Author Interviews, Brigham & Women's - Harvard, Cancer Research, Lancet, Pediatrics, Radiation Therapy / 02.02.2016
Proton Radiation Therapy: Treats Pediatric Brain Tumor With Fewer Long Term Side Effects
MedicalResearch.com Interview with:
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Dr. Torunn Yock[/caption]
Dr. Torunn Yock, MD
Director, Pediatric Radiation Oncology
Associate Professor, Harvard Medical School
Radiation Oncology Quality Assurance
Massachusetts General Hospital, Proton Center
Boston, MA
Medical Research: What is the background for this study?
Dr. Yock: Proton radiotherapy is a highly targeted form of radiation therapy that can spare normal tissues better than standard x-ray/photon based radiotherapy. Because, all side effects from radiotherapy come from radiation dose to normal healthy tissues, it is widely believed that proton radiotherapy has great potential to mitigate the side effects of treatment, both acute and long term side effects. There have been many planning studies that show that proton radiation can achieve a more highly conformal dose distribution and appear to spare 50% or more normal tissue from unnecessary irradiation. However, there have been only a handful of retrospective studies that report disease control and side effects of treatment. While the technology looked promising, the definitive clinical data has been lacking to date. Because of this lack of clinical outcome data, the role and benefit of proton radiotherapy has been a subject of great debate in the oncology community. Critics assert that proton radiotherapy is expensive and unproven and therefore a leading culprit in escalating costs of oncologic health care. Proponents assert that when used in the appropriate patient setting, the margin of benefit in terms of improved health outcomes, outweighs the increased cost of treatment.
We embarked on this study to answer help answer the call for prospectively collected clinical outcome data to better define the most appropriate role for proton radiotherapy. Importantly, this study addresses both disease control and side effects of treatment in a pediatric medulloblastoma cohort of children.
Medical Research: What are the main findings?
Dr. Yock: This study shows that disease control in the pediatric medulloblastoma population is very much the same as that which is achieved by photon based radiotherapy treatments. However, more importantly, late side effects commonly attributed to radiotherapy such as neurocognitive decline over time and hearing loss appear to be improved compared with published photon treated cohorts of pediatric medulloblastoma patients. Additionally, adverse late side effects on the cardiopulmonary, GI, and reproductive systems were essentially eliminated.
Dr. Torunn Yock[/caption]
Dr. Torunn Yock, MD
Director, Pediatric Radiation Oncology
Associate Professor, Harvard Medical School
Radiation Oncology Quality Assurance
Massachusetts General Hospital, Proton Center
Boston, MA
Medical Research: What is the background for this study?
Dr. Yock: Proton radiotherapy is a highly targeted form of radiation therapy that can spare normal tissues better than standard x-ray/photon based radiotherapy. Because, all side effects from radiotherapy come from radiation dose to normal healthy tissues, it is widely believed that proton radiotherapy has great potential to mitigate the side effects of treatment, both acute and long term side effects. There have been many planning studies that show that proton radiation can achieve a more highly conformal dose distribution and appear to spare 50% or more normal tissue from unnecessary irradiation. However, there have been only a handful of retrospective studies that report disease control and side effects of treatment. While the technology looked promising, the definitive clinical data has been lacking to date. Because of this lack of clinical outcome data, the role and benefit of proton radiotherapy has been a subject of great debate in the oncology community. Critics assert that proton radiotherapy is expensive and unproven and therefore a leading culprit in escalating costs of oncologic health care. Proponents assert that when used in the appropriate patient setting, the margin of benefit in terms of improved health outcomes, outweighs the increased cost of treatment.
We embarked on this study to answer help answer the call for prospectively collected clinical outcome data to better define the most appropriate role for proton radiotherapy. Importantly, this study addresses both disease control and side effects of treatment in a pediatric medulloblastoma cohort of children.
Medical Research: What are the main findings?
Dr. Yock: This study shows that disease control in the pediatric medulloblastoma population is very much the same as that which is achieved by photon based radiotherapy treatments. However, more importantly, late side effects commonly attributed to radiotherapy such as neurocognitive decline over time and hearing loss appear to be improved compared with published photon treated cohorts of pediatric medulloblastoma patients. Additionally, adverse late side effects on the cardiopulmonary, GI, and reproductive systems were essentially eliminated.
Dr. Lauren Fiechtner[/caption]
MedicalResearch.com Interview with:
Lauren Fiechtner MD MPH
Director of Nutrition
Division of Pediatric Gastroenterology and Nutrition
Massachusetts General Hospital for Children
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Fiechtner: In previous studies, we investigated if distance to a supermarket was associated with a child’s BMI or weight status. These were cross-sectional studies measuring only one point in time. We wondered if distance to a supermarket modified how much children in a behavioral intervention improved their weight or dietary intake. In particular we examined 498 children participating in the Study of Technology to Accelerate Research, which was a randomized controlled trial to treat childhood obesity in Eastern Massachusetts. The intervention included computerized clinician decision support plus a family self-guided behavior change intervention or a health coach intervention, which included text messages to the family to promote behavior change. We found that children living closer to supermarkets were able to increase their fruit and vegetable intake and decrease their BMI z-score more during the intervention period than children living farther from supermarkets.
Dr. Muraskas[/caption]
MedicalResearch.com Interview with:
Jonathan Muraskas M.D.
Professor of Pediatrics and OB/Gyne
Neonatal and Maternal Fetal Medicine
Director Neonatal-Perinatal Research
Loyola University Stritch School of Medicine
Loyola University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process.
In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours.
Dr. Christoph Correll[/caption]
More on Mental Health on MedicalResearch.com
MedicalResearch.com Interview with:
Christoph U. Correll, MD
Professor of Psychiatry and Molecular Medicine
Hofstra Northwell School of Medicine
Hempstead, New York, USA
Investigator, Center for Psychiatric Neuroscience
Feinstein Institute for Medical Research
Manhasset, New York,
Medical Director, Recognition and Prevention
The Zucker Hillside Hospital,
Department of Psychiatry
Medical Research: What is the background for this study?
Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment.
Medical Research: What are the main findings?
Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of 
Dr. Brian Elbel[/caption]
Brian Elbel, PhD, MPH, Associate Professor, Department of Population Health, NYU Langone Medical Center
Amy Schwartz, PhD, Director, New York University Institute for Education and Social Policy, and the Daniel Patrick Moynihan Chair in Public Affairs, Syracuse University
Michele Leardo, MA, Assistant Director
New York University Institute for Education and Social Policy
Medical Research: What is the background for this study? What are the main findings?
Response: New York City, as well as other school districts, is making tap water available to students during lunch by placing water dispensers, called water jets, in schools. Surprisingly, drinking water was not always readily available in the lunchroom. Water jets are part of a larger effort to combat child obesity.
We find small, but statistically significant, decreases in weight for students in schools with water jets compared to students in schools without water jets. We see a .025 reduction in standardized body mass index for boys and .022 for girls. We also see a .9 percentage point reduction in the likelihood of being overweight for boys and a .6 percentage point reduction for girls. In other words, the intervention is working.
Dr. Joanne Cranwell[/caption]
Dr. Svetlana Popova[/caption]
MedicalResearch.com Interview with:
Svetlana Popova, M.D., Ph.Ds., M.P.H.
Senior Scientist
Social and Epidemiological Research, Centre for Addiction and Mental Health
Associate Professor, Epidemiology Division, Dalla Lana School of Public Health, University of Toronto
Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
Graduate Faculty Associate Member, Institute of Medical Science, University of Toronto
MedicalResearch: What is the background for this study?
Dr. Popova: It has been known for many years that prenatal alcohol exposure is associated with a number of adverse health consequences for both the mother and developing fetus. Women who consume alcohol during pregnancy place their child(ren) at risk of developing Fetal Alcohol Spectrum Disorders (FASD), and can experience a number of other adverse pregnancy outcomes including stillbirth, spontaneous abortion, premature birth, intrauterine growth retardation, and low birth weight. It was also previously known that people with FASD have many comorbidities (the simultaneous presence of two or more chronic diseases or conditions in a patient) due to the permanent damage of prenatal alcohol exposure on the fetus. However, until now it was unknown how many and what type of diseases, and at what frequencies they occur. Therefore, we reviewed the medical and epidemiological literature to identify the disease conditions that have been found to occur in people with 
Dr. Daniel Mulrooney[/caption]
MedicalResearch.com Interview with:
Daniel A. Mulrooney, MD, MS
Cancer Survivorship
Jude Children's Research Hospital
TN 38105-3678
Medical Research: What is the background for this study? What are the main findings?
Dr. Mulrooney: This is a cross-sectional analysis performed in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study designed to facilitate longitudinal evaluation of health outcomes among adults previously treated for childhood cancer. Following patients over the life spectrum can be challenging making it difficult to understand the long-term health effects of childhood cancer therapy. Previous studies have relied on self-report, registry, or death certificate data. Our study is novel because we clinically evaluated cancer survivors on the St. Jude campus and identified substantial, asymptomatic cardiac disease (cardiomyopathy, coronary artery disease, valvular disease, and conduction/rhythm disorders).
Dr. Chugani[/caption]
MedicalResearch.com Interview with:
Diane C. Chugani, PhD
Director, Nemours Neuroscience Research
Nemours—AI DuPont Hospital for Children
Wilmington, DE 19803
Medical Research: What is the background for this study? What are the main findings?
Dr. Chugani: This clinical trial was performed at 5 sites throughout the country and was lead by our team at Wayne State University and Children’s Hospital of Michigan in Detroit. The study was sponsored by the National Institutes of Health through an Autism Centers of Excellence Network grant. Based upon our previous PET scanning studies showing low serotonin synthesis in the brains of young children with autism, we tested whether the serotonin-like drug buspirone would be beneficial in treating young children with Autism Spectrum Disorder. We found that low doses of buspirone were effective in reducing repetitive behaviors with no significant side effects in this group of children.
Dr. Rebold[/caption]
MedicalResearch.com Interview with:
Michael Rebold, PhD, CSCS
Assistant Professor
Department of Exercise Science
Bloomsburg University
Bloomsburg, PA 17815
Medical Research: What is the background for this study?
Dr. Rebold: The obesity epidemic seen in children. If we can make children at a young age physically active then maybe they will be more likely to be physically active into their adult years. Since parents are the primary role models for younger children we must find ways to get the parents involved in physical activity as well, because children will model their parent's behaviors.
Medical Research: What are the main findings?
Dr. Rebold: The main findings from this study are that when parents are actively participating in activities with their children, their children spend more time in physical activities and less time in sedentary activities. When parents are not present and children are alone, then they spend more time engaging in sedentary activities and less time in physical activities. When parents are actively watching their children, children still engaged in a significant more amount of time in physical activities than sedentary activities when compared to the alone condition but still not as great as with parents participating.
Children also liked and were motivated to engage in additional physical activity time when parents were participating with them.
Dr. Deirdre Murray[/caption]
MedicalResearch.com Interview with:
Dr. Deirdre Murray
Senior Lecturer/Consultant Paediatrician
Dept of Paediatrics and Child Health
University College Cork
Clinical Investigations Unit Cork University Hospital
Principal Investigator
Irish Centre for Fetal and Neonatal Translational Research
Medical Research: What is the background for this study? What are the main findings?
Dr. Murray: Everyday in clinic, and in waiting rooms and in restaurants we see parents are handing over their smart phones and iPads to occupy young children. The nature of childhood play is changing rapidly. The exact frequency and the effect of this change in unknown. We wanted to first measure how young children 12-36 months are using touchscreen devices. We asked parents who attended our paediatric unit, both outpatients and short stay inpatients to answer a study specific questionnaire.
We found that of the 82 parents surveyed, 82% of parents owned a touchscreen device, and of these 87% gave their device to their toddler to play with. Thus 71% of toddlers had access to a touchscreen device. This rate was similar across the age range studied (12-36 months). By parental report, 24 months was the median age of ability to swipe (IQR: 19.5–30.5), unlock (IQR: 20.5–31.5) and active looking for touch-screen features (IQR: 22–30.5), while 25 months (IQR: 21–31.25) was the median age of ability to identify and use specific touch-screen features. Overall, 32.8% of toddlers could perform all four skills.
Touchscreen usage was common at a very young age and from 2 years of age toddlers have the ability to interact purposefully with touch-screen technology. 
Dr. Van Naarden Braun[/caption]
MedicalResearch.com Interview with:
Kim Van Naarden Braun, Ph.D.
Epidemiologist
Developmental Disabilities Branch
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
Atlanta, GA 30341
Medical Research: What is the background for this study? What are the main findings?
Dr. Van Naarden Braun: Over the past five decades, remarkable improvements have been made in obstetric and neonatal care resulting in significant declines in infant mortality both in the US and abroad, particularly for infants born premature and very low birthweight. Successes in neonatal survival have been met by concerns that the occurrence of developmental disabilities, most notably cerebral palsy, would increase. By monitoring changes over time in the prevalence of cerebral palsy, we can try to understand the impact of these advances further. Our recently published study reported that the 
Prof. Schmid-Schonbein[/caption]
MedicalResearch.com Interview with:
Geert W. Schmid-Schonbein, Ph.D.
Distinguished Professor and Chairman
Department of Bioengineering
Adjunct Professor in Medicine
University of California San Diego
Medical Research: What is the background for this study? What are the main findings?
Dr. Schmid-Schonbein: Most approaches to control/reduce body weight focus on reducing food quantity, improving quality and promoting daily activity. These approaches, effective in the short term, only yield modest weight control. Weight management strategies recommended in the past have not significantly diminished the current trend towards childhood and adolescence obesity.
We developed and tested an alternative approach to control weight gain in healthy individuals to reduce the risk for development of obesity and diabetes complications. The essence is to:
“Eat deliberately slow AND stop eating when you feel no longer hungry”.
The approach avoids any form of special diet, uses no drugs, can be adopted for a lifetime and used in any ethnic environment. Children in a Mexican School in Durango were instructed by a pediatrician to learn to eat deliberately slow and to stop eating when the satiety reflex sets in, i.e. the moment when the feeling of hunger has disappeared.
They were instructed to:
Dr. Minneci[/caption]
MedicalResearch.com Interview with:
Dr. Peter C. Minneci, M.D., MHSc
Center for Innovation in Pediatric Practice
Assistant Professor, Pediatric Surgery
The Ohio State's Wexner Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Minneci: Non-operative management of uncomplicated appendicitis has been shown to safe and effective studied in several international adult trials. To be a reasonable treatment alternative to urgent appendectomy, non-operative management of appendicitis in children must have a clinically acceptable success rate with minimal harm in patients that fail and subsequently undergo appendectomy. We performed a prospective single-institution patient choice trial allowing the families of children with acute uncomplicated appendicitis to choose between urgent appendectomy or non-operative management with antibiotics alone. We enrolled 102 patients, with 65 choosing surgery and 37 choosing non-operative management with antibiotics alone. Non-operative management had an in-hospital success rate of 94%, a 30-day success rate of 89%, and a 1-year success rate of 76%. Compared to the surgery group, patients managed non-operatively reported higher quality of life scores at 30 days and had significantly fewer disability days and lower costs, with no differences in the rates of complicated appendicitis or treatment-related complications at 1 year of follow-up. With this being said, there are some cases that I have read about where doctors have failed to diagnose patients for Appendicitis even after they have complained about having a number of the symptoms associated with it. Following this, some patients have even contacted companies like 
Dr. Alison Cooke[/caption]
MedicalResearch.com Interview with:
Dr Alison Cooke PhD, MRes, BMidwif (Hons), RM
Lecturer in Midwifery (Teaching and Research)
School of Nursing, Midwifery & Social Work
The University of Manchester
Oxford Road Manchester
Medical Research: What is the background for this study? What are the main findings?
Dr. Cooke: The use of topical oils for the management of newborn dry skin or for massage is a common practice across the globe. In the UK, olive oil and sunflower oil are commonly recommended by maternity service health professionals for baby dry skin, yet there is no evidence to support this practice. The OBSeRvE study was conducted to investigate the effect of these two oils on healthy term newborn baby skin barrier function. The study found that both oils impeded the development of the skin barrier function from birth.
Dr. Eric Christensen[/caption]
MedicalResearch.com Interview with:
Dr. Eric W. Christensen, PhD
Health Economist
Children’s Hospitals and Clinics of Minnesota
Minneapolis, MN
Medical Research: What is the background for this study?
Dr. Christensen: National healthcare expenditures are up from 5.0% of gross domestic product in 1960 to 17.4% in 2013. We must find ways to control cost while maintaining quality. Accountable care organizations (ACOs) were designed to control a population’s health care cost while maintaining or improving quality. This study was an examination of one ACO exclusively covering a pediatric Medicaid population.
Medical Research: What are the main findings?
Dr. Christensen: We found that health care utilization and cost patterns were associated with the length of time patients were attributed to this 
Dr. Zachary Kerr[/caption]
MedicalResearch.com Interview with:
Zachary Y. Kerr, PhD, MPH
Sports Injury Epidemiologist
Director, NCAA Injury Surveillance Program
Datalys Center for Sports Injury Research and Prevention
Indianapolis, IN 46202
Medical Research: What is the background for this study? What are the main findings?
Dr. Kerr: The NCAA Injury Surveillance Program has been ongoing since 1982, but the Datalys Center for Sports Injury Research and Prevention began management in 2009. We provide the NCAA sports and medical committees with evidence-based data they can use to make rule and policy decisions aimed at student-athlete health and safety. However, among the research community, there lacks current injury incidence data across the collegiate student-athlete population.
The main findings of this study is that the rate of injury was higher in competitions than in practices. However, the total number of 
Dr. Mairead Black[/caption]
MedicalResearch.com Interview with:
Dr Mairead Black MBChB, MRCOG, MSc
Research Fellow, Wellcome Trust
Clinical Lecturer, Obstetrics and Gynaecology
School of Medicine and Dentistry, Division of Applied Health Sciences
University of Aberdeen
Aberdeen Maternity Hospital, Cornhill Road
Aberdeen AB25 2ZD
Medical Research: What is the background for this study?
Dr. Black: The current thinking is, if a baby is exposed to labour, then it is also exposed to ‘good bacteria’ that mothers pass on during the birth, and they are also exposed to a degree of natural stress at the time of birth that might make them more resistant to developing future illnesses.
The World Health Organisation formerly recommended that no more than 15 percent of deliveries should be C-sections. However rates in some countries have soared – China and Brazil have rates in excess of 50%, whilst in the UK the figure is 26% with almost half of these being planned in advance.
The main purpose of this study was to explore whether health outcomes in children up to very early adulthood differ according to how they are delivered and whether avoiding labour entirely, i.e. via a planned C-section, could put children at a disadvantage compared to those delivered vaginally or by emergency C-section, where most will have been exposed to labour. The study analysed data from over 300,000 births between 1993 and 2007 across Scotland, using routinely collected data from seven linked databases.
Dr. Thompson[/caption]
MedicalResearch.com Interview with:
Professor Benjamin Thompson PhD
School of Optometry and Vision Science
Faculty of Science, University of Waterloo
Waterloo, Ontario
Canada
Medical Research: What is the background for this study?
Dr. Thompson: Our investigation was part of the longitudinal Infant Development and Environment and Lifestyle (IDEAL) study that was designed to investigate the effect of prenatal methamphetamine exposure on neurodevelopment. Although the negative impact of prenatal drug exposure on a wide range of neurodevelopmental outcomes such cognitive and motor function is established, the effect on vision is not well understood. To address this issue, vision testing was conducted when children in the New Zealand arm of the IDEAL study turned four and half years of age.
Although the primary focus of the IDEAL study was the impact of methamphetamine on neurodevelopment, the majority of children enrolled in the study were exposed to a range of different drugs prenatally including marijuana, nicotine and alcohol. Many children were exposed to multiple drugs. This allowed us to investigate the impact of individual drugs and their combination on the children’s visual development.
Alongside standard clinical vision tests such as visual acuity (the ‘sharpness’ of vision) and stereopsis (3D vision), we also tested the children’s ability to process complex moving patterns. This test, known as global motion perception, targets a specific network of higher-level visual areas in the brain that are thought to be particularly vulnerable to neurodevelopmental risk factors.
Dr. Schulert[/caption]
MedicalResearch.com Interview
Grant S Schulert MD, PhD
Clinical Fellow, Division of Rheumatology
Cincinnati Childrens Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Schulert: Influenza infection causes millions of illnesses annually, but most of those are relatively mild. In a subset of cases, patients can become critically ill, even if they are relatively young and healthy. Several previous reports had observed in these critically ill patients features of a hyperinflammatory syndrome known as HLH (hemophagocytic lymphohistiocytosis) or MAS (macrophage activation syndrome). This hyperinflammation can be triggered by other infections as well as in a subtype of juvenile arthritis, but there is also a familial form occurring in early childhood with known genetic causes. Our questions with this study were
1) how often are features consistent with HLH/MAS seen in fatal H1N1 influenza infections and
2) do patients with fatal H1N1 infection have genetic mutations associated with HLH/MAS?
Our collaborator Paul Harms, MD, and his team at the Michigan Center for Translational Pathology, University of Michigan Medical School identified 16 cases of fatal H1N1 influenza infection. Based on their clinical features, between 41-88% of these patients could be categorized as having a hyperinflammatory HLH/MAS. We then used processed tissue samples from the patients for whole exome genetic sequencing, which reads the entire genetic code of every gene in a person. Five patients carried mutations in genes which cause HLH, and several others carried mutations in genes linked to MAS. This suggests that there may be genetic risk factors for developing fatal hyperinflammatory syndromes in H1N1 infection.
MedicalResearch.com Interview with:
Dr. Ffion C Davies
Consultant in Emergency Medicine & Paediatric Lead
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Leicester UK
Medical Research: What is the background for this study?
Dr. Davies: This study is from the Trauma Audit Research Network data, which is a major trauma database receiving data from nearly all hospitals in England and Wales. A 2012 TARN report on major trauma in children showed a peak of injuries resulting from child abuse in the younger age group. In this study we analysed the database in more detail, in order to profile this peak of injuries from non-accidental injury (NAI).
Medical Research: What are the main findings?
Dr. Davies: The main findings are that severe injury and death resulting from non-accidental injury occurs nearly always in the under 5 year old age group, and 75% of cases are under 1 year old. This contrasts with reports in the media, whereby high profile deaths in children from non-accidental injury are often older children. This probably reflects reporting bias, because those children experienced a prolonged period of abuse, despite involvement of health and social services. Our study shows that very small infants are the most likely to die, or to sustain severe head injuries.