Digital Commons Network^™

Nonparametric Confidence Intervals For The One- And Two-Sample Problems, Xiao-Hua Zhou, Phillip Dinh

UW Biostatistics Working Paper Series

Confidence intervals for the mean of one sample and the difference in means of two independent samples based on the ordinary-t statistic suffer deficiencies when samples come from skewed distributions. In this article, we evaluate several existing techniques and propose new methods to improve coverage accuracy. The methods examined include the ordinary-t, the bootstrap-t, the biased-corrected acceleration (BCa) bootstrap, and three new intervals based on transformation of the t-statistic. Our study shows that our new transformation intervals and the bootstrap-t intervals give best coverage accuracy for a variety of skewed distributions; and that our new transformation intervals have shorter interval …

Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments, Robert E. Mechanic

National Health Policy Forum

This background paper describes the history and political evolution of Medicaid’s disproportionate share hospital (DSH) program and examines DSH as it exists today. It highlights the importance of DSH payments for the viability of safety net hospitals and considers the consequences of states’ creative financing strategies for maximizing federal Medicaid matching funds. Finally, this paper reviews several options for improving the structure and effectiveness of the DSH program.

Occupational Exposure To Hot Environments: Florida Workers Need Help

Florida Public Health Review

No abstract provided.

Estimation Of Treatment Effects In Randomized Trials With Noncompliance And A Dichotomous Outcome , Mark J. Van Der Laan, Alan E. Hubbard, Nicholas P. Jewell

U.C. Berkeley Division of Biostatistics Working Paper Series

We propose a class of estimators of the treatment effect on a dichotomous outcome among the treated subjects within covariate and treatment arm strata in randomized trials with non-compliance. Recent articles by Vansteelandt and Goethebeur (2003) and Robins and Rotnitzky (2004) have presented consistent and asymptotically linear estimators of a causal odds ratio, which rely, beyond correct specification of a model for the causal odds ratio, on a correctly specified model for a potentially high dimensional nuisance parameter. In this article we propose consistent, asymptotically linear and locally efficient estimators of a causal relative risk and a new parameter -- …

Re-Engineering Systems For The Treatment Of Depression In Primary Care: Cluster Randomised Controlled Trial, A. J. Dietrich, Thomas E. Oxman, John W. Williams Jr., Herbert C. Schulberg, Martha L. Bruce, Pamela W. Lee, Sheila Barry

Dartmouth Scholarship

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Laboratory Reporting Of Tuberculosis Test Results And Patient Treatment Initiation In California, Lisa Pascopella, Steffi Kellam, John Ridderhof, Daniel P. Chin, Arthur Reingold, Edward Desmond, Jennifer Flood, Sarah Royce

Public and Community Health Sciences Faculty Publications

Prompt laboratory reporting of tuberculosis (TB) test results is necessary for TB control. To understand the extent of and factors contributing to laboratory reporting delays and the impact of reporting delays on initiation of treatment of TB patients, we analyzed data from 300 consecutive culture-positive TB cases reported in four California counties in 1998. Laboratory reporting to the specimen submitter was delayed for 26.9% of smear-positive patients and 46.8% of smear-negative patients. Delays were associated with the type of laboratory that performed the testing and with delayed transport of specimens. Referral laboratories (public health and commercial) had longer median reporting …

Physical Activity In A Cohort Of Medicaid Beneficiaries With Physical Impairments: Recruitment And Outcomes, Craig Ravesloot Ph.D., James Laskin Ph.D., Melody Huskey M.A., Sara Laney, Nancy Cherot, Huw Griffiths, Barbara Cowan, Lisa Brennan M.L.S., Catherine Ipsen, Sheri Martinez, Ann Szalda-Petree Ph.D., Rod Brod, University Of Montana Rural Institute

Health and Wellness

This document reports on research conducted by the University of Montana for the Office of Disability and Health at the Centers for Disease Control and Prevention. The research project, conducted between September 30, 2000 and September 29, 2004 was accomplished in three separate but related studies. The research was conducted at the New Directions programs, a community-based health promotion and wellness clinic operated through the rural Institute on Disabilities at the University of Montana. We collaborated with the State Department of Medicaid to recruit Medicaid beneficiaries with mobility impairments in Missoula County to participate in the research. We recruited 368 …

Pharmacokinetics Of Once-Daily Amikacin In Healthy Foals And Therapeutic Drug Monitoring In Hospitalized Equine Neonates, Erica Paige Bucki, Steeve Giguère, Margo Macpherson, Rachel E. Davis

Faculty Publications

The objectives of this study were to investigate the pharmacokinetics of once-daily amikacin in healthy neonates, to determine amikacin concentrations in hospitalized foals, and to determine the minimum inhibitory concentrations (MICs) of amikacin against gram-negative isolates from blood cultures in septic foals. Median half-life, clearance, and volume of distribution of amikacin in healthy 2- to 3-day-old foals after administration of an intravenous bolus of amikacin (25 mg/kg) were 5.07 hours (4.86-5.45 hours), 1.82 mL/min/kg (1.35-1.97 mL/min/kg), and 0.785 L/kg (0.638-0.862 L/kg), respectively. Statistically significant (P or = 3 microg/mL between the 2 groups. An initial dose at 25 mg/kg is …

Cultural Value Orientations, Attributions, And Breast Cancer Screening Behaviors, Patricia M. Flynn

Loma Linda University Electronic Theses, Dissertations & Projects

Discrepancies in breast cancer screening behavior exist among various ethnic groups in the United States (Jacobs & Lauderdale, 2001), with Latino American women reporting particularly low screening rates in comparison to Anglo American women (ACS, 2002). Research indicates that behavior is in part influenced by aspects of culture and relevant psychological processes (Betancourt & Lopez, 1993; Betancourt & Fuentes, 2001). This study was designed to investigate the relations among cultural values, attributional processes, and breast cancer screening behavior among Anglo and Latino women. This study also investigated the influence of acculturation among Latino women in relation to the other study …

Pediatric Obesity: Intervention Outcomes, Kristy Anne Kuehfuss

Loma Linda University Electronic Theses, Dissertations & Projects

Childhood obesity is a national epidemic with serious medical and psychological implications. Almost one-fourth of children in the United States are overweight. Children do not typically grow out of obesity and without intervention the majority of overweight children become overweight adults. Further, childhood obesity results in numerous chronic medical conditions. Thus, the prevention and treatment of childhood obesity are paramount to the avoidance of resultant physical and psychological risk factors. Loma Linda University’s Growing Fit Program seeks to serve the critical and urgent needs of the ever-increasing population of obese children with a multi-disciplinary approach to pediatric weight management. Evaluating …

Psychological Factors Associated With Anticipatory Nausea And Vomiting, Melinda L. Nielsen

Loma Linda University Electronic Theses, Dissertations & Projects

Many cancer patients experience adverse chemotherapy-related side effects. The present study examined the relationships among disease variables (i.e. stage of cancer, type of breast cancer), medical treatment variables (i.e. toxicity of chemotherapy regimen, strength of antiemetic treatment), psychological variables (i.e. health locus of control, anxiety sensitivity, desire for control, coping strategies), and anticipatory nausea and vomiting in women with breast cancer. One hundred women with breast cancer completed the Multidimensional Health Locus of Control Scale - Form C, the Anxiety Sensitivity Index, the Krantz Health Opinion Survey, the Coping Inventory for Stressful Situations, and the Morrow Assessment of Nausea and …

Fundamentals Of Community Health Centers, Jessamyn Taylor

National Health Policy Forum

This background paper examines the dominant model of federal grant funding for primary care in the health care safety net: the community health center. It describes the history of the health center program and highlights key policy issues influencing health centers, such as Medicaid payment policies and medically underserved area designations. The paper also examines the recent presidential initiative to expand health centers, including a review of the process used to identify new grantees, an assessment of remaining gaps in capacity, an exploration of continuing challenges, and a discussion of unresolved policy questions.

A Report From The Forum Session "Implementing The New Medicare Drug Benefit: Challenges And Opportunities For States", Judith D. Moore

National Health Policy Forum

The National Health Policy Forum convened a meeting on July 22, 2004 to discuss state-based challenges associated with implementing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The meeting brought together an extremely insightful and experienced group of current and former state officials and other experts to discuss key issues. In keeping with its tradition of promoting a frank, off-the-record exchange on health policy issues, NHPF does not normally prepare written summaries or reports of meetings. However, because this meeting provided vivid illustrations of the importance of state-federal collaboration for the successful implementation of the new Medicare drug benefit, …

How Much Weight Is Too Much For Manual Lifting : Determining A Weight Limit Guideline For Team-Effort Lifting Tasks, Piyush G. Chapla

Theses

Manual material handling is the primary cause of musculoskeletal injuries, which includes injuries related to lower back, at the workplaces in the U.S. Of all the manual material handling tasks, lifting has been the leading contributor to lower back injuries. These injuries may be induced by several risk factors associated with lifting tasks, weight of the object being lifted being one of them.

Weight limit guidelines have been developed by various groups recommending the weights that workers can lift safely without sustaining injuries. However, these guidelines are aimed to serve individual lifting tasks. Even though team lifting is a common …

Development Of Dose Conversion Coefficients For Radionuclides Produced In Spallation Neutron Sources: Quarterly Progress Report 5/1/04 – 8/31/04, Phillip W. Patton, Mark Rudin

Transmutation Sciences Physics (TRP)

The research consortium comprised of representatives from several universities and national laboratories has successfully generated internal and external dose conversion coefficients for twenty radionuclides produced in spallation neutron sources. These dose coefficients fill data gaps exist in Federal Guide Report No. 11 and in Publications 68 and 72 of the International Commission on Radiological Protection (ICRP). Currently, more nuclear data is needed for the rare radionuclides produced from a mercury target.

Studying Effects Of Primary Care Physicians And Patients On The Trade-Off Between Charges For Primary Care And Specialty Care Using A Hierarchical Multivariate Two-Part Model, John W. Robinson, Scott L. Zeger, Christopher B. Forrest

Johns Hopkins University, Dept. of Biostatistics Working Papers

Objective. To examine effects of primary care physicians (PCPs) and patients on the association between charges for primary care and specialty care in a point-of-service (POS) health plan.

Data Source. Claims from 1996 for 3,308 adult male POS plan members, each of whom was assigned to one of the 50 family practitioner-PCPs with the largest POS plan member-loads.

Study Design. A hierarchical multivariate two-part model was fitted using a Gibbs sampler to estimate PCPs' effects on patients' annual charges for two types of services, primary care and specialty care, the associations among PCPs' effects, and within-patient associations between charges for …

A Hierarchical Multivariate Two-Part Model For Profiling Providers' Effects On Healthcare Charges, John W. Robinson, Scott L. Zeger, Christopher B. Forrest

Johns Hopkins University, Dept. of Biostatistics Working Papers

Procedures for analyzing and comparing healthcare providers' effects on health services delivery and outcomes have been referred to as provider profiling. In a typical profiling procedure, patient-level responses are measured for clusters of patients treated by providers that in turn, can be regarded as statistically exchangeable. Thus, a hierarchical model naturally represents the structure of the data. When provider effects on multiple responses are profiled, a multivariate model rather than a series of univariate models, can capture associations among responses at both the provider and patient levels. When responses are in the form of charges for healthcare services and sampled …

Fundamentals Of The Prescription Drug Market, Christie Provost Peters

National Health Policy Forum

This background paper is a primer on the prescription drug market. It provides information on the fundamentals of the pharmaceutical industry and various marketplace stakeholders, including manufacturers, retailers, consumers, regulators, researchers, and purchasers. This paper also examines the various ways the federal government interacts with the pharmaceutical market. Due to the breadth of material addressed, some complex issues and relationships are presented in broad conceptual terms without extensive technical detail.

Tick-Tock: Preparing For The Next Influenza Pandemic, Eileen Salinsky

National Health Policy Forum

This paper describes the nature of pandemic influenza and highlights key challenges for responding to this disease threat. It explains how an influenza pandemic would differ from annual influenza outbreaks and examines how a pandemic virus could emerge. It also explores important issues involved in pandemic preparedness capabilities, including disease surveillance, vaccine production and distribution, antiviral stockpiling, health care system readiness, and public health containment measures. The national pandemic preparedness plan is briefly reviewed, and unresolved policy issues related to the plan’s implementation are identified.

Estimation Of Direct And Indirect Causal Effects In Longitudinal Studies, Mark J. Van Der Laan, Maya L. Petersen

U.C. Berkeley Division of Biostatistics Working Paper Series

The causal effect of a treatment on an outcome is generally mediated by several intermediate variables. Estimation of the component of the causal effect of a treatment that is mediated by a given intermediate variable (the indirect effect of the treatment), and the component that is not mediated by that intermediate variable (the direct effect of the treatment) is often relevant to mechanistic understanding and to the design of clinical and public health interventions. Under the assumption of no-unmeasured confounders, Robins & Greenland (1992) and Pearl (2000), develop two identifiability results for direct and indirect causal effects. They define an …

Treatment Patterns For Cancer In Western Australia: Does Being Indigenous Make A Difference?, Sonja E. Hall, Caroline E. Bulsara, Max K. Bulsara, Timothy G. Leahy, Margaret R. Culbong, Delia Hendrie, C D'Arcy J. Holman

Aboriginal Policy Research Consortium International (APRCi)

Objective: To examine whether hospital patients with cancer who were identified as Indigenous were as likely to receive surgery for the cancer as non-Indigenous patients. Design, setting and patients: Epidemiological survey of all Western Australian (WA) patients who had a cancer registration in the state-based WA Record Linkage Project that mentioned cancer of the breast (1982–2000) or cancer of the lung or prostate (1982–2001).

Main outcome measures: The likelihoods of receiving breast-conserving surgery or mastectomy for breast cancer, lung surgery for lung cancer, or radical or non-radical prostatectomy for prostate cancer were compared between the Indigenous and non-Indigenous populations using …

Development Of A Safe Neutralization Assay For Sars-Cov And Characterization Of S-Glycoprotein, Dong P. Han, Hyung G. Kim, Young B. Kim, Michael W. Cho

Faculty Scholarship

The etiological agent of severe acute respiratory syndrome (SARS) has been identified as a novel coronavirus SARS-CoV. Similar to other coronaviruses, spike (S)-glycoprotein of the virus interacts with a cellular receptor and mediates membrane fusion to allow viral entry into susceptible target cells. Accordingly, S-protein plays an important role in virus infection cycle and is the primary target of neutralizing antibodies. To begin to understand its biochemical and immunological properties, we expressed both full-length and ectodomain of the protein in various primate cells. Our results show that the protein has an electrophoretic mobility of about 160–170 kDa. The protein is …

Quality Of Life In The Chronically Mentally Ill: Impact Of Demographics, Symptomatology, And Coping Styles, Dawn Castner

All-Inclusive List of Electronic Theses and Dissertations

Schizophrenia and schizoaffective disorder are often persistent and disabling conditions that require a wide range ofbiopsychosocial treatments. In recent decades, treatment has largely focused on assisting persons to maintain community tenure, while little attention has been devoted to quality of life. For many, these illnesses have a negative impact on life satisfaction due to their chronic and variable nature, lack of completely efficacious treatments, and social stigma. Some have speculated that various demographic, symptom, or treatment variables influence quality of life, but the nature and amount of influence is uncertain. 111 The purpose of this study was to investigate the …

Episodic Heavy Drinking And Marijuana Use Among Undergraduate Students At Western Kentucky University, Ariel L. Sarmiento

Masters Theses & Specialist Projects

Research has documented that Episodic Heavy Drinking (EHD), defined as consuming four or more and five or more alcoholic drinks per drinking episode among females and males, respectively, is a prevalent risk behavior among undergraduate college students throughout the United States. Moreover, studies have shown that EHD is the leading cause of preventable morbidity and mortality among college students as unintentional injuries, sexual assaults, and unsafe sexual behaviors among this population have been linked to this risk behavior.

Illicit substance use, although often portrayed as a separate risk behavior, is also associated with EHD. Nationally, the most frequently used illicit …

Homicides In The Workplace, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent workplace violence:

• Assessment for workplace violence risks should be done in all workplaces.
• Workplaces should have policies that clearly delineate that violence is not appropriate during any workplace interaction and violence policies should mirror other workplace policies in terms of strategies for reporting and investigation of incidents, and progressive discipline.
• A clear and consistent reporting system for workplace violence should be in place and every worker should understand how it works.
• Safety training should be attended by employers, supervisors, and employees.
• Policy, training, and employee assistance for domestic violence should be implemented in collaboration with community service providers.

Homicidios En El Lugar De Trabajo, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

Para prevenir la violencia ocupacional:

Una valoración de los riesgos de violencia ocupacional deberá ser llevada a cabo en todos los lugares de trabajo.

Los lugares de trabajo deben implementar políticas que aclaren que la violencia no es apropiada durante ninguna interacción laboral; de igual forma las políticas sobre violencia deberán reflejar los procedimientos del lugar de trabajo en términos de estrategias para reportar e investigar los casos y la progresión de la disciplina.

Un sistema de reporte de la violencia laboral claro y consistente deberá ser implementado en el lugar de trabajo, y cada trabajador deberá comprender como funciona. …

Will Knowledge Of Green Tea Benefits Influence Coffee Consumption?, I-Fang Wang

All-Inclusive List of Electronic Theses and Dissertations

Many recent studies have focused on the health benefits of green tea consumption. Although there is conflicting evidence, there is a strong trend showing positive effects of green tea to human health. This current study was done to explore whether the knowledge of such green tea benefits will influence the willingness of coffee drinkers to consider switching to green tea consumption. The survey study included a convenience sample of 132 adults who considered themselves regular coffee drinkers. From the statistical analyses of the collected data, results were obtained primarily through frequency distributions and phi coefficients. Data analysis suggested a significant …

Frequency Of Mental Health Service Use In School-Based Health Centers: School Performance And Family Characteristics, James William Depetro

All-Inclusive List of Electronic Theses and Dissertations

Public schools and community health organizations have created partnerships to provide mental health services to children. One such collaboration has led to the development of School-Based Health Centers (SBHC). SBHC provide mental health services in an attempt to enhance students' development and performance. The research findings regarding SBHC impact on school performance are mixed (Gall, Pagano, Desmond, Perrin, & Murphy, 2000; McCord, Klein, Foy, & Fothergill, 1993; Weist, Proescher, Freedman, Paskewitz, & Flaherty, 1995; Wolk & Kaplan, 1993 ). The purpose of this research study was to determine if the frequency of use of mental health services at SBHC are …

Body Image, Emotional Regulation, And Binge Eating In Obese Females, Courtney D. Stahl

All-Inclusive List of Electronic Theses and Dissertations

Individuals with binge eating disorder (BED) tend to endorse significant overconcerns with weight and shape and a greater propensity to eat in response to negative mood states. The primary aim of this study was to examine the impact of body image disturbance on the self-regulation of affect in female obese non-binge (n=46) and binge eaters (n=l09). Groups were similar in age (M=46.3) and race (84% Caucasian). Obese non-binge eaters were significantly less obese (BMI=35.50) than their binge eating counterparts (BMI=38.60). On the Multidimensional Body Self-Relations Questionnaire (MBSRQ), obese binge eaters endorsed significantly higher levels of body dissatisfaction, greater feelings of …

Determination Of The Efficacy Of Two Building Decontamination Strategies By Surface Sampling With Culture And Quantitative Pcr Analysis, Mark P. Buttner, Patrica Cruz, Linda Stetzenbach, Amy Klima-Comba

Environmental & Global Health Faculty Research

The efficacy of currently available decontamination strategies for the treatment of indoor furnishings contaminated with bioterrorism agents is poorly understood. Efficacy testing of decontamination products in a controlled environment is needed to ensure that effective methods are used to decontaminate domestic and workplace settings. An experimental room supplied with materials used in office furnishings (i.e., wood laminate, painted metal, and vinyl tile) was used with controlled dry aerosol releases of endospores of Bacillus atrophaeus (“Bacillus subtilis subsp. niger,” also referred to as BG), a Bacillus anthracis surrogate. Studies were performed using two test products, a foam decontaminant and chlorine dioxide …