Medicine and Health Sciences Commons^™

Outcomes Of Care By Hospitalists, General Internists, And Family Physicians, Peter K. Lindenauer, Michael B. Rothberg, Penelope Susan Pekow, Christopher Kenwood, Evan M. Benjamin, Andrew D. Auerbach

Peter Lindenauer MD

Background: The hospitalist model is rapidly altering the landscape for inpatient care in the United States, yet evidence about the clinical and economic outcomes of care by hospitalists is derived from a small number of single-hospital studies examining the practices of a few physicians.

Methods: We conducted a retrospective cohort study of 76,926 patients 18 years of age or older who were hospitalized between September 2002 and June 2005 for pneumonia, heart failure, chest pain, ischemic stroke, urinary tract infection, acute exacerbation of chronic obstructive pulmonary disease, or acute myocardial infarction at 45 hospitals throughout the United States. We used …

Synergistic Induction Of Ahr Regulated Genes In Developmental Toxicity From Co-Exposure To Two Model Pahs In Zebrafish, Alicia R. Timme-Laragy, Crystal J. Cockman, Cole W. Matson, Richard T. Di Giulio

Alicia R. Timme-Laragy

Polycyclic aromatic hydrocarbons (PAHs) are pollutants created by the incomplete combustion of carbon, and are increasing in the environment largely due to the burning of fossil fuels. PAHs occur as complex mixtures, and some combinations have been shown to cause synergistic developmental toxicity in fish embryos, characterized by pericardial edema and craniofacial malformations. Previous studies have indicated that in the zebrafish model, this toxicity is mediated by the aryl hydrocarbon receptor 2 (AHR2), and enhanced by inhibition of CYP1A activity. In this study, we further examined this interaction of the model PAH and AHR agonist β-naphthoflavone (BNF) with and without …

Exact One-Sided Confidence Limits For The Difference Between Two Correlated Proportions, Chris Lloyd, Max V. Moldovan

Chris J. Lloyd

We construct exact and optimal one-sided upper and lower confidence bounds for the difference between two probabilities based on matched binary pairs using well-established optimality theory of Buehler (1957). Starting with five different approximate loer and upper limits, we adjust them to have coverage probability exactly equal to the desired nominal level and then compare the resulting exact limits by their mean size. Exact limits based on the signed root likelihood ratio statistic are preferred and recommended for practical use.

Ethnicity And Mental Health Treatment Utilization By Patients With Personality Disorders, Donna S. Bender, Andrew E. Skodol, Ingrid R. Dyck, John C. Markowitz, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Anthony Pinto, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson, Maria T. Daversa, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic …

Correction: Using Participatory Design To Develop (Public) Health Decision Support Systems Through Gis, S. Michelle Driedger, Anita Kothari, Jason Morrison, Michael Sawada, Eric J. Crighton, Ian D. Graham

Anita Kothari

Background: Organizations that collect substantial data for decision-making purposes are often characterized as being 'data rich' but 'information poor'. Maps and mapping tools can be very useful for research transfer in converting locally collected data into information. Challenges involved in incorporating GIS applications into the decision-making process within the non-profit (public) health sector include a lack of financial resources for software acquisition and training for nonspecialists to use such tools. This on-going project has two primary phases. This paper critically reflects on Phase 1: the participatory design (PD) process of developing a collaborative web-based GIS tool.

Methods: A case study …

Biological Variability Dominates And Influences Analytical Variance In Hplc-Ecd Studies Of The Human Plasma Metabolome, Yevgeniya I. Shurubor, Wayne R. Matson, Walter C. Willett, Susan E. Hankinson, Bruce S. Kristal

Susan E. Hankinson

Background Biomarker-based assessments of biological samples are widespread in clinical, pre-clinical, and epidemiological investigations. We previously developed serum metabolomic profiles assessed by HPLC-separations coupled with coulometric array detection that can accurately identify ad libitum fed and caloric-restricted rats. These profiles are being adapted for human epidemiology studies, given the importance of energy balance in human disease. Methods Human plasma samples were biochemically analyzed using HPLC separations coupled with coulometric electrode array detection. Results We identified these markers/metabolites in human plasma, and then used them to determine which human samples represent blinded duplicates with 100% accuracy (N = 30 of 30). …

Complementary And Alternative Medicine: Opportunities And Challenges, William Marty Martin, Hugh Long

William Marty Martin

Health care finance is complex in all sectors of the health care industry. This article highlights both the challenges and opportunities of financing and reimbursing care with a focus on CAM providers and CAM provider organizations.

Anopheles Gambiae Purine Nucleoside Phosphorylase: Catalysis, Structure And Inhibition, Erika Taylor, Agnes Rinaldo-Matthis, Lei Li, Mahmoud Ghanem, Keith Hazleton, M. Belen Cassera, Steven Almo, Vern Schramm

Erika A. Taylor, Ph.D.

The purine salvage pathway of Anopheles gambiae, a mosquito that transmits malaria, has been identified in genome searches on the basis of sequence homology with characterized enzymes. Purine nucleoside phosphorylase (PNP) is a target for the development of therapeutic agents in humans and purine auxotrophs, including malarial parasites. The PNP from Anopheles gambiae (AgPNP) was expressed in Escherichia coli and compared to the PNPs from Homo sapiens (HsPNP) and Plasmodium falciparum (PfPNP). AgPNP has kcat values of 54 and 41 s-1 for 2'-deoxyinosine and inosine, its preferred substrates, and 1.0 s-1 for guanosine. However, the chemical step is fast for …

Combining A Strength And Power Program For Semi-Professional Footballers (Afl), Christopher Joyce

Christopher Joyce

Pillbox Organizers Are Associated With Improved Adherence To Hiv Antiretroviral Therapy And Viral Suppression: A Marginal Structural Model Analysis., Maya Petersen, Yue Wang, Mark Van Der Laan, David Guzman, Elise Riley, David Bangsberg

Maya Petersen

Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, …

Public Health Citation Patterns: An Analysis Of The American Journal Of Public Health, 2003-2005, Melissa L. Rethlefsen, Lisa C. Wallis

Lisa C. Wallis, MSPH, MS

Tgfb1 And Tgfbr1 Polymorphisms And Breast Cancer Risk In The Nurses' Health Study, David G. Cox, Kathryn Penney, Qun Guo, Susan E. Hankinson, David J. Hunter

Susan E. Hankinson

Background Transforming growth factor beta 1 (TGFB1) forms a signaling complex with transforming growth factor beta receptors 1 and 2 and has been described as both a tumor suppressor and tumor promoter. Single nucleotide polymorphisms in TGFB1 and a microsatellite in TGFBR1 have been investigated for association with risk of breast cancer, with conflicting results. Methods We examined polymorphisms in the promoter region of the TGFB1 gene as well as the TGFBR1*6A microsatellite in the Nurses' Health Study cohort. Results No overall associations between the L10P polymorphism of TGFB1 or the TGFBR1 microsatellite were detected. However, we observed an inverse …

A Role For The Forebrain In Mediating Time-Of-Day Differences In Glucocorticoid Counterregulatory Responses To Hypoglycemia In Rats, Lori M. Gorton, Arshad M. Khan, Maryann Bohland, Graciela Sanchez-Watts, Casey M. Donovan, Alan G. Watts

Arshad M. Khan, Ph.D.

No abstract provided.

Functional Principal Component Regression And Functional Partial Least Squares, Philip T. Reiss, R. Todd Ogden

Philip T. Reiss

Regression of a scalar response on signal predictors, such as near-infrared (NIR) spectra of chemical samples, presents a major challenge when, as is typically the case, the dimension of the signals far exceeds their number. Most solutions to this problem reduce the dimension of the predictors either by regressing on components--e.g. principal component regression (PCR) and partial least squares (PLS)--or by smoothing methods which restrict the coefficient function to the span of a spline basis. This paper introduces functional versions of PCR and PLS, which combine both of the above dimension reduction approaches. Two versions of functional PCR are developed, …

Lenalidomide: A New Agent For Patients With Relapsed Or Refractory Multiple Myeloma, Joseph Tariman

Joseph D Tariman PhD

No abstract provided.

Meta-Analysis Evidence Of A Differential Risk Of The Fcrl3 -169t->C Polymorphism In White And East Asian Rheumatoid Arthritis Patients, Steven J. Schrodi, Begovich Ann, Chang Monica

Steven J Schrodi

Association between a functional promoter polymorphism (rs7528684) in the Fc receptor-like gene, FCRL3, and rheumatoid arthritis (RA) has been observed in 3 independent Japanese case-control sample sets ([1][2]). Studies examining the role of this polymorphism in risk of RA in 9 independent white sample sets, however, have yielded conflicting results ([3-8]). Further, a large study of Korean subjects failed to demonstrate association of this single-nucleotide polymorphism (SNP) with RA ([9]). Although the precise function of FCRL3, which has strong structural homology with the classic Fc receptors, is unknown, the existing data are consistent with the hypothesis that it may influence …

Tumor-Targeted Induction Of Oxystress For Cancer Therapy., Arun K. Iyer

Arun Iyer

Reactive oxygen species (ROS), such as superoxide anion radicals (O.-2) and hydrogen peroxide (H2O2) are potentially harmful by-products of normal cellular metabolism that directly affect cellular functions. ROS is generated by all aerobic organisms and it seems to be indispensable for signal transduction pathways that regulate cell growth and reduction-oxidation (redox) status. However, overproduction of these highly reactive oxygen metabolites can initiate lethal chain reactions, which involve oxidation and damage to structures that are crucial for cellular integrity and survival. In fact, many antitumor agents, such as vinblastine, cisplatin, mitomycin C, doxorubicin, camptothecin, inostamycin, neocarzinostatin and many others exhibit antitumor …

Catecholaminergic Control Of Mitogen-Activated Protein Kinase Signaling In Paraventricular Neuroendocrine Neurons In Vivo And In Vitro: A Proposed Role During Glycemic Challenges, Arshad M. Khan, Todd A. Ponzio, Graciela Sanchez-Watts, B. Glenn Stanley, Glenn I. Hatton, Alan G. Watts

Arshad M. Khan, Ph.D.

No abstract provided.

Tooth Size Discrepancies In An Orthodontic Population, Othman S. A., Harradine N.

Siti Adibah Othman

Objective: To explore how many millimeters of tooth size discrepancy (TSD) are clinically significant, to determine what percentage of a representative orthodontic population has such a tooth size discrepancy, and to determine the ability of simple visual inspection to detect such a discrepancy. Materials and Methods: The sample comprised 150 pretreatment study casts with fully erupted and complete permanent dentitions from first molar to first molar, which were selected randomly from 1100 consecutively treated white orthodontic patients. The mesiodistal diameter tooth sizes were measured using digital calipers, and the Bolton analysis and the tooth size corrections were calculated by the …

Faculty And Male Student Athletes In Higher Education: Racial Differences In The Environmental Predictors Of Academic Achievement, Keith Harrison

Dr. C. Keith Harrison

Studies have examined the impact of environmental variables on academic achievement among student athletes in the revenue-generating sports of men’s basketball and football. However, while evidence concerning the positive impact of male student athlete and faculty interaction is virtually unequivocal, we are not certain whether the benefits accruing from particular types of interaction vary across different racial/ethnic groups. This study explores the relationship between male Black and White student athletes and faculty as well as the impact of specific forms of student athlete– faculty interaction on academic achievement. Data are drawn from the Cooperative Institutional Research Program’s 2000 Freshman Survey …

Accelerated Second-Degree Program Evaluation At Graduation And 1 Year Later, Deborah A. Raines

Deborah A. Raines, PhD, EdS, RN, ANEF, FAAN

No abstract provided.

Talented Children And Adults: Their Development And Education, Jane Piirto

Jane Piirto

No abstract provided.

Comparison Of Alternative Models For Personality Disorders, Leslie C. Morey, Christopher J. Hopwood, John G. Gunderson, Andrew E. Skodol, M. Tracie Shea, Shirley Yen, Robert L. Stout, Mary C. Zanarini, Carlos M. Grilo, Charles A. Sanislow, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

BACKGROUND: The categorical classification system for personality disorder (PD) has been frequently criticized and several alternative dimensional models have been proposed.

METHOD: Antecedent, concurrent and predictive markers of construct validity were examined for three models of PDs: the Five-Factor Model (FFM), the Schedule for Nonadaptive and Adaptive Personality (SNAP) model and the DSM-IV in the Collaborative Study of Personality Disorders (CLPS) sample.

RESULTS: All models showed substantial validity across a variety of marker variables over time. Dimensional models (including dimensionalized DSM-IV) consistently outperformed the conventional categorical diagnosis in predicting external variables, such as subsequent suicidal gestures and hospitalizations. FFM facets …

Positive Childhood Experiences: Resilience And Recovery From Personality Disorder In Early Adulthood, Andrew E. Skodol, Donna S. Bender, Maria E. Pagano, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Carlos M. Grilo, Maria T. Daversa, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

OBJECTIVE: Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder.

METHOD: Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from …

Psychosocial Impairment And Treatment Utilization By Patients With Borderline Personality Disorder, Other Personality Disorders, Mood And Anxiety Disorders, And A Healthy Comparison Group, Emily B. Ansell, Charles A. Sanislow, Thomas H. Mcglashan, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

This study compared psychosocial functioning and treatment utilization in 130 participants who were diagnosed with a borderline personality disorder (BPD), a non-BPD personality disorder (OPD), a mood and/or anxiety disorder (MAD), or had no current psychiatric diagnosis and served as a healthy comparison group. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) diagnoses, psychosocial functioning, and treatment utilization were determined by using well-established semistructured research interviews conducted by trained doctoral-level clinicians. Analysis of variance revealed the most severe deficits in functioning characterized the BPD group across areas of global functioning with more moderate impairments in functioning occurring in OPD …

Longitudinal Diagnostic Efficiency Of Dsm-Iv Criteria For Borderline Personality Disorder: A 2-Year Prospective Study, Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, Donna S. Bender, Shirley Yen, M. Tracie Shea, Leslie C. Morey, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for borderline personality disorder (BPD). METHODS: At baseline, we used semistructured diagnostic interviews to determine criteria and diagnoses; blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (specifically, conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, with the independent BPD diagnosis at follow-up used as the standard. RESULTS: Longitudinal diagnostic efficiencies for the BPD criteria varied, with the criteria of suicidality or self-injury and unstable relationships demonstrating the most predictive utility. CONCLUSIONS: BPD criteria differ in their predictive …

A Large-Scale Rheumatoid Arthritis Genetic Study Identifies Association At Chr 9q33.2, Steven J. Schrodi

Steven J Schrodi

No abstract provided.

Collaboration Between Developed And Developing Nations , Nishith K. Singh, Vineet Gupta

Vineet Gupta, MD, FACP

No abstract provided.

Strategic Planning For Environmental Stewardship At Eastern Kentucky University, Steven Konkel, Dr. Robert Weise, Dr. Alan Banks, Dr. Danita Lasage, Professor Joseph Beck, James Street, Dr. Charles Elliott, Professor Barbara Szubinska, Dr. Robert Frederick, Dr. Melinda Wilder, Dr. Robert Huston, Rebecca Jones, Dr. Alice Jones, Kyle Moon

Steve Konkel

The 2006-2010 Strategic Plan for Eastern Kentucky University, under Strategic Direction 5.4, mandates the formulation of a plan to guide the University toward greater environmental stewardship. The creation and implementation of that plan is the charge of the Eastern Committee on Responsible Environmental Stewardship (ECRES), which was formed in September of 2005. On October 27th, 2006, ECRES hosted a Strategic Planning Workshop. This workshop brought together a wide range of paticipants, including elected officials, college and university representatives, and interested citizens. The result was a broad consenus in the identification of environmental goals and objectives toward which EKU should strive.

The Neuropharmacology Of The Ketogenic Diet, Adam Hartman, Maciej Gasior, Elaine Vining, Michael Rogawski

Michael A. Rogawski

The ketogenic diet is a valuable therapeutic approach for epilepsy, one in which most clinical experience has been with children. Although the mechanism by which the diet protects against seizures is unknown, there is evidence that it causes effects on intermediary metabolism that influence the dynamics of the major inhibitory and excitatory neurotransmitter systems in brain. The pattern of protection of the ketogenic diet in animal models of seizures is distinct from that of other anticonvulsants, suggesting that it has a unique mechanism of action. During consumption of the ketogenic diet, marked alterations in brain energy metabolism occur, with ketone …