Candidate agents for pancreatic ductal adenocarcinoma identified by a sub-pathway based method.

AIM: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death worldwide. This study aims to explore the molecular mechanism of PDAC and identify biologically active small molecules capable of targeting the sub-pathways which were dysregulated in the development of PDAC. METHODS: The gene expression profile of GSE28735 microarray data (including 45 matching pairs of pancreatic tumor and adjacent non-tumor tissues) was downloaded from GEO (Gene Expression Omnibus) database. Differentially expressed genes (DEGs) between pancreatic tumor tissues and non-tumor tissues were identified, and then the sub-pathway enrichment analysis was performed. Moreover, an approach based on targeting sub-pathways was used to reveal potential agents for PDAC. RESULTS: A total of 5315 DEGs were identified between pancreatic tumor tissues and non-tumor tissues with a false discovery rate of 0.01. Genes of collagen family and integrin receptor family which were involved in pathways of focal adhesion and ECM-receptor interaction respectively were differentially expressed in the pancreatic tumor tissue. Besides, a total of 85 small molecules including fludrocortisone, latamoxef and metronidazole were revealed by bioinformatics analysis. CONCLUSION: This study proposed the use of an approach based on targeting sub-pathways to identify potential agents for PDAC. The sub-pathways and small molecules discovered in this study were not only related to PDAC but also play a role in perturbing the development of PDAC.

Prevalence of hoarding disorder in individuals at potential risk of eviction in New York City: a pilot study.

This study estimated the prevalence of hoarding disorder (HD) in individuals seeking help from Eviction Intervention Services Housing Research Center (EIS), a not-for-profit community organization in New York City (NYC) that aids clients with housing problems including eviction. One hundred fifteen EIS clients were screened for HD. The prevalence of HD among those seeking help from EIS was 22% (clinician-rated) and 23% (self-rated), which is nearly 5 to 10 times greater than the rate of hoarding (2% to 5%) in the general population. Of individuals seeking help from EIS who met the criteria for HD (n = 25), 32% were currently in legal eviction proceedings (i.e., threatened with imminent eviction), 44% had a history of previous legal eviction proceedings, and 20% had been evicted from their home one or more times, yet only 48% were currently seeking mental health treatment. Almost a quarter of individuals seeking help for housing problems from a community eviction prevention organization met the criteria for HD; only about half of these individuals were receiving mental health treatment. Future studies are needed to determine whether HD treatment can reduce the risk of eviction and homelessness in NYC.

[Measuring and analyzing infrared spectrum of periodically polarized lithium niobate].

The present paper reports theoretical and experimental research on the tunable output characteristics of periodically polarized lithium niobate. We made six equal distance crystal grating sections, with each distance being 0.5 mm and the polarization period range of 29.0-31.5 mm. Especially, at room temperature, the signal-wavelength tunable output in the range of 1 449.7-1 665.0 nm and idle-wavelength tunable output in the range of 3 989.2-2 946.0 nm were achieved by LD end-pumped Nd : YVO4 laser with Q-switch in sound-wave. The lowest excitation threshold was 108.0 mW, while the highest excitation threshold was 149.2 mW. When the pump power was 649 mW, the highest gained signal-wave output was 118.5 mW and its conversion efficiency was 18.26%. Meanwhile, the idle-wave output was 46.6 mW and its conversion efficiency was 7.18%. These parameters approached the practicality level.

A 6-year experience with Pap smears in an urban adolescent practice: the scope and burden of abnormalities.

STUDY OBJECTIVE: To determine the prevalence of cervical dysplasia and adherence to recommendations for referral/follow-up in a group of adolescent girls undergoing routine reproductive health care in a primary care setting. DESIGN: Retrospective review of all screening Papanicolaou (Pap) smears performed between 12/99 and 12/05. SETTING: An urban academic adolescent medicine practice in New York City. PARTICIPANTS: 824 sexually active adolescent girls. MAIN OUTCOMES: Cytology and cervical biopsy results and adherence to follow-up and colposcopy recommendations. RESULTS: Among 824 adolescents ages 12-21 years (mean = 17) who underwent 1 to 6 screening Paps, 81% (n = 666) had normal Pap smears only and 19% (n = 158) had at least one abnormal Pap. Of the 1214 screening Pap smears reviewed, only one was suggestive of a high grade lesion, 85 (7%) revealed atypical squamous cells of undetermined significance (ASCUS), 81 (6.6%) showed low-grade squamous intraepithelial lesions (LGSIL), and the rest were normal. Fifteen percent of patients (n = 123) were referred for at least one colposcopy; only 72% (n = 88) complied. Biopsy identified 5 high-grade lesions; 3 patients required cervical Loop Electrosurgical Excision Procedures: Despite appropriate referrals and access to services, 32% of patients with ASCUS and 28% of patients with LGSIL lacked evidence of either follow-up Pap or colposcopy by the time of last review. CONCLUSIONS: High-grade lesions were rare in our sample, supporting new guidelines for less colposcopy in this age group. Although many adolescents were followed within primary care, achieving appropriate follow-up for those with cervical dysplasia was challenging and often unsuccessful.

Changes in childhood immunization disparities between central cities and their respective states, 2000 versus 2006.

Central cities have lower childhood immunization coverage rates than states in which they are located. We conducted a secondary analysis of the National Immunization Survey (NIS) 2000 and 2006 of children 19-35 months old for 26 NIS-defined central cities and the rest of their respective states in order to examine patterns in early childhood immunization disparities between central cities and their respective states and the contextual factors associated with these disparities. We examined three measures of immunization disparities (absolute, difference, and ratio of change) and the patterns of disparity change with regard to selected contextual factors derived from the census. In 2000, immunization coverage in central cities was 68.3% and 74.7% in the rest of their states, a 6.4% disparity (t = 3.82, p < 0.000). Between 2000 and 2006, the overall city/state disparity narrowed to 3.5%, with the central city coverage up to 78.7% vs. 82.5% for the rest of state (t = 2.48, p = 0.017). However, changes in immunization disparities were not uniform: six cities narrowed, 14 had minimal change, and six widened. Central cities with a larger share of Hispanics experienced less reduction in disparities than other cities (beta = -4.2, t = -2.11, p = 0.047). Despite overall progress in childhood immunization coverage, most central cities still show significant disparities with respect to the rest of their states. Cities with larger Hispanic populations may need extra help in narrowing their disparities.

Effectiveness of a community coalition for improving child vaccination rates in New York City.

We used a retrospective, matching, birth cohort design to evaluate a comprehensive, coalition-led childhood immunization program of outreach, education, and reminders in a Latino, urban community. After we controlled for Latino ethnicity and Medicaid, we found that children enrolled in the program were 53% more likely to be up-to-date (adjusted odds ratio = 1.53; 95% confidence interval = 1.33, 1.75) and to receive timely immunizations than were children in the control group (t = 3.91). The coalition-led, community-based immunization program was effective in improving on-time childhood immunization coverage.

Is underimmunization associated with child maltreatment?

OBJECTIVE: To assess the relationship between underimmunization and child maltreatment among children referred to a child advocacy center for a child maltreatment evaluation. METHODS: We conducted a secondary data analysis of 399 children aged 3 to 48 months who were referred to a child advocacy center at an academic medical center. The primary independent variable was age-appropriate immunization status. The dependent variable was maltreatment (confirmed, suspected, or ruled out). Multivariate models were used to control for insurance, race/ethnicity, and maternal education. RESULTS: At 3 and 7 months of age, underimmunized children were significantly more likely to have confirmed maltreatment than children whose immunizations were up to date (at 3 months, 32.0% vs 17.6%, P < .05; at 7 months, 23.7% vs 8.6%, P < .01). At 19 months, rates were not significantly different (16.1% vs 24.1%, P = .33). In multivariate analyses, children underimmunized at 3 or 7 months of age were 4 times more likely to have confirmed maltreatment compared with children whose immunizations were up to date (at 3 months, adjusted odds ratio [AOR], 3.97, 95% confidence interval [95% CI], 1.67-9.49; at 7 months, AOR, 4.79, 95% CI, 1.47-15.66). This relationship was statistically significant for children evaluated for physical abuse (AOR, 4.34, 95% CI, 1.18-16.02), but not for sexual abuse. CONCLUSIONS: Underimmunization at 3 and 7 months of age was associated with confirmed maltreatment, specifically physical abuse, in children evaluated for child maltreatment. The association between underimmunization and child abuse in the general population deserves further study.

Early onset of overweight and obesity among low-income 1- to 5-year olds in New York City.

Early-childhood obesity has reached epidemic proportions, particularly among low-income, minority, urban children. Understanding the progression of obesity prevalence rates from infancy through early childhood can inform public health efforts to combat this epidemic and create developmentally appropriate strategies. In this study, we assessed the prevalence of overweight and obesity among urban 1- to 5-year olds and estimated risk by age and gender. We surveyed the medical records of a random sample of 1,713 children seen at a New York City primary-care network. Outcome measures were weight-for-length for <2-year olds and body mass index for 2- to 5-year olds. Overweight was defined as percentiles >or=85% to <95%, obesity >or=95%. Analysis utilized chi-square, logistic regression, and z tests. Between 1 and 5 years of age, overweight increased 3.7% to 20.8% and obesity 7.5% to 29.8% (p < 0.01). Risk increased with age: compared with 1-year olds, 5-year olds were 8.2 times as likely (95% confidence interval (CI) = 5.5-12.21) to be overweight or obese. Boys were more likely to be obese than girls (adjusted odds ratio = 1.3; 95% CI = 1-1.64). Significant increases in overweight and obesity occurred between ages 1 and 3 years (overweight, 3.7% to 16%, p < 0.01; obesity, 7.5% to 30.2%, p < 0.01). Among urban children, more than half were overweight or obese by age 5. Overweight and obesity rates increased dramatically between the ages of 1 and 3 years. Interventions aimed at this age period may have the greatest impact at preventing childhood obesity.

Is there a relationship between lacking a primary care provider and child abuse?

OBJECTIVE: To examine the association between lacking a primary care provider and child abuse. METHODS: We conducted a secondary data analysis of 1462 children aged

"Energy Up": a novel approach to the weight management of inner-city teens.

There are few successful adolescent obesity prevention programs. We evaluated "Energy Up," an innovative program for inner-city girls that focuses on addictive food avoidance, exercise, and self-esteem building. Over a 9-month period, obese participants lost 12.9 pounds and overweight participants lost 2.9 pounds, prompting expansion to other schools.

Influenza vaccine coverage and missed opportunities among inner-city children aged 6 to 23 months: 2000-2005.

OBJECTIVE: In 2002, the Advisory Committee on Immunization Practices recommended universal influenza vaccination of 6- to 23-month-olds. Little is known about coverage and missed opportunities for influenza vaccination at inner-city practices. The objective of this study was to assess the 2000-2001 to 2004-2005 coverage and the prevalence of missed opportunities for influenza vaccination among inner-city children. METHODS: We conducted a retrospective review for the 2000-2001 to 2004-2005 influenza seasons at a practice network in New York City. The study population included 5 annual cohorts of 6- to 29-month olds as of March 31 of each year with > or = 1 visit to the network in the previous 12 months (n = 7063). Immunization data were obtained from the network registry and the New York Citywide Immunization Registry. Coverage levels were estimated for 1 dose (partial) and 2 doses (full). Missed opportunities were assessed for visits within each influenza season. RESULTS: Coverage rose steadily throughout the 5 years (full: 1.6% to 23.7%; partial: 1.5% to 18.1%). The relationship between year and coverage was linear. Missed opportunities occurred in 82% of visits and were more common for first (89%) than for repeat doses (38%). Missed opportunities per child per season decreased from 2.9 to 2.0 during the study period. CONCLUSIONS: Influenza vaccine coverage among 6- to 23-month-olds at inner-city practices increased steadily from 2000-2001 through 2004-2005, and the prevalence of missed opportunities per child decreased. However, coverage remained suboptimal, with most of children not vaccinated or undervaccinated. Missed opportunities were major contributors to low coverage.

The impact of DTaP-IPV-HB vaccine on use of health services for young infants.

BACKGROUND: In 2003, a pentavalent vaccine (diphtheria, tetanus and acellular pertussis, injectable polio and hepatitis B) was introduced into the childhood vaccination schedule. A premarketing study showed a higher incidence of fever than with the vaccines administered separately. Because fevers in young infants prompt medical evaluations, this study examines the impact of this vaccine (DTaP-IPV-HB) on subsequent use of health services. METHODS: We compared use of health services among 6- to 10-week-old infants receiving DTaP-IPV-HB (n = 1776) with a historical control receiving the prior schedule (n = 2162) at an inner-city practice network. Data sources included a hospital immunization registry and medical records. Outcome measures were visits to the emergency department and ambulatory practices, fever, tests, antibiotics and hospitalizations. Outcomes were stratified by age (<8, 8-10 weeks) and days since vaccination (3, 7). RESULTS: Infants vaccinated with DTaP-IPV-HB were more likely to visit the ED (1.2% versus 0.6%, P = 0.03) and receive tests (47.6% versus 8.3%, P = 0.03) within 3 days of vaccination compared with the controls. Multivariate analysis showed infants vaccinated with DTaP-IPV-HB had a 7-fold increased risk of receiving a full sepsis workup and a 3-fold increased risk of receiving antibiotics within 7 days of vaccination. Medical evaluations decreased over time after implementation of the DTaP-IPV-HB vaccine. Concurrently, the rate of vaccination for infants <8 weeks markedly dropped. CONCLUSIONS: The DTaP-IPV-HB vaccine was associated with increased use of health services in the emergency department, but these associations lessened over time. These findings reveal a conflict between the obligation of timely and efficient vaccination with the medical management of febrile young infants.

Community-based strategies to reduce childhood immunization disparities.

This study demonstrates how community-based immunization promotion reduced immunization disparities. In 2002 to 2004, the coalition enrolled 3,748 children younger than 5, with 1,502 aged 19 to 35 months in April 2004. Disparity reduction was assessed by comparing coalition immunization coverage rates (4:3:1:3:3) to the National Immunization Survey 2003 rates. Logistic regression was used to assess factors contributing to up-to-date immunizations. Coverage increased from 46.0% at enrollment to 80.5%, matching nationwide rates for all (t = 0.87) or White (t = 1.99) children. The 78% for African Americans was higher than 73% for U.S. African American children (t = 2.90); 84% for Latinos was higher than 77% for U.S. Latinos (t = 2.32). Being current with age-appropriate immunizations at enrollment (OR = 9.8), being Latino (OR = 1.6), and participating through child health insurance enrollment (OR = 4.9), Women, Infants, and Children (OR = 3.1), or child care or parenting (OR = 1.9) programs increased immunization coverage. Embedding immunization promotion into existing community programs was successful in eliminating immunization disparities. Most effective programs were those with direct linkages to health care systems or that targeted young children.

Challenges and successes of immunization registry reminders at inner-city practices.

OBJECTIVES: To assess the effectiveness of two serial registry reminder protocols and the interactive effects of reminders with child characteristics on immunization rates. METHODS: At an inner city practice network in New York City we randomized 1662 children aged 6 weeks-15 months due or late for a diphtheria-tetanus-pertussis (DTaP) to 3 groups: continuous reminders (as needed), limited reminders (up to 3) and controls, for 6 months. Reminders were triggered by the hospital registry and immunizations were tracked with both the hospital and city registries. Analyses were based on intention to treat. RESULTS: At randomization, the study groups were comparable (9.2 months of age, 77% Latino, 86% Medicaid, 49.3% up-to date). A quarter of the children were sent false reminders, 15% had incorrect contact information, and 15% had missed opportunities for vaccination. In the univariate analysis, reminders improved coverage rates, but only for the children sent continuous reminders (51.2% vs. 44.9% controls, p < .01). Multivariate analysis showed reminders had no independent effect on immunization outcomes. Age, up-to-date and Medicaid status at randomization were strong predictors of a child receiving any subsequent immunization. However, reminders interacted synergistically with Medicaid to increase the likelihood of receiving an immunization. CONCLUSION: At an inner city practice network, registry reminders were not effective at improving immunization outcomes due to major system barriers. Immunization registries are powerful vehicles for identifying children in need of immunizations and generating reminders but system challenges must be addressed if this promise is to be achieved in inner city practices.

Early continuity of care and immunization coverage.

OBJECTIVE: We examined the relationship between early and exclusive continuity of care at the initial source of care and immunization coverage. METHODS: We used a cohort study design with 641 randomly selected children initiating care before 3 months and making 2 or more visits to an inner-city practice network. We used 2 complementary data sources: medical records and the New York City Department of Health Citywide Immunization Registry. Immunization measures were cumulative age appropriate and up-to-date at 18 months (UTD18). RESULTS: There was a gradual attrition from the initial source of care. By 18 months, less than half the children (46%) remained in care. Regardless of continuity, nearly half (42%) had used other immunization providers. The initial source of care contributed most immunizations (89%-94%); however, across all levels of continuity, children who also used other providers had higher immunization rates. We found a threshold effect of continuity beginning at 12 months: children in care from 12 to 14 months were 17.5 times more likely to be UTD18 than those in care less than 6 months. Each additional period in care increased the time remaining current with immunizations. Among children UTD18, 88% were in care at 11 months compared with 38% among those not UTD18, a 50% difference. CONCLUSIONS: Continuity of care at the initial source of care had a significant and lasting impact on immunization coverage, even if not used exclusively. Interventions promoting continued use of the medical home over the first 2 years of life may help improve immunization coverage.

Community empowerment to reduce childhood immunization disparities in New York City.

This paper reports on the impact of the community-based Start Right program on childhood immunization coverage in 2 communities of color in New York City. Fully launched in 2002, Start Right operates through the major social service programs of its 23 member organizations. Immunization promotion strategies are based on the following guiding principles: community leadership; integration with community programs; parental empowerment; peer health educators; tracking and feedback; and linkage with health providers. By September 2003, 2,433 children under age 5 years (14% of that age group in the community) were enrolled in Start Right. The rates for the cohort of children enrolled in 2003 were substantially higher than for those enrolled in 2002. Among the 2003 cohort of 19- to 35-month-old children, the coverage rate was 88%, significantly more than national rates: 75% for total population, 68% for African Americans, and 73% for Hispanics. The rate for our 2003 enrollment cohort exceeded the rate for New York City (78%) but did not exceed the New York City average for Hispanics (79%). Of the 2003 enrollment cohort, the Washington Heights children had the highest rates for enrollment (89.6%), exceeding New York City rates. Parents reported a high level of satisfaction with the program.

Impact of the Advisory Committee on Immunization Practices' 4-day grace period in a low-income community.

BACKGROUND: In 2002, the Advisory Committee on Immunization Practices (ACIP) recommended vaccine doses administered < or = 4 days before the minimum age or interval be counted as valid. The study objective was to assess the impact of the 4-day grace period on the need for revaccination and associated costs in a low-income community, compared to standard practice (i.e., repeating all doses that fall outside current ACIP guidelines). METHODS: From 1999 to 2001, semi-annual immunization assessments of 8293 randomly selected children, aged 19-35 months, were conducted at a 16-practice network serving an underserved community in New York City. Outcome measures were rates of antigen-specific invalid doses and number of children needing revaccination, with and without the 4-day grace period. Revaccination costs were based on the Vaccines for Children (VFC) price list. RESULTS: The 4-day grace period reduced the number of children needing revaccination from 17.1% to 12.0%, a drop of 30%. The rates of invalid doses decreased from 1.9% to 1.3%, a drop of 33%. Invalid doses for hepatitis B (HepB)-2 decreased by two thirds (69.7%); for diphtheria-tetanus-acellular pertussis (DTaP)-1, Haemophilus influenzae type b (Hib)-1 and Hib-3 by half (44.9%-50.0%); for Polio-1, Polio-2, Polio-3, and measles-mumps-rubella (MMR) by one third (31.6%-33.3%); and for DTaP-2, DTaP-3, HepB-3, and varicella by nearly one quarter (20.0%-24.0%). At these rates, revaccinating 100,000 children younger than age 3 years would cost 213,588 dollars per year, compared to 152,539 dollars with the 4-day grace period, in vaccine costs alone. CONCLUSIONS: In a low-income community, ACIP's 4-day grace period made a significant impact on the number of children requiring revaccination and on revaccination costs. However, the number of children needing revaccination remains high.

Community-provider partnerships to reduce immunization disparities: field report from northern Manhattan.

In 1996 we launched a community-provider partnership to raise immunization coverage for children aged younger than 3 years in Northern Manhattan, New York City. The partnership was aimed at fostering provider knowledge and accountability, practice improvements, and community outreach. By 1999 the partnership included 26 practices and 20 community groups. Between 1996 and 1999, immunization coverage rates increased in Northern Manhattan 5 times faster than in New York City and 8 times faster than in the United States (respectively, 3.4% vs 0.4% [t = 6.05, p < 0.001] and vs 0.6% [t = 5.65, p < 0.001]). The coverage rate for Northern Manhattan stayed constant through 2000, although it declined during this period for the United States and New York City. We attribute the success at reducing the gap to the effectiveness of our partnership.