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Ford A, Kovacs-Balint ZA, Wang A, Feczko E, Earl E, Miranda-Domínguez Ó, Li L, Styner M, Fair D, Jones W, Bachevalier J, Sánchez MM. Corrigendum to "Functional maturation in visual pathways predicts attention to the eyes in infant rhesus macaques: Effects of social status" [Dev. Cogn. Neurosci., 60 C (2023): 101213]. Dev Cogn Neurosci 2024:101364. [PMID: 38490845 DOI: 10.1016/j.dcn.2024.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Affiliation(s)
- Aiden Ford
- Neuroscience Program, Emory University, Atlanta, GA, USA; Marcus Autism Center, USA.
| | | | - Arick Wang
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept of Psychology, Emory University, Atlanta, GA, USA
| | - Eric Feczko
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Eric Earl
- Data Science and Sharing Team, National Institute of Mental Health, NIH, DHHS, Bethesda, MD, USA
| | - Óscar Miranda-Domínguez
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Longchuan Li
- Marcus Autism Center, USA; Children's Healthcare of Atlanta, GA, USA; Dept. of Pediatrics, Emory University, Sch. of Med., Atlanta, GA, USA
| | - Martin Styner
- Dept. of Psychiatry, Univ. of North Carolina, Chapel Hill, NC, USA
| | - Damien Fair
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA; Institute of Child Development, University of Minnesota, Minneapolis, MN, USA; Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Warren Jones
- Marcus Autism Center, USA; Children's Healthcare of Atlanta, GA, USA; Dept. of Pediatrics, Emory University, Sch. of Med., Atlanta, GA, USA
| | - Jocelyne Bachevalier
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept of Psychology, Emory University, Atlanta, GA, USA
| | - Mar M Sánchez
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept. Psychiatry & Behavioral Sciences, Emory Univ., Sch. of Med., Atlanta, GA, USA
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Klaiman C, White S, Richardson S, McQueen E, Walum H, Aoki C, Smith C, Minjarez M, Bernier R, Pedapati E, Bishop S, Ence W, Wainer A, Moriuchi J, Tay SW, Deng Y, Jones W, Gillespie S, Klin A. Expert Clinician Certainty in Diagnosing Autism Spectrum Disorder in 16-30-Month-Olds: A Multi-site Trial Secondary Analysis. J Autism Dev Disord 2024; 54:393-408. [PMID: 36396807 PMCID: PMC9672659 DOI: 10.1007/s10803-022-05812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
Differential diagnosis of young children with suspected autism spectrum disorder (ASD) is challenging, and clinician uncertainty about a child's diagnosis may contribute to misdiagnosis and subsequent delays in access to early treatment. The current study was designed to replicate and expand a recent report in this Journal (McDonnell et al. in J Autism Dev Disord 49:1391-1401, https://doi.org/10.1080/15374416.2020.1823850 , 2019), in which only 60% of diagnoses were made with complete certainty by clinicians evaluating 478 toddlers and preschool children referred for possible ASD to specialized clinics. In this study, secondary analyses were performed on diagnostic, demographic and clinical data for 496 16-30-month-old children who were consecutive referrals to a 6-site clinical trial executed by specialized centers with experienced clinicians following best-practice procedures for the diagnosis of ASD. Overall, 70.2% of diagnoses were made with complete certainty. The most important factor associated with clinician uncertainty was mid-level autism-related symptomatology. Mid-level verbal age equivalents were also associated with clinician uncertainty, but measures of symptomatology were stronger predictors. None of the socio-demographic variables, including sex of the child, was significantly associated with clinician certainty. Close to one third of early diagnoses of ASD are made with a degree of uncertainty. The delineation of specific ranges on the ADOS-2 most likely to result in clinician uncertainty identified in this study may provide an opportunity to reduce random subjectivity in diagnostic decision-making via calibration of young-child diagnostic thresholds based on later-age longitudinal diagnostic outcome data, and via standardization of decision-making in regard to clinical scenarios frequently encountered by clinicians.
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Affiliation(s)
- Cheryl Klaiman
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Stormi White
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shana Richardson
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Emma McQueen
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Hasse Walum
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Christa Aoki
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Mendy Minjarez
- Seattle Children's Hospital & Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Raphael Bernier
- Seattle Children's Hospital & Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Ernest Pedapati
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Somer Bishop
- University of California San Francisco, San Francisco, CA, USA
| | - Whitney Ence
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Translational Social Neuroscience, Emory University, 954 Gatewood Road, Atlanta, GA, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Translational Social Neuroscience, Emory University, 954 Gatewood Road, Atlanta, GA, USA.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Ami Klin
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
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Jones W, Klaiman C, Richardson S, Aoki C, Smith C, Minjarez M, Bernier R, Pedapati E, Bishop S, Ence W, Wainer A, Moriuchi J, Tay SW, Klin A. Eye-Tracking-Based Measurement of Social Visual Engagement Compared With Expert Clinical Diagnosis of Autism. JAMA 2023; 330:854-865. [PMID: 37668621 PMCID: PMC10481242 DOI: 10.1001/jama.2023.13295] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
Importance In the US, children with signs of autism often experience more than 1 year of delay before diagnosis and often experience longer delays if they are from racially, ethnically, or economically disadvantaged backgrounds. Most diagnoses are also received without use of standardized diagnostic instruments. To aid in early autism diagnosis, eye-tracking measurement of social visual engagement has shown potential as a performance-based biomarker. Objective To evaluate the performance of eye-tracking measurement of social visual engagement (index test) relative to expert clinical diagnosis in young children referred to specialty autism clinics. Design, Setting, and Participants In this study of 16- to 30-month-old children enrolled at 6 US specialty centers from April 2018 through May 2019, staff blind to clinical diagnoses used automated devices to measure eye-tracking-based social visual engagement. Expert clinical diagnoses were made using best practice standardized protocols by specialists blind to index test results. This study was completed in a 1-day protocol for each participant. Main Outcomes and Measures Primary outcome measures were test sensitivity and specificity relative to expert clinical diagnosis. Secondary outcome measures were test correlations with expert clinical assessments of social disability, verbal ability, and nonverbal cognitive ability. Results Eye-tracking measurement of social visual engagement was successful in 475 (95.2%) of the 499 enrolled children (mean [SD] age, 24.1 [4.4] months; 38 [8.0%] were Asian; 37 [7.8%], Black; 352 [74.1%], White; 44 [9.3%], other; and 68 [14.3%], Hispanic). By expert clinical diagnosis, 221 children (46.5%) had autism and 254 (53.5%) did not. In all children, measurement of social visual engagement had sensitivity of 71.0% (95% CI, 64.7% to 76.6%) and specificity of 80.7% (95% CI, 75.4% to 85.1%). In the subgroup of 335 children whose autism diagnosis was certain, sensitivity was 78.0% (95% CI, 70.7% to 83.9%) and specificity was 85.4% (95% CI, 79.5% to 89.8%). Eye-tracking test results correlated with expert clinical assessments of individual levels of social disability (r = -0.75 [95% CI, -0.79 to -0.71]), verbal ability (r = 0.65 [95% CI, 0.59 to 0.70]), and nonverbal cognitive ability (r = 0.65 [95% CI, 0.59 to 0.70]). Conclusions and Relevance In 16- to 30-month-old children referred to specialty clinics, eye-tracking-based measurement of social visual engagement was predictive of autism diagnoses by clinical experts. Further evaluation of this test's role in early diagnosis and assessment of autism in routine specialty clinic practice is warranted. Trial Registration ClinicalTrials.gov Identifier: NCT03469986.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Christa Aoki
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Mendy Minjarez
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Raphael Bernier
- Seattle Children’s Autism Center and Department of Psychiatry, University of Washington, Seattle
| | - Ernest Pedapati
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disorders, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Jones W, Klaiman C, Richardson S, Lambha M, Reid M, Hamner T, Beacham C, Lewis P, Paredes J, Edwards L, Marrus N, Constantino JN, Shultz S, Klin A. Development and Replication of Objective Measurements of Social Visual Engagement to Aid in Early Diagnosis and Assessment of Autism. JAMA Netw Open 2023; 6:e2330145. [PMID: 37669054 PMCID: PMC10481232 DOI: 10.1001/jamanetworkopen.2023.30145] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/11/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Autism spectrum disorder is a common and early-emerging neurodevelopmental condition. While 80% of parents report having had concerns for their child's development before age 2 years, many children are not diagnosed until ages 4 to 5 years or later. Objective To develop an objective performance-based tool to aid in early diagnosis and assessment of autism in children younger than 3 years. Design, Setting, and Participants In 2 prospective, consecutively enrolled, broad-spectrum, double-blind studies, we developed an objective eye-tracking-based index test for children aged 16 to 30 months, compared its performance with best-practice reference standard diagnosis of autism (discovery study), and then replicated findings in an independent sample (replication study). Discovery and replication studies were conducted in specialty centers for autism diagnosis and treatment. Reference standard diagnoses were made using best-practice standardized protocols by specialists blind to eye-tracking results. Eye-tracking tests were administered by staff blind to clinical results. Children were enrolled from April 27, 2013, until September 26, 2017. Data were analyzed from March 28, 2018, to January 3, 2019. Main Outcomes and Measures Prespecified primary end points were the sensitivity and specificity of the eye-tracking-based index test compared with the reference standard. Prespecified secondary end points measured convergent validity between eye-tracking-based indices and reference standard assessments of social disability, verbal ability, and nonverbal ability. Results Data were collected from 1089 children: 719 children (mean [SD] age, 22.4 [3.6] months) in the discovery study, and 370 children (mean [SD] age, 25.4 [6.0] months) in the replication study. In discovery, 224 (31.2%) were female and 495 (68.8%) male; in replication, 120 (32.4%) were female and 250 (67.6%) male. Based on reference standard expert clinical diagnosis, there were 386 participants (53.7%) with nonautism diagnoses and 333 (46.3%) with autism diagnoses in discovery, and 184 participants (49.7%) with nonautism diagnoses and 186 (50.3%) with autism diagnoses in replication. In the discovery study, the area under the receiver operating characteristic curve was 0.90 (95% CI, 0.88-0.92), sensitivity was 81.9% (95% CI, 77.3%-85.7%), and specificity was 89.9% (95% CI, 86.4%-92.5%). In the replication study, the area under the receiver operating characteristic curve was 0.89 (95% CI, 0.86-0.93), sensitivity was 80.6% (95% CI, 74.1%-85.7%), and specificity was 82.3% (95% CI, 76.1%-87.2%). Eye-tracking test results correlated with expert clinical assessments of children's individual levels of ability, explaining 68.6% (95% CI, 58.3%-78.6%), 63.4% (95% CI, 47.9%-79.2%), and 49.0% (95% CI, 33.8%-65.4%) of variance in reference standard assessments of social disability, verbal ability, and nonverbal cognitive ability, respectively. Conclusions and Relevance In two diagnostic studies of children younger than 3 years, objective eye-tracking-based measurements of social visual engagement quantified diagnostic status as well as individual levels of social disability, verbal ability, and nonverbal ability in autism. These findings suggest that objective measurements of social visual engagement can be used to aid in autism diagnosis and assessment.
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Affiliation(s)
- Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Shana Richardson
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Meena Lambha
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Morganne Reid
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Taralee Hamner
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Chloe Beacham
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Peter Lewis
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jose Paredes
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Edwards
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Natasha Marrus
- Department of Psychiatry, Washington University in St Louis School of Medicine, St Louis, Missouri
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - John N. Constantino
- Intellectual and Developmental Disabilities Research Center, Washington University in St Louis School of Medicine, St Louis, Missouri
- Now with Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
- Now with Division of Behavioral and Mental Health, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia
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Alviar C, Sahoo M, Edwards L, Jones W, Klin A, Lense M. Infant-directed song potentiates infants' selective attention to adults' mouths over the first year of life. Dev Sci 2023; 26:e13359. [PMID: 36527322 PMCID: PMC10276172 DOI: 10.1111/desc.13359] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/03/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
The mechanisms by which infant-directed (ID) speech and song support language development in infancy are poorly understood, with most prior investigations focused on the auditory components of these signals. However, the visual components of ID communication are also of fundamental importance for language learning: over the first year of life, infants' visual attention to caregivers' faces during ID speech switches from a focus on the eyes to a focus on the mouth, which provides synchronous visual cues that support speech and language development. Caregivers' facial displays during ID song are highly effective for sustaining infants' attention. Here we investigate if ID song specifically enhances infants' attention to caregivers' mouths. 299 typically developing infants watched clips of female actors engaging them with ID song and speech longitudinally at six time points from 3 to 12 months of age while eye-tracking data was collected. Infants' mouth-looking significantly increased over the first year of life with a significantly greater increase during ID song versus speech. This difference was early-emerging (evident in the first 6 months of age) and sustained over the first year. Follow-up analyses indicated specific properties inherent to ID song (e.g., slower tempo, reduced rhythmic variability) in part contribute to infants' increased mouth-looking, with effects increasing with age. The exaggerated and expressive facial features that naturally accompany ID song may make it a particularly effective context for modulating infants' visual attention and supporting speech and language development in both typically developing infants and those with or at risk for communication challenges. A video abstract of this article can be viewed at https://youtu.be/SZ8xQW8h93A. RESEARCH HIGHLIGHTS: Infants' visual attention to adults' mouths during infant-directed speech has been found to support speech and language development. Infant-directed (ID) song promotes mouth-looking by infants to a greater extent than does ID speech across the first year of life. Features characteristic of ID song such as slower tempo, increased rhythmicity, increased audiovisual synchrony, and increased positive affect, all increase infants' attention to the mouth. The effects of song on infants' attention to the mouth are more prominent during the second half of the first year of life.
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Affiliation(s)
- Camila Alviar
- Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manash Sahoo
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Edwards
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Miriam Lense
- Department of Otolaryngology - Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- The Curb Center for Art, Enterprise, and Public Policy, Vanderbilt University, Nashville, TN, USA
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Ford A, Kovacs-Balint ZA, Wang A, Feczko E, Earl E, Miranda-Domínguez Ó, Li L, Styner M, Fair D, Jones W, Bachevalier J, Sánchez MM. Functional maturation in visual pathways predicts attention to the eyes in infant rhesus macaques: Effects of social status. Dev Cogn Neurosci 2023; 60:101213. [PMID: 36774827 PMCID: PMC9925610 DOI: 10.1016/j.dcn.2023.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Differences in looking at the eyes of others are one of the earliest behavioral markers for social difficulties in neurodevelopmental disabilities, including autism. However, it is unknown how early visuo-social experiences relate to the maturation of infant brain networks that process visual social stimuli. We investigated functional connectivity (FC) within the ventral visual object pathway as a contributing neural system. Densely sampled, longitudinal eye-tracking and resting state fMRI (rs-fMRI) data were collected from infant rhesus macaques, an important model of human social development, from birth through 6 months of age. Mean trajectories were fit for both datasets and individual trajectories from subjects with both eye-tracking and rs-fMRI data were used to test for brain-behavior relationships. Exploratory findings showed infants with greater increases in FC between left V1 to V3 visual areas have an earlier increase in eye-looking before 2 months. This relationship was moderated by social status such that infants with low social status had a stronger association between left V1 to V3 connectivity and eye-looking than high status infants. Results indicated that maturation of the visual object pathway may provide an important neural substrate supporting adaptive transitions in social visual attention during infancy.
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Affiliation(s)
- Aiden Ford
- Neuroscience Program, Emory University, Atlanta, GA, USA; Marcus Autism Center, USA.
| | | | - Arick Wang
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept of Psychology, Emory University, Atlanta, GA, USA
| | - Eric Feczko
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Eric Earl
- Data Science and Sharing Team, National Institute of Mental Health, NIH, DHHS, Bethesda, MD, USA
| | - Óscar Miranda-Domínguez
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Longchuan Li
- Marcus Autism Center, USA; Children's Healthcare of Atlanta, GA, USA; Dept. of Pediatrics, Emory University, Sch. of Med., Atlanta, GA, USA
| | - Martin Styner
- Dept. of Psychiatry, Univ. of North Carolina, Chapel Hill, NC, USA
| | - Damien Fair
- Dept. of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Masonic Institute of the Developing Brain, University of Minnesota, Minneapolis, MN, USA; Institute of Child Development, University of Minnesota, Minneapolis, MN, USA; Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Warren Jones
- Marcus Autism Center, USA; Children's Healthcare of Atlanta, GA, USA; Dept. of Pediatrics, Emory University, Sch. of Med., Atlanta, GA, USA
| | - Jocelyne Bachevalier
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept of Psychology, Emory University, Atlanta, GA, USA
| | - Mar M Sánchez
- Emory Natl. Primate Res. Ctr., Emory Univ., Atlanta, GA, USA; Dept. Psychiatry & Behavioral Sciences, Emory Univ., Sch. of Med., Atlanta, GA, USA
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Falcinelli M, Al-Hity G, Baron S, Mampay M, Allen MC, Samuels M, Jones W, Cilibrasi C, Flaherty RL, Giamas G, Thaker PH, Flint MS. Propranolol reduces IFN-γ driven PD-L1 immunosuppression and improves anti-tumour immunity in ovarian cancer. Brain Behav Immun 2023; 110:1-12. [PMID: 36796704 DOI: 10.1016/j.bbi.2023.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
The immune system plays an important role in controlling epithelial ovarian cancer (EOC). EOC is considered to be a "cold tumour," a tumour that has not triggered a strong response by the immune system. However, tumour infiltrating lymphocytes (TILs) and the expression of programmed cell death ligand (PD-L1) are used as prognostic indicators in EOC. Immunotherapy such as PD-(L)1 inhibitors have shown limited benefit in EOC. Since the immune system is affected by behavioural stress and the beta-adrenergic signalling pathway, this study aimed to explore the impact of propranolol (PRO), a beta-blocker, on anti-tumour immunity in both in vitro and in vivo EOC models. Noradrenaline (NA), an adrenergic agonist, did not directly regulate PD-L1 expression but PD-L1 was significantly upregulated by IFN-γ in EOC cell lines. IFN-γ also increased PD-L1 on extracellular vesicles (EVs) released by ID8 cells. PRO significantly decreased IFN-γ levels in primary immune cells activated ex vivo and showed increased viability of the CD8+ cell population in an EV-immune cell co-incubation. In addition, PRO reverted PD-L1 upregulation and significantly decreased IL-10 levels in an immune-cancer cell co-culture. Chronic behavioural stress increased metastasis in mice while PRO monotherapy and the combo of PRO and PD-(L)1 inhibitor significantly decreased stress-induced metastasis. The combined therapy also reduced tumour weight compared to the cancer control group and induced anti-tumour T-cell responses with significant CD8 expression in tumour tissues. In conclusion, PRO showed a modulation of the cancer immune response by decreasing IFN-γ production and, in turn, IFN-γ-mediated PD-L1 overexpression. The combined therapy of PRO and PD-(L)1 inhibitor decreased metastasis and improved anti-tumour immunity offering a promising new therapy.
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Affiliation(s)
- M Falcinelli
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK
| | - G Al-Hity
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK
| | - S Baron
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK
| | - M Mampay
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK
| | - M C Allen
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK
| | - M Samuels
- University of Sussex, Department for Biochemistry and Biomedicine, Falmer, Brighton BN1 9QG, UK
| | - W Jones
- University of Sussex, Department for Biochemistry and Biomedicine, Falmer, Brighton BN1 9QG, UK
| | - C Cilibrasi
- University of Sussex, Department for Biochemistry and Biomedicine, Falmer, Brighton BN1 9QG, UK
| | - Renee L Flaherty
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, SW3 6JG London, UK
| | - G Giamas
- University of Sussex, Department for Biochemistry and Biomedicine, Falmer, Brighton BN1 9QG, UK
| | - P H Thaker
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO 63110, United States
| | - M S Flint
- University of Brighton, School of Pharmacy & Biosciences, Brighton BN2 4GJ, UK.
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9
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Blake H, Somerset S, Jones W, Evans C, Cirelli C, Mbang D. Evaluation of opt-in HIV testing in the construction workplace using the socioecological framework. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.473] [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] Open
Abstract
Abstract
Background
Late diagnosis of HIV remains a challenge and the construction workforce has several risk factors for HIV. In the Test@Work programme, we delivered HIV tests embedded within a general health check to construction workers, with high uptake and acceptability. Here, we report the experiences of construction managers and health professionals involved in Test@Work and explore the suitability of construction worksites as a venue for opt-in HIV testing.
Methods
Qualitative interviews (n = 24) were conducted with construction managers who facilitated events (n = 13), and HIV/health check delivery partners (n = 11) at 21 Test@Work events held on construction sites. Interviews explored experiences of events and views towards workplace HIV testing. Event exit questionnaires (n = 107) completed by delivery partners provided qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework (individual, interpersonal, organisational, industry, public health).
Results
Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities.
Conclusions
The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, increase uptake, and reduce HIV stigma. However, there are practical barriers to testing in the construction environment. This has global implications for delivery of HIV testing in construction workplace settings.
Key messages
• Delivering workplace HIV testing as part of a general health check helps to normalise HIV testing and reduce HIV-related stigma.
• Workplace testing is convenient, accessible and reaches populations at risk for HIV, but there are some barriers to implementation of rapid tests on construction sites.
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Affiliation(s)
- H Blake
- School of Health Sciences, University of Nottingham , Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham , Nottingham, UK
| | - S Somerset
- School of Medicine, University of Nottingham , Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham , Nottingham, UK
| | - W Jones
- School of Health Sciences, University of Nottingham , Nottingham, UK
| | - C Evans
- School of Health Sciences, University of Nottingham , Nottingham, UK
| | - C Cirelli
- School of Medicine, University of Nottingham , Nottingham, UK
| | - D Mbang
- School of Medicine, University of Nottingham , Nottingham, UK
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10
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Jones W, Pearson A, Glassbrook D, Slater G, Dodd-Reynolds C, Hind K. Precision of the GE Lunar Total Body-Less Head Scan for the Measurement of Three-Compartment Body Composition in Athletes. J Clin Densitom 2022; 25:692-698. [PMID: 36137876 DOI: 10.1016/j.jocd.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dual energy X-ray absorptiometry (DXA) is widely used for the assessment of lean mass (LM), fat mass (FM) and bone mineral content (BMC). When observing standardised protocols, DXA has a high level of precision for the assessment of total body composition, including the head region. However, including the head region may have limited relevance in athletes and can be problematic when positioning taller athletes who exceed scan boundaries. This study investigated the precision of a new total-body-less-head (TBLH) DXA scan for three-compartment body composition measurement in athletes, with outcomes compared to the standard total-body DXA scan. METHODS Precision errors were calculated from two consecutive scans with re-positioning (Lunar iDXA, GE Healthcare, Madison, WI), in male and female athletes from a range of sports. TBLH precision was determined from repeat scans in 95 athletes (male n = 55; female n = 40; age: 26.0 ± 8.5 y; body mass: 81.2 ± 20.5 kg; stature: 1.77 ± 0.11 m), and standard total-body scan precision was derived from a sub-sample of 58 athletes (male n = 19; female n = 39; age: 27.6 ± 9.9 y; body mass: 69.6 ± 14.8 kg; stature: 1.72 ± 0.94 m). Data from the sub-sample were also used to compare precision error and 3-compartment body composition outcomes between the standard total-body scan and the TBLH scan. RESULTS TBLH precision errors [root mean squared-standard deviation, RMS-SD (coefficient of variation, %CV)] were bone mineral content (BMC): 15.6 g (0.5%), lean mass (LM): 254.3 g (0.4%) and fat mass (FM): 199.4 g (1.3%). These outcomes compared favourably to the precision errors derived from the standard total-body scan [BMC: 12.4 g (0.4%), LM: 202.2 g (0.4%), and FM: 160.8 g (1.1%)]. The TBLH scan resulted in lower BMC (-19.5%), LM (-6.6%), and FM (-4.5%) compared to the total-body scan (BMC: 2,308 vs. 2,865 g; LM: 46,954 vs. 50,276 g; FM: 15,183 vs. 15,888 g, all p<0.005). ConclusionThe TBLH scan demonstrates high in-vivo precision comparable to that of the standard total-body scan in a heterogeneous cohort of athletes. Given the impact of head exclusion on total body composition outcomes, TBLH scans should not be used interchangeably with the standard total-body scan.
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Affiliation(s)
- W Jones
- Department of Sport and Exercise Sciences, Durham University, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom
| | - A Pearson
- Department of Sport and Exercise Sciences, Durham University, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom
| | - D Glassbrook
- Department of Sport and Exercise Sciences, Durham University, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom
| | - G Slater
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - C Dodd-Reynolds
- Department of Sport and Exercise Sciences, Durham University, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom
| | - K Hind
- Department of Sport and Exercise Sciences, Durham University, United Kingdom; Wolfson Research Institute for Health and Wellbeing, Durham University, United Kingdom.
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11
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Rudoler D, Kurdyak P, Gomes T, Huang A, Jones W, Littleford S, Paracha N, Fischer B. Evaluating the population-level effects of oxycodone restrictions on prescription opioid utilization in Ontario. Pharmacoepidemiol Drug Saf 2022; 31:769-778. [PMID: 35470515 DOI: 10.1002/pds.5442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate the impact of restrictions on access to long acting oxycodone on prescription opioid use and opioid-related harms. METHODS Administrative health data from Ontario, Canada was used to measure differences in opioids dispensed and ED visits for opioid-related overdose, poisoning or substance use following provincial restrictions on access to publicly insured OxyContin (February 29, 2012) and OxyNeo (February 28, 2013). This study focused on the cohort of provincial drug insurance eligible people (people 65+ and select low-income populations) who were dispensed oxycodone prior to the restrictions. Difference-in-differences models with a propensity score matched comparison group of people who were dispensed non-oxycodone opioids were used to estimate the main effects. RESULTS In the six months following the delisting of OxyContin, MMEs per person per week for all opioids fell by an average of 7.5% in people dispensed oxycodone relative to the comparison group, and an average of 13.8% in chronic recipients of oxycodone. In the six months following the restrictions on OxyNeo, MMEs per person per week fell by an average of 3.1% in all people dispensed oxycodone, and 25.2% in chronic oxycodone recipients. The decline in oxycodone dispensing amongst chronic oxycodone recipients corresponded with an increase in dispensing of other opioid formulations, particularly hydromorphone and fentanyl. No important differences were observed for ED visits related to opioid poisoning, overdose, or substance use disorder. CONCLUSIONS Province-wide restrictions on access to long acting oxycodone had an impact on quantities of all opioids dispensed to chronic recipients of oxycodone, but small impacts on the full population of people dispensed oxycodone; the decline in use was partially offset by increases in use of other publicly-funded opioid formulations. This study suggests that policies limiting access to specific prescription opioids led to overall reductions in publicly-funded prescription opioid use, particularly in chronic oxycodone recipients, without immediate evidence of changes in opioid-related ED visits. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- D Rudoler
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - P Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - T Gomes
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - A Huang
- ICES, Toronto, Ontario, Canada
| | - W Jones
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada
| | - S Littleford
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - N Paracha
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - B Fischer
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400 515 W. Hastings Street, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario, Canada.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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12
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Thayer N, White S, Islam J, Jones W, Kenzie S, Kullu R. Evaluation of a collaborative pharmacy service initiative for people with intellectual disabilities in residential care homes. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.054] [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
Introduction
People with Intellectual Disabilities (ID) often have complex care needs and increased likelihood of premature death.1 The NHS has committed to improving the use of psychotropic medicines in people with ID with the Stopping the Over-Medication of People with Learning Disabilities (STOMP) programme.2 In the Wirral a cross-sector, collaborative service initiative involving community pharmacists and a specialist mental health pharmacist was developed to provide pharmaceutical care reviews for ID care home residents, which included an evaluation of the initiative.
Aim
This study aimed to determine the number and type of pharmacists’ interventions and GP recommendations in this service initiative.
Methods
Pharmacists provided pharmaceutical care reviews for ID care home residents using a framework and where applicable made interventions or recommendations to residents’ GPs or consultant psychiatrist. The framework was devised by the lead Consultant, Mental Health Trust lead pharmacist and Local Pharmaceutical Committee representatives to align with national ID priorities.1 Pharmacists were recruited via expressions of interest and direct recruitment by the mental health trust. Using anonymised, aggregated, Clinical Commissioning Group data, an Oversight Group divided all ID care homes in the locality into two groups: homes with residents with low psychotropic medicines use were primarily assigned to community pharmacists, whilst those with higher psychotropic use were assigned to the specialist mental health pharmacist. Pharmacists contacted care home managers and arranged reviews with all residents, sharing learnings in weekly reviews. Community pharmacists identified residents who would benefit from specialist mental health pharmacist review and referred them. Data collected included patient demographic details, medication history, results of assessments completed and interventions/recommendations. Following institutional ethical approval, this data was downloaded from PharmOutcomes into Microsoft Excel and personally identifiable data removed. The data underwent descriptive statistical analysis in SPSS, including frequency counting interventions by type.
Results
The pharmacists conducted reviews with 160 residents (76 by community pharmacists and 84 by the specialist mental health pharmacist) from November 2019 – May 2020, reflecting all residents in visited care homes. These residents were prescribed 1207 medicines, 74% were prescribed 5 or more medicines (i.e. polypharmacy) and 507 interventions or recommendations were made, averaging 3.3 per resident. Table 1 shows that the highest proportion (30.4%) of these were public health related, whilst changing and stopping medicines accounted for 17.9% and 12.8% respectively. The majority (63%) of interventions made by community pharmacists were public health related, whilst those made by the mental health specialist pharmacist most frequently concerned changing medicines (25%), stopping medicines (18%), and blood monitoring (13%).
Conclusion
The study findings indicate a high level of polypharmacy among the ID residents and a high number of interventions / recommendations were needed to improve care, in line with national priorities.1,2 The small scale of the study is acknowledged, and further research is warranted. However, the findings suggest that this service model may be an effective use of the respective skill sets of the pharmacists involved and suitable for wider adoption, with community pharmacists focusing on holistic care and specialist mental health making specialist medicines interventions.
References
1. University of Bristol Norah Fry Centre for Learning Disability Studies. The Learning Disability Mortality Review (LeDeR) Programme Annual Report 2018. Available at: https://www.hqip.org.uk/wp-content/uploads/2019/05/LeDeR-Annual-Report-Final-21-May-2019.pdf (last accessed 12/10/20).
2. NHS England. Stopping over medication of people with a learning disability, autism or both (STOMP). https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/ (last accessed 12/10/20).
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Affiliation(s)
- N Thayer
- School of Pharmacy and Bioengineering, Keele University, UK
- Community Pharmacy Cheshire and Wirral, UK
| | - S White
- School of Pharmacy and Bioengineering, Keele University, UK
| | - J Islam
- Cheshire and Wirral NHS Partnership Trust, UK
| | - W Jones
- School of Pharmacy and Bioengineering, Keele University, UK
- Community Pharmacy Cheshire and Wirral, UK
- Boots UK Ltd
| | - S Kenzie
- Cheshire and Wirral NHS Partnership Trust, UK
| | - R Kullu
- Cheshire and Wirral NHS Partnership Trust, UK
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13
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Shedden R, McCulloch A, Laidlaw S, Love S, McLuckie S, Jones W, Taylor J, Pennington R, Tipton C. 112 Outcomes and Clinical Characteristics of COVID-19 Disease in the Frail, Elderly Population of Tayside. Age Ageing 2021. [PMCID: PMC7989604 DOI: 10.1093/ageing/afab030.73] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction With advancing age, frailty, multi-morbidity and need for care, elderly patients are some of the most vulnerable to Covid-19 disease. In NHS Tayside, a dedicated Covid-19 Medicine for the Elderly (MFE) Team was formed to care for patients identified as frail and likely to benefit from comprehensive geriatric assessment. Methods All Covid-19 patients meeting frailty criteria1, cared for by the Covid-19 MFE Team were identified. Data on outcomes and clinical characteristics for all (140) patients admitted during the first pandemic wave (March–July 2020) was collected using electronic patient records and analysed. Results Patients were predominantly male (58.6%). Ages ranged from 65–99 years, with 43.6% aged ≥85 years. 82.1% had one or more of cough, fever and anosmia on admission fitting Covid-19 case definition 2. Lymphopenia was present in 92.1%. Of note, 26.5% of patients had a normal or unchanged chest x-ray report, with only 10.2% showing bilateral peripheral infiltrates. 28-day mortality was 37.1% with Covid-19 Disease listed as primary cause of death in 90.4%. Conclusion(s) Entering further “waves” of infection, it is vital that we understand the clinical presentation and course of Covid-19 disease in elderly patients. Our data highlights that any Covid-19 symptom, even in isolation, should raise suspicion of disease. Chest x-rays should not be used alone as a diagnostic tool. The presence of lymphopenia should raise suspicion of Covid-19 infection. In developing an understanding of how elderly patients with Covid-19 present, we can ensure early identification and initiation of appropriate infection control measures. References 1. Healthcare Improvement Scotland. Think Frailty. 2014. http://www.healthcareimprovementscotland.org/his/idoc.ashx?docid=8abd8530-48f3-4152-bbfb-d0918b870ec9&version=-1 2. Scottish Government. Update to Coronavirus Symptoms 2020. https://www.gov.scot/news/update-to-coronavirus-symptoms
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Affiliation(s)
| | | | | | - S Love
- Ninewells Hospital, Dundee
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14
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Affiliation(s)
| | - W Jones
- Specialist Pharmacist Breastfeeding and Medication, Portsmouth, UK
| | - E Winkley
- Northumbria Healthcare NHS Foundation Trust, UK
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15
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Koirala S, Parmaksiz D, Yuan S, Shultz S, Klin A, Jones W, Edwards LA. Visual attention in the first two years of life differentially predicts language abilities in children with and without autism spectrum disorder. J Vis 2020. [DOI: 10.1167/jov.20.11.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | | | - Ami Klin
- Marcus Autism Center
- Emory University
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16
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Shi Y, Jones W, Beatty W, Tan Q, Mecham RP, Kumra H, Reinhardt DP, Gibson MA, Reilly MA, Rodriguez J, Bassnett S. Latent-transforming growth factor beta-binding protein-2 (LTBP-2) is required for longevity but not for development of zonular fibers. Matrix Biol 2020; 95:15-31. [PMID: 33039488 DOI: 10.1016/j.matbio.2020.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 01/06/2023]
Abstract
Latent-transforming growth factor beta-binding protein 2 (LTBP-2) is a major component of arterial and lung tissue and of the ciliary zonule, the system of extracellular fibers that centers and suspends the lens in the eye. LTBP-2 has been implicated previously in the development of extracellular microfibrils, although its exact role remains unclear. Here, we analyzed the three-dimensional structure of the ciliary zonule in wild type mice and used a knockout model to test the contribution of LTBP-2 to zonule structure and mechanical properties. In wild types, zonular fibers had diameters of 0.5-1.0 micrometers, with an outer layer of fibrillin-1-rich microfibrils and a core of fibrillin-2-rich microfibrils. LTBP-2 was present in both layers. The absence of LTBP-2 did not affect the number of fibers, their diameters, nor their coaxial organization. However, by two months of age, LTBP-2-depleted fibers began to rupture, and by six months, a fully penetrant ectopia lentis phenotype was present, as confirmed by in vivo imaging. To determine whether the seemingly normal fibers of young mice were compromised mechanically, we compared zonule stress/strain relationships of wild type and LTBP-2-deficient mice and developed a quasi-linear viscoelastic engineering model to analyze the resulting data. In the absence of LTBP-2, the ultimate tensile strength of the zonule was reduced by about 50%, and the viscoelastic behavior of the fibers was altered significantly. We developed a harmonic oscillator model to calculate the forces generated during saccadic eye movement. Model simulations suggested that mutant fibers are prone to failure during rapid rotation of the eyeball. Together, these data indicate that LTBP-2 is necessary for the strength and longevity of zonular fibers, but not necessarily for their formation.
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Affiliation(s)
- Y Shi
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave, Box 8096, St. Louis, MO 63110, USA
| | - W Jones
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave, Box 8096, St. Louis, MO 63110, USA
| | - W Beatty
- Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
| | - Q Tan
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave, Box 8096, St. Louis, MO 63110, USA
| | - R P Mecham
- Department of Cell Biology & Physiology, Washington University, St. Louis, MO, USA
| | - H Kumra
- Department of Anatomy & Cell Biology, and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - D P Reinhardt
- Department of Anatomy & Cell Biology, and Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - M A Gibson
- Department of Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - M A Reilly
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Ophthalmology and Visual Science, The Ohio State University, Columbus, OH, USA
| | - J Rodriguez
- Department of Basic Sciences, St. Louis College of Pharmacy, St. Louis, MO, USA
| | - S Bassnett
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave, Box 8096, St. Louis, MO 63110, USA; Department of Cell Biology & Physiology, Washington University, St. Louis, MO, USA.
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17
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Abstract
The national priority to advance early detection and intervention for children with autism spectrum disorder (ASD) has not reduced the late age of ASD diagnosis in the US over several consecutive Centers for Disease Control and Prevention (CDC) surveillance cohorts, with traditionally under-served populations accessing diagnosis later still. In this review, we explore a potential perceptual barrier to this enterprise which views ASD in terms that are contradicted by current science, and which may have its origins in the current definition of the condition and in its historical associations. To address this perceptual barrier, we propose a re-definition of ASD in early brain development terms, with a view to revisit the world of opportunities afforded by current science to optimize children's outcomes despite the risks that they are born with. This view is presented here to counter outdated notions that potentially devastating disability is determined the moment a child is born, and that these burdens are inevitable, with opportunities for improvement being constrained to only alleviation of symptoms or limited improvements in adaptive skills. The impetus for this piece is the concern that such views of complex neurodevelopmental conditions, such as ASD, can become self-fulfilling science and policy, in ways that are diametrically opposed to what we currently know, and are learning every day, of how genetic risk becomes, or not, instantiated as lifetime disabilities.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Megan Micheletti
- Department of Psychology, University of Texas at Austin, Austin, Texas
| | - Cheryl Klaiman
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Shultz
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - John N. Constantino
- Departments of Psychiatry and Pediatrics, Intellectual and Developmental Disabilities Research Center, Washington University School of Medicine, St Louis,MO
| | - Warren Jones
- Marcus Autism Center, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
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18
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El-Jawhari JJ, Ilas DC, Jones W, Cuthbert R, Jones E, Giannoudis PV. Enrichment and preserved functionality of multipotential stromal cells in bone marrow concentrate processed by vertical centrifugation. Eur Cell Mater 2020; 40:58-73. [PMID: 32749666 DOI: 10.22203/ecm.v040a04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/31/2023] Open
Abstract
The concentration of bone marrow (BM) aspirate (BMA) is increasingly valued for bone and cartilage repair, particularly with the rarity and donor-variability of BM-multipotential stromal cells (BM-MSCs). The present study aimed to assess BM-MSC yield following BM concentration using a fast and compact-sized vertical centrifugation system. BMA concentrate (BMAC) was separated in a 1 min process and collected easily after an automatic discarding of plasma and red blood cells. A significant increase in CD45low CD271high cells per BMAC volume (measured using flow-cytometry) was noted (4-fold, p = 0.0001). Additionally, the vertical centrifugation system helped to enrich colony numbers (assessed by CFU-F assays) in BMAC comparably with conventional centrifugation systems, BioCUE™ and SmartPReP-2® (4.3-fold, 4.6-fold and 3-fold, respectively). Next, a functional assessment of BM-MSCs processed by vertical centrifugation was performed, and MSC viability and proliferation were not affected. Also, these BM-MSCs showed similar alkaline phosphatase and calcium levels to those of BMA-MSCs when osteogenically induced. Furthermore, glycosaminoglycans and Nile red levels in addition to the gene expression assays confirmed that there was no significant change in chondrogenic or adipogenic abilities between BMA-MSCs and BMAC-MSCs. The expression levels of selected angiogenic and immunomodulatory mediators were also similar between the two groups. Collectively, the vertical centrifugation system helped to enrich BM-MSCs effectively, while maintaining cell viability and functions. Thus, such a vertical centrifugation system for BM concentration can be valuable for various regenerative therapies.
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Affiliation(s)
| | | | | | | | | | - P V Giannoudis
- Leeds General Infirmary, School of Medicine, University of Leeds, Leeds,
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19
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Mitchell J, Jones W, Winkley E, Kinsella SM. Guideline on anaesthesia and sedation in breastfeeding women 2020. Anaesthesia 2020; 75:1482-1493. [DOI: 10.1111/anae.15179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/23/2022]
Affiliation(s)
- J. Mitchell
- Department of Anaesthesia University Hospital Ayr UK
| | - W. Jones
- Breastfeeding and Medication Portsmouth UK
| | - E. Winkley
- Department of Anaesthesia Northumbria NHS Foundation Trust UK
| | - S. M. Kinsella
- Department of Anaesthesia St Michael’s Hospital Bristol UK
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20
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Bowker M, Jones W. Methanol photo-reforming with water on pure titania for hydrogen production. Philos Trans A Math Phys Eng Sci 2020; 378:20200058. [PMID: 32623989 PMCID: PMC7422889 DOI: 10.1098/rsta.2020.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
The behaviour of titania for the photo-reforming of methanol with water at ambient temperature has been examined. It is shown that the reactivity is very poor, compared with metal-loaded catalysts at low methanol levels in solution, but the rate becomes much higher at high methanol levels, such that the difference from metal-loaded samples is much less. The optimum yield is with approximately a 1 : 1 methanol/water solution. The reaction also proceeds well in the gas phase. During all such catalysis, the titania becomes blue, due to light absorption increasing across the range 400-800 nm. However, this does not result in visible range activity for the photo-reforming and is due to the reduction of the material in the presence of light and the formation of anion vacancies and Ti3+ centres. These anion vacancies are only very slowly re-oxidized in air on P25 titania, taking days to recover the original whiteness of the oxide. The performance of anatase, rutile and the mixed phase is compared. This article is part of a discussion meeting issue 'Science to enable the circular economy'.
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Affiliation(s)
- M. Bowker
- Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, UK
- The UK Catalysis Hub, Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell, Oxon OX11 0FA, UK
| | - W. Jones
- Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, UK
- The UK Catalysis Hub, Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell, Oxon OX11 0FA, UK
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Byrne R, Bird J, Reeve S, Jones W, Shiers D, Morrison A, Pyle M, Peters S. Understanding young peoples' and family members' views of treatment for first episode psychosis in a randomised controlled trial (MAPS). EClinicalMedicine 2020; 24:100417. [PMID: 32775967 PMCID: PMC7393652 DOI: 10.1016/j.eclinm.2020.100417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is limited evidence to inform treatment decision-making in adolescents experiencing first episode psychosis (FEP). In the MAPS trial (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with FEP received either antipsychotic medication (AP), psychological intervention (PI), or both. We investigated treatment views of young people and family members across each treatment arm of MAPS. METHODS Thirteen adolescents participating in MAPS and eighteen family members attended in-depth audio-recorded interviews to discuss trial treatments. Interviews were analysed using inductive Thematic Analysis, identifying salient themes across these accounts. FINDINGS Family members in particular reported an urgent need for treatment regardless of type. Both AP and PI were broadly viewed as acceptable treatment approaches, but for differing reasons which participants weighed against a range of concerns. AP were often seen to reduce symptoms of psychosis, though participants expressed concerns about side effects. PI were viewed as interactive treatment approaches that helped improve understanding of psychosis and enhanced coping, although some found PI emotionally and cognitively challenging. Combining treatments was seen to maximise benefits, with a perceived interaction whereby AP facilitated engagement with PI. INTERPRETATION Acceptability of and engagement with treatments for FEP may differ between individual young people and their family/carers. In order to be able to offer fully informed choices, and determine an optimum treatment approach for young people with FEP, definitive trial evidence should be established to determine wanted and unwanted treatment impacts. FUNDING NIHR HTA programme (project number 15/31/04).
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Affiliation(s)
- R.E. Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - J.C. Bird
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK
| | - S. Reeve
- Department of Clinical, Educational, and Health Psychology, University College London, WC1E 6BT, UK
| | - W. Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - D. Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
| | - A.P. Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - M. Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - S. Peters
- Division of Psychology and Mental Health, University of Manchester, Manchester, M13 9PL, UK
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Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Abstract
Eye-blinking has emerged as a promising means of measuring viewer engagement with visual content. This method capitalizes on the fact that although we remain largely unaware of our eye-blinking in everyday situations, eye-blinks are inhibited at precise moments in time so as to minimize the loss of visual information that occurs during a blink. Probabilistically, the more important the visual information is to the viewer, the more likely he or she will be to inhibit blinking. In the present study, viewer engagement was experimentally manipulated in order to: (1) replicate past studies suggesting that a group of viewers will blink less often when watching content that they perceive as more important or relevant; (2) test the reliability of the measure by investigating constraints on the timescale over which blink rate patterns can be used to accurately quantify viewer engagement; and (3) examine whether blink rate patterns can be used to quantify what an individual - as opposed to a group of viewers-perceives as engaging. Results demonstrate that blink rate patterns can be used to measure changes in individual and group engagement that unfold over relatively short (1 second) and long (60 second) timescales. However, for individuals with lower blink rates, blink rate patterns may provide less optimal measures when engagement shifts rapidly (at intervals of 1 second or less). Findings support the use of eye-blink measures in future studies investigating a person's subjective perception of how engaging a stimulus is.
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Affiliation(s)
- Carolyn Ranti
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia, 30329, USA
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, 30022, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia, 30329, USA
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, 30022, USA
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia, 30022, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia, 30329, USA
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, 30022, USA
- Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia, 30022, USA
| | - Sarah Shultz
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia, 30329, USA.
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, 30022, USA.
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Micheletti M, McCracken C, Constantino J, Mandell D, Jones W, Klin A. Research Review: Outcomes of 24- to 36-month-old children with autism spectrum disorder vary by ascertainment strategy: a systematic review and meta-analysis. J Child Psychol Psychiatry 2020; 61:4-17. [PMID: 31032937 PMCID: PMC6819204 DOI: 10.1111/jcpp.13057] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite widespread recommendations for early surveillance of risk for autism spectrum disorder (ASD), no research to date has shown that early surveillance leads to better clinical outcomes. Preliminary research has suggested that children with ASD ascertained via prospective follow-up have better outcomes than those ascertained via community referral. Because prospective studies include early surveillance, by comparing outcomes of children with ASD across ascertainment strategies, we may gain insight into the effects of early surveillance relative to its absence. METHODS A systematic review was conducted to identify studies reporting outcomes of 24- to 36-month-olds with ASD ascertained via prospective follow-up, community referral, or universal screening. A meta-analysis using a random effects model was used to calculate overall effect size estimates for developmental level and symptom severity across ascertainment cohorts. RESULTS Eleven prospective, ten community referral, and eight universal screening studies were identified, reporting on 1,658 toddlers with ASD. We found no differences in outcomes between community referral and universal screening studies. Relative to both, prospective studies reported significantly higher developmental levels and lower symptom severities. CONCLUSIONS Outcomes of young children with ASD ascertained via prospective follow-up are better than those of children with ASD recruited via community referral or universal screening. Although we discuss why sampling bias is not likely the driving force behind these findings, we cannot rule out the possibility that sampling bias contributes to the observed differences; future studies should probe the effects of sociodemographic variables on clinical outcomes as a function of ascertainment strategy. This limitation notwithstanding, our results raise the possibility that prospective follow-up may confer a 'surveillance effect' that contributes to improved developmental and diagnostic outcomes in children with ASD. Future research should test this hypothesis and determine the specific mechanism by which surveillance may improve outcomes.
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Affiliation(s)
- Megan Micheletti
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Courtney McCracken
- Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - John Constantino
- Departments of Psychiatry and Pediatrics, and Intellectual and Developmental Disabilities Research Center, Washington University, St Louis, MO
| | - David Mandell
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Jones
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,Emory Center for Translational Social Neuroscience, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Atlanta, GA,Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,Emory Center for Translational Social Neuroscience, Atlanta, GA, USA
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Mozola MA, Peng X, Wendorf M, Alles S, Artiga L, Buchholz T, Camacho A, Charveron N, Clayborn J, Decker C, Deibel C, Donohue T, Draughon A, Ewings J, Feldworth M, Gane P, Goodwin J, Gunter T, Gutierrez M, Hovland R, Jechorek R, Jones W, Keskinen L, Lamproe B, Larson E, Manwarren H, Merkling A, Osing C, Pangloli P, Remes A, Richter E, Rogers A, Rose B, Ryser E, Secraw S, Slupik M, Wessinger A, Westmoreland R, Yan Z, Zahoor T, Zhang L. Evaluation of the GeneQuence® DNA Hybridization Method in Conjunction with 24-Hour Enrichment Protocols for Detection of Salmonella spp. in Select Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/90.3.738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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
A multilaboratory study was conducted to compare performance of the GeneQuence® DNA hybridization (DNAH) method incorporating new 24 h enrichment protocols and reference culture procedures for detection of Salmonella spp. in select foods. Six food types (raw ground turkey, raw ground beef, dried whole egg, milk chocolate, walnuts, and dry pet food) were tested by the DNAH method and by the culture methods of either the U.S. Department of Agriculture-Food Safety and Inspection Service (USDA-FSIS) or the U.S. Food and Drug Administration's Bacteriological Analytical Manual (FDA/BAM). Fifteen laboratories participated in the study. Four of the foods tested (raw ground turkey, dried whole egg, milk chocolate, and dry pet food), showed no statistically significant differences in performance between the DNAH method and the reference procedure as determined by Chi square analysis. Sensitivity rates for the DNAH method ranged from 92 to 100. The DNAH method, with the specific enrichment protocol evaluated, was found to be ineffective for detection of Salmonella spp. in walnuts. For raw ground beef, results from one trial showed a statistically significant difference in performance, with more positives obtained by the reference method. However, evidence suggests that the difference in the number of positives was likely due to lack of homogeneity of the test samples rather than to DNAH method performance.
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Affiliation(s)
| | - Xuan Peng
- Neogen Corp., 620 Lesher Pl, Lansing, MI 48912
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27
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Keitel WA, Potter GE, Diemert D, Bethony J, El Sahly HM, Kennedy JK, Patel SM, Plieskatt JL, Jones W, Deye G, Bottazzi ME, Hotez PJ, Atmar RL. A phase 1 study of the safety, reactogenicity, and immunogenicity of a Schistosoma mansoni vaccine with or without glucopyranosyl lipid A aqueous formulation (GLA-AF) in healthy adults from a non-endemic area. Vaccine 2019; 37:6500-6509. [PMID: 31515141 DOI: 10.1016/j.vaccine.2019.08.075] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Schistosomiasis caused by Schistosoma mansoni (Sm) is a chronic, debilitating and potentially deadly neglected tropical disease. The licensure of a vaccine to prevent schistosomiasis would represent a major breakthrough in public health. METHODS The safety and immunogenicity of a candidate Sm vaccine were assessed in this phase I, double-blind, dose-escalation trial. Seventy-two healthy Sm-naïve 18-50 year olds were randomized to receive 3 doses ∼ 8 weeks apart of saline placebo, or 10 µg, 30 µg, or 100 µg of recombinant Sm-Tetraspanin-2 vaccine formulated on aluminum hydroxide adjuvant (Sm-TSP-2/Al) with or without 5 µg of glucopyranosyl lipid A aqueous formulation (GLA-AF). Clinical and serologic responses were assessed for 1 year after dose 3. RESULTS Vaccines were safe and well-tolerated. The most common reactions were injection site tenderness and pain, and headache and fatigue. Tenderness and pain were more frequent in groups receiving vaccine with GLA-AF than placebo (p = 0.0036 and p = 0.0014, respectively). Injection site reactions among those given Sm-TSP-2/Al with GLA-AF lasted 1.22 and 1.33 days longer than those receiving Sm-TSP-2/Al without GLA-AF or placebo (p < 0.001 for both). Dose- and adjuvant-related increases in serum IgG against Sm-TSP-2 were observed. Peak IgG levels occurred 14 days after dose 3. Seroresponse frequencies were low among recipients of Sm-TSP-2/Al without GLA-AF, but higher among subjects receiving 30 µg or 100 µg of Sm-TSP-2/Al with GLA-AF. More seroresponses were observed among those given 30 µg or 100 µg of Sm-TSP-2/Al with GLA-AF compared to placebo (p = 0.023 and p < 0.001, respectively). Seroresponse frequencies were 0%, 30%, 50%, and 89%, respectively, among those given placebo, or 10 µg, 30 µg or 100 µg of Sm-TSP-2/Al with GLA-AF, suggesting a dose-response relationship for Sm-TSP-2/Al with GLA-AF (p = 0.0001). CONCLUSIONS Sm-TSP-2/Al with or without GLA-AF was safe and well tolerated in a Sm-naïve population. A vaccine like the one under development may represent our best hope to eliminating this neglected tropical disease.
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Affiliation(s)
- W A Keitel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States.
| | | | - D Diemert
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, DC, United States
| | - J Bethony
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, DC, United States
| | - H M El Sahly
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - S M Patel
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
| | - J L Plieskatt
- Department of Microbiology, Immunology and Tropical Medicine, The George Washington University, Washington, DC, United States
| | - W Jones
- Division of Microbiology and Infectious Diseases (DMID), National Institutes of Allergy and Infectious. Diseases (NIAID), National Institutes of Health (NIH), United States
| | - G Deye
- Division of Microbiology and Infectious Diseases (DMID), National Institutes of Allergy and Infectious. Diseases (NIAID), National Institutes of Health (NIH), United States
| | - M E Bottazzi
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States; Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - P J Hotez
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States; Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - R L Atmar
- Departments of Molecular Virology & Microbiology and Medicine, Baylor College of Medicine, Houston, TX, United States
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Abstract
Although a large body of research has identified discrete neuroanatomical regions involved in social cognition and behavior (the "social brain"), the existing findings are based largely on studies of specific brain structures defined within the context of particular tasks or for specific types of social behavior. The objective of the current work was to view these regions as nodes of a larger collective network and to quantitatively characterize both the topology of that network and the relative criticality of its many nodes. Large-scale data mining was performed to generate seed regions of the social brain. High-quality diffusion MRI data of typical adults were used to map anatomical networks of the social brain. Network topology and nodal centrality were analyzed using graph theory. The structural social brain network demonstrates a high degree of global functional integration with strong local segregation. Bilateral dorsomedial prefrontal cortices and amygdala play the most central roles in the network. Strong probabilistic evidence supports modular divisions of the social brain into subnetworks bearing good resemblance to functionally classified clusters. The present network-driven approach quantifies the structural topology of the social brain as a whole. This work can serve as a critical benchmark against which to compare (1) developmental change in social brain topology over time (from infancy through adolescence and beyond) and (2) atypical network topologies that may be a sign or symptom of disorder (as in conditions such as autism, Williams syndrome, schizophrenia, and others).
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Affiliation(s)
- Longchuan Li
- 1 Marcus Autism Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,2 Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .,3 Center for Translational Social Neuroscience, Emory University , Atlanta, Georgia
| | - Jocelyne Bachevalier
- 4 Department of Psychology, Yerkes National Primate Research Center, Emory University , Atlanta, Georgia
| | - Xiaoping Hu
- 5 Department of Bioengineering, University of California Riverside , California
| | - Ami Klin
- 1 Marcus Autism Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,2 Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .,3 Center for Translational Social Neuroscience, Emory University , Atlanta, Georgia
| | - Todd M Preuss
- 3 Center for Translational Social Neuroscience, Emory University , Atlanta, Georgia .,4 Department of Psychology, Yerkes National Primate Research Center, Emory University , Atlanta, Georgia .,6 Department of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center , Atlanta, Georgia
| | - Sarah Shultz
- 1 Marcus Autism Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,2 Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia
| | - Warren Jones
- 1 Marcus Autism Center , Children's Healthcare of Atlanta, Atlanta, Georgia .,2 Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia .,3 Center for Translational Social Neuroscience, Emory University , Atlanta, Georgia
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, 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Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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Gunalda J, Hosmer K, Hartman N, Smith L, Chapman B, Jones W, Irick M, Pariyadath M. Satisfaction Academy: A Novel Residency Curriculum to Improve the Patient Experience in the Emergency Department. MedEdPORTAL 2018; 14:10737. [PMID: 30800937 PMCID: PMC6342346 DOI: 10.15766/mep_2374-8265.10737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/13/2018] [Indexed: 11/18/2022]
Abstract
Introduction Patient satisfaction is a key indicator of health care value and an increasingly important metric used to assess emergency physician performance and often reimbursement. To our knowledge, there is no standardized curriculum within emergency medicine (EM) residency programs that focuses on the patient experience in EM. Methods Our novel resident curriculum is an organized approach to enhancing patient-centered care by optimizing the patient experience. It spans the academic year, with key topics organized into a quarterly time line. Topics include physician courtesy and respect, pain management, discussion of diagnostic and therapeutic interventions, timely communication, and delivery of quality care. Each quarter has three components: introduction/didactics, an interactive workshop, and stories and reflection. The instructional methods used include didactic lectures, role-playing, and group reflection and storytelling. Results Of 44 participants, 54.5% completed a preintervention survey, and 45.5% completed a postintervention survey. The surveys consisted of 5-point Likert scales measuring degree of agreement with statements that reflected desired behaviors and/or attitudes. On the postintervention survey, participants gave scores indicating general agreement with desired behaviors including sitting at the bedside, acknowledging all persons in the room, and giving an anticipated disposition, as well as with feeling more knowledgeable about patient satisfaction. Discussion Our Satisfaction Academy has filled a significant gap related to enhancing the patient experience. This curriculum is generalizable to other EM residency programs, and the interactive peer-to-peer format is both engaging and customizable.
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Affiliation(s)
- Jonah Gunalda
- Assistant Professor, Department of Emergency Medicine, University of Mississippi School of Medicine
| | - Kathleen Hosmer
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Nicholas Hartman
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Lane Smith
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Bradley Chapman
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Warren Jones
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Michael Irick
- Resident, Department of Emergency Medicine, Wake Forest Baptist Medical Center
| | - Manoj Pariyadath
- Assistant Professor, Department of Emergency Medicine, Wake Forest Baptist Medical Center
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Latimer G, Marcum WR, Howard TK, Jones W, Phillips AM, Woolstenhulme N, Liu S, Weiss A, Campbell J, Moussaoui M, Jensen C. On the flow induced vibration of an externally excited nuclear reactor experiment. Nuclear Engineering and Design 2018. [DOI: 10.1016/j.nucengdes.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shultz S, Klin A, Jones W. Neonatal Transitions in Social Behavior and Their Implications for Autism. Trends Cogn Sci 2018; 22:452-469. [PMID: 29609895 PMCID: PMC6554740 DOI: 10.1016/j.tics.2018.02.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 01/18/2023]
Abstract
Within the context of early infant-caregiver interaction, we review a series of pivotal transitions that occur within the first 6 months of typical infancy, with emphasis on behavior and brain mechanisms involved in preferential orientation towards, and interaction with, other people. Our goal in reviewing these transitions is to better understand how they may lay a necessary and/or sufficient groundwork for subsequent phases of development, and also to understand how the breakdown thereof, when development is atypical and those transitions become derailed, may instead yield disability. We review these developmental processes in light of recent studies documenting disruptions to early-emerging brain and behavior mechanisms in infants later diagnosed with autism spectrum disorder, shedding light on the brain-behavior pathogenesis of autism.
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Affiliation(s)
- Sarah Shultz
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA 30329, USA; Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30022, USA.
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA 30329, USA; Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30022, USA; Center for Translational Social Neuroscience, Emory University, Atlanta, GA 30022, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA 30329, USA; Division of Autism and Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30022, USA; Center for Translational Social Neuroscience, Emory University, Atlanta, GA 30022, USA.
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Klin A, Jones W. An agenda for 21st century neurodevelopmental medicine: lessons from autism. Rev Neurol 2018; 66:S3-S15. [PMID: 29516447 PMCID: PMC6606044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
The future of neurodevelopmental medicine has the potential of situating child neurology at the forefront of a broad-based public health effort to optimize neurodevelopmental outcomes of children born with high-prevalence and diverse genetic, pre- and peri-natal, and environmental burdens compromising early brain development and leading to lifetime disabilities. Building on advancements in developmental social neuroscience and in implementation science, this shift is already occurring in the case of emblematic neurodevelopmental disorders such as autism. Capitalizing on early neuroplasticity and on quantification of trajectories of social-communicative development, new technologies are emerging for high-throughput and cost-effective diagnosis and for community-viable delivery of powerful treatments, in seamless integration across previously fragmented systems of healthcare delivery. These solutions could be deployed in the case of other groups of children at greater risk for autism and communication delays, such as those born extremely premature or with congenital heart disease. The galvanizing concept in this aspirational future is a public health focus on promoting optimal conditions for early brain development, not unlike current campaigns promoting pre-natal care, nutrition or vaccination.
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Affiliation(s)
- A Klin
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
| | - W Jones
- Children's Healthcare of Atlanta and Emory University School of Medicine. Atlanta, Georgia, EE.UU
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Sifre R, Olson L, Gillespie S, Klin A, Jones W, Shultz S. A Longitudinal Investigation of Preferential Attention to Biological Motion in 2- to 24-Month-Old Infants. Sci Rep 2018; 8:2527. [PMID: 29410484 PMCID: PMC5802706 DOI: 10.1038/s41598-018-20808-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/23/2018] [Indexed: 01/07/2023] Open
Abstract
Preferential attention to biological motion is an early-emerging mechanism of adaptive action that plays a critical role in social development. The present study provides a comprehensive longitudinal mapping of developmental change in preferential attention to biological motion in 116 infants at 7 longitudinal time points. Tested repeatedly from 2 until 24 months of age, results reveal that preferential attention to biological motion changes considerably during the first months of life. Previously reported preferences in both neonates and older infants are absent in the second month but do reemerge by month 3 and become increasingly pronounced during the subsequent two years. These results highlight the second month of life as a potentially critical transition period in social visual engagement.
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Affiliation(s)
- Robin Sifre
- Institute of Child Development, University of Minnesota Twin Cities, Minneapolis, USA
| | - Lindsay Olson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Translational Social Neuroscience, Emory University, Atlanta, GA, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Translational Social Neuroscience, Emory University, Atlanta, GA, USA
| | - Sarah Shultz
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Constantino JN, Kennon-McGill S, Weichselbaum C, Marrus N, Haider A, Glowinski AL, Gillespie S, Klaiman C, Klin A, Jones W. Infant viewing of social scenes is under genetic control and is atypical in autism. Nature 2017; 547:340-344. [PMID: 28700580 PMCID: PMC5842695 DOI: 10.1038/nature22999] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/25/2017] [Indexed: 01/19/2023]
Abstract
Long before infants reach, crawl, or walk, they explore the world by looking: they look to learn and to engage1, giving preferential attention to social stimuli including faces2, face-like stimuli3, and biological motion4. This capacity—social visual engagement—shapes typical infant development from birth5 and is pathognomonically impaired in children affected by autism6. Here we show that variation in viewing of social scenes—including levels of preferential attention and the timing, direction, and targeting of individual eye movements—is strongly influenced by genetic factors, with effects directly traceable to the active seeking of social information7. In a series of eye-tracking experiments conducted with 338 toddlers—including 166 epidemiologically-ascertained twins, 88 non-twins with autism, and 84 singleton controls—we find high monozygotic twin-twin concordance (0.91) and relatively low dizygotic concordance (0.35). Moreover, the measures that are most highly heritable, preferential attention to eye and mouth regions of the face, are also those that are differentially diminished in children with autism (Χ2=64.03, P<0.0001). These results—which implicate social visual engagement as a neurodevelopmental endophenotype—not only for autism, but for population-wide variation in social-information-seeking8—reveal a means of human biological niche construction, with phenotypic differences emerging from the interaction of individual genotypes with early life experience7.
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Affiliation(s)
- John N Constantino
- Department of Psychiatry, Washington University, St Louis, Missouri 63110, USA.,Department of Pediatrics, Washington University, St Louis, Missouri 63110, USA.,Intellectual and Developmental Disabilities Research Center, Washington University, St Louis, Missouri 63110, USA
| | | | - Claire Weichselbaum
- Department of Psychiatry, Washington University, St Louis, Missouri 63110, USA
| | - Natasha Marrus
- Department of Psychiatry, Washington University, St Louis, Missouri 63110, USA.,Intellectual and Developmental Disabilities Research Center, Washington University, St Louis, Missouri 63110, USA
| | - Alyzeh Haider
- Department of Psychiatry, Washington University, St Louis, Missouri 63110, USA
| | - Anne L Glowinski
- Department of Psychiatry, Washington University, St Louis, Missouri 63110, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, Georgia 30307, USA
| | - Cheryl Klaiman
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA.,Division of Autism &Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30329, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA.,Division of Autism &Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30329, USA.,Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30329, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA.,Division of Autism &Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30329, USA.,Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30329, USA
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Schlögl R, Jones W. The influence of the preparation method on the stability of graphite intercalation compounds with antimony chloride in air. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/jcp/1984810877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Sun Y, Jones W, Varikatt W, Chin R. Malignant glomus tumour – a case report and review of the literature. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.005] [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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Bahruji H, Bowker M, Jones W, Hayward J, Ruiz Esquius J, Morgan DJ, Hutchings GJ. PdZn catalysts for CO2 hydrogenation to methanol using chemical vapour impregnation (CVI). Faraday Discuss 2017; 197:309-324. [DOI: 10.1039/c6fd00189k] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The formation of PdZn bimetallic alloys on ZnO, TiO2 and Al2O3 supports was investigated, together with the effect of alloy formation on the CO2 hydrogenation reaction. The chemical vapour impregnation (CVI) method produced PdZn nanoparticles with diameters of 3–6 nm. X-ray photoelectron spectroscopy and X-ray diffraction revealed the changes in the structure of the PdZn alloy that help stabilise formate intermediates during methanol synthesis. PdZn supported on TiO2 exhibits high methanol productivity of 1730 mmol kgcat−1 h−1 that is associated with the high dispersion of the supported PdZn alloy.
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Affiliation(s)
- H. Bahruji
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - M. Bowker
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - W. Jones
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - J. Hayward
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - J. Ruiz Esquius
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - D. J. Morgan
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
| | - G. J. Hutchings
- Cardiff Catalysis Institute
- School of Chemistry
- Cardiff University
- CF10 3AT Cardiff
- UK
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Abstract
OBJECTIVE Two hypotheses, gaze aversion and gaze indifference, are commonly cited to explain a diagnostic hallmark of autism: reduced attention to others' eyes. The two posit different areas of atypical brain function, different pathogenic models of disability, and different possible treatments. Evidence for and against each hypothesis is mixed but has thus far focused on older children and adults. The authors evaluated both mechanistic hypotheses in two sets of experiments at the time of initial diagnosis. METHOD Eye-tracking data were collected in 86 2-year-olds: 26 with autism, tested at initial diagnosis; 38 matched typically developing children; and 22 matched developmentally delayed children. In two experiments, the authors measured response to direct and implicit cueing to look at the eyes. RESULTS When directly cued to look at the eyes, 2-year-olds with autism did not look away faster than did typically developing children; their latency varied neither categorically nor dimensionally by degree of eye cueing. Moreover, direct cueing had a stronger sustained effect on their amount of eye-looking than on that of typically developing children. When presented with implicit social cues for eye-looking, 2-year-olds with autism neither shifted their gaze away nor more subtly averted their gaze to peripheral locations. CONCLUSIONS The results falsify the gaze aversion hypothesis; instead, at the time of initial diagnosis, diminished eye-looking in autism is consistent with passive insensitivity to the social signals in others' eyes.
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Affiliation(s)
- Jennifer M. Moriuchi
- Psychology Department, Emory University, Atlanta, Georgia 30022, USA,Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA
| | - Ami Klin
- Psychology Department, Emory University, Atlanta, Georgia 30022, USA,Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA,Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30022, USA,Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30022, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, Georgia 30329, USA,Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30022, USA,Center for Translational Social Neuroscience, Emory University, Atlanta, Georgia 30022, USA
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41
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French JI, McGregor JA, Jones W, Draper D, Parker R, McFee J. Bacterial vaginosis and increased vaginal fluid phospholipase A2: defining women at risk for preterm birth. Int J STD AIDS 2016. [DOI: 10.1258/0956462971919390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J I French
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
| | - J A McGregor
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
| | - W Jones
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
| | - D Draper
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
| | - R Parker
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
| | - J McFee
- Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box B198, Denver, CO 80262, USA
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42
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Allam O, Gray WA, Jones W, Bater A, Morrey D. Designing an information interface to support sharing of information in cancer care. Health Informatics J 2016. [DOI: 10.1177/146045820200800305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the design, implementation and testing of a functional prototype interface which enables primary healthcare teams to access the information system supporting clinical oncology specialists in South Wales, UK. A lack of information sharing has been recognized for some time as a barrier to improving the primary care of cancer patients. This extension to the existing ISCO information system will allow sharing of information about patient management at all levels of cancer patient support (general practitioners, hospital-based clinicians and palliative care teams). The application was designed to allow general practitioners to gain access to the existing system. This will give all healthcare professionals interested in a cancer patient's care the advantage of accessing detailed multiple providers' electronic casenotes in almost real time, thus improving communication of information within a care team. However, no attempt was made to include the much bigger issue of patients and their families or carers in the scope of the project at this stage, as this is an area requiring separate investigation. The pilot also enables general practitioners to determine the information they require and the information they need to be able to communicate with the cancer specialists.
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Affiliation(s)
- O. Allam
- Computer Science Department, Cardiff University, Queen's Buildings Newport Road, PO Box 916, Cardiff CF24 3XF, UK,
| | - W. A. Gray
- Computer Science Department, Cardiff University, Queen's Buildings Newport Road, PO Box 916, Cardiff CF24 3XF, UK,
| | - W. Jones
- Velindre NHS Trust, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK,
| | - A. Bater
- Velindre NHS Trust, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK,
| | - D. Morrey
- Velindre NHS Trust, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK,
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43
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Caravaca A, Jones W, Hardacre C, Bowker M. H 2 production by the photocatalytic reforming of cellulose and raw biomass using Ni, Pd, Pt and Au on titania. Proc Math Phys Eng Sci 2016; 472:20160054. [PMID: 27493561 PMCID: PMC4971237 DOI: 10.1098/rspa.2016.0054] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Here, we report a method for sustainable hydrogen production using sunlight and biomass. It is shown that cellulose can be photoreformed to produce hydrogen, even in solid form, by use of metal-loaded titania photocatalysts. The experiments performed verified that the process is enabled by initial hydrolysis via glucose, which itself is shown to be efficiently converted to produce hydrogen by photocatalysis. Importantly, it is shown that not only precious metals such as Pt, Pd and Au can be used as the metal component, but also much more economic and less environmentally damaging Ni is effective. Even more importantly, we show for the first time, to the best our knowledge, that fescue grass as raw biomass can be effective for hydrogen production without significant pre-treatment. This provides additional benefits for the efficiency of biomass hydrogen production, because fewer processing steps for the raw material are required than in the production of purer forms of cellulose, for example.
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Affiliation(s)
- A Caravaca
- School of Chemistry and Chemical Engineering, Queen's University Belfast, Belfast BT9 5AG, UK; UK Catalysis Hub, Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell, Oxford OX11 0FA, UK
| | - W Jones
- UK Catalysis Hub, Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell, Oxford OX11 0FA, UK; Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, UK
| | - C Hardacre
- School of Chemistry and Chemical Engineering, Queen's University Belfast , Belfast BT9 5AG, UK
| | - M Bowker
- UK Catalysis Hub, Research Complex at Harwell, Rutherford Appleton Laboratory, Harwell, Oxford OX11 0FA, UK; Cardiff Catalysis Institute, School of Chemistry, Cardiff University, Cardiff CF10 3AT, UK
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44
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Doedens J, Jones W, Hill K, Mason M, Linsley P, Mease P, Dall'Era M, Aranow C, Martin R, Cohen S, Fleischmann R, Kivitz A, Burge D, Chaussabel D, Elkon K, Posada J, Gabel C. OP0186 Immune Complex Bound U1 and Y1 RNA Correlates with Interferon-Stimulated Gene Expression and Disease Activity: An Observational Study of Sysytemic Lupus Erythematosus Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2747] [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]
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45
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Licon A, Ford J, Defoor D, Crownover R, Li Y, Ha C, Eng T, Jones W, Papanikolaou N, Stathakis S, Mavroidis P. SU-F-T-411: A Quantitative Parameter for Treatment Plan Quality. Med Phys 2016. [DOI: 10.1118/1.4956596] [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: 11/07/2022] Open
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46
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Burger-Caplan R, Saulnier C, Jones W, Klin A. Predicting social and communicative ability in school-age children with autism spectrum disorder: A pilot study of the Social Attribution Task, Multiple Choice. Autism 2016; 20:952-962. [PMID: 27121244 DOI: 10.1177/1362361315617589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Social Attribution Task, Multiple Choice is introduced as a measure of implicit social cognitive ability in children, addressing a key challenge in quantification of social cognitive function in autism spectrum disorder, whereby individuals can often be successful in explicit social scenarios, despite marked social adaptive deficits. The 19-question Social Attribution Task, Multiple Choice, which presents ambiguous stimuli meant to elicit social attribution, was administered to children with autism spectrum disorder (N = 23) and to age-matched and verbal IQ-matched typically developing children (N = 57). The Social Attribution Task, Multiple Choice performance differed between autism spectrum disorder and typically developing groups, with typically developing children performing significantly better than children with autism spectrum disorder. The Social Attribution Task, Multiple Choice scores were positively correlated with age (r = 0.474) while being independent from verbal IQ (r = 0.236). The Social Attribution Task, Multiple Choice was strongly correlated with Vineland Adaptive Behavior Scales Communication (r = 0.464) and Socialization (r = 0.482) scores, but not with Daily Living Skills scores (r = 0.116), suggesting that the implicit social cognitive ability underlying performance on the Social Attribution Task, Multiple Choice is associated with real-life social adaptive function.
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Affiliation(s)
- Rebecca Burger-Caplan
- Department of Psychology, Emory University, USA Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, USA
| | - Celine Saulnier
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta and Emory University School of Medicine, USA
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Marrus N, Glowinski AL, Jacob T, Klin A, Jones W, Drain CE, Holzhauer KE, Hariprasad V, Fitzgerald RT, Mortenson EL, Sant SM, Cole L, Siegel SA, Zhang Y, Agrawal A, Heath A, Constantino JN. Rapid video-referenced ratings of reciprocal social behavior in toddlers: a twin study. J Child Psychol Psychiatry 2015; 56:1338-46. [PMID: 25677414 PMCID: PMC4775094 DOI: 10.1111/jcpp.12391] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Accepted: 12/18/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reciprocal social behavior (RSB) is a developmental prerequisite for social competency, and deficits in RSB constitute a core feature of autism spectrum disorder (ASD). Although clinical screeners categorically ascertain risk of ASD in early childhood, rapid methods for quantitative measurement of RSB in toddlers are not yet established. Such measurements are critical for tracking developmental trajectories and incremental responses to intervention. METHODS We developed and validated a 20-min video-referenced rating scale, the video-referenced rating of reciprocal social behavior (vrRSB), for untrained caregivers to provide standardized ratings of quantitative variation in RSB. Parents of 252 toddler twins [Monozygotic (MZ) = 31 pairs, Dizygotic (DZ) = 95 pairs] ascertained through birth records, rated their twins' RSB at two time points, on average 6 months apart, and completed two developmental measures, the Modified Checklist for Autism in Toddlers (M-CHAT) and the MacArthur Communicative Development Inventory Short Form (MCDI-s). RESULTS Scores on the vrRSB were fully continuously distributed, with excellent 6-month test-retest reliability ([intraclass correlation coefficient] ICC = 0.704, p < .000). MZ twins displayed markedly greater trait concordance than DZ twins, (MZ ICC = 0.863, p < .000, DZ ICC = 0.231, p < .012). VrRSB score distributions were highly distinct for children passing versus failing the M-CHAT (t = -8.588, df = 31, p < .000), incrementally improved from 18-24 months, and were inversely correlated with receptive and expressive vocabulary on the MCDI-s. CONCLUSIONS Like quantitative autistic trait ratings in school-aged children and adults, toddler scores on the vrRSB are continuously distributed and appear highly heritable. These ratings exhibited minimal measurement error, high inter-individual stability, and developmental progression in RSB as children matured from 18-24 months, supporting their potential utility for serially quantifying the severity of early autistic syndromes over time and in response to intervention. In addition, these findings inform the genetic-environmental structure of RSB in early typical development.
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Affiliation(s)
- Natasha Marrus
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | | | - Theodore Jacob
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA, Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA, Center for Translational Social Neuroscience, Emory University, Atlanta, GA, USA
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA, Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA, Center for Translational Social Neuroscience, Emory University, Atlanta, GA, USA
| | - Caroline E. Drain
- Department of Psychiatry, Washington University, St. Louis, MO, USA, Department of Neurology, Washington University, St. Louis, MO, USA
| | | | | | | | | | - Sayli M. Sant
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Lyndsey Cole
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | | | - Yi Zhang
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Arpana Agrawal
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Andrew Heath
- Department of Psychiatry, Washington University, St. Louis, MO, USA
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Hull NC, O’Toole D, Miller MM, Shoults H, Deck R, Jones W, Johnson GC, Shaw DP, Schumaker BA. Canine dysautonomia in a litter of Havanese puppies. J Vet Diagn Invest 2015; 27:627-31. [DOI: 10.1177/1040638715595838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Canine dysautonomia is a sporadic, generally fatal disease that rarely affects groups of related animals. Four 10-week-old Havanese puppies from a litter of 5 developed clinical signs of canine dysautonomia. The 4 affected dogs were exposed to an outdoor environment, whereas the fifth littermate was not exposed to the outdoors and remained clinically healthy. Clinical signs of dysautonomia developed 10–16 days after going outside the house. An unrelated dog also developed dysautonomia after exposure to 1 of the affected Havanese littermates. All 5 dogs had morphological changes consistent with dysautonomia (widespread neuronal degeneration in autonomic ganglia, select brainstem nuclei, and ventral horn motor neurons). Differential diagnoses were excluded through negative toxicological evaluation, fecal parasite screening, negative Canine distemper virus reverse transcription polymerase chain reaction, fluorescent antibody testing, attempted virus isolation, and electron microscopy. The 5 affected dogs were in the Kansas City, Missouri area, where there is a high incidence of dysautonomia.
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Affiliation(s)
- Noah C. Hull
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Donal O’Toole
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Myrna M. Miller
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Hannah Shoults
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Robin Deck
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Warren Jones
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Gayle C. Johnson
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Daniel P. Shaw
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
| | - Brant A. Schumaker
- Department of Veterinary Sciences, University of Wyoming, Laramie, WY (Hull, O’Toole, Miller, Shoults, Schumaker)
- Wyoming State Veterinary Laboratory, Laramie, WY (O’Toole, Miller, Schumaker)
- DVM, Gainesville, MO (Deck)
- Strothertowne Pet Hospital, Lee’s Summit, MO (Jones)
- Department of Veterinary Medicine, University of Missouri, Columbia, MO (Johnson, Shaw)
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Klin A, Shultz S, Jones W. Social visual engagement in infants and toddlers with autism: early developmental transitions and a model of pathogenesis. Neurosci Biobehav Rev 2015; 50:189-203. [PMID: 25445180 PMCID: PMC4355308 DOI: 10.1016/j.neubiorev.2014.10.006] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
Abstract
Efforts to determine and understand the causes of autism are currently hampered by a large disconnect between recent molecular genetics findings that are associated with the condition and the core behavioral symptoms that define the condition. In this perspective piece, we propose a systems biology framework to bridge that gap between genes and symptoms. The framework focuses on basic mechanisms of socialization that are highly-conserved in evolution and are early-emerging in development. By conceiving of these basic mechanisms of socialization as quantitative endophenotypes, we hope to connect genes and behavior in autism through integrative studies of neurodevelopmental, behavioral, and epigenetic changes. These changes both lead to and are led by the accomplishment of specific social adaptive tasks in a typical infant's life. However, based on recent research that indicates that infants later diagnosed with autism fail to accomplish at least some of these tasks, we suggest that a narrow developmental period, spanning critical transitions from reflexive, subcortically-controlled visual behavior to interactional, cortically-controlled and social visual behavior be prioritized for future study. Mapping epigenetic, neural, and behavioral changes that both drive and are driven by these early transitions may shed a bright light on the pathogenesis of autism.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University School of Medicine, 1920 Briarcliff Rd NE, Atlanta, GA 30329, United States.
| | - Sarah Shultz
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University School of Medicine, 1920 Briarcliff Rd NE, Atlanta, GA 30329, United States
| | - Warren Jones
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University School of Medicine, 1920 Briarcliff Rd NE, Atlanta, GA 30329, United States
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50
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Klin A, Wetherby AM, Woods J, Saulnier C, Stapel-Wax J, Klaiman C, Jones W, Rubin E, Scahill L, Call N, Bearss K, Gunter C, Courtemanche CJ, Lemieux A, Cox JC, Mandell DS, Van Decar JP, Miller RA, Shireman CL. Toward innovative, cost-effective, and systemic solutions to improve outcomes and well-being of military families affected by autism spectrum disorder. Yale J Biol Med 2015; 88:73-9. [PMID: 25745376 PMCID: PMC4345541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit.
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Affiliation(s)
- Ami Klin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Amy M. Wetherby
- Autism Institute, Florida State University, Tallahassee, Florida
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, Florida
| | - Juliann Woods
- Autism Institute, Florida State University, Tallahassee, Florida
- School of Communication Science and Disorders, College of Communication and Information, Florida State University, Tallahassee, Florida
| | - Celine Saulnier
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Stapel-Wax
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Cheryl Klaiman
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Warren Jones
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Emory Center for Translational Social Neuroscience, Atlanta, Georgia
| | - Emily Rubin
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Lawrence Scahill
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan Call
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Karen Bearss
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Chris Gunter
- Marcus Autism Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Charles J. Courtemanche
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Anthony Lemieux
- Division of Autism & Related Disabilities, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Department of Communication, Georgia State University, Atlanta, Georgia
| | - James C. Cox
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
- Experimental Economics Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - David S. Mandell
- Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Cherri L. Shireman
- 81st Medical Operations Squadron, Keesler Air Force Base, Biloxi, Mississippi
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