Medicine and Health Sciences Commons^™

Learning From Near Misses In Medication Errors: A Bayesian Approach, Jessica A. Myers, Francesca Dominici, Laura Morlock

Johns Hopkins University, Dept. of Biostatistics Working Papers

Medical errors originating in health care facilities are a significant source of preventable morbidity, mortality, and healthcare costs. Voluntary error report systems that collect information on the causes and contributing factors of medi- cal errors regardless of the resulting harm may be useful for developing effective harm prevention strategies. Some patient safety experts question the utility of data from errors that did not lead to harm to the patient, also called near misses. A near miss (a.k.a. close call) is an unplanned event that did not result in injury to the patient. Only a fortunate break in the chain of …

A Small Sample Correction For Estimating Attributable Risk In Case-Control Studies, Daniel B. Rubin

U.C. Berkeley Division of Biostatistics Working Paper Series

The attributable risk, often called the population attributable risk, is in many epidemiological contexts a more relevant measure of exposure-disease association than the excess risk, relative risk, or odds ratio. When estimating attributable risk with case-control data and a rare disease, we present a simple correction to the standard approach making it essentially unbiased, and also less noisy. As with analogous corrections given in Jewell (1986) for other measures of association, the adjustment often won't make a substantial difference unless the sample size is very small or point estimates are desired within fine strata, but we discuss the possible utility …

Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters

National Health Policy Forum

Medicaid costs for health and long-term care services for low-income individuals are substantial. As a result, each state’s “match rate,” or federal medical assistance percentage (FMAP), which determines the share of Medicaid benefit costs the federal government pays, has enormous implications for state budgets and state economies, as well as for Medicaid beneficiaries and providers. Shifts in the FMAP from year to year, even minor ones, can mean the gain or loss of tens or hundreds of millions of federal matching dollars, depending on the size of the state’s Medicaid program. This paper explains the FMAP formula, examines the limitations …

Gender Specific Differences In The Pros And Cons Of Smoking Among Current Smokers In Eastern Kentucky: Implications For Future Smoking Cessation Interventions, Dana A. Hazen, David M. Mannino, Richard Clayton

Preventive Medicine and Environmental Health Faculty Publications

This study investigated gender differences in the perceived “pros” and “cons” of smoking using the constructs of decisional balance (DB) and stage of change from the Transtheoretical Model. The population distribution for stage of change among a population-based, cross-sectional survey of 155 current smokers over 40 years was: precontemplation (22.6%), contemplation (41.9%), preparation (35.5%). Results of stepwise regression models indicated significant gender differences in DB were in the preparation stage of change; scores on the DB measure increased 3.94 points (95% CI: 1.94, 5.93) for male smokers. Interventions targeting the “pros” and “cons” of smoking may need to be gender …

Development Of Unicef Latin America/Caribbean (Lac) Well-Being Indicators, Mark Edberg

Prevention and Community Health Faculty Publications

No abstract provided.

Visioning The Future: Schoolbased Wellness Centers In Delaware: The Next 25 Years, Center For Health And Health Care In Schools

Center for Health and Health Care in Schools

In 2008, the Delaware Division of Public Health and Delaware Department of Education joined Nemours Prevention and Health Promotion in sponsoring a project to review 23 years of Wellness Center operations with the goal of identifying future directions for the program. The project was undertaken with a view towards determining what is the best health system and most effective wellness center strategies to support Delaware’s children. To assist with this work, the Center for Health and Health Care in Schools at George Washington University was asked to examine wellness center history, interview key participants in program and policy development, and …

Spatial Misalignment In Time Series Studies Of Air Pollution And Health Data, Roger D. Peng, Michelle L. Bell

Johns Hopkins University, Dept. of Biostatistics Working Papers

Time series studies of environmental exposures often involve comparing daily changes in a toxicant measured at a point in space with daily changes in an aggregate measure of health. Spatial misalignment of the exposure and response variables can bias the estimation of health risk and the magnitude of this bias depends on the spatial variation of the exposure of interest. In air pollution epidemiology, there is an increasing focus on estimating the health effects of the chemical components of particulate matter. One issue that is raised by this new focus is the spatial misalignment error introduced by the lack of …

An Analysis Of Current Healthcare Proposals: Obama And Mccain, Dan Terrell

Honors Projects in Economics

The healthcare system of the U.S. is broken. The next opportunity for overwhelming healthcare system reform will be when the next president takes office. This paper analyzes the 2008 presidential election candidates McCain and Obama healthcare proposals through a look at key players in the current healthcare system (government, pharmaceuticals, doctors, hospitals, and health insurance companies) and the affects of implementing such a plan. The presidential plans are presented side by side. Projected outcomes of the changes offered by Obama will be an increased role of the government and decreased power of the health insurance companies while increasing coverage. The …

Ecological Niche Of The 2003 West Nile Virus Epidemic In The Northern Great Plains Of The United States, Michael Wimberly, Michael B. Hildreth, Stephen P. Boyte, Erik Lindquist, Lon Kightlinger

Public Health Resources

Background: The incidence of West Nile virus (WNv) has remained high in the northern Great Plains compared to the rest of the United States. However, the reasons for the sustained high risk of WNv transmission in this region have not been determined. To assess the environmental drivers of WNv in the northern Great Plains, we analyzed the county-level spatial pattern of human cases during the 2003 epidemic across a seven-state region.
Methodology/Principal Findings: County-level data on WNv cases were examined using spatial cluster analysis, and were used to fit statistical models with weather, climate, and land use variables as predictors. …

Young People's Blood Alcohol Concentration And The Alcohol Consumption City Law, Brazil, Raquel De Boni, Carl G. Leukefeld, Flavio Pechansky

Center on Drug and Alcohol Research Faculty Publications

The paper assesses blood alcohol concentration and risk behaviors for traffic accidents before and after the implementation of a law which prohibits the use of alcoholic beverages on city gas stations. In Porto Alegre, Southern Brazil, young people go out at night and drive to gas station convenience stores to buy alcoholic beverages which are consumed on the premises of parking lots in gas stations. Data were obtained from self-administered questionnaires and breath analyzers in two cross-sectional collections with purposive samples of youngsters in May and July 2006 (n=62, and n=50, respectively). There were no significant differences between the groups …

How Does A Riverine Setting Affect The Lifestyle Of Shellmound Builders In Brazil?, Sabine Eggers, C. C. Petronilho, K. Brandt, C. Jericó-Daminello, J. Filippini, Karl Reinhard

Karl Reinhard Publications

The contact of inland and coastal prehistoric groups in Brazil is believed to have been restricted to regions with no geographical barrier, as is the case in the Ribeira de Iguape valley. The inland osteological collection from the riverine shellmound Moraes (5800–4500 BP) represents a unique opportunity to test this assumption for this region. Despite cultural similarities between riverine and coastal shellmounds, important ecological and site distribution differences are expected to impact on lifestyle. The purpose of this study is thus to document and interpret health and lifestyle indicators in Moraes in comparison to coastal shellmound groups. Specifically we test …

A Lesson On Homophobia And Teasing, Eva S. Goldfarb

Department of Public Health Scholarship and Creative Works

Homophobia and gay-related teasing are already present among young children. This lesson introduces the term “prejudice” and places the concept of homophobia within the context of bullying and teasing with which 8–11 year olds are already familiar. The lesson builds empathy as children think about and discuss how they have felt when they have been teased or called a name and how they think people in gay or lesbian families would feel. The lesson celebrates the lives of gay and lesbian people as it celebrates diversity among all people and families. Children are encouraged to think about the diversity within …

A Lesson On Homophobia And Teasing, Eva Goldfarb

Department of Public Health Scholarship and Creative Works

Homophobia and gay-related teasing are already present among young children. This lesson introduces the term “prejudice” and places the concept of homophobia within the context of bullying and teasing with which 8–11-year-olds are already familiar. The lesson builds empathy as children think about and discuss how they have felt when they have been teased or called a name and how they think people in gay or lesbian families would feel. The lesson celebrates the lives of gay and lesbian people as it celebrates diversity among all people and families. Children are encouraged to think about the diversity within their own …

Extended Kalman Filter For Estimation Of Parameters In Nonlinear State-Space Models Of Biochemical Networks, Xiaodian Sun, Li Jin, Momiao Xiong

Journal Articles

It is system dynamics that determines the function of cells, tissues and organisms. to develop mathematical models and estimate their parameters are an essential issue for studying dynamic behaviors of biological systems which include metabolic networks, genetic regulatory networks and signal transduction pathways, under perturbation of external stimuli. In general, biological dynamic systems are partially observed. Therefore, a natural way to model dynamic biological systems is to employ nonlinear state-space equations. Although statistical methods for parameter estimation of linear models in biological dynamic systems have been developed intensively in the recent years, the estimation of both states and parameters of …

The Role Of The Environment In Poverty Alleviation, Paolo Galizzi, Alena Herklotz

Environment

The new millennium raised hopes for a better future for humanity through a new spirit of international cooperation. Participants at the United Nations Millennium Summit agreed on an ambitious agenda for international cooperation that singled out, among other issues, environmental protection and development as key objectives.

The increasing degradation of our planet continues to emphasize the need to conserve and preserve natural resources. Yet with more than half of the global population still living on $2 dollars a day or less, there is also a glaring need for development initiatives to combat poverty.

This book draws on contributions to the …

Inaugural Conference Of The Mosakowski Institute For Public Enterprise- Program, Jim Gomes

Mosakowski Institute for Public Enterprise

Program for University Research and the American Agenda: Discovering Knowledge, Enabling Leadership. The Inaugural Conference of the Mosakowski Institute for Public Enterprise.

Klimowicz, Teresa Dolores (Fa 352), Manuscripts & Folklife Archives

FA Finding Aids

Finding aid and full-text scan of paper (Click on “Additional Files” below) for Folklife Archives Project 352. Paper: "[Aerobics Class]" written by Teresa Dolores Klimowicz for a Western Kentucky University folk studies class.

Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit

National Health Policy Forum

Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a …

Surgical Management Of Blunt Pancreatic Trauma: A Modus Operandi Or Individualized Therapy?, Muhammad Rizwan Khan, Kiran Ejaz

Section of General Surgery

The overall rate of blunt pancreatic trauma observed in level one trauma centers is rather low compared to other injuries, with a reported prevalence of 0.4 per 100,000 hospital admissions. The situation may be further complicated by the presence of associated major visceral injuries in these patients. A number of previous reports indicate that blunt pancreatic trauma carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Many mandate prompt surgical explorations for organ-specific diagnosis on CT; however other literature and upcoming studies prove otherwise. Over the years, several technologic advances have increased the …

Exploratory Study Of Environmental Effects On Physical Activity And Overweight In Older Women: Research Update, Heather A. Whitcomb, Kosuke Tamura, Lauren Milius, Francine Laden, Steve Melly, Peter James, Robin Puett, Ellen Cromley, Eran Ben-Joseph, Philip J. Troped

GIS Day

Background: Physical inactivity and obesity are major public health issues. Recent studies have provided evidence that attributes of the built environment influence physical activity among adults and that factors such as greater urban sprawl are related to overweight and obesity. Few studies have developed objective individual-level measures of the built environment, a geographic scale that may be more relevant to certain types of physical activity, such as walking. In addition, further research is needed to assess the associations of both objective and perceived environmental factors with physical activity. In this 2-year exploratory study funded by the National Cancer Institute, we …

Australian Consumer Attitudes To Health Claim - Food Product Compatibility For Functional Foods, P. G. Williams, L. Ridges, M. Batterham, B. Ripper, M. C. Hung

Faculty of Health and Behavioural Sciences - Papers (Archive)

This study with Australian consumers investigated how appealing different health claims combined with particular food carriers were to Australian consumers, and compared the results of a similar study with Dutch consumers. 149 shoppers considered up to 30 different food concepts, rating how ‘attractive’, ‘believable’, and ‘new and different’ they found each concept and their ‘intention to try’. Each variable was significantly related to intention to try (p<0.001) and together explained 56% of the intention score. Claims and carriers independently had a significant effect on ratings of attractiveness and intention to try but, unlike the Dutch study, the carrier was a more important predictor of intention to purchase than the claim. Implications for regulation of health claims for food are discussed.

Toward Using National Cancer Surveillance Data For Preventing And Controlling Cervical And Other Human Papillomavirus-Associated Cancers In The Us, Mona Saraiya, Faruque Ahmed, Mary White, Herschel Lawson, Elizabeth R. Unger, Christie Eheman

Public Health Resources

This supplement, known as the ABHACUS (Assessing the Burden of HPV-Associated Cancers in the United States) supplement, contains 22 articles. Together, these articles provide a comprehensive snapshot of data related to the occurrence and control of multiple cancers that have been associated with the human papillomavirus (HPV). These analyses highlight the burden of HPV associated cancers in the US population as a whole and among vulnerable population subgroups. We anticipate that these findings will be an important resource for enhancing existing strategies for the prevention and control of HPV associated cancers.

HPV is estimated to be responsible for 5.2% of …

Breast Cancer Fatalism: The Role Of Women's Perceptions Of The Health Care System, Allyson G. Hall, Amal J. Khoury, Ellen D.S. Lopez, Nedra Lisovicz, Amanda Avis-Williams, Amal K. Mitra

Faculty Publications

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents' knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, …

Childhood Lymphohematopoietic Cancer Incidence And Hazardous Air Pollutants In Southeast Texas, 1995–2004, Kristina W. Whitworth, Elaine Symanski, Ann L. Coker

CRVAW Faculty Journal Articles

BACKGROUND: Cancer is the second leading cause of death among U.S. children with few known risk factors. There is increasing interest in the role of air pollutants, including benzene and 1,3-butadiene, in the etiology of childhood cancers.

OBJECTIVE: Our goal was to assess whether census tracts with the highest benzene or 1,3-butadiene ambient air levels have increased childhood lymphohematopoietic cancer incidence.

METHODS: Our ecologic analysis included 977 cases of childhood lymphohematopoietic cancer diagnosed from 1995–2004. We obtained the U.S. Environmental Protection Agency’s 1999 modeled estimates of benzene and 1,3-butadiene for 886 census tracts surrounding Houston, Texas. We ran Poisson regression …

Cardiorespiratory Fitness As A Predictor Of Fatal And Nonfatal Stroke In Asymptomatic Women And Men, Steven P. Hooker, Xuemei Sui, Natalie Colabianchi, John E. Vena, James N. Laditka, Michael J. Lamonte, Steven N. Blair

Faculty Publications

Background and Purpose - Prospective data on the association between cardiorespiratory fitness (CRF) and stroke are largely limited to studies in men or do not separately examine risks for fatal and nonfatal stroke. This study examined the association between CRF and fatal and nonfatal stroke in a large cohort of asymptomatic women and men.

Methods - A total of 46,405 men and 15,282 women without known myocardial infarction or stroke at baseline completed a maximal treadmill exercise test between 1970 and 2001. CRF was grouped as quartiles of the sex-specific distribution of maximal metabolic equivalents achieved. Mortality follow-up was through …

Neuroimaging And Recovery Of Language In Aphasia, Cynthia K. Thompson, Dirk B. Den Ouden

Faculty Publications

The use of functional neuroimaging techniques has advanced what is known about the neural mechanisms used to support language processing in aphasia resulting from brain damage. This paper highlights recent findings derived from neuroimaging studies focused on neuroplasticity of language networks, the role of the left and right hemispheres in this process, and studies examining how treatment affects the neurobiology of recovery. We point out variability across studies as well as factors related to this variability, and we emphasize challenges that remain for research.

Roofing Foreman Dies From Telescopic Boom Lift Fall, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

On a winter day in 2008, a male roofer/ foreman died after falling from a telescopic boom lift. He and four other roofing crew members were installing a new roof at a residence undergoing restoration. They had arrived at the job site at approximately 7:45 AM.

At approximately 8:00 AM, the foreman and two roofers were installing flashing on the roof of an alcove on the south side of the house while two other roofers were in a pickup truck putting on coveralls. The crew on the roof needed red rosin underlayment (paper) which was in the pickup truck. Using …

Concept, Design And Implementation Of A Cardiovascular Gene-Centric 50 K Snp Array For Large-Scale Genomic Association Studies, Brendan J. Keating, Sam Tischfield, Sarah S. Murray, Tushar Bhangale, Thomas S. Price, Joseph T. Glessner, Luana Galver, Jeffrey C. Barrett, Struan F A Grant, Deborah N. Farlow, Hareesh R. Chandrupatla, Mark Hansen, Saad Ajmal, George J. Papanicolaou, Yiran Guo, Mingyao Li, Stephanie Derohannessian, Paul I W. De Bakker, Swneke D. Bailey, Alexandre Montpetit, Andrew C. Edmondson, Kent Taylor, Xiaowu Gai, Susanna S. Wang, Myriam Fornage, Tamim Shaikh, Leif Groop, Michael Boehnke, Alistair S. Hall, Andrew T. Hattersley, Edward Frackelton, Nick Patterson, Charleston K W Chiang, Cecelia E. Kim, Richard R. Fabsitz, Willem Ouwehand, Alkes L. Price, Patricia Munroe, Mark Caulfield, Thomas Drake, Eric Boerwinkle, David Reich, A Stephen Whitehead, Thomas P. Cappola, Nilesh J. Samani, A Jake Lusis, Eric Schadt, James G. Wilson, Wolfgang Koenig, Mark I. Mccarthy, Sekar Kathiresan, Stacey B. Gabriel, Hakon Hakonarson, Sonia S. Anand, Muredach Reilly, James C. Engert, Deborah A. Nickerson, Daniel J. Rader, Joel N. Hirschhorn, Garret A. Fitzgerald

Journal Articles

A wealth of genetic associations for cardiovascular and metabolic phenotypes in humans has been accumulating over the last decade, in particular a large number of loci derived from recent genome wide association studies (GWAS). True complex disease-associated loci often exert modest effects, so their delineation currently requires integration of diverse phenotypic data from large studies to ensure robust meta-analyses. We have designed a gene-centric 50 K single nucleotide polymorphism (SNP) array to assess potentially relevant loci across a range of cardiovascular, metabolic and inflammatory syndromes. The array utilizes a "cosmopolitan" tagging approach to capture the genetic diversity across approximately 2,000 …

Calibrating Parametric Subject-Specific Risk Estimation, Tianxi Cai, Lu Tian, Hajime Uno, Scott D. Solomon, L. J. Wei

Harvard University Biostatistics Working Paper Series

No abstract provided.

Tending To Richmond's Children: Community Strategies To Bridge Service Gaps, Judith D. Moore, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community's efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and …