcriptional functions. Previous studies have demonstrated the expression of PPARγ in several tumours including colon, breast, bladder, prostate, lung and stomach. This study demonstrates the relative expression of PPARγ in normal ovaries and different pathological grades of ovarian tumours of serous, mucinous, endometrioid, clear cell and mixed subtypes. A total of 56 ovarian specimens including 10 normal, eight benign, 10 borderline, seven grade 1, nine grade 2 and 12 grade 3 were analysed using immunohistochemistry. Immunoreactive PPARγ was not expressed in normal ovaries. Out of eight benign and 10 borderline tumours, only one tumour in each group showed weak cytoplasmic PPARγ expression. In contrast, 26 out of 28 carcinomas studied were positive for PPARγ expression with staining confined to cytoplasmic and nuclear regions. An altered staining pattern of PPARγ was observed in high-grade ovarian tumours with PPARγ being mostly localized in the nuclei with little cytoplasmic immunoreactivity. On the other hand, predominant cytoplasmic staining was observed in lower-grade tumours. Significantly increased PPARγ immunoreactivity was observed in malignant ovarian tumours (grade 1, 2 and 3) compared to benign and borderline tumours (χ2=48.80, P<0.001). Western blot analyses showed significant elevation in the expression of immunoreactive PPARγ in grade 3 ovarian tumours compared with that of normal ovaries and benign ovarian tumours (P<0.01). These findings suggest an involvement of PPARγ in the onset and development of ovarian carcinoma and provide an insight into the regulation of this molecule in the progression of the disease.
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Affiliation(s)
- G Y Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan 250012, PR China
| | - N Ahmed
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia. E-mail:
| | - C Riley
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
| | - K Oliva
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
| | - G Barker
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
| | - M A Quinn
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
| | - G E Rice
- Gynaecological Cancer Research Centre, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
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Ahmed N, Barker G, Oliva KT, Hoffmann P, Riley C, Reeve S, Smith AI, Kemp BE, Quinn MA, Rice GE. Proteomic-based identification of haptoglobin-1 precursor as a novel circulating biomarker of ovarian cancer. Br J Cancer 2004; 91:129-40. [PMID: 15199385 PMCID: PMC2364749 DOI: 10.1038/sj.bjc.6601882] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Screening for specific biomarkers of early-stage detection of ovarian cancer is a major health priority due to the asymptomatic nature and poor survival characteristic of the disease. We utilised two-dimensional gel electrophoresis (2DE) to identify differentially expressed proteins in the serum of ovarian cancer patients that may be useful as biomarkers of this disease. In this study, 38 ovarian cancer patients at different pathological grades (grade 1 (n=6), grade 2 (n=8) and grade 3 (n=24)) were compared to a control group of eight healthy women. Serum samples were treated with a mixture of Affigel-Blue and protein A (5 : 1) for 1 h to remove high abundance protein (e.g. immunoglobulin and albumin) and were displayed using 11 cm, pH 4–7 isoelectric focusing strips for the first dimension and 10% acrylamide gel electrophoresis for the second dimension. Protein spots were visualised by SYPRO-Ruby staining, imaged by FX-imager and compared and analysed by PDQuest software. A total of 24 serum proteins were differentially expressed in grade 1 (P<0.05), 31 in grade 2 (P<0.05) and 25 in grade 3 (P<0.05) ovarian cancer patients. Six of the protein spots that were significantly upregulated in all groups of ovarian cancer patients were identified by nano-electrospray quadrupole quadrupole time-of-flight mass spectrometry (n-ESIQ(q)TOFMS) and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOFMS) as isoforms of haptoglobin-1 precursor (HAP1), a liver glycoprotein present in human serum. Further identification of the spots at different pathological grades was confirmed by Western blotting using monoclonal antibody against a haptoglobin epitope contained within HAP1. Immunohistochemical localisation of HAP1-like activity was present in malignant ovarian epithelium and stroma but strong immunostaining was present in blood vessels, areas with myxomatous stroma and vascular spaces. No tissue localisation of HAP1-like immunoreactivity was observed in normal ovarian surface epithelium. These data highlight the need to assess circulating concentration of HAP1 in the serum of ovarian cancer patients and evaluate its potential as a biomarker in the early diagnosis of ovarian cancer.
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Affiliation(s)
- N Ahmed
- Gynaecological Cancer Research Centre, Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria 3053, Australia.
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