Digital Commons Network^™

Longitudinal Varying Coefficient Single-Index Model With Censored Covariates, Shikun Wang, Jing Ning, Ying Xu, Ya-Chen Tina Shih, Yu Shen, Liang Li

Faculty, Staff and Student Publications

It is of interest to health policy research to estimate the population-averaged longitudinal medical cost trajectory from initial cancer diagnosis to death, and understand how the trajectory curve is affected by patient characteristics. This research question leads to a number of statistical challenges because the longitudinal cost data are often non-normally distributed with skewness, zero-inflation, and heteroscedasticity. The trajectory is nonlinear, and its length and shape depend on survival, which are subject to censoring. Modeling the association between multiple patient characteristics and nonlinear cost trajectory curves of varying lengths should take into consideration parsimony, flexibility, and interpretation. We propose a …

It's Not That We Care Less: Insights Into Health Care Utilization For Comorbid Diabetes And Depression Among Latinos, Sharon Borja, Miriam G Valdovinos, Kenia M Rivera, Natalia Giraldo-Santiago, Robin E Gearing, Luis R Torres

Faculty, Staff and Student Publications

Despite robust knowledge regarding the socio-economic and cultural factors affecting Latino* access to healthcare, limited research has explored service utilization in the context of comorbid conditions like diabetes and depression. This qualitative study, embedded in a larger mixed-methods project, aimed to investigate perceptions held by Latinos and their social support systems (i.e., family members) regarding comorbid diabetes and depression and to identify barriers and facilitators to their help-seeking behaviors and treatment engagement. Bilingual and bicultural researchers conducted eight focus groups with 94 participants in a large U.S. metropolitan area and were primarily conducted in Spanish. The participants either had a …

Virology-The Path Forward, Angela L Rasmussen, Gigi K Gronvall, Anice C Lowen, Felicia Goodrum, James Alwine, Kristian G Andersen, Simon J Anthony, Joel Baines, Arinjay Banerjee, Andrew J Broadbent, Christopher B Brooke, Samuel K Campos, Patrizia Caposio, Arturo Casadevall, Gary C Chan, Anna R Cliffe, Donna Collins-Mcmillen, Nancy Connell, Blossom Damania, Matthew D Daugherty, Kari Debbink, Terence S Dermody, Daniel Dimaio, W Paul Duprex, Michael Emerman, Denise A Galloway, Robert F Garry, Stephen A Goldstein, Alexander L Greninger, Amy L Hartman, Brenda G Hogue, Stacy M Horner, Peter J Hotez, Jae U Jung, Jeremy P Kamil, Stephanie M Karst, Lou Laimins, Seema S Lakdawala, Igor Landais, Michael Letko, Brett Lindenbach, Shan-Lu Liu, Micah Luftig, Grant Mcfadden, Andrew Mehle, Juliet Morrison, Anne Moscona, Elke Mühlberger, Joshua Munger, Karl Münger, Eain Murphy, Christopher J Neufeldt, Janko Z Nikolich, Christine M O'Connor, Andrew Pekosz, Sallie R Permar, Julie K Pfeiffer, Saskia V Popescu, John G Purdy, Vincent R Racaniello, Charles M Rice, Jonathan A Runstadler, Martin J Sapp, Rona S Scott, Gregory A Smith, Erin M Sorrell, Emily Speranza, Daniel Streblow, Scott A Tibbetts, Zsolt Toth, Koenraad Van Doorslaer, Susan R Weiss, Elizabeth A White, Timothy M White, Christiane E Wobus, Michael Worobey, Satoko Yamaoka, Andrew Yurochko

Faculty, Staff and Students Publications

In the United States (US), biosafety and biosecurity oversight of research on viruses is being reappraised. Safety in virology research is paramount and oversight frameworks should be reviewed periodically. Changes should be made with care, however, to avoid impeding science that is essential for rapidly reducing and responding to pandemic threats as well as addressing more common challenges caused by infectious diseases. Decades of research uniquely positioned the US to be able to respond to the COVID-19 crisis with astounding speed, delivering life-saving vaccines within a year of identifying the virus. We should embolden and empower this strength, which is …

Analysis Of Breast Cancer Mortality In The Us-1975 To 2019, Jennifer L Caswell-Jin, Liyang P Sun, Diego Munoz, Ying Lu, Yisheng Li, Hui Huang, John M Hampton, Juhee Song, Jinani Jayasekera, Clyde Schechter, Oguzhan Alagoz, Natasha K Stout, Amy Trentham-Dietz, Sandra J Lee, Xuelin Huang, Jeanne S Mandelblatt, Donald A Berry, Allison W Kurian, Sylvia K Plevritis

Faculty, Staff and Student Publications

IMPORTANCE: Breast cancer mortality in the US declined between 1975 and 2019. The association of changes in metastatic breast cancer treatment with improved breast cancer mortality is unclear.

OBJECTIVE: To simulate the relative associations of breast cancer screening, treatment of stage I to III breast cancer, and treatment of metastatic breast cancer with improved breast cancer mortality.

DESIGN, SETTING, AND PARTICIPANTS: Using aggregated observational and clinical trial data on the dissemination and effects of screening and treatment, 4 Cancer Intervention and Surveillance Modeling Network (CISNET) models simulated US breast cancer mortality rates. Death due to breast cancer, overall and by …

Chagas Disease Diagnostic Practices At Four Major Hospital Systems In California And Texas, Emily A Kelly, Jose I Echeverri Alegre, Katherine Promer, Jesica Hayon, Roumen Iordanov, Khuzaima Rangwalla, Jerry J Zhang, Zian Fang, Cindy Huang, Cassiana E Bittencourt, Sharon Reed, Rosa M Andrade, Caryn Bern, Eva H Clark, Jeffrey D Whitman

Faculty, Staff and Students Publications

BACKGROUND: Chagas disease (CD) is a parasitic disease that affects ∼300 000 people living in the United States. CD leads to cardiac and/or gastrointestinal disease in up to 30% of untreated people. However, end-organ damage can be prevented with early diagnosis and antiparasitic therapy.

METHODS: We reviewed electronic health records of patients who underwent testing for CD at four hospital systems in California and Texas between 2016 and 2020. Descriptive analyses were performed as a needs assessment for improving CD diagnosis.

RESULTS: In total, 470 patients were tested for CD. Cardiac indications made up more than half (60%) of all …

Regional Variability In The Prevalence Of Food Insecurity And Diet Quality Among United States Children, Jayna M Dave, Tzuan A Chen, Alexandra N Castro, Mamie White, Elizabeth A Onugha, Sloane Zimmerman, Debbe Thompson

Children’s Nutrition Research Center Staff Publications

Understanding the association between food security status (FSS) and diet quality in children is crucial. This study investigated regional variability in FSS, participation in the federal nutrition assistance program (FNAP), and diet quality among US children. National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016 were analyzed. The association between FSS, FNAP participation, and diet quality (Healthy Eating Index—HEI-2015) was assessed using multiple linear/logistic regression models. The sample included 6403 children (mean age: 7.5 years; 51% male; 33% Hispanic). Within the sample, 13% reported child food insecurity, and 30% reported household food insecurity. Additionally, 90% participated in …

County-Level Trends And Potential Disparities In The Suicide Rates In Virginia, 2020 – 2022, Sharon A. Olowoyo, Oluwatosin M. Oduneye, Glodi B. Bokanya, Ayooluwa G. Olowoyo, Coralie E. Mugenga, Yuhan Yan, Robyn L. Anderson

Montview Journal of Research & Scholarship

Abstract

Objectives

This study aims to investigate the influence of social determinants of health (SDH) on suicide patterns in the state of Virginia.

Methods

A secondary statistical analysis was conducted using publicly accessible data from the County Health Rankings & Roadmaps database for Virginia. Data from 2020 to 2022 were analyzed, focusing on age-adjusted suicide rates and SDH factors, including % rural, mental health provider rate, median household income, high school completion, and unemployment rates. Multiple regression analysis and visualizations were employed for data interpretation.

Results

The analysis revealed that SDH factors significantly predicted suicide rates across the study period. …

Effect Of Acupuncture Vs Sham Acupuncture On Patients With Poststroke Motor Aphasia: A Randomized Clinical Trial, Boxuan Li, Shizhe Deng, Bifang Zhuo, Bomo Sang, Junjie Chen, Menglong Zhang, Guang Tian, Lili Zhang, Yuzheng Du, Peng Zheng, Gonglei Yue, Zhihong Meng

Faculty, Staff and Student Publications

IMPORTANCE: Motor aphasia is common among patients with stroke. Acupuncture is recommended as an alternative therapy for poststroke aphasia, but its efficacy remains uncertain.

OBJECTIVE: To investigate the effects of acupuncture on language function, neurological function, and quality of life in patients with poststroke motor aphasia.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, sham-controlled, randomized clinical trial was conducted in 3 tertiary hospitals in China from October 21, 2019, to November 13, 2021. Adult patients with poststroke motor aphasia were enrolled. Data analysis was performed from February to April 2023.

INTERVENTIONS: Eligible participants were randomly allocated (1:1) to manual acupuncture (MA) …

Collateral Effects Of Covid-19 Stay-At-Home Orders On Violence Against Women In The United States, January 2019 To December 2020, Patricia C. Lewis, Yuk F. Cheong, Nadine J. Kaslow, Kathryn M. Yount

Health Science Faculty Publications

Background: The necessary execution of non-pharmaceutical risk-mitigation (NPRM) strategies to reduce the transmission of COVID-19 has created an unprecedented natural experiment to ascertain whether pandemic-induced social-policy interventions may elevate collateral health risks. Here, we assess the efects on violence against women (VAW) of the duration of NPRM measures that were executed through jurisdictional-level orders in the United States. We expect that stay-at-home orders, by reducing mobility and disrupting non-coresident social ties, are associated with higher incident reporting of VAW.

Methods: We used aggregate data from the Murder Accountability Project from January 2019 through December 2020, to estimate count models examining …

Pediatric Medical Subspecialist Use In Outpatient Settings, Christopher B Forrest, Candice P Chen, Eliana M Perrin, Christopher J Stille, Ruth Cooper, Katherine Harris, Qian Luo, Mitchell G Maltenfort, Lauren E Parlett

Faculty, Staff and Student Publications

Importance

A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation’s children is describing rates of use and trends over time.

Objectives

To quantify rates of outpatient pediatric medical subspecialty use.

Design, Setting, and Participants

This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information …

Cost-Effectiveness Of Icosapent Ethyl In Reduce-It Usa: Results From Patients Randomized In The United States, William S Weintraub, Deepak L Bhatt, Zugui Zhang, Sarahfaye Dolman, William E Boden, Adam P Bress, Brandon K Bellows, Catherine G Derington, Sephy Philip, Gabriel Steg, Michael Miller, Eliot A Brinton, Terry A Jacobson, Jean-Claude Tardif, Christie M Ballantyne, Paul Kolm

Faculty, Staff and Students Publications

Background: In 3146 REDUCE-IT USA (Reduction of Cardiovascular Events With Icosapent Ethyl Intervention Trial USA) participants, icosapent ethyl (IPE) reduced first and total cardiovascular events by 31% and 36%, respectively, over 4.9 years of follow-up.

Methods and results: We used participant-level data from REDUCE-IT USA, 2021 US costs, and IPE costs ranging from $4.59 to $11.48 per day, allowing us to examine a range of possible medication costs. The in-trial analysis was participant-level, whereas the lifetime analysis used a Markov model. Both analyses considered value from a US health sector perspective. The incremental cost-effectiveness ratio (incremental costs divided by incremental …

High Suicide Rates Among Young Adults In The United States, Glory Thomas

Ballard Brief

The United States has a much higher suicide rate than other developed countries with an average of 14.5 deaths by suicide per 100,000 people per year. By contrast, the majority of countries across Europe, South America, and Asia report substantially lower rates, typically falling below 10 deaths per 100,000 people each year. Suicide is the second leading cause of death for young adults in the United States. Suicide is a public health crisis and is caused by multiple factors like untreated mental illness, individual attitudes towards suicide, and socio-economic status. Suicide leads to the negative consequence of suicide copycats, or …

The Overconsumption Of Ultra-Processed Foods In The United States, Emily Grover

Ballard Brief

The consumption of ultra-processed foods (UPFs) in America is at an all-time high, with over 50% of daily calories eaten being sourced from UPFs. The increase of consumption of UPFs is due to the growing population, urbanization, and industrialization. UPFs lead to declines in the physical health and mental health of the US population, as those who consume higher amounts of UPFs are more likely to be depressed, overweight, and have a higher all-cause mortality risk. The production of ultra-processed foods also disrupts the health of the climate due to unsustainable farming and livestock practices. The best practices for alleviating …

The Link Between Social Media And Body Image Issues Among Youth In The United States, James Krzymowski

Ballard Brief

Social media has a pervasive impact on body image in the United States, influencing one’s mental, physical, and social health. Body image issues encompass negative feelings and experiences related to one's physical appearance and are characterized by a preoccupation with perceived physical defects. This occurrence is especially common among youth. The harmful effects of constant exposure to idealized images, unrealistic beauty standards, and the influence of social media influencers are wide-ranging and severe. This brief focuses on the United States because of the competitive culture, the high cosmetic surgery rates, and leadership in social media use. Contributing factors such as …

Exploration Of Associations Between Asthma And Depression In Older American Adults: A Pooled Cross-Sectional Analysis Of Medicare Recipients, Brian Ring

Graduate Research Theses & Dissertations

Background

While unclear in older populations within the US, individuals with asthma are disproportionally affected by depression relative to those without asthma. This work explores the associations between asthma, depression, sociodemographic, and disease-related factors in a US population ≥ 65 years of age.

Methods

A pooled cross-sectional analysis of Medicare Current Beneficiary Survey (MCBS) data was utilized to determine the association between asthma and depression from 2018 to 2020. Depression was defined as a score of ≥ 10 from the Patient Health Questionnaire-9 (PHQ-9). Disease-related variables were recorded if the subject met Medicare claims criteria for the calendar year. Multivariable …

Multivariate Evaluation Of Flash Drought Across The United States, J. A. Otkin, Y. Zhong, T. W. Ford, M. C. Anderson, C. Hain, A. Hoell, Mark D. Svoboda, H. Wang

School of Natural Resources: Faculty Publications

No abstract provided.

The Shortage Of Primary Care Physicians In The United States, Its Impact On Health Outcomes, And Rationale For Potential Solutions, Jacob Mardovin, Graham Kessler

Scholarship in Medicine - All Papers

Purpose: In the United States there is a growing shortage of primary care physicians that has the potential to negatively impact health outcomes of the general population. In this study, we aim to explore this potential impact by investigating the relationship between the primary care physician to patient ratio, a representation of the shortage, and various health outcomes. Methods: The data for this study was collected from County Health Rankings and the variables included were the primary care physician to patient ratio, several health outcome variables looking at both length and quality of life, and the other primary care provider …

United States Of America, In The Forum Of Federations Handbook On Local Government In Federal Systems, Meryl Justin Chertoff

SALPAL Papers & Reports

Municipalities in the United States (US), particularly those in its largest metropolitan areas, drive economic growth and innovation and are home to the majority of the nation’s population, but their political status under the federal constitutional system of divided government is relatively weak. That does not mean US cities lack political power; it means that the federalist structure weakens, rather than enhances, city power. The US Constitution does not even mention cities, and the US federal structure has not evolved to reflect ‘city power’. There is a mismatch between the rise of cities on the global stage and their role …

Comparative Study Of Bystander Liability In The U.S. & The Iranian Legal Systems, Abbas Mirshekari, Zahra Takhshid, Mona Abdi

Sturm College of Law: Faculty Scholarship

Imagine that A has witnessed an incident in which B injures or kills C. It is undoubtedly painful to witness, but does it also follow that one can recover damages for suffering emotional distress as the result of witnessing the accident? The recognition of the tort of negligent infliction of emotional harm, also known as NIED, has been one of the ways that tort law has attempted to provide a remedy for the emotionally injured. Nevertheless, the relatively new tort has raised many questions. In the U.S. legal system, different criteria have been proposed over the years to allow for …

Exploring The Motivators Of Medical Tourism By Americans, Sebastian Uribe

Honors Program Theses

The purpose of this study was to look at the factors that influence Americans' decisions to engage in medical tourism (going overseas for medical treatment). The research aimed to empirically analyze the key criteria motivating Americans to participate in medical tourism. This involved a comprehensive examination of factors such as cost considerations, waiting times, the availability of procedures, and possible destinations. The study utilized both primary and secondary data. The primary data was collected by the means of a Qualtrics survey, in which a representative US respondent´s sample was used to test the various underlying hypotheses. A mixed-methods approach was …

Public Library Lending Programs Increase Radon Testing In Rural Communities, Stacy Stanifer, Kathy Rademacher, Whitney Beckett, King Simpson, Mary Kay Rayens, Amanda Thaxton Wigging, Ellen J. Hahn

UK CARES Faculty Publications

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public’s access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron- staff interactions …

Redesigning Surveillance Through The Global Emerging Infections Surveillance Program, David Brett-Major

Journal Articles: Epidemiology

No abstract provided.

“We’Ll Offer Asylum Just So Long As…” The Discrimination Of Poc And Lgbtq+ Refugees In Ongoing Refugee Crises, Faith N. Schaefer

Undergraduate Honors Theses

An ongoing refugee crisis is apparent in global politics and foreign relations. Still, the way receiving countries regard certain communities in this critical period has brought to light the inhumane discrimination solely based on one’s skin color and/or sexual identity. Despite the “open arms” policy that most nations tend to project, there is an unwritten protocol along borders that some states have chosen a “pick and choose” approach when it comes to People of Color (POC) and Lesbian, Gay, Bisexual, Transgender, Queer, and other gender non-conforming (LGBTQ+) individuals who are fleeing their country of origin. Any such prejudice and inequity …

Is The Women's Treaty A Paper Tiger? Indian Courts' Application Of The United Nations Treaty, Amanda L. Stephens

Faculty Articles

This Article examines whether the United Nations ("U.N.") Treaty, the Convention on the Elimination of All Forms of Discrimination Against Women ("CEDAW'), is a "paper tiger"-a law that seems powerful but is in fact weak and ineffectual. While some scholars question the Treaty's effectiveness based on statistical studies, others point to legal reforms in state parties as evidence of its success. Neither provides a nuanced middle ground by examining the CEDAW at a micro rather than a macro level. This Article fills this gap by conducting a qualitative analysis of 10 Indian judicial opinions. Specifically, the Article explores how the …

A Culturally Sensitive And Intersectional Approach To Healthcare Among Latinx Communities, Gabriela Meza

Nursing | Senior Theses

Various factors, including immigration status, language barriers, age, and socioeconomic status, influence healthcare service utilization among the Latinx population. This study seeks to assess whether culturally sensitive care addressing intersectional factors enhances health access and outcomes in low-income Latinx communities (Purpose). The research proposes a longitudinal quasi-experimental study involving 400 Latinx participants aged 18 and above in low-income urban Los Angeles neighborhoods. A control group of 200 participants and an intervention group of 200 will be established, with the latter receiving culturally sensitive interventions when seeking care during the study. A pre-study survey will collect demographic information, health history, healthcare …

The 2023 Society For Vascular Surgery, American Venous Forum, And American Vein And Lymphatic Society Clinical Practice Guidelines For The Management Of Varicose Veins Of The Lower Extremities. Part Ii: Endorsed By The Society Of Interventional Radiology And The Society For Vascular Medicine., Peter Gloviczki, Peter F Lawrence, Suman M Wasan, Mark H Meissner, Jose Almeida, Kellie R Brown, Ruth L Bush, Michael Di Iorio, John Fish, Eri Fukaya, Monika L Gloviczki, Anil Hingorani, Arjun Jayaraj, Raghu Kolluri, M Hassan Murad, Andrea T Obi, Kathleen J Ozsvath, Michael J Singh, Satish Vayuvegula, Harold J Welch

Heart and Vascular Articles

The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention …

Update To Gabapentinoid Use In The United States, 2002-2021., Michael E Johansen, Donovan T Maust

Ambulatory and Primary Care Articles

Gabapentinoids are commonly used medications for numerous off-label conditions. The 2002-2021 Medical Expenditure Panel Survey (MEPS) was used to investigate the proportion of the adult population who were gabapentinoid users, the ages of these users, medications and diagnoses associated with users, and the likelihood of starting, stopping, or continuing gabapentinoids. Gabapentinoid users continued to increase since our last publication from 4.0% in 2015 to 4.7% in 2021. Gabapentinoid use was much more likely among individuals who used other medications used in chronic pain. Between 2017-2021, numerous chronic pain conditions were associated with gabapentinoid use. New gabapentinoid users clearly outnumbered gabapentinoid …

Characterization And Z-Score Calculation Of Cardiovascular Magnetic Resonance Imaging Parameters In Patients After The Fontan Operation: A Fontan Outcome Registry Using Cardiovascular Magnetic Resonance Examinations Study, Tarek Alsaied, Manish Aggarwal, Et Al.

2020-Current year OA Pubs

BACKGROUND: Cardiac magnetic resonance (CMR) offers valuable hemodynamic insights post-Fontan, but is limited by the absence of normative single ventricle data. The Fontan Outcomes Registry using CMR Examinations (FORCE) is a large international Fontan-specific CMR registry. This study used FORCE registry data to evaluate expected CMR ventricular size/function and create Fontan-specific z-scores adjusting for ventricular morphology (VM) in healthier Fontan patients.

METHODS: "Healthier" Fontan patients were defined as patients free of adverse outcomes, who are New York Heart Association class I, have mild or less valve disease, and < 30% aortopulmonary collateral burden. General linear modeling was performed on 70% of the dataset to create z-scores for volumes and function. Models were tested using the remainder (30%) of the data. The z-scores were compared between children and adults. The z-scores were also compared between "healthier" Fontan and patients with adverse outcomes (death, listing for transplantation, or multiorgan disease).

RESULTS: The "healthier" Fontan population included 885 patients (15.0 ± 7.6 years) …

Equine Rescue Success In The United States: A Statistical Analysis, Carly J. Cave

Honors Theses and Capstones

The high inflation that has characterized the post-pandemic period in the United States has increased the costs of horse ownership for private owners and equine rescue organizations, which are facing critical pressures. Over 200,000 equines are at risk for neglect or slaughter in the United States each year, which far exceeds the capacity to house these equines at rescue organizations. While demand on these organizations is high, their ability to afford appropriate resources for their care is insufficient. This study examined geographical and economic factors that impact equine rescues’ success in taking in at-risk equines and adopting them to forever …

Exploring The Factors That Influence Female Offending In The U.S. And Mexico, Dana Villasenor

CMC Senior Theses

Hollywood has painted a picture of the criminal woman as a sexy, sneaky, and often psychotic female fatale. This is because men run Hollywood. Much like movies, research on why women offend had historically focused on men as their stellar. However, towards the turn of the century and with the disproportionate rise in female incarceration, literature caught up to the fact that women and men do not experience the same socialization, standards, or reality and, therefore, have different reasons for and ways of offending. This research explores those reasons for women in the U.S. and Mexico and paints the picture …