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Venchiarutti RL, Clark JR, Palme CE, Dwyer P, Tahir ARM, Hill J, Ch'ng S, Elliott MS, Young JM. Associations between patient-level health literacy and diagnostic time intervals for head and neck cancer: A prospective cohort study. Head Neck 2024; 46:857-870. [PMID: 38213101 DOI: 10.1002/hed.27633] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). METHODS A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. RESULTS One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients -0.25 to -0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients -0.23 to -0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. CONCLUSIONS HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes.
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Affiliation(s)
- Rebecca L Venchiarutti
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Patrick Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Jane M Young
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Camperdown, New South Wales, Australia
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2
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Baiden KMP, Williams ZJ, Schuck RK, Dwyer P, Wang M. The Social Validity of Behavioral Interventions: Seeking Input from Autistic Adults. J Autism Dev Disord 2024:10.1007/s10803-024-06297-3. [PMID: 38470531 DOI: 10.1007/s10803-024-06297-3] [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] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
Many in the autistic community have expressed concerns regarding the use of behavioral interventions with autistic children, suggesting that these interventions may not be socially valid. Though behavioral interventions have evolved to be more naturalistic and child-centered, little structured research has been done to explicitly seek autistic perspectives on the acceptability of specific components of behavioral interventions. Autistic adults (N = 235) were recruited online to take the Autism Intervention Attitudes Scale (AIAS), a questionnaire designed to gather feedback on common intervention goals and practices. Results indicate that participants find goals and practices that highlight quality of life, safety, and autistic interactions acceptable, while those that focus on normalization based on neurotypical standards are not. An exploratory graph analysis revealed three communities of goals ("uncontroversial goals", "controversial goals", and "social goals"). Comparison between naturalistic and structured intervention components additionally showed that autistic participants favored naturalistic strategies. These findings are in line with known criticisms of behavioral intervention from autistic adults, but also provide more information on the specific ways in which behavioral interventions can be reformed. This information can guide professionals in the development of appropriate goals and decisions around intervention planning.
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Affiliation(s)
- Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA.
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, USA
| | - Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
- Olga Tennison Autism Research Centre (OTARC), School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
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3
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Dwyer P, Vukusic S, Williams ZJ, Saron CD, Rivera SM. "Neural Noise" in Auditory Responses in Young Autistic and Neurotypical Children. J Autism Dev Disord 2024; 54:642-661. [PMID: 36434480 PMCID: PMC10209352 DOI: 10.1007/s10803-022-05797-4] [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] [Accepted: 10/13/2022] [Indexed: 11/27/2022]
Abstract
Elevated "neural noise" has been advanced as an explanation of autism and autistic sensory experiences. However, functional neuroimaging measures of neural noise may be vulnerable to contamination by recording noise. This study explored variability of electrophysiological responses to tones of different intensities in 127 autistic and 79 typically-developing children aged 2-5 years old. A rigorous data processing pipeline, including advanced visualizations of different signal sources that were maximally independent across different time lags, was used to identify and eliminate putative recording noise. Inter-trial variability was measured using median absolute deviations (MADs) of EEG amplitudes across trials and inter-trial phase coherence (ITPC). ITPC was elevated in autism in the 50 and 60 dB intensity conditions, suggesting diminished (rather than elevated) neural noise in autism, although reduced ITPC to soft 50 dB sounds was associated with increased loudness discomfort. Autistic and non-autistic participants did not differ in MADs, and indeed, the vast majority of the statistical tests examined in this study yielded no significant effects. These results appear inconsistent with the neural noise account.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, Davis, CA, USA.
- Center for Mind and Brain, UC Davis, Davis, CA, USA.
- MIND Institute, UC Davis Health, Sacramento, CA, USA.
| | | | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clifford D Saron
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- MIND Institute, UC Davis Health, Sacramento, CA, USA
| | - Susan M Rivera
- Department of Psychology, UC Davis, Davis, CA, USA
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- MIND Institute, UC Davis Health, Sacramento, CA, USA
- College of Behavioral and Social Sciences, University of Maryland, College Park, MD, USA
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4
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Schuck RK, Dwyer P, Baiden KMP, Williams ZJ, Wang M. Social Validity of Pivotal Response Treatment for Young Autistic Children: Perspectives of Autistic Adults. J Autism Dev Disord 2024; 54:423-441. [PMID: 36427175 PMCID: PMC10821825 DOI: 10.1007/s10803-022-05808-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
The social validity of autism behavioral intervention has been questioned. Naturalistic Developmental Behavioral Interventions (NDBIs) attempt to address some concerns, but it is unclear whether autistic people consider NDBIs socially valid. Social validity of an NDBI, Pivotal Response Treatment (PRT), was investigated through autistic adults commenting on videos of autistic children receiving PRT. Qualitative coding of responses generated three themes: respect for individuals; assessment of intervention implementation; and socioemotional considerations. Although video brevity limits the scope of the present study's conclusions, participants highlighted PRT components that appeared socially valid (e.g., reinforcing attempts, following the child's lead) and aspects appearing invalid (e.g., overemphasis on spoken language). Therefore, adjustments appear necessary for PRT to be fully acceptable to the autistic community.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
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5
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Ahn J, Yeghiaian-Alvandi R, Hegi-Johnson F, Browne LH, Graham PH, Chin Y, Gee H, Vinod S, Ludbrook J, Last A, Dwyer P, Ong A, Aherne N, Azzi M, Hau E. SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life. Int J Radiat Oncol Biol Phys 2023; 117:1213-1221. [PMID: 37482136 DOI: 10.1016/j.ijrobp.2023.07.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to report pulmonary function tests (PFTs) and clinician-reported and patient-reported quality-of-life (QoL) outcomes on a cohort of patients with non-small cell lung cancer (NSCLC) treated with SABR. METHODS AND MATERIALS A total of 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and QoL measures were obtained at baseline pretreatment and at 6-month intervals. Here we report on the 6- to 18-month time points. Analysis of covariance (ANCOVA) methods adjusting for baseline analyzed potential predictors on outcomes of PFTs and patient-reported dyspnea at 18 months. RESULTS The only statistically significant decline in PFTs was seen in forced expiratory volume in 1 second (FEV1) at 18 months post-SABR, with a decline of -0.11 L (P = .0087; 95% CI, -0.18 to -0.02). Of potential predictors of decline, only a 1-unit increase in smoking pack-years resulted in a -0.12 change in diffusing capacity for carbon monoxide (P = .026; 95% CI, -0.02 to -0.23) and a 0.003 decrease in FEV1 (P = .026; 95% CI, -0.006 to -0.0004). For patient-reported outcomes, statistically significant worsening in both the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30 Version 3) and the lung module (QLQ-LC13) dyspnea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores. CONCLUSIONS We found a statistically significant decline in FEV1 at 18 months posttreatment. Smoking pack-years was a predictor for decline in diffusing capacity for carbon monoxide and FEV1 at 18 months. Worsening of patient-reported dyspnea scores was observed, consistent with the expected progression of lung comorbid disease.
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Affiliation(s)
- Julie Ahn
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia.
| | - Roland Yeghiaian-Alvandi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia; Department of Radiation Oncology, Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Fiona Hegi-Johnson
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Clinical Oncology, University of Melbourne, Victoria, Australia
| | - Lois H Browne
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Henry Graham
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yaw Chin
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; Children's Medical Research Institute (CMRI), University of Sydney, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, New South Wales, Australia
| | - Jane Ludbrook
- Department of Radiation Oncology, Calvary Mater Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Patrick Dwyer
- University of Sydney, Sydney, New South Wales, Australia; Department of Radiation Oncology, Northern NSW Cancer Institute, Lismore, New South Wales, Australia
| | - Anselm Ong
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia
| | - Noel Aherne
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Maria Azzi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
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6
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Chapman CR, Quinn GP, Natri HM, Berrios C, Dwyer P, Owens K, Heraty S, Caplan AL. Consideration and Disclosure of Group Risks in Genomics and Other Data-Centric Research: Does the Common Rule Need Revision? Am J Bioeth 2023:1-14. [PMID: 38010648 DOI: 10.1080/15265161.2023.2276161] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Harms and risks to groups and third-parties can be significant in the context of research, particularly in data-centric studies involving genomic, artificial intelligence, and/or machine learning technologies. This article explores whether and how United States federal regulations should be adapted to better align with current ethical thinking and protect group interests. Three aspects of the Common Rule deserve attention and reconsideration with respect to group interests: institutional review board (IRB) assessment of the risks/benefits of research; disclosure requirements in the informed consent process; and criteria for waivers of informed consent. In accordance with respect for persons and communities, investigators and IRBs should systematically consider potential group harm when designing and reviewing protocols, respectively. Research participants should be informed about any potential group harm in the consent process. We call for additional public discussion, empirical research, and normative analysis on these issues to determine the right regulatory and policy path forward.
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Affiliation(s)
| | | | | | - Courtney Berrios
- Children's Mercy Kansas City
- University of Missouri-Kansas City School of Medicine
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7
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Poulsen R, Dwyer P, Gassner D, Heyworth M, Williams ZJ. The INSAR Community Collaborator Request: Using community-academic partnerships to enhance outcomes of participatory autism research. Autism Res 2023; 16:2071-2076. [PMID: 37688487 DOI: 10.1002/aur.3027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Abstract
Participatory approaches, in which researchers work together with members of the autism community (e.g., autistic people, family members, caregivers, or other stakeholders) to design, conduct, and disseminate research, have become increasingly prominent within the field of autism research over the past decade. Despite growing academic and community interest in conducting participatory studies, stakeholder collaboration remains infrequent in autism research, at least partially due to systemic barriers. To help reduce barriers to engaging in participatory autism research, the International Society for Autism Research (INSAR) Autistic Researchers Committee has launched the INSAR Community Collaborator Request (ICCR; https://www.autism-insar.org/page/iccr), a platform on the INSAR website that allows autism researchers conducting participatory research to seek out stakeholder collaborators from the autism community (including both autistic people and their family members/caregivers, as relevant to a given research project). Interested stakeholders also have the opportunity to subscribe to ICCR posts, allowing them to be alerted of new opportunities for collaboration and potentially increasing their involvement in autism research. Overall, the ICCR provides a venue to connect autism researchers with potential community collaborators, reducing barriers to participatory autism research and increasing the frequency of successful community-academic partnerships within the field. We are hopeful that in the long term, such changes will lead to greater alignment between research outputs and the goals of the greater autism community, and consequently an increase in the overall quality and relevance of autism research.
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Affiliation(s)
- Rebecca Poulsen
- Macquarie University Hearing, Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Reframing Autism, St Leonards, New South Wales, Australia
| | - Patrick Dwyer
- Center for Mind and Brain, University of California Davis, Davis, California, USA
- Department of Psychology, University of California Davis, Davis, California, USA
- MIND Institute, UC Davis Health, Sacramento, California, USA
| | - Dena Gassner
- School of Social Work, Adelphi University, Garden City, New York, USA
- Department of Health Sciences, Towson University, Towson, Maryland, USA
| | - Melanie Heyworth
- Reframing Autism, St Leonards, New South Wales, Australia
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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8
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Dwyer P, Williams ZJ, Vukusic S, Saron CD, Rivera SM. Habituation of auditory responses in young autistic and neurotypical children. Autism Res 2023; 16:1903-1923. [PMID: 37688470 PMCID: PMC10651062 DOI: 10.1002/aur.3022] [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: 03/24/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Abstract
Prior studies suggest that habituation of sensory responses is reduced in autism and that diminished habituation could be related to atypical autistic sensory experiences, for example, by causing brain responses to aversive stimuli to remain strong over time instead of being suppressed. While many prior studies exploring habituation in autism have repeatedly presented identical stimuli, other studies suggest group differences can still be observed in habituation to intermittent stimuli. The present study explored habituation of electrophysiological responses to auditory complex tones of varying intensities (50-80 dB SPL), presented passively in an interleaved manner, in a well-characterized sample of 127 autistic (MDQ = 65.41, SD = 20.54) and 79 typically developing (MDQ = 106.02, SD = 11.50) children between 2 and 5 years old. Habituation was quantified as changes in the amplitudes of single-trial responses to tones of each intensity over the course of the experiment. Habituation of the auditory N2 response was substantially reduced in autistic participants as compared to typically developing controls, although diagnostic groups did not clearly differ in habituation of the P1 response. Interestingly, the P1 habituated less to loud 80 dB sounds than softer sounds, whereas the N2 habituated less to soft 50 dB sounds than louder sounds. No associations were found between electrophysiological habituation and cognitive ability or participants' caregiver-reported sound tolerance (Sensory Profile Hyperacusis Index). The results present study results extend prior research suggesting habituation of certain sensory responses is reduced in autism; however, they also suggest that habituation differences observed using this study's paradigm might not be a primary driver of autistic participants' real-world sound intolerance.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, Davis, CA, USA
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- MIND Institute, UC Davis, Davis, CA, USA
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of
Medicine, Nashville, TN, USA
- Department of Hearing & Speech Sciences, Vanderbilt University
Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN,
USA
- Frist Center for Autism and Innovation, Vanderbilt University,
Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center,
Nashville, TN, USA
| | - Svjetlana Vukusic
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- Department of General Practice, Melbourne Medical School, the
University of Melbourne, Melbourne, VIC, Australia
| | - Clifford D. Saron
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- MIND Institute, UC Davis, Sacramento, CA, USA
| | - Susan M. Rivera
- Department of Psychology, UC Davis, Davis, CA, USA
- Center for Mind and Brain, UC Davis, Davis, CA, USA
- MIND Institute, UC Davis, Sacramento, CA, USA
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Natri HM, Chapman CR, Heraty S, Dwyer P, Walker N, Kapp SK, Dron HA, Martinez-Agosto JA, Mikkola L, Doherty M. Ethical challenges in autism genomics: Recommendations for researchers. Eur J Med Genet 2023; 66:104810. [PMID: 37478903 DOI: 10.1016/j.ejmg.2023.104810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
Equitable and just genetic research and clinical translation require an examination of the ethical questions pertaining to vulnerable and marginalized communities. Autism research and advocate communities have expressed concerns over current practices of genetics research, urging the field to shift towards paradigms and practices that ensure benefits and avoid harm to research participants and the wider autistic community. Building upon a framework of bioethical principles, we provide the background for the concerns and present recommendations for ethically sustainable and justice-oriented genetic and genomic autism research. With the primary goal of enhancing the health, well-being, and autonomy of autistic persons, we make recommendations to guide priority setting, responsible research conduct, and informed consent practices. Further, we discuss the ethical challenges particularly pertaining to research involving highly vulnerable individuals and groups, such as those with impaired cognitive or communication ability. Finally, we consider the clinical translation of autism genetics studies, including the use of genetic testing. These guidelines, developed by an interdisciplinary working group comprising autistic and non-autistic individuals, will aid in leveraging the potential of genetics research to enhance the quality of life of autistic individuals and are widely applicable across stigmatized traits and vulnerable communities.
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Affiliation(s)
- Heini M Natri
- Translational Genomics Research Institute (TGen), Phoenix, AZ, 85004, USA.
| | - Carolyn R Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, 10016, USA; Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Síofra Heraty
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, University of London, Birkbeck, London, WC1E 7HX, UK
| | - Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, CA, 95618, USA; Department of Psychology, UC Davis, Davis, CA, 95618, USA; MIND Institute, UC Davis Health, Sacramento, CA, 95817, USA
| | - Nick Walker
- California Institute of Integral Studies, San Francisco, CA, 94103, USA
| | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, Hampshire, PO1 2UP, UK
| | - Heather A Dron
- Sterilization and Social Justice Lab, UCLA Institute for Genetics and Society, Los Angeles, CA, 90095, USA
| | | | - Lea Mikkola
- Turku Bioscience Center, InFLAMES Research Flagship Center, University of Turku, Turku, 20520, Finland
| | - Mary Doherty
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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10
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Hotez E, Haley M, Martinez-Agosto JA, Anderson J, Brown H, Choi K, Croen LA, Dwyer P, Fernandes P, Gassner D, Giwa Onaiwu M, Gragnani CM, Graham Holmes L, Kapp S, Kim D, Massolo M, Montgomery B, Natri HM, Rava JA, Rosenau KA, Roth J, Rudolph D, Ryan JG, Shattuck P, Shea L, Williams ZJ, Wilson RB, Kuo A. Updates to the Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda. Cureus 2023; 15:e44388. [PMID: 37779815 PMCID: PMC10541233 DOI: 10.7759/cureus.44388] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Autistic individuals, now representing one in 36 individuals in the U.S., experience disproportionate physical health challenges relative to non-autistic individuals. The Health Resources and Services Administration's (HRSA) Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multi-center Research Network that aims to increase the health, well-being, and quality of life of autistic individuals. The current paper builds on the initial AIR-P Research Agenda (proposed in Year 1) and provides an updated vision for the Network. METHODS Updates to the Research Agenda were made via the administration of a Qualtrics survey, and disseminated widely to all AIR-P entities, including the Research Node Leaders, Steering Committee, Autistic Researcher Review Board, and collaborating academic and non-academic entities. Network members were tasked with evaluating the Year 1 Research Agenda and proposing additional priorities. RESULTS Within each Research Node, all Year 1 priorities were endorsed as continued priorities for research on autism and physical health. Specific topics, including co-occurring conditions and self-determination, advocacy, and decision-making, were particularly endorsed. Opportunities for exploratory studies and intervention research were identified across Research Nodes. Qualitative responses providing feedback on additional research priorities were collected. CONCLUSION The updated AIR-P Research Agenda represents an important step toward enacting large-scale health promotion efforts for autistic individuals across the lifespan. This updated agenda builds on efforts to catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health promotion.
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Affiliation(s)
- Emily Hotez
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Madeline Haley
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | | | - Jeffrey Anderson
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Heather Brown
- Department of Educational Psychology, Faculty of Education, Edmonton, CAN
| | - Kristen Choi
- Department of Nursing, School of Nursing, University of California Los Angeles, Los Angeles, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Patrick Dwyer
- Laboratory of Neurocognitive Development, Center for Mind and Brain, University of California Davis, Davis, USA
| | - Priyanka Fernandes
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Dena Gassner
- Department of Health Sciences, School of Social Work, Adelphi University, New York, USA
| | | | - Candace M Gragnani
- Department of Pediatrics, University of California Los Angeles, Los Angeles, USA
| | - Laura Graham Holmes
- Department of Social Work, School of Public Health, Boston University, Boston, USA
| | - Steven Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, GBR
| | - Dana Kim
- Department of Research, Association of University Centers on Disabilities, Silver Spring, USA
| | - Maria Massolo
- Department of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Brianna Montgomery
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Heini M Natri
- Department of Computational Science, Translational Genomics Research Institute, Part of City of Hope Cancer Center, Phoenix, USA
| | - Julianna A Rava
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Kashia A Rosenau
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Jeffrey Roth
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Dawn Rudolph
- Department of Technical Assistance & Network Engagement, Association of University Centers on Disabilities, Silver Springs, USA
| | - Jackie G Ryan
- Department of Neurodiversity Strategy and Education, University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, USA
| | - Paul Shattuck
- Department of Policy Research, Mathematica, Princeton, USA
| | - Lindsay Shea
- Center of Policy and Analytics, A.J. Drexel Autism Institute, Drexel University, Philadelphia, USA
| | - Zachary J Williams
- Department of Hearing & Speech Sciences, Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
| | - Rujuta B Wilson
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | - Alice Kuo
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Pediatrics, University of California Los Angeles, Los Angeles, USA
- Department of Preventive Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
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11
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Dwyer P, Mineo E, Mifsud K, Lindholm C, Gurba A, Waisman T. Building Neurodiversity-Inclusive Postsecondary Campuses: Recommendations for Leaders in Higher Education. Autism Adulthood 2023; 5:1-14. [PMID: 36941859 PMCID: PMC10024274 DOI: 10.1089/aut.2021.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, California, USA
- Department of Psychology, UC Davis, Davis, California, USA
- Address correspondence to: Patrick Dwyer, MA, PhD Candidate, Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA 95618, USA
| | - Erica Mineo
- College of Biological Sciences, UC Davis, Davis, California, USA
| | - Kristin Mifsud
- Department of Political Science, UC Davis, Davis, California, USA
| | | | - Ava Gurba
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York, USA
| | - T.C. Waisman
- Adapt Coaching & Training, Vancouver, British Columbia, Canada
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12
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Waisman TC, Williams ZJ, Cage E, Santhanam SP, Magiati I, Dwyer P, Stockwell KM, Kofner B, Brown H, Davidson D, Herrell J, Shore SM, Caudel D, Gurbuz E, Gillespie-Lynch K. Learning from the experts: Evaluating a participatory autism and universal design training for university educators. Autism 2023; 27:356-370. [PMID: 35652315 DOI: 10.1177/13623613221097207] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT Autistic university students have many strengths. They also go through difficulties that professors may not understand. Professors may not understand what college life is like for autistic students. They might judge autistic students. A team of autistic and non-autistic researchers made a training to help professors understand autistic students better. This training also gave professors ideas to help them teach all of their students. Ninety-eight professors did an online survey before the autism training. They shared how they felt about autism and teaching. Before our training, professors who knew more about autism appreciated autism more. Professors who thought people should be equal and women also appreciated autism more. Then, 89 of the professors did our training and another survey after the training. This helped us see what they learned from the training. They did one more survey a month later. This helped us see what they remembered. Our training helped professors understand and value autism. It also helped them understand how they can teach all students better. The professors remembered a lot of what we taught them. This study shows that a training that autistic people helped make can help professors understand their autistic students better.
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13
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Oredipe T, Kofner B, Riccio A, Cage E, Vincent J, Kapp SK, Dwyer P, Gillespie-Lynch K. Does learning you are autistic at a younger age lead to better adult outcomes? A participatory exploration of the perspectives of autistic university students. Autism 2023; 27:200-212. [PMID: 35404160 DOI: 10.1177/13623613221086700] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
LAY ABSTRACT People learn they are autistic at different ages. We wanted to know if telling kids they are autistic earlier helps them feel better about their lives when they grow up. We are a team of autistic and non-autistic students and professors. Seventy-eight autistic university students did our online survey. They shared how they found out they were autistic and how they felt about being autistic. They also shared how they feel about their lives now. Around the same number of students learned they were autistic from doctors and parents. Students who learned they were autistic when they were younger felt happier about their lives than people who learned they were autistic when they were older. Students who learned they were autistic when they were older felt happier about being autistic when they first found out than people who did not have to wait as long. Our study shows that it is probably best to tell people they are autistic as soon as possible. The students who did our study did not think it was a good idea to wait until children are adults to tell them they are autistic. They said that parents should tell their children they are autistic in ways that help them understand and feel good about who they are.
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Affiliation(s)
- Tomisin Oredipe
- College of Staten Island, The City University of New York, USA
| | - Bella Kofner
- College of Staten Island, The City University of New York, USA
| | - Ariana Riccio
- The Graduate Center, The City University of New York, USA
| | | | | | | | | | - Kristen Gillespie-Lynch
- College of Staten Island, The City University of New York, USA.,The Graduate Center, The City University of New York, USA
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14
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Asbridge E, Dwyer P. Marine Vegetation Management Strategies: A framework for estuary wide prioritisation of protection and rehabilitation. Restor Ecol 2022. [DOI: 10.1111/rec.13819] [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] [Indexed: 11/27/2022]
Affiliation(s)
- Emma Asbridge
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Northfields Ave Wollongong NSW 2522 Australia
- Coastal Systems, NSW Department of Primary Industries Fisheries Wollstonecraft NSW 2065
| | - Patrick Dwyer
- Coastal Systems, NSW Department of Primary Industries Fisheries Wollongbar NSW 2477
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15
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Schuck RK, Tagavi DM, Baiden KMP, Dwyer P, Williams ZJ, Osuna A, Ferguson EF, Jimenez Muñoz M, Poyser SK, Johnson JF, Vernon TW. Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. J Autism Dev Disord 2022; 52:4625-4645. [PMID: 34643863 PMCID: PMC9508016 DOI: 10.1007/s10803-021-05316-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/25/2022]
Abstract
Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA.
| | - Daina M Tagavi
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, CA, USA
- Center for Mind and Brain, University of California, Davis, Davis, CA, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN, USA
| | - Anthony Osuna
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily F Ferguson
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Maria Jimenez Muñoz
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Samantha K Poyser
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
| | | | - Ty W Vernon
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, USA
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16
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Dwyer P, Takarae Y, Zadeh I, Rivera SM, Saron CD. Multisensory integration and interactions across vision, hearing, and somatosensation in autism spectrum development and typical development. Neuropsychologia 2022; 175:108340. [PMID: 36028085 DOI: 10.1016/j.neuropsychologia.2022.108340] [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: 07/21/2021] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Most prior studies of multisensory integration (MSI) in autism have measured MSI in only a single combination of modalities - typically audiovisual integration. The present study used onset reaction times (RTs) and 125-channel electroencephalography (EEG) to examine different forms of bimodal and trimodal MSI based on combinations of auditory (noise burst), somatosensory (finger tap), and visual (flash) stimuli presented in a spatially-aligned manner using a custom desktop apparatus. A total of 36 autistic and 19 non-autistic adolescents between the ages of 11-14 participated. Significant RT multisensory facilitation relative to summed unisensory RT was observed in both groups, as were significant differences between summed unisensory and multisensory ERPs. Although the present study's statistical approach was not intended to test effect latencies, these interactions may have begun as early as ∼45 ms, constituting "early" (<100 ms) MSI. RT and ERP measurements of MSI appeared independent of one another. Groups did not significantly differ in multisensory RT facilitation, but we found exploratory evidence of group differences in the magnitude of audiovisual interactions in ERPs. Future research should make greater efforts to explore MSI in under-represented populations, especially autistic people with intellectual disabilities and nonspeaking/minimally-verbal autistic people.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, USA; Center for Mind and Brain, UC Davis, USA.
| | - Yukari Takarae
- Department of Neurosciences, UC San Diego, USA; Department of Psychology, San Diego State University, USA
| | | | - Susan M Rivera
- Department of Psychology, UC Davis, USA; Center for Mind and Brain, UC Davis, USA; MIND Institute, UC Davis, USA
| | - Clifford D Saron
- Center for Mind and Brain, UC Davis, USA; MIND Institute, UC Davis, USA
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17
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Vivanti G, Rogers SJ, Dwyer P, Rivera S. Early learning in autism as an atypical balance between assimilation and accommodation processes. Hum Dev 2022. [DOI: 10.1159/000526416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many children on the autism spectrum are capable of learning large amounts of material in specific areas - yet, they often show learning delays across multiple domains. Additionally, they typically show the ability and motivation to learn from practice and from the outcomes of their own actions while having difficulties learning from novel situations and from others’ actions and communications. We propose that these and other phenomena reflect, in part, an atypical balance between cognitive assimilation and accommodation processes during early childhood. Adopting a constructivist perspective that connects Piaget’s heuristics with experimental and clinical research in autism, we examine empirical supports as well as implications of this notion for autism research, advocacy, and intervention.
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18
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Dwyer P, Takarae Y, Zadeh I, Rivera SM, Saron CD. A Multidimensional Investigation of Sensory Processing in Autism: Parent- and Self-Report Questionnaires, Psychophysical Thresholds, and Event-Related Potentials in the Auditory and Somatosensory Modalities. Front Hum Neurosci 2022; 16:811547. [PMID: 35620155 PMCID: PMC9127065 DOI: 10.3389/fnhum.2022.811547] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reconciling results obtained using different types of sensory measures is a challenge for autism sensory research. The present study used questionnaire, psychophysical, and neurophysiological measures to characterize autistic sensory processing in different measurement modalities. Methods Participants were 46 autistic and 21 typically developing 11- to 14-year-olds. Participants and their caregivers completed questionnaires regarding sensory experiences and behaviors. Auditory and somatosensory event-related potentials (ERPs) were recorded as part of a multisensory ERP task. Auditory detection, tactile static detection, and tactile spatial resolution psychophysical thresholds were measured. Results Sensory questionnaires strongly differentiated between autistic and typically developing individuals, while little evidence of group differences was observed in psychophysical thresholds. Crucially, the different types of measures (neurophysiological, psychophysical, questionnaire) appeared to be largely independent of one another. However, we unexpectedly found autistic participants with larger auditory Tb ERP amplitudes had reduced hearing acuity, even though all participants had hearing acuity in the non-clinical range. Limitations The autistic and typically developing groups were not matched on cognitive ability, although this limitation does not affect our main analyses regarding convergence of measures within autism. Conclusion Overall, based on these results, measures in different sensory modalities appear to capture distinct aspects of sensory processing in autism, with relatively limited convergence between questionnaires and laboratory-based tasks. Generally, this might reflect the reality that laboratory tasks are often carried out in controlled environments without background stimuli to compete for attention, a context which may not closely resemble the busier and more complex environments in which autistic people's atypical sensory experiences commonly occur. Sensory questionnaires and more naturalistic laboratory tasks may be better suited to explore autistic people's real-world sensory challenges. Further research is needed to replicate and investigate the drivers of the unexpected association we observed between auditory Tb ERP amplitudes and hearing acuity, which could represent an important confound for ERP researchers to consider in their studies.
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Affiliation(s)
- Patrick Dwyer
- Neurocognitive Development Lab, Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
- MIND Institute, University of California, Davis, Davis, CA, United States
| | - Yukari Takarae
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Iman Zadeh
- Oracle Cloud Infrastructure, Oracle Corporation, Los Angeles, CA, United States
| | - Susan M. Rivera
- Neurocognitive Development Lab, Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
- MIND Institute, University of California, Davis, Davis, CA, United States
| | - Clifford D. Saron
- MIND Institute, University of California, Davis, Davis, CA, United States
- Saron Lab, Center for Mind and Brain, University of California, Davis, Davis, CA, United States
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19
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Abstract
This paper presents the concepts of "neurodiversity" and the "neurodiversity approaches" towards disability and discusses how confusion regarding the meaning of these concepts exacerbates debate and conflict surrounding the neurodiversity approaches. For example, some claim the neurodiversity approaches focus solely on society and deny contributions of individual characteristics to disability (a controversial stance), whereas this paper joins other literature in acknowledging the contributions of both individual and society to disability. This paper also addresses other controversies related to neurodiversity, such as uncertainty regarding the scope of the approaches - to whom do they apply? - and their implications for diagnostic categories. Finally, it provides recommendations for developmental researchers who wish to carry out neurodiversity-aligned research: scholars are urged to study both individual neurodivergent people and the contexts around them; to consider both strengths and weaknesses; to recognize their own biases; and to listen to and learn from neurodivergent people.
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Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California at Davis, Davis, California, USA
- Department of Psychology, University of California at Davis, Davis, California, USA
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20
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Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California Davis, Davis, California
- Department of Psychology, University of California Davis, Davis, California
| | - Jacalyn G Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
| | - Dena L Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
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21
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Dwyer P. Stigma, Incommensurability, or Both? Pathology-First, Person-First, and Identity-First Language and the Challenges of Discourse in Divided Autism Communities. J Dev Behav Pediatr 2022; 43:111-113. [PMID: 34984993 DOI: 10.1097/dbp.0000000000001054] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, CA
- Department of Psychology, University of California, Davis, CA
- MIND Institute, University of California, Davis, CA
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22
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Nordahl CW, Andrews DS, Dwyer P, Waizbard-Bartov E, Restrepo B, Lee JK, Heath B, Saron C, Rivera SM, Solomon M, Ashwood P, Amaral DG. The Autism Phenome Project: Toward Identifying Clinically Meaningful Subgroups of Autism. Front Neurosci 2022; 15:786220. [PMID: 35110990 PMCID: PMC8801875 DOI: 10.3389/fnins.2021.786220] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
One of the most universally accepted facts about autism is that it is heterogenous. Individuals diagnosed with autism spectrum disorder have a wide range of behavioral presentations and a variety of co-occurring medical and mental health conditions. The identification of more homogenous subgroups is likely to lead to a better understanding of etiologies as well as more targeted interventions and treatments. In 2006, we initiated the UC Davis MIND Institute Autism Phenome Project (APP) with the overarching goal of identifying clinically meaningful subtypes of autism. This ongoing longitudinal multidisciplinary study now includes over 400 children and involves comprehensive medical, behavioral, and neuroimaging assessments from early childhood through adolescence (2-19 years of age). We have employed several strategies to identify sub-populations within autistic individuals: subgrouping by neural, biological, behavioral or clinical characteristics as well as by developmental trajectories. In this Mini Review, we summarize findings to date from the APP cohort and describe progress made toward identifying meaningful subgroups of autism.
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Affiliation(s)
- Christine Wu Nordahl
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Derek Sayre Andrews
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Einat Waizbard-Bartov
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Bibiana Restrepo
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Joshua K. Lee
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Brianna Heath
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Clifford Saron
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Susan M. Rivera
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Marjorie Solomon
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Paul Ashwood
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - David G. Amaral
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
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23
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Dower K, Ford A, Sandford M, Doherty A, Greenham S, Kerin L, Dwyer P, Hansen C, Westhuyzen J, Shakespeare T. Retrospective evaluation of planning margins for patients undergoing radical radiation therapy treatment for bladder cancer using volumetric modulated arc therapy and cone beam computed tomography. J Med Radiat Sci 2021; 68:371-378. [PMID: 34288566 PMCID: PMC8656189 DOI: 10.1002/jmrs.532] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/20/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Current contouring guidelines for curative radiation therapy for muscle-invasive bladder cancer (MIBC) recommend margins of 1.5-2.0 cm, applied to the clinical target volume (CTV). This study assessed whether the use of volumetric modulated arc therapy (VMAT), cone beam computed tomography (CBCT) and strict bladder preparation allowed for a reduced planning target volume (PTV) expansion, resulting in lower doses to surrounding organs at risk (OARs). METHODS Daily CBCT images for 12 patients (382 scans total) were retrospectively reviewed against four potential PTV margins created on and exported with the reference CT scan. To form the PTVs, three isotropic expansions of 0.5, 1.0 and 1.5 cm were applied to the CTV, as well as an anisotropic expansion of 1.5 cm superiorly and 1.0 cm in all other dimensions. Following treatment completion, the CBCTs were visually assessed to determine the margins encapsulating the bladder. For retrospective planning purposes, the 1.0-cm and anisotropic margins were compared with the previously recommended margins to determine differences in OAR doses. RESULTS The 0.5-, 1.0- and 1.5-cm isotropic margins (IM) and the anisotropic margin (ANIM) covered the CTV in 46.1, 96.8, 100 and 100% of CBCTs retrospectively. Doses to OARs were significantly lower for the reduced margin plans for the small bowel, rectum and sigmoid. CONCLUSION Bladder planning target volumes may be safely reduced. We endorse a PTV margin of 1.0cm anteriorly, posteriorly and inferiorly with 1.0-1.5 cm superiorly for radical whole bladder cases using strict bladder preparation, VMAT and pretreatment CBCTs.
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Affiliation(s)
- Kathleene Dower
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Andriana Ford
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Michael Sandford
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Andrew Doherty
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Stuart Greenham
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Luke Kerin
- Mid North Coast Cancer Institute Port MacquariePort MacquarieNew South WalesAustralia
| | - Patrick Dwyer
- Northern NSW Cancer InstituteLismoreNew South WalesAustralia
| | - Carmen Hansen
- Mid North Coast Cancer Institute Port MacquariePort MacquarieNew South WalesAustralia
| | - Justin Westhuyzen
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
| | - Thomas Shakespeare
- Mid North Coast Cancer Institute Coffs HarbourCoffs HarbourNew South WalesAustralia
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Cheriyan C, Shevchuk-Hill S, Riccio A, Vincent J, Kapp SK, Cage E, Dwyer P, Kofner B, Attwood H, Gillespie-Lynch K. Exploring the Career Motivations, Strengths, and Challenges of Autistic and Non-autistic University Students: Insights From a Participatory Study. Front Psychol 2021; 12:719827. [PMID: 34744884 PMCID: PMC8568013 DOI: 10.3389/fpsyg.2021.719827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Supports for the growing number of autistic university students often focus on helping them succeed in university. However, even educated autistic people experience discrimination and other challenges which can make it very difficult for them to obtain meaningful jobs. Little remains known about how universities can better support their autistic students and alumni in overcoming barriers to meaningful employment. In this participatory study, a team of autistic and non-autistic researchers asked autistic (n = 92) and non-autistic (n = 774) university students about their career aspirations, strengths they believe will help them succeed in their "dream jobs," and obstacles they expect to encounter. Autistic participants' top goal in attending college was to improve their career prospects. However, relatively few autistic students reported learning career-specific skills at university. Autistic students were more likely to seek an academic job and less likely to seek a career in healthcare than non-autistic students. Autistic students highlighted writing skills and detail orientation as strengths that could help them succeed in their dream jobs more often than non-autistic students. However, they were also more likely to expect discrimination, social, and psychological difficulties to stand in the way of their dream jobs. These findings suggest that universities should prioritize experiential learning opportunities to help autistic (and non-autistic) students develop employment-related skills while providing mental health supports. Universities should demonstrate their commitment to supporting diverse learners by seeking out and hiring autistic professionals and by teaching their own staff and employers how to appreciate and support autistic colleagues.
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Affiliation(s)
- Chinnu Cheriyan
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Sergey Shevchuk-Hill
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Ariana Riccio
- The Graduate Center, The City University of New York, New York, NY, United States
| | - Jonathan Vincent
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Eilidh Cage
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Sacramento, CA, United States
| | - Bella Kofner
- College of Staten Island, The City University of New York, Staten Island, NY, United States
| | - Helen Attwood
- School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Kristen Gillespie-Lynch
- College of Staten Island, The City University of New York, Staten Island, NY, United States
- The Graduate Center, The City University of New York, New York, NY, United States
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Dwyer P, Ferrer E, Saron CD, Rivera SM. Exploring Sensory Subgroups in Typical Development and Autism Spectrum Development Using Factor Mixture Modelling. J Autism Dev Disord 2021; 52:3840-3860. [PMID: 34499275 PMCID: PMC9349169 DOI: 10.1007/s10803-021-05256-6] [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] [Accepted: 08/23/2021] [Indexed: 12/29/2022]
Abstract
This study uses factor mixture modelling of the Short Sensory Profile (SSP) at two time points to describe subgroups of young autistic and typically-developing children. This approach allows separate SSP subscales to influence overall SSP performance differentially across subgroups. Three subgroups were described, one including almost all typically-developing participants plus many autistic participants. SSP performance of a second, largely-autistic subgroup was predominantly shaped by a subscale indexing behaviours of low energy/weakness. Finally, the third subgroup, again largely autistic, contained participants with low (or more “atypical”) SSP scores across most subscales. In this subgroup, autistic participants exhibited large P1 amplitudes to loud sounds. Autistic participants in subgroups with more atypical SSP scores had higher anxiety and more sleep disturbances.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, Davis, USA. .,Center for Mind and Brain, UC Davis, Davis, USA.
| | | | - Clifford D Saron
- Center for Mind and Brain, UC Davis, Davis, USA.,MIND Institute, UC Davis, Davis, USA
| | - Susan M Rivera
- Department of Psychology, UC Davis, Davis, USA.,Center for Mind and Brain, UC Davis, Davis, USA.,MIND Institute, UC Davis, Davis, USA
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Dwyer P, Acevedo SM, Brown HM, Grapel J, Jones SC, Nachman BR, Raymaker DM, Williams ZJ. An Expert Roundtable Discussion on Experiences of Autistic Autism Researchers. Autism Adulthood 2021; 3:209-220. [PMID: 36605367 PMCID: PMC8992911 DOI: 10.1089/aut.2021.29019.rtb] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California at Davis, Davis, California, USA.,Department of Psychology, University of California at Davis, Davis, California, USA.,Address correspondence to: Patrick Dwyer, MA, Center for Mind and Brain, University of California at Davis, 267 Cousteau PI, Davis, CA 95618, USA.
| | - Sara M. Acevedo
- Department of Disability Studies, Miami University, Miami, Ohio, USA
| | - Heather M. Brown
- Department of Educational Psychology, University of Alberta, Alberta, Canada
| | - Jordan Grapel
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina, USA
| | - Sandra C. Jones
- Department of Engagement, Australian Catholic University, Melbourne, Australia
| | - Brett Ranon Nachman
- Belk Center for Community College Leadership and Research, North Carolina State University, Raleigh, North Carolina, USA
| | - Dora M. Raymaker
- Department of Social Work, Portland State University, Portland, Oregon, USA.,Department of Research and Education, Portland State University, Portland, Oregon, USA
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA.,Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee, USA
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Dwyer P, De Meo-Monteil R, Saron CD, Rivera SM. Effects of age on loudness-dependent auditory ERPs in young autistic and typically-developing children. Neuropsychologia 2021; 156:107837. [PMID: 33781752 DOI: 10.1016/j.neuropsychologia.2021.107837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Limited research has investigated the development of auditory ERPs in young children, and particularly how stimulus intensity may affect these auditory ERPs. Previous research has also yielded inconsistent findings regarding differences in the development of auditory ERPs in autism and typical development. Furthermore, stimulus intensity may be of particular interest in autism insofar as autistic people may have atypical experiences of sound intensity (e.g., hyperacusis). Therefore, the present study examined associations between age and ERPs evoked by tones of differing intensities (50, 60, 70, and 80 dB SPL) in a large sample of young children (2-5 years) with and without an autism diagnosis. Correlations between age and P1 latencies were examined, while cluster-based permutation testing was used to examine associations between age and neural response amplitudes, as well as group differences in amplitude, over all electrode sites in the longer time window of 1-350 ms. Older autistic participants had faster P1 latencies, but these effects only attained significance over the right hemisphere in response to soft 50 dB sounds. Autistic participants had slower P1 responses to 80 dB sounds over the right hemisphere. Over the scalp regions associated with the later N2 response, more negative response amplitudes (that is, larger N2 responses) were observed in typically-developing than autistic participants. Furthermore, continuous associations between response amplitudes and age suggested that older typically-developing participants exhibited stronger N2 responses to all intensities, though this effect may have at least in part reflected the absence of small positive voltage deflections in the N2 latency window. Age was associated with amplitudes of responses to 50 dB through 70 dB sounds in autism, but in contrast to Typical Development (TD), little evidence of relationships between age and amplitudes in the N2 latency window was found in autism in the 80 dB condition. Although caution should be exercised in interpretation due to the cross-sectional nature of this study, these findings suggest that developmental changes in auditory responses may differ across diagnostic groups in a manner that depends on perceived loudness and/or stimulus intensity.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, United States; Center for Mind and Brain, UC Davis, United States.
| | | | - Clifford D Saron
- Center for Mind and Brain, UC Davis, United States; MIND Institute, UC Davis, United States
| | - Susan M Rivera
- Department of Psychology, UC Davis, United States; Center for Mind and Brain, UC Davis, United States; MIND Institute, UC Davis, United States
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Dwyer P, Saron CD, Rivera SM. Identification of Longitudinal Sensory Subtypes in Typical Development and Autism Spectrum Development Using Growth Mixture Modelling. Res Autism Spectr Disord 2020; 78:101645. [PMID: 32944065 PMCID: PMC7491753 DOI: 10.1016/j.rasd.2020.101645] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Prior longitudinal investigations of trajectories of sensory features in Autism Spectrum Development (ASD) have not explored heterogeneity. The present study explores initial levels and trajectories of sensory features in ASD as well as, for comparison, typical development. METHOD Growth mixture modelling was used to explore classes of autistic and typically-developing participants based on caregiver-reported total sensory behaviours on the Short Sensory Profile (SSP) at two time points, when children were aged 2-5 and 4-10 years of age, respectively. RESULTS Three classes are described: a mixed class of autistic and typically-developing participants with few problematic sensory behaviours ("Stable Mild"), a mostly-autistic class with more problematic sensory features ("Stable Intense"), and a small class of autistic participants whose sensory features reportedly worsened ("Increasingly Intense"). Autistic participants in the Stable Intense class exhibited high anxiety, while autistic participants in the Increasingly Intense class appeared to obtain high scores on cognitive assessments. CONCLUSIONS The heterogeneity of sensory features and challenges found in the present study may suggest that practitioners should conduct individualized assessments of sensory features in ASD. Furthermore, practitioners should be aware of links between sensory features and anxiety in ASD, which may imply that sensory accommodations and supports could protect against anxiety. Finally, the worsening of sensory features over time in the Increasingly Intense subgroup may indicate a need for continued monitoring of changes in sensory features, perhaps especially as sensory environments change during periods of transition.
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Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA, USA 95618
| | | | - Susan M Rivera
- Department of Psychology, UC Davis, Center for Mind and Brain, UC Davis, MIND Institute, UC Davis
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Dwyer P, Wang X, De Meo-Monteil R, Hsieh F, Saron CD, Rivera SM. Defining clusters of young autistic and typically developing children based on loudness-dependent auditory electrophysiological responses. Mol Autism 2020; 11:48. [PMID: 32539866 PMCID: PMC7294610 DOI: 10.1186/s13229-020-00352-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/30/2020] [Accepted: 05/19/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Autistic individuals exhibit atypical patterns of sensory processing that are known to be related to quality of life, but which are also highly heterogeneous. Previous investigations of this heterogeneity have ordinarily used questionnaires and have rarely investigated sensory processing in typical development (TD) alongside autism spectrum development (ASD). METHODS The present study used hierarchical clustering in a large sample to identify subgroups of young autistic and typically developing children based on the normalized global field power (GFP) of their event-related potentials (ERPs) to auditory stimuli of four different loudness intensities (50, 60, 70, 80 dB SPL): that is, based on an index of the relative strengths of their neural responses across these loudness conditions. RESULTS Four clusters of participants were defined. Normalized GFP responses to sounds of different intensities differed strongly across clusters. There was considerable overlap in cluster assignments of autistic and typically developing participants, but autistic participants were more likely to display a pattern of relatively linear increases in response strength accompanied by a disproportionately strong response to 70 dB stimuli. Autistic participants displaying this pattern trended towards obtaining higher scores on assessments of cognitive abilities. There was also a trend for typically developing participants to disproportionately fall into a cluster characterized by disproportionately/nonlinearly strong 60 dB responses. Greater auditory distractibility was reported among autistic participants in a cluster characterized by disproportionately strong responses to the loudest (80 dB) sounds, and furthermore, relatively strong responses to loud sounds were correlated with auditory distractibility. This appears to provide evidence of coinciding behavioral and neural sensory atypicalities. LIMITATIONS Replication may be needed to verify exploratory results. This analysis does not address variability related to classical ERP latencies and topographies. The sensory questionnaire employed was not specifically designed for use in autism. Hearing acuity was not measured. Variability in sensory responses unrelated to loudness is not addressed, leaving room for additional research. CONCLUSIONS Taken together, these data demonstrate the broader benefits of using electrophysiology to explore individual differences. They illuminate different neural response patterns and suggest relationships between sensory neural responses and sensory behaviors, cognitive abilities, and autism diagnostic status.
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Affiliation(s)
- Patrick Dwyer
- Department of Psychology, UC Davis, One Shields Avenue, Davis, CA 95616 USA
- Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA 95618 USA
| | - Xiaodong Wang
- Department of Statistics, UC Davis, One Shields Avenue, Davis, CA 95616 USA
| | | | - Fushing Hsieh
- Department of Statistics, UC Davis, One Shields Avenue, Davis, CA 95616 USA
| | - Clifford D. Saron
- Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA 95618 USA
- MIND Institute, UC Davis, 2825 50th Street, Sacramento, CA 95817 USA
| | - Susan M. Rivera
- Department of Psychology, UC Davis, One Shields Avenue, Davis, CA 95616 USA
- Center for Mind and Brain, UC Davis, 267 Cousteau Place, Davis, CA 95618 USA
- MIND Institute, UC Davis, 2825 50th Street, Sacramento, CA 95817 USA
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Dykes N, Dwyer P, Rosamilia A, Zilberlicht A. Video and review of the surgical management of recurrent urethral diverticulum. Int Urogynecol J 2020; 31:2679-2681. [DOI: 10.1007/s00192-020-04357-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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Venchiarutti RL, Clark JR, Palme CE, Shakespare TP, Hill J, Tahir ARM, Dwyer P, Young JM. Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study. J Med Imaging Radiat Oncol 2020; 64:261-270. [PMID: 32037663 DOI: 10.1111/1754-9485.12990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/02/2019] [Accepted: 10/29/2019] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Geographic disparities in head and neck cancer (HNC) outcomes in Australia may be mediated by timeliness of diagnosis and treatment. This retrospective cohort study examines geographic variations in survival and time intervals leading up to treatment for HNC at two tertiary referral centres in New South Wales. METHODS Eligible patients were NSW residents aged ≥18 years, diagnosed with primary oropharynx or oral cavity squamous cell carcinoma (SCC) between 01 July 2008 and 30 June 2013, and treated with curative intent. Main outcomes were times from diagnosis to treatment and from surgery to post-operative radiotherapy and overall survival. Differences based on remoteness of residence (regional/remote or metropolitan) were assessed. RESULTS A total of 224 patients were eligible. Median time from symptom onset to treatment was longer for regional/remote patients with oropharynx SCC (4.7 vs. 3.8 months, P = 0.044) and oral cavity SCC (6.4 vs. 3.3 months, P = 0.003). Median time from diagnosis to treatment was longer for regional/remote patients with oropharyngeal SCC (47 days vs. 36 days, P = 0.003). Time from surgery to adjuvant radiotherapy was longer among regional/remote patients with oral cavity SCC (66 vs. 42 days, P = 0.001). Overall survival did not differ based on remoteness. CONCLUSION Regional/remote HNC patients experienced longer times to diagnosis and treatment, and regardless of remoteness of residence, fewer than half of patients were treated within guideline recommended timeframes. Despite this non-adherence to guidelines, there were no differences in survival outcomes among this cohort. However, the impact of not meeting guidelines on patient outcomes other than survival warrants further investigation.
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Affiliation(s)
- Rebecca L Venchiarutti
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Thomas P Shakespare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Patrick Dwyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Northern NSW Cancer Institute, Lismore, New South Wales, Australia
| | - Jane M Young
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia.,RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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Hau E, Hegi-Johnson F, Atkinson C, Barber J, Browne LH, Chin Y, Dwyer P, Graham PH, O'Hare J, Lu D, Rains M, Ragusa C, Schmidth L, Small K, Unicomb K, West K, White S, Last A, Ludbrook J, Azzi M, Aherne NJ, Van Tilburg K, Vinod S, Ma X, Yeghiaian Alvandi R. Collaborative implementation of stereotactic ablative body radiotherapy: A model for the safe implementation of complex radiotherapy techniques in Australia. Asia Pac J Clin Oncol 2019; 16:39-44. [PMID: 31777176 DOI: 10.1111/ajco.13277] [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: 12/23/2017] [Accepted: 10/04/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) for lung cancer is a modality of treatment that has improved outcomes for lung cancer patients. However, radiotherapy for lung cancer is underutilized and fewer than half of elderly patients with non-small cell lung cancer (NSCLC) receive active treatment. The purpose of this study is to report on a collaboration in implementing an NSCLC SABR (stereotactic ablative body radiation) program safely, efficiently, and uniformly across several centers, including regional sites. The first aim of this paper is to detail the collaboration and implementation that started in 2013 and is ongoing. The second aim of this paper is to document early toxicities and quality of life outcomes. METHOD A tripartite approach was used to develop the protocol and networks required for the implementation of SABR across multiple sites in NSW. Departments starting the programmes were supported and physics credentialing with central site submission was required before commencing the treatment. Additional ongoing support was available via an email discussion group involving all members of the collaboration. RESULTS Between July 22, 2013 and February 22, 2016, 41 patients were enrolled with 34 patients in active follow up. The toxicity profile so far is similar to those of published studies with no appreciable effect on quality of life outcomes. CONCLUSION The collaboration formed an effective framework in facilitating the implementation of SABR across several sites in NSW and could be used as a model for the safe and uniform implementation of new technologies in Australia.
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Affiliation(s)
- Eric Hau
- Sydney West Radiation Oncology Network, Sydney, Australia.,University of Sydney, Sydney, Australia
| | | | | | - Jeffrey Barber
- Blacktown Haematology and Cancer Care Centre, Sydney, Australia
| | | | - Yaw Chin
- St George Hospital, Kogarah, NSW, Australia
| | - Patrick Dwyer
- Northern New South Wales Cancer Institute, Lismore, NSW, Australia
| | | | - Jolyne O'Hare
- Northern Ireland Cancer Centre on the Belfast City Hospital site
| | - Dan Lu
- St George Hospital, Kogarah, NSW, Australia
| | | | | | | | | | | | | | - Sean White
- Nepean Cancer Care Centre, NSW, Australia
| | - Andrew Last
- Mid North Coast Cancer Institute, Port Macquarie, NSW, Australia
| | | | - Maria Azzi
- Nepean Cancer Care Centre, Nepean, Australia
| | - Noel J Aherne
- Mid North Coast Cancer Institute Coffs Harbour, NSW, Australia
| | | | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, UNSW, NSW, Australia
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Dwyer P, Xu B, Tanaka JW. Investigating the perception of face identity in adults on the autism spectrum using behavioural and electrophysiological measures. Vision Res 2019; 157:132-141. [DOI: 10.1016/j.visres.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 02/06/2018] [Accepted: 02/11/2018] [Indexed: 11/16/2022]
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Armstrong S, Dwyer P, Bettington A, Strutton G. Brain and lung metastasis secondary to metastatic atypical fibroxanthoma: A rare Australian case. Australas J Dermatol 2019; 58:150-151. [PMID: 28449288 DOI: 10.1111/ajd.12513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shreya Armstrong
- North Coast Cancer Institute, Radiation Oncology Department, Lismore, New South Wales,, Australia
| | - Patrick Dwyer
- North Coast Cancer Institute, Radiation Oncology Department, Lismore, New South Wales,, Australia
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Masoud Rahbari R, Winkley L, Hill J, Tahir ARM, McKay M, Last A, Shakespeare TP, Dwyer P. Definitive intensity-modulated radiotherapy concurrent with systemic therapy for oropharyngeal squamous cell carcinoma: Outcomes from an integrated regional Australian cancer centre. J Med Imaging Radiat Oncol 2016; 60:414-9. [DOI: 10.1111/1754-9485.12432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/06/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Reza Masoud Rahbari
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
| | - Lauren Winkley
- Senior Radiation Therapist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | - Jacques Hill
- Radiation Oncologist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | | | - Michael McKay
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
| | - Andrew Last
- Radiation Oncologist; North Coast Cancer Institute; Port Macquarie New South Wales Australia
| | - Thomas P Shakespeare
- Radiation Oncologist; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School; The University of New South Wales; Sydney New South Wales Australia
| | - Patrick Dwyer
- Radiation Oncologist; North Coast Cancer Institute; Lismore New South Wales Australia
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Abstract
The aim of this study was to compare the pubovaginal sling with a new Vicryl mesh rectus fascia (VMRF) sling in the surgical treatment of low urethral pressure genuine stress incontinence. Fifty-one consecutive women who had a VMRF (n = 27) or a pubovaginal sling (n = 24) procedure between March 1995 and December 1997 were evaluated. The patient-determined subjective success rate of the VMRF sling (85%) was significantly higher than that of the pubovaginal sling (58%) in women with low urethral pressure stress incontinence (P=0.03). The objective success rates following the VMRF and the pubovaginal sling were 52% and 50%, respectively. The prevalence of postoperative symptomatic voiding dysfunction and de novo detrusor instability was 7% after the VMRF sling and 25% following the pubovaginal sling (P = 0.08). The VMRF sling had a higher patient-determined success rate and a lower complication rate than the pubovaginal sling, and should be considered in the surgical management of women with low urethral pressure stress incontinence.
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Affiliation(s)
- C Maher
- Department of Urogynecology, Royal Women's Hospital, Melbourne, Australia
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Alvarez J, Cvach K, Dwyer P. Complications in pelvic floor surgery. Minerva Ginecol 2013; 65:53-67. [PMID: 23412020] [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: 06/01/2023]
Abstract
Pelvic floor disorders affect the quality of life of millions of women worldwide. Many options exist for the treatment of pelvic organ prolapse and urinary incontinence, surgery being one of the main strategies in the management of these conditions. Even though uncommon, all surgery has complications which can cause morbidity and rarely mortality. These complications can impair quality of life in the long-term and be a financial burden on both the patient and the health care system. Pelvic floor reconstructive surgery includes perioperative complications such as injury to neighboring organs, hemorrhage and infection. Recently the International Urogynecology Association and the International Continence Society have proposed a terminology and classification of complications related to female pelvic floor surgery, both using native tissue and synthetic implants to improve surgical audit and aid comparison between studies on pelvic floor procedures. Long-term complications such as pelvic pain and dyspareunia may be as high as 25%. Prolapse surgery associated with mesh may result in better anatomical outcomes but this is offset by the high complication rate, particularly that of mesh exposure which has been reported to be between 3-15%. Minimally invasive anti-incontinence procedures are associated with less morbidity than their abdominal predecessors but they are not free of complications. Complications of mid-urethral slings include those of mesh exposure (0.3%), voiding dysfunction (7%) and de novo urgency (25%). The risk and severity of complications varies depending on the procedure performed and on patient characteristics and, therefore, patients need to be informed of these risks or clinicians will be held responsible. This has never been more true than now with the debate regarding the value of transvaginal mesh and laparoscopic procedures for prolapse, their risks and potential benefits, and the associated medico-legal sequelae.
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Affiliation(s)
- J Alvarez
- Department of Urogynecology, Mercy Hospital for Women, Melbourne, Australia.
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Wilcox S, Yeo M, Amalaseelan J, Aherne N, Dwyer P, Hansen C, Tahir R, Hill J, McKay M, Shakespeare T. Efficacy of Androgen Deprivation in Combination With Dose-escalated Image Guided Intensity Modulated Radiation Therapy For Prostate Cancer: Five-year Outcomes From a Single Institution. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1007] [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: 11/26/2022]
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Dwyer P, Hickey B, Burmeister E, Burmeister B. Hypofractionated Whole-Breast Radiotherapy: Impact on Departmental Waiting Times and Cost. J Med Imaging Radiat Oncol 2010; 54:229-34. [DOI: 10.1111/j.1754-9485.2010.02163.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dwyer P. I96 Pudendal nerve neuropathy - fact or fiction? Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60096-5] [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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Dwyer P. I97 Role of cystoscopy - prevention and early detection of urinary tract injury. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60097-7] [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: 11/27/2022]
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Chehrehasa F, Meedeniya ACB, Dwyer P, Abrahamsen G, Mackay-Sim A. EdU, a new thymidine analogue for labelling proliferating cells in the nervous system. J Neurosci Methods 2008; 177:122-30. [PMID: 18996411 DOI: 10.1016/j.jneumeth.2008.10.006] [Citation(s) in RCA: 211] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/02/2008] [Accepted: 10/02/2008] [Indexed: 01/10/2023]
Abstract
Labelling and identifying proliferating cells is central to understanding neurogenesis and neural lineages in vivo and in vitro. We present here a novel thymidine analogue, ethynyl deoxyuridine (EdU) for labelling dividing cells, detected with a fluorescent azide which forms a covalent bond via the "click" chemistry reaction (the Huisgen 1,3-dipolar cycloaddition reaction of an organic azide to a terminal acetylene). Unlike the commonly used BrdU, EdU detection requires no heat or acid treatment. It is quick and easy and compatible with multiple probes for fluorescence immunochemistry, facilitating the characterisation of proliferating cells at high resolution.
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Affiliation(s)
- Fatemah Chehrehasa
- National Centre for Adult Stem Cell Research, Eskitis Institute for Cellular & Molecular Therapies, Griffith University, Brisbane, Qld 4111, Australia.
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Haab F, Stewart L, Dwyer P. Darifenacin, an M3 selective receptor antagonist, is an effective and well-tolerated once-daily treatment for overactive bladder. Eur Urol 2004; 45:420-9; discussion 429. [PMID: 15041104 DOI: 10.1016/j.eururo.2004.01.008] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy, tolerability and safety of darifenacin, a once-daily M3) selective receptor antagonist (M3 SRA), in patients with overactive bladder (OAB). METHODS This multicentre, double-blind, placebo-controlled, parallel-group study enrolled 561 patients (19-88 years; 85% female) with OAB symptoms for >6 months, and included some patients with prior exposure to antimuscarinic agents. After washout and a 2-week placebo run-in, patients were randomised (1:4:2:3) to once-daily oral darifenacin controlled-release tablets (3.75 mg [n=53], 7.5 mg [229] or 15 mg [n=115]) or matching placebo (n=164) for 12 weeks. Patients recorded daily incontinence episodes, micturition frequency, bladder capacity (mean volume voided), frequency of urgency, severity of urgency, incontinence episodes resulting in change of clothing or pads and nocturnal awakenings due to OAB using an electronic diary during weeks 2, 6 and 12 (directly preceding clinic visits). Tolerability data were evaluated from adverse event reports. RESULTS Darifenacin 7.5 mg and 15 mg had a rapid onset of effect, with significant improvement compared with placebo being seen for most parameters at the first clinic visit (week 2). This effect was sustained through week 12. At this time the number of incontinence episodes per week was reduced from baseline by 67.7% with darifenacin 7.5 mg and 72.8% with darifenacin 15 mg compared with 55.9% with placebo (p=0.010 and p=0.017, respectively, versus placebo). The 3.75 mg group (null dose arm) was included for proof of concept of dose flexibility, therefore formal sample sizing and statistical analysis were not performed for this group. Darifenacin 7.5 mg and 15 mg, respectively, were significantly superior to placebo for improvements in micturition frequency (p<0.001, p<0.001), bladder capacity (p<0.040, p<0.001), frequency of urgency (p<0.001, p=0.005), severity of urgency (p<0.001, p=0.002) and number of incontinence episodes leading to a change in clothing or pads (p<0.001, p=0.002). There was no significant reduction in nocturnal awakenings due to OAB. The most common adverse events were mild-to-moderate dry mouth and constipation. However, no patients withdrew from the study as a result of dry mouth and discontinuation related to constipation was rare (0.6% placebo versus 0.9% darifenacin). In addition, there was a low need for laxative use, with no difference between the darifenacin groups and those taking placebo. There were no reports of blurred vision and the CNS and cardiac safety profile was comparable to placebo. CONCLUSIONS Darifenacin significantly improves the major symptoms of OAB. No significant CNS (primarily M1-receptor mediated) adverse events or cardiac (primarily M2-receptor mediated) adverse events were identified in this study, as may be predicted from the M3 selective receptor profile of darifenacin.
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Affiliation(s)
- F Haab
- Département d'Urologie, Hôpital Tenon, 4 rue de la chine, 75020 Paris, France.
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Fukuzawa R, Breslow NE, Morison IM, Dwyer P, Kusafuka T, Kobayashi Y, Becroft DM, Beckwith JB, Perlman EJ, Reeve AE. Epigenetic differences between Wilms' tumours in white and east-Asian children. Lancet 2004; 363:446-51. [PMID: 14962525 DOI: 10.1016/s0140-6736(04)15491-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [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: 11/18/2022]
Abstract
BACKGROUND Variations in the international incidence of Wilms' tumour might be due to genetic factors. The maternal insulin-like growth factor 2 gene (IGF2) is imprinted in normal tissues, whereas in some Wilms' tumours and other tumour types the imprint is lost, leading to biallelic transcription of IGF2. We investigated whether the difference in incidence of Wilms' tumour between children of east-Asian descent and white children is due to variations in proportion of tumours with loss of IGF2 imprinting (IGF2 LOI). METHODS We assessed IGF2 LOI by use of an ApaI polymorphism in IGF2 exon 9 or quantitative PCR measuring DNA methylation of the H19 and KvDMR1 alleles. The frequencies of perilobar nephrogenic rests associated with Wilms' tumour were assessed histologically in Japanese children and children of white and east-Asian descent. FINDINGS IGF2 LOI was present in Wilms' tumours from predominantly white children from New Zealand (13 of 41 tumours) but absent in tumours from Japanese children (0 of 21 tumours; difference in proportions 0.32, 95% CI 0.07-0.52). Frequency of perilobar nephrogenic rests accompanying tumours from white American children (1192 of 5002, 24%) was significantly higher than in Japanese (one of 56, 1%, difference in proportions 0.22, 95% CI 0.14-0.25) and east-Asian American children (seven of 92, 8%, 0.16, 0.09-0.21). INTERPRETATION Wilms' tumours in the east-Asian population rarely arise from the IGF2 LOI mechanism frequently noted in white patients. Our findings that IGF2 LOI and perilobar nephrogenic rests associated with this mechanism arise at low frequency in Japanese and east-Asian American children lend support to this conclusion. Variation in frequency of this epigenetic mechanism provides one explanation for the difference in incidence of Wilms' tumour between populations.
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Affiliation(s)
- Ryuji Fukuzawa
- Cancer Genetics Laboratory, Department of Biochemistry, University of Otago, Dunedin, New Zealand
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Abstract
PURPOSE The aim of this study was to compare the results of two surgical techniques (direct end-to-end vs. overlapping) of delayed repair of a localized anterior defect of external anal sphincter after an obstetric trauma. METHODS During a five-year period, 23 patients were randomly assigned to direct end-to-end repair (n = 12) or overlapping sphincter repair (n = 11), using 2-0 PDS sutures. Two patients from each group had an internal anal sphincter defect that also was repaired. All patients had a normal pudendal nerve terminal motor latency preoperatively. Evaluations included endoanal ultrasound, anorectal manometry, and neurophysiologic evaluation. Continence was assessed by the Cleveland Clinic Continence Score (0-20; 0, perfect continence; 20, complete incontinence). RESULTS The two groups were comparable with regard to age (median, 45 years), past history of sphincter repair (n = 2), and posterior vaginal repair. There was no major morbidity. The wound-healing rate was identical between the two groups. However, of the patients undergoing overlapping repair, two had fecal impaction, and one had a urinary retention. Median preoperative continence score was 17 in both the direct-repair group (score, 8-20) and the overlap group (score, 7-20). At a median follow-up of 18 months, the improvement in continence was similar between the two surgical groups, with a median continence score of 3, respectively. In both surgical groups there was a significant and similar improvement in maximum squeeze pressure and in the functional anal canal length postoperatively (P < 0.05), but the mean resting pressure was relatively unchanged. In the overlap group, one patient developed a unilaterally prolonged pudendal nerve terminal motor latency that was persistent 22 months after surgery, and two patients had impaired fecal evacuation postoperatively. CONCLUSIONS This randomized, controlled study suggests that the outcome is similar whether direct end-to-end or overlapping repair of a sphincter defect is performed. Overlapping repair might be associated with more difficulties with fecal evacuation and a prolonged pudendal nerve terminal motor latency postoperatively.
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Affiliation(s)
- J J Tjandra
- Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Affiliation(s)
- A Rosamilia
- Urogynaecology Department, Royal Women's Hospital, Melbourne, Australia
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Abstract
OBJECTIVE To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebaek, Denmark) for treating stress incontinence in women. PATIENTS AND METHODS Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study. RESULTS Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side-effects were few and not serious. The women found both devices easy to prepare, insert and use; two-thirds preferred the CCT to the CCG. CONCLUSION The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior.
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Affiliation(s)
- H Thyssen
- Gynaecological Obstetric Department, Glostrup County Hospital, Denmark.
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Gerschman R, Gilbert D, Nye SW, Dwyer P, Fenn WO. Oxygen poisoning and X-irradiation: a mechanism in common. 1954. Nutrition 2001; 17:162. [PMID: 11683139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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