Digital Commons Network^™

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 …

A Novel Dengue Fever (Df) And Dengue Haemorrhagic Fever (Dhf) Analysis Using Artificial Neural Network (Ann), F. Ibrahim, M.N. Taib, W.A.B. Wan Abas, C.C. Guan, S. Sulaiman

Research Publications (2000 to 2005)

Dengue fever (DF) is an acute febrile viral disease frequently presented with headache, bone or joint and muscular pains, and rash. A significant percentage of DF patients develop a more severe form of disease, known as dengue haemorrhagic fever (DHF). DHF is the complication of DF. The main pathophysiology of DHF is the development of plasma leakage from the capillary, resulting in haemoconcentration, ascites, and pleural effusion that may lead to shock following defervescence of fever. Therefore, accurate prediction of the day of defervescence of fever is critical for clinician to decide on patient management strategy. To date, no known …

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. …

The Consequences Of The Growth Of Health Insurance Premiums, Katherine Baicker, Amitabh Chandra

Dartmouth Scholarship

n the United States, two-thirds of the non-elderly population is covered by employer- provided health insurance (EHI). According to a Kaiser Family Foundation national survey (2003), the cost of EHI has increased by over 59 percent since 2000 with no accompanying in- crease in the scale or scope of benefits. These increases in health insurance premiums may have significant effects on labor markets, including changes in the number of jobs, hours worked per employee, wages, and compensation packages. Indeed, it is possible that a significant portion of the increase in the uninsured population may be a consequence of employers shedding …

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 …

A Randomized, Controlled Trial Of In-Home Drinking Water Intervention To Reduce Gastrointestinal Illness, John M. Colford, Timothy J. Wade, Sukhminder K. Sandhu, Catherine C. Wright, Sherline Lee, Susan Shaw, Kim Fox, Susan Burns, Anne Benker, M. Alan Brookhart, Mark Van Der Laan, Deborah A. Levy

Journal Articles: Epidemiology

Trials have provided conflicting estimates of the risk of gastrointestinal illness attributable to tap water. To estimate this risk in an Iowa community with a well-run water utility with microbiologically challenged source water, the authors of this 2000-2002 study randomly assigned blinded volunteers to use externally identical devices (active device: 227 households with 646 persons; sham device: 229 households with 650 persons) for 6 months (cycle A). Each group then switched to the opposite device for 6 months (cycle B). The active device contained a 1-microm absolute ceramic filter and used ultraviolet light. Episodes of "highly credible gastrointestinal illness," a …

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 …

Mechanistic Differences In Rna-Dependent Dna Polymerization And Fidelity Between Murine Leukemia Virus And Hiv-1 Reverse Transcriptases, Mark Skasko, Kellie K. Weiss, Holly M. Reynolds, Varuni Jamburuthugoda, Kwi Lee, Baek Kim

Biology

We compared the mechanistic and kinetic properties of murine leukemia virus (MuLV) and human immunodeficiency virus type 1 (HIV-1) reverse transcriptases (RTs) during RNA-dependent DNA polymerization and mutation synthesis using pre-steady-state kinetic analysis. First, MuLV RT showed 6.5-121.6-fold lower binding affinity (Kd) to deoxynucleotide triphosphate (dNTP) substrates than HIV-1 RT, although the two RTs have similar incorporation rates (kpol). Second, compared with HIV-1 RT, MuLV RT showed dramatic reduction during multiple dNTP incorporations at low dNTP concentrations. Presumably, due to its low dNTP binding affinity, the dNTP binding step becomes rate-limiting in the multiple rounds of the dNTP incorporation by …

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 …

Loss Of Caveolin-1 Polarity Impedes Endothelial Cell Polarization And Directional Movement, Andrew Beardsley, Kai Fang, Heather Mertz, Vince Castranova, Sherri Friend, Jun Liu

Faculty & Staff Scholarship

No abstract provided.

Nitric Oxide Negatively Regulates Fas Cd95-Induced Apoptosis Through Inhibition Of Ubiquitin-Proteasome-Mediated Degradation Of Flice Inhibitory Protein, Pithi Chanvorachote, Ubonthip Nimmannit, Liying Wang, Christian Stehlik, Bin Lu, Neelam Azad, Yon Rojanasakul

Faculty & Staff Scholarship

No abstract provided.

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 …

Neurological Complications Following Extrusion Of Sodium Hypochlorite Solution During Root Canal Treatment., R. Witton, K. Henthorn, M. Ethunandan, S. Harmer, P. A. Brennan

Peninsula Dental School

AIM: To report the presentation and management of two cases with neurological complications secondary to the extrusion of sodium hypochlorite solution into the facial soft tissues during root canal treatment. SUMMARY: The clinical features, with particular emphasis on nerve deficit following inadvertent extrusion of sodium hypochlorite, are discussed and its management highlighted. Early and aggressive treatment is advocated following such incidents in order to reduce potentially serious complications. KEY LEARNING POINTS: *Neurological sequelae can follow inadvertent hypochlorite extrusion. *Early recognition may avert a potentially more serious outcome. *Active hospital treatment including intravenous steroids and antibiotics is recommended.

Identifying Inaccuracies On Emergency Medicine Residency Applications., Eric D Katz, Lee Shockley, Lawrence Kass, David Howes, Janis P Tupesis, Christopher Weaver, Osman R Sayan, Victoria Hogan, Jason Begue, Diamond Vrocher, Jackie Frazer, Timothy Evans, Gene Hern, Ralph Riviello, Antonio Rivera, Keith Kinoshita, Edward Ferguson

Department of Emergency Medicine Faculty Papers

BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans …

Identification Of Recql1 As A Holliday Junction Processing Enzyme In Human Cell Lines, Gary Leroy, Robert Carroll, Saw Kyin, Masayuki Seki, Michael D. Cole

Dartmouth Scholarship

Homologous recombination provides an effective way to repair DNA double-strand breaks (DSBs) and is required for genetic recombination. During the process of homologous recombination, a heteroduplex DNA structure, or a ‘Holliday junction’ (HJ), is formed. The movement, or branch migration, of this junction is necessary for recombination to proceed correctly. In prokaryotes, the RecQ protein or the RuvA/RuvB protein complex can promote ATP-dependent branch migration of Holliday junctions. Much less is known about the processing of Holliday junctions in eukaryotes. Here, we identify RecQL1 as a predominant ATP-dependent, HJ branch migrator present in human nuclear extracts. A reduction in the …

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.

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.

Separate And Concomitant Use Of Lamotrigine, Lithium, And Divalproex In Bipolar Disorders., Daniel Z Lieberman, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

Expert consensus emphasizes the need for better recognition and accurate diagnosis of bipolar disorder. Current research on lithium, divalproex, and lamotrigine provides new insight into the effective management of this illness. Advances in identifying the mechanism of action of mood stabilization has focused on signaling pathways within the cell that are associated with neurotrophic effects. Clinical research has led to confirmatory evidence of the efficacy of lithium in all phases of bipolar disorder, with the greatest effects seen in the treatment and prevention of mania. Compared to divalproex, lithium also has been found to have greater efficacy in the prevention …

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 …

Acgme Research Requirements For Residents In Psychiatry., Kathleen S. Peindl, Stephen Weinstein, Ashwin A. Patkar, Edward Silberman, Michael Vergare

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

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 …

Phylogenetic Analysis Of The Formin Homology 2 Domain, Henry N. Higgs, Kevin J. Peterson

Dartmouth Scholarship

Formin proteins are key regulators of eukaryotic actin filament assembly and elongation, and many species possess multiple formin isoforms. A nomenclature system based on fundamental features would be desirable, to aid the rapid identification and characterization of novel formins. In this article, we attempt to systematize the formin family by performing phylogenetic analyses of the formin homology 2 (FH2) domain, an independently folding region common to all formins, which alone can influence actin dynamics. Through database searches, we identify 101 FH2 domains from 26 eukaryotic species, including 15 in mice. Sequence alignments reveal a highly conserved yeast-specific insert in the …

Relationship Of Serum Prolactin With Severity Of Drug Use And Treatment Outcome In Cocaine Dependence., Ashwin A. Patkar, Paolo Mannelli, Kenneth M. Certa, Kathleen Peindl, Heather Murray, Michael J. Vergare, Wade H. Berrettini

Department of Psychiatry and Human Behavior Faculty Papers

RATIONALE: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence.

OBJECTIVE: We investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects.

METHODS: Basal PRL concentrations were assayed in 141 African-American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed …

Felix Platter: A Sixteenth-Century Medical Student, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

No abstract provided.

Collecting Duct Carcinoma Of The Kidney: An Immunohistochemical Study Of 11 Cases., Andrea Vecchione, Tommaso Prayer Galetti, Marina Gardiman, Hideshi Ishii, Enrico Giarnieri, Francesco Pagano, Leonard G Gomella, Carlo M Croce, Raffaele Baffa

Department of Urology Faculty Papers

BACKGROUND: Collecting duct carcinoma (CDC) is a rare but very aggressive variant of kidney carcinoma that arises from the epithelium of Bellini's ducts, in the distal portion of the nephron. In order to gain an insight into the biology of this tumor we evaluated the expression of five genes involved in the development of renal cancer (FEZ1/LZTS1, FHIT, TP53, P27kip1, and BCL2). METHODS: We studied eleven patients who underwent radical nephrectomy for primary CDC. All patients had an adequate clinical follow-up and none of them received any systemic therapy before surgery. The expression of the five markers for tumor initiation …

Gaps In Accessing Treatment For Anxiety And Depression: Challenges For The Delivery Of Care., Kerry A Collins, Henny A Westra, David J A Dozois, David D Burns

Psychology Publications

Epidemiological studies have identified high prevalence rates of anxiety and depression in North America [e.g., J. of Nerv. Ment. Dis. 182 (1994) 290]. However, only a small percentage of these individuals access effective treatment. The undertreatment of anxiety and depression is a major public health issue and is associated with significant personal, social, and economic burden. This article describes the existing discrepancy between prevalence of anxiety and depression and access to effective treatment for adults and children, the contributors to this discrepancy, and suggests various means through which access to effective treatment may be enhanced. We begin with a brief …

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 …

Excess Stroke In Mexican Americans Compared With Non-Hispanic Whites: The Brain Attack Surveillance In Corpus Christi Project, Lewis B Morgenstern, Melinda A Smith, Lynda D Lisabeth, Jan M H Risser, Ken Uchino, Nelda Garcia, Paxton J Longwell, David A Mcfarling, Olubumi Akuwumi, Areej Al-Wabil, Fahmi Al-Senani, Devin L Brown, Lemuel A Moyé

Faculty, Staff and Student Publications

Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurologists masked to subjects' ethnicity. From January 2000 to December 2002, 2,350 cerebrovascular events occurred. Of the completed strokes, 53% were in Mexican Americans. The crude cumulative incidence was 168/10,000 in …

From Biomedicine To Natural History Research: Est Resources For Ambystomatid Aalamanders, Srikrishna Putta, Jeramiah J. Smith, John A. Walker, Mathieu Rondet, David W. Weisrock, James Monaghan, Amy K. Samuels, D. Kevin Kump, David C. King, Nicholas J. Maness, Bianca Habermann, Elly Tanaka, Susan V. Bryant, David M. Gardiner, David M. Parichy, S. Randal Voss

Biology Faculty Publications

BACKGROUND: Establishing genomic resources for closely related species will provide comparative insights that are crucial for understanding diversity and variability at multiple levels of biological organization. We developed ESTs for Mexican axolotl (Ambystoma mexicanum) and Eastern tiger salamander (A. tigrinum tigrinum), species with deep and diverse research histories.

RESULTS: Approximately 40,000 quality cDNA sequences were isolated for these species from various tissues, including regenerating limb and tail. These sequences and an existing set of 16,030 cDNA sequences for A. mexicanum were processed to yield 35,413 and 20,599 high quality ESTs for A. mexicanum and A. t. tigrinum, respectively. Because the …