Digital Commons Network^™

Guideview: Structured Multi-Modal Delivery Of Clinical Guidelines, M Sriram Iyengar, Subhajit Sarkar, Kira Bacal, Gregory Defouw, Phyllis Mcculley, Victor Hurst

Faculty, Staff and Student Publications

GuideView is a system designed for structured, multi-modal delivery of clinical guidelines. Clinical instructions are presented simultaneously in voice, text, pictures or video or animations. Users navigate using mouse-clicks and voice commands. An evaluation study performed at a medical simulation laboratory found that voice and video instructions were rated highly.

A Pilot Randomized, Controlled Trial Of An In-Home Drinking Water Intervention Among Hiv + Persons, John M. Colford, Sona R. Saha, Timothy J. Wade, Catherine C. Wright, Mai Vu, Sandra Charles, Peter Jensen, Alan Hubbard, Deborah A. Levy, Joseph N. S. Eisenberg

Journal Articles: Epidemiology

Although immunocompromised persons may be at increased risk for gastrointestinal illnesses, no trials investigating drinking water treatment and gastrointestinal illness in such patients have been published. Earlier results from San Francisco suggested an association (OR 6.76) between tap water and cryptosporidiosis among HIV + persons. The authors conducted a randomized, triple-blinded intervention trial of home water treatment in San Francisco, California, from April 2000 to May 2001. Fifty HIV-positive patients were randomized to externally identical active (N = 24) or sham (N = 26) treatment devices. The active device contained a filter and UV light; the sham provided no treatment. …

Prevalence Of Obesity And Lack Of Physical Activity Among Kentucky Adolescents, Hatim A. Omar, Kristin Rager

Pediatrics Faculty Publications

Lack of physical activity and overweight status continues to be a significant health problem in the United States. To assess the actual prevalence of these problems, we reviewed data from the School-based Health Promotion Centers in one middle school, and one High school in central Kentucky. A total of 232 6th graders and 607 9th graders were included. A total of 92% of 6th graders and 45% of 9th graders reported complete lack of regular exercise. 37% of 9th graders and 59% of 6th graders had inappropriate nutrition, 47% of 9th graders and 33% of 6th graders had Body Mass …

Jmjd2a Is A Novel N-Cor-Interacting Protein And Is Involved In Repression Of The Human Transcription Factor Achaete Scute-Like Homologue 2 (Ascl2/Hash2), Dianzheng Zhang, Hoguen Yoon, Jiemin Wong

PCOM Scholarly Works

Corepressor N-CoR (nuclear receptor corepressor) and the highly related protein SMRT (silencing mediator of retinoid and thyroid hormone receptor) play important roles in different biological processes including proliferation, differentiation, and development. Understanding the biological function of these corepressors requires identification and characterization of their interacting proteins. Here we report the characterization of a novel N-CoR-interacting protein, JMJD2A (previously known as KIAA0677). JMJD2A is an evolutionarily conserved nuclear protein containing many functionally unknown domains. JMJD2A directly interacts with the N-terminal region of N-CoR through a small NID (N-CoR interaction domain) both in vitro and in vivo. Despite its copurification with N-CoR, …

The Relationship Between Future Orientation And Street Substance Use Among Texas Alternative School Students, R J Peters, Susan R Tortolero, Regina Jones Johnson, Robert C Addy, Christine M Markham, S Liliana Escobar-Chaves, Holly Lewis, George S Yacoubian

Faculty, Staff and Student Publications

Self-reported substance use data were collected from 963 alternative school students in grades 7-12 who were surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001. Logistic regression analyses indicated that lower levels of future orientation was significantly associated (OR = 0.88, 95% CI = 0.81-0.97) with thirty-day substance use after controlling for age and gender. In addition, lower levels of future orientation was found to have a significant association with students' lifetime substance use (OR = 0.93, 95% CI = 0.87-.99) after controlling for age, race, and gender. While the …

Medical Symptoms Associated With Tobacco Smoking With And Without Marijuana Abuse Among Crack Cocaine-Dependent Patients., Ashwin A. Patkar, Vikas Batra, Paolo Mannelli, Sarah Evers-Casey, Michael J. Vergare, Frank T. Leone

Department of Psychiatry and Human Behavior Faculty Papers

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling …

Changes In Beliefs Identify Unblinding In Randomized Controlled Trials: A Method To Meet Consort Guidelines, Judy R. Rees, Timothy J. Wade, Deborah A. Levy, John M. Colford, Joan F. Hilton

Journal Articles: Epidemiology

Double-blinded trials are often considered the gold standard for research, but significant bias may result from unblinding of participants and investigators. Although the CONSORT guidelines discuss the importance of reporting "evidence that blinding was successful", it is unclear what constitutes appropriate evidence. Among studies reporting methods to evaluate blinding effectiveness, many have compared groups with respect to the proportions correctly identifying their intervention at the end of the trial. Instead, we reasoned that participants' beliefs, and not their correctness, are more directly associated with potential bias, especially in relation to self-reported health outcomes. During the Water Evaluation Trial performed in …

Visual Error Augmentation For Enhancing Motor Learning And Rehabilitative Relearning, Yejun Wei, Preeti Bajaj, Robert A. Scheidt, James L. Patton

Biomedical Engineering Faculty Research and Publications

We developed a real-time controller for a 2 degree-of-freedom robotic system using xPC Target. This system was used to investigate how different methods of performance error feedback can lead to faster and more complete motor learning in individuals asked to compensate for a novel visuo-motor transformation (a 30 degree rotation). Four groups of normal human subjects were asked to reach with their unseen arm to visual targets surrounding a central starting location. A cursor tracking hand motion was provided during each reach. For one group of subjects, deviations from the "ideal" compensatory hand movement (i.e. trajectory errors) were amplified with …

Predicting Childhood Sexual Or Physical Abuse: A Logistic Regression Geo-Mapping Approach To Prevention, Roland K. Tadoum, Kamila Smolij, Michelle A. Lyn, Craig W. Johnson

Faculty, Staff and Student Publications

This study investigates the degree to which gender, ethnicity, relationship to perpetrator, and geomapped socio-economic factors significantly predict the incidence of childhood sexual abuse, physical abuse and non- abuse. These variables are then linked to geographic identifiers using geographic information system (GIS) technology to develop a geo-mapping framework for child sexual and physical abuse prevention.

Using Technology To Teach Technology: Design And Evaluation Of Bilingual Online Physician Education About Electronic Medical Records, Sarah R. Edmonson, Adol Esquivel, Pallavi Mokkarala, Craig W. Johnson, Cynthia L. Phelps

Faculty, Staff and Student Publications

The "EMR Tutorial" is designed to be a bilingual online physician education environment about electronic medical records. After iterative assessment and redesign, the tutorial was tested in two groups: U.S. physicians and Mexican medical students. Split-plot ANOVA revealed significantly different pre-test scores in the two groups, significant cognitive gains for the two groups overall, and no significant difference in the gains made by the two groups. Users rated the module positively on a satisfaction questionnaire.

Persuasive Email Messages For Patient Communication, Muhammad Walji, Kathy Johnson-Throop, Todd Johnson, Elmer Bernstam, Jiajie Zhang

Faculty, Staff and Student Publications

To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.

Analysis Of Oligonucleotide Array Experiments With Repeated Measures Using Mixed Models, Hao Li, Constance L. Wood, Thomas V. Getchell, Marilyn L. Getchell, Arnold J. Stromberg

Statistics Faculty Publications

BACKGROUND: Two or more factor mixed factorial experiments are becoming increasingly common in microarray data analysis. In this case study, the two factors are presence (Patients with Alzheimer's disease) or absence (Control) of the disease, and brain regions including olfactory bulb (OB) or cerebellum (CER). In the design considered in this manuscript, OB and CER are repeated measurements from the same subject and, hence, are correlated. It is critical to identify sources of variability in the analysis of oligonucleotide array experiments with repeated measures and correlations among data points have to be considered. In addition, multiple testing problems are more …

Influence Of Age, Gender, And Race On Depression In Heart Failure Patients., Ronald Freudenberger, Stacey C. Cahn, Christine Skotzko

PCOM Scholarly Works

No abstract provided.

Factors Influencing Appraisal Of Upset In Black Caregivers Of Persons With Alzheimer Disease And Related Dementias, Susan Toth-Cohen

Department of Occupational Therapy Faculty Papers

Black caregivers of persons with Alzheimer disease and related dementias (ADRD) have demonstrated significantly lower levels of stress and burden than white caregivers, as measured by instruments that assess caregiving burden and stressfulness of specific problem behaviors. However, the reasons for reported differences are unclear and cannot be attributed solely to race. This descriptive study used content analysis to compare black caregivers’ descriptions and interpretations of responses to memory and behavioral issues of relatives with ADRD to 11 explanations for lower levels of upset proposed in the caregiving literature. Findings confirmed only two explanations from the literature, social support and …

Control Of Mitochondrial Motility And Distribution By The Calcium Signal: A Homeostatic Circuit., Muqing Yi, David Weaver, György Hajnóczky

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Mitochondria are dynamic organelles in cells. The control of mitochondrial motility by signaling mechanisms and the significance of rapid changes in motility remains elusive. In cardiac myoblasts, mitochondria were observed close to the microtubular array and displayed both short- and long-range movements along microtubules. By clamping cytoplasmic [Ca2+] ([Ca2+]c) at various levels, mitochondrial motility was found to be regulated by Ca2+ in the physiological range. Maximal movement was obtained at resting [Ca2+]c with complete arrest at 1-2 microM. Movement was fully recovered by returning to resting [Ca2+]c, and inhibition could be repeated with no apparent desensitization. The inositol 1,4,5-trisphosphate- or …

Improved Quantification Of Small Objects In Near-Infrared Diffuse Optical Tomography, Subhadra Srinivasan, Brian W. Pogue, Hamid Dehghani, Shudong Jiang, Xiaomei Song, Keith D. Paulsen

Dartmouth Scholarship

Diffuse optical tomography allows quantification of hemoglobin, oxygen saturation, and water in tissue, and the fidelity in this quantification is dependent on the accuracy of optical properties determined during image reconstruction. In this study, a three-step algorithm is proposed and validated that uses the standard Newton minimization with Levenberg-Marquardt regularization as the first step. The second step is a modification to the existing algorithm using a two-parameter regularization to allow lower damping in a region of interest as compared to background. This second stage allows the recovery of the actual size of an inclusion. A region-based reconstruction is the final …

Multiple Roles Of Mucins In Pancreatic Cancer, A Lethal And Challenging Malignancy., N. Moniaux, M. Andrianifahanana, R. E. Brand, Surinder K. Batra

Journal Articles: Biochemistry & Molecular Biology

Mucins are members of an expanding family of large multifunctional glycoproteins. Pancreatic mucins have important biological functions, including the protection, lubrication, and moisturisation of the surfaces of epithelial tissues lining ductal structures within the pancreas. Several lines of evidence support the notion that deregulated mucin production is a hallmark of inflammatory and neoplastic disorders of the pancreas. Herein, we discuss the factors that contribute to the lethality of pancreatic cancer as well as the key role played by mucins, particularly MUC1 and MUC4, in the development and progression of the disease. Aspects pertaining to the aberrant expression and glycosylation of …

Update On Diabetes Mellitus, Murray Korc

Dartmouth Scholarship

Diabetes mellitus is a complex multi-system disorder that may be classified as autoimmune mediated type 1 diabetes, or as insulin resistance associated type 2 diabetes. In type 1 diabetes, there is selective loss of the beta cells within the endocrine islets, as a consequence of T-cell and cytokine mediated destruction of these cells, perhaps in conjunction with destruction of the peri-islet Schwann cells. In type 2 diabetes, the etiology of the resistance ranges from post-receptor defects in the insulin signaling pathway to excessive production of adipocyte derived cytokines that antagonize insulin action to mitochondrial defects that interfere with glucose disposal. …

Differential Expression Of Toll-Like Receptors 2 And 4 In Tissues Of The Human Female Reproductive Tract, Patricia A. Pioli, Eyal Amiel, Todd M. Schaefer, John E. Connolly, Charles R. Wira, Paul M. Guyre

Dartmouth Scholarship

Toll-like receptor (TLR) signal transduction is a central component of the innate immune response to pathogenic challenge. Although recent studies have begun to elucidate differences in acquired immunity in tissues of the human female reproductive tract, there is a relative paucity of work regarding innate defense mechanisms. We investigated TLR mRNA and protein expression in tissues of the human female reproductive tract. Constitutive mRNA expression of TLRs 1 to 6 was observed in fallopian tubes, uterine endometrium, cervix, and ectocervix. Furthermore, transcripts of the signaling adapter MyD88 and the accessory molecule CD14 were also detected in all tissues assayed. Quantitative …

Nf-Kappab And Ap-1 Connection: Mechanism Of Nf-Kappab-Dependent Regulation Of Ap-1 Activity, Shuichi Fujioka, Jiangong Niu, Christian Schmidt, Guido M Sclabas, Bailu Peng, Tadashi Uwagawa, Zhongkui Li, Douglas B Evans, James L Abbruzzese, Paul J Chiao

Faculty, Staff and Student Publications

Nuclear factor kappaB (NF-kappaB) and activator protein 1 (AP-1) transcription factors regulate many important biological and pathological processes. Activation of NF-kappaB is regulated by the inducible phosphorylation of NF-kappaB inhibitor IkappaB by IkappaB kinase. In contrast, Fos, a key component of AP-1, is primarily transcriptionally regulated by serum responsive factors (SRFs) and ternary complex factors (TCFs). Despite these different regulatory mechanisms, there is an intriguing possibility that NF-kappaB and AP-1 may modulate each other, thus expanding the scope of these two rapidly inducible transcription factors. To determine whether NF-kappaB activity is involved in the regulation of fos expression in response …

The Caenorhabditis Elegans F-Box Protein Sel-10 Promotes Female Development And May Target Fem-1 And Fem-3 For Degradation By The Proteasome, Sibylle Jager, Hillel T. Schwartz, H. Robert Horvitz, Barbara Conradt

Dartmouth Scholarship

The Caenorhabditis elegans F-box protein SEL-10 and its human homolog have been proposed to regulate LIN-12 Notch signaling by targeting for ubiquitin-mediated proteasomal degradation LIN-12 Notch proteins and SEL-12 PS1 presenilins, the latter of which have been implicated in Alzheimer's disease. We found that sel-10 is the same gene as egl-41, which previously had been defined by gain-of-function mutations that semidominantly cause masculinization of the hermaphrodite soma. Our results demonstrate that mutations causing loss-of-function of sel-10 also have masculinizing activity, indicating that sel-10 functions to promote female development. Genetically, sel-10 acts upstream of the genes fem-1, fem-2, and fem-3 and …

Academic Performance Of Psychiatrists Compared To Other Specialists Before, During, And After Medical School., Frederick S. Sierles, Michael Vergare, Mohammadreza Hojat, Joseph S. Gonnella

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: This study was designed to compare psychiatrists with other physicians on measures of academic performance before, during, and after medical school.

METHOD: More than three decades of data for graduates of Jefferson Medical College (N=5,701) were analyzed. Those who pursued psychiatry were compared to physicians in seven other specialties on 18 performance measures. Analysis of covariance was used to control for gender effect.

RESULTS: Compared to other physicians, psychiatrists scored higher on measures of verbal ability and general information before medical school and on evaluations of knowledge and skills in behavioral sciences during medical school, but they scored lower …

Melioration And The Behavioral Addiction Process: An Experimental Analysis, Jared Micah Dinehart

Theses and Dissertations

Melioration can be a factor contributing to behavioral addiction. In this study, 76 university undergraduates operated a "money machine" by selecting between choices that corresponded to maximization and melioration. Participants initially made choices consistent with a strategy of melioration and demonstrated significantly greater variability in choice behavior when visual cues were presented aimed at exposing the internality (or consequence) of the choice situation. Removal of the visual cues resulted in a return to lower responding. Visual cues may aid in interrupting the behavioral addiction pattern by limiting exclusive use of a melioration choice strategy. Methods of restructuring and experimentation with …

Clinical Profiles, Occurrence, And Management Of Adolescent Patients With Hair-An Syndrome, Hatim A. Omar, Stephanie Logsdon, Jessica Richards

Pediatrics Faculty Publications

The syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans (HAIR-AN) is a subphenotype of the polycystic ovary syndrome. It is one of the most common causes of menstrual problems, hyperandrogenic symptoms, and insulin resistance among young women. Review of clinical data in an outpatient adolescent clinic showed that of the 1,002 young women (ages 10-21 years) attending the clinic over a 2-year period, 50 (5%) were diagnosed with HAIR-AN syndrome. Mean age of the patients was 15.5, initial mean weight at diagnosis was 94.5 kg, and the mean BMI was 33.33 kg/m2. Patients were treated with a weight-stabilization and -reduction …

Efficacy Of Quality Criteria To Identify Potentially Harmful Information: A Cross-Sectional Survey Of Complementary And Alternative Medicine Web Sites, Muhammad Walji, Smitha Sagaram, Deepak Sagaram, Funda Meric-Bernstam, Craig Johnson, Nadeem Q Mirza, Elmer V Bernstam

Faculty, Staff and Student Publications

BACKGROUND: Many users search the Internet for answers to health questions. Complementary and alternative medicine (CAM) is a particularly common search topic. Because many CAM therapies do not require a clinician's prescription, false or misleading CAM information may be more dangerous than information about traditional therapies. Many quality criteria have been suggested to filter out potentially harmful online health information. However, assessing the accuracy of CAM information is uniquely challenging since CAM is generally not supported by conventional literature. OBJECTIVE: The purpose of this study is to determine whether domain-independent technical quality criteria can identify potentially harmful online CAM content. …

Test-Retest Reliability Of Temporal And Spatial Gait Characteristics Measured With An Instrumented Walkway System (Gaitrite)., Cornelis J T Van Uden, Marcus P Besser

Department of Physical Therapy Faculty Papers

BACKGROUND: The purpose of this study was to determine the test-retest reliability of temporal and spatial gait measurements over a one-week period as measured using an instrumented walkway system (GAITRite). METHODS: Subjects were tested on two occasions one week apart. Measurements were made at preferred and fast walking speeds using the GAITRite system. Measurements tested included walking speed, step length, stride length, base of support, step time, stride time, swing time, stance time, single and double support times, and toe in-toe out angle. RESULTS: Twenty-one healthy subjects participated in this study. The group consisted of 12 men and 9 women, …

Differences In Peripheral Noradrenergic Function Among Actively Drinking And Abstinent Alcohol-Dependent Individuals., Ashwin A. Patkar, Charles A. Marsden, Prakash C. Naik, David A. Kendall, Raman Gopalakrishnan, Michael J. Vergare, Stephen P. Weinstein

Department of Psychiatry and Human Behavior Faculty Papers

We examined whether excessive alcohol consumption was related to changes in plasma levels of noradrenaline (NA) and whether these changes recover following abstinence. We also explored whether there were differences in NA levels between Type I and Type II alcoholics and controls during active drinking and abstinence. Plasma concentrations of NA were determined in (1) 27 Caucasian men with alcohol dependence who were regularly drinking (active drinkers) within 24 hours of hospitalization, (2) 29 Caucasian alcohol-dependent men who were in remission (abstinent for a minimum of three months), and (3) 28 race- and gender-matched healthy controls. NA concentrations were significantly …

Characterization Of Hemoglobin, Water, And Nir Scattering In Breast Tissue: Analysis Of Intersubject Variability And Menstrual Cycle Changes, Brian W. Pogue, Shudong Jiang, Hamid Dehghani, Christine Kogel, Sandra Soho, Subhadra Srinivasan, Xiaomei Song, Tor D. Tosteson, Steven P. Poplack, Keith D. Paulsen

Dartmouth Scholarship

Near-infrared imaging was used to quantify typical values of hemoglobin concentration, oxygen saturation, water fraction, scattering power, and scattering amplitude within the breast tissue of volunteer subjects. A systematic study of the menstrual variations in these parameters was carried out by measuring a group of seven premenopausal normal women (aged 41 to 47 years) in the follicular (days 7 to 14 of the cycle) and secretory phases (days 21 to 28) of the cycle, for two complete menstrual cycles. An average increase in hemoglobin concentration of 2.6 μM or 13% of the background breast values was observed in the …

Depressed Type 1 Cytokine Synthesis By Superantigen-Activated Cd4+ T Cells Of Women With Human Papillomavirus-Related High-Grade Squamous Intraepithelial Lesions, Bang-Ning Lee, Michele Follen, De-Yu Shen, Anais Malpica, Karen Adler-Storthz, William T. Shearer, James M. Reuben

Faculty, Staff and Student Publications

Carcinoma of the cervix is causally related to infection with the human papillomavirus (HPV), and T cells play a pivotal role in the immune response of the host to rid itself of HPV infection. Therefore, we assessed the T-cell function of women with HPV-related cervical neoplasia against a superantigen, Staphylococcus enterotoxin B (SEB). Each woman provided a cervical brush specimen for HPV DNA testing and Papanicolaou (Pap) smears for the staging of cervical lesions. They also provided a blood specimen for determination of the ability of CD4(+) T and CD8(+) T cells to synthesize Th1 (interleukin-2 [IL-2], gamma interferon [IFN-gamma], …

Relationship Between Serotonin Transporter Gene Polymorphisms And Platelet Serotonin Transporter Sites Among African-American Cocaine-Dependent Individuals And Healthy Volunteers., Ashwin A. Patkar, Wade H. Berrettini, Paolo Mannelli, Raman Gopalakrishnan, Margret R. Hoehe, Louai Bilal, Stephen Weinstein, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric disorders including cocaine dependence. A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) appears to influence the expression of 5-HTT in human cell lines. We investigated whether 5-HTTLPR variants were related to differences in measures of platelet 5-HTT sites in cocaine-dependent patients and healthy volunteers (controls). Polymerase chain reaction-based genotyping of a 44 base pair insertion/deletion polymorphism in 5-HTTLPR was performed in 138 cocaine-dependent African-American subjects and 60 African-American controls. This yielded a short (S) and a long (L) allele. Platelet 5-HTT sites …