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Professor Jimmy Efird

Professor

School of Medicine and Public Health (Statistics)

Career Summary

Biography

Dr. Jimmy T. Efird is Chair of Public Health Statistics and Director of the Programme in Predictive Analytics and Outcomes Research at the University of Newcastle (UoN).  Prior to joining UoN, Dr. Efird was Chief Statistician for the Center of Health Disparities at Brody School of Medicine and Director of Epidemiology and Outcomes Research at the East Carolina Heart Institute. Additionally, he was Director of the Biostatistics and Database Management Facility at the John A. Burn School of Medicine before his move to the Mainland.  Dr. Efird specializes in multivariate statistical simulation, closed-testing methods for multiplicity  adjustment, sinusoidal Cox regression, mixed-effects modelling, and risk stratification/predictive analytics. His areas of application include neuroscience, cancer, heart disease, diabetes, and obesity. He serves as Editor-in-Chief of Cancer Informatics, Specialty Chief Editor of Frontiers in Epidemiology, Co-Editor-in-Chief of Journal of Medical Statistics and Informatics, Associate Editor of Bioinformatics and Biology Insights, and Senior Editor of International Journal of Molecular Epidemiology and Genetics.  Dr. Efird received his doctorate from Stanford University School of Medicine and has over 222 publications in scientific journals and technical proceedings (i10-index=89, h-index=43, citations=7,173).  

Qualifications

  • Doctor of Philosophy, The Leland Stanford Junior University USA

Professional Experience

UON Appointment

Title Organisation / Department
Professor University of Newcastle
School of Medicine and Public Health
Australia
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (178 outputs)

Year Citation Altmetrics Link
2017 Hong MK, Varghese RE, Jindal C, Efird JT, 'Refugee policy implications of U.S. immigration medical screenings: A new era of inadmissibility on health-related grounds', International Journal of Environmental Research and Public Health, 14 (2017)

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful... [more]

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the count ry as a whole.

DOI 10.3390/ijerph14101107
2017 Bith-Melander P, Chowdhury N, Jindal C, Efird JT, 'Trauma affecting asian-pacific islanders in the san francisco bay area', International Journal of Environmental Research and Public Health, 14 1-21 (2017) [C1]
DOI 10.3390/ijerph14091053
2017 Milton AH, Rahman M, Hussain S, Jindal C, Choudhury S, Akter S, et al., 'Trapped in Statelessness: Rohingya Refugees in Bangladesh.', Int J Environ Res Public Health, 14 (2017) [C1]
DOI 10.3390/ijerph14080942
Co-authors John Hall, Milton Hasnat
2017 Haga T, Efird JT, Tugizov S, Palefsky JM, 'Increased TNF-alpha and sTNFR2 levels are associated with high-grade anal squamous intraepithelial lesions in HIV-positive patients with low CD4 level', Papillomavirus Research, 3 1-6 (2017)

© 2016 Compared with HIV-negative individuals, HIV-positive individuals have a higher prevalence of anogenital human papillomavirus (HPV) infection, the causative agent of anogen... [more]

© 2016 Compared with HIV-negative individuals, HIV-positive individuals have a higher prevalence of anogenital human papillomavirus (HPV) infection, the causative agent of anogenital cancer. TNF-alpha is a major proinflammatory cytokine. sTNFR2 is the soluble form of one of its receptors and is strongly expressed on stimulated lymphocytes. To further understand the role of TNF-alpha, sTNFR2 and other cytokines in the pathogenesis in HPV-related neoplasia, the profiles of serum cytokines in high-risk patients were analyzed for association with anal lesion status. Patients were categorized into 4 groups based on HIV status (HIV-negative vs. HIV-positive with a CD4+ level < 200/uL) and anal lesion status [no lesion, low-grade anal squamous intraepithelial lesion (LSIL) vs. high-grade squamous intraepithelial lesion (HSIL)] based on high resolution anoscopy-guided biopsy. Following adjustment for multiplicity, HIV-negative men with HSIL had lower levels of sTNFR2 than HIV-positive men with low CD4 level and HSIL (p=0.02). HIV-positive men with HSIL had higher levels of TNF-alpha than HIV-negative men with HSIL (p < 0.001), as well as HIV-positive men with no lesion or LSIL (p=0.03). The levels of other factors, including IL-1beta, IL-2, IL-4, IL-8, IFN-gamma, GM-CSF, sTNFR1 and DR5, were not significantly different between groups. Although the sample size was small, these results suggest that systemic activation of TNF-alpha/sTNFR2 in HIV-positive patients with a low CD4 level may promote the development of HSIL and possibly anal cancer.

DOI 10.1016/j.pvr.2016.11.003
2017 Fitzgerald TL, Efird JT, Bellamy N, Russo SM, Jindal C, Mosquera C, et al., 'Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: A survival analysis of 5058 patients.', Cancer, 123 2909-2917 (2017)
DOI 10.1002/cncr.30692
Co-authors Liz Holliday
2017 Grubb W, Young R, Efird J, Jindal C, Biswas T, 'Local therapy for triple-negative breast cancer: A comprehensive review', Future Oncology, 13 1721-1730 (2017)

© 2017 Future Medicine Ltd. Owing to its aggressive course, triple-negative breast cancer remains an important clinical issue of current interest compared with hormone-receptor p... [more]

© 2017 Future Medicine Ltd. Owing to its aggressive course, triple-negative breast cancer remains an important clinical issue of current interest compared with hormone-receptor positive subtypes. Recent research has focused on determining the optimal local therapy (breast conversation therapy vs mastectomy) for this cancer subtype. In this overview, we examine outcomes based on immunohistochemistry, gene expression profiles, type of local therapy and in the era of neoadjuvant chemotherapy. Based on multiple observational reports risk for locoregional recurrence appears to be similar to reported outcomes in other subtypes. However, distant recurrence continues to be a significant concern for triple-negative breast cancer, indicating the need for better systemic therapies. To date, insufficient evidence exists to determine whether breast conserving therapy or mastectomy results in superior outcomes.

DOI 10.2217/fon-2017-0056
2017 Kang KH, Efird JT, Sharma N, Yang M, Dowlati A, Linden P, et al., 'Prognostic potential of neutrophil-to-lymphocyte ratio and lymphocyte nadir in stage III non-small-cell lung cancer', Future Oncology, 13 (2017)

© 2017 Future Medicine Ltd. Aim: Studies have shown increased pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to be predictive of survival in various canc... [more]

© 2017 Future Medicine Ltd. Aim: Studies have shown increased pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios to be predictive of survival in various cancers. Our aim was to evaluate the prognostic role of such inflammatory markers in non-small-cell lung cancer (NSCLC). Methods: One hundred and sixty-three patients with stage III NSCLC who received definitive treatment were included. Survival analysis was performed using Kaplan-Meier method. Hazard ratios for overall and recurrence-free survival were estimated using Cox proportional hazards model. Results: Both neutrophil-to-lymphocyte > Q75 (4.5) and lymphocyte nadir values < Q25 (0.25) and their unified values were associated with 90% increased overall mortality risk (p = 0.040) and a nonsignificant 50% decreased recurrence-free survival risk. Conclusion: Our exploratory analysis showed markers of systemic inflammation predicted survival outcomes in advanced NSCLC. Future prospective data analyses are needed to confirm this potential.

DOI 10.2217/fon-2017-0045
2017 Efird JT, Kiser AC, Crane PB, Landrine H, Kindell LC, Nelson MA, et al., 'Perioperative Inotrope Therapy and Atrial Fibrillation Following Coronary Artery Bypass Graft Surgery: Evidence of a Racial Disparity', Pharmacotherapy, 37 297-304 (2017)

© 2017 Pharmacotherapy Publications, Inc. Background and Objective: Following coronary artery bypass graft (CABG) surgery, mortality rates are significantly higher among black pa... [more]

© 2017 Pharmacotherapy Publications, Inc. Background and Objective: Following coronary artery bypass graft (CABG) surgery, mortality rates are significantly higher among black patients who experience postoperative atrial fibrillation (POAF). Perioperative inotropic therapy (PINOT) was associated with POAF in previous reports, but the extent to which race influences this association is unknown. In the present study, the relationship between PINOT, race, and POAF was examined in patients undergoing CABG surgery. Methods and Setting: Clinical records were examined from a prospectively maintained cohort of 11,855 patients (median age¿64 yrs; 70% male; 16% black) undergoing primary isolated CABG at a large cardiovascular institute in the southeastern region of the United States. Relative risk (RR) and 95% confidence intervals (CIs) were computed using log-binomial regression. Main Results: The association between PINOT and POAF was significantly increased among black patients (adjusted RR 1.7, CI 1.4¿2.0) compared with white patients (adjusted RR 1.3, CI 1.2¿1.4) (p interaction ¿=¿0.013). Conclusions: These findings suggest that PINOT may be disproportionately associated with POAF among black patients undergoing CABG surgery. Additional studies are needed to examine further the potential underlying mechanisms of this association.

DOI 10.1002/phar.1894
2017 O'Neal WT, Soliman EZ, Efird JT, Judd SE, Howard VJ, Howard G, Mcclure LA, 'Fine particulate air pollution and premature atrial contractions: The REasons for Geographic And Racial Differences in Stroke study', Journal of Exposure Science and Environmental Epidemiology, 27 271-275 (2017)

© 2017 Nature America, Inc., part of Springer Nature. All rights reserved. Several reports have suggested that particulate matter (PM) exposure increases the risk for atrial arrh... [more]

© 2017 Nature America, Inc., part of Springer Nature. All rights reserved. Several reports have suggested that particulate matter (PM) exposure increases the risk for atrial arrhythmias. However, data from large-scale epidemiologic studies supporting this hypothesis are lacking. We examined the association of PM o2.5 µm in diameter (PM 2.5 ) concentration with premature atrial contractions (PACs) in 26,609 (mean age = 65 ± 9.4 years; 55% female; 41% black) participants from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study. Estimates of short- (2 weeks) and long-Term (1 year) PM 2.5 exposure were computed before each participant's baseline visit using geographic information system data on the individual level at the coordinates of study participants' residences. PACs were identified from baseline electrocardiograms. A total of 2140 (8.2%) participants had evidence of PACs on the baseline electrocardiogram. Short-Term PM 2.5 (per 10 µg/m 3 ) exposure was not associated with PACs (OR = 1.09, 95% CI = 0.98, 1.23). Increases in long-Term PM 2.5 (per 10 µg/m 3 ) were associated with PACs (OR = 1.40, 95% CI = 1.10, 1.78). Interactions were not detected for short-And long-Term PM 2.5 exposure by age, sex, or race. Long- but not short-Term PM 2.5 exposure is associated with PACs. This suggests a role for long-Term PM 2.5 exposure in initiating supraventricular arrhythmias that are triggered by PACs.

DOI 10.1038/jes.2016.46
2017 Hall MB, Eden TM, Bess JJ, Landrine H, Corral I, Guidry JJ, Efird JT, 'Rural shop-based health program planning: A formative research approach among owners', Journal of Racial and Ethnic Health Disparities, 4 507-514 (2017)

© W. Montague Cobb-NMA Health Institute 2016. African American barbershops and beauty salons are settings that have been identified as a significant and culturally relevant venue... [more]

© W. Montague Cobb-NMA Health Institute 2016. African American barbershops and beauty salons are settings that have been identified as a significant and culturally relevant venue to reach minority populations for health promotion activities. By being located in almost every town in the USA, this setting is a viable means to promote healthy lifestyles among African Americans. The purpose of this formative research project was to assess African American barbershop and beauty salon owners¿ perceptions of providing health promotion programming in their shops, as well as to obtain information on health topics of interest and strategies for implementation. Interviewees were recruited using snowballing among clientele and owner referrals, between November 2014 and August 2015. A total of 20 barbershop and salon owners, across 11 counties in eastern North Carolina, completed face-to-face interviews. Responses were stratified by barbershops and beauty salons. Across both groups, all owners stated it would be a good idea to have health programs/interventions within the shop setting. Most noted topics of interest included diet and nutrition, hypertension, and (wo)men¿s reproductive health. When asked further about these desired topics, both benefits and relevance to customers and the African American community were the reasons for their selections. In addition, across barbershops and salons, 90 % of owners stated interest in having a program implemented in their shop. This information will be used to guide the development of shop-based interventions, with the aid of a community advisory board composed of shop owners, individual barbers and stylists and customers.

DOI 10.1007/s40615-016-0252-x
2017 O'Neal WT, Soliman EZ, Efird JT, Howard VJ, Howard G, McClure LA, 'Fine particulate air pollution and premature ventricular contractions: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study', Environmental Research, 154 115-119 (2017)

© 2016 Elsevier Inc. Background It is unknown if higher levels of ambient particulate matter (PM) exposure increase the risk for premature ventricular contractions (PVC) in a pop... [more]

© 2016 Elsevier Inc. Background It is unknown if higher levels of ambient particulate matter (PM) exposure increase the risk for premature ventricular contractions (PVC) in a population-based study of men and women, and if this relationship varies by race or sex. Metho ds We examined the association of PM < 2.5¿µm in diameter (PM 2.5 ) concentration with PVCs in 26,121 (mean age=64±9.3 years; 55% female; 41% black) participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Estimates of short- (2-week) and long-term (1-year) PM 2.5 exposures were computed prior to the baseline visit using geographic information system data on the individual level at the coordinates of study participants¿ residences. PVCs were identified from baseline electrocardiograms. Results PVCs were detected in 1719 (6.6%) study participants. Short- (OR=1.08, 95%CI=1.03, 1.14) and long- (OR=1.06, 95%CI=1.01, 1.12) term PM 2.5 exposures were associated with PVCs. Interactions were not detected by race or sex. An interaction between short-term PM 2.5 exposure and PVCs was detected for those with cardiovascular disease (OR=1.16, 95%CI=1.06, 1.27) compared with those without cardiovascular disease (OR=1.05, 95%CI=0.99, 1.12; p-interaction=0.027). Conclusion Our findings suggest that PM 2.5 exposure is associated with an increased risk for PVCs in a biracial population-based study of men and women. We also have identified persons with cardiovascular disease as an at-risk population for PVCs when increases in short-term PM 2.5 concentration occur.

DOI 10.1016/j.envres.2016.12.031
2016 Efird JT, Gudimella P, O'Neal WT, Griffin WF, Landrine H, Kindell LC, et al., 'Comparison of Risk of Atrial Fibrillation in Black Versus White Patients After Coronary Artery Bypass Grafting', AMERICAN JOURNAL OF CARDIOLOGY, 117 1095-1100 (2016)
DOI 10.1016/j.amjcard.2015.12.056
2016 Sherer AP, Crane PB, Abel WM, Efird J, 'Assessing Publics' Knowledge About Hypertension in a Community-Dwelling Sample', JOURNAL OF CARDIOVASCULAR NURSING, 31 114-120 (2016)
DOI 10.1097/JCN.0000000000000227
2016 Sherer AP, Crane PB, Abel WM, Efird J, 'Predicting heart failure readmissions', Journal of Cardiovascular Nursing, 31 114-120 (2016)

© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: In this study, the effects of sociodemographic and clinical factors on heart failure (HF) readmissio... [more]

© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: In this study, the effects of sociodemographic and clinical factors on heart failure (HF) readmission risk were examined. Background: Hospitals now incur financial penalties for excessive HF readmission rates; therefore, identifying factors associated with risk is essential for designing risk-reduction strategies. Methods: A retrospective cohort study using chart reviews compared HF inpatients (N = 245) who were readmitted with those who were not readmitted. Results: The sample included mostly white (64%) elderly (mean [SD] age, 69.8 [15.1] years) men (49%) and women (51%). Using Cox regression, the number of comorbidities (3Y4 or 5Y8) and type of comorbidities, specifically renal insufficiency (readmission ratio [RR], 1.7; P = .003), atrial fibrillation (RR, 1.7; P = .005), cardiomyopathy (RR, 1.5; P = .020), followed by a history of myocardial infarction/coronary artery disease (RR, 1.4; P = .055), were the predictors of HF readmission. Conclusions: Targeting those with high-risk comorbidities is important in designing measures to prevent or delay readmission of HF patients.

DOI 10.1097/JCN.0000000000000225
2016 Biswas T, Efird JT, Prasad S, James SE, Walker PR, Zagar TM, 'Inflammatory TNBC Breast Cancer: Demography and Clinical Outcome in a Large Cohort of Patients with TNBC', Clinical Breast Cancer, 16 212-216 (2016)
DOI 10.1016/j.clbc.2016.02.004
Citations Scopus - 1Web of Science - 1
2016 Efird JT, Griffin WF, Davies SW, O'Neal WT, Crane PB, Kindell LC, et al., 'Seasonal incidence of emergent coronary artery bypass grafting surgery', Heart Surgery Forum, 19 E48-E53 (2016)

© 2016 Forum Multimedia Publishing, LLC. Background: Emergent coronary artery bypass grafting (CABG) surgery is often required in the case of severe coronary artery disease, whic... [more]

© 2016 Forum Multimedia Publishing, LLC. Background: Emergent coronary artery bypass grafting (CABG) surgery is often required in the case of severe coronary artery disease, which is refractory to traditional management. The objective of our study was to test the hypothesis that there is seasonal variation in the incidence of emergent CABG. Methods: A sinusoidal logistic regression model was used to analyze operative data at our cardiovascular institute of 270 cases spanning 5939 calendar days. Results: A cyclic peak risk for emergent CABG was observed for late winter (calendar day 66; P = .036). The odds ratios for the 1-, 2-and 3-month window surrounding this peak were 1.8 (95% CI = 0.94-3.5, P = .072), 1.6 (95% CI = 1.06-2.5, P = .024) and 1.4 (95% CI = 0.9-1.8, P = .066), respectively. Conclusion: Our results suggest that a seasonal variation may exist in the incidence of patients presenting with severe coronary artery disease requiring emergent CABG. This information is useful in the scheduling of hospital resources and staff. It also provides important etiology clues underlying coronary artery disease that may lead to future interventions or targeted therapies.

DOI 10.1532/hsf.1277
2016 Landrine H, Corral I, Lee JGL, Efird JT, Hall MB, Bess JJ, 'Residential Segregation and Racial Cancer Disparities: A Systematic Review', Journal of Racial and Ethnic Health Disparities, 1-11 (2016)

© 2016 W. Montague Cobb-NMA Health Institute Background: This paper provides the first review of empirical studies of segregation and black-white cancer disparities. Methods: We ... [more]

© 2016 W. Montague Cobb-NMA Health Institute Background: This paper provides the first review of empirical studies of segregation and black-white cancer disparities. Methods: We searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained. Results: Segregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested. Conclusions: Empirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.

DOI 10.1007/s40615-016-0326-9
2016 Anderson EJ, Efird JT, Kiser AC, Crane PB, O'Neal WT, Ferguson TB, et al., 'Plasma Catecholamine Levels on the Morning of Surgery Predict Post-Operative Atrial Fibrillation', JACC: Clinical Electrophysiology, (2016)

© 2017 American College of Cardiology Foundation. Objectives: This study sought to determine whether plasma catecholamines and monoamine oxidase-B (MOA-B) are associated with pos... [more]

© 2017 American College of Cardiology Foundation. Objectives: This study sought to determine whether plasma catecholamines and monoamine oxidase-B (MOA-B) are associated with post-operative atrial fibrillation (POAF) in patients undergoing elective cardiac surgery. Background: Although intra- and post-operative adrenergic tone has been demonstrated to be an causative factor for POAF, the role and association of pre-operative plasma catecholamines remains unclear. Methods: Prior to administration of anesthesia on the morning of surgery, blood samples were obtained from 324 patients undergoing nonemergent coronary artery bypass graft and/or aortic valve surgery with cardiopulmonary bypass at East Carolina Heart Institute. The concentrations of norepinephrine (NE), dopamine (DA), epinephrine (EPI), and enzyme MAO-B were assessed in platelet-rich plasma. A log-binomial regression model was used to determine the association between quartiles of these variables and POAF. Results: Levels of NE (p = 0.0006) and EPI (p = 0.047) in the 4th quartile (Q4NE+) were positively associated with POAF, whereas DA (p = 0.0034) levels in the 4th quartile (Q4DA+) were inversely associated with POAF. Adjusting for age, heart failure (HF), and history of atrial fibrillation, the composite pre-operative (adrenergic) plasma marker (Q4NE+ V Q4DA-) was associated with a 4-fold increased occurrence of POAF (adjusted p = 0.0001). No association between plasma MAO-B and POAF was observed. Conclusions: Our results suggest that pre-operative adrenergic tone is an important factor underlying POAF. This information provides evidence that assessment of plasma catecholamines may be a low-cost method that is easy to implement for predicting which patients are likely to develop POAF. More investigation in a multicentric setting is needed to validate our results.

DOI 10.1016/j.jacep.2017.01.014
2016 O'Neal WT, Efird JT, Judd SE, McClure LA, Howard VJ, Howard G, Soliman EZ, 'Impact of Awareness and Patterns of Nonhospitalized Atrial Fibrillation on the Risk of Mortality: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study', Clinical Cardiology, 39 103-110 (2016)
DOI 10.1002/clc.22501
Citations Scopus - 5Web of Science - 5
2016 Efird JT, Griffin W, O'Neal WT, Davies SW, Shiue KY, Grzybowski M, et al., 'Long-term survival after cardiac surgery in patients with chronic obstructive pulmonary disease', American Journal of Critical Care, 25 266-276 (2016)
DOI 10.4037/ajcc2016119
2016 Davies SW, Efird JT, Guidry CA, Dietch ZC, Willis RN, Shah PM, Sawyer RG, 'Top Guns: The "maverick" and "goose" of Empiric Therapy', Surgical Infections, 17 38-47 (2016)
DOI 10.1089/sur.2015.104
Citations Scopus - 5Web of Science - 4
2016 Landrine H, Corral I, Hall MB, Bess JJ, Efird J, 'Self-rated health, objective health, and racial discrimination among African-Americans: Explaining inconsistent findings and testing health pessimism', Journal of Health Psychology, 21 2514-2524 (2016)
DOI 10.1177/1359105315580465
Citations Scopus - 2
2016 Awan M, Sharma N, Towe CW, Efird JT, Machtay M, Biswas T, 'Optimum treatment for mediastinal lymph node positive (N2) resectable non-small cell lung cancer: what is the role for surgery?', Expert Review of Anticancer Therapy, 16 1131-1144 (2016)
DOI 10.1080/14737140.2016.1240039
2016 Prasad S, Efird JT, James SE, Walker PR, Zagar TM, Biswas T, 'Failure patterns and survival outcomes in triple negative breast cancer (TNBC): a 15 year comparison of 448 non-Hispanic black and white women', SpringerPlus, 5 (2016)
DOI 10.1186/s40064-016-2444-6
Citations Scopus - 1
2015 Efird JT, O'Neal WT, Griffin WF, Anderson EJ, Davies SW, Landrine H, et al., 'Increased Coronary Artery Disease Severity in Black Women Undergoing Coronary Bypass Surgery', MEDICINE, 94 (2015)
DOI 10.1097/MD.0000000000000552
Citations Scopus - 2Web of Science - 2
2015 O'Neal WT, Tanner RM, Efird JT, Baber U, Alonso A, Howard VJ, et al., 'Atrial fibrillation and incident end-stage renal disease: The REasons for Geographic And Racial Differences in Stroke (REGARDS) study', INTERNATIONAL JOURNAL OF CARDIOLOGY, 185 219-223 (2015)
DOI 10.1016/j.ijcard.2015.03.104
Citations Scopus - 6Web of Science - 6
2015 Biswas T, Walker P, Podder T, Efird JT, 'Effect of Race and Insurance on the Outcome of Stage I Non-small Cell Lung Cancer', ANTICANCER RESEARCH, 35 4243-4249 (2015)
Citations Scopus - 1Web of Science - 3
2015 Davies SW, Efird JT, Guidry CA, Penn RI, Sawyer RG, Schirmer BD, Hallowell PT, 'Twenty-first century weight loss: banding versus bypass', SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 29 947-954 (2015)
DOI 10.1007/s00464-014-3758-5
Citations Scopus - 2Web of Science - 2
2015 Davies SW, Efird JT, Guidry CA, Dietch ZC, Willis RN, Shah PM, et al., 'Vancomycin-Associated Nephrotoxicity: The Obesity Factor', SURGICAL INFECTIONS, 16 684-693 (2015)
DOI 10.1089/sur.2014.198
Citations Scopus - 4Web of Science - 3
2015 O'Neal WT, Efird JT, Nazarian S, Alonso A, Heckbert SR, Soliman EZ, 'Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis', EUROPACE, 17 358-363 (2015)
DOI 10.1093/europace/euu265
Citations Scopus - 7Web of Science - 7
2015 Sharma S, Mather PJ, Efird JT, Kahn D, Shiue KY, Cheema M, et al., 'Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience', JOURNAL OF CLINICAL SLEEP MEDICINE, 11 717-723 (2015)
DOI 10.5664/jcsm.4842
Citations Scopus - 6Web of Science - 5
2015 Efird JT, Griffin WF, Sarpong DF, Davies SW, Vann I, Koutlas NT, et al., 'Increased Long-Term Mortality among Black CABG Patients Receiving Preoperative Inotropic Agents', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 12 7478-7490 (2015)
DOI 10.3390/ijerph120707478
Citations Scopus - 1
2015 O'Neal WT, Efird JT, Kamel H, Nazarian S, Alonso A, Heckbert SR, et al., 'The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis', CLINICAL RESEARCH IN CARDIOLOGY, 104 743-750 (2015)
DOI 10.1007/s00392-015-0838-z
Citations Scopus - 3Web of Science - 3
2015 O'Neal WT, Efird JT, Qureshi WT, Yeboah J, Alonso A, Heckbert SR, et al., 'Coronary Artery Calcium Progression and Atrial Fibrillation The Multi-Ethnic Study of Atherosclerosis', CIRCULATION-CARDIOVASCULAR IMAGING, 8 (2015)
DOI 10.1161/CIRCIMAGING.115.003786
Citations Scopus - 3Web of Science - 5
2015 Fontanals N, James RA, Ok YS, Balakrishnan M, Efird JT, 'Occurrence and Remediation of Pollutants in the Environment', JOURNAL OF CHEMISTRY, (2015)
DOI 10.1155/2015/651059
2015 Davies SW, Leonard KL, Falls RK, Mageau RP, Efird JT, Hollowell JP, et al., 'Lung protective ventilation (ARDSNet) versus airway pressure release ventilation: Ventilatory management in a combined model of acute lung and brain injury', JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 78 240-249 (2015)
DOI 10.1097/TA.0000000000000518
Citations Scopus - 4Web of Science - 2
2015 Sharma S, Mather P, Efird JT, Kahn D, Cheema M, Rubin S, et al., 'Photoplethysmographic Signal to Screen Sleep-Disordered Breathing in Hospitalized Heart Failure Patients Feasibility of a Prospective Clinical Pathway', JACC-HEART FAILURE, 3 725-731 (2015)
DOI 10.1016/j.jchf.2015.04.015
Citations Scopus - 6Web of Science - 7
2015 Bowling MR, Kohan MW, Walker P, Efird J, Ben Or S, 'The effect of general anesthesia versus intravenous sedation on diagnostic yield and success in electromagnetic navigation bronchoscopy.', J Bronchology Interv Pulmonol, 22 5-13 (2015)
DOI 10.1097/LBR.0000000000000120
Citations Scopus - 16
2015 Liang Y, Sun R, Li L, Yuan F, Liang W, Wang L, et al., 'A functional polymorphism in the promoter of MiR-143/145 is associated with the risk of cervical squamous cell carcinoma in Chinese Women: A case-control study', Medicine (United States), 94 (2015)

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. MiR-143/145 is down-regulated in cervical cancer, which may serve as a tumor suppressor by targeting KRAS and Ra... [more]

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. MiR-143/145 is down-regulated in cervical cancer, which may serve as a tumor suppressor by targeting KRAS and Ras-responsive element-binding protein (RREB1). Activated KRAS leads to down-regulation of miR-143/145 transcription in a RREB1-dependent manner, establishing a miR-143/145-KRAS-RREB1 feedback loop. A polymorphism rs4705343C/T in the promoter of miR-143/145 might influence the binding of TATA-binding protein. We hypothesized that the miR-143/145 rs4705343 and KRAS rs712 may be related to the occurrence of cervical squamous cell carcinoma (CSCC). In this study, we genotyped the 2 polymorphisms in 415 patients with CSCC and 504 controls using polymerase chain reaction-restriction fragment length polymorphism. The promoter activities were measured by the Dual-Luciferase Reporter Assay System. We found that the rs4705343TC genotype was associated with an increased risk of CSCC (adjusted odds ratio [OR]=1.37; 95% confidence interval [CI] , 1.05-1.80). The significantly increased association was also observed in a dominant genetic model (adjustedOR=1.32; 95% CI, 1.01-1.72). Combined analysis showed that individuals carrying the genotypes of rs4705343 TC/CC and rs712GT/TT had a 1.47-fold increased risk of CSCC (adjusted OR=1.47; 95% CI, 1.01-2.15). By using multifactor dimensionality reduction software method, we identified a significant interaction between the miR-143/145 rs4705343 and KRAS rs712. Dual-Luciferase Reporter Assay showed that the luciferase activity was significantly lower in cells transfected with the rs4705343C allele than that of the rs4705343T allele. These findings indicate that miR-143/145 rs4705343 and KRAS rs712 may contribute to the etiology of CSCC in Chinese women.

DOI 10.1097/MD.0000000000001289
Citations Scopus - 10
2015 Sharma S, Efird JT, Knupp C, Kadali R, Liles D, Shiue K, et al., 'Sleep disorders in adult sickle cell patients', Journal of Clinical Sleep Medicine, 11 219-223 (2015)

Study Objectives: While sleep apnea has been studied in children with sickle cell disease (SCD), little is known about sleep disorders in adult sickle cell patients. The objective... [more]

Study Objectives: While sleep apnea has been studied in children with sickle cell disease (SCD), little is known about sleep disorders in adult sickle cell patients. The objective of this study was to evaluate sleep disordered breathing and its polysomnographic characteristics in adult patients with sickle cell disease. Methods: The analysis cohort included 32 consecutive adult SCD patients who underwent a comprehensive sleep evaluation and overnight polysomnography in an accredited sleep center after reporting symptoms suggesting disordered sleep or an Epworth Sleepiness Scale score = 10. Epworth score, sleep parameters, comorbid conditions, and narcotic use were reviewed and compared in patients with and without sleep disordered breathing. SCD complication rates in the two groups also were compared. Results: In adult SCD patients who underwent overnight polysomnography, we report a high prevalence (44%) of sleep disordered breathing. Disease severity was mild to moderate (mean apnea-hypopnea index = 17/h (95% CI: 10-24/h). Concomitant sleep disorders, including insomnia complaints (57%) and delayed sleep-phase syndrome (57%), also were common in this population. In this limited cohort, we did not fi nd increased SCD complications associated with sleep disordered breathing in adult patients with sickle cell disease. Conclusions: A high burden of sleep disordered breathing and other sleep-related complaints were identifi ed in the adult sickle cell population. Our results provide important information on this unique population.

DOI 10.5664/jcsm.4530
Citations Scopus - 9
2015 Katunga LA, Gudimella P, Efird JT, Abernathy S, Mattox TA, Beatty C, et al., 'Obesity in a model of gpx4 haploinsufficiency uncovers a causal role for lipid-derived aldehydes in human metabolic disease and cardiomyopathy', Molecular Metabolism, 4 493-506 (2015)

© 2015 The Authors. Lipid peroxides and their reactive aldehyde derivatives (LPPs) have been linked to obesity-related pathologies, but whether they have a causal role has remain... [more]

© 2015 The Authors. Lipid peroxides and their reactive aldehyde derivatives (LPPs) have been linked to obesity-related pathologies, but whether they have a causal role has remained unclear. Glutathione peroxidase 4 (GPx4) is a selenoenzyme that selectively neutralizes lipid hydroperoxides, and human gpx4 gene variants have been associated with obesity and cardiovascular disease in epidemiological studies. This study tested the hypothesis that LPPs underlie cardio-metabolic derangements in obesity using a high fat, high sucrose (HFHS) diet in gpx4 haploinsufficient mice (GPx4 < sup > +/- < /sup > ) and in samples of human myocardium. Methods: Wild-type (WT) and GPx4 < sup > +/- < /sup > mice were fed either a standard chow (CNTL) or HFHS diet for 24 weeks, with metabolic and cardiovascular parameters measured throughout. Biochemical and immuno-histological analysis was performed in heart and liver at termination of study, and mitochondrial function was analyzed in heart. Biochemical analysis was also performed on samples of human atrial myocardium from a cohort of 103 patients undergoing elective heart surgery. Results: Following HFHS diet, WT mice displayed moderate increases in 4-hydroxynonenal (HNE)-adducts and carbonyl stress, and a 1.5-fold increase in GPx4 enzyme in both liver and heart, while gpx4 haploinsufficient (GPx4 < sup > +/- < /sup > ) mice had marked carbonyl stress in these organs accompanied by exacerbated glucose intolerance, dyslipidemia, and liver steatosis. Although normotensive, cardiac hypertrophy was evident with obesity, and cardiac fibrosis more pronounced in obese GPx4 < sup > +/- < /sup > mice. Mitochondrial dysfunction manifesting as decreased fat oxidation capacity and increased reactive oxygen species was also present in obese GPx4 < sup > +/- < /sup > but not WT hearts, along with up-regulation of pro-inflammatory and pro-fibrotic genes. Patients with diabetes and hyperglycemia exhibited significantly less GPx4 enzyme and greater HNE-adducts in their hearts, compared with age-matched non-diabetic patients. Conclusion: These findings suggest LPPs are key factors underlying cardio-metabolic derangements that occur with obesity and that GPx4 serves a critical role as an adaptive countermeasure.

DOI 10.1016/j.molmet.2015.04.001
Citations Scopus - 12
2015 Katunga LA, Gudimella P, Efird JT, Abernathy S, Mattox TA, Beatty C, et al., 'Corrigendum to Obesity in a model of gpx4 haploinsufficiency uncovers a causal role for lipid-derived aldehydes in human metabolic disease and cardiomyopathy [Mol Metab, 4, 6, (2015), 493-506] DOI: 10.1016/j.molmet.2015.04.001', Molecular Metabolism, 4 753 (2015)
DOI 10.1016/j.molmet.2015.06.005
2014 O'Neal WT, Efird JT, Davies SW, O'Neal JB, Griffin WF, Ferguson TB, et al., 'Discharge ß-blocker use and race after coronary artery bypass grafting', Frontiers in Public Health, 2 (2014)

© 2014 O&apos;Neal, Efird, Davies, O&apos;Neal, Griffin, Ferguson, Chitwood and Kypson. Introduction: The use of discharge ß-blockers after cardiac surgery is associated with a ... [more]

© 2014 O'Neal, Efird, Davies, O'Neal, Griffin, Ferguson, Chitwood and Kypson. Introduction: The use of discharge ß-blockers after cardiac surgery is associated with a long-term mortality benefit. b-Blockers have been suggested to be less effective in black cardiovascular patients compared with whites. To date, racial differences in the long-term survival of coronary artery bypass grafting (CABG) patients who receive ß-blockers at discharge have not been examined. Methods: A retrospective cohort study was conducted on patients undergoing CABG between 2002 and 2011. Long-term survival was compared in patients who were and who were not discharged with ß-blockers. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. P-for-interaction between race and discharge b-blocker use was computed using a likelihood ratio test. Results:A total of 853 (88%) black (nD970) and 3,038 (88%) white (nD3,460) patients had a history of b-blocker use at discharge (N D4,430). Black patients who received ß-blockers survived longer than those not receiving ß-blockers and the survival advantage was comparable with white patients (black, adjusted HRD0.33, 95% CID0.23-0.46; white, adjusted HRD0.48, 95% CID0.39-0.58; p-for-interactionD0.74). Among patients discharged on ß-blockers, we did not observe a long-term survival advantage for white compared with black patients (HRD1.2, 95% CID0.9 5-1.5). Conclusion: b-Blocker use at discharge was associated with a survival advantage among black patients after CABG and a similar association was observed in white patients.

DOI 10.3389/fpubh.2014.00094
Citations Scopus - 2
2014 Efird JT, Davies SW, O'Neal WT, Anderson EJ, 'Animal viruses, bacteria, and cancer: A brief commentary', Frontiers in Public Health, 2 (2014)

© 2014 Efird, Davies, O&apos;Neal and Anderson. Animal viruses and bacteria are ubiquitous in the environment. However, little is known about their mode of transmission and etiol... [more]

© 2014 Efird, Davies, O'Neal and Anderson. Animal viruses and bacteria are ubiquitous in the environment. However, little is known about their mode of transmission and etiologic role in human cancers, especially among high-risk groups (e.g., farmers, veterinarians, poultry plant workers, pet owners, and infants). Many factors may affect the survival, transmissibility, and carcinogenicity of these agents, depending on the animal-host environment, hygiene practices, climate, travel, herd immunity,and cultural differences in food consumption and preparation. Seasonal variations in immune function also may increase host susceptibility at certain times of the year. The lack of objective measures, inconsistent study designs, and sources of epidemiologic bias (e.g., residual confounding, recall bias, and non-randomized patient selection) are some of the factors that complicate a clear understanding of this subject.

DOI 10.3389/fpubh.2014.00014
Citations Scopus - 3
2014 O'Neal WT, Shah AJ, Efird JT, Rautaharju PM, Soliman EZ, 'Subclinical Myocardial Injury Identified by Cardiac Infarction/Injury Score and the Risk of Mortality in Men and Women Free of Cardiovascular Disease', AMERICAN JOURNAL OF CARDIOLOGY, 114 1018-1023 (2014)
DOI 10.1016/j.amjcard.2014.06.032
Citations Scopus - 1
2014 O'Neal WT, Efird JT, Dawood FZ, Yeboah J, Alonso A, Heckbert SR, Soliman EZ, 'Coronary Artery Calcium and Risk of Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis)', AMERICAN JOURNAL OF CARDIOLOGY, 114 1707-1712 (2014)
DOI 10.1016/j.amjcard.2014.09.005
Citations Scopus - 9Web of Science - 11
2014 Davies SW, Efird JT, Guidry CA, Penn RI, Sawyer RG, Schirmer BD, Hallowell PT, 'Long-term diabetic response to gastric bypass', JOURNAL OF SURGICAL RESEARCH, 190 498-503 (2014)
DOI 10.1016/j.jss.2014.01.047
Citations Scopus - 6Web of Science - 6
2014 Lea CS, Efird JT, Toland AE, Lewis DR, Phillips CJ, 'Melanoma Incidence Rates in Active Duty Military Personnel Compared With a Population-Based Registry in the United States, 2000-2007', MILITARY MEDICINE, 179 247-253 (2014)
DOI 10.7205/MILMED-D-13-00356
Citations Scopus - 4Web of Science - 3
2014 Biswas T, Walker P, Podder T, Rosenman J, Efird J, 'Important prognostic factors for lung cancer in tobacco predominant Eastern North Carolina: Study based on a single cancer registry', LUNG CANCER, 84 116-120 (2014)
DOI 10.1016/j.lungcan.2014.01.026
Citations Scopus - 1Web of Science - 2
2014 O'Neal WT, Efird JT, Davies SW, O'Neal JB, Anderson CA, Chitwood WR, et al., 'Race and Survival among Diabetic Patients after Coronary Artery Bypass Grafting', THORACIC AND CARDIOVASCULAR SURGEON, 62 308-316 (2014)
DOI 10.1055/s-0033-1357297
Citations Scopus - 5Web of Science - 5
2014 Hernandez AL, Efird JT, Holly EA, Berry JM, Jay N, Palefsky JM, 'Incidence of and risk factors for type-specific anal human papillomavirus infectionamongHIV-positive MSM', AIDS, 28 1341-1349 (2014)
DOI 10.1097/QAD.0000000000000254
Citations Scopus - 17Web of Science - 16
2014 Wu DS, Hu J, McCoy TP, Efird JT, 'The effects of a breastfeeding self-efficacy intervention on short-term breastfeeding outcomes among primiparous mothers in Wuhan, China', JOURNAL OF ADVANCED NURSING, 70 1867-1879 (2014)
DOI 10.1111/jan.12349
Citations Scopus - 17Web of Science - 14
2014 Efird JT, O'Neal WT, Davies SW, O'Neal JB, Kypson AP, 'Seasonal incidence of hospital admissions for Stanford type A aortic dissection', CHRONOBIOLOGY INTERNATIONAL, 31 954-958 (2014)
DOI 10.3109/07420528.2014.933842
Citations Scopus - 3Web of Science - 3
2014 Efird JT, Davies SW, O'Neal WT, Anderson CA, Anderson EJ, O'Neal JB, et al., 'The impact of race and postoperative atrial fibrillation on operative mortality after elective coronary artery bypass grafting', EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 45 E20-E25 (2014)
DOI 10.1093/ejcts/ezt529
Citations Scopus - 7Web of Science - 7
2014 O'Neal WT, Efird JT, Landrine H, Anderson CA, Davies SW, O'Neal JB, et al., 'The Effect of Preoperative beta-Blocker Use and Race on Long-Term Survival After Coronary Artery Bypass Grafting', JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 28 595-600 (2014)
DOI 10.1053/j.jvca.2013.06.009
Citations Scopus - 6Web of Science - 8
2014 Davies SW, Efird JT, Guidry CA, Hranjec T, Metzger R, Swenson BR, Sawyer RG, 'DOES IT MATTER IF WE GET IT RIGHT? IMPACT OF APPROPRIATENESS OF EMPIRIC ANTIMICROBIAL THERAPY AMONG SURGICAL PATIENTS', SHOCK, 42 185-191 (2014)
DOI 10.1097/SHK.0000000000000192
Citations Scopus - 5Web of Science - 5
2014 O'Neal WT, Efird JT, Yeboah J, Nazaria S, Alonso A, Heckbert SR, Soliman EZ, 'Brachial Flow-Mediated Dilation and Incident Atrial Fibrillation The Multi-Ethnic Study of Atherosclerosis', ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 34 2717-U248 (2014)
DOI 10.1161/ATVBAHA.114.304560
Citations Scopus - 11Web of Science - 11
2014 Efird JT, O'Neal WT, Davies SW, O'Neal JB, Chitwood WR, Ferguson TB, Kypson AP, 'Operative Status and Survival after Coronary Artery Bypass Grafting', HEART SURGERY FORUM, 17 E82-E90 (2014)
DOI 10.1532/HSF98.2013310
Citations Scopus - 1Web of Science - 1
2014 Snee LS, Nerurkar VR, Dooley DA, Efird JT, Shovic AC, Nerurkar PV, 'strategies to improve palatability and increase consumption intentions for Momordica charantia (bitter melon): a vegetable commonly used for diabetes management (vol 13, pg 3, 2014)', NUTRITION JOURNAL, 13 (2014)
DOI 10.1186/1475-2891-13-3
Citations Web of Science - 1
2014 Efird JT, O'Neal WT, Camargo GA, Davies SW, O'Neal JB, Kypson AP, 'Conditional survival of heart failure patients after coronary artery bypass grafting', JOURNAL OF CARDIOVASCULAR MEDICINE, 15 498-503 (2014)
DOI 10.2459/JCM.0b013e328365b615
Citations Scopus - 2Web of Science - 3
2014 Efird JT, Choi YM, Davies SW, Mehra S, Anderson EJ, Katunga LA, 'Potential for Improved Glycemic Control with Dietary Momordica charantia in Patients with Insulin Resistance and Pre-Diabetes', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 11 2328-2345 (2014)
DOI 10.3390/ijerph110202328
Citations Scopus - 11Web of Science - 9
2014 Efird JT, O'Neal WT, Davies SW, O'Neal JB, Kindell LC, Anderson CA, et al., 'Risk-Adjusted Survival after Coronary Artery Bypass Grafting: Implications for Quality Improvement', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 11 7470-7481 (2014)
DOI 10.3390/ijerph110707470
2014 Anderson EJ, Efird JT, Davies SW, O'Neal WT, Darden TM, Thayne KA, et al., 'Monoamine Oxidase is a Major Determinant of Redox Balance in Human Atrial Myocardium and is Associated With Postoperative Atrial Fibrillation', JOURNAL OF THE AMERICAN HEART ASSOCIATION, 3 (2014)
DOI 10.1161/JAHA.113.000713
Citations Scopus - 27Web of Science - 24
2014 O'Neal WT, Efird JT, Nazarian S, Alonso A, Heckbert SR, Soliman EZ, 'Peripheral Arterial Disease and Risk of Atrial Fibrillation and Stroke: The Multi-Ethnic Study of Atherosclerosis', JOURNAL OF THE AMERICAN HEART ASSOCIATION, 3 (2014)
DOI 10.1161/JAHA.114.001270
Citations Scopus - 12Web of Science - 11
2014 Davies SW, Efird JT, Guidry CA, Hranjec T, Metzger R, Swenson BR, Sawyer RG, 'Characteristics of surgical patients receiving inappropriate empiric antimicrobial therapy', JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 77 546-554 (2014)
DOI 10.1097/TA.0000000000000309
Citations Scopus - 1Web of Science - 1
2014 Efird JT, Landrine H, Shiue KY, O'Neal WT, Podder T, Rosenman JG, Biswas T, 'Race, insurance type, and stage of presentation among lung cancer patients', SPRINGERPLUS, 3 (2014)
DOI 10.1186/2193-1801-3-710
Citations Scopus - 5Web of Science - 3
2013 Efird JT, O'Neal WT, Anderson CA, O'Neal JB, Kindell LC, Ferguson TB, et al., 'The effect of race and chronic obstructive pulmonary disease on long-term survival after coronary artery bypass grafting', Frontiers in Public Health, 1 (2013)

© 2013 Efird, O&apos;Neal, Anderson, O&apos;Neal, Kindell, Fer-guson, Chitwood and Kypson. Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decrea... [more]

© 2013 Efird, O'Neal, Anderson, O'Neal, Kindell, Fer-guson, Chitwood and Kypson. Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 984 (20%) patients had COPD (black nD182; white nD802) at the time of CABG (N D4,801). The median follow-up for study participantswas 4.4 years. COPDwas observed to be a s tatistically significant predictor of decreased survival independent of race following CABG (no COPD: HRD1.0; white COPD: adjusted HRD1.9, 95% CID1.7-2.3; black COPD: adjusted HRD1.6, 95% CID1.1-2.2). Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.

DOI 10.3389/fpubh.2013.00004
Citations Scopus - 16
2013 Abel WM, Efird JT, 'The association between trust in health care providers and medication adherence among Black women with hypertension', Frontiers in Public Health, 1 (2013)

© 2013 Abel and Efird. Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy o... [more]

© 2013 Abel and Efird. Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens. Methods: Blackwomen (N = 80) whowere prescribed antihypertensive medicationswere recruited from urban communities in North Carolina. Study participants completed theTrust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence. Results: Mean age of study participants was 48±9.2 years. The majority of participants (67%) were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (P Trend = 0.015). Conclusion: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension.

DOI 10.3389/fpubh.2013.00066
Citations Scopus - 11
2013 Efird JT, O'Neal WT, Kennedy WL, Kypson AP, 'Grand challenge: Understanding survival paradoxes in epidemiology', Frontiers in Public Health, 1 (2013)
DOI 10.3389/fpubh.2013.00003
Citations Scopus - 4
2013 Efird JT, O'Neal WT, O'Neal JB, Ferguson TB, Chitwood WR, Kypson AP, 'Effect of Peripheral Arterial Disease and Race on Survival After Coronary Artery Bypass Grafting', ANNALS OF THORACIC SURGERY, 96 112-118 (2013)
DOI 10.1016/j.athoracsur.2013.04.006
Citations Scopus - 15Web of Science - 14
2013 Tung W-C, Hu J, Efird JT, Su W, Yu L, 'HIV knowledge and condom intention among sexually abstinent Chinese students', INTERNATIONAL NURSING REVIEW, 60 366-373 (2013)
DOI 10.1111/inr.12039
Citations Scopus - 3Web of Science - 4
2013 Salenger R, Rodriquez E, Efird JT, Gouge CA, Trubiano P, Lundy EF, 'Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta', JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 145 1584-1588 (2013)
DOI 10.1016/j.jtcvs.2012.05.045
2013 Ferguson TB, Chen C, Babb JD, Efird JT, Daggubati R, Cahill JM, 'Fractional flow reserve-guided coronary artery bypass grafting: Can intraoperative physiologic imaging guide decision making?', JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 146 824-833 (2013)
DOI 10.1016/j.jtcvs.2013.06.026
Citations Scopus - 21Web of Science - 14
2013 Elchoufani SE, Efird JT, O'Neal WT, Davies SW, Landrine H, Biswas T, 'The relation of race and type of health insurance to long-term risk of mortality among lung cancer patients in rural Eastern North Carolina.', North Carolina medical journal, 74 464-469 (2013)

Black patients with lung cancer have a higher mortality rate than do their white counterparts. Differences in insurance coverage, demographic characteristics, and treatment profil... [more]

Black patients with lung cancer have a higher mortality rate than do their white counterparts. Differences in insurance coverage, demographic characteristics, and treatment profiles may explain this disparity. The purpose of this study was to compare the longterm risk of mortality of black lung cancer patients with that of white lung cancer patients, by insurance type. Patients who were diagnosed with lung cancer in Eastern North Carolina and treated at the Leo Jenkins Cancer Center between 2001 and 2010 were included in this study. A Cox regression model was used to compare the risk of mortality of black patients with that of white patients. A total of 2,351 lung cancer patients (717 black and 1,634 white) were treated at the Leo Jenkins Cancer Center during the study period. Independent of age and sex, black patients with lung cancer were observed to die sooner than their white counterparts (hazard ratio = 1.2; 95% confidence interval, 1.04-1.3; P = .0070). However, this difference was not statistically significant after controlling for and stratifying by insurance type. Residual confounding and the misclassification of some variables could have biased estimated study effects. The racial disparity in lung cancer mortality observed in Eastern North Carolina is no longer apparent after health insurance type is accounted for.

Citations Scopus - 2
2013 O'Neal WT, Efird JT, Davies SW, Choi YM, Anderson CA, Kindell LC, et al., 'Preoperative atrial fibrillation and long-term survival after open heart surgery in a rural tertiary heart institute', HEART & LUNG, 42 442-447 (2013)
DOI 10.1016/j.hrtlng.2013.07.012
Citations Scopus - 8Web of Science - 9
2013 Sharma S, Efird J, Kadali R, Mehra S, Chohan H, Daggubati R, et al., 'Pulmonary Artery Occlusion Pressure May Overdiagnose Pulmonary Artery Hypertension in Sickle Cell Disease', CLINICAL CARDIOLOGY, 36 524-530 (2013)
DOI 10.1002/clc.22153
Citations Scopus - 4Web of Science - 4
2013 Hessol NA, Holly EA, Efird JT, Minkoff H, Weber KM, Darragh TM, et al., 'Concomitant anal and cervical human papillomavirusV infections and intraepithelial neoplasia in HIV-infected and uninfected women', AIDS, 27 1743-1751 (2013)
DOI 10.1097/QAD.0b013e3283601b09
Citations Scopus - 31Web of Science - 30
2013 O'Neal WT, Efird JT, Davies SW, O'Neal JB, Anderson CA, Ferguson TB, et al., 'The Impact of Postoperative Atrial Fibrillation and Race on Long-Term Survival after Coronary Artery Bypass Grafting', JOURNAL OF CARDIAC SURGERY, 28 484-491 (2013)
DOI 10.1111/jocs.12178
Citations Scopus - 10Web of Science - 10
2013 Mehta H, Efird JT, Kadali RA, Boettger P, Liles D, Knupp C, Sharma S, 'Daytime pulse oximetry measurements may not predict nocturnal desaturations in adult sickle cell patients', ANNALS OF HEMATOLOGY, 92 1291-1292 (2013)
DOI 10.1007/s00277-013-1708-2
Citations Scopus - 1Web of Science - 1
2013 Yu Y, Hu J, Efird JT, McCoy TP, 'Social support, coping strategies and health-related quality of life among primary caregivers of stroke survivors in China', JOURNAL OF CLINICAL NURSING, 22 2160-2171 (2013)
DOI 10.1111/jocn.12251
Citations Scopus - 9Web of Science - 9
2013 O'Neal WT, Efird JT, Anderson CA, Kindell LC, O'Neal JB, Ferguson TB, et al., 'The Impact of Prior Percutaneous Coronary Intervention on Long-Term Survival after Coronary Artery Bypass Grafting', HEART LUNG AND CIRCULATION, 22 940-945 (2013)
DOI 10.1016/j.hlc.2013.04.110
Citations Scopus - 11Web of Science - 7
2013 Hernandez AL, Efird JT, Holly EA, Berry JM, Jay N, Palefsky JM, 'Risk Factors for Anal Human Papillomavirus Infection Type 16 Among HIV-Positive Men Who Have Sex With Men in San Francisco', JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 63 532-539 (2013)
Citations Scopus - 10Web of Science - 11
2013 Sharma R, Efird JT, Chein A, Holly EA, Krajden M, Berry JM, et al., 'Prevalence and Risk Factors for Neutralizing Antibodies to Human Papillomavirus Types 16 and 18 in HIV-Positive Men Who Have Sex With Men', JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 64 479-487 (2013)
Citations Scopus - 4Web of Science - 3
2013 Efird JT, O'Neal WT, Bolin P, Davies SW, O'Neal JB, Anderson CA, et al., 'Racial Differences in Survival among Hemodialysis Patients after Coronary Artery Bypass Grafting', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 10 4175-4185 (2013)
DOI 10.3390/ijerph10094175
Citations Scopus - 6Web of Science - 6
2013 Efird JT, 'Computing Power and Sample Size for Informational Odds Ratio', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 10 5239-5243 (2013)
DOI 10.3390/ijerph10105239
2013 Deguchi M, Valente T, Efird J, Oropeza M, Niederman R, Nigg CR, 'Hawai'i's silent epidemic: children's caries (dental decay).', Hawai'i journal of medicine &amp; public health : a journal of Asia Pacific Medicine &amp; Public Health, 72 204-208 (2013)
Citations Scopus - 1
2013 Efird JT, 'Basic and Clinical Cancer Research in the Healthcare Reform Era', Journal of Cancer Science and Therapy, 5 1-2 (2013)
DOI 10.4172/1948-5956.1000e119
2012 Derauf C, Lester BM, Neyzi N, Kekatpure M, Gracia L, Davis J, et al., 'Subcortical and cortical structural central nervous system changes and attention processing deficits in preschool-aged children with prenatal methamphetamine and tobacco exposure', Developmental Neuroscience, 34 327-341 (2012)
DOI 10.1159/000341119
Citations Scopus - 21Web of Science - 18
2012 Biswas T, Efird J, James S, Walker P, Fried D, Moran J, et al., 'Clinical Outcome Of Stereotactic Body Radiotherapy Using Cyberknife For Primary And Secondary Lung Tumors', JOURNAL OF THORACIC ONCOLOGY, 7 S275-S276 (2012)
2012 Tung WC, Hu J, Efird JT, Yu L, Su W, 'HIV-related knowledge, attitudes and behaviours among college students in China', Health Education Journal, 71 606-616 (2012)
DOI 10.1177/0017896911406968
Citations Scopus - 1Web of Science - 2
2012 Arcidi JM, Rodriguez E, Elbeery JR, Nifong LW, Efird JT, Chitwood WR, 'Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve', Journal of Thoracic and Cardiovascular Surgery, 143 1062-1068 (2012)
DOI 10.1016/j.jtcvs.2011.06.036
Citations Scopus - 33Web of Science - 29
2012 Barba BE, Hu J, Efird J, 'Quality geriatric care as perceived by nurses in long-term and acute care settings', Journal of Clinical Nursing, 21 833-840 (2012)
DOI 10.1111/j.1365-2702.2011.03781.x
Citations Scopus - 2Web of Science - 3
2012 Zhu S, Hu J, Efird JT, 'Role of social support in cognitive function among elders', Journal of Clinical Nursing, 21 2118-2125 (2012)
DOI 10.1111/j.1365-2702.2012.04178.x
Citations Scopus - 18Web of Science - 15
2012 Kaholokula JKA, Mau MK, Efird JT, Leake A, West M, Palakiko DM, et al., 'A Family and Community Focused Lifestyle Program Prevents Weight Regain in Pacific Islanders: A Pilot Randomized Controlled Trial', Health Education and Behavior, 39 386-395 (2012)
DOI 10.1177/1090198110394174
Citations Scopus - 13Web of Science - 13
2012 Efird JT, 'Mapping the future-merging the old with the new across disciplines', Cancer Informatics, 11 191-192 (2012)
DOI 10.4137/CIN.S11195
2011 Biswas T, Hudson S, Podder TK, Brinson M, Rosenman J, Efird JT, 'Demography and Survival of Lung Cancer Patients in Tobacco Predominant Eastern North Carolina: A Single Institution Study', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 81 S582-S582 (2011)
2011 Efird J, 'Blocked Randomization with Randomly Selected Block Sizes', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 8 15-20 (2011)
DOI 10.3390/ijerph8010015
Citations Scopus - 71Web of Science - 66
2011 Novick LF, Lazorick S, Clay MC, Merricks PA, Daugherty JC, Efird JT, 'Using clinical skills exams to evaluate medical student skills in prevention', American Journal of Preventive Medicine, 41 s181-s186 (2011)
DOI 10.1016/j.amepre.2011.05.019
Citations Scopus - 4Web of Science - 3
2011 Efird JT, Toland AE, Lea CS, Phillips CJ, 'The combined influence of oral contraceptives and human papillomavirus virus on cutaneous squamous cell carcinoma', Clinical Medicine Insights: Oncology, 5 55-75 (2011)
DOI 10.4137/CMO.S6905
Citations Scopus - 3
2011 Snee LS, Nerurkar VR, Dooley DA, Efird JT, Shovic AC, Nerurkar PV, 'Strategies to improve palatability and increase consumption intentions for momordica charantia (bitter melon): A vegetable commonly used for diabetes management', Nutrition Journal, 10 78-78 (2011)
DOI 10.1186/1475-2891-10-78
Citations Scopus - 13Web of Science - 9
2010 Efird JT, 'An efficient gatekeeper algorithm for detecting GXE', Cancer Informatics, 9 115-120 (2010)

The risk for many complex diseases is believed to be a result of the interactive effects of genetic and environmental factors. Developing efficient techniques to identify gene-env... [more]

The risk for many complex diseases is believed to be a result of the interactive effects of genetic and environmental factors. Developing efficient techniques to identify gene-environment interactions (GxE) is important for unraveling the etiologic basis of many modern day diseases including cancer. The problem of false positives and false negatives continues to pose significant roadblocks to detecting GxE and informing targeted public health screening and intervention. A heuristic gatekeeper method is presented to guide the selection of single nucleotide polymorphisms (SNPs) in the design phase of a GxE study. © the author(s), publisher and licensee Libertas Academica Ltd.

2010 Efird JT, 'Sinusoidal Cox regression-A rare cancer example', Cancer Informatics, 9 265-279 (2010)

Evidence of an association between survival time and date of birth would suggest an etiologic role for a seasonally variable environmental exposure occurring within a narrow perin... [more]

Evidence of an association between survival time and date of birth would suggest an etiologic role for a seasonally variable environmental exposure occurring within a narrow perinatal time period. Risk factors that may exhibit seasonal epidemicity include diet, infectious agents, allergens, and antihistamine use. Typically data has been analyzed by simply categorizing births into months or seasons of the year and performing multiple pairwise comparisons. This paper presents a statistically robust alternative, based upon a trigonometric Cox regression model, to analyze the cyclic nature of birth dates related to patient survival. Disease birth-date results are presented using a sinusoidal plot with peak date(s) of relative risk and a single P value that indicates whether an overall statistically significant seasonal association is present. Advantages of this derivative-free method include ease of use, increased power to detect statistically significant associations, and the ability to avoid arbitrary, subjective demarcation of seasons. © The author(s), publisher and licensee Libertas Academica Ltd.

DOI 10.4137/CIN.S6202
2010 Mau MK, Keawe'aimoku Kaholokula J, West MR, Leake A, Efird JT, Rose C, et al., 'Translating diabetes prevention into native Hawaiian and Pacific Islander communities: the PILI 'Ohana Pilot project.', Progress in community health partnerships : research, education, and action, 4 7-16 (2010)

BACKGROUND: Native Hawaiians (NH) and Other Pacific Islanders (OPI) bear an excess burden of diabetes health disparities. Translation of empirically tested interventions such as t... [more]

BACKGROUND: Native Hawaiians (NH) and Other Pacific Islanders (OPI) bear an excess burden of diabetes health disparities. Translation of empirically tested interventions such as the Diabetes Prevention Program Lifestyle Intervention (DPP-LI) offers the potential for reversing these trends. Yet, little is known about how best to translate efficacious interventions into public health practice, particularly among racial/ethnic minority populations. Community-based participatory research (CBPR) is an approach that engages the community in the research process and has recently been proposed as a means to improve the translation of research into community practice. OBJECTIVES: To address diabetes health disparities in NHOPIs, CBPR approaches were used to: (1) culturally adapt the DPP-LI for NHOPI communities; and (2) implement and examine the effectiveness of the culturally-adapted program to promote weight loss in 5 NHOPI communities. METHODS: Informant interviews (n=15) and focus groups (n=15, with 112 NHOPI participants) were completed to inform the cultural adaptation of the DPP-LI program. A team of 5 community investigators and 1 academic research team collaboratively developed and implemented the 12-week pilot study to assess the effectiveness of the culturally adapted program. RESULTS: A total of 127 NHOPIs participated in focus groups and informant interviews that resulted in the creation of a significantly modified version of the DPP-LI, entitled the PILI 'Ohana Lifestyle Intervention (POLI). In the pilot study, 239 NHOPIs were enrolled and after 12 weeks (post-program), mean weight loss was -1.5 kg (95%CI -2.0, -1.0) with 26% of participants losing > or = 3% of their baseline weight. Mean weight loss among participants who completed all 8 lessons at 12 weeks was significantly higher (-1.8 kg, 95%CI -2.3, -1.3) than participants who completed less than 8 lessons (-0.70 kg, 95%CI -1.1, -0.29). CONCLUSION: A fully engaged CBPR approach was successful in translating an evidence based diabetes prevention program into a culturally relevant intervention for NHOPI communities. This pilot study demonstrates that weight loss in high risk minority populations can be achieved over a short period of time using CBPR approaches.

Citations Scopus - 49
2010 Efird JT, 'Season of birth and risk for adult onset glioma', International Journal of Environmental Research and Public Health, 7 1913-1936 (2010)

Adult onset glioma is a rare cancer which occurs more frequently in Caucasians than African Americans, and in men than women. The etiology of this disease is largely unknown. Expo... [more]

Adult onset glioma is a rare cancer which occurs more frequently in Caucasians than African Americans, and in men than women. The etiology of this disease is largely unknown. Exposure to ionizing radiation is the only well established environmental risk factor, and this factor explains only a small percentage of cases. Several recent studies have reported an association between season of birth and glioma risk. This paper reviews the plausibility of eviden ce focusing on the seasonal interrelation of farming, allergies, viruses, vitamin D, diet, birth weight, and handedness. To date, a convincing explanation for the occurrence of adult gliomas decades after a seasonal exposure at birth remains elusive. © 2010 by the authors.

DOI 10.3390/ijerph7051913
Citations Scopus - 12
2010 Asgari MM, Efird JT, Warton EM, Friedman GD, 'Potential Risk Factors for Cutaneous Squamous Cell Carcinoma include Oral Contraceptives: Results of a Nested Case-Control Study', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, 7 427-442 (2010)
DOI 10.3390/ijerph7020427
Citations Scopus - 11Web of Science - 10
2009 Hessol NA, Holly EA, Efird JT, Minkoff H, Schowalter K, Darragh TM, et al., 'Anal intraepithelial neoplasia in a multisite study of HIV-infected and high-risk HIV-uninfected women', AIDS, 23 59-70 (2009)

Objectives: To study anal intraepithelial neoplasia and its associations with anal and cervical human papillomavirus (HPV), cervical neoplasia, host immune status, and demographic... [more]

Objectives: To study anal intraepithelial neoplasia and its associations with anal and cervical human papillomavirus (HPV), cervical neoplasia, host immune status, and demographic and behavioral risk factors in women with and at risk for HIV infection. Design: Point-prevalence analysis nested within a prospective study of women seen at three clinical centers of the Women's Interagency HIV Study. Methods: In 2001-2003 participants were interviewed, received a gynecological examination, anal and cervical cytology testing and, if abnormal, colposcopy-guided or anoscopy-guided biopsy of visible lesions. Exfoliated cervical and anal specimens were assessed for HPV using PCR and type-specific HPV probing. Logistic regression analyses were performed, and odds ratios (ORs) estimated risks for anal intraepithelial neoplasia. Results: Four hundred and seventy HIV-infected and 185 HIV-uninfected women were enrolled. Low-grade anal intraepithelial neoplasia was present in 12% of HIV-infected and 5% of HIV-uninfected women. High-grade anal intraepithelial neoplasia was present in 9% of HIV-infected and 1% of HIV-uninfected women. In adjusted analyses among HIV-infected women, the risk factors for low-grade anal intraepithelial neoplasia were younger age [OR = 0.59, 95% confidence interval (CI) = 0.36-0.97], history of receptive anal intercourse (OR = 3.2, 95% CI = 1.5-6.8), anal HPV (oncogenic types only OR = 11, 95% CI = 1.2-103; oncogenic and nononcogenic types OR = 11, 95% CI = 1.3-96), and cervical HPV (oncogenic and nononcogenic types OR = 3.5, 95% CI = 1.1-11). In multivariable analyses among HIV-infected women, the only significant risk factor for high-grade anal intraepithelial neoplasia was anal HPV infection (oncogenic and nononcogenic types OR = 7.6, 95% CI = 1.5-38). Conclusion: Even in the era of highly active antiviral therapy, the prevalence of anal intraepithelial neoplasia was 16% in HIV-infected women. After controlling for potential confounders, several risk factors for low-grade anal intraepithelial neoplasia differed from risk factors for high-grade anal intraepithelial neoplasia. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

DOI 10.1097/QAD.0b013e32831cc101
Citations Scopus - 75
2009 Mau MK, Asao K, Efird J, Saito E, Ratner R, Hafi M, Seto T, 'Risk factors associated with methamphetamine use and heart failure among Native Hawaiians and other Pacific Island peoples', Vascular Health and Risk Management, 5 45-52 (2009)

Objective: Heart failure (HF), a long term outcome of chronic methamphetamine use (MU), occurs more frequently in racial and ethnic minority populations at high risk for cardiovas... [more]

Objective: Heart failure (HF), a long term outcome of chronic methamphetamine use (MU), occurs more frequently in racial and ethnic minority populations at high risk for cardiovascular disparities. This study examined the association of socio-demographic and clinical risk factors with MU among heart failure patients who are Native Hawaiians (NH) or other Pacific Island peoples (PIP). Design/Setting/Patient population: Cross-sectional study of NHs and PIPs with advanced heart failure enrolled in the Malama Pu'uwai Study, a randomized control trial to test an educational intervention to reduce re-hospitalization and/or death. A total of 82 participants were enrolled between 6/1/06 to 12/31/07 and met the following eligibility criteria: 1) self-identified NH or PIP, 2) Left ventricular systolic ejection fraction =45%, 3) Age of 21 years or older. Data were analyzed by odds ratios (OR), 95% confidence intervals (CI), and multiple logistic regression analysis. Main outcome measure: Methamphetamine use. Results: Twenty-two percent of HF participants were identified as being current or prior methamphetamine users. Younger age and non-married status (combined never married or divorced/separated) were independently associated with MU after adjustment for sex, education, and other co-morbidities associated with HF (ie, age > 50 years, OR = 0.16, 95% CI, 0.03-0.84; non-married status combined as never married OR = 8.5, CI, 1.5-47; divorced/separated OR = 11, CI 1.8-75). Conclusions: Risk factors associated with MU in NH and PIPs with heart failure include: younger age and being divorced/separated or never married. Health care providers should be aware of MU as a contributing factor in the approach and treatment of HF in NHs and PIPs. © 2009 Mau et al, publisher and licensee Dove Medical Press Ltd.

Citations Scopus - 6
2009 Andres MA, Baptista NC, Efird JT, Ogata KK, Bellinger FP, Zeyda T, 'Depletion of SK1 channel subunits leads to constitutive insulin secretion', FEBS LETTERS, 583 369-376 (2009)
DOI 10.1016/j.febslet.2008.12.024
Citations Scopus - 12Web of Science - 11
2008 Efird JT, Hong MK, 'Computing differential sample size for case-control studies of gene-environment interaction', Ethnicity and Disease, 18 (2008)

The rates for diseases such as cancer, cardiovascular disease, and diabetes are known to differ by ethnic/racial groups. However, neither genetic nor environmental factors fully e... [more]

The rates for diseases such as cancer, cardiovascular disease, and diabetes are known to differ by ethnic/racial groups. However, neither genetic nor environmental factors fully explain the observed differences. Failure to account for genetic expression in the absence or presence of an environmental factor, and vice-versa, may lead to erroneous conclusions regarding the importance of these factors in disease etiology. We present a novel method for computing sample size for case-control studies involving the interaction of genetic and environmental factors. The method is based on an indirect estimate of the odds ratio for gene- environment interaction given only the odds ratio for environmental exposure and population genotype frequency. A table is presented providing sample sizes required for detecting a minimum odds ratio for gene-environment interaction given varying genotype frequencies and environmental exposure odds ratio values. Sample size increases proportionately with genotype frequency for a given environment exposure odds ratio.

Co-authors Miki Hong
2008 Efird J, Hong M, 'Computing differential sample size for case-control studies of gene-environment interaction (Ethnicity & Disease (2008) 18, (S2-25-S2-29))', Ethnicity and Disease, 18 534 (2008)
Co-authors Miki Hong
2008 Efird JT, Nielsen SS, 'A method to model season of birth as a surrogate environmental risk factor for disease', International Journal of Environmental Research and Public Health, 5 49-53 (2008)

Environmental exposures, including some that vary seasonally, may play a role in the development of many types of childhood diseases such as cancer. Those observed in children are... [more]

Environmental exposures, including some that vary seasonally, may play a role in the development of many types of childhood diseases such as cancer. Those observed in children are unique in that the relevant period of exposure is inherently limited or perhaps even specific to a very short window during prenatal development or early infancy. As such, researchers have investigated whether specific childhood cancers are associated with season of birth. Typically a basic method for analysis has been used, for example categorization of births into one of four seasons, followed by simple comparisons between categories such as via logistic regression, to obtain odds ratios (ORs), confidence intervals (CIs) and p-values. In this paper we present an alternative method, based upon an iterative trigonometric logistic regression model used to analyze the cyclic nature of birth dates related to disease occurrence. Disease birth-date results are presented using a sinusoidal graph with a peak date of relative risk and a single p-value that tests whether an overall seasonal association is present. An OR and CI comparing children born in the 3-month period around the peak to the symmetrically opposite 3-month period also can be obtained. Advantages of this derivative-free method include ease of use, increased statistical power to detect associations, and the ability to avoid potentially arbitrary, subjective demarcation of seasons. © 2008 MDPI. All rights reserved.

DOI 10.3390/ijerph5010049
Citations Scopus - 11
2008 Mau MK, Wong KN, Efird J, West M, Saito EP, Maddock J, 'Environmental factors of obesity in communities with native Hawaiians.', Hawaii medical journal, 67 233-236 (2008)

OBJECTIVE: To compare the fast food outlets and exercise resources across 3 communities with varying percentages of Native Hawaiians (NH) and to correlate these findings with obes... [more]

OBJECTIVE: To compare the fast food outlets and exercise resources across 3 communities with varying percentages of Native Hawaiians (NH) and to correlate these findings with obesity prevalence. METHODS: Data on all food and exercise resources were collected from January through July 2006 within a 1-mile radius in 3 distinct communities (site A = higher % NH to site C = lower % NH). Comparisons between communities were analyzed in 2007 using Fisher's Exact and ANOVA. RESULTS: Trends in obesity prevalence paralleled the percentage of NHs. After adjusting for population size, site B had a greater number of fast food outlets (p < 0.001) than site A or C, and more exercise facilities compared to site A (p = 0.05). Availability of fast food outlets was significantly greater at site A compared to site C (p = 0.03). Usage of exercise facilities was not significantly different between sites although exercise resources were in 'poorer' condition at site A compared to site B or C (p < or = 0.05). DISCUSSION: Results confirm the increased frequency of obesogenic environmental factors and their correlation with obesity trends across 3 distinct NH communities. These results suggest that environmental factors may offer another means for reducing obesity disparities in minority communities.

Citations Scopus - 7
2008 Bith-Melander P, Efird JT, 'Tropical medicine within the Cambodia context: Cambodian health care systems, Khmer medicine, and HIV/AIDS therapy', ASIAN PACIFIC JOURNAL OF TROPICAL MEDICINE, 1 19-26 (2008)
2007 Yeo K-K, Wijetunga M, Ito H, Efird JT, Tay K, Seto TB, et al., 'The association of methamphetamine use and cardiomyopathy in young patients', AMERICAN JOURNAL OF MEDICINE, 120 165-171 (2007)
DOI 10.1016/j.amjmed.2006.01.024
Citations Scopus - 86Web of Science - 74
2007 Umylny B, Presting G, Efird JT, Klimovitsky BI, Ward WS, 'Most human Alu and murine b1 repeats are unique', JOURNAL OF CELLULAR BIOCHEMISTRY, 102 110-121 (2007)
DOI 10.1002/jcb.21278
Citations Scopus - 16Web of Science - 13
2007 Kerever A, Schnack J, Vellinga D, Ichikawa N, Moon C, Arikawa-Hirasawa E, et al., 'Novel extracellular matrix structures in the neural stem cell niche capture the neurogenic factor fibroblast growth factor 2 from the extracellular milieu', STEM CELLS, 25 2146-2157 (2007)
DOI 10.1634/stemcells.2007-0082
Citations Scopus - 163Web of Science - 158
2007 Lim STS, Dragull K, Tang C-S, Bittenbender HC, Efird JT, Nerurkar PV, 'Effects of kava alkaloid, pipermethystine, and kavalactones on oxidative stress and cytochrome P450 in F-344 rats', TOXICOLOGICAL SCIENCES, 97 214-221 (2007)
DOI 10.1093/toxsci/kfm035
Citations Scopus - 41Web of Science - 35
2007 Mau MK, West MR, Shara NM, Efird JT, Alimineti K, Saito E, et al., 'Epidemiologic and clinical factors associated with Chronic Kidney Disease among Asian Americans and native Hawaiians', ETHNICITY & HEALTH, 12 111-127 (2007)
DOI 10.1080/13557850601081720
Citations Scopus - 11Web of Science - 10
2006 Harrigan R, Mbabuike N, Efird JT, Easa D, Shintani T, Hammatt Z, et al., 'Use of provider delivered complementary and alternative therapies in Hawai'i: results of the Hawai'i Health Survey.', Hawaii medical journal., 65 (2006)

BACKGROUND: Provider delivered complementary and alternative medicine (CAM) is used increasingly as a treatment option. Nevertheless, data related to the prevalence of provider de... [more]

BACKGROUND: Provider delivered complementary and alternative medicine (CAM) is used increasingly as a treatment option. Nevertheless, data related to the prevalence of provider delivered CAM (or PDCAM) use in diverse racial and ethnic populations is limited. The purpose of this investigation was to describe the use of provider delivered CAM in Hawaiian, Asian, and other Pacific Island populations in Hawai'i. The investigation was undertaken to test the hypothesis that a significant difference existed in the use of provider delivered CAM in Hawai'i because of the cultural diversity existing within the population. METHODS: The data were collected through the Hawai'i Health Survey (HHS). The HHS was administered by telephone among 5,000 stratified, randomly selected households, representing each of the Hawaiian Islands. Data were collected on all members of sample households. The sample population was statistically adjusted to represent the population of Hawai'i. RESULTS: Several factors emerged that may indicate increased use of provider delivered CAM. Most provider delivered CAM users are more educated, have incomes 200% or more above the poverty line, and reported either good or very good health status. Among respondents with poor health status, 60.4% have used provider delivered CAM. Those with a body mass index indicating that they were overweight also reported a high level of provider delivered CAM use (51.4%). Similar percentages of both women and men use provider delivered CAM, while the youngest and oldest respondents reported the least use of provider delivered CAM. Whites (60.0%) and Koreans (56.6%) reported the highest percentage of use of provider delivered CAM, while African Americans (35.5%) and Filipinos (37. 1%) reported the lowest percentage. The majority of people without health insurance report provider delivered CAM use (53. 7%). The highest portion of people who have usedanyalternative health care service is found among those whose pain severely interferes with normal work (78.3%). CONCLUSIONS The use of provider delivered CAM was found to be significantly greater in Hawaii compared with the mainland. Our results suggest the need for additional investigation of provider delivered CAM use in specific ethnic subpopulations.

Citations Scopus - 4
2005 Efird JT, 'A method for indirectly estimating gene-environment effect modification and power given only genotype frequency and odds ratio of environmental exposure', European Journal of Epidemiology, 20 389-393 (2005)

Both genes and environment are important determinants of disease. In this paper we model gene-environment effect modification on the odds ratio scale OR(GE|D) and show how to indi... [more]

Both genes and environment are important determinants of disease. In this paper we model gene-environment effect modification on the odds ratio scale OR(GE|D) and show how to indirectly estimate the effect and 95% confidence intervals (CI) for the simple case of no main genetic and environmental effects [i.e., OR(GE|D) = OR(¿E|D) = 1]. A statistic is presented to test the null hypothesis OR(GE|D)=1 and to calculate corresponding power, given the odds ratio for environmental exposure OR(E|D) and population genotype frequency (g). Direct extension of the above model provides a mathematical framework for estimating confidence bounds in more complex cases involving partial genetic and/or environmental effects. © Springer 2005.

DOI 10.1007/s10654-005-2018-3
Citations Scopus - 2
2005 Gagne SE, Jensen R, Polvi A, Da Costa M, Ginzinger D, Efird JT, et al., 'High-resolution analysis of genomic alterations and human papillomavirus integration in anal intraepithelial neoplasia', Journal of Acquired Immune Deficiency Syndromes, 40 182-189 (2005)

Anal intraepithelial neoplasia (AIN) is the likely precursor to anal cancer. AIN is associated with human papillomavirus (HPV) infection, and HPV-associated genomic instability ma... [more]

Anal intraepithelial neoplasia (AIN) is the likely precursor to anal cancer. AIN is associated with human papillomavirus (HPV) infection, and HPV-associated genomic instability may play an important role in the progression of squamous intraepithelial neoplasia to cancer. Microarray-based comparative genome hybridization (aCGH) was performed on DNA from AIN specimens to determine the host genomic alterations and their correlation with HPV DNA integration or rearrangement. Of 27 high-grade AIN specimens tested by CGH, 8 (30%) showed regional DNA copy number abnormalities (CNAs). Five additional cases previously identified by chromosome CGH to carry CNAs were reanalyzed by aCGH and pooled with the 8 new cases for analysis. The most common regions of gain were on chromosome arms 1p, 1q, 3q, 8p, and 20q. The most common regions of loss were on chromosome arms 2q, 7q, 11p, 11q, and 15q. HPV16 DNA integration or rearrangement correlated with CNAs in host cell DNA (P = 0.007). Although aCGH can resolve amplicons at the 1- to 2-megabase (Mb) regional resolution, the most common alteration on chromosome 3 could only be resolved to a 75-Mb region from 3q21 to qte1. Our data suggest that there may be several oncogenes in this region that are coactivated to contribute to progression to high-grade AIN. Copyright © 2005 by Lippincott Williams & Wilkins.

DOI 10.1097/01.qai.0000179460.61987.33
Citations Scopus - 21
2005 Efird JT, Holly EA, Cordier S, Mueller BA, Lubin F, Filippini G, et al., 'Beauty product-related exposures and childhood brain tumors in seven countries: Results from the SEARCH International Brain Tumor Study', Journal of Neuro-Oncology, 72 133-147 (2005)

Data from 1218 cases of childhood brain tumors (CBT) diagnosed between 1976 and 1994 and 2223 matched controls from the general population were included in an analysis of maternal... [more]

Data from 1218 cases of childhood brain tumors (CBT) diagnosed between 1976 and 1994 and 2223 matched controls from the general population were included in an analysis of maternal beauty product exposure and beauty-related employment in 9 centers in 7 countries. A 50% increased odds ratio (OR) [95% confidence interval (CI) = 1.0-2.1] for CBT was observed among children of mothers who were exposed via personal use of and/or possible ambient contact with beauty products during the 5 years preceding the index child's birth compared with children of mothers never exposed to beauty products during this time period. Overall maternal personal use of hair-coloring agents in the month before or during the pregnancy of the index child's birth was not associated with CBT (OR = 1.0, CI = 0.83-1.3) or with astroglial (OR = 1.1, CI = 0.85-1.4), PNET (OR = 1.0, CI = 0.71-1.5) and other glial subtypes (OR = 1.0, CI = 0.62-1.0). Similarly, no statistically increased ORs or discernable pattern of risk estimates were observed for period of use or for number of applications per year for maternal personal use of hair-coloring agents overall or by histologic type. Among children born on or after 1980, increased ORs for CBT were associated with maternal non-work-related exposure to any beauty products (OR = 2.6, CI = 1.2-5.9), hair-dyes (OR = 11, CI = 1.2-90), and hair sprays (OR = 3.4, CI = 1.0-11). No overall increased OR for CBT was observed among children of mothers employed in beauty-related jobs during the 5 years preceding the index child's birth compared with those who reported no beauty-related employment. In general, other specific beauty product-related exposures were not associated with increased ORs for CBT. Data from our study provide little evidence of an increased risk for CBT with mothers'exposures to beauty products. © Springer 2005.

DOI 10.1007/s11060-004-3121-0
Citations Scopus - 19
2004 Pardo FS, Hsu DW, Zeheb R, Efird JT, Okunieff PG, Malkin DM, 'Mutant, wild type, or overall p53 expression: Freedom from clinical progression in tumours of astrocytic lineage', British Journal of Cancer, 91 1678-1686 (2004)

Abnormalities of the p53 tumor-suppressor gene are found in a significant proportion of astrocytic brain tumours. We studied tumour specimens from 74 patients evaluated over 20 ye... [more]

Abnormalities of the p53 tumor-suppressor gene are found in a significant proportion of astrocytic brain tumours. We studied tumour specimens from 74 patients evaluated over 20 years at the Massachusetts General Hospital, where clinical outcome could be determined and sufficient pathologic material was available for immunostaining. p53 expression studies employed an affinity-purified p53 monoclonal antibody, whose specificity was verified in absorption studies and, in a minority of cases, a second antibody recognising a different epitope of p53. Significant overexpression of p53 protein was found in 48% of the 74 tumours included in this series and high levels of expression were associated with higher mortality from astrocytic tumours (P < 0.001, log rank). Multivariate analyses revealed that immunohistochemically detected p53 was an independent marker of shortened progression-free and overall actuarial survival in patients with astrocytic tumours, suggesting that increased expression of p53 plays an important role in the pathobiology of these tumours. In a subset of 36 cases, coding regions of the p53 gene were completely sequenced via SSCP and direct DNA sequencing, revealing that overexpression of p53 protein is not always associated with point mutations in conserved exons of the p53 gene. Finally, we confirmed p53 protein expression in early-passage human glioma cell lines of known p53 mutational status and immunostaining scores. Although grade continues to be the strongest prognostic variable, the use of p53 staining as a prognostic indicator, in contrast to mutational DNA analyses, may be a useful adjunct in identifying patients at higher risk of treatment failure.

DOI 10.1038/sj.bjc.6602161
Citations Scopus - 22
2004 Pardo FS, Lien WW, Fox HS, Efird JT, Aguilera JA, Burton DW, Deftos LJ, 'Parathyroid hormone-related protein expression is correlated with clinical course in patients with glial tumors', Cancer, 101 2622-2628 (2004)

BACKGROUND. Parathyroid hormone-related protein (PTHrP) expression modulates cell survival in a number of human solid tumors. Although PTHrP is expressed in normal developing and ... [more]

BACKGROUND. Parathyroid hormone-related protein (PTHrP) expression modulates cell survival in a number of human solid tumors. Although PTHrP is expressed in normal developing and neoplastic central nervous system tissue, clinical data indicating the importance of this protein with respect to local control and/or survival in patients with glial tumors are sc arce. METHODS. Using a standard immunoperoxidase technique, the authors examined PTHrP expression in a population of 51 patients with Daumas-Duport Grade II-IV astrocytomas over a 15-year period. Both local control and survival were calculated from the date of definitive irradiation to the last time of known follow-up examination using the actuarial method. PTHrP expression was scored on examination under 40x magnification, with the incidence of cellular staining averaged over 10 high-power fields. The intensity and extent of staining were characterized semiquantitatively using the standard World Health Organization classification criteria. The median follow-up duration was approximately 5.5 years. Multivariate analyses were performed to ascertain the statistical significance of several standard clinicohistopatholgic factors (Karnofsky functional status, age, gender, extent of surgical resection, radiotherapy dose, grade, and PTHrP expression) with respect to local control and survival. P < 0.05 was considered indicative of statistical significance. RESULTS. Patients with high levels of PTHrP expression had significantly lower glial tumor local control rates and corresponding decreases in progression-free and overall actuarial survival after definitive irradiation (P < 0.01). In a Cox 3-variable model, the PTHrP staining score was independent of tumor grade or Karnofsky functional status. It is notable that the strongest predictor of survival was tumor grade (P < 0.001). CONCLUSIONS. PTHrP may be an important adjunct to standard immunopathologic criteria in the determination of glial tumor responses. A number of mechanisms were explored to derive a more mechanistic understanding of these translational results. Subsequent prospective studies involving larger patient populations will be necessary before findings can be translated to clinical practice. © 2004 American Cancer Society.

DOI 10.1002/cncr.20689
Citations Scopus - 8
2004 Efird JT, Friedman GD, Sidney S, Klatsky A, Habel LA, Udaltsova NV, et al., 'The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: Cigarette smoking and other lifestyle behaviors', Journal of Neuro-Oncology, 68 57-69 (2004)

Purpose: To determine the risk for malignant primary adult-onset glioma (MPAG) associated with cigarette smoking and other lifestyle behaviors in a large, multiethnic, managed-car... [more]

Purpose: To determine the risk for malignant primary adult-onset glioma (MPAG) associated with cigarette smoking and other lifestyle behaviors in a large, multiethnic, managed-care cohort. Methods: The study population included a cohort of 133,811 subscribers to the Kaiser Permanente Medical Care Program of Northern California who had received a multiphasic health checkup and questionnaire between 1977 and 1985, were at least 25 years old at their start of follow-up, and had no prior history of benign or malignant brain tumors. In this cohort, patients were followed for up to 21 years for the development of MPAG. Results: Risk for MPAG among women increased with increasing packs of cigarettes smoked per day p-for-trend = 0.04), adjusting for cigar and pipe smoking, patient age, sex, race, education, alcohol use and coffee consumption. A similar pattern was not observed for men. Individuals who smoked marijuana at least once a month, adjusting for cigarette smoking (packs smoked per day) and for the factors noted above, had a 2.8-fold (CI = 1.3-6.2) increased risk for MPAG. Relative risk for MPAG increased with increasing consumption of coffee (p-for-trend = 0.05). Conclusions: Cigarette smoking was associated with an increased risk for MPAG among women but not among men. Individuals who smoked marijuana at least once a month had an increased risk for MPAG, although no dose-response relation was observed. Drinkers of > 7 cups of coffee per day had a 70% increased risk for MPAG and smaller risk elevation for lower consumption. Alcohol usage was not associated with an increased risk for MPAG. © 2004 Kluwer Academic Publishers.

DOI 10.1023/B:NEON.0000024746.87666.ed
Citations Scopus - 59
2004 Cranston RD, Darragh TM, Holly EA, Jay N, Berry JM, Da Costa M, et al., 'Self-collected versus clinician-collected anal cytology specimens to diagnose anal intraepithelial neoplasia in HIV-positive men', Journal of Acquired Immune Deficiency Syndromes, 36 915-920 (2004)

Background: Anal intraepithelial neoplasia (AIN) is common in men who have sex with men (MSM) and may be diagnosed by anal cytology screening. Methods: One hundred two MSM with cl... [more]

Background: Anal intraepithelial neoplasia (AIN) is common in men who have sex with men (MSM) and may be diagnosed by anal cytology screening. Methods: One hundred two MSM with clinician-collected anal cytology and histopathology specimens were assessed from a cohort study of AIN at the University of California at San Francisco. The men were given a cytology self-collection kit with written instructions for use and requested to collect the sample 1 month after the clinic visit. Results: Ninety-one percent of self-collected and 99% of clinician-collected anal cytology samples were adequate for interpretation. The sensitivity of abnormal anal cytology to detect AIN by histology was 68% in self-collected samples and 70% in clinician-collected samples, and the sensitivity to detect AIN 2 or AIN 3 was 71% and 74%, respectively. Cytologic results did not differ by grade between self-collected and clinician-collected samples. Among MSM diagnosed with AIN 2 or 3 by biopsy, 33% of self-collected and 39% of clinician-collected cytology samples were high-grade. The sensitivity of both self-collected and clinician-collected samples to detect AIN 2 or 3 was higher among HIV-positive MSM than among HIV-negative MSM. Conclusions: MSM with biopsy-proven AIN can self-collect anal cytology samples with sensitivity comparable with that of experienced clinicians. This may facilitate screening for AIN.

DOI 10.1097/00126334-200408010-00004
Citations Scopus - 58
2003 Efird JT, Holly EA, Preston-Martin S, Mueller BA, Lubin F, Filippini G, et al., 'Farm-related exposures and childhood brain tumours in seven countries: Results from the search international brain tumour study', Paediatric and Perinatal Epidemiology, 17 201-211 (2003)

A total of 1218 cases of childhood brain tumours (CBT) and 2223 control subjects from the general population were included in a population-based case-control study conducted in ni... [more]

A total of 1218 cases of childhood brain tumours (CBT) and 2223 control subjects from the general population were included in a population-based case-control study conducted in nine centres in seven countries. Mothers were asked about farm- or agriculture-related exposures. Significantly elevated odds ratios (OR) for CBT were associated with children's personal and maternal prenatal exposure while living on a farm with pigs (child OR = 1.7, mother OR = 2.3), horses (child OR = 1.6, mother OR = 1.8), dogs (child OR = 1.5, mother OR = 1.5) and cats (child OR = 1.5, mother OR = 1.7). Children who were exposed to pigs, horses and cats combined, while living on a farm, had a threefold elevated OR for CBT. Increased ORs for primitive neuroectodermal tumours (PNET) were associated with children's farm exposure to dogs (OR = 1.9) and cats (OR = 2.2), and maternal farm exposure to pigs (OR = 4.2). The OR for CBT was elevated (OR = 2.3) for children of mothers who had preconception/prenatal farm- or agriculture-related employment involving potential contact with animals, relative to no farm- or agriculture-related employment. In particular, increased ORs for CBT were observed for children of mothers who were employed as general farmers (OR= 4.1) or general farm workers (OR = 3.8). During the 5 years preceding the index child's birth, maternal exposures were related to CBT, relative to no maternal exposure to agricultural chemicals or animal products: fertilisers (OR = 1.8), pesticides (OR = 2.0), animal manure (OR = 2.0) and unprocessed wool (OR = 3.0). Our findings suggest that various farm-related exposures are positively associated with CBT and warrant further investigation into the public health importance of these associations.

DOI 10.1046/j.1365-3016.2003.00484.x
Citations Scopus - 44
2002 Efird JT, Friedman GD, Habel L, Tekawa IS, Nelson LM, 'Risk of subsequent cancer following invasive or in situ squamous cell skin cancer', Annals of Epidemiology, 12 469-475 (2002)

PURPOSE: Determine the risk of subsequent cancer following squamous cell skin cancer. METHODS: Using computerized surgical pathology records and membership data from a health main... [more]

PURPOSE: Determine the risk of subsequent cancer following squamous cell skin cancer. METHODS: Using computerized surgical pathology records and membership data from a health maintenance organization, we retrospectively identified 822 individuals with primary squamous cell skin cancer (SCSC) and 3662 comparison subjects matched for age, sex, race, residence area, and length of membership. Patients were included in the study if they had no prior history of cancer, and received at least one multiphasic health checkup and questionnaire (MHC). Patients were followed for subsequent invasive cancer up to 24 years, with a mean follow-up time of 7.8 years. RESULTS: SCSC patients had a significantly greater risk [adjusted for body mass index (BMI) and education] for subsequent cancer overall (excluding non-melanoma skin cancer) [risk ratio (RR) = 1.4, 95% confidence interval (CI) = 1.2-1.6] , and for basal cell skin cancer (RR = 13.8, 95% CI = 8.8-21.9), digestive (RR = 1.6, 95% CI = 1.1-2.4), and genitourinary cancers (RR = 1.5, 95% CI = 1.0-2.0). An increased, but not statistically significant, adjusted risk (RR = 1.4) was also observed for lip, oral cavity, and pharynx cancer (RR = 3.9, 95% CI = 0.6-25.0); non-cutaneous squamous cell cancer (RR = 1.9, 95% CI = 0.9-4.4); and respiratory and intrathoracic cancer (RR = 1.4, 95% CI = 0.8-2.6). The addition of alcohol consumption, combined occupational exposure, marital status, and smoking history to the multivariate model did not materially change any significant positive associations with SCSC. CONCLUSIONS: Our results suggest that patients diagnosed with SCSC may be at an increased risk of subsequent cancer at many sites, although several estimated risk estimates were within the limits of chance given no true association. © 2002 Elsevier Science Inc. All rights reserved.

DOI 10.1016/S1047-2797(01)00276-9
Citations Scopus - 35
2001 Abraham EH, Sterling KM, Kim RJ, Salikhova AY, Huffman HB, Crockett MA, et al., 'Erythrocyte membrane ATP binding cassette (ABC) proteins: MRP1 and CFTR as well as CD39 (ecto-apyrase) involved in RBC ATP transport and elevated blood plasma ATP of cystic fibrosis', BLOOD CELLS MOLECULES AND DISEASES, 27 165-180 (2001)
DOI 10.1006/bcmd.2000.0357
Citations Scopus - 51Web of Science - 47
2000 Rordorf G, Koroshetz W, Efird JT, Cramer SC, 'Predictors of mortality in stroke patients admitted to an intensive care unit', Critical Care Medicine, 28 1301-1305 (2000)

Objective: Improved pathophysiologic insight and prognostic information regarding in-hospital risk of mortality among stroke patients admitted to an intensive care unit. Design: R... [more]

Objective: Improved pathophysiologic insight and prognostic information regarding in-hospital risk of mortality among stroke patients admitted to an intensive care unit. Design: Retrospective analysis. Setting: Neurology/neurosurgery intensive care unit in a tertiary care university medical center. Patients: A total of 63 consecutive ischemic stroke patients. Interventions: Patients were classified according to in-hospital mortality. Charts were reviewed to retrospectively generate an admitting Acute Physiology and Chronic Health Evaluation (APACHE) II score. The APACHE II score and its individual components were assessed for predicting subsequent death. Measurements and Main Results: Of 63 patients, 13 died and 50 survived to either discharge or surgical intervention. The mean admitting APACHE II score of survivors (6.9) was lower than that of patients who died (17.2; p < .0001). None of the 33 patients with a score < 9 died, compared with 43% of those with a score =9. A score =18 was uniformly associated with fatal outcome (n = 8). Univariate analysis identified APACHE II total score, Glasgow Coma Scale score, temperature, pH, and white blood cell count as significant predictors of death. Among multivariate logistic regression models examining the components of the APACHE II score, the model containing white blood cells, temperature, and creatinine best predicted death. Conclusions: Several features of the APACHE II score are associated with risk of death in this patient population. The findings suggest particular physiologic derangements that are associated with, and may contribute to, increased mortality in critically ill patients with acute ischemic stroke.

Citations Scopus - 53
1999 Chakravarti A, Spiro IJ, Hug EB, Mankin HJ, Efird JT, Suit HD, 'Megavoltage radiation therapy for axial and inoperable giant-cell tumor of bone', Journal of Bone and Joint Surgery - Series A, 81 1566-1573 (1999)

Background: Treatment of giant-cell tumor of bone generally involves wide en bloc resection of the lesion and the surrounding bone or curettage with or without bone-grafting or th... [more]

Background: Treatment of giant-cell tumor of bone generally involves wide en bloc resection of the lesion and the surrounding bone or curettage with or without bone-grafting or the use of cement. Radiation therapy has been used for patients who cannot be operated on for medical reasons or who have a tumor that is technically difficult to resect or that cannot be resected because of its location. We performed the present study to evaluate the efficacy of megavoltage radiation in terms of lack of tumor progression and treatment-related morbidity. Methods: Twenty patients who had giant-cell tumor of bone were managed with a single course of megavoltage radiation (forty to seventy gray administered at 1.8 to 2.0 gray per fraction with an average total duration of treatment of five to seven weeks) between March 1973 and March 1992. We used megavoltage photons, 160-megaelectron-volt proton beams, or a combination of the two. Results: After a median duration of follow-up of 9.3 years, the tumor had not progressed in seventeen of the twenty patients. Thus, the actuarial ten-year rate for lack of progression was 85 percent. Local regrowth was evident in one patient who had received radiation alone and in two of the thirteen patients who had been managed with partial resection and radiation. Operative treatment was successful in the three patients in whom the radiation treatment had failed. No radiation- induced tumors were observed in our series. Conclusions: We concluded that giant cell tumor of bone was effectively treated with megavoltage radiation in our series of twenty patients in whom operative resection would have been difficult or was not feasible. The rate of tumors that did not progress with this regimen of radiation is similar to that reported by investigators from several other centers. Furthermore, these results closely rival those obtained with modern curettage procedures. Malignant sarcomatous transformation was not observed in our series. A longer duration of follow-up of a larger group of patients is necessary to provide a better estimate of the risk of malignant transformation.

Citations Scopus - 59
1999 Debus J, Hug EB, Liebsch NJ, O'Farrel D, Finkelstein D, Efird J, Munzenrider JE, 'Dose-volume tolerance of the brainstem after high-dose radiotherapy', Frontiers of Radiation Therapy and Oncology, 33 305-314 (1999)
Citations Scopus - 12
1998 Hsu DW, Efird JT, Hedley-Whyte ET, 'MIB-1(Ki-67) index and transforming growth factor-alpha (TGFa) immunoreactivity are significant prognostic predictors for meningiomas', Neuropathology and Applied Neurobiology, 24 441-452 (1998)

Mitotic index &gt; 6, proliferating cell nuclear antigen (PCNA) index &gt; 5%, high tumour grade and absence of progesterone receptors (PR) are significant predictors for poor... [more]

Mitotic index > 6, proliferating cell nuclear antigen (PCNA) index > 5%, high tumour grade and absence of progesterone receptors (PR) are significant predictors for poor outcome in meningiomas. Since MIB-1 (Ki-67) is a more specific cell proliferation marker, and overexpression of TGF-alpha is also associated with tumour progression, we compared the prognostic significance of these factors with the other indices. Intracranial meningiomas from 21 men and 36 women (age 54.5 + 1.7, mean ± SEM) were classified as 24 benign, 24 atypical and nine malignant. Twenty-one of the 57 tumours recurred (mean interval to recurrence was 57.3 ± 13.1 months). The mean follow-up period for patients without tumour recurrence was 81.9 ± 8.7 months. MIB-1 labelling index (LI) was expressed as percentage of labelled nuclei to total tumour nuclei counted in the most densely labelled areas. Analysis of variance revealed significant differences between tumour grades for MIB-1 labelling indices (0.75 ± 0.21 for benign, 3.2 ± 0.57 for atypical, 6.04 ± 1.48 for malignant; P = 0.0066), and between malignant and non-malignant meningiomas for TGFa staining scores (P = 0.029). MIB-1 LI also correlated with mitotic and PCNA indices (P = 0.0001), but not with age of the patients. Male patients had higher tumour MIB-1 LI than females (P = 0.0128). Univariate analysis indicated that MIB-1 LI > 3%, TGFa score > 4 (scoring scale 0-5), mitotic index > 6, and negative PR status were significant factors for worse outcome. Higher MIB-1 LI, TGFa score and mitotic index as continuous variables were also significant negative predictors. With multivariate analysis, both MIB-1 LI and TGFa score remained significant factors when paired with all other variables: TGFa or MIB-1 LI, respectively, mitosis, PCNA, tumour grade, PR status, age, sex, postoperative radiation therapy. We conclude that MIB-1 LI and TGFa score are important independent prognostic indicators for patients with meningiomas.

DOI 10.1046/j.1365-2990.1998.00150.x
Citations Scopus - 71
1998 Spear MA, Jennings LC, Mankin HJ, Spiro IJ, Springfield DS, Gebhardt MC, et al., 'Individualizing management of aggressive fibromatoses', International Journal of Radiation Oncology Biology Physics, 40 637-645 (1998)

Purpose: To examine prognostic indicators in aggressive fibromatoses that may be used to optimize case-specific management strategy. Methods and Materials: One hundred and seven f... [more]

Purpose: To examine prognostic indicators in aggressive fibromatoses that may be used to optimize case-specific management strategy. Methods and Materials: One hundred and seven fibromatoses presenting between 1971 and 1992 were analyzed. The following treatment modalities were utilized: (a) surgery alone for 51 tumors; (b) radiation alone for 15 tumors; and (c) radiation and surgery (combined modality) for 41 tumors. Outcome analysis was based on 5-year actuarial local control rates. Results: Control rates among surgery, radiation therapy, and combined modality groups were 69%, 93%, and 72%. Multivariate analysis identified age < 18 years, recurrent disease, positive surgical margins, and treatment with surgery alone as predictors for failure. Patients treated with surgery alone had control rates of 50% (3 of 6) for gross residual, 56% for microscopically positive margins, and 77% for negative margins. Radiation and surgery resulted in rates of 59% for gross residual, 78% for microscopically positive margins, and 100% (6 of 6) for negative margins. For recurrent vs. primary tumors, control was achieved in 48% vs. 77%, 90% vs. 100% (5 of 5), and 67% vs. 79% in the Surgery, Radiation, and Combined modality Groups, respectively. Patients presenting with multiple disease sites tended to have aggressive diseas e. A radiation dose-control relation to > 60 Gy was seen in patients with unresected or gross residual disease. Of the patients, 23 with disease involving the plantar region had a control rate of 62%, with significantly worse outcomes in children. Conclusions: These results are consistent with those found in the relevent literature. They support primary resection with negative margins when feasible. Radiation is a highly effective alternative in situations where surgery would result in major functional or cosmetic defects. When negative surgical margins are not achieved in recurrent tumors, radiation is recommended. Perioperative radiation should be considered in other high-risk groups (recurrent disease, positive margins, and plantar tumors in young patients). Doses of 60-65 Gy for gross disease and 50-60 Gy for microscopic residual are recommended. Observation may be considered for primary tumors with disease remaining in situ when they are located such that progression would not cause significant morbidity. Although plantar lesions in children may represent a group at high risk for recurrence or aggressive behavior, the greater potential for radiation-induced morbidity in this group must also temper its use. Given the inconsistent nature and treatment response of this tumor, it is fundamental that treatment recommendations should be made based on the risk:benefit analysis for the individual patient, dependent on tumor characteristics and location, as well as patient characteristics and preferences.

DOI 10.1016/S0360-3016(97)00845-6
Citations Scopus - 201
1998 Santoni R, Liebsch N, Finkelstein DM, Hug E, Hanssens P, Goitein M, et al., 'Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull', International Journal of Radiation Oncology Biology Physics, 41 59-68 (1998)

Purpose: To determine the temporal lobe (TL) damage rate in 96 patients t reated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the ... [more]

Purpose: To determine the temporal lobe (TL) damage rate in 96 patients t reated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull. Methods and Materials: The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as 'primary tumors' and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group No.85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose- volume histograms were obtained for these patients. Results: Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from the tumor bed. Symptoms were severe to moderate in 8 patients. Several baseline factors, tumor- or host-related, were analyzed to evaluate their predictivity for TL damage: age, gender, tumor site, histology, type of presentation, type and number of surgical procedures, primary tumor volume, prescribed dose, normal tissue involvement, and volume of TL receiving doses ranging between 10 and 50 CGE or more. Only gender, in a univariate analysis (log rank) was a significant predictor of damage (0.0155), with male patients being at significantly higher risk of TL injury. In a stepwise Cox regression that included gender as a variable, no other baseline variable improved the prediction of damage. Conclusions: The 2- and 5-year cumulative TL damage rates were 7.6 and 13.2%, respectively. Despite the different TL damage rates related to age, tumor volume, number of surgical procedures prior to radiation therapy, and prescribed doses to the tumor, only gender was a significant predictor of damage (p = 0.0155) using a univariate (log rank) test. Chordomas and chondrosarcomas of the base of the skull may represent an interesting model to evaluate the TL damage rates because of their extradural origin, displacing the white matter instead of infiltrating it as gliomas do, because of their longer local recurrence-free survival other than gliomas and other brain tumors and because of the high doses of irradiation delivered to the target volume to obtain local control.

DOI 10.1016/S0360-3016(98)00031-5
Citations Scopus - 78
1997 Debus J, Hug EB, Liebsch NJ, OFarrel D, Finkelstein D, Efird J, Munzenrider JE, 'Brainstem tolerance to conformal radiotherapy of skull base tumors', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 39 967-975 (1997)
DOI 10.1016/S0360-3016(97)00364-7
Citations Scopus - 146Web of Science - 129
1997 Hsu DW, Louis DN, Efird JT, Hedley-Whyte ET, 'Use of MIB-1 (Ki-67) immunoreactivity in differentiating grade II and grade III gliomas', Journal of Neuropathology and Experimental Neurology, 56 857-865 (1997)

The grading of glial tumors has traditionally relied on histological assessment, but the distinction between grade II and grade III gliomas is still a subject of debate. We examin... [more]

The grading of glial tumors has traditionally relied on histological assessment, but the distinction between grade II and grade III gliomas is still a subject of debate. We examined the value of the monoclonal antibody MIB-1 (Ki-67) labeling index (LI) in the differentiation between grade II and grade III gliomas by either the 1993 WHO grading scheme or the St. Anne-Mayo grading scale. The MIB-1 LI in the most densely labeled areas from 80 diffuse cerebral hemispheric gliomas was determined. The tumors included 16 grade II, 31 grade III and 33 grade IV gliomas by the WHO scale. The mean LIs (%) were 0.88 ± 0.29 for grade II, 8.75±1.71 for grade III, and 9.12±1.55 for grade IV gliomas. Analysis of variance indicated a significant difference in mean LIs between grades II and III and grades II and IV (p = 0.0001), but not between grades III and IV. Seven tumors were classified differently by the 2 systems (grade III by WHO, but grade 2 by St. Anne-Mayo), and all had MIB-1 LI over 3%. Univariate analysis showed that MIB-1 LI with a cut-off point at 1.5% was a significant prognostic factor (p = 0.0005). High tumor grade (WHO, p = 0.0002; St. Anne-Mayo, p = 0.0006) and patient age > 50 (p = 0.0001) were also significant factors for shorter survival. Using Cox Regression Multivariate Analysis, MIB-1 LI > 1.5% was a significant independent predictor of shorter disease survival when paired with tumor grade (p = 0.032), patient age (p = 0.0065), or gender (p = 0.0007). We conclude that the MIB-1 immunoreactivity is useful in distinguishing grade II from grade III gliomas, and maybe more sensitive in assigning aggressive gliomas to grade III than the St. Anne-Mayo grading system.

Citations Scopus - 81
1997 Hsu DW, Efird JT, Hedley-Whyte ET, 'Progesterone and estrogen receptors in meningiomas: Prognostic considerations', Journal of Neurosurgery, 86 113-120 (1997)

Meningiomas often contain steroid hormone receptors, but the correlation of receptor presence with patient outcome or mitotic index is unclear. Intracranial meningiomas from 70 pa... [more]

Meningiomas often contain steroid hormone receptors, but the correlation of receptor presence with patient outcome or mitotic index is unclear. Intracranial meningiomas from 70 patients (27 males and 43 females, mean age 52.9 + 1.7 years [mean ± standard error of the mean], range 15-78 years) were evaluated immunocytochemically for female sex hormone receptors using specific monoclonal antibodies. Prognostic correlations were determined using statistical analyses that included clinical and histological variables. Twenty-eight tumors were benign, 27 had atypical features, and 15 were malignant. Thirty tumors were meningotheliomatous, 11 were fibroblastic, 28 were transitional, and one was secretory. Twenty-nine of the 70 primary tumors recurred (mean interval to recurrence 50.1 ± 10 months). The mean progression-free follow-up period for patients without recurrence was 82.1 ± 7.7 months. Nuclear staining for the progesterone receptor (PR) was found in 58 cases (83%) and PR status was scored as 0 (0% nuclei positive), 1 ( < 1%), 2 (1-9%), 3 (10-9%), or 4 ( > 50%). Only six tumors (8.6%) contained nuclear estrogen receptor (ER) staining, which was limited to a small number of nuclei ( < 1%). Fisher's exact test (two-tailed) showed an inverse correlation between tumor grade and PR staining score (p = 0.001), with 96% of benign and 40% of malignant meningiomas containing PR positive nuclei. No correlation between age or histological subtype and PR score was detected. Meningiomas from female patients had more PRs (p = 0.05). Analysis of variance revealed that the mitotic index (total counts of mitoses per 10 high-power fields) for tumors with 0 PR staining (18 ± 4.4) was higher (p = 0.0001) than for those with PR scores of 1 to 4 (4.3 ± 1.9, 5.1 ± 2, 2.2 ± 0.8, and 1.7 ± 0.9, respectively). Univariate analysis indicated that the absence of PR, high mitotic index, and higher tumor grade were significant factors for shorter disease-free intervals. Multivariate analysis showed that a three-factor interaction model, with a PR score of 0, mitotic index greater than 6, and malignant tumor grade, was a highly significant predictor (p = 0.001) for worse outcome in patients harboring meningiomas. These data indicate that the presence of PRs, even in a small number of tumor cells, is a favorable prognostic factor for meningiomas.

Citations Scopus - 219
1997 Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz WJ, 'Pharmacological elevation of blood pressure in acute stroke: Clinical effects and safety', Stroke, 28 2133-2138 (1997)

Background and Purpose: Lowering of blood pressure can adversely affect ischemic symptoms in acute stroke. The aim of our study was to determine whether induced hypertension in st... [more]

Background and Purpose: Lowering of blood pressure can adversely affect ischemic symptoms in acute stroke. The aim of our study was to determine whether induced hypertension in stroke is safe and to examine its effects on neurological deficits in patients presenting with acute cerebral ischemia. Methods: We retrospectively reviewed all patients admitted to our neurological intensive care unit with the diagnosis of ischemic stroke over a 2.5-year period. Thirty-three patients were not given a pressor agent (Ph- group), whil e 30 were treated with phenylephrine (Ph+ group) in an attempt to improve cerebral perfusion. Results: Baseline characteristics showed few differences between the Ph+ and Ph- groups. Intracerebral hemorrhage, brain edema, cardiac morbidity, and mortality were not increased in the Ph+ group. In 10 of 30 Ph+ patients, a systolic blood pressure threshold was identified below which ischemic deficits worsened and above which deficits improved. The mean threshold was 156 mm Hg (range, 120 to 190 mm Hg). The mean number of stenotic/occluded cerebral arteries was greater in those Ph+ patients with an identified clinical blood pressure threshold (mean, 2.1 per patient) than in Ph+ patients without a threshold (mean, 1.2 per patient; P < .05). Conclusions: The results suggest that careful use of phenylephrine-induced hypertension is not associated with an increase in morbidity or mortality in acute stroke. Although based on a retrospective analysis of clinical practice, this report suggests that a subset of patients, particularly those with multiple stenosis of cerebral arteries, may improve neurologically upon elevation of the blood pressure.

Citations Scopus - 159
1997 Willers H, Hug EB, Spiro IJ, Efird JT, Rosenberg AE, Wang CC, 'Adult soft tissue sarcomas of the head and neck: Treatment outcome after combined surgery and irradiation or radiotherapy alone', Strahlentherapie und Onkologie, 173 131-135 (1997)

Purpose: To analyse the experience treating soft tissue sarcomas of the head and neck at the Massachusetts General Hospital, Boston. Detailed results have been published previousl... [more]

Purpose: To analyse the experience treating soft tissue sarcomas of the head and neck at the Massachusetts General Hospital, Boston. Detailed results have been published previously. Patients and Method: Between 1972 and 1993, 57 patients were treated curatively with radiation alone (n = 13) or combined surgery and pre- and/or postoperative irradiation (n = 44). Gross complete resection was achieved in 82% of patients and margins were negative in 5 patients. Doses ranged from 36.0 to 79.2 Gy (median 64.8 Gy), usually conventionally fractionated. In 16 patients protons were used. Median follow-up time was 4.3 years (range 1.1 to 16.8 years). Results: After 5 years, patients with angiosarcomas (n = 11) and patients with other tumor types (n = 46) had locoregional control rates of 24% and 69%, distant failure rates of 58% and 17%, and overall survival rates of 31% and 74%, respectively (p < 0.01). In the group without angiosarcomas, prognostic factors were tumor grade (for overall survival) and T stage (for locoregional control) (p < 0.05). Particularly, gross completely resected T1 tumors had a locoregional control rate of 91%. Patients with locoregional recurrence were at an increased risk to die (p = 0.004 in multivariate analysis). Patients with and without direct tumor extension to neurovascular structures, bones, organs, or skin had distant failure rates of 27% and 0%, respectively (p = 0.031). In multivariate analysis, direct extension was additionally a negative prognosticator of overall survival (p = 0.034). Conclusion: 1. Angiosarcomas of the head and neck have a considerably poorer prognosis than other soft tissue sarcomas of this region. 2. Head and neck sarcomas have a higher local recurrence rate than for example soft tissue sarcomas of the extremities. Optimisation of local treatment through combination of surgery and high-dose irradiation, however, can achieve improved results, especially for prognostically favourable subgroups. 3. In addition to tumor grade and size, direct tumor extension may be a useful additional staging parameter.

Citations Scopus - 5
1996 Wang CC, Efird J, Nakfoor B, Martins P, 'Local control of T3 carcinomas after accelerated fractionation: A look at the ''gap''', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 35 439-441 (1996)
DOI 10.1016/S0360-3016(96)80004-6
Citations Web of Science - 19
1996 Suit H, Spiro I, Mankin HJ, Efird J, Rosenberg AE, 'Radiation in management of patients with dermatofibrosarcoma protuberans', JOURNAL OF CLINICAL ONCOLOGY, 14 2365-2369 (1996)
Citations Scopus - 101Web of Science - 84
1996 Ueki K, Ono Y, Henson JW, Efird JT, Von Deimling A, Louis DN, 'CDKN2/p16 or RB alterations occur in the majority of glioblastomas and are inversely correlated', Cancer Research, 56 150-153 (1996)

p16 is involved in a cell cycle regulatory cascade that includes cyclin- dependent kinase 4 tcdk4) cyclin D1, and pRb (retinoblastoma). Alterations of each of these components hav... [more]

p16 is involved in a cell cycle regulatory cascade that includes cyclin- dependent kinase 4 tcdk4) cyclin D1, and pRb (retinoblastoma). Alterations of each of these components have been described in primary human glioblastoma multiforme (GBM) or in GBM cell lines. Because perturbation of any component in this pathway may have similar oncogenic effects, be studied the relationship between abnormalities of CDKN2/p16 and RB, the two commonly involved tumor suppressor genes, in 55 astrocyte gliomas (42 GMBs, 8 anaplastic astrocytomas, and 5 astrocytomas). By using comparative multiplex PCR, homozygous deletions of the CDKN2/p16 gene were detected in 24 GBMs (57%) and in 2 anaplastic astrocytomas. Two additional GBMs and one anaplastic astrocytoma had allelic loss of chromosome 9p, as assessed by microsatellite polymorphisms flanking the CDKN2/p16 region. Single-strand conformation polymorphism and DNA sequencing analysis of all three coding exons of CDKN2/p16 revealed a frameshift mutation (four-bp deletion) in one of the three GBMs that had lost the remaining 9p allele. Allelic loss of chromosome 13q at the RB gene, RB gene mutations, or loss of pRb expression was noted in 14 GBMs (33%) and 2 anaplastic astrocytomas. Thirty-six of 42 GBMs (86%) had alterations of either CDKN2/p16 (n = 22), RB (n = 10), or both (n = 4); these two genetic changes, however, were relatively exclusive (P = 0.003). Furthermore, of the six GBMs without either CDKN2/p16 or RB gene abnormalities, one case had CDK4 gene amplification. These data indicate that the vast majority of GBMs probably have inactivation of the p16-cdk4/cyclin D1-pRb pathway. The findings also provide corroborative evidence that CDKN2/p16 and RB are the critical glioma tumor suppressor genes on chromosomes 9p and 13q, respectively.

Citations Scopus - 375
1996 Cramer SC, Glaspy JA, Efird JT, Louis DN, 'Chronic lymphocytic leukemia and the central nervous system: A clinical and pathological study', Neurology, 46 19-25 (1996)

Chronic lymphocytic leukemia is the most common human leukemia but infrequently causes neurologic symptoms. We have reviewed all previously reported cases of chronic lymphocytic l... [more]

Chronic lymphocytic leukemia is the most common human leukemia but infrequently causes neurologic symptoms. We have reviewed all previously reported cases of chronic lymphocytic leukemia in the CNS along with three new cases; one patient was diagnosed antemortem and treated with immediate improvement and 4-year survival. In addition, we reviewed all autopsy cases since 1972 and available lumbar puncture data on patients with chronic lymphocytic leukemia admitted to the Massachusetts General Hospital. Invasion of the CNS by chronic lymphocytic leukemia often leads to confusional state, meningitis with cranial nerve abnormalities, optic neuropathy, or cerebellar dysfunction. Lumbar puncture shows a lymphocytosis consisting of monoclonal B cells, but CSF cytology studies are of limited value in establishing the diagnosis. Long-term survival may be related to the stage of chronic lymphocytic leukemia at the time of CNS disease and may be associated with intrathecal chemotherapy. A mild, asymptomatic infiltration of the brain, frequently noted in late-stage chronic lymphocytic leukemia in autopsy series, may explain the CSF lymphocytosis in some patients with late-stage chronic lymphocytic leukemia.

Citations Scopus - 62
1996 Yang WI, Efird JT, Quintanilla-Martinez L, Choi N, Harris NL, 'Cell kinetic study of thymic epithelial tumors using PCNA (PC10) and Ki- 67 (MIB-1) antibodies', Human Pathology, 27 70-76 (1996)

We performed an immunohistochemical cell kinetic study with monoclonal antibodies to proliferating cell nuclear antigen (PCNA)-PC10 and Ki-67-MIB-1 - on 62 thymic epithelial tumor... [more]

We performed an immunohistochemical cell kinetic study with monoclonal antibodies to proliferating cell nuclear antigen (PCNA)-PC10 and Ki-67-MIB-1 - on 62 thymic epithelial tumors, to evaluate whether there is correlation between the proliferation indices of the neoplastic epithelial cells and histological subtype, stage, and risk of relapse. The 62 cases of thymic epithelial tumors were classified as medullary thymoma (4 cases), composite (mixed) thymoma (17 cases), organoid thymoma (predominantly cortical) (11 cases), cortical thymoma (10 cases), well-differentiated thymic carcinoma (18 cases), and poorly differentiated thymic carcinoma (2 cases). Labeling indices were expressed as percentage of epithelial cells with positive nuclear immunostaining by random counting of 1,000 epithelial tumor cells, using an oil immersion 100 x objective. PCNA labeling indices were consistently higher than those of Ki-67, and they correlated with each other. Well-differentiated thymic carcinoma showed higher labeling indices (3.11% ± 3.53%) by Ki-67 antibody compared with the medullary type (0.60% ± 0.07%) (P < .05) but there were no statistically significant differences between the other histological subtypes. Stage IV cases showed higher PCNA labeling indices (PCNA: 11.07% ± 7.35%, Ki-67: 6.86% ± 5.87%) than cases of the other stages (P < .05), but there were no statistically significant differences in either labeling index between the other stages. The number of patients who relapsed was too small to permit meaningful correlation between labeling indices and relapse. Our results indicate that the differences in biological behavior of the different histological subtypes of thymic epithelial tumors may be in part explained by differences in tumor growth fraction. Analysis of a larger group of patients will be required to determine whether proliferation fraction as determined by this method can be used to predict outcome in individual cases.

DOI 10.1016/S0046-8177(96)90140-9
Citations Scopus - 27
1996 Wang CC, Efird J, Nakfoor B, Martins P, 'Local control of T3 carcinomas after accelerated fractionation: A look at the 'gap'', International Journal of Radiation Oncology Biology Physics, 35 439-441 (1996)

Purpose: To study the effects of midcourse treatment break or gaps related to the local control of T3 carcinoma of the oropharynx and larynx following accelerated hyperfractionate... [more]

Purpose: To study the effects of midcourse treatment break or gaps related to the local control of T3 carcinoma of the oropharynx and larynx following accelerated hyperfractionated radiation therapy. Methods and Materials: All patients were treated at the Massachusetts General Hospital from 1979 through 1994 with treatment consisting of 1.6 Gy per fraction, two fractions a day for the treatment of T3 carcinoma of the oropharynx and larynx. They were entered in the head and neck data base. Their treatment dates, treatment breaks, and doses vs. local control were analyzed and compared. A p-value of 0.05 was considered statistically significant. Results: A total of 162 patients were available for review. Due to the acute severe mucosal effects, most of the patients required a midcourse pause or 'break' after a dose of 38.4-48 Gy before treatment could be resumed and completed. The data indicate that (a) prolongation of the treatment gap for more than 14 days, (b) total treatment course longer than 45 days, (c) total dose less than 67 Gy, and (d) male gender adversely affected local control. In spite of the gaps, the female patients with advanced carcinomas enjoyed the benefits of improved local control after the accelerated hyperfractionated radiation therapy. Conclusions: Accelerated hyperfractionation radiation therapy using 1.6 Gy per fraction/twice-a-day (b.i.d.) for a total dose of 70.4 Gy in 6 weeks is effective in achieving high local control of T3 squamous cell carcinoma of the oropharynx and larynx. The midcourse treatment gap should be as short as possible with the projected total dose and time. Should the gaps be unduly prolonged due to various circumstances, further increase in the total dose, for example, 72- 75 Gy, and/or increase of the fraction sizes, for example, 1.8-2.0 Gy/f b.i.d. after the gap may he necessary to compensate for the adverse effects of the tumor regeneration from the prolonged gap.

DOI 10.1016/0360-3016(96)00105-8
Citations Scopus - 21
1995 Dasgupta A, Rajagopal C, Efird J, McAfee S, Meehan K, Mazumder A, Spitzer T, 'High dose cyclophosphamide (CY) carboplatin (Carbo) and autologous bone marrow transplantation (ABMT) peripheral blood stem cell transplantation (PBSCT) for metastatic breast cancer: An analysis of prognostic factors.', BLOOD, 86 3757-3757 (1995)
1995 PEREZ LA, DOMBKOWSKI D, EFIRD J, PREFFER F, SUIT HD, 'CELL-PROLIFERATION KINETICS IN HUMAN TUMOR XENOGRAFTS MEASURED WITH IODODEOXYURIDINE LABELING AND FLOW-CYTOMETRY - A STUDY OF HETEROGENEITY AND A COMPARISON BETWEEN DIFFERENT METHODS OF CALCULATION AND OTHER PROLIFERATION MEASUREMENTS', CANCER RESEARCH, 55 392-398 (1995)
Citations Scopus - 23Web of Science - 20
1995 WANG CC, MONTGOMERY W, EFIRD J, 'LOCAL-CONTROL OF OROPHARYNGEAL CARCINOMA BY IRRADIATION ALONE', LARYNGOSCOPE, 105 529-533 (1995)
DOI 10.1288/00005537-199505000-00016
Citations Web of Science - 25
1995 BENK V, LIEBSCH NJ, MUNZENRIDER JE, EFIRD J, MCMANUS P, SUIT H, 'BASE OF SKULL AND CERVICAL-SPINE CHORDOMAS IN CHILDREN TREATED BY HIGH-DOSE IRRADIATION', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 31 577-581 (1995)
DOI 10.1016/0360-3016(94)00395-2
Citations Scopus - 96Web of Science - 92
1995 ALLAM A, PEREZ LA, HUANG PG, TAGHIAN A, AZINOVIC I, FREEMAN J, et al., 'THE EFFECT OF THE OVERALL TREATMENT TIME OF FRACTIONATED-IRRADIATION ON THE TUMOR-CONTROL PROBABILITY OF A HUMAN SOFT-TISSUE SARCOMA XENOGRAFT IN NUDE-MICE', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 32 105-111 (1995)
DOI 10.1016/0360-3016(95)00511-V
Citations Scopus - 25Web of Science - 25
1995 FAGUNDES MA, HUG EB, LIEBSCH NJ, DALY W, EFIRD J, MUNZENRIDER JE, 'RADIATION-THERAPY FOR CHORDOMAS OF THE BASE OF SKULL AND CERVICAL-SPINE - PATTERNS OF FAILURE AND OUTCOME AFTER RELAPSE', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 33 579-584 (1995)
DOI 10.1016/0360-3016(95)02014-3
Citations Scopus - 114Web of Science - 104
1995 Fitzek MM, Aronen H, Efird J, Hochberg F, Fischman A, Pardo FS, 'PET-FDG uptake as a prognostic indicator in gliomas', EUROPEAN JOURNAL OF CANCER, 31A 266-266 (1995)
1995 Hsu DW, Efird JT, Hedley-Whyte ET, 'Prognostic role of urokinase-type plasminogen activator in human gliomas', American Journal of Pathology, 147 114-123 (1995)

Urokinase-type plasminogen activator (u-PA) is a 54-kd enzyme shown to participate in tissue degradation under certain normal and pathological conditions, including cancer invasio... [more]

Urokinase-type plasminogen activator (u-PA) is a 54-kd enzyme shown to participate in tissue degradation under certain normal and pathological conditions, including cancer invasion and metastasis. Increased u-PA expression has been found in cancers of the breast, lung, colon, and prostate, and correlated with worse outcome in patients with lung and breast cancer. We examined the correlation between u-PA expression in gliomas and patient survival. Seventy-seven gliomas from 41 men and 36 women (ages 2 to 73) were immunostained for u-PA using monoclonal antibody 394 directed against human urokinase. The tumors included 32 grade 4, 16 grade 3, and 20 grade 2 astrocytomas (Daumas-Duport scale), and 9 pilocytic astrocytomas. Strong cytoplasmic staining was found in tumor cells of all grade 4, most of the grade 3, and a few of the lower grade tumors. Adjacent normal brain tissue showed faint staining associated with subpial cell processes and white mutter fibers. The fiber staining was stronger in brain tissue infiltrated by tumor cells. Cytoplasmic u-PA staining in tumor cells was scored from 0 (no staining) to 6 (strong and widespread staining). The mean u-PA scores were 5.08 ± 0.19 (mean ± SEM) for grade 4, 3.97 ± 0.46 for grade 3, 1.65 ± 0.39 for grade 2, and 1.22 ± 0.60 for pilocytic astrocytomas. The statistical analysis was based on cytoplasmic staining only. Analysis of variance revealed significant differences between the mean u-PA scores of different grades (P < 0.02 between grades 4 and 3, and P = 0.0001 between grades 4 or 3 and 2, and between grades 4 or 3 and pilocytic), except between grade 2 and pilocytic astrocytomas. Univariate analysis indicated that u-PA score =4 (P = 0.0001), tumor grade 4 (P = 0.01), and age > 50 (P < 0.001) were all significant predictors for shorter disease survival. A three-way interaction model by multivariate analysis indicated that u-PA score =4, tumor grade 4, and age > 50, taken together, were significant factors for shorter patient survival (P < 0.02). We conclude that u-PA may be used as a prognostic tool in conjunction with tumor grade and patients' age in predicting survival for patients with gliomas.

Citations Scopus - 87
1995 Wang CC, Montgomery W, Efird J, 'Local control of oropharyngeal carcinoma by irradiation alone', Laryngoscope, 105 529-533 (1995)

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation... [more]

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation therapy at Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary from 1970 through 1993. Radiation therapy remains the treatment of choice for these lesions. Although the data from this review were not randomized, the accelerated hyperfractionated radiation therapy twice-daily program was shown to achieve significantly higher 5-year local tumor control rates and disease-specific survival rates than the conventional once-daily radiation therapy program (historical control). In patients with early tumors of the faucial tonsil (cancer stages Tl and T2), the 5-year actuarial local tumor control and disease-specific survival rates following the twice-daily radiation therapy program were 91% and 77%, respectively. In patients with advanced tumors (T3), the corresponding rates following twice-daily radiation therapy showed marked improvement and were 80% and 68%. While the treatment results for carcinoma of the base of the tongue generally were inferior to those for carcinoma of the faucial tonsil, they were still much better after the twice-daily program than after conventional once-daily irradiation. For patients with carcinoma of the base of the tongue, the local tumor control and disease-specific survival rates for Tl and T2 lesions were 85% and 76%, respectively. For T3 lesions, the corresponding rates were 54% and 53%. Extensive T4 tumors are better managed by combined surgery and postoperative irradiation. Residual metastatic nodal disease is managed by neck dissection. © The American Laryngological, Rhinological & Otological Society, Inc.

Citations Scopus - 30
1995 Linggood RM, Hsu DW, Efird JT, Pardo FS, 'TGF a expression in meningioma - tumor progression and therapeutic response', Journal of Neuro-Oncology, 26 45-51 (1995)

Little is known of the molecular genetic mechanisms contributing to meningioma tumor progression. We evaluated a total of 26 clinical cases of meningioma: twenty three patients wi... [more]

Little is known of the molecular genetic mechanisms contributing to meningioma tumor progression. We evaluated a total of 26 clinical cases of meningioma: twenty three patients with meningioma treated at our institution between 1978 and 1990 and three asymptomatic cases found initially at autopsy. In addition, histologically normal meninges obtained at post-mortem examination from 5 cases were evaluated. There were 13 men and 10 women in the patient group with a median age of 48.7 years, treated by surgery and/or irradiation. Median follow-up was 46 months (range 16-152 months). Archival cases and age-matched normal meningeal tissue obtained at autopsy during the same time period were obtained for study. Patients with TGF a scores greater than 3.0 were more likely to fail treatment and had lower overall survival times than those with immunostaining scores of 1 or 2. Three autopsy cases where meningioma had been silent clinically had overall staining scores of 0.75, while 10 samples of normal meninges harvested from 5 cases at autopsy had staining scores of 0. Two patients each underwent 3 surgeries for recurrent tumor, serial specimens showed increased TGF a expression over time, though all material from these procedures was consistent with the diagnosis of histologically benign meningioma. © 1995 Kluwer Academic Publishers.

DOI 10.1007/BF01054768
Citations Scopus - 19
1995 Willers H, Hug EB, Spiro IJ, Efird JT, Rosenberg AE, Wang CC, 'Adult soft tissue sarcomas of the head and neck treated by radiation and surgery or radiation alone: Patterns of failure and prognostic factors', International Journal of Radiation Oncology, Biology, Physics, 33 585-593 (1995)

Purpose: To analyze our experience treating soft tissue sarcomas of the head and neck in adults, and to identify patterns of failure and prognostic factors. Methods and Materials:... [more]

Purpose: To analyze our experience treating soft tissue sarcomas of the head and neck in adults, and to identify patterns of failure and prognostic factors. Methods and Materials: The recors of 57 patients with Stage M0 disease treated by radiation with or without surgery between 1972 and 1993 were reviewed. Medial follow-up time was 4.3 years (range, 1.1-16.8 years). A group of potential prognostic factors was evaluated, including age diagnosis, sex, initial tumor presentation (primary vs. recurrent), grade, T-stage, direct tumor extension, tumor depth, duration of treatment, and radiation dose. Results: The subset of angiosarcomas (11 of 57 patients) had a considerably adverse effect on treatment outcome for the total group of sarcomas, with actuarial 5-year overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FDM) rates being 31%, 24%, and 42%, respectively. In contrast, for the remaining 46 patients with other histopathological tumor types, OS, LRC, and FDM rates were significantly higher (74%, 69%, and 83%, respectively). For this group of patients, significant prognostic factors identified by uni- and multivariate analysis included tumor grade as a predictor of OS and T-stage 3s a predictor of LRC (p = 0.050). Those patients who experienced a locoregional recurrence were at a significantly increased risk of dying (p = 0.004 in a multivariate model). All 17 patients withou direct tumor extension to neurovascular structures, bone, contiguous organs, or skin remained free from distant failure. In contrast, 27% of 29 patients with direct extension had developed distant metastases at 5 years. In multivariate analysis, the absence of direct extension was a positive predictor of FDM (p = 0.007) and of OS (p = 0.034). Conclusions: 1) Angiosarcomas of the head and neck have a considerably poorer prognosis than other soft tissue sarcomas of this site. 2) In addition to tumor grade and size, direct tumor extension may be a useful additional staging parameter. 3) High rates of locoregional failure in the head and neck area, a potential cause of morbidity and death, indicate a need for improved treatment strategies. © 1995.

DOI 10.1016/0360-3016(95)00256-X
Citations Scopus - 62
1994 QUINTANILLAMARTINEZ L, WILKINS EW, CHOI N, EFIRD J, HUG E, HARRIS NL, 'THYMOMA - HISTOLOGIC SUBCLASSIFICATION IS AN INDEPENDENT PROGNOSTIC FACTOR', CANCER, 74 606-617 (1994)
DOI 10.1002/1097-0142(19940715)74:2&lt;606::AID-CNCR2820740212&gt;3.0.CO;2-T
Citations Web of Science - 162
1994 SUIT H, ALLAM A, ALLALUNISTURNER J, BROCK W, GIRINSKY T, HILL S, et al., 'IS TUMOR-CELL RADIATION-RESISTANCE CORRELATED WITH METASTATIC ABILITY', CANCER RESEARCH, 54 1736-1741 (1994)
Citations Scopus - 28Web of Science - 28
1994 WILLETT CG, WARLAND G, CHEEK R, COEN J, EFIRD J, SHELLITO PC, COMPTON CC, 'PROLIFERATING CELL NUCLEAR ANTIGEN AND MITOTIC-ACTIVITY IN RECTAL-CANCER - PREDICTOR OF RESPONSE TO PREOPERATIVE IRRADIATION', JOURNAL OF CLINICAL ONCOLOGY, 12 679-682 (1994)
Citations Scopus - 30Web of Science - 35
1994 Schoenthaler R, Phillips TL, Castro J, Efird JT, Better A, Way LW, 'Carcinoma of the extrahepatic bile ducts: The University of California at San Francisco experience', Annals of Surgery, 219 267-274 (1994)

Objective: The authors investigated the combined experience of a single institution in treating bile duct carcinoma during the modern era. Summary Background Data: Bile duct carci... [more]

Objective: The authors investigated the combined experience of a single institution in treating bile duct carcinoma during the modern era. Summary Background Data: Bile duct carcinomas are notoriously difficult to cure, with locoregional recurrence the rule, even after radical resection. Adjuvant efforts have included various radiation modalities, with limited success. Recently, charged-particle radiotherapy has also been used in these patients. Methods: The authors performed a retrospective chart analysis of 129 patients with bile duct adenocarcinomas treated between 1977 and 1987 through the University of California at San Francisco, including 22 patients treated at Lawrence Berkeley Laboratory with the charged particles helium and neon. The minimum follow-up was 5 years. Survival, outcome, and complication results were analyzed. Results: Sixty-two patients were treated with surgery alone (S), 45 patients received conventional adjuvant x-ray radiotherapy (S + X), and 22 were treated with charged particles (S + CP). The median survival times were 6.5, 11, and 14 months, respectively, for the entire group, and 16, 16, and 23 months in patients treated with curative intent. There was a survival difference in patients undergoing total resection compared with debulking (p = 0.05) and minor resections (p = 0.0001). Patients with microscopic residual disease had increased median survival times when they were treated with adjuvant irradiation, most markedly after CP (p = 0.0005) but also with conventional X (p = 0.0109). Patients with gross residual disease had a less marked but still statistically significant extended survival (p = 0.05 for S + X and p = 0.0423 for S + CP) after irradiation. Conclusions: The mainstay of bile duct carcinoma management was maximal surgical resection in these patients. Postoperative radiotherapy gave patients with positive microscopic margins a significant survival advantage and may be of value in selected patients with gross disease.

Citations Scopus - 109
1994 O'Connell JX, Rosenberg AE, Renard LG, Liebsch NJ, Efird JT, Munzenrider JE, 'Base of skull chordoma. A correlative study of histologic and clinical features of 62 cases', Cancer, 74 2261-2267 (1994)

Background. Chordomas are uncommon primary malignant tumors of bone that typically occur in the axial skeleton including the sacrum, vertebrae, and skull base. The base of skull t... [more]

Background. Chordomas are uncommon primary malignant tumors of bone that typically occur in the axial skeleton including the sacrum, vertebrae, and skull base. The base of skull tumors usually are not amenable to complete surgical resection, and most require postoperative radiotherapy. The natural history of skull base chordoma is typified by slow locally invasive tumor progression and eventual death, although few parameters are known that allow stratification of patients into prognostic groups. Methods. Sixty-two patients with skull base chordomas treated at the Massachusetts General Hospital by proton beam irradiation therapy with at least 2 years of follow-up information were reviewed in an attempt to identify clinical and pathologic parameters that predicted outcome. Results. Female sex, tumor necrosis in preradiation treatment biopsy, and tumor volume in excess of 70 ml were each independent predictors of shortened overall survival after radiation therapy for skull base chordoma. Conclusions. Stratification of patients with skull base chordoma into poor and good outcome groups can be performed using the three parameters identified in our study. In addition, the striking difference in survival between the sexes suggests that further investigations of these tumors should include determination of their hormonal receptor status and consideration of hormonal manipulation in their management. Copyright © 1994 American Cancer Society

DOI 10.1002/1097-0142(19941015)74:8&amp;lt;2261::AID-CNCR2820740809&amp;gt;3.0.CO;2-0
Citations Scopus - 123
1994 Willett CG, Compton CC, Shellito PC, Efird JT, 'Selection factors for local excision or abdominoperineal resection of early stage rectal cancer', Cancer, 73 2716-2720 (1994)

Background. This study reviews the experience of patients with early stage rectal cancer managed by local excision or abdominoperineal resection to clarify the relative indication... [more]

Background. This study reviews the experience of patients with early stage rectal cancer managed by local excision or abdominoperineal resection to clarify the relative indications and results of these two approaches. Methods. From 1962 to 1991, 125 patients with T1 and T2 rectal cancer underwent local excision (56 patients) or abdominoperineal resection (69 patients). Outcome was analyzed by stage, treatment, and pathologic features of tumor grade and vessel involvement. Results. The 5-year actuarial recurrence-free survival and local control was 87% and 96%, respectively, for 28 patients undergoing local excision with favorable histologic features (well or moderately well differentiated histologic findings without venous/lymph vessel involvement). These results were 57% and 68% for 28 patients with unfavorable histologic features (poorly differentiated histology and/or venous/lymph vessel involvement). For patients undergoing abdominoperineal resection, the 5-year actuarial recurrence-free survival and local control of 49 patients with favorable histologic features was 91% and 91%, respectively. These results were 79% and 89%, respectively, for patients with poorly differentiated histology or venous/lymph vessel involvement. Conclusions. For patients with T1 and T2 tumors having favorable histologic features, a satisfactory survival and local control was achieved for patients undergoing local excision or abdominoperineal resection. In contrast, patients with T1 and T2 tumors having poorly differentiated histologic features and/or venous/lymph vessel involvement undergoing local excision or abdominoperineal resection appeared to have decreased rates of survival and of local control. For these patients, radical resection combined with pelvic irradiation and 5-fluorouracil-based chemotherapy should be investigated. Cancer 1994; 73:2716¿20. Copyright © 1994 American Cancer Society

DOI 10.1002/1097-0142(19940601)73:11&amp;lt;2716::AID-CNCR2820731111&amp;gt;3.0.CO;2-9
Citations Scopus - 136
1994 Quintanilla Martinez L, Harris NL, Wilkins EW, Choi N, Efird J, Hug E, 'Thymoma: Histologic subclassification is an independent prognostic factor', Cancer, 74 606-617 (1994)

Background. Several histologic classifications of thymomas have been proposed, and attempts have been made to correlate the different histologic subtypes to clinical behavior and ... [more]

Background. Several histologic classifications of thymomas have been proposed, and attempts have been made to correlate the different histologic subtypes to clinical behavior and prognosis. Recently, Marino and Müller-Hermelink and Kirchner et al. proposed a new morphologic classification of thymomas based on the resemblance of the neoplastic cells to subtypes of the normal thymic epithelial cells. In this classification, six categories of thymic epithelial tumors are recognized, They define four categories of thymoma: medullary, mixed, organoid (predominantly cortical), and cortical, and two subgroups of thymic carcinomas: well differentiated thymic carcinoma and high grade carcinomas. Methods. The authors studied 116 patients with thymic epithelial tumors classified according to the proposals of Marino and Müller-Hermelink and Kirchner et al. to assess the effect of histologic classification and other factors (stage, size of tumor, lymphoid hyperplasia, myasthenia gravis, age, sex, and treatment) on survival, and freedom from relapse. Results. Eight cases (7%) were medullary, 32 cases (28%) mixed, 20 cases (17%) organoid (predominantly cortical), 21 cases (18%) cortical, 29 cases (25%) well differentiated carcinoma (WDTC), two cases (2%) high grade carcinoma, and four cases (3%) unclassifiable. Fifty-two patients were in stage I, 32 stage II (16 HA, 16 HB), 28 stage III, and four Stage IVA. Only stage (P = 0.0001; hazard ratio = 5.36) and histology (P = 0.0019; hazard ratio = 8.010) were significant in predicting recurrence. Histology was highly correlated with stage, but by multivariate analysis was an independent factor in predicting relapse (P = 0.0281; hazard ratio = 5.92). None of the medullary or mixed thymornas recurred, even though 30% were invasive. Patients with WDTC recurred more often and earlier than patients with organoid and cortical thymoma (log rank, P = 0.001). The actuarial freedom from relapse for patients with WDTC was 58% at 5 years and 46% at 10 years compared with 100% for other subtypes. Both advanced stage (III and IV) and the WDTC histologic subtype significantly increased the risk of death from thymoma (log rank, P = 0.0001). The actuarial survival of patients with WDTC was 80% at 5 years and 54% at 10 years, whereas that of patients with the other subtypes was 100% at 5 and 10 years. Five of seven relapses and six of seven deaths from thymoma occurred in patients with WDTC. In Stage II patients, one of 16 minimally invasive (Stage IIA) tumors recurred, compared with 3 of 16 grossly invasive (Stage IIB) tumors, indicating that microscopic assessment of invasion is important in staging. Conclusions. The bistologic classification of Marino and Müller-Hermelink has prognostic significance, independent of tumor stage. Medullary and mixed thymomas were benign tumors with no risk of recurrence, even when capsular invasion was present. Organoid and cortical thymoma showed intermediate invasiveness and a low, but significant, risk of late relapse, even with minimal invasion. WDTC were always invasive and had a significantly increased risk of relapse and death, even for Stage II patients. Adjuvant therapy appears unnecessary for medullary and mixed thymomas, even when invasive Cancer 1994; 74:606-17. Copyright © 1994 American Cancer Society

DOI 10.1002/1097-0142(19940715)74:2&amp;lt;606::AID-CNCR2820740212&amp;gt;3.0.CO;2-T
Citations Scopus - 211
1994 Hsu DW, Pardo FS, Efird JT, Linggood RM, Hedley Whyte ET, 'Prognostic significance of proliferative indices in meningiomas', Journal of Neuropathology and Experimental Neurology, 53 247-255 (1994)

The prognostic value of tumor proliferative indices in meningiomas was assessed by mitotic counts and by immunocytochemistry using a monoclonal antibody against the proliferating ... [more]

The prognostic value of tumor proliferative indices in meningiomas was assessed by mitotic counts and by immunocytochemistry using a monoclonal antibody against the proliferating cell nuclear antigen (PCNA) (clone 19A2), a 36-kd nuclear protein involved in DNA synthesis. Sixty-three intracranial meningiomas were classified as benign (26), with atypical features (24) or as malignant (13). The patients included 24 men and 39 women, mean age 54.2 ± 1.7 (mean ± SEM) (range 15-78) at initial presentation. Twenty-four of the 63 primary tumors recurred locally, including 23.1% (6/26) of the benign, 37.5% (9/24) of the atypical, and 69.2% (9/13) of the malignant meningiomas. Among tumors that recurred, 1/9 (11%) of the atypical and 5/9 (55.5%) of the malignant tumors had had macroscopical total excision at the initial surgery. The mean interval to recurrence was 52 ± 11.8 months. The mean progression-free follow-up period for patients without tumor recurrence was 82 ± 8.5 months. Analysis of variance revealed that significant differences existed between tumor grades for both PCNA indices (1.16 ± 0.29% for benign; 14.14 ± 2.07% for atypical and 21.37 ± 5.47% for malignant) and mitotic indices (total counts per ten high power fields) (0.08 ± 0.05 for benign, 4.75 ± 0.91 for atypical and 19.00 ± 4.07 for malignant). Multivariate regression analysis indicated that mitotic index > 6 was the single most important factor (p < 0.05) for shorter disease-free interval. Age, sex and total surgical excision were not significant factors. PCNA index was a significant factor in the univariate model, but not in the multivariate model. However, a two-factor-interaction model with PCNA > 5% and mitoses > 6 was highly significant as a predictor of outcome (p < 0.0001). We conclude that PCNA index may be used as an adjunct with mitotic counts in predicting the clinical course of patients with meningiomas. © 1994 by the American Association of Neuropathologists.

Citations Scopus - 66
1994 Zietman AL, Coen JJ, Shipley WU, Willett CG, Efird JT, 'Radical radiation therapy in the management of prostatic adenocarcinoma: The initial prostate specific antigen value as a predictor of treatment outcome', Journal of Urology, 151 640-645 (1994)

We studied 161 prostate cancer patients treated by radical irradiation alone without endocrine therapy in whom pretreatment and posttreatment prostate specific antigen (PSA) value... [more]

We studied 161 prostate cancer patients treated by radical irradiation alone without endocrine therapy in whom pretreatment and posttreatment prostate specific antigen (PSA) values were measured, and who had a minimum followup of 2 years. Outcome was analyzed in an actuarial fashion using clinical disease-free survival and biochemical disease-free survival (freedom from an increasing PSA level or a PSA level of greater than 1.0 ng./ml. 2 years following irradiation) as end points. Of the patients 54% achieved a post-irradiation nadir value in the range 0 to 1.0 ng./ml. and 29% had a nadir value that was undetectably low (less than 0.5 ng./ml.). The likelihood of achieving these values was greater among patients with early stage than locally advanced tumors. For all T stages the likelihood of being disease- free at 4 years was substantially and significantly lower when PSA was used as an end point than when clinical evaluation alone was used: stages T1 and T2 (85 patients) 41% versus 71%, and stages T3 and T4 (76 patients) 15% versus 61%. For the whole group at 4 years clinical control was 67% but biochemical control was only 26% (p < 0.05). The likelihood of being free of biochemical evidence of persistent disease at 4 years was a function of the initial PSA value (PSA less than 4.0 in 81% of the cases, 4.1 to 10.0 in 43%, 10.1 to 20.0 in 31%, 20.1 to 50.0 in 6% and greater than 50.0 in 0%). For stages T1 and T2 cancer patients with an initial PSA level of less than 15 ng./ml. (67% of all early stage cases) this value was 65% and it was even higher (73%) when poorly differentiated tumors were excluded. When the initial PSA level for stages T1 and T2 tumors was greater than 15 ng./ml. the projected 4-year rate of freedom from biochemical failure was only 7%. For stages T3 and T4 cancer patients the corresponding figures were 39% for those with an initial PSA level of less than 15 ng./ml. and 0% for those with an initial PSA level of greater than 15 ng./ml. The prognostic power of the initial PSA level was independent of stage, grade, patient age and prior transurethral resection of the prostate in a multivariate analysis. An initial serum PSA level of more than 15 ng./ml. is, therefore, a powerful predictor of probable failure with conventional radiation therapy. Serum PSA monitoring is a sensitive detector of early relapse. Knowledge of both will, in the future, allow the selection of patients for more intensive initial therapy or for early salvage.

Citations Scopus - 203
1994 Wang CC, Efird JT, 'Does prolonged treatment course adversely affect local control of carcinoma of the larynx?', International Journal of Radiation Oncology, Biology, Physics, 29 657-660 (1994)

Purpose: The purpose of this paper is to present local control rates of carcinoma of the larynx in relation to the total treatment course after radical radiation therapy. Methods ... [more]

Purpose: The purpose of this paper is to present local control rates of carcinoma of the larynx in relation to the total treatment course after radical radiation therapy. Methods and Materials: A total of 1350 patients with laryngeal carcinoma treated at the Massachusetts General Hospital for the past three decades were available for analysis. Treatment courses were divided into two groups: 45 days and > 45 days. The local control rates were compared and evaluated for statistical differences. Results: The data indicated that prolonged treatment course adversely affects local tumor control of both advanced glottic and supraglottic lesions, but to a lesser degree for the early tumors. Conclusion: The study indicated that for optimal local control, radiation treatment should be completed as soon as possible, preferably within 6.5 weeks, either by once- or twice-daily accelerated programs. The local control of early T 1 glottic cancer has been exceedingly satisfactory by conventional once-daily radiation therapy. Further improvement by shortening of treatment time for such early lesions will be difficult to assess without a prospective randomized trial. © 1994.

DOI 10.1016/0360-3016(94)90551-7
Citations Scopus - 48
1994 Fung CY, Willett CG, Efird JT, Shellito PC, Kaufman DS, 'Chemoradiotherapy for anal carcinoma: What is the optimal radiation dose?', Radiation Oncology Investigations, 2 152-156 (1994)

A dose-response analysis was undertaken in a group of patients with clinically node-negative carcinoma of the anal canal treated with a sphincter-sparing approach. Twenty-three pa... [more]

A dose-response analysis was undertaken in a group of patients with clinically node-negative carcinoma of the anal canal treated with a sphincter-sparing approach. Twenty-three patients underwent biopsy of the primary tumor, followed by concurrent radiation and chemotherapy. The chemotherapy regimen of 5-fluorouracil and mitomycin C and radiation technique were uniform in all patients. The total radiation dose, given in daily fractions of 180¿200 cGy, was escalated over the years as an institutional policy. The total radiation dose was =5,200 cGy (mean 4,550 cGy) in 11 cases treated before September 1989 and > 5,200 cGy (mean 5,572 cGy) in 12 cases treated subsequently. The 3-year actuarial local control rates were 53% vs. 100% for the low vs. high dose groups, respectively (P = 0.015). The 3-year actuarial overall survival rates were 82% vs. 100% in the 2 groups, respectively. No increase in late toxicity in the high dose group has been observed compared to the low dose group. These results, albeit based on limited patient numbers, suggest that total radiation dose is an important determinant of long-term tumor control in patients with localized anal canal carcinoma. A total radiation dose of approximately 5,500 cGy has led to excellent tumor control and sphincter function. © Wiley-Liss, Inc. Copyright © 1994 Wiley-Liss, Inc., A Wiley Company

DOI 10.1002/roi.2970020307
Citations Scopus - 11
1993 WILLETT CG, LEWANDROWSKI K, WARSHAW AL, EFIRD J, COMPTON CC, 'RESECTION MARGINS IN CARCINOMA OF THE HEAD OF THE PANCREAS - IMPLICATIONS FOR RADIATION-THERAPY', ANNALS OF SURGERY, 217 144-148 (1993)
DOI 10.1097/00000658-199302000-00008
Citations Scopus - 343Web of Science - 302
1993 SADOSKI C, SUIT HD, ROSENBERG A, MANKIN H, EFIRD J, 'PREOPERATIVE RADIATION, SURGICAL MARGINS, AND LOCAL-CONTROL OF EXTREMITY SARCOMAS OF SOFT-TISSUES', JOURNAL OF SURGICAL ONCOLOGY, 52 223-230 (1993)
DOI 10.1002/jso.2930520405
Citations Scopus - 193Web of Science - 173
1993 TAMLER B, WANG CC, EFIRD J, CHEN YC, LEWIS A, ZLOTECKI R, 'IS PHOTON IRRADIATION EFFECTIVE IN MANAGING ADENOID CYSTIC CARCINOMA OF THE HEAD AND NECK', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 27 174-174 (1993)
1993 PARDO FS, HSU DW, SCHMIDT EV, EFIRD J, LINGGOOD RM, 'ELEVATED PCNA EXPRESSION IN PITUITARY-ADENOMAS FAILING DEFINITIVE RADIATION-THERAPY', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 27 205-205 (1993)
1993 FUNG CY, WILLETT CG, EFIRD J, KAUFMAN DS, SHELLITO PC, 'IMPROVED OUTCOME WITH ESCALATED RADIATION DOSING FOR ANAL CARCINOMA', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 27 278-278 (1993)
Citations Web of Science - 2
1993 WILLETT CG, FUNG CY, KAUFMAN DS, EFIRD J, SHELLITO PC, 'POSTOPERATIVE RADIATION-THERAPY FOR HIGH-RISK COLON-CARCINOMA', JOURNAL OF CLINICAL ONCOLOGY, 11 1112-1117 (1993)
Citations Scopus - 64Web of Science - 55
1993 Ferry JA, Linggood RM, Convery KM, Efird JT, Eliseo R, Harris NL, 'Hodgkin disease, nodular sclerosis. Type implications of histologic subclassification', Cancer, 71 457-463 (1993)

Background. The prognostic significance of the cellular composition of the nodules of Hodgkin disease, nodular sclerosis type (HDNS), is controversial. Methods Tumors from 79 pati... [more]

Background. The prognostic significance of the cellular composition of the nodules of Hodgkin disease, nodular sclerosis type (HDNS), is controversial. Methods Tumors from 79 patients with HDNS, who had a median follow-up time of 9.3 years, were studied. Results. Based on British National Lymphoma Investigation criteria, 58 cases were classified as NSI (low-grade) and 21 as NSII (high-grade). The study included 24 male and 55 female patients, aged 10¿57 years (mean, 27 years), who presented with Stage I (13 patients [12A, 1B]), Stage II (45 patients [40A, 5B] ), or Stage III (21 patients [16A, 5B]) disease. Fifty-three patients had no relapse, 4 died of other causes, and 49 are in complete clinical remission. Twenty-six patients had progression of disease during therapy or relapsed and 17 were successfully salvaged. Overall length of survival was significantly shorter with NSII (P = 0.0001), extensive necrosis (P = 0.0034), high stage (P = 0.0058), and B symptoms (P = 0.030). Multivariate analysis showed that grade had the strongest effect on overall survival (P = 0.0042; hazard ratio = 10.19). The 5-year survival was 100% for NSI patients and 75% for NSII patients. Only B symptoms were significantly associated with risk of relapse after initial therapy (P = 0.030). For patients who relapsed, only histologic grade predicted subsequent disease-free survival (P = 0.0023; hazard ratio = 26.5). Five-year disease-free survival after first relapse was 94% for NSI patients and 11% for NSII patients. Conclusions. Patients with NSI disease who relapse have a more successful salvage and longer period of survival than do those with NSII disease. Histologic subclassification of HDNS appears clinically relevant, and consideration of histologic subtype may be important when planning therapy. Copyright © 1993 American Cancer Society

DOI 10.1002/1097-0142(19930115)71:2&amp;lt;457::AID-CNCR2820710229&amp;gt;3.0.CO;2-U
Citations Scopus - 41
1993 Kaufman DS, Shipley WU, Griffin PP, Heney NM, Althausen AF, Efird JT, 'Selective Bladder Preservation by Combination Treatment of Invasive Bladder Cancer', New England Journal of Medicine, 329 1377-1382 (1993)

For patients with invasive bladder cancer the usual recommended treatment is radical cystectomy, although transurethral resection of the tumor, systemic chemotherapy, and radiothe... [more]

For patients with invasive bladder cancer the usual recommended treatment is radical cystectomy, although transurethral resection of the tumor, systemic chemotherapy, and radiotherapy are each effective in some patients. We sought to determine whether these treatments in combination might be as effective as radical cystectomy and thus might allow the bladder to be preserved and the cancer cured. We enrolled 53 consecutive patients with muscle-invading bladder cancer (stages T2 through T4, NXM0) in a trial of transurethral surgery, combination chemotherapy, and irradiation (4000 cGy) with concurrent cisplatin administration. Urologic evaluation of the tumor response directed further therapy: radical cystectomy in the 8 patients who had incomplete responses, additional chemotherapy and radiotherapy (6480 cGy) in the 34 patients who had complete responses or who were unsuited for cystectomy, and alternative care in the 11 patients who could not tolerate either irradiation or chemotherapy. After a median follow-up of 48 months, 24 of the 53 patients (45 percent) were alive and free of detectable tumor. In 31 patients (58 percent) the bladder was free of invasive tumor and functioning well, even though in 9 (17 percent) a superficial tumor recurred and required further transurethral surgery and intravesical drug therapy. Of the 28 patients who had complete responses after initial treatment, 89 percent had functioning tumor-free bladders. Conservative combination treatment may be an acceptable alternative to immediate cystectomy in selected patients with bladder cancer, although a randomized clinical trial that included a group for simultaneous comparison would be required to produce definitive results., The treatment of patients with invasive bladder cancer is undergoing dramatic changes, incorporating many potentially effective and complementary therapies from several disciplines, including transurethral surgical resection, systemic chemotherapy, improved techniques of radiotherapy, and advanced methods of surgical construction of a substitute bladder. All have the potential to improve the quality of life and cure the disease. Radical cystectomy has been the conventional treatment of muscle-invasive bladder cancer in the United States for the past two decades. This procedure is associated with excellent local control of the primary tumor, but it has a high probability, approaching 50 percent, of subsequent distant¿ © 1993, Massachusetts Medical Society. All rights reserved.

DOI 10.1056/NEJM199311043291903
Citations Scopus - 187
1993 Benk VA, Adams JA, Shipley WU, Urie MM, McManus PL, Efird JT, et al., 'Late rectal bleeding following combined x-ray and proton high dose irradiation for patients with stages T3-T4 prostate carcinoma', International Journal of Radiation Oncology, Biology, Physics, 26 551-557 (1993)

Purpose: Dose escalation for prostate cancer by external beam irradiation is feasible by a 160 MeV perineal proton beam that reduces the volume of rectum irradiated. We correlated... [more]

Purpose: Dose escalation for prostate cancer by external beam irradiation is feasible by a 160 MeV perineal proton beam that reduces the volume of rectum irradiated. We correlated the total doses received to portions of the anterior rectum to study the possible relationship of the volume irradiated to the incidence of late rectal toxicity. Methods: We have randomized 191 patients with stages T3 and T4 prostatic carcinoma to one of two treatment dose arms. These were: 1) 75.6 Cobalt-Gy-equivalent (CGE), 50.4 Gy delivered by 107-25 MV photons followed by 25.2 CGE delivered perineally by protons (Arm 1) or 2) 67.2 CGE delivered by 10-25 MV photons (Arm 2). Results: With a median follow-up of 3.7 years, post-irradiation rectal bleeding (grades 1 and 2 only, none requiring surgery or hospitalization) from telangietatic rectal mucosal vessels has occurred in 34% of 99 Arm-1 patients and 16% of 92 Arm-2 patients (p = 0.013). Dose-volume histograms (DVHs) for the anterior rectal wall, the posterior rectal wall and the total rectum in 41 patients treated on Arm 1 were calculated from the three dimensional dose distributions. Rectal bleeding has occurred in 14 or 34% of the 41 DVH-analyzed subset of Arm-1 patients. Both the fractional volume of the anterior rectum and the total dose received by fractional volumes of the anterior rectum significantly correlate with the actuarial probability of bleeding. Conclusions: Clinicians planning dose escalation to men with localized prostate cancer should approve with caution treatment plans raising more than 40% of the anterior rectum to more than 75 CGE without additional effort to protect the rectal mucosa because this late sequela data indicate that more than half of these men will otherwise have rectal bleeding. © 1993.

DOI 10.1016/0360-3016(93)90978-5
Citations Scopus - 138
1992 Suit H, Skates S, Taghian A, Okunieff P, Efird JT, 'Clinical implications of heterogeneity of tumor response to radiation therapy', Radiotherapy and Oncology, 25 251-260 (1992)

Heterogeneity of response of tumor tissue to radiation clearly exists. Major parameters include histopathologic type, size (number of tumor rescue units (TRUs)), hemoglobin concen... [more]

Heterogeneity of response of tumor tissue to radiation clearly exists. Major parameters include histopathologic type, size (number of tumor rescue units (TRUs)), hemoglobin concentration, cell proliferation kinetics and immune rejection reaction by host. Further, normal and presumably tumor tissue response is altered in certain genetic diseases, e.g. ataxia telangiectasia. Any assessment of response of tumor tissue to a new treatment method or the testing of a new clinical response predictor is optimally based upon a narrow strata, viz., uniform with respect to known parameters of response, e.g. size, histological type. Even among tumors of such a clinically defined narrow strata, there will be residual heterogeneity with respect to inherent cellular radiation sensitivity, distributions of pO 2 , (SH), cell proliferation etc. The value of a response predictor of an individual tumor will be determined by the heterogeneity of values for these and or other characteristics and by the coefficient of variation (CV) of the measured values of the individual parameters. Heterogeneity of one or more parameters of response is reflected in the slope of the dose response curve for local control, viz. the greater the heterogeneity the less steep the slope. To examine for this effect, the slope of dose response curves for control of model tumors of 10 8 tumor rescue units (TRU) and the SF 2 = 0.5 (survival fraction after a single dose of 2 Gy) has been used to assess the impact of inter- and intea-tumoral variation of SF 2 on slope, defined as ¿ 50 values. The ¿ 50 is the increase in local control expressed in percent points for a one percentage increment in dose, at the mid-point on the dose-response curve. The ¿ 50 was 6.5 for CV =0.0. For inter-tumoral CVs of 10%, 20% and 40%, the ¿ 50 rapidly decreased to 2.4, 1.3 and 0.7. Intra-tumoral variation was less important, viz., for CVs of 10%, 20%, and 40% the ¿ 50 values were reduced to 5.3, 3.8 and 2.2. Combining inter- and intea-tumoral variation reduced the ¿ 50 only slightly below that for inter-tumoral variation alone. For example, were the CV 10% for inter- and intea-tumoral variation, the ¿ 50 would be 2.1 as compared to 2.4 for inter-tumoral variation alone. The number of TRUs also affects slope, viz. ¿ 50 increased from 1 to 9.7 as the TRU number increased from 10 1 to 10 12 . However, the number of TRUs within a specified T stage would be expected to vary over a rather limited range, e.g. = a factor of 10 1-2 . Accordingly, the effect of heterogeneity with respect to TRU numbers would affect ¿ 50 to a lesser degree than the probable heterogeneity of cellular radiation sensitivity. The CVs for response of tumor and normal tissue in rodents (TCD 50 of independent tumor systems or LD 50 for different strains of mice) were in the range of 9-20%, i.e. less than found for SF 2 of human tumor cells as determined in vitro, 20-50%. Were the ¿ 50 for a narrow strata of human tumors to be ¿2, as judged likely, then the CV of radiation sensitivity of cells in vivo would be = 10-15%, a value comparable with that found for independent tissue systems. © 1992.

DOI 10.1016/0167-8140(92)90244-O
Citations Scopus - 102
Show 175 more journal articles

Conference (14 outputs)

Year Citation Altmetrics Link
2015 Mehra S, Efird J, Printz M, Hau VT, Hoang QB, Dagubati R, et al., 'Strategies for Patients with Acute Myocardial Infarction Presenting as Out-of Hospital Cardiac Arrest', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2015)
2014 Biswas T, Walker P, Podder TK, Efird JT, 'Is There Any Disparity in Treatment and Outcome of Stage I Non-Small Cell Lung Cancer (NSCLC): A Study From Single Cancer Registry?', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2014)
2014 Biswas T, Efird JT, Walker PR, James SE, Prasad S, Zagar T, 'Inflammatory TNBC breast cancer: Demography and clinical outcome in a large cohort of TNBC patients', JOURNAL OF CLINICAL ONCOLOGY (2014)
2013 Prasad S, Zagar TM, James S, Walker P, Raab R, Efird J, Biswas T, 'Patterns of Failure in Triple-Negative Breast Cancer (TNBC): A Retrospective Analysis in 476 Women', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2013)
2013 Biswas T, Efird J, Prasad S, Zagar T, James S, Walker P, et al., 'Treatment-Related Outcome in Triple-Negative Breast Cancer (TNBC): A Multi-institutional Retrospective Analysis', INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2013)
2013 Biswas T, Prasad S, Zagar T, Efird J, James SE, Walker PR, et al., 'Insurance status as a strong predictor of outcome in triple-negative breast cancer (TNBC): A multi-institutional retrospective study', JOURNAL OF CLINICAL ONCOLOGY (2013)
2013 Davies SW, O'Neal WT, Sawyer RG, Efird JT, Ferguson T, 'A COMPARISON OF THE LONG-TERM SURVIVAL OF 306,868 PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE UNDERGOING CABG AND PCI: A META-ANALYSIS OF RETROSPECTIVE STUDIES', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2013)
2013 O'Neal W, Efird J, Ferguson T, 'IMPACT OF PREOPERATIVE ATRIAL FIBRILLATION ON LONG-TERM SURVIVAL AFTER OPEN HEART SURGERY', JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2013)
2011 Kadali RA, Chohan HS, Efird J, Boettger P, Liles D, Knupp C, et al., 'DAYTIME PULSE-OXIMETRY MEASUREMENTS DO NOT PREDICT NOCTURNAL DESATURATIONS IN ADULT SICKLE CELL PATIENTS', SLEEP (2011)
2009 O'Phelan KH, Park D, Efird JT, Johnson K, Albano M, Beniga J, et al., 'Patterns of Increased Intracranial Pressure After Severe Traumatic Brain Injury', NEUROCRITICAL CARE (2009)
DOI 10.1007/s12028-008-9183-7
Citations Scopus - 15Web of Science - 13
2008 Efird JT, Nielsen SS, 'A method to compute multiplicity corrected confidence intervals for odds ratios and other relative effect estimates', International Journal of Environmental Research and Public Health (2008)

Epidemiological studies commonly test multiple null hypotheses. In some situations it may be appropriate to account for multiplicity using statistical methodology rather than simp... [more]

Epidemiological studies commonly test multiple null hypotheses. In some situations it may be appropriate to account for multiplicity using statistical methodology rather than simply interpreting results with greater caution as the number of comparisons increases. Given the one-to-one relationship that exists between confidence intervals and hypothesis tests, we derive a method based upon the Hochberg step-up procedure to obtain multiplicity corrected confidence intervals (CI) for odds ratios (OR) and by analogy for other relative effect estimates. In contrast to previously published methods that explicitly assume knowledge of P values, this method only requires that relative effect estimates and corresponding CI be known for each comparison to obtain multiplicity corrected CI. © 2008 MDPI. All rights reserved.

DOI 10.3390/ijerph5050394
Citations Scopus - 8
2008 O'Phelan K, Sasaki A, Albano M, Efird J, Green D, Chang C, et al., 'Incidence of low brain tissue oxygen in patients with severe traumatic brain injury', JOURNAL OF NEUROTRAUMA (2008)
2005 Nerurkar PV, Pearson L, Efird JT, Adeli K, Theriault AG, Nerurkar VR, 'Microsomal triglyceride transfer protein gene expression and ApoB secretion are inhibited by bitter melon in HepG2 cells', Journal of Nutrition (2005)

Momordica charantia or bitter melon is traditionally used as an antidiabetic agent in Asia, Africa, and South America. Recent studies indicate that bitter melon can also lower pla... [more]

Momordica charantia or bitter melon is traditionally used as an antidiabetic agent in Asia, Africa, and South America. Recent studies indicate that bitter melon can also lower plasma lipids and VLDL in diabetic animal models as well as animals fed a high-fat diet, suggesting an effect on lipoprotein metabolism. The aim of this study was to delineate the cellular and molecular mechanisms involved in the lipid-lowering properties of bitter melon and regulation of apolipoprotein B (apoB). Human hepatoma cells, HepG2, treated with bitter melon juice (BMJ) for 24 h reduced apoB secretion with and without the addition of lipids (P < 0.05). However, BMJ did not increase apoB secretion in cells treated with N-acetyl-leucyl-leucyl-norleucinal, indicating a lack of effect on the proteasomal degradation pathway. BMJ reduced the secretion of new triglycerides (P < 0.05) and decreased microsomal triglyceride transfer protein (MTP) mRNA expression, suggesting that lipid bioavailability and lipidation of lipoprotein assembly are likely involved in decreased apoB secretion. Interestingly, BMJ increased the nuclear translocation of the mature form of sterol regulatory element-binding protein-1c (SREBP-1c, P < 0.05), involved in MTP secretion. Our data suggest that BMJ is a potent inhibitor of apoB secretion and TG synthesis and secretion that may be involved in the plasma lipid- and VLDL-lowering effects observed in animal studies. © 2005 American Society for Nutritional Sciences.

Citations Scopus - 27
2004 Pardo FS, Aronen HJ, Fitzek M, Kennedy DN, Efird J, Rosen BR, Fischman AJ, 'Correlation of FDG-PET interpretation with survival in a cohort of glioma patients', ANTICANCER RESEARCH (2004)
Citations Scopus - 25Web of Science - 19
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Grants and Funding

Summary

Number of grants 6
Total funding $3,744,665

Click on a grant title below to expand the full details for that specific grant.


20171 grants / $648,883

Genetic determinants of race differences in pediatric and adult heart disease$648,883

Funding body: NC GENES

Funding body NC GENES
Project Team

Berg J (PI)

Scheme Research grant
Role Investigator
Funding Start 2017
Funding Finish 2022
GNo
Type Of Funding Not Known
Category UNKN
UON N

20151 grants / $40,000

Assessment of the antineoplastic activity of the cannabinoid, arachidonoyl-ethanolamide (AEA) and its novel metabolic product$40,000

Funding body: Brody School of Medicine

Funding body Brody School of Medicine
Project Team

Van Dross-Anderson (PI)

Scheme Internal Seed Grant
Role Investigator
Funding Start 2015
Funding Finish 2016
GNo
Type Of Funding External
Category EXTE
UON N

20141 grants / $2,298,864

Myocardial Redox Status, Catecholamine Metabolism and Post-Operative Arrhythmia$2,298,864

Funding body: Department of Health and Human Services

Funding body Department of Health and Human Services
Project Team

Anderson, E (PI)

Scheme Research Grant
Role Investigator
Funding Start 2014
Funding Finish 2019
GNo
Type Of Funding External
Category EXTE
UON N

20132 grants / $524,750

Placebo-controlled trial to assess the Effect of High-Dose Oral Cholecalciferol on Select Genetic Responses in Overweight, Hypertensive African-Americans with Hypovitaminosis D$500,000

Funding body: RCMI RTRN

Funding body RCMI RTRN
Scheme Research Grant
Role Investigator
Funding Start 2013
Funding Finish 2016
GNo
Type Of Funding External
Category EXTE
UON N

Disparities in Youth HPV Vaccination in Eastern North Carolina (ENC)$24,750

Funding body: ECU

Funding body ECU
Project Team

Landrine H

Scheme Internal Award
Role Investigator
Funding Start 2013
Funding Finish 2014
GNo
Type Of Funding External
Category EXTE
UON N

20121 grants / $232,168

Integrating Social, Behavior & Preventive Sciences to Reduce Children’s Caries$232,168

Funding body: NIH National Institutes of Health

Funding body NIH National Institutes of Health
Scheme Research Grant
Role Lead
Funding Start 2012
Funding Finish 2013
GNo
Type Of Funding External
Category EXTE
UON N
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Research Supervision

Number of supervisions

Completed22
Current4

Total current UON EFTSL

PhD1.5

Current Supervision

Commenced Level of Study Research Title Program Supervisor Type
2017 PhD The use of Multivariate Stochastic Models in Medical Research. PhD (CommunityMed & ClinEpid), Faculty of Health and Medicine, The University of Newcastle Principal Supervisor
2017 PhD Understanding the Australian Women Hospital use Dynamics at the End of Life: The Australian Longitudinal Study on Women's Health PhD (Gender & Health), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor
2016 Masters Farm related deaths and injuries in North Carolina
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined farm related deaths and injuries in North Carolina </span>
Public Health, Brody School of Medicine Principal Supervisor
2016 PhD Modelling Trajectories to Aged Care Service Use among Older Australian Women PhD (Gender & Health), Faculty of Health and Medicine, The University of Newcastle Co-Supervisor

Past Supervision

Year Level of Study Research Title Program Supervisor Type
2015 Masters A systematic literature review of second-tier tests in newborn screening for propionylcarnitine
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">A systematic literature review of second-tier tests in newborn screening for propionylcarnitine </span>
Public Health, Brody School of Medicine Principal Supervisor
2014 Masters Seasonality of childhood brain tumors: An international study of five countries
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined seasonality of childhood brain tumors: An international study of five countries </span>
Public Health, Brody School of Medicine Principal Supervisor
2014 Masters Who is responsible for the recruitment of health professionals in North Carolina
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined who is responsible for the recruitment of health professionals in North Carolina </span>
Public Health, Brody School of Medicine Principal Supervisor
2014 Masters Risk factors for intra- and post-operative inotropic use among coronary artery bypass grafting patients, Kristin Shiue
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined risk factors for intra- and post-operative inotropic use among coronary artery bypass grafting patients, Kristin Shiue</span>
Public Health, Brody School of Medicine Principal Supervisor
2014 Masters The impact of race and inotrope treatment on long-term survival after CABG
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined the impact of race and inotrope treatment on long-term survival after CABG </span>
Public Health, Brody School of Medicine Principal Supervisor
2014 Masters Cyclical trends in cardiothoracic surgery outcomes
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined cyclical trends in cardiothoracic surgery outcomes </span>
Public Health, Brody School of Medicine Principal Supervisor
2013 Masters A comparative analysis between laparoscopic and open adhesiolysis at tertiary care center
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">A comparative analysis between laparoscopic and open adhesiolysis at tertiary care center </span>
Public Health, Brody School of Medicine Principal Supervisor
2013 Masters Conditional survival of heart failure patients after coronary artery bypass grafting at a large tertiary referral heart institute in rural eastern North Carolina
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined conditional survival of heart failure patients after coronary artery bypass grafting at a large tertiary referral heart institute in rural eastern North Carolina </span>
Public Health, Brody School of Medicine Principal Supervisor
2013 Masters The effect of Phentermine and B12 on weight among obese patients
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined the effect of Phentermine and B12 on weight among obese patients </span>
Public Health, Brody School of Medicine Principal Supervisor
2013 Masters Prolonged length of CICU stay as a predictor of decreased long-term survival among non-emergent CABG patients with COPD
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined prolonged length of CICU stay as a predictor of decreased long-term survival among non-emergent CABG patients with COPD </span>
Public Health, Brody School of Medicine Principal Supervisor
2013 Masters Conditional survival outcomes after CABG accounting for time already survived
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined conditional survival outcomes after CABG accounting for time already survived </span>
Public Health, Brody School of Medicine Principal Supervisor
2012 Masters The drug court model: a statistical review of national parameters and performance
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined the drug court model: a statistical review of national parameters and performance </span>
Public Health, Brody School of Medicine Principal Supervisor
2012 Masters Diabetes education in African-American faith based organizations
Examined diabetes education in African-American faith based organizations
Public Health, Brody School of Medicine Principal Supervisor
2012 Masters Review of literature on occupational hazards associated with medical treatment of farm animals
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Review of literature on occupational hazards associated with medical treatment of farm animals </span>
Public Health, Brody School of Medicine Principal Supervisor
2012 Masters Alcohol and intercollegiate athletes: a review of consumption frequency, athletic environment, and interventions
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined alcohol and intercollegiate athletes: a review of consumption frequency, athletic environment, and interventions </span>
Public Health, Brody School of Medicine Principal Supervisor
2011 Masters An examination of NC collection sites that participate in the DEA national drug take back event
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">An examination of NC collection sites that participate in the DEA national drug take back event </span>
Public Health, Brody School of Medicine Principal Supervisor
2011 PhD A study that examines factors that motivate health consciousness in Eastern North Carolina
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">A study that examines factors that motivate health consciousness in Eastern North Carolina </span>
Public Health, Brody School of Medicine Principal Supervisor
2011 Masters Hospital emergency departments’ utilization will increase for children under Medicaid after proposed Medicaid expansion
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined hospital emergency departments&rsquo; utilization will increase for children under Medicaid after proposed Medicaid expansion </span>
Public Health, Brody School of Medicine Principal Supervisor
2011 Masters Racial disparity in long-term survival of hemodialysis patients after CABG
<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examined racial disparity in long-term survival of hemodialysis patients after CABG </span>
Public Health, Brody School of Medicine Principal Supervisor
2011 Masters Impact of preoperative atrial fibrillation on long-term survival after open heart surgery
<p><span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;">Examinem Impact of preoperative atrial fibrillation on long-term survival after open heart surgery </span></p>
Public Health, Brody School of Medicine Principal Supervisor
2007 PhD Most human Alu and murine B1 repeats are unique
Project examining if most hyuman Alu and murine B1 repeats are unique<span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;"></span>
Biol Sc Not Elsewhere Classifd, University of Hawaii at Manoa Consultant Supervisor
2006 PhD Copayment level and drug switching among new initiators of medication regimes for type 2 diabetes
&lt;span lang="EN-US" style="font-size:10.0pt;font-family:'Times New Roman',serif;"&gt;Project examined copayment level and drug switching among new initiators of medication regimes for type 2 diabetes. &lt;/span&gt;
Biol Sc Not Elsewhere Classifd, University of Hawaii at Manoa Consultant Supervisor
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Research Collaborations

The map is a representation of a researchers co-authorship with collaborators across the globe. The map displays the number of publications against a country, where there is at least one co-author based in that country. Data is sourced from the University of Newcastle research publication management system (NURO) and may not fully represent the authors complete body of work.

Country Count of Publications
United States 189
Australia 11
Canada 6
China 6
Germany 6
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Professor Jimmy Efird

Position

Professor
CCEB
School of Medicine and Public Health
Faculty of Health and Medicine

Focus area

Statistics

Contact Details

Email jimmy.efird@newcastle.edu.au
Phone (02) 4042 0377
Mobile 0439 269 981

Office

Room Level 4, West
Building HMRI Building
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