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Siddiqui ST, La Manna A, Connors E, Smith R, Vance K, Budesa Z, Goulka J, Beletsky L, Wood CA, Marotta P, Winograd RP. An evaluation of first responders' intention to refer to post-overdose services following SHIELD training. Harm Reduct J 2024; 21:39. [PMID: 38351046 PMCID: PMC10863209 DOI: 10.1186/s12954-024-00957-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.
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Affiliation(s)
- Saad T Siddiqui
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA.
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Elizabeth Connors
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Zach Budesa
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Jeremiah Goulka
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Leo Beletsky
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Phillip Marotta
- Department of Social Work, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
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Melisko M, Yardley DA, Blackwell K, Forero A, Ma C, Montero A, Daniel BR, Wright G, Fehrenbacher L, Chew H, Ferrario C, Nanda R, Seiler M, Guthrie T, Vance K, Ouellette G, He Y, Bagley RG, Zhang J, Vahdat LT. Abstract OT1-03-15: The METRIC trial: A randomized international study of the antibody-drug conjugate glembatumumab vedotin (GV or CDX-011) in patients with metastatic gpNMB-overexpressing triple-negative breast cancer (TNBC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot1-03-15] [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
Glycoprotein NMB (gpNMB) is an internalizable transmembrane protein overexpressed in approximately 20% of breast cancer (BC), including approximately 40% of TNBC. gpNMB is a poor prognostic marker in BC (Rose CCR 2010) and preclinically has been implicated in tumor invasion, metastasis, and angiogenesis. GV is a novel antibody-drug conjugate targeting the potent cytotoxin monomethylauristatin E (MMAE) to gpNMB overexpressing cancer cells.
In a Phase I/II study and the Phase II "EMERGE" study, GV demonstrated promising activity with TNBC patients (pts) deriving the greatest benefit and exhibiting the highest degree of gpNMB overexpression. GV was well-tolerated with the most frequent treatment-related toxicities consisting of rash, neutropenia, and neuropathy. In subset analyses of the EMERGE trial, objective response rate (ORR) was 30% (7/23) for GV vs. 9% (1/11) for investigator's choice in tumors with gpNMB overexpression (>25% of tumor epithelium); 18% (5/28) vs. 0% (0/11) in TNBC; and 40% (4/10) vs. 0% (0/6) in gpNMB-overexpressing TNBC for GV and IC respectively, with apparent improvements in progression-free survival (PFS; hazard ratio (HR) = 0.11) and overall survival (OS; HR = 0.14).
Trial design
The METRIC Trial (NCT#01997333) is an international (USA, CA, Aus), two-arm phase II study. Pts are randomized 2:1 to GV (1.88 mg/kg IV q 21 days) or capecitabine, a current standard of care for this population (2,500 mg/m2 daily for d1-14, q21 days) until progression or intolerance. Crossover is not permitted.
Eligibility criteria
Key eligibility criteria include: >25% of tumor epithelium gpNMB+ by central immunohistochemistry (IHC) screening of archival tissue; estrogen receptor and progesterone receptor <10% and HER2 negative [0-1+ IHC, or ISH copy number <4.0/ratio <2.0] by local assessment; ECOG 0-1; taxane resistance; anthracycline exposure (if indicated); <2 chemotherapy regimens for advanced BC; measurable disease; no persistent Grade >2 toxicity.
Specific aims
The primary endpoint is PFS per independent, blinded central review committee according to RECIST 1.1. Secondary endpoints are ORR, duration of response, OS, safety, pharmacokinetics and pharmacodynamics. Exploratory endpoints are quality of life and/or cancer-related pain.
Statistical methods and target accrual
The trial has 85% power to detect a PFS HR of 0.64 with two sided α = 0.05. The hypothesized median PFS is 4.0 months for capecitabine and 6.25 months for GV. Target accrual is open for 300 pts.
Citation Format: Melisko M, Yardley DA, Blackwell K, Forero A, Ma C, Montero A, Daniel BR, Wright G, Fehrenbacher L, Chew H, Ferrario C, Nanda R, Seiler Jr M, Guthrie T, Vance K, Ouellette G, He Y, Bagley RG, Zhang J, Vahdat LT. The METRIC trial: A randomized international study of the antibody-drug conjugate glembatumumab vedotin (GV or CDX-011) in patients with metastatic gpNMB-overexpressing triple-negative breast cancer (TNBC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT1-03-15.
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Affiliation(s)
- M Melisko
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - DA Yardley
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - K Blackwell
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - A Forero
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - C Ma
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - A Montero
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - BR Daniel
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - G Wright
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - L Fehrenbacher
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - H Chew
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - C Ferrario
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - R Nanda
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - M Seiler
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - T Guthrie
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - K Vance
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - G Ouellette
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - Y He
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - RG Bagley
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - J Zhang
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
| | - LT Vahdat
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Sarah Cannon Research Institute/Tennessee Oncology, PLLC; Duke University Medical Center; University of Alabama; Washington University; Cleveland Clinic; Chattanooga Oncology Hematology Associates; Florida Cancer Specialists; Kaiser Permanente; University of California Davis Comprehensive Cancer Center; Segal Cancer Center-Jewish General Hospital; University of Chicago; Crescent City Research Consortium, LLC; Baptist Cancer Institute; Alabama Oncology; Celldex Therapeutics, Inc.; Weill Cornell Medical College
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Muñoz P, Vance K, Gómez-Chiarri M. Protease activity in the plasma of American oysters, Crassostrea virginica, experimentally infected with the protozoan parasite Perkinsus marinus. J Parasitol 2003; 89:941-51. [PMID: 14627141 DOI: 10.1645/ge-3126] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Perkinsus marinus is responsible for disease and mortality of the American oyster, Crassostrea virginica. To investigate the interactions between P. marinus and oyster hemocytes, protease activity was measured in plasma of oysters collected 4 hr, 24 hr, 4 days, and 2 mo after experimental infection with P. marinus. A significant increase in protease activity was observed in oyster plasma 4 hr after injection with P. marinus, followed by a sharp decrease within 24 hr. Gelatin-impregnated gel electrophoresis showed the presence of 2 major bands (60 and 112 kDa) and 3 less prevalent bands (35, 92, and 200 kDa) with metalloproteinaselike activity in the plasma of noninfected oysters. Additional bands in the 40- to 60-kDa range, corresponding to P. marinus serine proteases, were observed in oyster plasma at early time points after infection. A transient, but significant, decrease in the activity of oyster metalloproteinases was observed at early time points after infection. Coincubation of oyster plasma with P. marinus extracellular products resulted in a decrease in oyster metalloproteinases and several P. marinus proteases. This study provides insights into the role of proteases in the pathogenesis of Dermo disease.
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Affiliation(s)
- P Muñoz
- Department of Fisheries, Animal, and Veterinary Science, University of Rhode Island, 23 Woodward Hall, Kingston, Rhode Island 02881, USA
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Fullerton CS, Ursano RJ, Epstein RS, Crowley B, Vance K, Kao TC, Dougall A, Baum A. Gender differences in posttraumatic stress disorder after motor vehicle accidents. Am J Psychiatry 2001; 158:1486-91. [PMID: 11532736 DOI: 10.1176/appi.ajp.158.9.1486] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women have higher rates of posttraumatic stress disorder (PTSD) than men. The authors examined prior trauma, PTSD, major depression, anxiety disorder not including PTSD, and peritraumatic dissociation; current peritraumatic dissociation; and passenger injury as possible explanations for the different rates of acute PTSD in women and men after a serious motor vehicle accident. METHOD Subjects age 18-65 years who had been in a serious motor vehicle accident (N=122) were assessed with the Structured Clinical Interview for DSM-III-R and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version 1 month after the accident. RESULTS Women did not differ from men in meeting the overall reexperiencing criterion for a diagnosis of PTSD (criterion B), but women were at greater risk for the specific reexperiencing symptoms of intense feelings of distress in situations similar to the motor vehicle accident and physical reactivity to memories of the motor vehicle accident. Women were 4.7 times more likely than men to meet the overall avoidance/numbing criterion (criterion C) and 3.8 times more likely to meet the overall arousal criterion (criterion D). Women were more likely than men to report the criterion C symptoms of avoiding thoughts and situations associated with the accident, loss of interest in significant activities, and a sense of foreshortened future and the criterion D symptoms of trouble sleeping, difficulty concentrating, and exaggerated startle response. Multiple logistic regression analysis indicated that the gender differences in acute PTSD were not associated with prior trauma, PTSD, peritraumatic dissociation, major depression, or anxiety disorder not including PTSD or with passenger injury. However, peritraumatic dissociative symptoms at the time of the accident were associated with a significantly higher risk for acute PTSD in women than in men. CONCLUSIONS Gender differences in peritraumatic dissociation may help explain differences in risk for PTSD and for some PTSD symptoms in women and men.
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Affiliation(s)
- C S Fullerton
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Abstract
In this paper we address three areas. First we review the literature on clinical intervention using debriefing, second we examine who attends debriefings by looking at a study of the 1989 plane crash at Ramstein, Germany and lastly we examine the effect of natural debriefing, i.e., talking to family and friends on psychiatric outcome in disaster workers by looking at a study of the Sioux City, Iowa United plane crash, 1989. Our data suggest that those with high exposure and females were more likely to attend a debriefing. People most likely to talk about the disaster with spouse/significant other, coworker and/or another person were: those with acute PTSD, higher total and intrusive Impact of Event symptoms, older, married, those with higher levels of education and higher levels of disaster exposure. Better understanding of who attends formal debriefings will help identify potential high-risk groups. Similarly, whether talking about the disaster is associated with fewer or greater psychological symptoms is important to understanding the outcome, mechanisms, and risks of debriefing.
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Affiliation(s)
- C S Fullerton
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA
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Ursano RJ, Fullerton CS, Epstein RS, Crowley B, Vance K, Kao TC, Baum A. Peritraumatic dissociation and posttraumatic stress disorder following motor vehicle accidents. Am J Psychiatry 1999; 156:1808-10. [PMID: 10553747 DOI: 10.1176/ajp.156.11.1808] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the relation between peritraumatic dissociation and posttraumatic stress disorder (PTSD) in victims of motor vehicle accidents. METHOD Victims of serious motor vehicle accidents (N = 122) were assessed for peritraumatic dissociation with the Peritraumatic Dissociative Experiences Questionnaire-Rater Version and followed longitudinally to assess acute and chronic PTSD (1 month and 3 months after the accident) with the Structured Clinical Interview for DSM-III-R. RESULTS The most common peritraumatic dissociative symptom was time distortion (56.6%). Subjects with peritraumatic dissociation were 4.12 times more likely than those without to have acute PTSD and 4.86 times more likely to develop chronic PTSD. The risk was independent of risk associated with the presence of PTSD before the accident. CONCLUSIONS Peritraumatic dissociation is common following motor vehicle accidents and is a risk factor for acute and chronic PTSD, independent of risk associated with prior PTSD.
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Affiliation(s)
- R J Ursano
- Department of Psychiatry, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD 20814-4799, USA
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Ursano RJ, Fullerton CS, Epstein RS, Crowley B, Kao TC, Vance K, Craig KJ, Dougall AL, Baum A. Acute and chronic posttraumatic stress disorder in motor vehicle accident victims. Am J Psychiatry 1999; 156:589-95. [PMID: 10200739 DOI: 10.1176/ajp.156.4.589] [Citation(s) in RCA: 43] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study reports the rates of acute and chronic posttraumatic stress disorder (PTSD) in a suburban community study group of 122 victims of serious motor vehicle accidents and a comparison group of 42 (who had been involved in minor, non-motor-vehicle accidents) followed over 12 months. METHOD Motor vehicle accident victims were systematically recruited and examined with comparison subjects at 1, 3, 6, 9, and 12 months after the accident. The authors used the Structured Clinical Interview for DSM-III-R to assess DSM-III-R axis I disorders including PTSD. RESULTS One month after the accident, 34.4% of the motor vehicle accident victims met criteria for PTSD (versus 2.4% of the comparison subjects). Similarly, at 3 and 6 months, rates of PTSD were higher (25.2% and 18.2%) in the motor vehicle accident victims than in the comparison group. Female victims were 4.64 times more likely than male victims to have PTSD at 1 month. Victims with a history of PTSD were 8.02 times more likely at 1 month and 6.81 times more likely at 3 months to have PTSD than those without a history of PTSD. Having an axis II disorder increased the risk for PTSD at 6 months. After adjustment for a history of PTSD and potentially confounding variables, women were 4.39 times more likely than men to develop PTSD at 1 month but did not have a higher risk for chronic PTSD; at 6 months, those with an axis II disorder were at greater risk of PTSD. CONCLUSIONS Rates of PTSD are high in victims of serious motor vehicle accidents and remain high 9 months later. Female victims have an increased risk of acute but not chronic PTSD. Individuals with a history of PTSD are at risk of acute and chronic PTSD. An axis II disorder increases the risk for chronic but not acute PTSD.
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Affiliation(s)
- R J Ursano
- Department of Psychiatry, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD 20814-4799, USA
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Abstract
OBJECTIVE Disaster workers who work with deceased victims are at increased risk of posttraumatic stress disorder (PTSD). Identification with the deceased has been proposed as one of the mechanisms in this stress-illness relationship. To examine this hypothesis, this study investigated three types of identification with the dead in a group of disaster workers: identification with the deceased as oneself, identification with the deceased as a friend, and identification with the deceased as a family member. METHOD Fifty-four volunteer disaster workers who worked with the dead following an explosion on the USS Iowa naval ship were assessed 1, 4, and 13 months after the disaster. PTSD symptoms (measured with the DSMPTSD-IV scale), intrusive and avoidant disaster-related symptoms (measured with the Impact of Event Scale), somatization and general distress (measured with the SCL-90-R), and health care utilization were assessed. RESULTS Disaster workers who reported identification with the deceased as a friend were more likely than those who did not to have PTSD, more intrusive and avoidant symptoms, and greater levels of other posttraumatic symptoms including somatization. Disaster workers who reported identification with the deceased as a family member had greater intrusive symptoms 1 month after the disaster than those who did not. There were no differences between those who did and did not identify with the deceased as self. Health care utilization was not associated with identification. CONCLUSIONS Identification with the deceased is a risk factor for PTSD and posttraumatic symptoms in disaster workers exposed to the dead. Identification with the dead as a friend is specifically associated with higher risk for these workers.
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Affiliation(s)
- R J Ursano
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Primm ND, Vance K, Wykle L, Hofacre CL. Application of normal avian gut flora by prolonged aerosolization onto turkey hatching eggs naturally exposed to Salmonella. Avian Dis 1997; 41:455-60. [PMID: 9201415] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A commercial preparation of normal avian gut flora (NAGF) was aerosolized for an extended period over turkey hatching eggs during pipping and hatching to examine any protective effects against natural exposure to salmonellae. Turkey hatching eggs, produced by salmonellae-infected breeder flocks and hatched in a commercial hatchery with a history of salmonellae contamination, were used in two trials. In Trial 1, four doses of NAGF inoculum per hatching egg were aerosolized through an automated hatcher fogging system during the final 48 hr of the pipping and hatching process. In Trial 2, two doses of NAGF inoculum were aerosolized in a like manner. In both trials, poults were exposed to Salmonella montevideo during hatching, as indicated by samples collected at the time of pull. At day 7, treated poults in both trials were culture negative for salmonellae and control poults were culture positive for salmonellae. In Trial 1, control poults were infected with Salmonella brandenburg, and in Trial 2, control poults were infected with S. montevideo. These studies justify further critical evaluation of the protective effects of prolonged aerosolization of normal avian gut flora during pipping and hatching against salmonellae colonization in turkey poults.
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Affiliation(s)
- N D Primm
- British United Turkeys of America, Lewisburg, West Virginia 24901, USA
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Odor EM, Salem M, Pope CR, Sample B, Primm M, Vance K, Murphy M. Isolation and identification of Ornithobacterium rhinotracheale from commercial broiler flocks on the Delmarva peninsula. Avian Dis 1997; 41:257-60. [PMID: 9087345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The growth and biological characteristics of isolates of Ornithobacterium rhinotracheale (ORT) from commercial broiler chickens in the mid-Atlantic region of the U.S.A. appear to be identical to those previously reported in the literature. The clinical disease and lesions are also similar to those reported from other poultry growing regions including South Africa and Europe. The diagnostic cases included in this report were often associated with known respiratory pathogens, namely, lentogenic Newcastle disease virus, and infectious bronchitis virus, and Escherichia coli bacteria. The role of ORT in the disease cases presented in this report is unclear.
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Affiliation(s)
- E M Odor
- Department of Animal and Food Science, University of Delaware, Newark 19716, USA
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Odor EM, Salem M, Pope CR, Sample B, Primm M, Vance K, Murphy M. Isolation and Identification of Ornithobacterium rhinotracheale from Commercial Broiler Flocks on the Delmarva Peninsula. Avian Dis 1997. [DOI: 10.2307/1592468] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Prezyna A, Attallah A, Vance K, Schoolman M, Lee J. A newly recognized structure of renomedullary interstitial cell origin associated with high prostaglandin content. Prostaglandins 1973; 3:669-78. [PMID: 4729596 DOI: 10.1016/0090-6980(73)90102-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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