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Lê-Scherban F, Wang A, Courts KA, Ettinger de Cuba S, Wade R, Chilton M. A Short Adverse Experiences Measure Among Mothers of Young Children. Pediatrics 2024; 153:e2023063882. [PMID: 38449423 DOI: 10.1542/peds.2023-063882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire's length and sensitive nature. Rapid screening tools may help address these challenges. We evaluated a 2-item short ACE measure developed for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department. METHODS From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency department in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household substance use, using 4+ ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, household, and child outcomes using adjusted log-binomial regression. RESULTS Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emotional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 4+ ACEs on the full questionnaire, the 2-item measure had sensitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes. CONCLUSIONS A 2-item ACE measure assessing childhood emotional abuse and household substance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.
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Affiliation(s)
- Félice Lê-Scherban
- Department of Epidemiology and Biostatistics
- Drexel Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Anqi Wang
- Department of Epidemiology and Biostatistics
| | - Kelly A Courts
- Department of Epidemiology and Biostatistics
- St Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Stephanie Ettinger de Cuba
- Boston University School of Public Health and Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Roy Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mariana Chilton
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Aysola J, Murdock HM, Lett E, Williams C, Wade R, Higginbotham EJ. Operationalizing inclusion: moving from an elusive goal to strategic action. Epidemiol Rev 2023; 45:140-145. [PMID: 37259471 DOI: 10.1093/epirev/mxad005] [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: 08/30/2022] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
To mitigate the structural and institutional biases that contribute to inequities in health, we need a diverse cadre of individuals to feel included and advance within our field in order to bring a multicultural set of perspectives to the studies we conduct, the science we generate, the health and academic systems we design, and the medical and scientific knowledge we impart. There has been increasing focus on diversity, inclusion, and equity in recent years; however, often these terms are presented without adequate precision and, therefore, the inability to effectively operationalize inclusion and achieve diversity within organizations. This narrative review details several key studies, with the primary objective of presenting a roadmap to guide defining, measuring, and operationalizing inclusion within work and learning environments.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Medicine, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
| | - H Moses Murdock
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elle Lett
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
| | - Corey Williams
- MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19178, United States
| | - Eve J Higginbotham
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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3
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Guevara JP, Aysola J, Wade R, Nfonoyim B, Qiu M, Reece M, Carroll KN. Diversity in the pediatric research workforce: a scoping review of the literature. Pediatr Res 2023; 94:904-914. [PMID: 37185966 PMCID: PMC10129297 DOI: 10.1038/s41390-023-02603-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.
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Affiliation(s)
- James P Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jaya Aysola
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bianca Nfonoyim
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maylene Qiu
- Biotech Commons Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Reece
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Mt Sinai School of Medicine, New York, NY, USA
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4
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Dearnaley D, Hinder V, Hijab A, Horan G, Srihari N, Rich P, Houston G, Henry A, Gibbs S, Venkitaraman R, Cruickshank C, Hassan S, Mason M, Pedley I, Payne H, Brock S, Wade R, Robinson A, Din O, Lees K, Murray J, Parker C, Griffin C, Sohaib A, Hall E. OC-0105 PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Affiliation(s)
- James P Guevara
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
| | - Roy Wade
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
| | - Jaya Aysola
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
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6
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James C, Jimenez ME, Wade R, Nepomnyaschy L. Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability. Acad Pediatr 2021; 21:1395-1403. [PMID: 34020101 DOI: 10.1016/j.acap.2021.05.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine associations between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship. METHODS We conducted a secondary analysis of population-based data from the Fragile Families & Child Wellbeing Study urban birth cohort. Disability status included physical/developmental/behavioral conditions (ages 1-5) using mother-reported child health conditions and cognitive disability (age 9), measured by the Peabody Picture Vocabulary Test (PPVT), an assessment of receptive vocabulary. We investigated whether either disability type moderates the relationship between ACEs occurring between ages 5 to 9 and behavior outcomes at age 15, specifically, standardized scales of caregiver-reported externalizing and youth-reported internalizing and delinquent behaviors. Associations were examined using multivariate linear regression models, including interaction effects of ACEs with low PPVT score and disability conditions to assess for potential moderation. RESULTS Of the 3038 children included, 15% had a cognitive disability and 24% had a disabling health condition. The presence of 2 or more ACEs (compared to none) is associated with more externalizing (by 0.34 standard deviations [SD]), internalizing (0.18 SD), and delinquent (0.18 SD) behaviors. Cognitive disability exacerbates this association for externalizing behaviors and delinquent behaviors while other disabling health conditions do not. CONCLUSIONS ACEs were associated with more behavior problems among urban youth. Cognitive disability, but not other disabling health conditions, compounded this association for externalizing and delinquent behaviors, indicating these children may be particularly vulnerable to the effects of trauma and adversity. Targeted assessment and resources for youth with cognitive disability are critical.
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Affiliation(s)
- Christine James
- Rutgers University School of Social Work (C James and L Nepomnyaschy), New Brunswick, NJ.
| | - Manuel E Jimenez
- Departments of Pediatrics and Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School (ME Jimenez), New Brunswick, NJ; The Boggs Center on Developmental Disabilities (ME Jimenez), New Brunswick, NJ; Child Health Institute of New Jersey (ME Jimenez), New Brunswick, NJ; Children's Specialized Hospital (ME Jimenez), New Brunswick, NJ
| | - Roy Wade
- Division of General Pediatrics, Children's Hospital of Philadelphia (R Wade Jr), Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (R Wade Jr), Philadelphia, PA
| | - Lenna Nepomnyaschy
- Rutgers University School of Social Work (C James and L Nepomnyaschy), New Brunswick, NJ
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7
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Mitchell KJ, Jones LM, Turner HA, Beseler CL, Hamby S, Wade R. Understanding the Impact of Seeing Gun Violence and Hearing Gunshots in Public Places: Findings From the Youth Firearm Risk and Safety Study. J Interpers Violence 2021; 36:8835-8851. [PMID: 31179801 DOI: 10.1177/0886260519853393] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a current public health emphasis on finding strategies for reducing the risks associated with children's gun violence exposure. This article examines the impact of seeing and hearing gun violence on youth of different ages and living in urban and nonurban areas. Participants were 630 youth, aged 2 to 17. Youth, ages 10 to 17, completed a self-report survey, and caregivers of young children, ages 2 to 9, completed the survey as a proxy for that child. Participants resided in Boston, MA; Philadelphia, PA; and rural areas of eastern TN. Participants were recruited through a variety of techniques including pediatric clinics, housing authorities, youth-serving agencies, festivals, word of mouth, and local e-mail lists for classified advertisements. Data were collected between October 2017 and April 2018 and analyzed in 2019. In total, 41% of youth in this study reported ever seeing or hearing gun violence; 32% had such an experience in the past year. Among exposed youth, 50% took protective action to keep themselves safe, and 58% reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence. More youth living in urban compared with nonurban areas took some protective action. Females and younger children had increased odds of experiencing high fear as a result of the violence. Current gun violence prevention has typically targeted adolescents; however, current findings suggest the need to focus on younger children as well, including the distress resulting from indirect exposure to gun violence.
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Affiliation(s)
| | | | | | | | - Sherry Hamby
- Life Paths Appalachian Research Center & Univerity of the South, Sewanee, TN, USA
| | - Roy Wade
- Children's Hospital of Philadelphia, PA, USA
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8
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Larson SL, Martin WA, Şengör SS, Wade R, Altamimi F. Amendment for increased methane production rate in municipal solid waste landfill gas collection systems. Sci Total Environ 2021; 772:145574. [PMID: 33770862 DOI: 10.1016/j.scitotenv.2021.145574] [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] [Received: 08/28/2020] [Revised: 12/30/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
Optimization of methane production rate can potentially decrease the operational lifetime of the landfill site and assist with better management of methane harvesting from the landfill cells. Increased moisture content in landfill cells is known to increase the rate of methane production. Several natural biopolymers can sustain moisture content in a solid matrix while providing a scaffolding for microbial communities to grow. This research examined the effect of the biopolymer, produced by Rhizobium tropici, on bench-scale methane generation from municipal solid waste. The addition of the R. tropici biopolymer increased the rate of methane production from 27% to 78% when compared to the control study for low and high concentrations of biopolymer amendment, respectively. R. tropici biopolymer shortened the lag phase by up to six days over the control, depending on the level of biopolymer amendment added to the solid waste. The mechanism appears to be facilitating biofilm formation through the combination of increased moisture retention and surface modification of the solid waste. Incorporation of biopolymer amendment in the alternative daily cover activities at commercial landfills could provide a viable approach for full scale application.
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Affiliation(s)
- Steven L Larson
- U.S. Army Engineer Research and Development Center, Environmental Laboratory, 3909 Halls Ferry Rd., Vicksburg, MS 39180, USA.
| | - William A Martin
- U.S. Army Engineer Research and Development Center, Installation Support Division, 3909 Halls Ferry Rd., Vicksburg, MS 39180, USA.
| | - S Sevinç Şengör
- Department of Environmental Engineering, Middle East Technical University, Dumlupınar Bulvarı No: 1, 06800 Ankara, Turkey; Civil and Environmental Engineering Department, Southern Methodist University, Dallas, TX, 75275, USA
| | - Roy Wade
- U.S. Army Engineer Research and Development Center, Environmental Laboratory, 3909 Halls Ferry Rd., Vicksburg, MS 39180, USA.
| | - Faris Altamimi
- Department of Environmental Engineering, Middle East Technical University, Dumlupınar Bulvarı No: 1, 06800 Ankara, Turkey.
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9
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Grant M, Scott-Bridge K, Wade R. 1023 The Role of Social Media in Disseminating Plastic Surgery Research: The Relationship Between Citations, Altmetrics and Article Characteristics. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Social media (SoMe) enable the dissemination of content immediately and directly to interested end-users. Alternative metrics (altmetrics) are non-traditional bibliometrics which describe the exposure and impact of an article on freely available platforms such as Twitter and Facebook. Altmetrics within days of publication are associated with ultimate citation counts in various medical disciplines, except plastic surgery which represents the rationale for this study.
Method
Altmetric explorer was used to extract altmetrics and citation rates for articles published during 2018 in Plastic and Reconstructive Surgery (PRS), the Journal of Plastic, Reconstructive and Aesthetic Surgery, the Annals of Plastics Surgery and Plastic Surgery. Multivariable negative binomial regression was used to estimate the relationship between citations and predictors (presented as the incidence rate ratio, IRR with 95% confidence interval, CI).
Results
Overall, 1215 articles were captured. On average, articles published in PRS were cited nearly five times as often as articles published elsewhere (adjusted IRR 4.77 [95% CI 2.36, 9.62]). Overall, SoMe mentions were positively associated with citation rates (adjusted IRR 1.01 [95% CI 1.01, 1.1]); marginal analysis showed that 45 mentions translated to one extra citation.
Conclusions
Dissemination of plastic surgery research through SoMe channels are associated with significant improvements in short term citations rates.
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Affiliation(s)
- M Grant
- University of Sheffield, Sheffield, United Kingdom
| | | | - R Wade
- Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, United Kingdom
- Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds, United Kingdom
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10
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Beseler C, Mitchell KJ, Jones LM, Turner HA, Hamby S, Wade R. The Youth Firearm Risk and Safety Tool (Youth-FiRST): Psychometrics and Validation of a Gun Attitudes and Violence Exposure Assessment Tool. Violence Vict 2020; 35:635-655. [PMID: 33060248 DOI: 10.1891/vv-d-19-00085] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study reports on the development of a comprehensive assessment of exposure to guns and gun-related violence for evaluating the risk of gun-related trauma. Gun access, gun attitudes, gun safety education, and exposure to gun violence were measured. Participants were 630 youth, aged 2-17. Youth, ages 10-17, completed a self-report survey and caregivers of young children, ages 2-9, completed the survey as a proxy for that child. The youth were from urban (n = 286) and rural (n = 344) areas. Factor analysis, item response theory, and structural equation modeling were used. Two factors described access to guns, two factors described gun attitudes, and a single construct captured gun safety education. The gun violence exposure factor showed strong associations with trauma symptomatology. The individual constructs showed good psychometric properties and measurement noninvariance by urbanicity.
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Affiliation(s)
- Cheryl Beseler
- Psychology Department, Colorado State University, Fort Collins, CO
| | | | - Lisa M Jones
- Psychology Department, University of New Hampshire, Durham, NH
| | | | - Sherry Hamby
- Life Paths Appalachian Research Center, Sewanee, TN
| | - Roy Wade
- Pediatrics Department, Children's Hospital of Philadelphia, Philadelphia, PA
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11
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Wade R, Sharif-Hurst S, Smith C, Dias S. Characteristics modifying response to biological treatments for psoriasis: considering subgroups in network meta-analysis. Br J Dermatol 2020; 184:358-359. [PMID: 32812647 DOI: 10.1111/bjd.19494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/24/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R Wade
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - S Sharif-Hurst
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - C Smith
- St John's Institute of Dermatology, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - S Dias
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
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12
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Shor D, Smith M, Abbas Z, Wade R, Kapur G, Nobes J, Swannie H. The Role of Pelvic Node Irradiation in Node Positive Prostate Cancer; the Norfolk and Norwich University Hospital (NNUH) Experience 2011–2015. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Turner HA, Mitchell KJ, Jones LM, Hamby S, Wade R, Beseler CL. Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth. J Trauma Stress 2019; 32:881-889. [PMID: 31833114 DOI: 10.1002/jts.22466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 01/15/2023]
Abstract
Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2-17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10-17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2-9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10-.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10-17 years) polyvictimization was most strongly associated with posttraumatic symptoms, β = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, β = .18, p < .01. For younger children (ages 2-9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, β = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.
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Affiliation(s)
- Heather A Turner
- Crimes Against Children Research Center, University of New Hampshire, Durham, New Hampshire, USA
| | - Kimberly J Mitchell
- Crimes Against Children Research Center, University of New Hampshire, Durham, New Hampshire, USA
| | - Lisa M Jones
- Crimes Against Children Research Center, University of New Hampshire, Durham, New Hampshire, USA
| | - Sherry Hamby
- Life Paths Appalachian Research Center and University of the South, Monteagle, Tennessee, USA
| | - Roy Wade
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cheryl L Beseler
- Departmet of Psychology, Colorado State University, Fort Collins, Colorado, USA
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Gnatiuc L, Alegre-Diaz J, Garcilazo-Avila A, Ramirez R, Gonzales-Carballo C, Solano-Sanchez M, Chiquete E, Wade R, Clarke R, Herrington WG, Collins R, Peto R, Tapia-Conyer R, Kuri-Morales P, Emberson J. P3824Body composition and mortality from vascular or metabolic causes among 150,000 participants in the Mexico City Prospective Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Higher body-mass index is associated with increased mortality from vascular disease, renal disease and other metabolic causes. However, body mass reflects both fat and lean mass, which may have very different effects on risk. We investigated the individual and joint relevance of fat and lean mass to mortality from these causes, using data from the Mexico City Prospective Study.
Methods
Between 1998 and 2004, 150,000 adults from Mexico City were recruited into a prospective study and tracked for cause-specific mortality for 14 years. Fat and lean mass at recruitment were predicted using Mexican-specific anthropometric equations, validated in a subset of participants with additional bio-impedance measures. Cox regression was used to assess the relevance of fat and lean mass at recruitment to mortality from a vascular, renal, or other metabolic cause at ages 35–74 years. Analyses were adjusted for age at risk, sex, residential district, education, recreational physical activity, smoking and alcohol consumption. To avoid reverse causality, analyses excluded those with diabetes or other chronic diseases at recruitment, and deaths in the first 5 years of follow-up. Mortality rate ratios (RRs) relate to the differences per SD of the usual values of various factors or the differences between the top tenth and bottom fifth of the values.
Results
Among 112,923 participants aged 35–74 years, mean (SD) fat mass in men and women was 22.0 (6.4) kgs and 29.4 (7.8) kgs respectively, while mean (SD) lean mass was 54.9 (7.2) kgs and 39.2 (5.0) kgs respectively. In both men and women, equation-predicted fat and lean mass closely matched the bio-impedance values (all r>0.86). Both fat and lean mass were positively and approximately log-linearly associated with mortality from a vascular or metabolic cause. However, the association of lean mass with mortality was more than accounted for by the correlation of lean with fat mass. Hence, after adjustment for fat mass, lean mass was inversely associated with risk. For a given amount of fat mass, the RR for vascular/metabolic mortality comparing those in the top tenth versus bottom fifth of the predicted lean mass was 0.35 (95% CI 0.24–0.52). Conversely, for a given amount of lean mass, the RR comparing those in the top tenth versus bottom fifth of the predicted fat mass was 4.06 (3.06–5.39). The RRs associated with each SD higher fat mass (1.51, 1.40–1.63) or lean mass (0.79, 0.73–0.86) appeared to be little affected by age, sex, or levels of other confounders, and were broadly similar for the major vascular, renal, and other metabolic mortality. The height-adjusted RRs were 1.41 (1.30–1.53) for fat mass and 0.91 (0.82–1.00) for lean mass.
Conclusions
In this Mexican cohort, predicted fat and lean mass had opposing effects on vascular and other metabolic deaths, with no evidence of any thresholds throughout the ranges studied.
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Affiliation(s)
- L Gnatiuc
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - J Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - A Garcilazo-Avila
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - C Gonzales-Carballo
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - M Solano-Sanchez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - E Chiquete
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - W G Herrington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Peto
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - P Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
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Daveson B, Milch V, Chynoweth J, Kable L, Austen M, Basrai H, Salvestrin D, Wade R, Andereisz C, Zorbas H. Improving Outcomes Through Principles of Best Practice Management: Australia's National Lung Cancer Framework. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.97500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Lung cancer is estimated to be the fifth most commonly diagnosed cancer and leading cause of cancer death in Australia, representing 9.2% of all new cancer cases (n = 138,321) diagnosed and 18.9% of all cancer deaths (n = 48,586). The 5-year survival rate for those with lung cancer is 16%, compared with 68% for all cancers combined (between 2009 and 2013). Lung cancer is also the leading cause of cancer burden in Australia and patients affected by lung cancer may experience high levels of unmet need with associated psychological distress and decreased quality of life. Cancer Australia, Australia's national cancer control agency, developed the national Lung Cancer Framework: Principles for Best Practice Lung Cancer Care (Framework) to provide evidence-based, best practice information, strategies, tools and resources to support local adoption of the 5 principles for best practice management of lung cancer (principles): patient-centered care; multidisciplinary care; timely access to evidence-based care; coordination, communication and continuity of care; and data-driven improvements. Aim: The framework aims to improve the outcomes and experiences of people affected by lung cancer in Australia by supporting national uptake of the principles. Strategy/Tactics: Cancer Australia: • established a Lung Cancer Advisory Group to advise on strategies for national implementation of the framework and its principles • conducted a national lung cancer demonstration project, with advice from an Expert Steering Group, to demonstrate the delivery of lung cancer care according to the principles across a range of service delivery settings, and identify key factors contributing to ongoing delivery of best practice cancer care • completed systematic reviews for each principle to determine the effectiveness of the principles in improving lung cancer care processes and outcomes. Program/Policy process: To support national adoption of the framework and its principles, Cancer Australia: • developed a promotion and communication strategy for widespread national dissemination • convened a National Summit to bring together policy makers, clinical stakeholders and consumers to support local application of the principles, and drive optimal care for people affected by lung cancer • identified and communicated consumer, service, and system-level approaches to aid sustainable use of the principles. Outcomes: The evidence-based approach to the development of the framework and its principles identified ways to improve the healthcare system to achieve better outcomes for those affected by lung cancer in Australia. A coordinated approach to the delivery of the National Summit supported those involved in lung cancer care to share and adopt innovative and multilevel strategies for best practice care. What was learned: Embedding strategies to support implementation of the principles, responsive to local context, was key to enabling sustainable improvements in national lung cancer control.
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Affiliation(s)
| | - V. Milch
- Cancer Australia, Sydney, Australia
| | | | - L. Kable
- Cancer Australia, Sydney, Australia
| | | | | | | | - R. Wade
- Independent Health Researcher, Green Point, Australia
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Wade R, Llewellyn A, Jones-Diette J, Wright K, Rice S, Layton A, Levell N, Craig D, Woolacot N. 多汗症的二级护理管理. Br J Dermatol 2018. [DOI: 10.1111/bjd.17060] [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: 11/30/2022]
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17
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Wade R, Llewellyn A, Jones-Diette J, Wright K, Rice S, Layton A, Levell N, Craig D, Woolacott N. Management of hyperhidrosis in secondary care. Br J Dermatol 2018. [DOI: 10.1111/bjd.17044] [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: 11/29/2022]
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18
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Gnatiuc L, Alegre-Diaz J, Wade R, Ramirez R, Herrington WG, Solano M, Clarke R, Lewington SL, Collins R, Peto R, Tapia-Conyer R, Emberson J, Kuri-Morales P. P6282Adiposity and vascular-metabolic mortality among 150,000 Mexican adults followed for 15 years. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6282] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Gnatiuc
- University of Oxford, CTSU, Oxford, United Kingdom
| | - J Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | | | - M Solano
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R Clarke
- University of Oxford, CTSU, Oxford, United Kingdom
| | - S L Lewington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R Collins
- University of Oxford, CTSU, Oxford, United Kingdom
| | - R Peto
- University of Oxford, CTSU, Oxford, United Kingdom
| | - R Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - P Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
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Wade R, Llewellyn A, Jones-Diette J, Wright K, Rice S, Layton AM, Levell NJ, Craig D, Woolacott N. Interventional management of hyperhidrosis in secondary care: a systematic review. Br J Dermatol 2018; 179:599-608. [PMID: 29573391 DOI: 10.1111/bjd.16558] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating, which occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. OBJECTIVES To undertake a systematic review of the clinical effectiveness and safety of treatments available in secondary care for the management of primary hyperhidrosis. METHODS Fifteen databases (including trial registers) were searched to July 2016 to identify studies of secondary-care treatments for primary hyperhidrosis. For each intervention randomized controlled trials (RCTs) were included where available; where RCT evidence was lacking, nonrandomized trials or large prospective case series were included. Outcomes of interest included disease severity, sweat rate, quality of life, patient satisfaction and adverse events. Trial quality was assessed using a modified version of the Cochrane Risk of Bias tool. Results were pooled in pairwise meta-analyses where appropriate, otherwise a narrative synthesis was presented. RESULTS Fifty studies were included in the review: 32 RCTs, 17 nonrandomized trials and one case series. The studies varied in terms of population, intervention and methods of outcome assessment. Most studies were small, at high risk of bias and poorly reported. The interventions assessed were iontophoresis, botulinum toxin (BTX) injections, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland. CONCLUSIONS The evidence for the effectiveness and safety of treatments for primary hyperhidrosis is limited overall, and few firm conclusions can be drawn. However, there is moderate-quality evidence to support the use of BTX for axillary hyperhidrosis. A trial comparing BTX with iontophoresis for palmar hyperhidrosis is warranted.
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Affiliation(s)
- R Wade
- Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K
| | - A Llewellyn
- Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K
| | - J Jones-Diette
- Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K
| | - K Wright
- Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K
| | - S Rice
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K
| | - A M Layton
- Harrogate and District NHS Foundation Trust, Harrogate, U.K
| | - N J Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, U.K
| | - D Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, U.K
| | - N Woolacott
- Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, U.K
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20
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Doheny-Adams T, Lilley CJ, Barker A, Ellis S, Wade R, Atkinson HJ, Urwin PE, Redeker K, Hartley SE. Constant Isothiocyanate-Release Potentials across Biofumigant Seeding Rates. J Agric Food Chem 2018; 66:5108-5116. [PMID: 29624055 DOI: 10.1021/acs.jafc.7b04610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Biofumigation is an integrated pest-management method involving the mulching of a glucosinolate-containing cover crop into a field in order to generate toxic isothiocyanates (ITCs), which are effective soil-borne-pest-control compounds. Variation in biofumigation efficacy demonstrates a need to better understand the factors affecting pest-control outcomes and develop best practices for choosing biofumigants, growth conditions, and mulching methods that allow the greatest potential isothiocyanate release. We measured the glucosinolate concentrations of six different commercial varieties of three biofumigant plant species: Brassica juncea (ISCI99, Vitasso, and Scala) Raphanus sativus (Diablo and Bento), and Sinapis alba (Ida Gold). The plants were grown in the range of commercially appropriate seeding rates and sampled at three growth stages (early development, mature, and 50% flowering). Within biofumigant species, the highest ITC-release potentials were achieved with B. juncea cv. ISCI99 and R. sativus cv. Bento. The highest ITC-release potential occurred at the 50% flowering growth stage across the species. The seeding rate had a minor impact on the ITC-release potential of R. sativus but had no significant effects on the ITC-release potentials of the B. juncea or S. alba cultivars.
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Affiliation(s)
- T Doheny-Adams
- Department of Biology , University of York , York YO10 5DD , England
| | - C J Lilley
- Faculty of Biological Sciences , University of Leeds , Leeds LS2 9JT , England
| | - A Barker
- Barworth Agriculture Ltd. , Sleaford NG34 9NB , England
| | - S Ellis
- Department of Biology , University of York , York YO10 5DD , England
| | - R Wade
- Department of Biology , University of York , York YO10 5DD , England
| | - H J Atkinson
- Faculty of Biological Sciences , University of Leeds , Leeds LS2 9JT , England
| | - P E Urwin
- Faculty of Biological Sciences , University of Leeds , Leeds LS2 9JT , England
| | - K Redeker
- Department of Biology , University of York , York YO10 5DD , England
| | - S E Hartley
- Department of Biology , University of York , York YO10 5DD , England
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Alegre-Diaz J, Gnatiuc L, Wade R, Ramirez R, Herrington W, Lewington S, Lopez Cervantes M, Solano M, Peto R, Collins R, Tapia-Conyer R, Kuri-Morales P, Emberson J. P6257Blood pressure and death from vascular and metabolic diseases in Mexico City: 12-year follow-up of 150,000 adults. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J. Alegre-Diaz
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - L. Gnatiuc
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R. Wade
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - R. Ramirez
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - W.G. Herrington
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - S.L. Lewington
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
| | - M. Lopez Cervantes
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - M. Solano
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - R. Peto
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R. Collins
- University of Oxford, CTSU, Nuffield Department of Population Health,, Oxford, United Kingdom
| | - R. Tapia-Conyer
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - P. Kuri-Morales
- National Autonomous University of Mexico, School of Medicine, Mexico City, Mexico
| | - J.R. Emberson
- University of Oxford, MRC Population Health Research Unit; Nuffield Department of Population Health, Oxford, United Kingdom
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22
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Jimenez ME, DuRivage NE, Bezpalko O, Suh A, Wade R, Blum NJ, Fiks AG. A Pilot Randomized Trial of a Video Patient Decision Aid to Facilitate Early Intervention Referrals From Primary Care. Clin Pediatr (Phila) 2017; 56:268-277. [PMID: 27834191 DOI: 10.1177/0009922816677038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many young children identified with developmental concerns in pediatric settings do not receive early intervention (EI). We assessed the impact of a video decision aid and text message reminder on knowledge and attitudes regarding developmental delay and EI as well as referral completion. We conducted a pilot randomized controlled trial in an urban setting and enrolled 64 parent-child dyads referred to EI. Compared with controls, participants who received the intervention demonstrated increased knowledge regarding developmental delay and EI as well as more favorable attitudes in certain topics. Although we did not find a significant difference between arms in EI intake and evaluation, we found a pattern suggestive of increased intake and evaluation among participants with low health literacy in the intervention arm. Additional study is needed to identify strategies that improve the EI referral process for families and to understand the potential targeted role for decision aids and text messages.
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Affiliation(s)
- Manuel E Jimenez
- 1 Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,2 Children's Specialized Hospital, New Brunswick, NJ, USA
| | | | - Orysia Bezpalko
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Suh
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Roy Wade
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA.,4 Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Nathan J Blum
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA.,4 Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - Alexander G Fiks
- 3 Children's Hospital of Philadelphia, Philadelphia, PA, USA.,4 Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
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23
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Wade R, Becker BD, Bevans KB, Ford DC, Forrest CB. Development and Evaluation of a Short Adverse Childhood Experiences Measure. Am J Prev Med 2017; 52:163-172. [PMID: 27865652 PMCID: PMC5596508 DOI: 10.1016/j.amepre.2016.09.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/16/2016] [Accepted: 09/30/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Clinicians require tools to rapidly identify individuals with significant childhood adversity as part of routine primary care. The goal of this study was to shorten the 11-item Behavioral Risk Factor Surveillance System Adverse Childhood Experiences (ACEs) measure and evaluate the feasibility and validity of this shortened measure as a screener to identify adults who have experienced significant childhood adversity. METHODS Statistical analysis was conducted in 2015. ACE item responses obtained from 2011-2012 Behavioral Risk Factor Surveillance System data were combined to form a sample of 71,413 adults aged ≥18 years. The 11-item Behavioral Risk Factor Surveillance System ACE measure was subsequently reduced to a two-item screener by maintaining the two dimensions of abuse and household stressors and selecting the most prevalent item within each dimension. RESULTS The screener included household alcohol and childhood emotional abuse items. Overall, 42% of respondents and at least 75% of the individuals with four or more ACEs endorsed one or both of these experiences. Using the 11-item ACE measure as the standard, a cut off of one or more ACEs yielded a sensitivity of 99%, but specificity was low (66%). Specificity improved to 94% when using a cut off of two ACEs, but sensitivity diminished (70%). There was no substantive difference between the 11-and two-item ACE measures in their strength of association with an array of health outcomes. CONCLUSIONS A two-item ACE screener appropriate for rapid identification of adults who have experienced significant childhood adversity was developed.
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Affiliation(s)
- Roy Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Brandon D Becker
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katherine B Bevans
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Derek C Ford
- Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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24
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Jimenez ME, Wade R, Schwartz-Soicher O, Lin Y, Reichman NE. Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample. Acad Pediatr 2017; 17:356-361. [PMID: 28003143 PMCID: PMC5555409 DOI: 10.1016/j.acap.2016.12.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine associations between adverse childhood experiences (ACEs) and attention-deficit/hyperactivity disorder (ADHD) at age 9 years using longitudinal data and assess the extent to which ACEs during middle childhood are independently associated with ADHD at age 9 years. METHODS We conducted a secondary analysis of data from the Fragile Families urban birth cohort 5- and 9-year interviews. The sample was limited to children for whom mothers were the primary caregiver and mother-reported information on 8 ACEs and ADHD were available at age 5 and 9 years. We examined associations between ACEs and parent-reported ADHD at age 9 years using logistic regression and controlling for potential confounders. RESULTS We included 1572 children; 48% were African American, 11% had parent-reported ADHD at age 9 years, 41% and 42% experienced ≥1 ACE by age 5 years and between the ages of 5 and 9 years, respectively. ACEs before age 5 years were associated with ADHD at age 9 years. One, 2, and ≥3 ACEs between age 5 and 9 years were associated with ADHD at age 9 years even after controlling for ACEs before age 5 years and ADHD at age 5 years (adjusted odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2-3; AOR, 2.1; 95% CI, 1.2-3.8; and AOR, 2.2; 95% CI, 1.1-4.3). CONCLUSIONS In this study of urban children, ACEs occurring before age 5 years as well as between the ages of 5 and 9 years were associated with ADHD at age 9 years. Even after controlling for early childhood ACEs and ADHD at age 5 years, the association between ADHD and ACEs in middle childhood remained significant, highlighting the importance of screening and intervention throughout childhood.
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Affiliation(s)
- Manuel E Jimenez
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Boggs Center on Developmental Disabilities, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Children's Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Children's Specialized Hospital, New Brunswick, NJ.
| | - Roy Wade
- Department of Pediatrics, The Children's Hospital of Philadelphia, Pa
| | | | - Yong Lin
- Rutgers Biomedical Health Sciences, The School of Public Health, Piscataway, NJ
| | - Nancy E Reichman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Children's Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Princeton University, NJ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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25
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Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, Braveman P. Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice. Acad Pediatr 2017; 17:S51-S69. [PMID: 28865661 PMCID: PMC6035880 DOI: 10.1016/j.acap.2017.04.161] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 02/21/2017] [Accepted: 04/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation. METHODS We identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice. RESULTS Of 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children's ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs. CONCLUSIONS Although important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.
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Abstract
UNLABELLED Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is difficult and its correlation with histology uncertain. We prospectively biopsied the palmar skin of consecutive patients undergoing single digit fasciectomy (for primary Dupuytren's disease without clinically involved skin) and dermofasciectomy (for clinically involved skin or recurrence) in order to investigate this relationship. We found dermal fibromatosis in 22 of 44 patients (50%) undergoing fasciectomy and 41 of 59 patients (70%) undergoing dermofasciectomy. Dermal fibromatosis appeared to be associated with greater preoperative angular deformity, presence of palmar nodules and occupations involving manual labour. Dermal fibromatosis exists in the absence of clinical features of skin involvement and we hypothesize that the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought. LEVEL OF EVIDENCE III.
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Affiliation(s)
- R Wade
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - L Igali
- Norfolk and Waveney Cellular Pathology Network, Cotman Centre, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A Figus
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, Lewis G, Osman CJ, Jo Messito M, Wade R, Shonna Yin H, Cox J, Fierman AH. Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Curr Probl Pediatr Adolesc Health Care 2016; 46:135-53. [PMID: 27101890 PMCID: PMC6039226 DOI: 10.1016/j.cppeds.2016.02.004] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [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: 10/21/2022]
Abstract
Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.
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Affiliation(s)
- Esther K Chung
- The Department of Pediatrics, The Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Nemours, Wilmington, DE.
| | - Benjamin S Siegel
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Arvin Garg
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Kathleen Conroy
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
| | - Rachel S Gross
- The Department of Pediatrics, Albert Einstein College of Medicine, The Children׳s Hospital at Montefiore, Bronx, NY
| | - Dayna A Long
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Gena Lewis
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Cynthia J Osman
- The Department of Pediatrics, New York University, New York, NY
| | - Mary Jo Messito
- The Department of Pediatrics, New York University, New York, NY
| | - Roy Wade
- The Department of Pediatrics, The Children׳s Hospital of Philadelphia, Philadelphia, PA
| | - H Shonna Yin
- The Department of Pediatrics, New York University, New York, NY
| | - Joanne Cox
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
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Wade R, Cronholm PF, Fein JA, Forke CM, Davis MB, Harkins-Schwarz M, Pachter LM, Bair-Merritt MH. Household and community-level Adverse Childhood Experiences and adult health outcomes in a diverse urban population. Child Abuse Negl 2016; 52:135-45. [PMID: 26726759 DOI: 10.1016/j.chiabu.2015.11.021] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/31/2015] [Accepted: 11/30/2015] [Indexed: 05/07/2023]
Abstract
Adverse Childhood Experiences (ACEs), which include family dysfunction and community-level stressors, negatively impact the health and well being of children throughout the life course. While several studies have examined the impact of these childhood exposures amongst racially and socially diverse populations, the contribution of ACEs in the persistence of socioeconomic disparities in health is poorly understood. To determine the association between ACEs and health outcomes amongst a sample of adults living in Philadelphia and examine the moderating effect of Socioeconomic Status (SES) on this association, we conducted a cross-sectional survey of 1,784 Philadelphia adults, ages 18 and older, using random digit dialing methodology to assess Conventional ACEs (experiences related to family dysfunction), Expanded ACEs (community-level stressors), and health outcomes. Using weighted, multivariable logistic regression analyses along with SES stratified models, we examined the relationship between ACEs and health outcomes as well as the modifying effect of current SES. High Conventional ACE scores were significantly associated with health risk behaviors, physical and mental illness, while elevated Expanded ACE scores were associated only with substance abuse history and sexually transmitted infections. ACEs did have some differential impacts on health outcomes based on SES. Given the robust impact of Conventional ACEs on health, our results support prior research highlighting the primacy of family relationships on a child's life course trajectory and the importance of interventions designed to support families. Our findings related to the modifying effect of SES may provide additional insight into the complex relationship between poverty and childhood adversity.
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Affiliation(s)
- Roy Wade
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel A Fein
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christine M Forke
- Violence Prevention Initiative, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Lee M Pachter
- St. Christopher's Hospital for Children, Philadelphia, PA, USA; Department of Pediatrics, Drexel University School of Medicine, Philadelphia, PA, USA
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Abstract
OBJECTIVE To examine associations between adverse childhood experiences (ACEs) in early childhood and teacher-reported academic and behavioral problems in kindergarten. METHODS We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. Subjects with primary caregiver-reported information on ACE exposures ascertained at 5 years and teacher-reported outcomes at the end of the child's kindergarten year were included. Outcomes included teacher ratings of academic skills, emergent literacy skills, and behavior. We included 8 ACE exposures on the basis of the original Centers for Disease Control and Prevention Kaiser study and created an ACE score by summing individual adversities. We examined the associations between teacher-reported academic and behavioral outcomes and ACE scores by using logistic regression. RESULTS In the study sample, 1007 children were included. Fifty-five percent had experienced 1 ACE and 12% had experienced ≥ 3. Adjusting for potential confounders, experiencing ≥ 3 ACEs was associated with below-average language and literacy skills (adjusted odds ratio [AORs]: 1.8; 95% confidence interval [CI]: 1.1-2.9) and math skills (AOR: 1.8, 95% CI: 1.1-2.9), poor emergent literacy skills, attention problems (AOR: 3.5, 95% CI: 1.8-6.5), social problems (AOR: 2.7, 95% CI: 1.4-5.0), and aggression (AOR: 2.3, 95% CI: 1.2-4.6). CONCLUSIONS In this study of urban children, experiencing ACEs in early childhood was associated with below-average, teacher-reported academic and literacy skills and behavior problems in kindergarten. These findings underscore the importance of integrated approaches that promote optimal development among vulnerable children.
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Affiliation(s)
- Manuel E. Jimenez
- Departments of Pediatrics and,Family Medicine and Community Health,,Boggs Center for Developmental Disabilities, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;,Children’s Specialized Hospital, New Brunswick, New Jersey
| | - Roy Wade
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yong Lin
- School of Public Health, Rutgers Biomedical Health Sciences, Piscataway, New Jersey, and
| | - Lesley M. Morrow
- Graduate School of Education, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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Abstract
BACKGROUND AND OBJECTIVE Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area. METHODS Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains. RESULTS Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination. CONCLUSIONS Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults.
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Affiliation(s)
- Roy Wade
- Department of General Pediatrics, and
| | - Judy A Shea
- Division of General Internal Medicine, Department of Medicine, and
| | - David Rubin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Joanne Wood
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaPolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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Wade R, Spackman E, Corbett M, Walker S, Light K, Naik R, Sculpher M, Eastwood A. Adjunctive colposcopy technologies for examination of the uterine cervix--DySIS, LuViva Advanced Cervical Scan and Niris Imaging System: a systematic review and economic evaluation. Health Technol Assess 2013; 17:1-240, v-vi. [PMID: 23449335 PMCID: PMC4781255 DOI: 10.3310/hta17080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women in England (aged 25-64 years) are invited for cervical screening every 3-5 years to assess for cervical intraepithelial neoplasia (CIN) or cancer. CIN is a term describing abnormal changes in the cells of the cervix, ranging from CIN1 to CIN3, which is precancerous. Colposcopy is used to visualise the cervix. Three adjunctive colposcopy technologies for examination of the cervix have been included in this assessment: Dynamic Spectral Imaging System (DySIS), the LuViva Advanced Cervical Scan and the Niris Imaging System. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of adjunctive colposcopy technologies for examination of the uterine cervix for patients referred for colposcopy through the NHS Cervical Screening Programme. DATA SOURCES Sixteen electronic databases [Allied and Complementary Medicine Database (AMED), BIOSIS Previews, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Management Information Consortium (HMIC), Health Technology Assessment (HTA) database; Inspec, Inside Conferences, MEDLINE, NHS Economic Evaluation Database (NHS EED), PASCAL, Science Citation Index Expanded (SCIE) and Science Citation Index (SCI) - Conference Proceedings], and two clinical trial registries [ClinicalTrials.gov and Current Controlled Trials (CCT)] were searched to September-October 2011. REVIEW METHODS Studies comparing DySIS, LuViva or Niris with conventional colposcopy were sought; a narrative synthesis was undertaken. A decision-analytic model was developed, which measured outcomes in terms of quality-adjusted life-years (QALYs) and costs were evaluated from the perspective of the NHS and Personal Social Services with a time horizon of 50 years. RESULTS Six studies were included: two studies of DySIS, one study of LuViva and three studies of Niris. The DySIS studies were well reported and had a low risk of bias; they found higher sensitivity with DySIS (both the DySISmap alone and in combination with colposcopy) than colposcopy alone for identifying CIN2+ disease, although specificity was lower with DySIS. The studies of LuViva and Niris were poorly reported and had limitations, which indicated that their results were subject to a high risk of bias; the results of these studies cannot be considered reliable. The base-case cost-effectiveness analysis suggests that both DySIS treatment options are less costly and more effective than colposcopy alone in the overall weighted population; these results were robust to the ranges tested in the sensitivity analysis. DySISmap alone was more costly and more effective in several of the referral groups but the incremental cost-effectiveness ratio (ICER) was never higher than £1687 per QALY. DySIS plus colposcopy was less costly and more effective in all reasons for referral. Only indicative analyses were carried out on Niris and LuViva and no conclusions could be made on their cost-effectiveness. LIMITATIONS The assessment is limited by the available evidence on the new technologies, natural history of the disease area and current treatment patterns. CONCLUSIONS DySIS, particularly in combination with colposcopy, has higher sensitivity than colposcopy alone. There is no reliable evidence on the clinical effectiveness of LuViva and Niris. DySIS plus colposcopy appears to be less costly and more effective than both the DySISmap alone and colposcopy alone; these results were robust to the sensitivity analyses undertaken. Given the lack of reliable evidence on LuViva and Niris, no conclusions on their potential cost-effectiveness can be drawn. There is some uncertainty about how generalisable these findings will be to the population of women referred for colposcopy in the future, owing to the introduction of the human papillomavirus (HPV) triage test and uptake of the HPV vaccine.
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Affiliation(s)
- R Wade
- CRD/CHE Technology Assessment Group, Centre for Reviews and Dissemination, University of York, York, UK
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Matutes E, Bosanquet AG, Wade R, Richards SM, Else M, Catovsky D. The use of individualized tumor response testing in treatment selection: second randomization results from the LRF CLL4 trial and the predictive value of the test at trial entry. Leukemia 2013; 27:507-10. [PMID: 22810506 PMCID: PMC3567236 DOI: 10.1038/leu.2012.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
MESH Headings
- Antineoplastic Agents/pharmacology
- Biological Assay
- Drug Monitoring
- Drug Resistance, Neoplasm
- Follow-Up Studies
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Multicenter Studies as Topic
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Patient Selection
- Predictive Value of Tests
- Prognosis
- Random Allocation
- Randomized Controlled Trials as Topic
- Survival Rate
- Vidarabine/analogs & derivatives
- Vidarabine/pharmacology
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Affiliation(s)
- E Matutes
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
| | - A G Bosanquet
- Bath Cancer Research, Royal United Hospital, Bath, UK
| | - R Wade
- Clinical Trial Service Unit, Oxford University, Oxford, UK
| | - S M Richards
- Clinical Trial Service Unit, Oxford University, Oxford, UK
| | - M Else
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
| | - D Catovsky
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, UK
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Jenkinson S, Koo K, Mansour MR, Goulden N, Vora A, Mitchell C, Wade R, Richards S, Hancock J, Moorman AV, Linch DC, Gale RE. Impact of NOTCH1/FBXW7 mutations on outcome in pediatric T-cell acute lymphoblastic leukemia patients treated on the MRC UKALL 2003 trial. Leukemia 2013; 27:41-7. [PMID: 22814294 DOI: 10.1038/leu.2012.176] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 12/24/2022]
Abstract
Activating mutations in the NOTCH1 pathway are frequent in pediatric T-cell acute lymphoblastic leukemia (T-ALL) but their role in refining risk stratification is unclear. We screened 162 pediatric T-ALL patients treated on the MRC UKALL2003 trial for NOTCH1/FBXW7 gene mutations and related genotype to response to therapy and long-term outcome. Overall, 35% were wild-type (WT) for both genes (NOTCH1(WT)FBXW7(WT)), 38% single NOTCH1 mutant (NOTCH1(Single)FBXW7(WT)), 3% just FBXW7 mutant (NOTCH1(WT)FBXW7(MUT)) and 24% either double NOTCH1 mutant (NOTCH1(Double)FBXW7(WT)) or mutant in both genes (NOTCH1(MUT)FBXW7(MUT)), hereafter called as NOTCH1±FBXW7(Double). There was no difference between groups in early response to therapy, but NOTCH1±FBXW7(Double) patients were more likely to be associated with negative minimal residual disease (MRD) post-induction than NOTCH1(WT)FBXW7(WT) patients (71% versus 40%, P=0.004). Outcome improved according to the number of mutations, overall survival at 5 years 82%, 88% and 100% for NOTCH1(WT)FBXW7(WT), NOTCH1(Single)FBXW7(WT) and NOTCH1±FBXW7(Double) patients, respectively (log-rank P for trend=0.005). Although 14 NOTCH1±FBXW7(Double) patients were classified as high risk (slow response and/or MRD positive), only two had disease progression and all remain alive. Patients with double NOTCH1 and/or FBXW7 mutations have a very good outcome and should not be considered for more intensive therapy in first remission, even if slow early responders or MRD positive after induction therapy.
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Affiliation(s)
- S Jenkinson
- Department of Haematology, UCL Cancer Institute, London, UK
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McKenna C, Wade R, Faria R, Yang H, Stirk L, Gummerson N, Sculpher M, Woolacott N. EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation. Health Technol Assess 2012; 16:1-188. [PMID: 22449757 DOI: 10.3310/hta16140] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND EOS is a biplane X-ray imaging system manufactured by EOS Imaging (formerly Biospace Med, Paris, France). It uses slot-scanning technology to produce a high-quality image with less irradiation than standard imaging techniques. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of EOS two-dimensional (2D)/three-dimensional (3D) X-ray imaging system for the evaluation and monitoring of scoliosis and other relevant orthopaedic conditions. DATA SOURCES For the systematic review of EOS, electronic databases (MEDLINE, Allied and Complementary Medicine Database, BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, EMBASE, Health Management Information Consortium, Inspec, ISI Science Citation Index and PASCAL), clinical trials registries and the manufacturer's website were searched from 1993 to November 2010. REVIEW METHODS A systematic review of studies comparing EOS with standard X-ray [film, computed radiography (CR) or digital radiography] in any orthopaedic condition was performed. A narrative synthesis was undertaken. A decision-analytic model was developed to assess the cost-effectiveness of EOS in the relevant indications compared with standard X-ray and incorporated the clinical effectiveness of EOS and the adverse effects of radiation. The model incorporated a lifetime horizon to estimate outcomes in terms of quality-adjusted life-years (QALYs) and costs from the perspective of the NHS. RESULTS Three studies met the inclusion criteria for the review. Two studies compared EOS with film X-ray and one study compared EOS with CR. The three included studies were small and of limited quality. One study used an earlier version of the technology, the Charpak system. Both studies comparing EOS with film X-ray found image quality to be comparable or better with EOS overall. Radiation dose was considerably lower with EOS: ratio of means for posteroanterior spine was 5.2 (13.1 for the study using the Charpak system); ratio of means for the lateral spine was 6.2 (15.1 for the study using the Charpak system). The study comparing EOS with CR found image quality to be comparable or better with EOS. Radiation dose was considerably lower with EOS than CR; ratio of means for the centre of the back was 5.9 and for the proximal lateral point 8.8. The lowest ratio of means was at the nape of the neck, which was 2.9. No other outcomes were assessed in the included studies, such as implications for patient management from the nature and quality of the image. Patient throughput is the major determinant of the cost-effectiveness of EOS. The average cost per procedure of EOS decreases with utilisation. Using estimates of patient throughput at national level from Hospital Episode Statistics data suggests that EOS is not cost-effective for the indications considered. Throughput in the region of 15,100 to 26,500 (corresponding to a workload of 60 to 106 patient appointments per working day) for EOS compared with a throughput of only 7530 for CR (30 patient appointments per working day) is needed to achieve an incremental cost-effectiveness ratio of £30,000 per QALY. EOS can be shown to be cost-effective only when compared with CR if the utilisation for EOS is about double the utilisation of CR. LIMITATIONS The main limitation of the systematic review of the clinical effectiveness of EOS was the limited number and quality of the data available. In particular, there were no studies assessing the potential health benefits arising from the quality and nature of the image, over and above those associated with reduced radiation exposure. Uncertainty in the model inputs was not fully explored owing to a lack of reporting of standard deviations or confidence intervals in the published literature for most of the parameters. As a result, uncertainty in the cost-effectiveness results was not presented. CONCLUSIONS Radiation dose is considerably lower with EOS than standard X-ray, whereas image quality remains comparable or better with EOS. However, the long-term health benefits from reduced radiation exposure with EOS are very small and there was a lack of data on other potential patient health benefits. The implications of any changes in the quality and nature of the EOS image compared with standard X-ray, for patient health outcomes, needs to be assessed. Given the higher cost of an EOS machine, utilisation is the major determinant of cost-effectiveness. Estimates of patient throughput at national level suggest that EOS is not cost-effective. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C McKenna
- Centre for Health Economics, University of York, York, UK
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Patwardhan AR, Kale S, Nemade P, Wade R. Evaluation of nature and extent of injuries during Dahihandi festival. J Postgrad Med 2012; 58:262-4. [DOI: 10.4103/0022-3859.105445] [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: 11/04/2022] Open
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Doan J, Wade R, Brown L, Copeland J. 206 WALKING, WORK ACTIVITY, AND MUSCULOSKELETAL HEALTH EXPERIENCED IN BRIDGE EMPLOYMENT. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70207-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Catovsky D, Richards S, Matutes E, Oscier D, Dyer M, Bezares RF, Pettitt AR, Hamblin T, Milligan DW, Child JA, Hamilton MS, Dearden CE, Smith AG, Bosanquet AG, Davis Z, Brito-Babapulle V, Else M, Wade R, Hillmen P. Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukaemia (the LRF CLL4 Trial): a randomised controlled trial. Lancet 2007; 370:230-239. [PMID: 17658394 DOI: 10.1016/s0140-6736(07)61125-8] [Citation(s) in RCA: 600] [Impact Index Per Article: 35.3] [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: 11/20/2022]
Abstract
BACKGROUND Previous studies of patients with chronic lymphocytic leukaemia reported high response rates to fludarabine combined with cyclophosphamide. We aimed to establish whether this treatment combination provided greater survival benefit than did chlorambucil or fludarabine. METHODS 777 patients with chronic lymphocytic leukaemia requiring treatment were randomly assigned to fludarabine (n=194) or fludarabine plus cyclophosphamide (196) for six courses, or chlorambucil (387) for 12 courses. The primary endpoint was overall survival, with secondary endpoints of response rates, progression-free survival, toxic effects, and quality of life. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number NCT 58585610. FINDINGS There was no significant difference in overall survival between patients given fludarabine plus cyclophosphamide, fludarabine, or chlorambucil. Complete and overall response rates were better with fludarabine plus cyclophosphamide than with fludarabine (complete response rate 38%vs 15%, respectively; overall response rate 94%vs 80%, respectively; p<0.0001 for both comparisons), which were in turn better than with chlorambucil (complete response rate 7%, overall response rate 72%; p=0.006 and 0.04, respectively). Progression-free survival at 5 years was significantly better with fludarabine plus cyclophosphamide (36%) than with fludarabine (10%) or chlorambucil (10%; p<0.00005). Fludarabine plus cyclophosphamide was the best combination for all ages, including patients older than 70 years, and in prognostic groups defined by immunoglobulin heavy chain gene (V(H)) mutation status and cytogenetics, which were tested in 533 and 579 cases, respectively. Patients had more neutropenia and days in hospital with fludarabine plus cyclophosphamide, or fludarabine, than with chlorambucil. There was less haemolytic anaemia with fludarabine plus cyclophosphamide (5%) than with fludarabine (11%) or chlorambucil (12%). Quality of life was better for responders, but preliminary analyses showed no significant difference between treatments. A meta-analysis of these data and those of two published phase III trials showed a consistent benefit for the fludarabine plus cyclophosphamide regimen in terms of progression-free survival. INTERPRETATION Fludarabine plus cyclophosphamide should now become the standard treatment for chronic lymphocytic leukaemia and the basis for new protocols that incorporate monoclonal antibodies.
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Affiliation(s)
- D Catovsky
- Section of Haemato-Oncology, Institute of Cancer Research, Sutton, UK.
| | | | - E Matutes
- Section of Haemato-Oncology, Institute of Cancer Research, Sutton, UK
| | - D Oscier
- Royal Bournemouth Hospital, Bournemouth, UK
| | - Mjs Dyer
- Leicester Royal Infirmary, Leicester, UK
| | | | | | - T Hamblin
- Royal Bournemouth Hospital, Bournemouth, UK
| | | | | | | | - C E Dearden
- Section of Haemato-Oncology, Institute of Cancer Research, Sutton, UK
| | - A G Smith
- Southampton General Hospital, Southampton, UK
| | | | - Z Davis
- Royal Bournemouth Hospital, Bournemouth, UK
| | - V Brito-Babapulle
- Section of Haemato-Oncology, Institute of Cancer Research, Sutton, UK
| | - M Else
- Section of Haemato-Oncology, Institute of Cancer Research, Sutton, UK
| | - R Wade
- Clinical Trial Service Unit, Oxford, UK
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Dale JR, Wade R, Dichristina TJ. A conserved histidine in cytochrome c maturation permease CcmB of Shewanella putrefaciens is required for anaerobic growth below a threshold standard redox potential. J Bacteriol 2007; 189:1036-43. [PMID: 17142390 PMCID: PMC1797334 DOI: 10.1128/jb.01249-06] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 11/19/2006] [Indexed: 11/20/2022] Open
Abstract
Shewanella putrefaciens strain 200 respires a wide range of compounds as terminal electron acceptor. The respiratory versatility of Shewanella is attributed in part to a set of c-type cytochromes with widely varying midpoint redox potentials (E'(0)). A point mutant of S. putrefaciens, originally designated Urr14 and here renamed CCMB1, was found to grow at wild-type rates on electron acceptors with high E'0 [O2, NO3-, Fe(III) citrate, MnO2, and Mn(III) pyrophosphate] yet was severely impaired for growth on electron acceptors with low E'0 [NO2-, U(VI), dimethyl sulfoxide, TMAO (trimethylamine N-oxide), fumarate, gamma-FeOOH, SO3(2-), and S2O3(2-)]. Genetic complementation and nucleotide sequence analyses indicated that the CCMB1 respiratory mutant phenotype was due to mutation of a conserved histidine residue (H108Y) in a protein that displayed high homology to Escherichia coli CcmB, the permease subunit of an ABC transporter involved in cytochrome c maturation. Although CCMB1 retained the ability to grow on electron acceptors with high E'(0), the cytochrome content of CCMB1 was <10% of that of the wild-type strain. Periplasmic extracts of CCMB1 contained slightly greater concentrations of the thiol functional group (-SH) than did the wild-type strain, an indication that the E(h) of the CCMB1 periplasm was abnormally low. A ccmB deletion mutant was unable to respire anaerobically on any electron acceptor, yet retained aerobic respiratory capability. These results suggest that the mutation of a conserved histidine residue (H108) in CCMB1 alters the redox homeostasis of the periplasm during anaerobic growth on electron acceptors with low (but not high) E'0. This is the first report of the effects of Ccm deficiencies on bacterial respiration of electron acceptors whose E'0 nearly span the entire redox continuum.
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Affiliation(s)
- Jason R Dale
- School of Biology, Georgia Institute of Technology, 310 Ferst Drive, Atlanta, GA 30332-0230, USA
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Brundish DE, Wade R. Synthesis of N-[2-3H] acetyl-D-muramyl-L-alanyl-D-iso-glutaminyl-L-alanyl-2-(1′,2′-dipalmitoyl -sn-glycero-3′-phosphoryl) ethylamide of high specific radioactivity. J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580220105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brundish DE, Combe MG, Wade R. Tritiated peptides. Part 141. Catalytic exchange labelling of various synthetic peptides. J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580200712] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brundish DE, Wade R. Tritiated peptides. Part 101. Catalytic exchange labelling of β-corticotrophin- (1-24) -tetracosapeptide. J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580180807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Osborn GD, Beer H, Wade R, Brook D, Stevens G, Evans J, Fielder H, Gower-Thomas K. Two-view mammography at the incident round has improved the rate of screen-detected breast cancer in Wales. Clin Radiol 2006; 61:478-82. [PMID: 16713418 DOI: 10.1016/j.crad.2005.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 07/12/2005] [Revised: 11/18/2005] [Accepted: 11/23/2005] [Indexed: 11/25/2022]
Abstract
AIM To investigate whether pre-invasive and invasive cancer detection rates were improved in Wales after the introduction of two views at incident screens. METHODS The records of women attending follow-up screening for 2 years before and 2 years after the introduction of two-view incident screening were analysed. Cancer detection rates were compared before and after introduction of two view screening. RESULTS At the incident round 98,752 women had one and 95,464 had two views. Five hundred and fifty-five cancers were detected with one view and 744 with two, an increased detection rate from 5.6 to 7.8 cancers per 1000 women screened (p=0.01). Two hundred and thirty-nine small cancers were detected with one view and 323 with two, increasing the detection rate from 2.4 to 3.4 per 1000 women screened (p=0.05). CONCLUSIONS Two-view mammography at incident rounds detects more cancers and more favourable prognosis small cancers than single-view mammograms.
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Lester JF, Hudson E, Flubacher M, Macbeth F, Baker J, Wade R, Morrey D, Hanna L, Brewster A, Linnane SJ. Small Cell Lung Cancer Treated in Southeast Wales. Clin Oncol (R Coll Radiol) 2006; 18:378-82. [PMID: 16817328 DOI: 10.1016/j.clon.2006.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS In small cell lung cancer (SCLC), consolidation thoracic irradiation (CTI) increases 3-year absolute survival by 5.4% in patients with limited disease and a complete response to chemotherapy. Early concurrent thoracic radiotherapy has been shown to improve local control and prolong survival compared with CTI in some trials. The standard management of patients with SCLC in southeast Wales is CTI in individuals with limited disease and a complete response to chemotherapy. A review of patients with SCLC was carried out to establish whether survival locally is comparable with that reported in published studies, and if patients given CTI have survival comparable with that reported in studies where early concurrent thoracic radiotherapy was used. MATERIALS AND METHODS Between January 2000 and December 2002, 303 patients were registered with SCLC in southeast Wales. One hundred and fifteen (47%) patients had limited disease and 60/115 (52%) received CTI. RESULTS Patients with limited disease receiving CTI had a median survival of 17.7 months (95% confidence interval: 15-27.9 months). The 2- and 5-year survivals were 38 and 13%, respectively. CONCLUSIONS These results compare favourably with previously published studies on SCLC. There are no plans to change our current treatment policy for SCLC in southeast Wales.
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Affiliation(s)
- J F Lester
- Department of Oncology, Velindre Hospital, Cardiff, UK.
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Abstract
BACKGROUND Delirium is common in ill medical patients. Several drugs and polypharmacy are recognised risk factors, yet little is known about drug metabolism in people with delirium. OBJECTIVE The aim of this study was to investigate the activities of plasma esterases (drug metabolising enzymes) in delirium. DESIGN This was a prospective study of delirium present at time of hospital admission (community acquired) or developing later (hospital acquired) in patients admitted as a medical emergency and aged 75 years or over. METHODS Following informed consent or assent cognitive screening was completed on all patients on admission and every 48 hours subsequently. Delirium was diagnosed by Confusion Assessment Method and DSM IV criteria. Blood samples were taken on admission and at onset of delirium if this was later. Four plasma esterase assays were performed spectrophotometrically: acetylcholinesterase, aspirin esterase, benzoylcholinesterase, butyrylcholinesterase. RESULTS 283 patients (71% of eligible) were recruited, with mean age 82.4 years and 59% female. 27% had community acquired delirium, 10% developed hospital acquired delirium, 63% never developed delirium. On admission the mean activities of all four esterase assays were statistically significantly lower in delirious than non delirious patients. There were no significant differences on admission in any plasma esterase activity between patients with hospital and community acquired delirium. In-hospital mortality was associated with low plasma esterase activities on admission. CONCLUSION Plasma esterase activities are suppressed during delirium. These data reinforce the need for extreme caution with drugs in this vulnerable population.
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Affiliation(s)
- Susan White
- Department of Geriatric Medicine, Cardiff University, Academic Centre, Llandough Hospital, Penarth CF64 2XX, UK
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Lester J, Flubacher M, Macbeth F, Hanna L, Brewster A, Baker J, Wade R. P-781 Small cell lung cancer (SCLC) treated in South East Wales, UK. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81274-7] [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: 11/29/2022]
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Fogelson N, Wade R, Patton G, Schnorr J. Aspiration of excess follicles in ovulation induction cycles may reduce high order multiple pregnancies. Fertil Steril 2004. [DOI: 10.1016/j.fertnstert.2004.07.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Izumiya N, Wade R, Winitz M, Otey MC, Birnbaum SM, Koegel RJ, Greenstein JP. Studies on Diastereoisomeric α-Amino Acids and Corresponding α-Hydroxy Acids. VIII. Configuration of the Isomeric Octopines. J Am Chem Soc 2002. [DOI: 10.1021/ja01560a039] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wade R, Winitz M, Greenstein JP. Studies on Polycysteine Peptides and Proteins. III. Configurations of the Peptides of L-Cystine Obtained by Oxidation of L-Cysteinyl-L-cysteine. J Am Chem Soc 2002. [DOI: 10.1021/ja01583a034] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wade R, Birnbaum SM, Winitz M, Koegel RJ, Greenstein JP. Preparation and Properties of the Isomeric Forms of α-Amino- and α,[UNK]-Diaminopimelic Acid. J Am Chem Soc 2002. [DOI: 10.1021/ja01560a038] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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