Adverse Childhood Experiences in Children Presenting to Integrated Pediatric Primary Care

The prevalence of adverse childhood experiences (ACEs) has created a significant public health concern in the United States. A vast body of literature examining adult populations has displayed a dose-response association between cumulative ACEs and chronic illnesses (Chapman et al., 2004; Felitti et al., 1998). ACEs research conducted with children and adolescents has indicated higher ACE scores associated with learning and behavioral problems (Burke et al., 2011), health risk behaviors (Garrido et al., 2018), and mental health challenges (Mackner et al., 1997). However, ACEs research and subsequent interventions have largely relied upon retrospective data retrieved from adults (Felitti et al., 1998) and national datasets (Centers for Disease Control and Prevention, 2019; Greeson et al., 2014). Given the growing literature on ACEs in children and adolescents, the goal of the thesis project was to investigate the ACEs, psychosocial functioning, and healthcare utilization of youth presenting to a pediatric integrated primary care clinic (IPC) in an urban community. Participants were patients who complete an initial visit with the Pediatric Behavioral Health Team (Peds BHT) at VCU’s Children’s Hospital of Richmond. This IPC clinic serves a low income, racially diverse pediatric population (ages 3-17). This study utilized clinical data obtained from caregivers of patients presenting to the Peds BHT. Measures of cumulative childhood adversity (Adverse Childhood Experiences Questionnaire), child mental health (Pediatric Symptom Checklist-17), and demographic characteristics were examined. The present study utilized descriptive statistical analyses and linear regression models to examine relations between ACEs, mental health, and healthcare utilization in a pediatric sample presenting to IPC. The results indicated 81.3% of participants experienced at least 1or more Original ACEs (an ACE score ≥ 1), and 58.7% experienced ≥ 2 or more Original ACEs. For children in the 3-12 age group, Original ACE scores predicted overall mental health, (p =.008). The results also indicated a relationship between medical diagnoses and healthcare utilization. The results underscore the importance of screening for ACEs and mental health in pediatric primary care as early childhood stressors emerge

An Empirical Analysis of Racial Categories in the Algorithmic Fairness Literature

Recent work in algorithmic fairness has highlighted the challenge of defining racial categories for the purposes of anti-discrimination. These challenges are not new but have previously fallen to the state, which enacts race through government statistics, policies, and evidentiary standards in anti-discrimination law. Drawing on the history of state race-making, we examine how longstanding questions about the nature of race and discrimination appear within the algorithmic fairness literature. Through a content analysis of 60 papers published at FAccT between 2018 and 2020, we analyze how race is conceptualized and formalized in algorithmic fairness frameworks. We note that differing notions of race are adopted inconsistently, at times even within a single analysis. We also explore the institutional influences and values associated with these choices. While we find that categories used in algorithmic fairness work often echo legal frameworks, we demonstrate that values from academic computer science play an equally important role in the construction of racial categories. Finally, we examine the reasoning behind different operationalizations of race, finding that few papers explicitly describe their choices and even fewer justify them. We argue that the construction of racial categories is a value-laden process with significant social and political consequences for the project of algorithmic fairness. The widespread lack of justification around the operationalization of race reflects institutional norms that allow these political decisions to remain obscured within the backstage of knowledge production.Comment: 13 pages, 2 figures, FAccT '2

‘Warrant’ revisited: Integrating mathematics teachers’ pedagogical and epistemological considerations into Toulmin’s model for argumentation

In this paper, we propose an approach to analysing teacher arguments that takes into account field dependence—namely, in Toulmin’s sense, the dependence of warrants deployed in an argument on the field of activity to which the argument relates. Freeman, to circumvent issues that emerge when we attempt to determine the field(s) that an argument relates to, proposed a classification of warrants (a priori, empirical, institutional and evaluative). Our approach to analysing teacher arguments proposes an adaptation of Freeman’s classification that distinguishes between: epistemological and pedagogical a priori warrants, professional and personal empirical warrants, epistemological and curricular institutional warrants, and evaluative warrants. Our proposition emerged from analyses conducted in the course of a written response and interview study that engages secondary mathematics teachers with classroom scenarios from the mathematical areas of analysis and algebra. The scenarios are hypothetical, grounded on seminal learning and teaching issues, and likely to occur in actual practice. To illustrate our proposed approach to analysing teacher arguments here, we draw on the data we collected through the use of one such scenario, the Tangent Task. We demonstrate how teacher arguments, not analysed for their mathematical accuracy only, can be reconsidered, arguably more productively, in the light of other teacher considerations and priorities: pedagogical, curricular, professional and personal

Process of diffusing cancer survivorship care into oncology practice

The LIVESTRONG Centers of Excellence were funded to increase the effectiveness of survivorship care in oncology practice. This study describes the ongoing process of adopting and implementing survivorship care using the framework of the diffusion of innovation theory of change. Primary data collection included telephone interviews with 39 members from the eight centers and site visits. Organizational characteristics, overall progress, and challenges for implementation were collected from proposals and annual reports. Creating an awareness of cancer survivorship care was a major accomplishment (relative advantage). Adoption depended on the fit within the cancer center (compatibility), and changed over time based on trial and error (trialability). Implementing survivorship care within the existing culture of oncology and breaking down resistance to change was a lengthy process (complexity). Survivorship care became sustainable as it became reimbursed, and more new patients were seen (observability). Innovators and early adopters were crucial to success. Diffusion of innovation theory can provide a strategy to evaluate adoption and implementation of cancer survivorship programs into clinical practice

p63 is an alternative p53 repressor in melanoma that confers chemoresistance and a poor prognosis.

The role of apoptosis in melanoma pathogenesis and chemoresistance is poorly characterized. Mutations in TP53 occur infrequently, yet the TP53 apoptotic pathway is often abrogated. This may result from alterations in TP53 family members, including the TP53 homologue TP63. Here we demonstrate that TP63 has an antiapoptotic role in melanoma and is responsible for mediating chemoresistance. Although p63 was not expressed in primary melanocytes, up-regulation of p63 mRNA and protein was observed in melanoma cell lines and clinical samples, providing the first evidence of significant p63 expression in this lineage. Upon genotoxic stress, endogenous p63 isoforms were stabilized in both nuclear and mitochondrial subcellular compartments. Our data provide evidence of a physiological interaction between p63 with p53 whereby translocation of p63 to the mitochondria occurred through a codependent process with p53, whereas accumulation of p53 in the nucleus was prevented by p63. Using RNA interference technology, both isoforms of p63 (TA and ΔNp63) were demonstrated to confer chemoresistance, revealing a novel oncogenic role for p63 in melanoma cells. Furthermore, expression of p63 in both primary and metastatic melanoma clinical samples significantly correlated with melanoma-specific deaths in these patients. Ultimately, these observations provide a possible explanation for abrogation of the p53-mediated apoptotic pathway in melanoma, implicating novel approaches aimed at sensitizing melanoma to therapeutic agents

Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network

The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care

Simulated effect of pneumococcal vaccination in the Netherlands on existing rules constructed in a non-vaccinated cohort predicting sequelae after bacterial meningitis

BACKGROUND: Previously two prediction rules identifying children at risk of hearing loss and academic or behavioral limitations after bacterial meningitis were developed. Streptococcus pneumoniae as causative pathogen was an important risk factor in both. Since 2006 Dutch children receive seven-valent conjugate vaccination against S. pneumoniae. The presumed effect of vaccination was simulated by excluding all children infected by S. pneumoniae with the serotypes included in the vaccine, from both previous collected cohorts (between 1990-1995). METHODS: Children infected by one of the vaccine serotypes were excluded from both original cohorts (hearing loss: 70 of 628 children; academic or behavioral limitations: 26 of 182 children). All identified risk factors were included in multivariate logistic regression models. The discriminative ability of both new models was calculated. RESULTS: The same risk factors as in the original models were significant. The discriminative ability of the original hearing loss model was 0.84 and of the new model 0.87. In the academic or behavioral limitations model it was 0.83 and 0.84 respectively. CONCLUSION: It can be assumed that the prediction rules will also be applicable on a vaccinated population. However, vaccination does not provide 100% coverage and evidence is available that serotype replacement will occur. The impact of vaccination on serotype replacement needs to be investigated, and the prediction rules must be validated externally

BET Bromodomain Inhibition as a Therapeutic Strategy to Target c-Myc

SummaryMYC contributes to the pathogenesis of a majority of human cancers, yet strategies to modulate the function of the c-Myc oncoprotein do not exist. Toward this objective, we have targeted MYC transcription by interfering with chromatin-dependent signal transduction to RNA polymerase, specifically by inhibiting the acetyl-lysine recognition domains (bromodomains) of putative coactivator proteins implicated in transcriptional initiation and elongation. Using a selective small-molecule bromodomain inhibitor, JQ1, we identify BET bromodomain proteins as regulatory factors for c-Myc. BET inhibition by JQ1 downregulates MYC transcription, followed by genome-wide downregulation of Myc-dependent target genes. In experimental models of multiple myeloma, a Myc-dependent hematologic malignancy, JQ1 produces a potent antiproliferative effect associated with cell-cycle arrest and cellular senescence. Efficacy of JQ1 in three murine models of multiple myeloma establishes the therapeutic rationale for BET bromodomain inhibition in this disease and other malignancies characterized by pathologic activation of c-Myc.PaperFlic

Mass Measurements of Neutron-Deficient Yb Isotopes and Nuclear Structure at the Extreme Proton-Rich Side of the N=82 Shell

International audienceHigh-accuracy mass measurements of neutron-deficient Yb isotopes have been performed at TRIUMF using TITAN’s multiple-reflection time-of-flight mass spectrometer (MR-TOF-MS). For the first time, an MR-TOF-MS was used on line simultaneously as an isobar separator and as a mass spectrometer, extending the measurements to two isotopes further away from stability than otherwise possible. The ground state masses of Yb150,153 and the excitation energy of Ybm151 were measured for the first time. As a result, the persistence of the N=82 shell with almost unmodified shell gap energies is established up to the proton drip line. Furthermore, the puzzling systematics of the h11/2-excited isomeric states of the N=81 isotones are unraveled using state-of-the-art mean field calculation