Religion and the Cell-Only Population

Compares the religious affiliations, church attendance, and religious salience of the cell phone-only, landline, and combined cell/landline samples, and explores the extent to which the differences are due to the relative youth of the cell-only group

From “Mind Playing Tricks On Me” to “Trauma”: Adverse Childhood Experiences and Hip Hop’s Prescription

Over the past two decades, research focused on the causes and the lasting impact of Adverse Childhood Experiences, or ACEs, has been changing the way researchers, healthcare providers, and advocates approach areas like mental health, risky behaviors, and chronic disease. Numerous studies have produced and solidified results that present three undeniable truths: (1) the vast majority of Americans have experienced some form of trauma in their childhood, (2) people with low income or educational attainment and people of color experience increased instances of childhood trauma and adversity, and (3) the more childhood trauma an individual experiences, the higher the risk that he or she will be exposed to “multiple risk factors for several of the leading causes of death in adults.” The causal link between childhood trauma and negative health outcomes has been shown to be so severe that Dr. Robert Block, former president of the American Academy of Pediatrics, notably stated, “Adverse Childhood Experiences are the single greatest unaddressed public health threat facing our nation today.” Childhood trauma and adversity has shaped the music, careers, and lives of many of hip-hop’s brightest stars. The lasting impact of traumatic childhood experiences has propelled some artists to international stardom, as listeners around the globe are able to connect with them through the honest and raw lyrics and musical styles born out of, and in spite of, such adversity. What can hip-hop, a proud and storied genre that is no stranger to taking on taboo topics, and its artists, many of whom are the products of communities teeming with adversity, tell us about Adverse Childhood Experiences? How can lawmakers, mental healthcare providers, and community activists work to address and curtail the prevalence and negative impact of childhood trauma through the framework provided to them by hip-hop artists and messages? Messages that dictate action by courageously challenging the complacent status quo, beginning with efforts that spread awareness and education, and building on the work of those in the field that have come before? What would laws and policies developed through a hip hop framework look like? This article seeks to answer these questions and to encourage immediate action in combating the epidemic of childhood trauma

A target based approach identifies genomic predictors of breast cancer patient response to chemotherapy

BACKGROUND: The efficacy of chemotherapy regimens in breast cancer patients is variable and unpredictable. Whether individual patients either achieve long-term remission or suffer recurrence after therapy may be dictated by intrinsic properties of their breast tumors including genetic lesions and consequent aberrant transcriptional programs. Global gene expression profiling provides a powerful tool to identify such tumor-intrinsic transcriptional programs, whose analyses provide insight into the underlying biology of individual patient tumors. For example, multi-gene expression signatures have been identified that can predict the likelihood of disease reccurrence, and thus guide patient prognosis. Whereas such prognostic signatures are being introduced in the clinical setting, similar signatures that predict sensitivity or resistance to chemotherapy are not currently clinically available. METHODS: We used gene expression profiling to identify genes that were co-expressed with genes whose transcripts encode the protein targets of commonly used chemotherapeutic agents. RESULTS: Here, we present target based expression indices that predict breast tumor response to anthracycline and taxane based chemotherapy. Indeed, these signatures were independently predictive of chemotherapy response after adjusting for standard clinic-pathological variables such as age, grade, and estrogen receptor status in a cohort of 488 breast cancer patients treated with adriamycin and taxotere/taxol. CONCLUSIONS: Importantly, our findings suggest the practicality of developing target based indices that predict response to therapeutics, as well as highlight the possibility of using gene signatures to guide the use of chemotherapy during treatment of breast cancer patients

Long-Term Survival after Blood and Marrow Transplantation: Comparison with an Age- and Gender-Matched Normative Population

AbstractA plateau in long-term survival patterns of patients undergoing blood and marrow transplantation (BMT) from allogeneic donors is apparent, but whether their expected survival ever parallels that of the normative population is unclear. This study attempts to identify a cutoff time for classifying BMT patients as long-term survivors and compares their actual survival with the expected survival of an age- and gender-matched “normal” population. In this study, the records of 1386 patients who underwent allogeneic BMT at Princess Margaret Hospital between 1970 and 2002 were reviewed. Hazard rates (HRs), Kaplan-Meier survival estimates, and loess curves were used to propose a cutoff time classifying patients as long-term survivors. Factors predictive of overall survival and survival for long-term survivors were investigated. Actual survival for these patients was compared with the expected survival of the Canadian “normal” population. A cutoff time of 6 years post-BMT was proposed to define long-term survivors based on loess curves of hazard ratios and yearly survival statistics. The only statistically significant predictor of survival among long-term survivors was having a male donor (HR = 0.39; 95% confidence interval [CI] = 0.17–0.88). Although only 62% of patients survived the first year post-BMT, 98.5% of patients alive after 6 years survived at least another year. Almost 1/3 (31%) of the deaths in long-term survivors resulted from causes unrelated to transplantation or relapse. The observed number of deaths among BMT patients exceeded the expected number from the Canadian population; however, the difference in life expectancy decreased the longer that a patient survived. The 95% CIs for the observed/expected number of deaths cover 1, indicative of no difference, after the tenth year post-BMT. A cutoff of 6 years is proposed to define long-term survivorship after BMT. Life expectancy remained reduced compared with that of the “normal” population; however, this difference decreased the longer that a patient survived. Known risk factors of short-term survival disappeared, with only donor gender predictive of survival among long-term survivors

Meek Mill’s Trauma: Brutal Policing as an Adverse Childhood Experience

Meek Mill’s life and career have been punctuated by trauma, from his childhood lived on the streets of Philadelphia, through his rise to fame and eventual arrival as one of hip hop’s household names. his 2018 track Trauma, Meek Mill describes, in revealing prose, just how the traumatic experiences he endured personally impacted and harmed him. He also embodies a role as narrator in describing the same traumas and harms that impact the daily lives of countless similarly situated young Black people in the United States. As a child, Mill’s lived experience was one of pervasive poverty and fear, as the world surrounding him consisted of large-scale poverty, addiction, crime, violence, and death. As a young man—at just 19 years of age—he was beaten by police, wrongfully arrested and incarcerated, and ultimately convicted of crimes that he did not commit, becoming another statistic as a young Black man swallowed by the American criminal justice system. Meek’s story, lyrics and contributions to hip hop illuminate the Black experience with law enforcement. His personal involvements provide a powerful narrative for exactly how a racially biased criminal justice system perpetrates a trauma that extends far greater than the law has traditionally recognized. This article highlights this narrative through the lens that Meek Mill provides because of his current prominence in hip hop and the importance of his narrative claims. Despite his success in achieving the status of a true hip hop icon, Meek Mill suffered the kind of childhood adversity and trauma that emerging health care research indicates leads to debilitating health outcomes in adulthood. Powerful health studies conducted over the past two decades have uncovered the startling impact of Adverse Childhood Experiences (“ACEs”). ACEs are traumatic events that occur in childhood, ranging from abuse and neglect to other traumatic experiences derived from household and community dysfunction. Today, ACEs are generally placed by health researchers into seven to ten categories of childhood adversities ranging from sexual, physical and emotional abuse to the incarceration of a family member, living with someone who abuses alcohol or drugs and poverty, community violence and homelessness. These identified categories of trauma, although not fully understood or grasped as late as the 1990s, were known to occur in the lives of children all over the United States; however, the overall impact of childhood trauma on an individual’s long term health outcomes was only first measured in the now famous CDC-Kaiser Permanente ACE study. The findings of this study shook the health care world, forever altering the understanding of the link between childhood trauma and adult health outcomes. These links pushed researchers to look more deeply into the ultimate impact of traumatic childhood experiences on overall adult health. The groundbreaking study concluded that the more trauma a child experiences, the fewer years that child would live as an adult. In fact, in a 2009 study, CDC researchers determined that exposure to childhood trauma literally shortens an individual’s lifespan. On average, a person with six or more ACEs died twenty years earlier than a person that had experienced no Adverse Childhood Experiences. This reality, that traumatic childhood experiences are directly and inextricably linked to negative health outcomes, is now widely recognized in the public health and clinical literature. Dr. Robert Block, former President of the American Academy of Pediatrics, has warned that “[a]dverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.” More recently, this literature has begun to explore the connection between trauma and race, outlining how structural violence and historical trauma—particularly violence and discrimination experienced by Black, indigenous, and persons of color—is often experienced both at the individual and community levels. Such work has focused on improving economic opportunities for trauma- stricken communities, improving the physical/built environment, and supporting the development of healthy social-cultural environments. The prevailing framework for addressing the ACEs crisis has been a medical model focused on interventions for individual survivors and communities rather than addressing the glaring systemic issues that directly contribute to the vast majority of the trauma suffered by those communities and the individuals and families that inhabit them. Largely and undeniably absent from the body of work on childhood trauma, and the proposed solutions to confronting and rectifying its deadly impact, is the exploration of how the American legal and justice systems, from municipal law enforcement to the appellate courts, stands at the epicenter of the current crisis. Each of the recognized categories of ACEs listed in medical screening instruments used by physicians to identity trauma have a direct nexus to the justice system. If we as a society are committed to treating ACEs as the public health crisis that they are, it is incumbent upon us to examine where and how our legal system is complicit in perpetuating trauma upon minority children. In addition, we need to consider how it can intervene—both at the individual and structural levels—to eliminate practices that contribute to multi-generational cycles of trauma and work to equip those with justice-system involvement to succeed and build the resilience necessary to heal minority individuals and communities who have been stricken by trauma and its life-long negative consequences. Indeed it is the responsibility of our justice system, as a major contributor to so-called “social determinants of health.” Meek Mill, in his intimate autobiographical tracks of Trauma, Oodles O’Noodles Babies, and Otherside of America, describes experiencing not just several instances of childhood trauma as identified by the CDC-Kaiser Permanente study, but as a teenager, he suffered additional cruel trauma at the hands of U.S. police and a criminal justice system that wrongly imprisoned and unfairly positioned him in a revolving door between probation and prison. The data tells us that the trauma Meek experienced as a child and teenager statistically predicts a poorer life expectancy for him than those individuals that experienced no trauma or little trauma as a child and youth. Because of the anti-Black culture of policing in America, and because of the deep systemic racism that permeates the criminal justice system, simple exposure to U.S. policing and its courts should qualify as an Adverse Childhood Experience for Black and minority children—one that contributes to harmful adult outcomes, including a shortened life expectancy. Mill’s personal childhood trauma as described in his music carefully extrapolates the ways that American policing and the criminal justice system literally traumatized and endangered his young Black life, as it does so many Black children. This article begins in Section I by providing an in-depth examination of ACEs research, including how the groundbreaking original ACE study discovered the direct link between high ACE scores and poor health outcomes and the prevalence of ACEs in the Black community. It then turns, in Section II, to a brief discussion of the broad ACE category of social disadvantage, and how a child growing up in an environment built on a foundation of poverty and violence will inevitably have more trauma, more ACEs, and be harmed through his or her experience of toxic stress. Section III will provide an overview of anti-Black policing and how law enforcement, as currently constituted, traumatizes minority communities and youth. Section IV explains how criminal charging, jailing, and sentencing traditions have disproportionately targeted Black men, contributing to the trauma that their children and families experience with the loss of a loved one to death or incarceration. The article next argues that minority youth exposure to U.S. law enforcement agents and the justice system at large functions as an ACE for youth of color in a way that is simply not present for non-minority youth and, as such, should be added to the list of ACEs that are formally recognized by public health officials. Finally, the article concludes with how Meek Mill himself is seeking to reform a system rife with debilitating trauma. Throughout each section, Meek Mill, and the raw lyrics from some of his most personal tracks, will serve as an illustration, and example, of how social disadvantage, police misconduct and brutality, and the American criminal justice system at large, cause harmful and lifelong trauma for Black Americans

Virtually building a community of experts in the medication-assisted treatment (MAT) of opioid use using the project ECHO model

Purpose: Project Extension for Community Healthcare Outcomes (ECHO) utilizes telemedicine to connect a multidisciplinary team of experts with a network of primary care physicians to enable rapid dissemination of evidence-based guidelines and practices at scale. In this study, the Project ECHO model disseminated the Arizona Pain and Addiction Curriculum to providers in rural Arizona with the goal to educate providers on MAT. Methods: Participants engaged in biweekly, virtual teleECHO sessions and post-session surveys were used to collect data on provider satisfaction, self-efficacy, knowledge, barriers to change and changes in practice behavior. Results: Between February 2020 – November 2020, the MAT-ECHO program hosted 20 teleECHO sessions (n=20) with 255 unique participating providers and delivered 877 learning hours. Analysis of a six-month post-ECHO survey (n=13) demonstrated that teleECHO sessions had broad geographic outreach. Participants had an average of 12 years of experience, 38% held NP/PA professional degrees, and 54% percent practiced in opioid treatment program (OTP) settings. Assessment of job satisfaction and well-being revealed overall improved satisfaction among the small cohort of non-waivered respondents (N=8), except for meeting patient’s needs. MAT-waivered respondents reported no post-session changes (Table 3). Conclusions: Data from this study demonstrated that teleECHO sessions were well attended, consisted of a diverse cohort with various degrees, and had broad geographic outreach; hence, the utilization of the teleECHO model has the potential to reach rural providers and subsequently increase the availability and efficacy of MAT in rural America

Correlation of baseline biomarkers with clinical outcomes and response to fulvestrant with vandetanib or placebo in patients with bone predominant metastatic breast cancer: An OCOG ZAMBONEY sub-study

AbstractBackgroundBone metastases are common in women with breast cancer and often result in skeletal related events (SREs). As the angiogenic factor vascular endothelial growth factor (VEGF) regulates osteoclast activity and is associated with more extensive bone metastases and SRE risk in metastatic breast cancer, we hypothesized that blockade of VEGF signaling could be a therapeutic strategy for inhibiting bone metastases progression and possibly prolonging overall (OS) or progression-free survival (PFS). The Zamboney trial was a randomized placebo-controlled study designed to assess whether patients with bone predominant metastatic breast cancer benefited from addition of the VEGF receptor (VEGFR) targeting agent, vandetanib, to endocrine therapy with fulvestrant. As a companion study, evaluation of biomarkers and their potential association with response to vandetanib or SRE risk was performed.MethodsBaseline overnight fasted serum from enrolled patients was analyzed for levels of various putative biomarkers including; VEGF-A, soluble (s)VEGFR2, sVEGFR3, transforming growth factor (TGF)-β1 and activinA by ELISA. Spearman correlation coefficients and Wilcoxon rank sum tests were used to investigate potential relationships between biomarker values and baseline clinical parameters. Prognostic and predictive ability of each marker was investigated using Cox proportional hazards regression with adjustments for treatment and baseline strata of serum CTx (<400 versus ≥400ng/L).ResultsOf 129 enrolled patients, serum was available for analysis in 101; 51 in vandetanib and 50 in placebo arm. Mean age amongst consenting patients was 59.8 years. Clinical characteristics were not significantly different between patients with or without serum biomarker data and serum markers were similar for patients by treatment arm. Baseline sVEGFR2 was prognostic for OS (HR=0.77, 95% CI=0.61–0.96, p=0.020), and although a modest association was observed, it was not significant for PFS (HR=0.90, 95% CI=0.80–1.01, p=0.085) nor time to first SRE (HR=0.82, 95% CI=0.66–1.02, p=0.079). When interaction terms were evaluated, sVEGFR2 was not found to be predictive of response to vandetanib, although a modest association remained with respect to PFS (interaction p=0.085). No other marker showed any significant prognostic or predictive ability with any measured outcome.ConclusionsIn this clinical trial, sVEGFR2 appeared prognostic for OS, hence validation of sVEGFR2 should be conducted. Moreover, the role of sVEGFR2 in breast cancer bone metastasis progression should be elucidated

Influence of statistician involvement on reporting of randomized clinical trials in medical oncology

International audienceIdeally, statisticians should be involved in the design, analysis, and reporting of randomized clinical trials (RCTs). This study assessed the impact of a statistician involvement in published medical oncology RCTs between 2005 and 2009. The reporting quality of each publication was rated using the Overall Reporting Quality Score on the basis of either 2001 or 2010 Consolidated Standards of Reporting Trials criteria. A four-question email survey on the statistical design and analysis was sent to the corresponding authors of each trial. Nonresponders were approached a maximum of three times. Overall, 107 responses were received from 357 solicited authors (30%). Corresponding authors from industry-funded RCTs were less likely to respond (51 vs. 65%, P = 0.013). The same person was responsible for statistical design and analyses in 47% of cases. Overall, the statistician involved held a PhD (or equivalent) in statistics in most cases. The statisticians responsible for the statistical design and analysis were listed as coauthors in 68 and 81% of RCT manuscripts. There was no statistically significant impact on manuscript reporting quality of the degree of statistician involvement in manuscript preparation. Fewer trials were reported as positive when the responsible statistician was listed as a coauthor. It is possible that RCTs included in this review are in general of higher quality or were more likely to have a greater level of statistician involvement than smaller, single-arm, or unpublished studies. This imbalance could explain the lack of significant difference observed in the Overall Reporting Quality Score between trials where statisticians were listed as coauthors or not