Medicine and Health Sciences Commons^™

Microbial Communities In Human Milk Relate To Measures Of Maternal Weight, Sara N. Lundgren, Juliette C. Madan, Margaret R. Karagas, Hilary G. Morrison, Anne G. Hoen, Brock C. Christensen

Dartmouth Scholarship

The process of breastfeeding exposes infants to bioactive substances including a diversity of bacteria from breast milk as well as maternal skin. Knowledge of the character of and variation in these microbial communities, as well as the factors that influence them, is limited. We aimed to identify profiles of breastfeeding-associated microbial communities and their association with maternal and infant factors. Bilateral milk samples were collected from women in the New Hampshire Birth Cohort Study at approximately 6 weeks postpartum without sterilization of the skin in order to capture the infant-relevant exposure. We sequenced the V4–V5 hypervariable region of the bacterial …

Determining Levers Of Cost-Effectiveness For Screening Infants At High Risk For Peanut Sensitization Before Early Peanut Introduction, Matthew Greenhawt, Marcus Shaker

Dartmouth Scholarship

Importance Early peanut introduction reduces the risk of developing peanut allergy, especially in high-risk infants. Current US recommendations endorse screening but are not cost-effective relative to other international strategies.

Objective To identify scenarios in which current early peanut introduction guidelines would be cost-effective.

Design, Setting, and Participants This simulation/cohort economic evaluation used microsimulations and cohort analyses in a Markov model to evaluate the cost-effectiveness of early peanut introduction with and without peanut skin prick test (SPT) screening in high-risk infants during an 80-year horizon from a societal perspective. Data were analyzed from April to May 2019.

Exposures High-risk infants with …

Replication Study: Biomechanical Remodeling Of The Microenvironment By Stromal Caveolin-1 Favors Tumor Invasion And Metastasis, Mee Rie Sheen, Jennifer L. Fields, Brian Northan, Judith Lacoste, Lay-Hong Ang, Steven Fiering

Dartmouth Scholarship

As part of the Reproducibility Project: Cancer Biology we published a Registered Report (Fiering et al., 2015) that described how we intended to replicate selected experiments from the paper ‘Biomechanical remodeling of the microenvironment by stromal caveolin-1 favors tumor invasion and metastasis’ (Goetz et al., 2011). Here we report the results. Primary mouse embryonic fibroblasts (pMEFs) expressing caveolin 1 (Cav1WT) demonstrated increased extracellular matrix remodeling in vitro compared to Cav1 deficient (Cav1KO) pMEFs, similar to the original study (Goetz et al., 2011). In vivo, we found higher levels of intratumoral stroma remodeling, determined by fibronectin fiber orientation, in tumors …

Feasibility And Acceptability Of A Rural, Pragmatic, Telemedicine‐ Delivered Healthy Lifestyle Programme, John A. Batsis, Auden C. Mcclure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, Richard I. Rothstein

Dartmouth Scholarship

Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two‐way video‐conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth‐Hitchcock Weight and Wellness Center were recruited into a pragmatic, single‐arm, nonrandomized study of a remotely delivered 16‐week evidence‐based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on …

Exploring The State-Of-Receptivity For Mhealth Interventions, Florian Künzler, Varun Mishra, Jan-Niklas Kramer, David Kotz, Elgar Fleisch, Tobias Kowatsch

Dartmouth Scholarship

Recent advancements in sensing techniques for mHealth applications have led to successful development and deployments of several mHealth intervention designs, including Just-In-Time Adaptive Interventions (JITAI). JITAIs show great potential because they aim to provide the right type and amount of support, at the right time. Timing the delivery of a JITAI such as the user is receptive and available to engage with the intervention is crucial for a JITAI to succeed. Although previous research has extensively explored the role of context in users’ responsiveness towards generic phone notiications, it has not been thoroughly explored for actual mHealth interventions. In this …

Association Of Receiving Multiple, Concurrent Fracture-Associated Drugs With Hip Fracture Risk, Rebecca T. Emeny, Chiang-Hua Chang, Jonathan Skinner, James A. O'Malley, Jeremy Smith, Gouri Chakraborti, Clifford J. Rosen, Nancy E. Morden

Dartmouth Scholarship

Importance: Many prescription drugs increase fracture risk, which raises concern for patients receiving 2 or more such drugs concurrently. Logic suggests that risk will increase with each additional drug, but the risk of taking multiple fracture-associated drugs (FADs) is unknown.

Objective: To estimate hip fracture risk associated with concurrent exposure to multiple FADs.

Design, Setting, and Participants: This cohort study used a 20% random sample of Medicare fee-for-service administrative data for age-eligible Medicare beneficiaries from 2004 to 2014. Sex-stratified Cox regression models estimated hip fracture risk associated with current receipt of 1, 2, or 3 or more of 21 FADs …

Characterization Of A Non-Contact Imaging Scintillator-Based Dosimetry System For Total Skin Electron Therapy., Irwin I. Tendler, Petr Bruza, Michael Jermyn, Xu Cao, Benjamin B. Williams, Lesley A. Jarvis, Brian W. Pogue, David J. Gladstone

Dartmouth Scholarship

Surface dosimetry is required for ensuring effective administration of total skin electron therapy (TSET); however, its use is often reduced due to the time consuming and complex nature of acquisition. A new surface dose imaging technique was characterized in this study and found to provide accurate, rapid and remote measurement of surface doses without the need for post-exposure processing. Disc-shaped plastic scintillators (1 mm thick  ×  15 mm [Formula: see text]) were chosen as optimal-sized samples and designed to attach to a flat-faced phantom for irradiation using electron beams. Scintillator dosimeter response to radiation damage, dose rate, and temperature were …

Use Of Amulet In Behavioral Change For Geriatric Obesity Management, John A. Batsis, Alexandra B. Zagaria, Ryan J. Halter, George G. Boateng, Patrick Proctor, Stephen J. Bartels, David Kotz

Dartmouth Scholarship

Background: Obesity in older adults is a significant public health concern. Weight-loss interventions are known to improve physical function but risk the development of sarcopenia. Mobile health devices have the potential to augment existing interventions and, if designed accordingly, could improve one’s physical activity and strength in routine physical activity interventions.

Methods and results: We present Amulet, a mobile health device that has the capability of engaging patients in physical activity. The purpose of this article is to discuss the development of applications that are tailored to older adults with obesity, with the intention to engage and improve their health. …

Development And Usability Assessment Of A Connected Resistance Exercise Band Application For Strength-Monitoring, John A. Batsis, George G. Boateng, Lillian M. Seo, Curtis L. Petersen, Karen L. Fortuna, Emily V. Wechsler, Ronald J. Peterson, Summer B. Cook, Dawna Pidgeon, Rachel S. Dokko, Ryan J. Halter, David F. Kotz

Dartmouth Scholarship

Resistance exercise bands are a core component of any physical activity strengthening program. Strength training can mitigate the development of sarcopenia, the loss of muscle mass or strength and function with aging. Yet, the adherence of such behavioral exercise strategies in a home-based setting are fraught with issues of monitoring and compliance. Our group developed a Bluetooth-enabled resistance exercise band capable of transmitting data to an open-source platform. In this work, we developed an application to capture this information in real-time, and conducted three usability studies in two mixed-aged groups of participants (n=6 each) and a group of older adults …

Signal Intensity Analysis And Optimization For In Vivo Imaging Of Cherenkov And Excited Luminescence., Ethan P. M. Larochelle, Jennifer R. Shell, Jason R. Gunn, Scott C. Davis, Brian W. Pogue

Dartmouth Scholarship

During external beam radiotherapy (EBRT), in vivo Cherenkov optical emissions can be used as a dosimetry tool or to excite luminescence, termed Cherenkov-excited luminescence (CEL) with microsecond-level time-gated cameras. The goal of this work was to develop a complete theoretical foundation for the detectable signal strength, in order to provide guidance on optimization of the limits of detection and how to optimize near real time imaging. The key parameters affecting photon production, propagation and detection were considered and experimental validation with both tissue phantoms and a murine model are shown. Both the theoretical analysis and experimental data indicate that the …

Technology For Behavioral Change In Rural Older Adults With Obesity, John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels, Elizabeth Carpenter-Song

Dartmouth Scholarship

Background: Mobile health (mHealth) technologies comprise a multidisciplinary treatment strategy providing potential solutions for overcoming challenges of successfully delivering health promotion interventions in rural areas. We evaluated the potential of using technology in a high-risk population.

Methods: We conducted a convergent, parallel mixed-methods study using semi-structured interviews, focus groups, and self-reported questionnaires, using purposive sampling of 29 older adults, 4 community leaders and 7 clinicians in a rural setting. We developed codes informed by thematic analysis and assessed the quantitative data using descriptive statistics.

Results: All groups expressed that mHealth could improve health behaviors. Older adults were optimistic that mHealth …