{"id":816,"date":"2017-05-24T10:01:52","date_gmt":"2017-05-24T10:01:52","guid":{"rendered":"http:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/?p=816"},"modified":"2022-04-13T13:59:11","modified_gmt":"2022-04-13T13:59:11","slug":"were-not-in-kansas-anymore-or-even-wales","status":"publish","type":"post","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/were-not-in-kansas-anymore-or-even-wales\/","title":{"rendered":"We\u2019re Not In Kansas Anymore \u2026 Or Even Wales"},"content":{"rendered":"

Background<\/h2>\n

In the last fortnight I was fortunate to have attended the Pediatric Academic Societies (PAS) annual meeting in San Francisco at the vast Moscone Convention Center. Around 6000, mostly US-based, delegates attended and yet were all comfortably accommodated within just one of the three parts of the centre (and the smaller one at that).<\/p>\n

The influence of epigenetics<\/h2>\n

PAS draws together a range of sub-specialties in paediatrics, which meant the programme was highly diverse. There were some sessions that I had been keen to attend, including an invited science workshop on epigenetics and the influence of the antenatal and postnatal environment on gene expression. Put simply this is about how experiences before and after birth can alter the way that a child\u2019s genes will influence his or her subsequent health and behaviour. For example, it is suggested that abuse suffered by some children in infancy may activate (or suppress) genes which could\u00a0then alter fundamental biological processes and adversely affect health later in life.<\/p>\n

This is a topic we spent some time looking at a couple of years ago as part of the Building Blocks trial although our plans never came to fruition. One talk I particularly enjoyed was by Alicia Smith from Atlanta who described her work from the Grady Trauma Project and the potential for accelerated biological aging in children exposed to community violence. A fascinating talk by Jeffery Craig from Melbourne explored the role of twin studies and in particular in twins who developed from a single egg but with different adult characteristics. Some of these differences may be due to non-shared antenatal environments impacting on gene expression. I came away feeling (a bit more) educated but realizing I need to find out more. I bought a book online and signed up for a workshop in Bristol!<\/p>\n

Infant feeding<\/h2>\n

With our work on breast feeding (for example, the Mam-Kind study) there was plenty to explore on matters of infant feeding. An interesting talk on micronutrients in breast milk by Lindsay Allen (UC Davis) dealt with some of the uncertainty when establishing reference values for milk micro-nutrients. For example, the values recommended by the US Institute of Medicine for vitamin A are based on a sample of just three American women. By the way, for those who are interested, freezing breast milk does not apparently affect the micronutrients but exposure to light may do. Another salutary presentation from Christine Stewart (also UC Davis) described how much of the apparent beneficial intervention effect in one breast feeding promotion study was actually down to reporting bias by mums in the study. Something for us to watch out for in our own studies!<\/p>\n

Adverse Childhood Experiences (ACEs)<\/h2>\n

Other key sessions were on attachment, on maltreatment and on other toxic aspects of the early childhood environment. ACEs \u2013 Adverse Childhood Experiences \u2013 was very much on the agenda, including interventions for clinicians to better explore for ACEs within routine well kid checks. It\u2019s sobering that 15 million children live in poverty in the US, that\u2019s one in 5<\/a>. Some public health challenges have a particular presence in the US setting – a study reporting the independent effect of community gun violence in Chicago upon birth weight after controlling for socio-demographic factors being an example.<\/p>\n

Research ethics and children<\/h2>\n

There were stimulating posters about both about the history and ethics of medical experimentation involving children, some of which has driven the development of research ethics. For example, the famous study in Willowbrook State School, NY in the 1960s where children with developmental disorders were intentionally exposed to hepatitis – including some being fed extracts of stools from infected individuals. \u00a0The researchers then observed the natural history and also response to gamma globulin. It\u2019s worth looking the debates around pros and cons of the experiments (go on, Google it) including contemporary correspondence in The Lancet in 1971. Research easier to value, but as hard to read about was that on the effects of starvation conducted clandestinely by Jewish doctors caring for children and families in the Warsaw ghetto in the Second World War. A team of 28 physicians led by Dr Israel Milezkowski used equipment smuggled into the ghetto to conduct landmark observational research on the effects of semi-starvation, conditions which the researchers themselves were experiencing (longer narrative account here<\/a>).<\/p>\n

From grapes to\u00a0engineering<\/h2>\n

Another example of circumstances and necessity driving medical innovation was found in a slightly more unexpected setting. On a day off we went exploring the wineries of Sonoma and Napa valleys. Our first port of call was the Jacuzzi Family Vineyards. Familiar name? The Jacuzzi family originated from Italy in the early twentieth century and as well as growing grapes several of the family\u2019s adult brothers were accomplished engineers. When one of the families\u2019 children developed rheumatoid arthritis, the uncles invented a small aerating pump for baths to provide hydrotherapeutic pain relief. The rest is history.<\/p>\n

For me two other well-established features of the San Francisco tourist skyline retain contemporary relevance, the Golden Gate and Bay Bridges. \u00a0Both iconic but did you know were financed in an effort to support the economy following the consequences of the Great Depression? I quite like this one commentators quote:<\/p>\n

But perhaps the most spectacular feature of the Golden Gate Bridge is the fact that it was funded by the people \u2014 people who managed to see past the bleakness that had swept the nation and get on board with the notion that all was not lost.<\/p><\/blockquote>\n

–\u00a0Professor Mike Robling<\/a>
\nDirector of Population Health Trials
\nSouth East Wales Trials Unit
\nCentre for Trials Research<\/p>\n","protected":false},"excerpt":{"rendered":"Background In the last fortnight I was fortunate to have attended the Pediatric Academic Societies (PAS) annual meeting in San Francisco at the vast Moscone Convention Center. Around 6000, mostly […]","protected":false},"author":1204,"featured_media":822,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[13,7],"tags":[49,51,50,52,10],"class_list":["post-816","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-children-and-young-people","category-events","tag-children-and-young-people","tag-epigenetics","tag-pediatric-academic-societies","tag-pediatrics","tag-south-east-wales-trials-unit"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7dIou-da","jetpack-related-posts":[{"id":1197,"url":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/rdcs-2-day-grant-writing-event-2018-supporting-health-and-care-research-wales-grant-proposals\/","url_meta":{"origin":816,"position":0},"title":"RDCS 2-Day Grant Writing Event 2018: Supporting Health And Care Research Wales Grant Proposals","author":"Philip Pallmann","date":"November 15, 2018","format":false,"excerpt":"Last week the Research Design and Conduct Service (RDCS) South East Wales hosted a two-day grant writing retreat at Birchwood House, Cardiff. Nine NHS pharmacists, midwives, physiotherapists, GPs, psychologists, and public health researchers working across both Cardiff and Vale and Aneurin Bevan University Health Boards as well as Public Health\u2026","rel":"","context":"In "Events"","block_context":{"text":"Events","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/category\/events\/"},"img":{"alt_text":"Dr Philip Pallmann presenting at the RDCS Grant Writing Event 2018","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=1050%2C600&ssl=1 3x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/11\/Dr-Philip-Pallmann-Presenting-at-the-RDCS-Grant-Writing-Event-2018-scaled.jpg?resize=1400%2C800&ssl=1 4x"},"classes":[]},{"id":2730,"url":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/treialon-cymru-associate-programme\/","url_meta":{"origin":816,"position":1},"title":"Treialon Cymru Associate Programme","author":"Sue Channon","date":"November 21, 2023","format":false,"excerpt":"We are pleased to say that the Treialon Cymru Associate Programme is now well and truly up and running, with our first cohort of six Associates paired up with mentors and with plans in place for what they want to work on over their time with the programme. 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The event brought\u00a0together over 160 experts and researchers in the field\u2026","rel":"","context":"In "Children and Young People"","block_context":{"text":"Children and Young People","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/category\/children-and-young-people\/"},"img":{"alt_text":"Gwenllian Moody presenting on the challenge of collecting focus group data in partnership with geographically dispersed and time-pressed professionals.","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=1050%2C600&ssl=1 3x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2016\/03\/SWSAPC-Gwen-scaled.jpg?resize=1400%2C800&ssl=1 4x"},"classes":[]},{"id":1813,"url":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/international-year-of-the-nurse-and-midwife-2020-celebrating-nurses-and-midwives-roles-in-the-work-of-the-centre-for-trials-research\/","url_meta":{"origin":816,"position":3},"title":"International Year Of The Nurse And Midwife 2020 – Celebrating Nurses And Midwives\u2019 Roles In The Work Of The Centre For Trials Research","author":"Victoria Shepherd","date":"January 29, 2020","format":false,"excerpt":"The World Health Organization has dedicated 2020 to nurses and midwives to create a \u2018once in a generation opportunity\u2019 to showcase the critical role that the nursing and midwifery professions play in supporting global health. It chose the theme to coincide with the 200th anniversary of the birth of Florence\u2026","rel":"","context":"In "Events"","block_context":{"text":"Events","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/category\/events\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2020\/01\/IYOTNM-2020-image.png?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2020\/01\/IYOTNM-2020-image.png?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2020\/01\/IYOTNM-2020-image.png?resize=525%2C300&ssl=1 1.5x"},"classes":[]},{"id":1069,"url":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/rdcs-se-wales-year-in-review-supporting-research-capacity-development-in-wales\/","url_meta":{"origin":816,"position":4},"title":"RDCS SE Wales: Year In Review Supporting Research Capacity Development In Wales","author":"Sue Channon","date":"July 12, 2018","format":false,"excerpt":"Supporting Staff In The NHS And Social Care In Wales To Develop Their Own Research The Research Design and Conduct Service (RDCS) South East Wales is part of the All Wales RDCS and supports staff working within the National Health Service and social care to develop high quality research funding\u2026","rel":"","context":"In "Research Design and Conduct Service (RDCS)"","block_context":{"text":"Research Design and Conduct Service (RDCS)","link":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/category\/research-design-and-conduct-service-rdcs\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/07\/DY5BQLmWsAEplLF.jpg?resize=350%2C200&ssl=1","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/07\/DY5BQLmWsAEplLF.jpg?resize=350%2C200&ssl=1 1x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/07\/DY5BQLmWsAEplLF.jpg?resize=525%2C300&ssl=1 1.5x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/07\/DY5BQLmWsAEplLF.jpg?resize=700%2C400&ssl=1 2x, https:\/\/i0.wp.com\/blogs.cardiff.ac.uk\/centre-for-trials-research\/wp-content\/uploads\/sites\/499\/2018\/07\/DY5BQLmWsAEplLF.jpg?resize=1050%2C600&ssl=1 3x"},"classes":[]},{"id":1746,"url":"https:\/\/blogs.cardiff.ac.uk\/centre-for-trials-research\/rdcs-south-east-wales-grant-writing-day-2019\/","url_meta":{"origin":816,"position":5},"title":"RDCS South East Wales Grant Writing Day 2019","author":"Philip Pallmann","date":"October 31, 2019","format":false,"excerpt":"Background On 26th September 2019 the Research Design and Conduct Service (RDCS) South East Wales hosted an all-day grant writing Day at Birchwood House, Cardiff. 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