Digital Commons Network^™

The Cervical Dystonia Impact Profile (Cdip-58): Can A Rasch Developed Patient Reported Outcome Measure Satisfy Traditional Psychometric Criteria?, Stefan J. Cano, Thomas T. Warner, Alan J. Thompson, Kailash P. Bhatia, Ray Fitzpatrick, Jeremy C. Hobart

Peninsula Medical School

BACKGROUND: The United States Food and Drug Administration (FDA) are currently producing guidelines for the scientific adequacy of patient reported outcome measures (PROMs) in clinical trials, which will have implications for the selection of scales used in future clinical trials. In this study, we examine how the Cervical Dystonia Impact Profile (CDIP-58), a rigorous Rasch measurement developed neurologic PROM, stands up to traditional psychometric criteria for three reasons: 1) provide traditional psychometric evidence for the CDIP-58 in line with proposed FDA guidelines; 2) enable researchers and clinicians to compare it with existing dystonia PROMs; and 3) help researchers and clinicians …

Intravenous Lidocaine For Refractory Chronic Orofacial Pain : Two Case Reports And A Literature Review, Abdulaziz Almahrezi, Louise Lamb, Mark A. Shir, Yoram, Ibrahim Al-Zakwani

Sultan Qaboos University Medical Journal

This report presents the results of treatment of two adults, at the Pain Center of Montreal General Hospital, Canada, with intravenous lidocaine for intractable orofacial pain. Repeated lidocaine infusions (1mg/kg in a bolus, followed by 4mg/kg infused over 1 hour) resulted in satisfactory pain relief in both patients, and the drug was well tolerated. Intravenous lidocaine therapy may be considered for intractable orofacial pain; further research is warranted.

Integrative Medicine Research At An Academic Medical Center: Patient Characteristics And Health-Related Quality-Of-Life Outcomes., Jeffrey M Greeson, Steven Rosenzweig, Steven C Halbert, Ira S Cantor, Matthew T Keener, George C Brainard

College of Science & Mathematics Departmental Research

OBJECTIVE: To characterize patients seeking care at a university-based integrative medicine practice, and to assess short-term changes in health-related quality of life (HRQoL) associated with integrative medical treatment.

DESIGN: Prospective, observational study.

SETTING: This study was conducted at a large U.S. academic medical center affiliated with the Consortium of Academic Health Centers for Integrative Medicine.

PARTICIPANTS: Seven hundred and sixty-three (763) new patients with diverse medical conditions participated in the study. Mean age was 49 years (standard deviation = 16, range = 14-93). Two thirds of patients were women and three quarters were white. The most common International Classification of …

Freesurfer-Initiated Fully-Automated Subcortical Brain Segmentation In Mri Using Large Deformation Diffeomorphic Metric Mapping., Ali R Khan, Lei Wang, Mirza Faisal Beg

Brain and Mind Institute Researchers' Publications

Fully-automated brain segmentation methods have not been widely adopted for clinical use because of issues related to reliability, accuracy, and limitations of delineation protocol. By combining the probabilistic-based FreeSurfer (FS) method with the Large Deformation Diffeomorphic Metric Mapping (LDDMM)-based label-propagation method, we are able to increase reliability and accuracy, and allow for flexibility in template choice. Our method uses the automated FreeSurfer subcortical labeling to provide a coarse-to-fine introduction of information in the LDDMM template-based segmentation resulting in a fully-automated subcortical brain segmentation method (FS+LDDMM). One major advantage of the FS+LDDMM-based approach is that the automatically generated segmentations generated are …

A Pooled Analysis Of Two Placebo-Controlled Trials Of Desvenlafaxine In Major Depressive Disorder., Daniel Z Lieberman, Stuart A Montgomery, Karen A Tourian, Claudine Brisard, Gregory Rosas, Krishna Padmanabhan, Jean-Michel Germain, Bruno Pitrosky

Psychiatry and Behavioral Sciences Faculty Publications

The efficacy, safety, and tolerability of desvenlafaxine (administered as desvenlafaxine succinate) were evaluated in two similarly designed, phase 3, randomized, double-blind, placebo-controlled, venlafaxine-extended-release-referenced, flexible-dose studies of outpatients with a primary diagnosis of major depressive disorder. Owing to a high placebo response, the individual studies were underpowered. Therefore, a post-hoc pooled analysis was performed (desvenlafaxine and placebo data were pooled; venlafaxine extended release data were not, owing to different flexible-dose regimens in the two studies). The primary outcome measure was the change from baseline on the 17-item Hamilton Rating Scale for Depression; the Clinical Global Impressions-Improvement item score was a secondary …

Pathways To Change: The Effect Of A Web Application On Treatment Interest., Daniel Z Lieberman, Suena H Massey

Psychiatry and Behavioral Sciences Faculty Publications

Most individuals with drinking problems do not receive treatment, generally because they do not perceive the need for it. It is difficult to access this population of problem drinkers in order to encourage treatment-seeking. A Web-based program was written, designed to increase motivation for change. The program guided non-treatment-seekers through a multi-stage assessment and provided them with feedback. The level of interest in treatment was measured pre-and post-intervention. Compared to baseline, after the intervention, significantly more individuals rated themselves "very interested" in participating in some form of traditional treatment (19% vs. 28%), and their focus on a specific modality increased.

Medical Students: Abuse Of Psychoactive Substances And Sexuality Aspects, Kepler Alencar Mendes Carvalho, Maria José Carvalho Sant'anna, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

University students aged 17 to 24 years of age are prone to many risk factors.

OBJECTIVES: Identify risk factors related to exploring sexuality and characteristics of consumption of psychoactive substances in students attending medical school.

METHODS: 465 Medical students from Santa Casa of São Paulo Faculty of Medical Sciences (FCMSCSP) were prospectively and transversely evaluated during 2005. An anonymous, semi-structured, self-filling questionnaire was used. The average age of the students was 21.5 years, 43% females. 76.2% preferred alcohol, and 11.1% tobacco consumption; chloroethane (lança-perfume) consumption occurred in 22.6% and 15.3% consumption of other types of illicit drugs, with marijuana as …

The Temporal Relationship Between The Coronavirus Disease 2019 (Covid-19) Pandemic And Preterm Birth, Harold E Bedell, Mahalakshmi Ramamurthy, Saumil S Patel, Shobana Subramaniam, Lan-Phuong Vu-Yu, Jianliang Tong

Faculty, Staff and Student Publications

Despite rapid to-and-fro motion of the retinal image that results from their incessant involuntary eye movements, persons with infantile nystagmus (IN) rarely report the perception of motion smear. We performed two experiments to determine if the reduction of perceived motion smear in persons with IN is associated with an increase in the speed of the temporal impulse response. In Experiment 1, increment thresholds were determined for pairs of successively presented flashes of a long horizontal line, presented on a 65-cd/m2 background field. The stimulus-onset asynchrony (SOA) between the first and second flash varied from 5.9 to 234 ms. In experiment …

Effects Of Acute Ethyl Alcohol Consumption On A Psychophysical Measure Of Lateral Inhibition In Human Vision., Kevin D Johnston, Brian Timney

Brain and Mind Institute Researchers' Publications

Acute consumption of ethyl alcohol affects a variety of visual functions. However, there have been few systematic attempts to investigate the neural mechanisms underlying these effects. Here, we employed the Westheimer paradigm to investigate the hypothesis that alcohol reduces lateral inhibition within human "perceptive fields", the psychophysical analogue of physiological receptive fields. Westheimer functions obtained under alcohol and no-alcohol conditions at photopic, mesopic, and scotopic levels of adaptation showed changes consistent with an alcohol-induced decrease in lateral inhibition. We conclude that this decrease in lateral inhibition may be responsible for some of the changes in visual perception that result from …

Primary Care Physicians And Insulin Initiation: Multiple Barriers, Lack Of Knowledge Or Both?, Serge Jabbour, Md, Facp, Face

Department of Medicine Faculty Papers

Primary care physicians (PCPs) provide diabetes care for 82% of patients with type 2 diabetes (1). Many patients with type 2 diabetes will eventually need insulin. The UKPDS (2) showed that ß-cell failure is progressive. From 50% of normal ß-cell function present at diagnosis, there is a steady decline with almost complete loss of ß-cell mass within 10-15 years, even earlier in some patients. On average, as many as 40-80% of patients with type 2 diabetes will need insulin within 10 years after diagnosis (1,2). These statistics can vary between patients and depending on the different agents used after the …

Caffeine Use: Association With Nicotine Use, Aggression, And Other Psychopathology In Psychiatric And Pediatric Outpatient Adolescents, Catherine A. Martin, Circe Cook, John H. Woodring, Gretchen Burkhardt, Greg Guenthner, Hatim A. Omar, Tom H. Kelly

Psychiatry Faculty Publications

The objective of this study was to evaluate the relationship between caffeine use, other drug use, and psychopathology in adolescents, using self-report measures. The study group consisted of 132 adolescents (average age 14.01 ± 2.06 years, 52% female, 19% African American, 5% other categories, 76% Caucasian). Most (47%) were recruited from a child psychiatry clinic with emphasis on youth with disruptive disorders, with 35% from an adolescent pediatric clinic with emphasis on prevention of risk-taking behavior and 18% from a pediatric clinic for families with limited resources. Subjects were consecutively recruited before or after regular clinic visits. Consent was obtained …

Surrogate Markers Of Success In The Bariatric Surgery Population, Alain Ramirez

Yale Medicine Thesis Digital Library

Purpose: The purpose of this study was to examine the associations between pre-operative weight loss, weight loss programs, and clinic attendance relative to the success of gastric bypass in class II and III obese patients. Background: The increasing number of obese children and adults in the United States poses an extensive social problem in the era of managed care. Notwithstanding the stigmatization associated with obesity, the considerable health implications along with the financial burden it imposes create a formidable adversary. Surgical procedures have proved to be superior to conservative and pharmacotherapeutic interventions in the morbidly obese. Despite the overall success …

Meta-Analysis Of Alexithymia In Posttraumatic Stress Disorder., Paul A Frewen, David J A Dozois, Richard W J Neufeld, Ruth A Lanius

Psychology Publications

The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.

The State Of The Art In Evaluating The Performance Of Assistant And Associate Deans As Seen By Deans And Assistant And Associate Deans., David G. Dunning, Timothy M. Durham, Mert N. Aksu, Brian M. Lange

Journal Articles: College of Dentistry

This study explores the little-understood process of evaluating the performance of assistant and associate deans at dental colleges in the United States and Canada. Specifically, this research aimed to identify the methods, processes, and outcomes related to the performance appraisals of assistant/associate deans. Both deans and assistant/associate deans were surveyed. Forty-four of sixty-six deans (66.7 percent) and 227 of 315 assistant/associate deans (72.1 percent) completed surveys with both close-ended and open-ended questions. In addition, ten individuals from each group were interviewed. Results indicate that 75-89 percent of assistant/associate deans are formally evaluated, although as many as 27 percent may lack …

Functional Imaging Of The Auditory Processing Applied To Speech Sounds, Roy D Patterson, Ingrid Johnsrude

Brain and Mind Institute Researchers' Publications

In this paper, we describe domain-general auditory processes that we believe are prerequisite to the linguistic analysis of speech. We discuss biological evidence for these processes and how they might relate to processes that are specific to human speech and language. We begin with a brief review of (i) the anatomy of the auditory system and (ii) the essential properties of speech sounds. Section 4 describes the general auditory mechanisms that we believe are applied to all communication sounds, and how functional neuroimaging is being used to map the brain networks associated with domain-general auditory processing. Section 5 discusses recent …

A Technological Approach To Reaching A Hidden Population Of Problem Drinkers., Daniel Z Lieberman, Suena W Huang

Psychiatry and Behavioral Sciences Faculty Publications

OBJECTIVE: The most common obstacle to the treatment of individuals with drinking problems is that most do not seek treatment. This study compared a group of treatment-seeking patients with users of an alcohol-evaluation Web site to determine whether an Internet application could reach a population of problem drinkers who are distinct from those served by currently available forms of care.

METHODS: An open-source application was developed that was modeled on the Drinker's Check-Up, which has been shown to increase motivation for behavior change while presenting itself as a nonthreatening evaluation. To recruit non-treatment seekers, the program was offered as a …

Verb Generation In Children With Spina Bifida, Maureen Dennis, Derryn Jewell, Ross Hetherington, Christine Burton, Michael E. Brandt, Susan E. Blaser, Jack M Fletcher

Faculty, Staff and Student Publications

We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance …

Using Built Environment Characteristics To Predict Walking For Exercise, Gina S. Lovasi, Anne V. Moudon, Amber L. Pearson, Philip M. Hurvitz, Eric B. Larson, David S. Siscovick, Ethan M. Berke

Dartmouth Scholarship

Environments conducive to walking may help people avoid sedentary lifestyles and associated diseases. Recent studies developed walkability models combining several built environment characteristics to optimally predict walking. Developing and testing such models with the same data could lead to overestimating one's ability to predict walking in an independent sample of the population. More accurate estimates of model fit can be obtained by splitting a single study population into training and validation sets (holdout approach) or through developing and evaluating models in different populations. We used these two approaches to test whether built environment characteristics near the home predict walking for …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Surgical Versus Nonsurgical Therapy For Lumbar Spinal Stenosis., James N Weinstein, Tor D Tosteson, Jon D Lurie, Anna N A Tosteson, Emily Blood, Brett Hanscom, Harry Herkowitz, Frank Cammisa, Todd J Albert, Scott D Boden, Alan Hilibrand, Harley Goldberg, Sigurd Berven, Howard An

Rothman Institute Papers

BACKGROUND: Surgery for spinal stenosis is widely performed, but its effectiveness as compared with nonsurgical treatment has not been shown in controlled trials.

METHODS: Surgical candidates with a history of at least 12 weeks of symptoms and spinal stenosis without spondylolisthesis (as confirmed on imaging) were enrolled in either a randomized cohort or an observational cohort at 13 U.S. spine clinics. Treatment was decompressive surgery or usual nonsurgical care. The primary outcomes were measures of bodily pain and physical function on the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36) and the modified Oswestry Disability Index at 6 weeks, …

Switching Language Switches Mind: Linguistic Effects On Developmental Neural Bases Of ‘Theory Of Mind’, Chiyoko Kobayashi, Gary H. Glover, Elise Temple

Dartmouth Scholarship

Theory of mind (ToM)—our ability to predict behaviors of others in terms of their underlying intentions—has been examined through false-belief (FB) tasks. We studied 12 Japanese early bilingual children (8−12 years of age) and 16 late bilingual adults (18−40 years of age) with FB tasks in Japanese [first language (L1)] and English [second language (L2)], using fMRI. Children recruited more brain regions than adults for processing ToM tasks in both languages. Moreover, children showed an overlap in brain activity between the L1 and L2 ToM conditions in the medial prefrontal cortex (mPFC). Adults did not show such a convergent activity …

Neuroimaging Studies Of Psychological Interventions For Mood And Anxiety Disorders: Empirical And Methodological Review., Paul A Frewen, David J A Dozois, Ruth A Lanius

Psychology Publications

This article reviews the methods and results of published neuroimaging studies of the effects of structured psychological interventions for mood and anxiety disorders. The results are consistent with neural models of improved affective- and self-regulation, as evidenced by psychotherapeutic modulation of brain metabolic activity within the dorsolateral, ventrolateral, and medial prefrontal cortices, the anterior cingulate, the posterior cingulate/precuneus, and the insular cortices. Specific recommendations for future studies are outlined, and the clinical and theoretical significance of this research is discussed.

Selective Attention To Threat Versus Reward: Meta-Analysis And Neural-Network Modeling Of The Dot-Probe Task., Paul A Frewen, David J A Dozois, Marc F Joanisse, Richard W J Neufeld

Psychology Publications

Two decades of research conducted to date has examined selective visual attention to threat and reward stimuli as a function of individual differences in anxiety using the dot-probe task. The present study tests a connectionist neural-network model of meta-analytic and key individual-study results derived from this literature. Attentional bias for threatening and reward-related stimuli is accounted for by connectionist model implementation of the following clinical psychology and affective neuroscience principles: 1) affective learning and temperament, 2) state and trait anxiety, 3) intensity appraisal, 4) affective chronometry, 5) attentional control, and 6) selective attention training. Theoretical implications for the study of …

Clinical And Neural Correlates Of Alexithymia In Posttraumatic Stress Disorder., Paul A Frewen, Ruth A Lanius, David J A Dozois, Richard W J Neufeld, Clare Pain, James W Hopper, Maria Densmore, Todd K Stevens

Psychology Publications

Individuals with posttraumatic stress disorder (PTSD) often exhibit deficits in emotional experience and expression, which suggests that certain individuals with PTSD may be alexithymic. In this study, in a sample of 105 individuals with PTSD, clinical correlates of alexithymia included reexperiencing, hyperarousal, numbing, dissociative symptoms, and retrospectively reported experiences of childhood emotional neglect. In a subsample of 26 individuals with PTSD related to a motor vehicle accident, functional neural responses to trauma-script imagery were associated with severity of alexithymia, including increased right posterior-insula and ventral posterior-cingulate activation and decreased bilateral ventral anterior-cingulate, ventromedial prefrontal, anterior-insula, and right inferior frontal cortex …

Dissociation Predicts Later Attention Problems In Sexually Abused Children, Julie B Kaplow, Erin Hall, Karestan C Koenen, Kenneth A Dodge, Lisa Amaya-Jackson

Faculty, Staff and Students Publications

OBJECTIVE: The goals of this research are to develop and test a prospective model of attention problems in sexually abused children that includes fixed variables (e.g., gender), trauma, and disclosure-related pathways.

METHODS: At Time 1, fixed variables, trauma variables, and stress reactions upon disclosure were assessed in 156 children aged 8-13 years. At the Time 2 follow-up (8-36 months following the initial interview), 56 of the children were assessed for attention problems.

RESULTS: A path analysis involving a series of hierarchically nested, ordinary least squares multiple regression analyses indicated two direct paths to attention problems including the child's relationship to …

A Neuroanatomically Grounded Hebbian-Learning Model Of Attention-Language Interactions In The Human Brain., Max Garagnani, Thomas Wennekers, Friedemann Pulvermüller

School of Engineering, Computing and Mathematics

Meaningful familiar stimuli and senseless unknown materials lead to different patterns of brain activation. A late major neurophysiological response indexing 'sense' is the negative component of event-related potential peaking at around 400 ms (N400), an event-related potential that emerges in attention-demanding tasks and is larger for senseless materials (e.g. meaningless pseudowords) than for matched meaningful stimuli (words). However, the mismatch negativity (latency 100-250 ms), an early automatic brain response elicited under distraction, is larger to words than to pseudowords, thus exhibiting the opposite pattern to that seen for the N400. So far, no theoretical account has been able to reconcile …

Women's Colposcopy Experience And Preferences: A Mixed Methods Study., Dawn R. Swancutt, Sheila M. Greenfield, Sue Wilson

Peninsula Medical School

BACKGROUND: The colposcopy service is a key component in the UK Cervical Screening Programme. Over 120,000 women are referred to the service annually, however up to 25% of women fail to attend their appointment. Little is known about patients' preferences for colposcopic investigation and treatment. This study aims to investigate women's experience of colposcopy, to identify patients' preferences for aspects of appointments within the colposcopy service, and to make suggestions for service improvement. METHODS/DESIGN: This study has been designed as a two stage, mixed method project. Stage one will involve in-depth interviews with new colposcopy patients to ascertain their experience …

Combinations Of Dsm-Iv-Tr Criteria Sets For Bipolar Disorders., Daniel Z Lieberman, Roger Peele, Maryam Razavi

Psychiatry and Behavioral Sciences Faculty Publications

BACKGROUND: DSM-IV-TR is the standard for making psychiatric diagnoses in many countries. The diagnostic categorization of DSM-IV-TR is valued for its reliability, however it is well accepted that patients with the same diagnosis demonstrate substantial heterogeneity. In order to quantitatively characterize the degree of possible heterogeneity that can exist, combinatorial mathematics was used to calculate the number of possible ways to satisfy symptom criteria for the diagnosis of bipolar disorder as an example of this problem.

SAMPLING AND METHODS: The formula n!/(r!(n - r)!), which calculates the number of different ways of choosing an unordered number of items without repetition …

Interdependent Group Contingency Management For Cocaine-Dependent Methadone Maintenance Patients., Kimberly C Kirby, Mary Louise Kerwin, Carolyn M Carpenedo, Beth J Rosenwasser, Robert S Gardner

College of Science & Mathematics Departmental Research

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. …

A Meta-Analysis Of Cbt For Pathological Worry Among Clients With Gad., Roger Covin, Allison J Ouimet, Pamela M Seeds, David J A Dozois

Psychology Publications

Previous meta-analyses assessing the effectiveness of Cognitive Behavioural Therapy (CBT) for Generalized Anxiety Disorder (GAD) used general measures of anxiety to assess symptom severity and improvement (e.g., Hamilton Anxiety Ratings Scale or a composite measure of anxiety). While informative, these studies do not provide sufficient evidence as to whether CBT significantly reduces the cardinal symptom of GAD: pathological worry. The current meta-analysis employed stringent inclusion criteria to evaluate relevant outcome studies, including the use of the Penn State Worry Questionnaire as the main outcome variable. Results showed a large overall effect size (ES) that was moderated by age and modality …