Medicine and Health Sciences Commons^™

Alcohol And Environmental Justice: The Density Of Liquor Stores And Bars In Urban Neighborhoods In The United States, John Romley, Deborah Cohen, Jeanne Ringel, Roland Sturm

Roland Sturm

Objective: This study had two purposes: (1) to characterize the density of liquor stores and bars that individuals face according to race, economic status, and age in the urban United States and (2) to assess alternative measures of retailer density based on the road network and population. Method: We used census data on business counts and sociodemographic characteristics to compute the densities facing individuals in 9,361 urban zip codes. Results: Blacks face higher densities of liquor stores than do whites. The density of liquor stores is greater among nonwhites in lower-income areas than among whites in lower- and higher-income areas …

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

Penelope Susan Pekow

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 …

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 …

‘The Psychological Effects Of Euthanasia And Physician-Assisted Suicide On The Administering Doctor’., M Hicks

Madelyn Hsiao-Rei Hicks

No abstract provided.

Statistical Issues In Proteomic Research, Jeffrey S. Morris

Jeffrey S. Morris

No abstract provided.

Systemic And Mucosal Infection Program Protective Memory Cd8 T Cells In The Vaginal Mucosa., Thandi M. Onami, P. K. Suvas, H. M. Dech, J. Zeng

Thandi M. Onami

Whether mucosal immunization is required for optimal protective CD8 T cell memory at mucosal surfaces is controversial. In this study, using an adoptive transfer system, we compare the efficacy of two routes of acute lymphocytic choriomeningitis viral infection on the generation, maintenance, and localization of Ag-specific CD8 T cells in tissues, including the vaginal mucosa. Surprisingly, at day 8, i.p. infection results in higher numbers of Ag-specific CD8 T cells in the vaginal mucosa and iliac lymph node, as well as 2-3x more Ag-specific CD8 T cells that coexpress both IFN-gamma and TNF-alpha in comparison to the intranasal route of …

Interprofessional Information Work: Innovations In The Use Of The Chart On Internal Medicine Teams, Lorelei Lingard, Lesley Conn, Ann Russell, Scott Reeves, Karen-Lee Miller, Chris Kenaszchuk, Merrick Zwarenstein

Lorelei Lingard

An abundance of evidence suggests that communication in interprofessional healthcare teams is a complex endeavour. Even relatively simple communication processes involving information work - the gathering, storage, retrieval and discussion of patient information - may be fraught with pitfalls, and yet teams manage to conduct their daily information work, often with a high degree of effectiveness. In this article, we explore one commonplace dimension of information work - the use of patient charts to foster collaborative decision-making and care enactment - towards building an elaborated understanding of how teams innovate in the face of daily complexities in their information work …

The Suitability Of Mindfulness-Based Stress Reduction For Chronic Hepatitis C, Lynn Koerbel, Donna Zucker

Donna M. Zucker

As incidence of chronic hepatitis C (CHC) in the United States increases, management of physical and psychological symptoms over the long term becomes crucial. Research has shown meditation to be a valuable tool in reducing such symptoms for various chronic illnesses. In particular, the Mindfulness-Based Stress Reduction (MBSR) program offers curriculum that has been show to influence both physiology and perception of disease states. Although there has been not direct research to date on the effectiveness of the MBSR program for CHC, several studies have shown significant findings affecting other chronic conditions including heart disease, fibromyalgia and HIV. The purpose …

Delivering Library Services To Distance Learners: A Grass Roots Effort At A Regional Campus., Tammy Guerrero, Kimberly Whalen, Lynda Willer

Kimberly J. Whalen

No abstract provided.

Caring For Children With Intellectual And Developmental Disabilities: Virtual Patient Instruction Improves Students' Knowledge And Comfort Level, Ida Slusher, Carla Sanders, Harold Kleinert, Teresa Free, Kim Clevenger, Stephanie Johnson, Sara Boyd

Ida Slusher

Nurses play a vital role in providing health care to children with developmental disability (DD) throughout the United States. Unfortunately, most nurses continue to report that they receive little or no clinical education in the area of DDs. In response to this need, a core development team consisting of nurse practitioners and nursing faculty from three universities, one physician assistant faculty, parents of children with DD, and educational specialists developed two multimedia (virtual patient) pediatric instructional modules in CD-ROM format—one involving a child with Down syndrome, and the other involving an infant born at 26 weeks' gestation. Participants were required …

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 …

Cara Alami Menghilangkan Gatal Di Selangkangan, Caramengatasigatal Padaselakanganpk01a1

caramengatasigatal padaselakanganpk01a1

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 …

Obesity And Diabetes In Vulnerable Populations: Reflection On Proximal And Distal Causes, Lucy M. Candib

Lucy M. Candib

Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting …

Weight, Mortality, Years Of Healthy Life, And Active Life Expectancy In Older Adults, Paula Diehr

Paula Diehr

OBJECTIVES: To determine whether weight categories predict subsequent mortality and morbidity in older adults. DESIGN: Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population-based cohort of older adults. SETTING: Data were provided by community-dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. PARTICIPANTS: Five thousand eight hundred eighty-eight adults aged 65 and older at baseline. MEASUREMENTS: The age- and sex-specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years …

Librarian Outreach: Better Research For Better Careers, Todd Prusin

Todd Prusin

Medical librarianship is changing in healthcare environments. Since 1996, by which time the standards that determine how hospitals acquire accreditation changed, many hospitals are acquiring accreditation without a qualified medical librarian on site. For that reason, it has become even more important that healthcare professionals, doctors, nurses and other clinicians, learn to access and evaluate quality information as an integral part of their academic training. Because of this, medical clinicians must begin their careers with strong research skills. These skills must be attained during their academic matriculation and studies in the field of librarianship have shown that departmental outreach hours …

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). …

The Number Of Sick Persons In A Cohort, Paula Diehr

Paula Diehr

To see if the number of sick persons in a cohort was approximately constant over time, we calculated the number of sick persons in a “research” cohort of older adults followed for up to 14 years, and also in a synthetic birth cohort. Methods: In the research cohort, we calculated the actual number of persons in each health state over time, using eight different definitions of “sick”. For the birth cohort, we estimated the number of sick persons each year after birth. Results: The number of sick persons in the research cohort was approximately constant for 14 years, for all …

History-Adjusted Marginal Structural Models To Estimate Time-Varying Effect Modification, Maya Petersen, Steven Deeks, Jefferey Martin, Mark Van Der Laan

Maya Petersen

Much of epidemiology and clinical medicine is focused on the estimation of treatments or interventions administered over time. In such settings of longitudinal treatment, time-dependent confounding is often an important source of bias. Marginal structural models are a powerful tool for estimating the causal effect of a treatment using observational data, particularly when time-dependent confounding is present. Recent statistical work presented a generalization of marginal structural models, called history-adjusted marginal structural models. Unlike standard marginal structural models, history-adjusted marginal structural models can be used to estimate modification of treatment effects by time-varying covariates. Estimation of time-dependent causal effect modification is …

Gold Foil Restoration: A Never-Ending Beauty, Liviu Steier, Giovanni Dicran Meghighian, Gabriela Steier

Gabriela Steier

No abstract provided.

Statistical Methods For Analyzing Sequentially Randomized Trials, Oliver Bembom, Mark J. Van Der Laan

Oliver Bembom

In this issue of JNCI, Thall et al. present the results of a clinical trial that makes use of sequential randomization, a novel trial design that allows the investigator to study adaptive treatment strategies. Our aim is to complement this groundbreaking work by reviewing the current state of the art of statistical methods available for such analyses. Using the data collected by Thall et al. as an example, we focus on two different approaches for estimating the success rates of different adaptive treatment strategies of interest. By emphasizing the intuitive appeal and straightforward implementation of these methods and illustrating the …

Co-Management In Healthcare: Negotiating Professional Boundaries, Catherine Schryer, Olga Gladkova, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article investigates discursive practices associated with the co-management of patients between healthcare providers. Specifically, we focus on two genres (38 referral letters and 37 consultant reports) written by optometrists and ophthalmologists — two groups who are experiencing interprofessional tension over their scopes of practice. In our analysis we foreground four kinds of modality associated with verbs — epistemic, deontic, phatic and subjective. We found that these healthcare providers shared in the epistemic resources used to hedge their sense of clinical certainty, and that ophthalmologists used deontic resources to control future action. However, we also noted that both professions used …

Grand Slam Marketing: A Student-Run Sport Markerting Agency, Anthony Lachowetz

Anthony J Lachowetz

No abstract provided.

Ethics Of Surgical Training In Developing Countries, Kevin Ramsey, Charles Weijer

Charles Weijer

The practice of surgical trainees operating in developing countries is gaining interest in the medical community. Although there has been little analysis about the ethical impact of these electives, there has been some concerns raised over the possible exploitation of trainees and their patients. An ethical review of this practice shows that care needs to be taken to prevent harm. Inexperienced surgeons learning surgical skills in developing countries engender greater risk of violating basic ethical principles. Advanced surgical trainees who have already achieved surgical competence are best qualified to satisfy these ethical issues. All training programs need to develop a …

Negotiating The Politics Of Identity In An Interdisciplinary Research Team, Lorelei Lingard, Catherine Schryer, Marlee Spafford, Sandra Campbell

Lorelei Lingard

This article explores the politics of identity in an interdisciplinary health research team that has been engaged in a qualitative research program for over five years. We draw on sociological theories of power and knowledge to explore our experiences of identity conflict, team socialization, and knowledge production. Structurally, our article integrates individual and group perspectives through personal narratives and collaborative critique as we explore the complex negotiations required to realize and maintain our team dynamic. These negotiations take place not only with one another as particularly positioned individuals, but also with the ideological and organizational forces that structure our scholarly …

Systematic Review Of Baseline Low-Dose Ct Lung Cancer Screening., Michael Lock

Michael Lock

The purpose of this systematic review was to provide physicians and patients with a synthesis of the available data and an assessment of the operating characteristics associated with baseline LDCT screening for lung cancer. Various databases, meeting abstracts, clinical trials in progress, and major textbooks for relevant data from 1966 to 2006 were searched for relevant studies. The median value of sensitivity, specificity, positive predictive value and negative predictive value were 81%, 81%, 8% and 99%, respectively. Of the studies that compared LDCT with other lung cancer screening maneuvers, it was found that LDCT detected a greater number of cancerous …

Use Of Psychometric Assessment To Identify Fall Risk In Seniors At Home, Kitsum Li

Kitsum Li

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.