Publications by authors named "Rebecca Williamson"

49 Publications

Emotional Contexts Influence Toddlers' Prosocial Strategies.

Int J Behav Dev 2020 Nov 20;44(6):551-556. Epub 2020 Mar 20.

Department of Psychology, Georgia State University, Atlanta, USA.

Prosocial behavior is a highly heterogeneous construct, and young children use distinct prosocial actions in response to differing emotional needs of another person. This study examined whether toddlers' prosocial responses differed in response to two understudied emotional contexts-whether or not children caused a victim's distress, and the specific emotion expressed by the victim. Toddlers ( = 86; =35 months) and their parent participated in two separate mishap paradigms in which parents feigned pain and sadness, respectively. Half of the sample was led to believe they had transgressed to cause their parent's distress, whereas the other half simply witnessed parent distress as bystanders. Results indicated that toddlers were overall equally prosocial when they were transgressors compared to when they were bystanders, and significantly more prosocial in response to sadness than pain Toddlers were significantly more likely to use affection as transgressors than bystanders, information seeking as bystanders than transgressors, and affection in response to pain than sadness. All children used greater helping in response to sadness than pain, and this was especially true when they were bystanders. Findings add to mounting evidence of the complexity of prosocial action in early childhood by identifying that two, distinct emotional contexts influence the amount and type of prosocial behaviors that toddlers use to help others.
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http://dx.doi.org/10.1177/0165025420912007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983853PMC
November 2020

Obstetric and perinatal outcomes for women with pre-existing diabetes in rural compared to metropolitan settings in Victoria, Australia.

Aust N Z J Obstet Gynaecol 2021 06 24;61(3):373-379. Epub 2021 Jan 24.

Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.

Background: Pre-existing diabetes in pregnancy is associated with an increased risk of complications. Likewise, living in rural, regional and remote Victoria, Australia, is also associated with poorer health outcomes. There is a gap in the literature with regard to whether Victorian women with pre-existing diabetes experience a greater risk of adverse pregnancy outcomes compared to their metropolitan counterparts.

Aim: Our objective is to compare obstetric and perinatal outcomes for women with pre-existing diabetes delivering in rural vs metropolitan hospitals in Victoria, Australia.

Materials And Methods: Retrospective population-based study using routinely collected state-based data of singleton births to women with type 1 and type 2 diabetes who delivered in metropolitan (n = 3233) and rural hospitals (n = 693) in Victoria, Australia, between 2006-2015. Pearson's χ test, Fisher's exact test and MannWhitney U-test were used to compare obstetric and perinatal outcomes between metropolitan and rural locations.

Results: Delivery in a rural hospital was associated with higher rates of stillbirth (2.3% vs 1.1%, P = 0.027), macrosomia (25.9% vs 16.9%, P < 0.001), shoulder dystocia (8.4% vs 3.5%, P < 0.001) and admission to the neonatal intensive care unit/special care nursery (73.2% vs 59.3%, P < 0.001). Smoking (18.0% vs 8.9%, P < 0.001), overweight/obesity (P = 0.047) and socioeconomic disadvantage (P < 0.001) were more common in rural women.

Conclusions: Women with pre-existing diabetes who deliver in rural hospitals experience a greater risk of adverse perinatal outcomes and present with increased maternal risk factors. These results suggest a need to improve care for women with pre-existing diabetes in rural Victoria.
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http://dx.doi.org/10.1111/ajo.13295DOI Listing
June 2021

Sleep habits of intermediate-aged students: roles for the students, parents and educators.

N Z Med J 2020 04 3;133(1512):59-66. Epub 2020 Apr 3.

Respiratory and Sleep Physician, School of Medicine, University of Otago, Christchurch; Department of Respiratory Medicine, CDHB, Christchurch.

Aim: Obtain an overview of the current sleep habits and sleep hygiene practices in a group of intermediate-aged students, and establish whether these students achieve adequate sleep according to the New Zealand education and health guidelines.

Methods: A standardised sleep health questionnaire and seven-day sleep diary were completed by 163 participants (aged 11-13; 62% female) from a cross-section of five Christchurch schools.

Results: In this group, 71% of students reported 9-11 hours of sleep per night (averaged over seven days). Total sleep time was independent of gender and the day of the week. Bedtimes and wake-times were earlier from Monday-Thursday compared to the weekend (p<0.0001). Fifty-nine percent of students used a device in the hour before bed. Pre-bedtime device users were more likely to achieve less sleep than non-device users (p<0.001). The majority of students (66%) did not choose their bedtime.

Conclusions: In this group of students, the majority achieved a sleep duration within the advised Ministry of Education and Sleep Health Foundation guidelines, despite non-recommended sleep hygiene practices in the pre-bed routine. Parental guidance, with respect to bed times and reduction in device usage before sleep are two factors that could be employed to improve sleep in this group.
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April 2020

Effect of tobacco smoking on outcomes after left ventricular assist device implantation.

Artif Organs 2020 Jul 26;44(7):693-699. Epub 2020 Feb 26.

Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.

Despite the well-established correlation between the tobacco use and cardiovascular disease, little is known about postoperative outcomes following the left ventricular assist device (LVAD) implantation. We aimed to elucidate the effect of tobacco smoking on post-LVAD implant outcomes. Patients who received LVADs from 2013 to 2018 were retrospectively characterized as current, former, or never smokers at the time of implant. We examined 1-year survival, total hospital readmissions, and specific hospital readmissions for LVAD-related adverse events based on patient's smoking status. Of the enrolled patients (n = 292), 55% were former smokers, 33% were never smokers, and 11% were current smokers. The majority of patients were African-American (48%) with a median age of 58 years. Never smokers were younger and less likely to be Caucasian compared to former or current smokers (P < .05, for both). The category of former smokers had statistically comparable total readmission rates with never smokers (2.49 vs. 2.13 event/year), whereas current smokers had significantly higher rates compared to never smokers (2.81 events/year, P < .05), with odds ratio 2.12 (95% CI = 1.35-3.32) adjusted for age and Caucasian race for >5 times of total readmissions per year. The rates of driveline infection, stroke, and hemolysis were statistically comparable between the never smokers and former smokers, while current smokers had significantly higher rates compared to never smokers (P < .05 for all).
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http://dx.doi.org/10.1111/aor.13660DOI Listing
July 2020

Toddlers imitate prosocial demonstrations in bystander but not transgressor contexts.

J Exp Child Psychol 2020 04 16;192:104776. Epub 2020 Jan 16.

Department of Psychology, Georgia State University, Atlanta, GA 30303, USA.

Although prosocial abilities are associated with a wide range of healthy outcomes, few studies have experimentally examined socialization practices that may cause increased prosocial responding. The purpose of this study was to investigate conditions under which 2- and 3-year-old children can acquire prosocial behaviors through imitation. In Study 1 (N = 53), toddlers in the experimental condition watched a video of an adult comfort a woman in distress by performing a novel prosocial action without depicting how the woman was hurt. Parents then pretended they hurt their own finger and feigned distress. Children in the experimental condition were more likely to imitate the novel action relative to two control groups: (a) children who did not watch the video but witnessed a distressed parent, and (b) children who watched the video but witnessed parents engage in a neutral interaction. Thus, in a bystander context where children witnessed parent distress, toddlers imitated a general demonstration of how to respond prosocially to distress and applied this information to a specific distress scenario. In Study 2 (N = 54), the procedures were identical to those in the first study except that children were led to believe that they had transgressed to cause parent distress. In a transgressor context, children in the experimental condition were not more likely to imitate the prosocial behavior relative to children in either control group. These studies demonstrate that whether or not children have caused a victim's distress greatly affects their ability to apply a socially learned prosocial behavior, possibly due to self-conscious emotions such as guilt and shame.
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http://dx.doi.org/10.1016/j.jecp.2019.104776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397716PMC
April 2020

Pregnancy outcomes for women with pre-pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review.

Aust N Z J Obstet Gynaecol 2019 04 31;59(2):183-194. Epub 2018 Oct 31.

Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.

Background: Historically, pre-pregnancy diabetes (PPDM) is a recognised risk factor for poor pregnancy outcome. Co-existing pathology and adverse social determinants including rural-metropolitan inequities in health and healthcare access may confer additional risks. Multidisciplinary care before, during and after pregnancy can improve outcomes for women with PPDM and their infants. The extent to which rural Australian women and their families share in improved outcomes is unknown. We aimed to summarise maternal characteristics and pregnancy outcomes for women with PPDM, including women in rural settings and examine applications of existing clinical guidelines to rural Australian practice.

Methods: We sought English language population and cohort studies about PPDM using Medline, Embase, PubMed, Australian epidemiological and international clinical practice guidelines.

Results: Women with PPDM are changing: older, more obese, of lower parity, less likely to smoke, more likely to have type 2 rather than type 1 diabetes and shorter duration of PPDM. Women with PPDM continue to experience excess adverse pregnancy outcomes, including maternal morbidity, complicated birth, perinatal loss, congenital anomalies and mother-infant separation. On face value, clinical guidelines appear relevant to women living in rural settings but there are only a few, conflicting outcome studies for rural women with PPDM.

Conclusions: PPDM is changing. A significant minority live in rural locations, and although perinatal mortality/morbidity seems to be improving, it is unclear if this is also true for rural women due to a lack of recent Australian studies. Further research is necessary to achieve excellence everywhere for women with PPDM and their babies.
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http://dx.doi.org/10.1111/ajo.12913DOI Listing
April 2019

Cardiac recovery via extended cell-free delivery of extracellular vesicles secreted by cardiomyocytes derived from induced pluripotent stem cells.

Nat Biomed Eng 2018 May 23;2(5):293-303. Epub 2018 Apr 23.

Department of Medicine, Columbia University, New York, NY, USA.

The ability of extracellular vesicles (EVs) to regulate a broad range of cellular processes has recently been exploited for the treatment of diseases. For example, EVs secreted by stem cells injected into infarcted hearts can induce recovery through the delivery of stem-cell-specific miRNAs. However, the retention of the EVs and the therapeutic effects are short-lived. Here, we show that an engineered hydrogel patch capable of slowly releasing EVs secreted from cardiomyocytes derived from induced pluripotent stem (iPS) cells reduced arrhythmic burden, promoted ejection-fraction recovery, decreased cardiomyocyte apoptosis 24 hours after infarction, and reduced infarct size and cell hypertrophy 4 weeks post-infarction when implanted onto infarcted rat hearts. We also show that the EVs are enriched with cardiac-specific miRNAs known to modulate cardiomyocyte-specific processes. The extended delivery of EVs secreted from iPS-cell-derived cardiomyocytes into the heart may help understand heart recovery and treat heart injury.
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http://dx.doi.org/10.1038/s41551-018-0229-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159913PMC
May 2018

Preschool physics: Using the invisible property of weight in causal reasoning tasks.

PLoS One 2018 21;13(3):e0192054. Epub 2018 Mar 21.

Institute for Learning & Brain Sciences, University of Washington, Seattle, Washington, United States of America.

Causal reasoning is an important aspect of scientific thinking. Even young human children can use causal reasoning to explain observations, make predictions, and design actions to bring about specific outcomes in the physical world. Weight is an interesting type of cause because it is an invisible property. Here, we tested preschool children with causal problem-solving tasks that assessed their understanding of weight. In an experimental setting, 2- to 5-year-old children completed three different tasks in which they had to use weight to produce physical effects-an object displacement task, a balance-scale task, and a tower-building task. The results showed that the children's understanding of how to use object weight to produce specific object-to-object causal outcomes improved as a function of age, with 4- and 5-year-olds showing above-chance performance on all three tasks. The younger children's performance was more variable. The pattern of results provides theoretical insights into which aspects of weight processing are particularly difficult for preschool children and why they find it difficult.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192054PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862406PMC
June 2018

Do Children Understand Iconic Gestures About Events as Early as Iconic Gestures About Entities?

J Psycholinguist Res 2018 Jun;47(3):741-754

Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302, USA.

Children can understand iconic co-speech gestures that characterize entities by age 3 (Stanfield et al. in J Child Lang 40(2):1-10, 2014; e.g., "I'm drinking" [Formula: see text] tilting hand in C-shape to mouth as if holding a glass). In this study, we ask whether children understand co-speech gestures that characterize events as early as they do so for entities, and if so, whether their understanding is influenced by the patterns of gesture production in their native language. We examined this question by studying native English speaking 3- to 4 year-old children and adults as they completed an iconic co-speech gesture comprehension task involving motion events across two studies. Our results showed that children understood iconic co-speech gestures about events at age 4, marking comprehension of gestures about events one year later than gestures about entities. Our findings also showed that native gesture production patterns influenced children's comprehension of gestures characterizing such events, with better comprehension for gestures that follow language-specific patterns compared to the ones that do not follow such patterns-particularly for manner of motion. Overall, these results highlight early emerging abilities in gesture comprehension about motion events.
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http://dx.doi.org/10.1007/s10936-017-9550-7DOI Listing
June 2018

Disruption of amyloid precursor protein ubiquitination selectively increases amyloid β (Aβ) 40 levels via presenilin 2-mediated cleavage.

J Biol Chem 2017 12 11;292(48):19873-19889. Epub 2017 Oct 11.

From the Department of Pathology and Cell Biology and

Amyloid plaques, a neuropathological hallmark of Alzheimer's disease, are largely composed of amyloid β (Aβ) peptide, derived from cleavage of amyloid precursor protein (APP) by β- and γ-secretases. The endosome is increasingly recognized as an important crossroad for APP and these secretases, with major implications for APP processing and amyloidogenesis. Among various post-translational modifications affecting APP accumulation, ubiquitination of cytodomain lysines may represent a key signal controlling APP endosomal sorting. Here, we show that substitution of APP C-terminal lysines with arginine disrupts APP ubiquitination and that an increase in the number of substituted lysines tends to increase APP metabolism. An APP mutant lacking all C-terminal lysines underwent the most pronounced increase in processing, leading to accumulation of both secreted and intracellular Aβ40. Artificial APP ubiquitination with rapalog-mediated proximity inducers reduced Aβ40 generation. A lack of APP C-terminal lysines caused APP redistribution from endosomal intraluminal vesicles (ILVs) to the endosomal limiting membrane, with a subsequent decrease in APP C-terminal fragment (CTF) content in secreted exosomes, but had minimal effects on APP lysosomal degradation. Both the increases in secreted and intracellular Aβ40 were abolished by depletion of presenilin 2 (PSEN2), recently shown to be enriched on the endosomal limiting membrane compared with PSEN1. Our findings demonstrate that ubiquitin can act as a signal at five cytodomain-located lysines for endosomal sorting of APP. They further suggest that disruption of APP endosomal sorting reduces its sequestration in ILVs and results in PSEN2-mediated processing of a larger pool of APP-CTF on the endosomal membrane.
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http://dx.doi.org/10.1074/jbc.M117.818138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712626PMC
December 2017

Type of iconicity influences children's comprehension of gesture.

J Exp Child Psychol 2018 Feb;166:327-339

Georgia State University, Department of Psychology, PO Box 5010, Atlanta, GA 30302-5010, United States. Electronic address:

Children produce iconic gestures conveying action information earlier than the ones conveying attribute information (Özçalışkan, Gentner, & Goldin-Meadow, 2014). In this study, we ask whether children's comprehension of iconic gestures follows a similar pattern, also with earlier comprehension of iconic gestures conveying action. Children, ages 2-4years, were presented with 12 minimally-informative speech+iconic gesture combinations, conveying either an action (e.g., open palm flapping as if bird flying) or an attribute (e.g., fingers spread as if bird's wings) associated with a referent. They were asked to choose the correct match for each gesture in a forced-choice task. Our results showed that children could identify the referent of an iconic gesture conveying characteristic action earlier (age 2) than the referent of an iconic gesture conveying characteristic attribute (age 3). Overall, our study identifies ages 2-3 as important in the development of comprehension of iconic co-speech gestures, and indicates that the comprehension of iconic gestures with action meanings is easier than, and may even precede, the comprehension of iconic gestures with attribute meanings.
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http://dx.doi.org/10.1016/j.jecp.2017.08.009DOI Listing
February 2018

Adding sound to theory of mind: Comparing children's development of mental-state understanding in the auditory and visual realms.

J Exp Child Psychol 2017 12 14;164:239-249. Epub 2017 Aug 14.

A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA.

Theory of mind (ToM) gradually develops during the preschool years. Measures of ToM usually target visual experience, but auditory experiences also provide valuable social information. Given differences between the visual and auditory modalities (e.g., sights persist, sounds fade) and the important role environmental input plays in social-cognitive development, we asked whether modality might influence the progression of ToM development. The current study expands Wellman and Liu's ToM scale (2004) by testing 66 preschoolers using five standard visual ToM tasks and five newly crafted auditory ToM tasks. Age and gender effects were found, with 4- and 5-year-olds demonstrating greater ToM abilities than 3-year-olds and girls passing more tasks than boys; there was no significant effect of modality. Both visual and auditory tasks formed a scalable set. These results indicate that there is considerable consistency in when children are able to use visual and auditory inputs to reason about various aspects of others' mental states.
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http://dx.doi.org/10.1016/j.jecp.2017.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591778PMC
December 2017

Meaningful Use of an Electronic Personal Health Record (ePHR) among Pediatric Cancer Survivors.

Appl Clin Inform 2017 03 15;8(1):250-264. Epub 2017 Mar 15.

Rebecca Williamson, MPH, 2015 Upper Gate Drive, 4th Floor, Atlanta, GA 30322, Phone: 404.785.9929 Fax: 404.785.9248, Email:

Background and Objectivs: Survivors of pediatric and adolescent cancer are at an increased risk of chronic and debilitating health conditions and require life-long specialized care. Stand-alone electronic personal health records (ePHRs) may aid their self-management. This analysis characterizes young adult survivors and parents who meaningfully use an ePHR, Cancer SurvivorLink, designed for survivors of pediatric and adolescent cancer.

Methods: This was a retrospective observational study of patients seen at a pediatric survivor clinic for annual survivor care. Young adult survivors and/or parent proxies for survivors <18 years old who completed ePHR registration prior to their appointment or within 90 days were classified as registrants. Registrants who uploaded or downloaded a document and/or shared their record were classified as meaningful users.

Results: Overall, 23.7% (148/624) of survivors/parents registered and 38% of registrants used SurvivorLink meaningfully. Young adult registrants who transferred to adult care during the study period were more likely to be meaningful users (aOR: 2.6 (95% CI: 1.1, 6.1)) and used the ePHR twice as frequently as those who continued to receive care in our institution's pediatric survivor clinic. Among survivors who continued to receive care at our institution, being a registrant was associated with having an annual follow-up visit (aOR: 2.6 (95% CI: 1.2, 5.8)).

Conclusions: While ePHRs may not be utilized by all survivors, SurvivorLink is a resource for a subset and may serve as an important bridge for patients who transfer their care. Using SurvivorLink was also associated with receiving recommended annual survivor care.
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http://dx.doi.org/10.4338/ACI-2016-11-RA-0189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373768PMC
March 2017

Yield of screening echocardiograms during pediatric follow-up in survivors treated with anthracyclines and cardiotoxic radiation.

Pediatr Blood Cancer 2017 06 14;64(6). Epub 2016 Dec 14.

Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Background: Guidelines published by the Children's Oncology Group recommend screening echocardiograms for childhood cancer survivors exposed to anthracyclines and/or cardiotoxic radiation. This study aims to assess risk factors for cardiac late effects while evaluating the overall yield of screening echocardiograms.

Procedure: Demographics, exposures, and echocardiogram results were abstracted from the medical records of survivors diagnosed at ≤ 21 years old and ≥ 2 years off therapy who were exposed to anthracyclines and/or potentially cardiotoxic radiotherapy. Descriptive statistics and logistic regressions were performed and the yield of screening echocardiograms was calculated.

Results: Of 853 patients, 1,728 screening echocardiograms were performed, and 37 patients had an abnormal echocardiogram (overall yield 2.1%). Yields were only somewhat higher in more frequently screened patients. Risk factors for an abnormal result included anthracycline dose of ≥300 mg/m (adjusted odds ratio [aOR] 3.1; 95% confidence interval [CI]: 1.3-7.2; P < 0.01) with a synergist relationship in patients who also received radiation doses ≥30 Gy (aOR 7.0; 95% CI: 1.6-31.9; P = 0.01), as well as autologous bone marrow transplant (OR 3.3; 95% CI: 1.3-8.5; P = 0.01). Sex, race, age at diagnosis, and cyclophosphamide exposure were not statistically significant risk factors, and no patient receiving <100 mg/m anthracycline dose without concomitant radiation had an abnormal echocardiogram.

Conclusions: Dose-dependent and synergist anthracycline and cardiotoxic radiotherapy risks for developing cardiomyopathy were confirmed. However, previously identified risk factors including female sex, black race, and early age at diagnosis were not replicated in this cohort. The yields showed weak correlation across frequency categories. Echocardiographic screening recommendations for low-risk pediatric patients may warrant re-evaluation.
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http://dx.doi.org/10.1002/pbc.26367DOI Listing
June 2017

Alcohol Electronic Screening and Brief Intervention: A Community Guide Systematic Review.

Am J Prev Med 2016 11;51(5):801-811

Los Angeles County Department of Public Health, Los Angeles, California.

Context: Excessive drinking is responsible for one in ten deaths among working-age adults in the U.S. annually. Alcohol screening and brief intervention is an effective but underutilized intervention for reducing excessive drinking among adults. Electronic screening and brief intervention (e-SBI) uses electronic devices to deliver key elements of alcohol screening and brief intervention, with the potential to expand population reach.

Evidence Acquisition: Using Community Guide methods, a systematic review of the scientific literature on the effectiveness of e-SBI for reducing excessive alcohol consumption and related harms was conducted. The search covered studies published from 1967 to October 2011. A total of 31 studies with 36 study arms met quality criteria and were included in the review. Analyses were conducted in 2012.

Evidence Synthesis: Twenty-four studies (28 study arms) provided results for excessive drinkers only and seven studies (eight study arms) reported results for all drinkers. Nearly all studies found that e-SBI reduced excessive alcohol consumption and related harms: nine study arms reported a median 23.9% reduction in binge-drinking intensity (maximum drinks/binge episode) and nine study arms reported a median 16.5% reduction in binge-drinking frequency. Reductions in drinking measures were sustained for up to 12 months.

Conclusions: According to Community Guide rules of evidence, e-SBI is an effective method for reducing excessive alcohol consumption and related harms among intervention participants. Implementation of e-SBI could complement population-level strategies previously recommended by the Community Preventive Services Task Force for reducing excessive drinking (e.g., increasing alcohol taxes and regulating alcohol outlet density).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082433PMC
http://dx.doi.org/10.1016/j.amepre.2016.04.013DOI Listing
November 2016

Multivitamin Use and Serum Vitamin B12 Concentrations in Older-Adult Metformin Users in REGARDS, 2003-2007.

PLoS One 2016 11;11(8):e0160802. Epub 2016 Aug 11.

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.

Metformin, an insulin-sensitizing drug, is a first line treatment for type 2 diabetes. Long-term use of metformin has been associated with subsequent reductions in vitamin B12 concentrations. The objective of our study was to determine whether metformin use is associated with lower serum vitamin B12 concentrations in older adults, and whether concurrent use of multivitamins modifies this association. We examined 2,510 participants aged 50 years and over, participating in the national population-based Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Multivariable linear and logistic regression models were used to assess associations between multivitamin use and serum vitamin B12 concentrations. We estimated adjusted odds ratios (aOR)s and confidence intervals (CI)s. Results were stratified by three metformin/diabetes sub-groups: 1) participants with diabetes who were metformin users; 2) participants with diabetes who were not metformin users; and 3) participants without diabetes. We found that diabetic metformin users had significantly lower geometric mean serum B12 concentrations (409 pmol/L) than the group with diabetes not taking metformin (485 pmol/L; P<0.01), and the group without diabetes (445 pmol/L; P = 0.02). The geometric mean serum B12 concentrations were greater for multivitamin users (509 pmol/L) compared to those who did not use multivitamins (376 pmol/L; p<0.01). Among the participants with diabetes who were on metformin therapy, multivitamin use was associated with geometric mean serum vitamin B12 concentrations that were 50% (or 161 pmol/L) higher, compared to those not using multivitamins. Among metformin users, multivitamin use was associated with lower prevalence of combined low and borderline vitamin B12 concentrations (aOR = 0.14; 95% CI = 0.04, 0.54) compared to those not using multivitamins. In conclusion, metformin use was associated with lower geometric mean serum vitamin B12 concentrations among diabetic older adults compared to their counterparts. Concurrent multivitamin use may potentially protect against low or borderline vitamin B12 concentrations in long-term metformin users. Additional research is needed to further examine this association as low or borderline vitamin B12 concentrations can be preventable, or treatable if detected at an early stage, in long-term metformin users.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160802PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981300PMC
July 2017

Analysis of Risk Factors for Abnormal Pulmonary Function in Pediatric Cancer Survivors.

Pediatr Blood Cancer 2016 07 22;63(7):1264-71. Epub 2016 Mar 22.

Georgia Pediatric Pulmonary Associates, Atlanta, Georgia.

Background: Childhood cancer survivors are at increased risk for pulmonary-related morbidity and mortality. The Children's Oncology Group Long-Term Follow-Up (COG-LTFU) guidelines recommend pulmonary function testing after treatment with bleomycin, busulfan, carmustine, lomustine, thoracic radiation, bone marrow transplant, or pulmonary surgery. The aim of this analysis was to determine the prevalence of pulmonary function abnormalities in a pediatric survivor cohort.

Procedure: Patients ≥5 years old seen in our survivor clinic with at least one exposure outlined by COG-LFTU Guidelines were included. Original pulmonary function test (PFT) results were obtained and blindly reinterpreted by a single reviewer. Demographic, diagnosis, treatment factors, and clinical and/or patient-reported symptoms of cough, wheeze, and/or dyspnea were abstracted from their medical record.

Results: Overall, 143 (63.3%) survivors had PFT results available; 55.2% were male, 49.7% were white, and the mean age was 14.1 ± 4.8 years. Abnormal PFTs were found in 65.0% (n = 93) with 21.0% having multiple abnormalities. Specifically, 41.3% had hyperinflation, 25.9% had obstructive, and 13.3% had restrictive disease. Patients diagnosed at <5 years were more likely to have a pulmonary abnormality (P = 0.04); a majority of those diagnosed <5 years underwent pulmonary surgery or thoracic radiation. Regardless of the presence of a PFT abnormality, more than 80% of survivors were asymptomatic (82.9% vs.81.5%; P-value = 0.54).

Conclusions: Almost two-thirds of survivors screened per the COG-LTFU Guidelines had an abnormal PFT but a majority reported no clinical symptoms. Hyperinflation was the most prevalent abnormality.
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http://dx.doi.org/10.1002/pbc.25969DOI Listing
July 2016

Infertility Education: Experiences and Preferences of Childhood Cancer Survivors.

J Pediatr Oncol Nurs 2016 07 18;33(4):257-64. Epub 2015 Nov 18.

Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA.

The majority of children diagnosed with cancer will become long-term survivors; however, many will suffer late effects of treatment, including infertility. Educating patients about potential risk for infertility is important, yet little is known regarding when patients would like to hear this information. The purpose of this study was to assess young adult survivors' previous experience in receiving education about their risk for infertility and determine their preferences for infertility education at various time points during and after treatment. Only 36% of survivors report receiving education about risk for infertility at diagnosis, 39% at end of therapy, and 72% in long-term follow-up/survivor clinic visits. Survivors consistently identified their oncologist as a preferred educator at each time point. Although almost all participants identified wanting education at diagnosis, this time point alone may not be sufficient. End of therapy and survivorship may be times this message should be repeated and adapted for the survivor's needs and developmental stage: conversations about the impact of cancer treatment on future fertility should be ongoing.
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http://dx.doi.org/10.1177/1043454215607342DOI Listing
July 2016

Autophagy and endosomal trafficking inhibition by Vibrio cholerae MARTX toxin phosphatidylinositol-3-phosphate-specific phospholipase A1 activity.

Nat Commun 2015 Oct 26;6:8745. Epub 2015 Oct 26.

Department of Microbiology-Immunology, Northwestern University, Feinberg School of Medicine, 303 E Chicago Avenue, Chicago, Illinois 60611, USA.

Vibrio cholerae, responsible for acute gastroenteritis secretes a large multifunctional-autoprocessing repeat-in-toxin (MARTX) toxin linked to evasion of host immune system, facilitating colonization of small intestine. Unlike other effector domains of the multifunctional toxin that target cytoskeleton, the function of alpha-beta hydrolase (ABH) remained elusive. This study demonstrates that ABH is an esterase/lipase with catalytic Ser-His-Asp triad. ABH binds with high affinity to phosphatidylinositol-3-phosphate (PtdIns3P) and cleaves the fatty acid in PtdIns3P at the sn1 position in vitro making it the first PtdIns3P-specific phospholipase A1 (PLA1). Expression of ABH in vivo reduces intracellular PtdIns3P levels and its PtdIns3P-specific PLA1 activity blocks endosomal and autophagic pathways. In accordance with recent studies acknowledging the potential of extracellular pathogens to evade or exploit autophagy to prevent their clearance and facilitate survival, this is the first report highlighting the role of ABH in inhibiting autophagy and endosomal trafficking induced by extracellular V. cholerae.
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http://dx.doi.org/10.1038/ncomms9745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640098PMC
October 2015

Brief Report: Imitation of Object-Directed Acts in Young Children with Autism Spectrum Disorders.

J Autism Dev Disord 2016 Feb;46(2):691-7

Department of Psychology, Georgia State University, P. O. Box 5010, Atlanta, GA, 30302, USA.

Children with autism spectrum disorders (ASD) imitate less than typically developing (TD) children; however, the specific features and causes of this deficit are still unclear. The current study investigates the role of joint engagement, specifically children's visual attention to demonstrations, in an object-directed imitation task. This sample was recruited from an early ASD screening study, which allows for an examination of these behaviors prior to formal diagnosis and ASD-specific intervention. Children with ASD imitated less than TD children; children with other developmental delays showed no significant difference from the two other screen-positive groups. Additionally, only the ASD group showed decreased visual attention, suggesting that early visual attention plays a role in the social learning of children with ASD.
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http://dx.doi.org/10.1007/s10803-015-2596-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726474PMC
February 2016

Imitation as a mechanism in cognitive development: a cross-cultural investigation of 4-year-old children's rule learning.

Front Psychol 2015 13;6:562. Epub 2015 May 13.

Institute for Learning and Brain Sciences, University of Washington , Seattle, WA, USA.

Children learn about the social and physical world by observing other people's acts. This experiment tests both Chinese and American children's learning of a rule. For theoretical reasons we chose the rule of categorizing objects by the weight. Children, age 4 years, saw an adult heft four visually-identical objects and sort them into two bins based on an invisible property-the object's weight. Children who saw this categorization behavior were more likely to sort those objects by weight than were children who saw control actions using the same objects and the same bins. Crucially, children also generalized to a novel set of objects with no further demonstration, suggesting rule learning. We also report that high-fidelity imitation of the adult's "hefting" acts may give children crucial experience with the objects' weights, which could then be used to infer the more abstract rule. The connection of perception, action, and cognition was found in children from both cultures, which leads to broad implications for how the imitation of adults' acts functions as a lever in cognitive development.
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http://dx.doi.org/10.3389/fpsyg.2015.00562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429617PMC
June 2015

The effects of hydroxyurea and bone marrow transplant on Anti-Müllerian hormone (AMH) levels in females with sickle cell anemia.

Blood Cells Mol Dis 2015 Jun 31;55(1):56-61. Epub 2015 Mar 31.

Emory University School of Medicine, Department of Pediatrics, Division of Endocrinology and Metabolism, 2015 Uppergate Drive, NE Atlanta, GA 30322, USA; Division of Hematology/Oncology/BMT and Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, 2015 Uppergate Drive, NE Atlanta, GA 30322, USA.

Gonadal hypofunction is described in male and female patients with sickle cell anemia (SCA) after bone marrow transplant (BMT) and in males treated with hydroxyurea (HU). Anti-Müllerian hormone (AMH) is a serum marker of ovarian reserve. This study describes AMH and follicle-stimulating hormone (FSH) levels in female SCA subjects treated with supportive care (SCA-SC), HU (SCA-HU) and BMT (SCA-BMT). SCA (SS/Sβ(0)) subjects not on HU, on HU and status-post BMT, ages 10-21 years were recruited. SCA-HU subjects were treated with HU ≥ 20 mg/kg for ≥ 12 consecutive months. SCA-BMT subjects had received busulfan and cyclophosphamide. Serum AMH and random FSH levels were obtained. Diminished ovarian reserve (DOR) was defined as AMH level <5th percentile for age-matched controls. Subjects also with FSH >40 IU/L were classified as having premature ovarian insufficiency (POI). 14 SCA-SC (14.5 ± 2.7 years), 33 SCA-HU (14.4 ± 2.4 years) and 9 SCA-BMT (14.3 ± 2.7 years) females were included. AMH was undetectable in all SCA-BMT subjects and <5th percentile in 24% of SCA-HU subjects. FSH was menopausal (>40 IU/L) in 88.9% of SCA-BMT subjects. All SCA-BMT subjects and 24% of subjects on HU had DOR; 89% of SCA-BMT subjects had POI. AMH and FSH may be useful tools in assessing ovarian reserve and function.
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http://dx.doi.org/10.1016/j.bcmd.2015.03.012DOI Listing
June 2015

Social learning promotes understanding of the physical world: Preschool children's imitation of weight sorting.

J Exp Child Psychol 2015 Aug 9;136:82-91. Epub 2015 Apr 9.

Department of Psychology, Georgia State University, Atlanta, GA 30302, USA.

We investigated whether social learning, specifically imitation, can advance preschoolers' understanding of weight. Preschoolers were randomly assigned to experimental and control groups. The experimental group saw an adult intentionally categorize an array of four visually identical objects based on weight. Then, children's weight-based sorting of the objects was evaluated. To test generalization, children were presented with novel objects (differing in shape, color, and weight from the original ones) and not shown what to do with them. Results indicate that 48-month-olds learned to sort by weight via observing the adult's demonstration of categorization and that children generalized weight sorting to novel objects. This shows that children imitate at a more abstract level than merely motor actions. They learn and imitate generalizable rules. 36-month-olds did not succeed on this weight sorting task. Children's cognitive development constrains what children learn through social observation and imitation.
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http://dx.doi.org/10.1016/j.jecp.2015.02.010DOI Listing
August 2015

Knowledge and risk perception of late effects among childhood cancer survivors and parents before and after visiting a childhood cancer survivor clinic.

J Pediatr Oncol Nurs 2014 Nov-Dec;31(6):339-49. Epub 2014 Jul 10.

Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA.

Survivors of childhood cancer are at risk for a variety of treatment-related late effects and require lifelong individualized surveillance for early detection of late effects. This study assessed knowledge and perceptions of late effects risk before and after a survivor clinic visit. Young adult survivors (≥ 16 years) and parents of child survivors (< 16 years) were recruited prior to initial visit to a cancer survivor program. Sixty-five participants completed a baseline survey and 50 completed both a baseline and follow-up survey. Participants were found to have a low perceived likelihood of developing a late effect of cancer therapy and many incorrect perceptions of risk for individual late effects. Low knowledge before clinic (odds ratio = 9.6; 95% confidence interval, 1.7-92.8; P = .02) and low perceived likelihood of developing a late effect (odds ratio = 18.7; 95% confidence interval, 2.7-242.3; P = .01) were found to predict low knowledge of late effect risk at follow-up. This suggests that perceived likelihood of developing a late effect is an important factor in the individuals' ability to learn about their risk and should be addressed before initiation of education.
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http://dx.doi.org/10.1177/1043454214532022DOI Listing
September 2016

College health as a partner in the care of pediatric cancer survivors.

J Am Coll Health 2014 ;62(7):506-10

a University Health Center, University of Georgia , Athens , Georgia.

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center.

Participants: PARTICIPANTS were University of Georgia (UGA) college health providers.

Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction.

Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms.

Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.
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http://dx.doi.org/10.1080/07448481.2014.917655DOI Listing
February 2016

Extending serum half-life of albumin by engineering neonatal Fc receptor (FcRn) binding.

J Biol Chem 2014 May 20;289(19):13492-502. Epub 2014 Mar 20.

From the Centre for Immune Regulation and Department of Biosciences, University of Oslo, N-0316 Oslo, Norway.

A major challenge for the therapeutic use of many peptides and proteins is their short circulatory half-life. Albumin has an extended serum half-life of 3 weeks because of its size and FcRn-mediated recycling that prevents intracellular degradation, properties shared with IgG antibodies. Engineering the strictly pH-dependent IgG-FcRn interaction is known to extend IgG half-life. However, this principle has not been extensively explored for albumin. We have engineered human albumin by introducing single point mutations in the C-terminal end that generated a panel of variants with greatly improved affinities for FcRn. One variant (K573P) with 12-fold improved affinity showed extended serum half-life in normal mice, mice transgenic for human FcRn, and cynomolgus monkeys. Importantly, favorable binding to FcRn was maintained when a single-chain fragment variable antibody was genetically fused to either the N- or the C-terminal end. The engineered albumin variants may be attractive for improving the serum half-life of biopharmaceuticals.
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http://dx.doi.org/10.1074/jbc.M114.549832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036356PMC
May 2014

Predictors of successful use of a web-based healthcare document storage and sharing system for pediatric cancer survivors: Cancer SurvivorLink™.

J Cancer Surviv 2014 Sep 18;8(3):355-63. Epub 2014 Feb 18.

Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA,

Purpose: Cancer SurvivorLink™, www.cancersurvivorlink.org , is a patient-controlled communication tool where survivors can electronically store and share documents with healthcare providers. Functionally, SurvivorLink serves as an electronic personal health record-a record of health-related information managed and controlled by the survivor. Recruitment methods to increase registration and the characteristics of registrants who completed each step of using SurvivorLink are described.

Methods: Pediatric cancer survivors were recruited via mailings, survivor clinic, and community events. Recruitment method and Aflac Survivor Clinic attendance was determined for each registrant. Registration date, registrant type (parent vs. survivor), zip code, creation of a personal health record in SurvivorLink, storage of documents, and document sharing were measured. Logistic regression was used to determine the characteristics that predicted creation of a health record and storage of documents.

Results: To date, 275 survivors/parents have completed registration: 63 were recruited via mailing, 99 from clinic, 56 from community events, and 57 via other methods. Overall, 66.9 % registrants created a personal health record and 45.7 % of those stored a health document. There were no significant predictors for creating a personal health record. Attending a survivor clinic was the strongest predictor of document storage (p < 0.01). Of those with a document stored, 21.4 % shared with a provider.

Conclusions: Having attended survivor clinic is the biggest predictor of registering and using SurvivorLink.

Implications For Cancer Survivors: Many survivors must advocate for their survivorship care. Survivor Link provides educational material and supports the dissemination of survivor-specific follow-up recommendations to facilitate shared clinical care decision making.
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http://dx.doi.org/10.1007/s11764-014-0346-6DOI Listing
September 2014

Gambling primates: reactions to a modified Iowa Gambling Task in humans, chimpanzees and capuchin monkeys.

Anim Cogn 2014 Jul 7;17(4):983-95. Epub 2014 Feb 7.

Department of Psychology, Georgia State University, Atlanta, GA, USA,

Humans will, at times, act against their own economic self-interest, for example, in gambling situations. To explore the evolutionary roots of this behavior, we modified a traditional human gambling task, the Iowa Gambling Task (IGT), for use with chimpanzees, capuchin monkeys and humans. We expanded the traditional task to include two additional payoff structures to fully elucidate the ways in which these primate species respond to differing reward distributions versus overall quantities of rewards, a component often missing in the existing literature. We found that while all three species respond as typical humans do in the standard IGT payoff structure, species and individual differences emerge in our new payoff structures. Specifically, when variance avoidance and reward maximization conflicted, roughly equivalent numbers of apes maximized their rewards and avoided variance, indicating that the traditional payoff structure of the IGT is insufficient to disentangle these competing strategies. Capuchin monkeys showed little consistency in their choices. To determine whether this was a true species difference or an effect of task presentation, we replicated the experiment but increased the intertrial interval. In this case, several capuchin monkeys followed a reward maximization strategy, while chimpanzees retained the same strategy they had used previously. This suggests that individual differences in strategies for interacting with variance and reward maximization are present in apes, but not in capuchin monkeys. The primate gambling task presented here is a useful methodology for disentangling strategies of variance avoidance and reward maximization.
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http://dx.doi.org/10.1007/s10071-014-0730-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137781PMC
July 2014
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