Medicine and Health Sciences Commons^™

Management Of Children With Chronic Wet Cough And Protracted Bacterial Bronchitis Chest Guideline And Expert Panel Report, Anne B. Chang, John J. Oppenheimer, Miles M. Weinberger, Bruce K. Rubin, Cameron C. Grant, Kelly Weir, Richard S. Irwin, Chest Expert Cough Panel

Pediatrics Publications

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged
METHODS: We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus for the recommendations/suggestions made.

RESULTS: Combining data from the …

Impaired Myocardial Relaxation With Exercise Determines Peak Aerobic Exercise Capacity In Heart Failure With Preserved Ejection Fraction, Cory Trankle, Justin M. Canada, Leo Buckley, Salvatore Carbone, Dave Dixon, Ross Arena, Benjamin Van Tassell, Antonio Abbate

Pharmacotherapy and Outcomes Science Publications

Background

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by impaired exercise capacity due to shortness of breath and/or fatigue. Assessment of diastolic dysfunction at rest and with exercise may provide insight into the pathophysiology of exercise intolerance in HFpEF.

Aims

To measure echocardio-Doppler-derived parameters of diastolic function as they relate to various indices of aerobic exercise capacity in HFpEF.

Methods

We selected 16 subjects with clinically stable HFpEF, no evidence of volume overload, but impaired functional capacity by cardiopulmonary exercise testing [peak oxygen consumption (VO₂)]. We measured the transmitral E and A flow …

A Comparison Of Parameter Covariance Estimation Methods For Item Response Models In An Expectation-Maximization Framework, Joshua N. Pritikin

Psychiatry Publications

The Expectation-Maximization (EM) algorithm is a method for finding the maximum likelihood estimate of a model in the presence of missing data. Unfortunately, EM does not produce a parameter covariance matrix for standard errors. Both Oakes and Supplemented EM are methods for obtaining the parameter covariance matrix. SEM was discovered in 1991 and is implemented in both opensource and commercial item response model estimation software. Oakes, a more recent method discovered in 1999, had not been implemented in item response model software until now. Convergence properties, accuracy, and elapsed time of Oakes and Supplemental EM family algorithms are compared for …

Symptom Domain Groups Of The Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations And Re-Hospitalizations In Cirrhosis, Kavish R. Patidar, Leroy R. Thacker, James B. Wade, Melanie B. White, Edith A. Gavis, Andrew Fagan, Richard K. Sterling, Michael Fuchs, Mohammad S. Siddiqui, Scott Matherly, Richard T. Stravitz, Arun J. Sanyal, Puneet Puri, Velimir A. Luketic, Jasmohan S. Bajaj

Psychiatry Publications

Background

Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication.

Aim

Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis.

Methods

Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated …

A Power Calculator For The Classical Twin Design, Brad Verhulst

Psychiatry Publications

Power is a ubiquitous, though often overlooked, component of any statistical analyses. Almost every funding agency and institutional review board requires that some sort of power analysis is conducted prior to data collection. While there are several excellent on line power calculators for independent observations, twin studies pose unique challenges that are not incorporated into these algorithms. The goal of the current manuscript is to outline a general method for calculating power in twin studies, and to provide functions to allow researchers to easily conduct power analyses for a range of common twin models. Several scenarios are discussed to demonstrate …

Somatic Symptom Disorder In Dermatology, James L. Levenson, Aditi A. Sharma, Alex G. Ortega-Loayza

Psychiatry Publications

Somatic symptom disorder (SSD) is defined by the prominence of somatic symptoms associated with abnormal thoughts, feelings, and behaviors related to the symptoms, resulting in significant distress and impairment. Individuals with these disorders are more commonly encountered in primary care and other medical settings, including dermatology practice, than in psychiatric and other mental health settings. What defines the thoughts, feelings, and behaviors as abnormal is that they are excessive, that is, out of proportion to other patients with similar somatic symptoms, and that they result in significant distress and impairment. SSD may occur with or without the presence of a …

Molecular Genetic Influences On Normative And Problematic Alcohol Use In A Population-Based Sample Of College Students, Bradley T. Webb, Alexis C. Edwards, Aaron R. Wolen, Jessica E. Salvatore, Fazil Aliev, Brien P. Riley, Cuie Sun, Vernell S. Williamson, James N. Kitchens, Kimberly Pedersen, Amy Adkins, Megan E. Cooke, Jeanne E. Savage, Zoe Neale, Seung B. Cho, Danielle M. Dick, Kenneth S. Kendler

Psychiatry Publications

Background: Genetic factors impact alcohol use behaviors and these factors may become increasingly evident during emerging adulthood. Examination of the effects of individual variants as well as aggregate genetic variation can clarify mechanisms underlying risk.

Methods: We conducted genome-wide association studies (GWAS) in an ethnically diverse sample of college students for three quantitative outcomes including typical monthly alcohol consumption, alcohol problems, and maximum number of drinks in 24 h. Heritability based on common genetic variants (h2SNP) was assessed. We also evaluated whether risk variants in aggregate were associated with alcohol use outcomes in an independent sample of young …

Electroconvulsive Therapy In Geriatric Patients: A Literature Review And Program Report From Virginia Commonwealth University, Richmond, Virginia, Usa, Andrew D. Snyder, Vasu Venkatachalam, Ananda Pandurangi

Psychiatry Publications

Electroconvulsive therapy (ECT) is an effective therapeutic intervention in the elderly patients with major depression, especially those with psychosis, suicidality, catatonia, nutritional compromise, and resistance to medications. Response rates can be as high as 80%. We present an extensive review of the relevant literature, provide a description of the ECT program at Virginia Commonwealth University in Richmond, Virginia, USA, and present results of our experience with ECT in fifty elderly patients. The treatments were safe, well tolerated, and produced high response rates, variably between 68% and 84%. Patients in the long‑term maintenance ECT program continue to show sustained benefits from …

Prevalence Of Past-Year Dental Visit Among Us Adults, 1999– 2010: Comparison Of Trends And Estimates Between The Behavioral Risk Factor Surveillance System And Three National Surveys, Mei Lin, Chen-Hsun Li, Liang Wei, Shillpa Naavaal, Shellie Kolavic Gray, Michael C. Manz, Laurie Barker

Dental Public Health and Policy Publications

Objectives: To compare estimated prevalence of past-year dental visit (PPYDV) among US adults aged ≥18 years from the Behavioral Risk Factor Surveillance System (BRFSS) to estimates from the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), and National Health and Nutrition Examination Survey (NHANES).

Methods: We estimated PPYDV adjusted for covariates (age, race/ethnicity, education level, poverty status, edentulism) using BRFSS, MEPS, and NHIS 1999-2010, and NHANES 1999-2004. We tested trend in overall PPYDV for BRFSS, MEPS, and NHIS from 1999-2010. For 2002 and 2010, we calculated absolute differences (AD) and 95% confidence intervals (CI) in PPYDV between BRFSS …

The Effect Of Health And Dental Insurance On Us Children’S Dental Care Utilization For Urgent And Non-Urgent Dental Problems - 2008, Shillpa Naavaal, Laurie K. Barker, Susan O. Griffin

Dental Public Health and Policy Publications

Objective: We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage.

Methods: We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had …

Quantifying Variation In Gait Features From Wearable Inertial Sensors Using Mixed Effects Models, Kellen Garrison Cresswell, Yongyun Shin, Shanshan Chen

Biostatistics Publications

The emerging technology of wearable inertial sensors has shown its advantages in collecting continuous longitudinal gait data outside laboratories. This freedom also presents challenges in collecting high-fidelity gait data. In the free-living environment, without constant supervision from researchers, sensor-based gait features are susceptible to variation from confounding factors such as gait speed and mounting uncertainty, which are challenging to control or estimate. This paper is one of the first attempts in the field to tackle such challenges using statistical modeling. By accepting the uncertainties and variation associated with wearable sensor-based gait data, we shift our efforts from detecting and correcting …

Comorbidity, Pain, Utilization, And Psychosocial Outcomes In Older Versus Younger Sickle Cell Adults: The Pisces Project, Donna K. Mcclish, Wally R. Smith, James L. Levenson, Imoigele P. Aisiku, John D. Roberts, Susan D. Roseff, Viktor E. Bovbjerg

Biostatistics Publications

Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16–25 (transition), 26–36 (younger adults), and 37–64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer …

Tobacco Use And Health Insurance Literacy Among Vulnerable Populations: Implications For Health Reform, Robert T. Braun, Yaniv Hanoch, Andrew J. Barnes

Health Policy Publications

Background: Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy – a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces …

Evaluation Of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review, Susan O. Griffin, Shillpa Naavaal, Christina Scherrer, Mona Patel, Sajal Chattopadhyay

Dental Public Health and Policy Publications

Context

A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review.

Evidence acquisition

Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies—ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); …

Virginia Dental Journal (Vol. 94, No. 1, 2017)

Virginia Dental Journal

No abstract provided.

Virginia Dental Journal (Vol. 94, No. 3, 2017)

Virginia Dental Journal

No abstract provided.

A Comprehensive Summary Of Services And Resources Provided By Librarians In Support Of Coda Accredited Predoctoral (Dds/Dmd) Dental Education Programs In The United States And Canada, Irene M. Lubker, Elizabeth Stellrecht, Richard Mcgowan, Nena Schvaneveldt, Susan Arnold, Elisa Cortez, Rebecca Davis, Michael Kronenfield, Nicole Theis-Mahon

VCU Libraries Faculty and Staff Presentations

Objective

The objective of this study is to provide a summary of library services and resources that support dental education and research. This summary will demonstrate trends in dental librarianship as well as services and resources that can be adopted to serve the needs of dental related education programs. To date, there has not been a comprehensive summary of these services.

Methods

An environmental scan was carried out to take inventory of services that dental librarians (1) provide. The study population consisted of librarians who work in dental libraries or college / university libraries that serve dental programs. The librarians …

Feasibility Of A Relaxation Guided Imagery Intervention To Reduce Maternal Stress In The Nicu, Lois C. Howland, Nancy Jallo, Cynthia D. Connelly, Rita H. Pickler

School of Nursing Publications

Objective: To test the feasibility of a relaxation guided imagery (RGI) intervention for mothers of hospitalized preterm infants and to explore the biobehavioral effects of RGI on their distress, responsiveness, and physiological stress.

Design: Single sample, pretest-posttest design.

Setting: A large Level III NICU in Southern California.

Participants: Twenty mothers of hospitalized preterm infants (24-32 weeks gestational age).

Methods: Correlational analyses of RGI use with self-reported measures of distress (perceived stress, state anxiety, and depression symptoms), awakening salivary cortisol level, and salivary cortisol awakening response collected from mothers at baseline and after 8 weeks of an RGI intervention.

Results: Nineteen …

Factors Distinguishing Positive Deviance Among Low-Income African American Women: A Qualitative Study On Infant Feeding, Cecilia E. Barbosa, Saba W. Masho, Kellie E. Carlyle, Maghboeba Mosavel

School of Nursing Publications

Background: Positive deviant individuals practice beneficial behaviors in spite of having qualities characterizing them as high risk for unhealthy behaviors.

Objective: This study aimed to identify and understand factors distinguishing low-income African American women who breastfeed the longest (positive deviants) from those who breastfeed for a shorter duration or do not breastfeed.

Methods: Seven mini-focus groups on infant-feeding attitudes and experiences were conducted with 25 low-income African American women, grouped by infant-feeding practice. Positive deviants, who had breastfed for 4 months or more, were compared with formula-feeding participants who had only formula fed their babies and short-term breastfeeding participants who …

Collaborative Instruction For Information Retrieval And Appraisal Skills In Evidence-Based Practice Models For Dental Hygiene Students., Irene M. Lubker, Joan M. Pellegrini

VCU Libraries Faculty and Staff Presentations

Objectives:

1. Collaborate with VCU Dental Hygiene Program faculty to develop and evaluate a model of evidence-based practice (EBP) for students in didactic and clinical settings.

2. Describe how a course was modified to emphasize evidence-based practice.

3. Analyze course evaluations and student scholarly output.

Methods/Materials:

Dental educators strive to develop graduates who practice evidence-based practice and whose clinical decisions are based on current scientific research. A medical librarian was invited to assist in integrating EBP into the dentistry curriculum in 2012. To gain a better understanding of EBP in dental settings, the librarian and dental hygiene faculty attended the …

Assessing Attitudinal Barriers To Health Insurance Enrollment And Facilitation In Vulnerable Populations, Christopher Brown

Health Sciences Education Symposium

Introduction: Homeless individuals bear a disproportionately high burden of disease. Lack of health insurance amongst homeless populations is a significant barrier to healthcare access.

Methods: This study explored barriers and facilitators to health insurance via a survey-format that focused predominantly on attitudes towards health insurance and enrollment assistance.

Results: Majority of respondents endorse a facilitator to guide the enrollment process at their location of healthcare. While 43.8% of participants reported they knew where to go for enrollment assistance, 43.7% did not. 100% of participants agreed that health insurance is important, while only 43.1% were insured.

Conclusion: Distrust regarding facilitation in …

Depression In Low-Income Adolescents: Guidelines For School-Based Depression Intervention Programs, Gopika Hari

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Adolescent depression is growing in interest to clinicians. In addition to the estimated 2 million cases of adolescent major depressive episodes each year, depressive symptoms in youth have become indicators of mental health complications later in life. Studies indicate that being low-income is a risk factor for depression and that socioeconomically disadvantaged teenagers are more than twice as likely to develop mental illnesses. Only an estimated 1 in 4 children with mental illnesses receive adequate help and 80% of these resources come through schools. Thus, this study focuses on establishing the importance of depression intervention programs in low-income high schools …

Liver Adiposity And Metabolic Profile In Individuals With Chronic Spinal Cord Injury, Kathleen C. Rankin, Laura C. O’Brien, Liron Segal, M. Rehan Khan, Ashraf S. Gorgey

Physiology and Biophysics Publications and Presentations

Purpose. To quantify liver adiposity using magnetic resonance imaging (MRI) and to determine its association with metabolic profile in men with spinal cord injury (SCI). Materials and Methods. MRI analysis of liver adiposity by fat signal fraction (FSF) and visceral adipose tissue (VAT) was completed on twenty participants. Intravenous glucose tolerance test was conducted to measure glucose effectiveness (𝑆g) and insulin sensitivity (𝑆i ). Lipid panel, fasting glucose, glycated hemoglobin (HbA1c), and inflammatory cytokines were also analyzed. Results. Average hepatic FSF was 3.7% ± 2.1. FSF was positively related to TG, non-HDL-C, fasting glucose, HbA1c, VAT, and …

Cyclic-Amp Regulates Postnatal Development Of Neural And Behavioral Responses To Nacl In Rats, Jie Qian, Shobha Mummalaneni, Tam-Hao T. Phan, Gerard L. Heck, John A. Desimone, David West, Sunila Mahavadi, Deanna Hojati, Karnam S. Murthy, Mee-Ra Rhyu, Andrew I. Spielman, Mehmet H. Özdener, Vijay Lyall

Physiology and Biophysics Publications and Presentations

During postnatal development rats demonstrate an age-dependent increase in NaCl chorda tympani (CT) responses and the number of functional apical amiloride-sensitive epithelial Na+channels (ENaCs) in salt sensing fungiform (FF) taste receptor cells (TRCs). Currently, the intracellular signals that regulate the postnatal development of salt taste have not been identified. We investigated the effect of cAMP, a downstream signal for arginine vasopressin (AVP) action, on the postnatal development of NaCl responses in 19–23 day old rats. ENaC-dependent NaCl CT responses were monitored after lingual application of 8-chlorophenylthio-cAMP (8-CPT-cAMP) under open-circuit conditions and under ±60 mV lingual voltage clamp. Behavioral responses were …

Elucidation Of Molecular Kinetic Schemes From Macroscopic Traces Using System Identification, Miguel Fribourg, Diomedes E. Logothetis, Javier González-Maeso, Stuart C. Sealfon, Belén Galocha-Iragüen, Fernando Las-Heras Andrés, Vladimir Brezina

Physiology and Biophysics Publications and Presentations

Overall cellular responses to biologically-relevant stimuli are mediated by networks of simpler lower-level processes. Although information about some of these processes can now be obtained by visualizing and recording events at the molecular level, this is still possible only in especially favorable cases. Therefore the development of methods to extract the dynamics and relationships between the different lower-level (microscopic) processes from the overall (macroscopic) response remains a crucial challenge in the understanding of many aspects of physiology. Here we have devised a hybrid computational-analytical method to accomplish this task, the SYStems-based MOLecular kinetic scheme Extractor (SYSMOLE). SYSMOLE utilizes system-identification input-output …

Aerobic Fitness Impacts Sympathoadrenal Axis Responses To Concurrent Challenges, Heather E. Webb, Deena A. Rosalky, Matthew J. Mcallister, Edmund O. Acevedo, Gary H. Kamimori

Physiology and Biophysics Publications and Presentations

The combination of mental and physical challenges can elicit exacerbated cardiorespiratory (CR) and catecholamine responses above that of a single challenge alone.

Purpose

This study examined the effects of a combination of acute mental challenges and physical stress on cardiorespiratory and catecholamine responses.

Method

Eight below-average fitness (LF VO2max = 36.58 +/- 3.36 ml(-1) kg(-1) min(-1)) and eight above-average fitness (HF VO2max = 51.18 +/- 2.09 ml(-1) kg(-1) min(-1)) participants completed an exercise-alone condition (EAC) session consisting of moderate-intensity cycling at 60% VO2max for 37 min, and a dual-challenge condition (DCC) that included concurrent participation in mental challenges while cycling. …

Prevalence And Clinical Characteristics Of Teeth Extracted With A Diagnosis Of Cracked Tooth: A Retrospective Study, Riley B. Sturgill

Theses and Dissertations

The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth …

The Impact Of Objective Quality Ratings On Patient Selection Of Community Pharmacies: A Discrete Choice Experiment And Latent Class Analysis, Julie A. Patterson

Theses and Dissertations

Background: Pharmacy-related performance measures have gained significant attention in the transition to value-based healthcare. Pharmacy-level quality measures, including those developed by the Pharmacy Quality Alliance, are not yet publicly accessible. However, the publication of report cards for individual pharmacies has been discussed as a way to help direct patients towards high-quality pharmacies. This study aimed to measure the relative strength of patient preferences for community pharmacy attributes, including pharmacy quality. Additionally, this study aimed to identify and describe community pharmacy market segments based on patient preferences for pharmacy attributes.

Methods: This study elicited patient preferences for community pharmacy attributes …

Smoking Behavior In Arab Americans: Acculturation And Health Beliefs, Roula Ghadban

Theses and Dissertations

Background: Arab Americans, a growing population in the U.S., tend to have high rates of smoking and low rates of smoking cessation. Arab Americans and their families are at a high risk for poor health outcomes related to smoking.

Objective: The purpose of this study is to better understand the smoking behaviors of Arabs in the U.S., using the two publishable manuscripts format. The first manuscript is a systematic review of the literature exploring the smoking behavior, prevalence and use among Arab Americans and examining studies addressing the effect of acculturation on this behavior. The second manuscript is a cross-sectional …

Identification Of Expression And Function Of The Glucagon-Like Peptide-1 Receptor In Gastrointestinal Smooth Muscle, Alexander T. May

Theses and Dissertations

In response to ingestion of nutrients, enteroendocrine L cells secrete the incretin hormone, glucagon-like peptide-1 (GLP-1), to enhance glucose-dependent insulin release. Therapies related to GLP-1 are approved for type 2 diabetes. The GLP-1 receptor (GLP-1R) is expressed in cells of the gastrointestinal tract and elsewhere. In pancreatic beta cells, GLP-1R are coupled to the Gs/cAMP/PKA pathway. The expression and function of GLP-1R in gastrointestinal smooth muscle are not known. Aim. To test the hypothesis that GLP-1 regulates smooth muscle function by acting on GLP-1R expressed on smooth muscle. Methods. Smooth muscle cells (SMC) were isolated and cultured. Expression of GLP-1R …