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Bartlett C.,University of North Carolina at Chapel Hill | Bartlett C.,Scimetrika | Orvis T.J.,University of North Carolina at Chapel Hill | Rosson G.S.,University of North Carolina at Chapel Hill | Weissman B.E.,University of North Carolina at Chapel Hill
Journal of Cellular Physiology | Year: 2011

Eukaryotic organisms package DNA into chromatin for compact storage in the cell nucleus. However, this process promotes transcriptional repression of genes. To overcome the transcriptional repression, chromatin remodeling complexes have evolved that alter the configuration of chromatin packaging of DNA into nucleosomes by histones. The SWI/SNF chromatin remodeling complex uses energy from ATP hydrolysis to reposition nucleosomes and make DNA accessible to transcription factors. Recent studies showing mutations of BRG1, one of two mutually exclusive ATPase subunits, in human tumor cell lines and primary tissue samples have implicated a role for its loss in cancer development. While most of the mutations lead to complete loss of BRG1 protein expression, others result in single amino acid substitutions. To better understand the role of these BRG1 point mutations in cancer development, we characterized SWI/SNF function in human tumor cell lines with these mutations in the absence of BRM expression, the other ATPase component. We found that the mutant BRG1 proteins still interacted with the core complex members and appeared at the promoters of target genes. However, while these mutations did not affect CD44 and CDH1 expression, known targets of the SWI/SNF complex, they did abrogate Rb-mediated cell-cycle arrest. Therefore, our results implicate that these mutations disrupt the de novo chromatin remodeling activity of the complex without affecting the status of existing nucleosome positioning. © 2010 Wiley-Liss, Inc..

Tai E.,Centers for Disease Control and Prevention | Buchanan N.,Centers for Disease Control and Prevention | Eliman D.,Scimetrika | Westervelt L.,Scimetrika | And 3 more authors.
Pediatrics | Year: 2014

Despite overall improvement in survival, morbidity, and quality of life of US patients with cancer, this progress is less prevalent in the population of adolescent and young adult patients with cancer, including those between the ages of 15 and 19 years. Evidence suggests that participation in clinical trials is associated with better survival outcomes among children and adolescents with cancer; however, adolescents have lower clinical trial participation rates compared with younger age cohorts. To better understand the unique concerns among adolescent patients with cancer, the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention convened a workgroup of researchers and health care providers in the field of adolescent and young adult oncology and cancer survivorship to examine the barriers and challenges limiting the participation of adolescents in clinical trials and to define ways to improve upon these concerns. This article summarizes the activities of the workgroup and their suggestions for enhanced accrual. Copyright © 2014 by the American Academy of Pediatrics.

Roland K.B.,Centers for Disease Control and Prevention | Rodriguez J.L.,Centers for Disease Control and Prevention | Patterson J.R.,Scimetrika | Trivers K.F.,Centers for Disease Control and Prevention
Psycho-Oncology | Year: 2013

Objective: To identify and comprehensively present the psychosocial needs of ovarian cancer (OvCa) survivors, including young survivors <45 years of age. Methods: A literature review was conducted using keywords specific to psychosocial health and OvCa survivorship to identify peer-reviewed, original research articles published in English between January 2000 and December 2010; 28 articles were identified as relevant. Articles were abstracted and results categorized according to six psychosocial domains: quality of life (QoL), social support and relationships, self-image and sexual functioning, psychological distress and functioning, fear of death/recurrence, and personal growth and coping. Findings unique to young survivors are presented when applicable. Psychosocial measurement tools used in relevant studies are also presented. Results: Physical complications and side effec ts have significant impact on OvCa survivors' psychosocial health. Access to social support services and relational support is critical, as feelings of isolation are common. Survivors report low levels of sexual activity and satisfaction, potentially causing strain on personal relationships, and survivors experience high levels of distress, depression, and anxiety. However, QoL can improve after diagnosis for some OvCa survivors, many of whom report spiritual growth and strengthened personal relationships. Younger survivors are likely to have greater distress and lower QoL compared with older survivors. Conclusions: OvCa is the deadliest of all gynecologic cancers, greatly impacting the psychosocial health of survivors. Increased awareness of psychosocial health among OvCa survivors themselves, their social support system, and their health care providers is necessary to adequately address their unique needs. Copyright © 2013 John Wiley & Sons, Ltd.

Helmick C.G.,CDC LLC | Lee-Han H.,Scimetrika | Hirsch S.C.,Scimetrika | Baird T.L.,Scimetrika | Bartlett C.L.,Scimetrika
American Journal of Preventive Medicine | Year: 2014

Background A 2010 CDC-sponsored consultation of psoriasis, psoriatic arthritis, and public health experts developed a public health agenda for psoriasis and psoriatic arthritis indicating that additional population-based research is needed to better characterize psoriasis in the population. Purpose To better characterize the burden of psoriasis in the U.S. using recent population-based, cross-sectional data in this 2012 analysis. Methods A subset of 10,676 adults aged 20-59 years from the 2003-2006 and 2009-2010 National Health and Nutrition Examination Surveys was used to examine psoriasis prevalence, severity, disparities, health-related quality of life, and selected comorbidities. Results The overall prevalence of psoriasis was 3.1% (95% CI=2.6, 3.6); extrapolating to older adults suggests that 6.7 million adults aged ≥20 years are affected. Psoriasis was significantly more prevalent among non-Hispanic whites than other race/ethnicity subgroups, as well as among those with arthritis. Approximately 82% reported no/little or mild disease; the impact of psoriasis on daily life increased with disease severity (p=0.0001 for trend). Those with psoriasis reported significantly more frequent mental distress or mild to severe depression than those without psoriasis. Psoriasis was also significantly associated with obesity and former smoking status. Conclusions Psoriasis is a large public health problem. Further characterizing psoriasis from a public health perspective will require better survey questions and inclusion of these questions in national surveys. © 2014 American Journal of Preventive Medicine.

Trivers K.F.,Centers for Disease Control and Prevention | Patterson J.R.,Scimetrika | Roland K.B.,Centers for Disease Control and Prevention | Rodriguez J.L.,Centers for Disease Control and Prevention
Supportive Care in Cancer | Year: 2013

Purpose: As the number of ovarian cancer survivors increases, so does the need for appropriate intervention and care. A literature review was conducted to assess the issues affecting ovarian cancer survivors in the USA, including the needs of younger survivors. Methods: Articles on six topics (finances/ employment, reproductive and sexual health, treatment effects, information needs, genomics, and end-of-life/palliative care) among ovarian cancer survivors were identified through comprehensive database searches. Abstracts for all citations were reviewed to determine relevancy. Data from relevant articles, defined as including a sample size of ≥20, published in English, involving human subjects in the USA, and published between 2000 and 2010, were abstracted. Results: Thirty-four articles were relevant. Common, but often unaddressed, treatment side effects included infertility and issues with sexual health. Survivors reported not receiving adequate information about their disease. Hereditary cancer can lead to concern for family members. End-of-life/palliative care was often not addressed by physicians. Most of the studies used a cross-sectional design and lacked control groups. Participants were primarily recruited from academic medical centers or clinical trials and tended to be White. Few studies specifically addressed young survivors; however, reproductive health issues are common. Conclusions: Ovarian cancer has wide-ranging impacts. This review emphasizes the need for more research among ovarian cancer survivors, particularly related to finances, reproductive and sexual health, information, genomics, and end-of-life care. Issues specific to young survivors also deserve more attention. Direction for future research and clinical implications are discussed. © 2013 Springer-Verlag Berlin Heidelberg (outside the USA).

Weaver L.K.,University of Utah | Cooney D.,Scimetrika
Respiratory Care | Year: 2013

BACKGROUND: Symptoms of carbon monoxide (CO) poisoning are non-specific. Diagnosis requires suspicion of exposure, confirmed by measuring ambient CO levels or carboxyhemoglobin (COHb). An FDA-approved pulse oximeter (Rad-57) can measure CO saturation (SpCO). The device accuracy has implications for clinical decision-making. METHODS: From April 1 to August 15, 2008, study personnel measured SpCO and documented demographic factors at time of clinical blood draw, in a convenience sample of 1,363 subjects presenting to the emergency department at Intermountain Medical Center, Murray, Utah. The technician then assayed COHb. COHb and SpCO values were compared by subject; false positive or negative values were defined as SpCO at least 3 percentage points greater or less than COHb level, reported by the manufacturer to be ± 1 SD in performance. RESULTS: In 1,363 subjects, 613 (45%) were male, 1,141 (84%) were lightskinned, 14 in shock, 4 with CO poisoning, and 122 (9%) met the criteria for a false positive value (range 3-19 percentage points), while 247 (18%) met the criteria for a false negative value (-13 to -3 percentage points). Risks for a false positive SpCO reading included being female and having a lower perfusion index. Methemoglobin, body temperature, and blood pressure also appear to influence the SpCO accuracy. There was variability among monitors, possibly related to technician technique, as rotation of monitors among technicians was not enforced. CONCLUSIONS: While the Rad-57 pulse oximeter functioned within the manufacturer's specifications, clinicians using the Rad-57 should expect some SpCO readings to be significantly higher or lower than COHb measurements, and should not use SpCO to direct triage or patient management. An elevated SpCO could broaden the diagnosis of CO poisoning in patients with non-specific symptoms. However, a negative SpCO level in patients suspected of having CO poisoning should never rule out CO poisoning, and should always be confirmed by COHb. © 2013 Daedalus Enterprises.

Tai E.,Centers for Disease Control and Prevention | Buchanan N.,Centers for Disease Control and Prevention | Westervelt L.,Scimetrika | Elimam D.,Scimetrika | Lawvere S.,University of North Carolina at Chapel Hill
Pediatrics | Year: 2014

BACKGROUND: There has been an overall improvement in survival rates for persons with cancer over the past 35 years. However, these gains are less prevalent among adolescents with cancer aged 15 to 19 years, which may be due to lower clinical trial enrollment among adolescents with cancer. METHODS: We conducted a literature review to assess current research regarding clinical trial enrollment and subsequent outcomes among adolescents with cancer. The search included English-language publications that reported original data from January 1985 to October 2011. RESULTS: The search identified 539 records. Of these 539 records, there were 30 relevant original research articles. Multiple studies reported that adolescents with cancer are enrolled in clinical trials at lower rates compared with younger children and older adults. Treatment setting, physician type, and institution type may all be factors in the low enrollment rate among adolescents. Few data focused solely on adolescents, with many studies combining adolescents with young adults. The number of available studies related to this topic was limited, with significant variability in study design, methods, and outcomes. CONCLUSIONS: This literature review suggests that adolescents with cancer are not treated at optimal settings and are enrolled in clinical trials at low rates. This may lead to inferior treatment and poor subsequent medical and psychosocial outcomes. The scarcity in data further validates the need for additional research focusing on this population. Copyright © 2014 by the American Academy of Pediatrics.

Jack Jr. L.,National Center for Chronic Disease and Health Promotion | Liburd L.C.,Minority | Tucker P.,National Center for Chronic Disease and Health Promotion | Cockrell T.,Scimetrika
Clinical Therapeutics | Year: 2014

Using an illness narratives framework, we provide 1 method that health care providers can use to obtain insight into the perceptions and experiences of their patients living with diabetes. We propose that understanding patients' cultural perspectives help explains their health behavior and can lead to more productive partnering between provider, patient, and community health resources that support adherence and improved health outcomes. We conclude with resources available to assist health care providers in their efforts to deliver culturally appropriate diabetes care and examples of culturally tailored community-based public health initiatives that have been effective in improving diabetes outcomes among African-American patients. © 2014 The Authors.

Labre M.P.,Scimetrika | Herman E.J.,Air Pollution and Respiratory Health Branch | Dumitru G.G.,Air Pollution and Respiratory Health Branch | Valenzuela K.A.,Scimetrika | Cechman C.L.,Centers for Disease Control and Prevention
American Journal of Preventive Medicine | Year: 2012

Context: Asthma is a chronic respiratory disease increasingly prevalent in the U.S., particularly among children and certain minority groups. This umbrella review sought to assess and summarize existing systematic reviews of asthma-related interventions that might be carried out or supported by state or community asthma control programs, and to identify gaps in knowledge. Evidence acquisition: Eleven databases were searched through September 2010, using terms related to four concepts: asthma, review, intervention, and NOT medication. Reviews of the effectiveness of medications, medical procedures, complementary and alternative medicine, psychological interventions, family therapy, and nutrients or nutritional supplements were excluded. Two coders screened each record and extracted data from the included reviews. Evidence synthesis: Data analysis was conducted from May to December 2010. Of 42 included reviews, 19 assessed the effectiveness of education and/or self-management, nine the reduction of indoor triggers, nine interventions to improve the provision of health care, and five examined other interventions. Several reviews found consistent evidence of effectiveness for self-management education, and one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective for children. Other reviews found limited or insufficient evidence because of study limitations. Conclusions: State or community asthma control programs should prioritize (1) implementing interventions for which the present review found evidence of effectiveness and (2) evaluating promising interventions that have not yet been adequately assessed. © 2012 American Journal of Preventive Medicine.

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