1
|
Maharaj A, Jefferies JL, Mulrooney DA, Armstrong GT, Brinkman TM, O'Neil ST, Terrell S, Partin RE, Srivastava DK, Hudson MM, Wang Z, Ness KK. Design and methods of a randomized telehealth-based intervention to improve fitness in survivors of childhood cancer with exercise intolerance. Contemp Clin Trials 2023; 133:107339. [PMID: 37730199 PMCID: PMC10591872 DOI: 10.1016/j.cct.2023.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Exercise intolerance among childhood cancer survivors substantially increases risk for early mortality, reduced cognitive function, poor quality of life, emotional distress, and sub-optimal participation in social roles. Fortunately, exercise intolerance is modifiable, even among individuals with impaired cardiopulmonary and neuromuscular health. This study aims to evaluate the impact of tailored exercise intervention remotely supervised by fitness professionals in survivors with exercise intolerance. Telehealth-based delivery of the intervention aims to enhance uptake by removing the burden of travel and allowing participants to gain confidence with exercise and physical activity at home. METHODS This is an ongoing single-blind, two-arm, prospective, clinical trial that will randomize 160 participants 1:1 to intervention (n = 80) and attention control (n = 80) groups. The intervention group receives an individually tailored exercise prescription based on results from baseline assessments performed remotely via a Health Insurance Portability and Accountability Act-compliant virtual platform and personal preferences for aerobic exercise. Each prescription includes aerobic and strengthening components designed to progress gradually to 150-300-min of moderate aerobic activity and twice weekly strengthening exercises over 20-weeks. The first two weeks are supervised for 6 sessions, tapering to twice/week for weeks 3-4, once/week for weeks 5-8, every other week for weeks 9-16 and once midway between weeks 17-20. The schedule is modifiable depending on participant need, adherence, and response to exercise. Each session is approximately one hour. CONCLUSION This study tests the efficacy of an individually prescribed, virtually supervised exercise intervention on exercise intolerant childhood cancer survivors. CLINICALTRIALS gov registration: NCT04714840.
Collapse
Affiliation(s)
- Arun Maharaj
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - John L Jefferies
- Department of Medicine, University of Tennessee Health Science Center, 920 Madison Avenue, Memphis, TN 38163, USA.
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-260, Memphis, TN 38105, USA.
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Tara M Brinkman
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-740, Memphis, TN 38105, USA.
| | - Sean T O'Neil
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Sarah Terrell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-768, Memphis, TN 38105, USA.
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Zhaoming Wang
- Departments of Epidemiology and Cancer Control and Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MS-735, Memphis, TN 38105, USA.
| |
Collapse
|
2
|
Ware ME, Kadan-Lottick NS, Devidas M, Terrell S, Chow EJ, Ehrhardt MJ, Hardy KK, Chemaitilly W, Hein W, Winick N, Teachey D, Esbenshade A, Armenian SH, Partin RE, Ness KK. Design and methods of a randomized web-based physical activity intervention among children with cancer: A report from the Children's Oncology Group. Contemp Clin Trials 2022; 122:106961. [PMID: 36228982 PMCID: PMC9669240 DOI: 10.1016/j.cct.2022.106961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Promoting physical activity soon after treatment for childhood cancer may benefit health because sedentary lifestyle during curative therapy may perpetuate physical and emotional complications. The primary goals of this study are to evaluate the effects of a 6-month web-based, rewards-based physical activity intervention on fitness, biomarkers of cardiometabolic health, inflammation, adipokine status, quality of life and school attendance, and determine if effect of intervention on markers of cardiometabolic health is mediated by changes in fitness. The primary outcome of interest is fitness (physiological cost index, six-minute walk test) measured at end of intervention. METHODS This ongoing study is a two-arm, prospective, randomized design with accrual goals of 192 children for intervention and control groups. Children ≥8 years and < 16 years of age, not meeting recommended levels of physical activity, who completed therapy within the past 12 months are eligible. Both groups receive: 1) educational materials encouraging physical activity, 2) activity monitor, 3) access to web-based interface designed to motivate physical activity, 4) rewards based on physical activity levels, and 5) access to their activity data on the web-interface. Those randomized to intervention: 1) can view others' activity and interact with other participants, and 2) receive rewards based on physical activity levels throughout the intervention (vs. at the end of the intervention for control group). CONCLUSION Unique, scalable, and portable physical activity interventions that motivate young survivors are needed. This study will inform future web-based physical activity interventions for children with cancer by demonstrating effects of rewards and social interaction. CLINICAL TRIALS ClinicalTrials.gov Identifier: NCT03223753; COG Identifier: ALTE1631.
Collapse
Affiliation(s)
- Megan E Ware
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Sarah Terrell
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Matthew J Ehrhardt
- Oncology Department, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Kristina K Hardy
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Wassim Chemaitilly
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Wendy Hein
- Children's Mercy, Kansas City, MO, United States of America
| | - Naomi Winick
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - David Teachey
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Adam Esbenshade
- Department of Pediatrics, Vanderbilt University, Nashville, TN, United States of America
| | - Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, CA, United States of America
| | - Robyn E Partin
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America.
| |
Collapse
|
3
|
Ostlund BD, Pérez-Edgar KE, Shisler S, Terrell S, Godleski S, Schuetze P, Eiden RD. Prenatal substance exposure and maternal hostility from pregnancy to toddlerhood: Associations with temperament profiles at 16 months of age. Dev Psychopathol 2021; 33:1566-1583. [PMID: 35095214 PMCID: PMC8794013 DOI: 10.1017/s0954579421001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We investigated whether infant temperament was predicted by level of and change in maternal hostility, a putative transdiagnostic vulnerability for psychopathology, substance use, and insensitive parenting. A sample of women (N = 247) who were primarily young, low-income, and had varying levels of substance use prenatally (69 nonsmokers, 81 tobacco-only smokers, and 97 tobacco and marijuana smokers) reported their hostility in the third trimester of pregnancy and at 2, 9, and 16 months postpartum, and their toddler's temperament and behavior problems at 16 months. Maternal hostility decreased from late pregnancy to 16 months postpartum. Relative to pregnant women who did not use substances, women who used both marijuana and tobacco prenatally reported higher levels of hostility while pregnant and exhibited less change in hostility over time. Toddlers who were exposed to higher levels of prenatal maternal hostility were more likely to be classified in temperament profiles that resemble either irritability or inhibition, identified via latent profile analysis. These two profiles were each associated with more behavior problems concurrently, though differed in their association with competence. Our results underscore the utility of transdiagnostic vulnerabilities in understanding the intergenerational transmission of psychopathology risk and are discussed in regards to the Research Domain Criteria (RDoC) framework.
Collapse
Affiliation(s)
- Brendan D. Ostlund
- Department of Psychology, The Pennsylvania State University, University Park, USA
| | | | - Shannon Shisler
- Research Institute on Addictions, University at Buffalo, State University of New York, Buffalo, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, USA
| | - Stephanie Godleski
- Department of Psychology, Rochester Institute of Technology, Rochester, USA
| | - Pamela Schuetze
- Department of Psychology, State University of New York, Buffalo, USA
| | - Rina D. Eiden
- Department of Psychology, The Pennsylvania State University, University Park, USA
| |
Collapse
|
4
|
Shakiba N, Gao MM, Conradt E, Terrell S, Lester BM. Parent-child relationship quality and adolescent health: Testing the differential susceptibility and diathesis-stress hypotheses in African American youths. Child Dev 2021; 93:269-287. [PMID: 34473345 DOI: 10.1111/cdev.13667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study tested two competing models of differential susceptibility and diathesis-stress in a prospective longitudinal study of African American youths (N = 935). It examined whether individual variations in the functioning of the hypothalamic-pituitary-adrenocortical axis at age 11 interact with middle childhood parent-child relationship quality to predict mental and physical health problems in adolescence (ages 11-15 years old). Adolescent boys with lower levels of cortisol reactivity to laboratory challenges had the highest levels of internalizing problems if they experienced a high conflictual relationship with their parents. Equally low-reactive boys, however, reported the lowest number of physical illnesses if their relationship with their parents was characterized by high levels of intimacy and support.
Collapse
Affiliation(s)
- Nila Shakiba
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, Massachusetts, 02215, USA
| | | | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Department of OB/GYN, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Barry M Lester
- Department of Psychiatry, Brown University, Providence, Rhode Island, USA.,Department of Pediatrics, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
5
|
Kaliush PR, Terrell S, Vlisides-Henry RD, Lin B, Neff D, Shakiba N, Conradt E, Crowell SE. Influences of adversity across the lifespan on respiratory sinus arrhythmia during pregnancy. Dev Psychobiol 2021; 63:e22132. [PMID: 34053065 DOI: 10.1002/dev.22132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 12/27/2022]
Abstract
There is limited understanding of factors across the lifespan that influence pregnant women's respiratory sinus arrhythmia (RSA), which could have implications for their health and offspring development. We examined associations among 162 English- and Spanish-speaking pregnant women's childhood maltreatment history, emotion dysregulation, recent life stress, and resting RSA during the third trimester. Moderated mediation analyses indicated that more severe childhood maltreatment history (95% confidence interval (CI) [0.26, 0.63]) and higher emotion dysregulation (95% CI [0.001, 0.006]) predicted more stress during pregnancy, and childhood maltreatment history interacted with emotion dysregulation to predict resting RSA (95% CI [-0.04, -0.0003]). Exploratory analyses revealed that women's health-related stress during pregnancy mediated the relation between emotion dysregulation and RSA regardless of childhood maltreatment severity (95% CI [-0.007, -0.002]). These findings suggest that women's resting RSA during pregnancy may reflect physical and emotional stress accumulation across the lifespan and that relations between early life adversity and prenatal psychophysiology may be buffered by protective factors, such as emotion regulation. In addition, these findings underscore the importance of distinguishing between types of prenatal stress. Given the implications for women's health and offspring development, we urge researchers to continue exploring factors associated with pregnant women's psychophysiology.
Collapse
Affiliation(s)
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, Pennsylvania, USA
| | | | - Betty Lin
- Department of Psychology, University at Albany, State University of New York, New York, USA
| | - Dylan Neff
- Department of Psychology, University of Utah, Utah, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Utah, USA
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Utah, USA.,Department of Pediatrics, University of Utah, Utah, USA.,Department of Obstetrics and Gynecology, University of Utah, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Utah, USA.,Department of Obstetrics and Gynecology, University of Utah, Utah, USA.,Department of Psychiatry, University of Utah, Utah, USA
| |
Collapse
|
6
|
Vlisides-Henry RD, Deboeck PR, Grill-Velasquez W, Mackey S, Ramadurai DKA, Urry JO, Neff D, Terrell S, Gao MM, Thomas LR, Conradt E, Crowell SE. Behavioral and physiological stress responses: Within-person concordance during pregnancy. Biol Psychol 2021; 159:108027. [PMID: 33476701 DOI: 10.1016/j.biopsycho.2021.108027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
During pregnancy, a woman's emotions can have longstanding implications for both her own and her child's health. Within-person emotional concordance refers to the simultaneous measurement of emotional responses across multiple levels of analysis. This method may provide insight into how pregnant women experience emotions in response to stress. We enrolled 162 pregnant women and assessed concordance through autonomic physiology (electrodermal activity [EDA], respiratory sinus arrhythmia [RSA]), and coded behavior (Prosocial, Flight, Displacement) during the Trier Social Stress Test-Speech. We used multilevel models to examine behavioral-physiological concordance and whether self-reported emotion dysregulation moderated these effects. Participants exhibited EDA-Prosocial concordance, suggesting that prosocial behavior may be a marker of stress. Emotion dysregulation did not moderate concordance. These findings provide novel information about behavioral coping to stress in pregnancy. Given the importance of observed behavior in the maintenance and treatment of psychopathology, these findings may provide a launchpad for future perinatal intervention research.
Collapse
Affiliation(s)
- Robert D Vlisides-Henry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA.
| | - Pascal R Deboeck
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Wendy Grill-Velasquez
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Shantavia Mackey
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dinesh K A Ramadurai
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Joshua O Urry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dylan Neff
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Terrell
- 115 Health and Human Development Building, Dept. of Human Development and Family Studies, Pennsylvania State University, State College, PA 16802, USA
| | - Mengyu Miranda Gao
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leah R Thomas
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA; 295 Chipeta Way, Dept. of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - Sheila E Crowell
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 501 Chipeta Way, Dept. of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
| |
Collapse
|
7
|
Conradt E, Shakiba N, Ostlund B, Terrell S, Kaliush P, Shakib JH, Crowell SE. Prenatal maternal hair cortisol concentrations are related to maternal prenatal emotion dysregulation but not neurodevelopmental or birth outcomes. Dev Psychobiol 2020; 62:758-767. [PMID: 32002996 DOI: 10.1002/dev.21952] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/18/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
Hair cortisol concentrations measured during pregnancy have emerged as a novel biomarker for prenatal stress exposure. However, associations between prenatal stress and distress, broadly defined, and hair cortisol concentrations during pregnancy are inconsistent. We examined relations among hair cortisol concentrations during the third trimester with (a) emotion dysregulation and (b) detailed measures of maternal prenatal stress. We also examined the predictive validity of maternal hair cortisol during pregnancy for adverse newborn health outcomes. Cortisol concentrations were derived from 6 cm of hair during the third trimester of pregnancy. Mothers reported on their emotion dysregulation and stress at this time. A standardized newborn neurobehavioral exam was conducted shortly after birth and newborn birth weight and gestational age were assessed from medical records. All hypotheses were preregistered on the Open Science Framework (osf.io/279ng). High levels of emotion dysregulation, but not stress, were predictive of high hair cortisol concentrations. Maternal prenatal BMI mediated the relation between maternal prenatal emotion dysregulation and hair cortisol concentrations. There was no association between hair cortisol and infant birth outcomes. This research supports the notion that transdiagnostic markers of psychopathology are important correlates of hair cortisol concentrations during pregnancy.
Collapse
Affiliation(s)
- Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brendan Ostlund
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | - Parisa Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Julie H Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.,Department of OB/GYN, University of Utah, Salt Lake City, UT, USA.,Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Lin B, Kaliush PR, Conradt E, Terrell S, Neff D, Allen AK, Smid MC, Monk C, Crowell SE. Intergenerational transmission of emotion dysregulation: Part I. Psychopathology, self-injury, and parasympathetic responsivity among pregnant women. Dev Psychopathol 2019; 31:817-831. [PMID: 31064587 PMCID: PMC6790982 DOI: 10.1017/s0954579419000336] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation-a multilevel, transdiagnostic risk factor for psychopathology-and its associations with stress, distress, and SITBs in a sample of pregnant women (26-40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.
Collapse
Affiliation(s)
- Betty Lin
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Parisa R. Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Sarah Terrell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Dylan Neff
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Ashley K. Allen
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Marcela C. Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Catherine Monk
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Sheila E. Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Terrell S, Conradt E, Dansereau L, Lagasse L, Lester B. A developmental origins perspective on the emergence of violent behavior in males with prenatal substance exposure. Infant Ment Health J 2018; 40:54-66. [PMID: 30576590 DOI: 10.1002/imhj.21758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Children with prenatal substance exposure are at increased risk for externalizing behavior problems and violence. However, the contribution of early life experiences for placing these individuals at risk is not well understood. Utilizing a sample of 1,388 children with prenatal substance exposure from the Maternal Lifestyle Study, we attempt to shed light on these contributing factors by examining the impact of infant temperament, maternal sensitivity, and early life stress on the expression of violent behavior at ages 12 through 14 years. Males may be more at risk for increases in violent behavior in early adolescence through a number of early life experiences, such as variability in responses to maternal flexibility and engagement related to individual differences in temperament, as well as exposure to early adversity. Comparing two prevailing developmental theoretical frameworks, deficit models and differential susceptibility, we aim to understand the developmental origins of violent behavior in males by identifying children who may be most susceptible to early caregiving experiences.
Collapse
Affiliation(s)
- Sarah Terrell
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | | | - Lynne Dansereau
- Center for the Study of Children at Risk, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Linda Lagasse
- Center for the Study of Children at Risk, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Barry Lester
- Center for the Study of Children at Risk, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
10
|
Kehne DM, Karasik M, Aglitsky Y, Smyth Z, Terrell S, Weaver JL, Chan Y, Lehmberg RH, Obenschain SP. Implementation of focal zooming on the Nike KrF laser. Rev Sci Instrum 2013; 84:013509. [PMID: 23387652 DOI: 10.1063/1.4789313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In direct drive inertial confinement laser fusion, a pellet containing D-T fuel is imploded by ablation arising from absorption of laser energy at its outer surface. For optimal coupling, the focal spot of the laser would continuously decrease to match the reduction in the pellet's diameter, thereby minimizing wasted energy. A krypton-fluoride laser (λ = 248 nm) that incorporates beam smoothing by induced spatial incoherence has the ability to produce a high quality focal profile whose diameter varies with time, a property known as focal zooming. A two-stage focal zoom has been demonstrated on the Nike laser at the Naval Research Laboratory. In the experiment, a 4.4 ns laser pulse was created in which the on-target focal spot diameter was 1.3 mm (full width at half maximum) for the first 2.4 ns and 0.28 mm for the final 2 ns. These two diameters appear in time-integrated focal plane equivalent images taken at several locations in the amplification chain. Eight of the zoomed output beams were overlapped on a 60 μm thick planar polystyrene target. Time resolved images of self-emission from the rear of the target show the separate shocks launched by the two corresponding laser focal diameters.
Collapse
Affiliation(s)
- D M Kehne
- Plasma Physics Division, Naval Research Laboratory, Washington, DC 20375, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Tylavsky FA, Cowan PA, Terrell S, Hutson M, Velasquez-Mieyer P. Calcium intake and body composition in African-American children and adolescents at risk for overweight and obesity. Nutrients 2010; 2:950-64. [PMID: 22254064 PMCID: PMC3257713 DOI: 10.3390/nu2090950] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 08/27/2010] [Accepted: 09/09/2010] [Indexed: 02/05/2023] Open
Abstract
This study examined the role of calcium intake on body composition in 186 African-American adolescents at risk for overweight and obesity. The average weight of 89.8 kg ± 23.6 (SD) had a mean BMI z score of 2.2. Females with a calcium intake of <314 mg/day had higher percent fat mass compared to those with the highest calcium intakes that were ≥634 mg/day. Compared to those with a low calcium intake (<365 mg/day), those with the highest calcium intake of >701 mg/day had higher intake of thiamin, folate, cobalamin, vitamin D, phosphorus, iron, zinc.
Collapse
Affiliation(s)
- Frances A. Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, 600 Jefferson Avenue, Suite 300, Memphis, TN 38112, USA
- Author to whom correspondence should be addressed;
| | - Patricia A. Cowan
- College of Nursing, University of Tennessee Health Science Center, 920 Madison Avenue, Suite 507N, Memphis, TN 38103, USA;
| | - Sarah Terrell
- Department of Preventive Medicine, University of Tennessee Health Science Center, 600 Jefferson Avenue, Suite 300, Memphis, TN 38112, USA;
| | - Merschon Hutson
- General Clinical Research Center, University of Tennessee Health Science Center, 8 East Methodist University Hospital, Memphis, TN 38104, USA;
| | - Pedro Velasquez-Mieyer
- Lifestyle Diabetes and Obesity Center, University of Tennessee Health Science Center, 1068 Cresthaven, Suite 300, Memphis, TN 38119, USA;
| |
Collapse
|
12
|
Levesque DA, Prochaska JO, Cummins CO, Terrell S, Miranda D. Assessing Medicare beneficiaries' readiness to make informed health plan choices. Health Care Financ Rev 2001; 23:87-104. [PMID: 12500365 PMCID: PMC4194730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Transtheoretical Model (TTM, the "stage model") can guide development of programs to increase Medicare beneficiaries' readiness to make informed health plan choices. In this study, TTM staging algorithms were developed to assess readiness to engage in three types of informed choice: (1) learning about the Medicare program; (2) learning about Medicare health maintenance organizations (HMOs); and (3) reviewing different plan options. Stage of change based on all three algorithms is related to knowledge about the Medicare program and information-seeking. Findings provide evidence for the construct validity of the stage measures and for the applicability of the TTM to informed choice among beneficiaries.
Collapse
|
13
|
Segurado A, Granade T, Parekh B, Nunez CA, Meza R, Amador L, Terrell S, George JR, Lal RB. Presence of HTLV-I and HTLV-II infection in Honduras. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16:308. [PMID: 9402080 DOI: 10.1097/00042560-199712010-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
14
|
Stetler HC, Granade TC, Nunez CA, Meza R, Terrell S, Amador L, George JR. Field evaluation of rapid HIV serologic tests for screening and confirming HIV-1 infection in Honduras. AIDS 1997; 11:369-75. [PMID: 9147429 DOI: 10.1097/00002030-199703110-00015] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the ability of simple, rapid tests to identify HIV-1 antibody-positive specimens in field settings using the World Health Organization's (WHO) alternative testing strategies. DESIGN Three-phase evaluation of simple, rapid assays using banked specimens and prospectively collected serum specimens at regional hospitals and rural clinics. METHODS Seven test (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were evaluated and results compared with standard enzyme immunoassay (EIA) and Western blot results (phase 1). Further evaluation consisted of prospective testing of routine specimens at regional (phase 2; n = 900) and rural, peripheral laboratories (phase 3; n = 1266) throughout Honduras with selected assays. RESULTS Sensitivity and specificity were calculated for each assay and combination of assays for each phase to evaluate the effectiveness of the WHO alternative testing strategies. All tests in all phases were > 99% sensitive after correcting for technical errors, with two exceptions (SUDS, phase 1; HIVCHEK, phase 3). In phase 3, where the testing algorithm was diagnostic, several combinations of assays were 100% sensitive and specific using WHO strategy II or III. For the Honduras Ministry of Health, the combination of Retrocell and Genie was found to be equally sensitive, more specific (no indeterminate results), and less expensive than EIA/Western blot. CONCLUSION Combinations of rapid, simple HIV antibody assays provide sensitivity and specificity performance comparable to EIA/Western blot. Application of these combinations in the WHO alternative testing strategies provides an inexpensive and effective method of determining HIV status. Assay combinations using these strategies can be easily performed in small, rural laboratories and have been implemented in routine HIV screening in Honduras.
Collapse
Affiliation(s)
- H C Stetler
- Division of AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
This study develops two sets of price indices for Medicare physician services. The first measures price changes, and the second measures geographic price differentials. The indices can be used to adjust Medicare physician spending data to examine growth or variations in the volume and intensity of services. In both instances, it is necessary to apply an index form that reflects both the rapid changes and variability in the mix of physician services received by Medicare beneficiaries and their relative importance. This suggests that an index based on a fixed basket of services (e.g., a Laspeyres index) can produce a biased measure of price. An alternative methodology based on the Fisher's Ideal Index form was used. This index allows service weights to vary over time and across areas. In the case of price change, the index is "chained" to acknowledge the introduction of new services over several years. It is concluded that the Fisher's Ideal approach is essential for cross-sectional price comparisons, in light of the high variability in service mix across areas. In measuring price changes, it was found that "chaining" was more important empirically than allowing the relative importance of services to change between years. During the 1985-1989 study period, Medicare payment rates grew, on average, by 3.5% annually. This rate varied across both time and types of services as a result of differential fee updates and explicit pricing policies implemented by Medicare (e.g., reductions in payments for "overvalued" procedures). Cross-sectionally, our results show that 1988 fees in the highest-priced areas were more than 1.5 times those in the lowest-priced areas.
Collapse
|
16
|
Brown TH, Davidson PF, Terrell S, Rayford P, Larson GM. The effect of an intragastric balloon on weight loss, gastric acid secretion, and serum peptide levels. Am Surg 1988; 54:109-12. [PMID: 3341643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The results of our preliminary experience with the gastric balloon program for weight loss in morbidly obese patients are reported. In a pilot project, we measured gastric-acid secretion, gastrin and cholecystokinin (CCK) levels in ten patients before and during balloon therapy in a study of the impact of the balloon on gastric physiology. Gastric-acid secretion tended to decrease following balloon treatment, while gastrin and CCK levels were unchanged suggesting that weight loss is achieved by mechanisms, which are not mediated by gastrin or CCK. The balloon program was then expanded to a group of 29 patients who met the criteria. They were followed for a period of 4 months. Average weight loss for the group was 31 +/- 4 pounds for a monthly average of 8 pounds. The main complications were gastric ulcers in four patients and a small-bowel obstruction in one patient. Satisfactory weight loss was achieved in 80 per cent of patients, but this benefit must be balanced against a relatively high incidence (17%) of side effects, some of which were quite serious. Therefore, the gastric balloon program should still be considered experimental.
Collapse
Affiliation(s)
- T H Brown
- Department of Surgery, University of Louisville, School of Medicine, KY 40292
| | | | | | | | | |
Collapse
|