Center for Translational Science

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Center for Translational Science

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BIRMINGHAM, Ala.--(BUSINESS WIRE)--Proton International and the University of Alabama at Birmingham (UAB) announced today they are securing necessary approvals to begin construction this year of a proton therapy center that will provide cancer patients with an effective treatment option that is an alternative to traditional radiation therapy. Proton therapy is a highly precise treatment for treating cancer and some non-cancerous tumors without many of the side effects that often accompany traditional radiation therapy. This will be the 4th of 7 centers Proton International has been involved with as one of the world’s leading developers of facilities offering this advanced therapy. The UAB center, which will be the first in the State, has been approved by an Administrative Law Judge appointed by the Alabama State Health Planning and Development Agency. The two-year construction process is expected to begin this year with an opening planned for 2019. Proton International will build and own the center with UAB physicians providing clinical services and providing the leadership for education and research within the facility. “This is a significant step forward in cancer treatment for residents of Alabama and surrounding areas,” said Will Ferniany, PhD, and CEO of the UAB Health System. “Proton therapy is an extremely advanced cancer-fighting technology. Coupled with the skill, experience and resources of the UAB Comprehensive Cancer Center, the UAB Proton Therapy Center will be a life-changing resource for thousands of cancer patients throughout our region.” The Comprehensive Cancer Center is the only National Cancer Institute Designated Cancer Center in Alabama. “UAB is joining a stellar group of 25 of the nation’s top hospitals and cancer treatment centers providing proton therapy to patients,” said Chris Chandler, CEO, who founded Proton International after developing, opening and overseeing the operation of some of the first proton centers in the U.S. and Europe. “This center will have advanced proton therapy technology – a fully featured system with dynamic peak pencil beam scanning, developed by Varian Medical Systems an important technology leader.” “Recent advances in imaging have made proton therapy much more viable,” said John Fiveash, M.D., professor in the UAB Department of Radiation Oncology. “It uses sophisticated imaging to create a 3D image of the tumor. It then delivers a focused beam of radiation, custom-sized and shaped, so that it paints the tumor site while leaving surrounding tissue generally untouched, reducing collateral damage.” It is conservatively estimated that some 250,000 cancer patients in the U.S. alone could benefit from proton therapy, which is mainly being used to treat solid cancer tumors, including tumors of the brain and central nervous system, spine, head and neck, lung, prostate, liver, gastrointestinal tract and colon, and some breast tumors. While it primarily treats single-site tumors, it can in some cases be used for treating cancer that has spread (metastasized) to surrounding tissue because of its focused dose capabilities. Protons are widely used to treat children, who are particularly sensitive to the effects of radiation therapy. Because of its precision in targeting tumors, proton therapy greatly reduces damage to nearby healthy tissue, which is the cause of most short- and long-term side-effects, including cancer recurrence later in life. The three-story UAB Proton Center will be built on the Campus of UAB. Planning and pre-treatment will continue to be done at UAB’s Hazelrig-Salter Radiation Oncology Center and medical staff will be exclusively from UAB. The center will enroll its patients in national proton therapy registries and will participate in clinical research studies to advance the application of proton therapy and determine best practices. In partnering with Proton International UAB has a team of proven providers. Proton International is currently participating in the development of 7 centers two of which are under construction; another set to break ground in March, and a memorandum of understanding approved for 4 others. PI’s turnkey development model significantly lowers project risk and provides access to long-term funding. For this project UAB and PI have selected Varian Medical Systems, an innovator in proton therapy systems Varian has been a longtime partner with UAB in the delivery of radiation therapy, and this new proton system will integrate UAB’s existing network of Varian products, including TrueBeam linear accelerators, Eclipse treatment planning, and ARIA information system. UAB Medicine comprises the School of Medicine and the $3 billion UAB Health System that includes all of the University of Alabama at Birmingham’s patient-care activities and 2,300 licensed beds in six hospitals, one of which is UAB Hospital — the third-largest public hospital in the United States, winner of the Women's Choice award, and one of U.S. News and World Report's Best Hospitals. UAB is the state of Alabama’s largest single employer and an internationally renowned research university and academic health center; its professional schools and specialty patient-care programs are consistently ranked among the nation’s top 50. UAB is the largest academic medical center in Alabama and one of the top four largest academic medical centers in the United States. UAB’s Center for Clinical and Translational Science is advancing innovative discoveries for better health as a two-time recipient of the prestigious Center for Translational Science Award. Find more information at and Proton International (PI) has an experienced team dedicated to bringing proton therapy to patients. The company works with hospitals and physician groups to develop one- and two-room proton therapy facilities, as well as larger facilities, on a turnkey basis. The PI team has developed and operated large centers and as well as the smaller alternatives. PI has centers under construction with Beaumont Hospital, Royal Oak, Mich., and the University Medical Center in Groningen, The Netherlands; as well as an upcoming project with Delray Medical Center, Delray Beach, Fla. PI’s business model ensures that projects are completed on time, on budget, and within the scope and needs of the Institution. Services include business planning, organizational structure, financing, building design and construction, installation and commissioning, equipment, staff training and more.

Tester J.M.,UCSF Benioff Childrens Hospital Oakland | Laraia B.A.,University of California at Berkeley | Leung C.W.,University of California at San Francisco | Mietus-Snyder M.L.,Center for Translational Science
Preventing Chronic Disease | Year: 2016

Introduction: Low levels of food security are associated with dyslipidemia and chronic disease in adults, particularly in women. There is a gap in knowledge about the relationship between food security among youth and dyslipidemia and chronic disease. We investigated the relationship between food security status and dyslipidemia among low-income adolescents. Methods: We analyzed data from adolescents aged 12 to 18 years (N = 1,072) from households with incomes at or below 200% of the federal poverty level from the National Health and Nutrition Examination Survey (NHANES) 2003-2010. We used logistic regression to examine the relationship between household food security status and the odds of having abnormalities with fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDLC), serum triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), TG/HDL-C ratio, and apolipoprotein B (Apo B). Models included age, sex, race/ethnicity, smoking status, partnered status in the household, and maternal education, with additional adjustment for adiposity. Results: Household food security status was not associated with elevated TC or LDL-C. Adolescents with marginal food security were more likely than food-secure peers to have elevated TGs (odds ratio [OR] = 1.86; 95% confidence interval [CI], 1.14-3.05), TG/HDLC ratio (OR = 1.74; 95% CI, 1.11-2.82), and Apo B (OR = 1.98; 95% CI, 1.17-3.36). Female adolescents with marginal food security had greater odds than male adolescents of having low HDLC (OR = 2.69; 95% CI, 1.14-6.37). No elevated odds of dyslipidemia were found for adolescents with low or very low food security. Adjustment for adiposity did not attenuate estimates. Conclusion In this nationally representative sample, low-income adolescents living in households with marginal food security had increased odds of having a pattern consistent with atherogenic dyslipidemia, which represents a cardiometabolic burden above their risk from adiposity alone.

Cramer M.T.,University of Alabama at Birmingham | Charlton J.R.,University of Virginia | Fogo A.B.,Vanderbilt University | Fathallah-Shaykh S.A.,University of Alabama at Birmingham | And 2 more authors.
Pediatric Nephrology | Year: 2014

Background: Dent disease is an X-linked recessive renal tubular disorder characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis, nephrolithiasis, and progressive renal failure (MIM 300009). A recent case series identified four patients with CLCN5 mutations who presented with nephrotic-range proteinuria, histologic evidence of focal segmental and/or global sclerosis, and low molecular weight proteinuria.Case-Diagnosis/Treatment: We characterize the clinical, genetic, and histopathological features of seven unrelated adolescent males with nephrotic-range proteinuria and CLCN5 mutations. Six patients underwent renal biopsy prior to assessing tubular proteinuria. All biopsied patients had either segmental sclerosis (3/6) or segmental increase in mesangial matrix (3/6). Five patients revealed some degree of foot process effacement, but only one patient biopsy revealed >50 % foot process effacement. The attenuated foot process effacement suggests the glomerulosclerosis is not due to a primary podocytopathy.Conclusions: These data suggest that clinicians should consider a diagnostic evaluation for Dent disease in young males presenting with high-grade proteinuria. © 2014, IPNA.

Hinds P.S.,Center for Translational Science | Menard J.C.,Childrens National Medical Center | Jacobs S.S.,Childrens National Medical Center
Progress in Palliative Care | Year: 2012

Introduction: Although much is asked clinically and emotionally of children and adolescents who are receiving treatment for a life-threatening illness, they are not routinely asked how they experience the treatment that is intended to save or prolong their lives. Without their subjective reports (the 'child's voice'), the treatment risk/benefit ratio cannot be fully known. Our purpose is to offer a description of the term 'child's voice' and to describe methods used to solicit and validate the ill child's reports of treatmentrelated symptoms and quality of life during palliative or end-of-life care. Methods: Study methods included a targeted literature review from three literature databases to develop the description of the 'child's voice' and to provide evidence regarding the ability of children with cancer to give voice to their treatment experience. Results: Many children ages 5-7 years and most children 8 years of age and older in treatment for cancer or receiving end-of-life care were able to validly report their symptoms, treatment experiences, and quality of life through qualitative and quantitative measures. Discussion: Although relevant literature is limited, research findings indicate that a majority of ill children and adolescents are able to report on their treatment-related symptoms and quality of life. The absence of the child's voice in palliative and end-of-life care jeopardizes best care efforts. We believe that seeking the ill child's voice in palliative and end-of-life care should now be standard of care. © W.S. Maney & Son Ltd 2012.

Robb A.,Center for Translational Science
Postgraduate medicine | Year: 2013

Attention-deficit/hyperactivity disorder (ADHD) is often considered a childhood disorder. However, in those diagnosed with ADHD as children, inattention, impulsivity, and hyperactivity can persist into adulthood, causing significant functional impairment and emotional distress, even if the condition no longer meets diagnostic criteria. This review examines the developmental and psychosocial factors to consider in adolescents with ADHD and the strategies that facilitate the transition from pediatric to adult care. Our findings are based on PubMed database searches conducted on November 29, 2011, that identified articles pertaining to ADHD and continuity or transition in medical care for adolescents published in English within the 5-year period preceding this date. Adolescents with ADHD face specific burdens associated with transitioning into adulthood that can impede the achievement of academic and occupational goals. The main finding of the literature review was that ADHD treatment rates decline sharply from childhood through young adulthood, despite the fact that functional impairment often persists. Moreover, although psychosocial therapy can play an important role in resolving functional difficulties and encouraging patient adherence to pharmacotherapy, the existing literature focuses mainly on pharmacotherapy as first-line treatment for ADHD. Therefore, careful, advanced planning to ensure continuity of medical and psychiatric care is essential. This planning involves the pediatric service that has been providing care, the adult service that will assume the responsibility of providing care, the young person with ADHD, and the family. Although recommendations for planning initiatives have been developed by a variety of professional organizations, they do not seem to be routinely implemented for the transition of ADHD care. Such careful advanced transition planning can ensure continuity of treatment, encourage treatment adherence, and help young individuals adjust to new life circumstances and avoid negative educational, social, and vocational results. Guidelines designed to facilitate this transition of care may be helpful.

Herbert L.,Center for Translational Science | Shemesh E.,Mount Sinai School of Medicine | Bender B.,Center for Health Promotion
Journal of Allergy and Clinical Immunology: In Practice | Year: 2016

Current estimates indicate that 4% to 8% of children in the United States are diagnosed with food allergy, and more than 40% of US children with food allergy experience severe allergic reactions. Families trying to avoid foods that may trigger an allergic reaction and ensure adequate treatment of allergic reactions that do occur face numerous challenges. The rise in the number of children diagnosed with food allergies underscores the importance of food allergy-related interventions to address elevated psychosocial concerns, such as parenting stress, anxiety, and worries about bullying. This review provides an overview of common psychosocial concerns among children with food allergy and their families across the developmental spectrum, and offers guidance to medical providers regarding the identification and treatment of food allergy-related psychosocial challenges. © 2016 American Academy of Allergy, Asthma & Immunology.

Hartung E.A.,Children's Hospital of Philadelphia | Guay-Woodford L.M.,Center for Translational Science
Pediatrics | Year: 2014

Autosomal recessive polycystic kidney disease (ARPKD) is an important cause of chronic kidney disease in children. The care of ARPKD patients has traditionally been the realm of pediatric nephrologists; however, the disease has multisystem effects, and a comprehensive care strategy often requires a multidisciplinary team. Most notably, ARPKD patients have congenital hepatic fibrosis, which can lead to portal hypertension, requiring close follow-up by pediatric gastroenterologists. In severely affected infants, the diagnosis is often first suspected by obstetricians detecting enlarged, echogenic kidneys and oligohydramnios on prenatal ultrasounds. Neonatologists are central to the care of these infants, who may have respiratory compromise due to pulmonary hypoplasia and massively enlarged kidneys. Surgical considerations can include the possibility of nephrectomy to relieve mass effect, placement of dialysis access, and kidney and/or liver transplantation. Families of patients with ARPKD also face decisions regarding genetic testing of affected children, testing of asymptomatic siblings, or consideration of preimplantation genetic diagnosis for future pregnancies. They may therefore interface with genetic counselors, geneticists, and reproductive endocrinologists. Children with ARPKD may also be at risk for neurocognitive dysfunction and may require neuropsychological referral. The care of patients and families affected by ARPKD is therefore a multidisciplinary effort, and the general pediatrician can play a central role in this complex web of care. In this review, we outline the spectrum of clinical manifestations of ARPKD and review genetics of the disease, clinical and genetic diagnosis, perinatal management, management of organ-specific complications, and future directions for disease monitoring and potential therapies.

Sweenie R.,Center for Translational Science | Mackey E.R.,Center for Translational Science | Streisand R.,Center for Translational Science
Families, systems & health : the journal of collaborative family healthcare | Year: 2014

Interactions between parents and children can influence behavioral and emotional functioning related to Type 1 diabetes (T1D), yet have been relatively unexplored during preadolescence. The present study examined associations among child problem behaviors, critical parenting behaviors, and pediatric parenting stress in a sample of preadolescent youth with T1D. Data are available from 86 preadolescent-parent dyads who participated in the initial baseline assessment of a randomized controlled trial designed to assess the efficacy of an adherence promotion program. Measures included the Eyberg Child Behavior Inventory, the Diabetes Family Behavior Checklist, and the Pediatric Inventory for Parents. After controlling for significant demographic and medical characteristics, parents who reported their child's behavior as more problematic reported more difficulty with pediatric parenting stress, which was also associated with more child-reported critical parenting behaviors. Child problem behaviors and critical parenting behaviors were associated with one another, partially via their association with increased pediatric parenting stress. Potential clinical applications include interventions geared toward helping parents manage difficult child behaviors as well as cope with pediatric parenting stress, with the ultimate goal of improving the parent-child relationship and management of T1D.

Holmes C.S.,Virginia Commonwealth University | Holmes C.S.,Georgetown University | Chen R.,Georgetown University | Mackey E.,Center for Translational Science | And 2 more authors.
Diabetes Care | Year: 2014

OBJECTIVE To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11-14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a longterm follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriersdwithout a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population. © 2014 by the American Diabetes Association.

Glauser T.,University of Cincinnati | Ben-Menachem E.,Gothenburg University | Bourgeois B.,Harvard University | Cnaan A.,Center for Translational Science | And 6 more authors.
Epilepsia | Year: 2013

Summary The purpose of this report was to update the 2006 International League Against Epilepsy (ILAE) report and identify the level of evidence for long-term efficacy or effectiveness for antiepileptic drugs (AEDs) as initial monotherapy for patients with newly diagnosed or untreated epilepsy. All applicable articles from July 2005 until March 2012 were identified, evaluated, and combined with the previous analysis (Glauser et al., 2006) to provide a comprehensive update. The prior analysis methodology was utilized with three modifications: (1) the detectable noninferiority boundary approach was dropped and both failed superiority studies and prespecified noninferiority studies were analyzed using a noninferiority approach, (2) the definition of an adequate comparator was clarified and now includes an absolute minimum point estimate for efficacy/effectiveness, and (3) the relationship table between clinical trial ratings, level of evidence, and conclusions no longer includes a recommendation column to reinforce that this review of efficacy/evidence for specific seizure types does not imply treatment recommendations. This evidence review contains one clarification: The commission has determined that class I superiority studies can be designed to detect up to a 20% absolute (rather than relative) difference in the point estimate of efficacy/effectiveness between study treatment and comparator using an intent-to-treat analysis. Since July, 2005, three class I randomized controlled trials (RCT) and 11 class III RCTs have been published. The combined analysis (1940-2012) now includes a total of 64 RCTs (7 with class I evidence, 2 with class II evidence) and 11 meta-analyses. New efficacy/effectiveness findings include the following: levetiracetam and zonisamide have level A evidence in adults with partial onset seizures and both ethosuximide and valproic acid have level A evidence in children with childhood absence epilepsy. There are no major changes in the level of evidence for any other subgroup. Levetiracetam and zonisamide join carbamazepine and phenytoin with level A efficacy/effectiveness evidence as initial monotherapy for adults with partial onset seizures. Although ethosuximide and valproic acid now have level A efficacy/effectiveness evidence as initial monotherapy for children with absence seizures, there continues to be an alarming lack of well designed, properly conducted epilepsy RCTs for patients with generalized seizures/epilepsies and in children in general. These findings reinforce the need for multicenter, multinational efforts to design, conduct, and analyze future clinically relevant adequately designed RCTs. When selecting a patient's AED, all relevant variables and not just efficacy and effectiveness should be considered. © Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

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