Medicine and Health Sciences Commons^™

Medicaid Expansion In Indiana, Jim P. Stimpson, Fernando A. Wilson, Anh T. Nguyen, Kelly Shaw-Sutherland

Reports: Center for Health Policy

No abstract provided.

Postoperative Pain Management In Children Of Hispanic Origin: A Descriptive Cohort Study, Rebecca Brown, Michelle A. Fortier, Sheeva Zolghadr, Padma Gulur, Brooke N. Jenkins, Zeev N. Kain

Psychology Faculty Articles and Research

BACKGROUND:

It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations.

METHODS:

This study included 105 families of children aged 2 to 15 years of Hispanic origin and low income undergoing outpatient tonsillectomy and adenoidectomy surgery. Participating parents completed baseline and demographic packets. Recorded postoperative pain ratings and administration of analgesics at home for 1 week were collected during home visits.

RESULTS:

Despite the high (70%; 99% confidence interval [CI], 57%–82%) incidence of significant pain in the first 24 hours home, 32% (95% CI, …

Organophosphate Retinopathy, Hang Pham, Michelle D. Lingao, Anuradha Ganesh, Jenina E. Capasso, Rosanne Keep, Karthikeyan A. Sadagopan, Alex V. Levin

Wills Eye Hospital Papers

Organophosphates have rarely been reported to cause various ocular sequelae including retinal degeneration. Retinal manifestations have been rarely reported and poorly characterized. We describe a case of a 76-year-old man with vision loss beginning in his 20s due to acute on chronic exposure to dimethoate, an organophosphate. He presented with bilateral geographic macular atrophy and midperipheral pigmentary clumping which we characterized by dilated fundoscopic examination, optical coherence tomography, and fundus autofluorescence.

The Impact Of Climate Variability And Conflict On Childhood Diarrhea And Malnutrition In West Africa, Gillian Dunn

Dissertations, Theses, and Capstone Projects

Objectives: This dissertation aims to contribute to our understanding of how climate variability and armed conflict impacts diarrheal disease and malnutrition among young children in West Africa. Two studies examine the associations between climate and diarrheal disease across the whole study area – ten countries in West Africa during the period 2008-2013. The third study examines diarrheal disease and malnutrition in Northeast Nigeria before (2008) and after (2013) the start of the current armed conflict in the area.

Methods: Outcome variables and child, caregiver, and household characteristics for these studies are from the Demographic and Health Surveys. Additional datasets include …

Geographic Access To Working Family Planning Centers And Unintended Pregnancies Among Married Women: A Community Based Nested Case Control Study., Sumera Aziz Ali, Sarah Saleem, Neelofar Sami, Mir Shabbar, Muhammad Ahmed, Shafquat Rozi, Robert L. Goldenberg, Margo S. Harrison, Omrana Pasha

Community Health Sciences

Background:

Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas.

Objective:

The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women.

Methods:

We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and …

Modified Appleby Procedure With Arterial Reconstruction For Locally Advanced Pancreatic Adenocarcinoma: A Literature Review And Report Of Three Unusual Cases., Jessica A. Latona, Kathleen M. Lamb, Michael J. Pucci, Warren R. Maley, Charles J. Yeo

Department of Surgery Faculty Papers

BACKGROUND: Pancreatic body and tail ductal adenocarcinomas are often diagnosed with local vascular invasion of the celiac axis (CA) and its various branches. With such involvement, these tumors have traditionally been considered unresectable. The modified Appleby procedure allows for margin negative resection of some such locally advanced tumors. This procedure involves distal pancreatectomy with en bloc splenectomy and CA resection and relies on the presence of collateral arterial circulation via an intact pancreaticoduodenal arcade and the gastroduodenal artery to maintain prograde hepatic arterial perfusion. When the resultant collateral circulation is inadequate to provide sufficient hepatic and gastric arterial inflow, arterial …

Which Individual Therapist Behaviors Elicit Client Change Talk And Sustain Talk In Motivational Interviewing?, Timothy R. Apodaca, Kristina M. Jackson, Brian Borsari, Molly Magill, Richard Longabaugh, Nadine R. Mastroleo, Nancy P. Barnett

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To identify individual therapist behaviors which elicit client change talk or sustain talk in motivational interviewing sessions.

METHOD: Motivational interviewing sessions from a single-session alcohol intervention delivered to college students were audio-taped, transcribed, and coded using the Motivational Interviewing Skill Code (MISC), a therapy process coding system. Participants included 92 college students and eight therapists who provided their treatment. The MISC was used to code 17 therapist behaviors related to the use of motivational interviewing, and client language reflecting movement toward behavior change (change talk), away from behavior change (sustain talk), or unrelated to the target behavior (follow/neutral).

RESULTS: …

The Lived Experience Of Aging Black Women With Diabetes Nurse-Person Relationships, Deidra G. Brown

Dissertations, Theses, and Capstone Projects

The lived experience of the nurse-person relationship may have meaning for Black women with diabetes as they grow older. However, insufficient nursing research has been conducted in this area. This hermeneutic phenomenological study was designed to provide insight into the experiences of older Black women with diabetes as they transition through the aging process and to elucidate their perceptions of the nurse-person relationship. In-depth semi-structured interviews were conducted to explore the lived experience and perceptions of these women, and data was collected for developing a deeper understanding of this phenomenon. The method used to conduct this research was Max van …

The Specificity Of Mental Pain In Borderline Personality Disorder Compared To Depressive Disorders And Healthy Controls, Eric A. Fertuck, Esen Karan, Barbara Stanley

Publications and Research

Background: Individuals with Borderline Personality Disorder (BPD) may experience a qualitatively distinct depression which includes “mental pain.” Mental pain includes chronic, aversive emotions, negative self-concept, and a sense of pervasive helplessness. The present study investigated whether mental pain is elevated in BPD compared to Depressive Disorders (DD) without BPD.

Methods: The Orbach and Mikulincer Mental Pain Scale (OMMP) was administered to BPD (N = 57), DD (N = 22), and healthy controls (N = 31). The OMMP assesses total mental pain, comprised of nine subtypes: irreversibility, loss of control, narcissistic wounds, emotional flooding, freezing, self-estrangement, confusion, social distancing, and emptiness. …

Endosteal Biologic Augmentation For Surgical Fixation Of Displaced Femoral Neck Fractures, Lionel E Lazaro, Jacqueline F Birnbaum, Nadja A Farshad-Amacker, David L Helfet, Hollis G Potter, Dean G Lorich

Faculty, Staff and Student Publications

OBJECTIVES: To report outcomes of a cohort with displaced femoral neck fractures (FNFs) treated with a length/angle-stable construct augmented with an endosteal fibular allograft serving as a biologic dowel.

DESIGN: Prospective.

SETTING: Level I Trauma Center.

PATIENTS: The study group consists of 27 patients with isolated FNF surgically treated by a single surgeon.

INTERVENTION: Open reduction of the femoral neck, fixed with a length- and angle-stable construct of 2 fully threaded cannulated screws augmented with an endosteal fibular allograft serving as a biologic dowel.

MAIN OUTCOME MEASUREMENTS: Clinical and radiographic outcomes of the fixation construct and the viability of both …

A Model Of Children's Acquisition Of Grammatical Word Categories From Adult Language Input Using An Adaption And Selection Algorithm, Emily Marie Berardi

Theses and Dissertations

Previous models of language acquisition have had partial success describing the processes that children use to acquire knowledge of the grammatical categories of their native language. The present study used a computer model based on the evolutionary principles of adaptation and selection to gain further insight into children's acquisition of grammatical categories. Transcribed language samples of eight parents or caregivers each conversing with their own child served as the input corpora for the model. The model was tested on each child's language corpus three times: two fixed mutation rates as well as a progressively decreasing mutation rate, which allowed less …

Polytobacco Use Among College Students, Karen M. Butler, Melinda J. Ickes, Mary Kay Rayens, Amanda T. Wiggins, Ellen J. Hahn

Nursing Faculty Publications

INTRODUCTION: Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students.

METHODS: Of 10,000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users …

Analysis Of Slc16a11 Variants In 12,811 American Indians: Genotype-Obesity Interaction For Type 2 Diabetes And An Association With Rnasek Expression, Michael Traurig, Robert L. Hanson, Alejandra Marinelarena, Sayuko Kobes, Paolo Piaggi, Shelley A. Cole, Joanne E. Curran, John Blangero, Harald H. H. Goring, Satish Kumar

School of Medicine Publications

Genetic variants in SLC16A11 were recently reported to be associated with type 2 diabetes in Mexican and other Latin American populations. The diabetes risk haplotype had a frequency of 50% in Native Americans from Mexico but was rare in Europeans and Africans. In the current study, we analyzed SLC16A11 in 12,811 North American Indians and found that the diabetes risk haplotype, tagged by the rs75493593 A allele, was nominally associated with type 2 diabetes (P = 0.001, odds ratio 1.11). However, there was a strong interaction with BMI (P = 5.1 × 10(-7)) such that the diabetes association was stronger …

A Large Genome-Wide Association Study Of Age-Related Macular Degeneration Highlights Contributions Of Rare And Common Variants, Lars G. Fritsche, Wilmar Igl, Jessica N. Cooke Bailey, Felix Grassmann, Sebanti Sengupta, Jennifer L. Bragg-Gresham, Kathryn P. Burdon, Scott J. Hebbring, Matthew P. Johnson, John Blangero

School of Medicine Publications

Advanced age-related macular degeneration (AMD) is the leading cause of blindness in the elderly with limited therapeutic options. Here, we report on a study of >12 million variants including 163,714 directly genotyped, most rare, protein-altering variant. Analyzing 16,144 patients and 17,832 controls, we identify 52 independently associated common and rare variants (P < 5×10–8) distributed across 34 loci. While wet and dry AMD subtypes exhibit predominantly shared genetics, we identify the first signal specific to wet AMD, near MMP9 (difference-P = 4.1×10–10). Very rare coding variants (frequency < 0.1%) in CFH, CFI, and TIMP3 suggest causal roles for these genes, as does a splice variant in SLC16A8. Our results support the hypothesis that rare coding variants can pinpoint causal genes within known genetic loci and illustrate …

New Loci For Body Fat Percentage Reveal Link Between Adiposity And Cardiometabolic Disease Risk, Yingchang Lu, Felix R. Day, Stefan Gustafsson, Martin L. Buchkovich, Jianbo Na, Veronique Bataille, Diana L. Cousminer, Zari Dastani, Joanne E. Curran, John Blangero

School of Medicine Publications

To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P<5 × 10−8), of which eight were previously associated with increased overall adiposity (BMI, BF%) and four (in or near COBLL1/GRB14, IGF2BP1, PLA2G6, CRTC1) were novel associations with BF%. Seven loci showed a larger effect on BF% than on BMI, suggestive of a primary association with adiposity, while five loci showed larger effects on BMI than on BF%, suggesting association with both fat and lean mass. In particular, the loci more strongly associated with BF% showed …

The Mediating Effects Of Positive Cognitions On Autism Caregivers' Depression And Their Children's Challenging Behaviors, Abir K. Bekhet

College of Nursing Faculty Research and Publications

Caregivers of persons with Autism Spectrum Disorders (ASD) are prone to depression and psychological problems, which have an impact on their children's challenging behaviors. Positive cognitions include specific positive thinking patterns that enhance one's ability to effectively manage daily activities and promote mental health. The purpose of this research is to test the mediating effects of positive cognitions on the relationship between caregivers' depression and their children's challenging behaviors among 117 caregivers of persons with ASD. Positive cognitions were found to have mediating effects on the relationship between caregiver's depression and their children's challenging behaviors in this sample of caregivers …

Primary Angiosarcoma Of Breast, Saroona Haroon, Naveen Faridi, Faisal Rashid Lodhi

Department of Pathology and Laboratory Medicine

Primary breast sarcomas, except for phyllodes tumour, are very rare entities, accounting for < 0.1% of all malignant neoplasms. Angiosarcoma of breast is infrequent malignancy and differential diagnosis from other sarcomatous and angiomatous breast tumours holds importance. Two cases of primary angiosarcoma of breast were encountered. One involved a 32 years lady who was treated by wide local excision and six cycles of chemotherapy. The other occurred in a 54 years old lady who was treated with mastectomy, did not receive any radiation or chemotherapy and was later lost to follow-up. Neither of the patient had history of previous breast surgery, chemotherapy or radiotherapy.

Genetic Influences On Schizophrenia And Subcortical Brain Volumes: Large-Scale Proof-Of-Concept And Roadmap For Future Studies, Barbara Franke, Jason L. Stein, Stephan Ripke, Verneri Anttila, Derrek P. Hibar, Kimm J. E. Van Hulzen, Alejandro Arias-Vasquez, Jordan W. Smoller, Thomas E. Nichols, Anderson M. Winkler

School of Medicine Publications

Schizophrenia is a devastating psychiatric illness with high heritability. Brain structure and function differ, on average, between schizophrenia cases and healthy individuals. As common genetic associations are emerging for both schizophrenia and brain imaging phenotypes, we can now use genome-wide data to investigate genetic overlap. Here we integrated results from common variant studies of schizophrenia (33,636 cases, 43,008 controls) and volumes of several (mainly subcortical) brain structures (11,840 subjects). We did not find evidence of genetic overlap between schizophrenia risk and subcortical volume measures either at the level of common variant genetic architecture or for single genetic markers. The current …

Type 2 Diabetes As A Risk Factor For Dementia In Women Compared With Men: A Pooled Analysis Of 2.3 Million People Comprising More Than 100,000 Cases Of Dementia, Saion Chatterjee, Sanne A. Peters, Mark Woodward, Silvia Mejia-Arango, G. David Batty, Nigel Beckett, Alexa Beiser, Amy R. Borenstein, Paul K. Crane, Mary Haan

School of Medicine Publications

Objective: Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia.

Research design and methods: A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and …

Spatial Distributions Of Hiv Infection In An Endemic Area Of Western Kenya: Guiding Information For Localized Hiv Control And Prevention, Tomonori Hoshi, Yoshito Fuji, Samson Muuo Nzou, Chihiro Tanigawa, Ibrahim Kiche, Matilu Mwau, Anne Wanjiru Mwangi, Mohamed Karama, Kenji Hirayama, Kensuke Goto, Satoshi Kaneko

All Peer-Reviewed Publications

HIV is still a major health problem in developing countries. Even though high HIV-risk-taking behaviors have been reported in African fishing villages, local distribution patterns of HIV infection in the communities surrounding these villages have not been thoroughly analyzed. The objective of this study was to investigate the geographical distribution patterns of HIV infection in communities surrounding African fishing villages. In 2011, we applied age- and sex-stratified random sampling to collect 1,957 blood samples from 42,617 individuals registered in the Health and Demographic Surveillance System in Mbita, which is located on the shore of Lake Victoria in western Kenya. We …

The Effect Of Age, Noise Level, And Frequency On Loudness Matching Functions Of Normal Hearing Listeners With Noise Masking, Linda Titera Parrish

Theses and Dissertations

Loudness recruitment is an abnormally rapid growth of perceived loudness above the hearing threshold that slows to normal growth as the intensity of the signal increases. Recruitment is common in sensorineural hearing loss and in simulated hearing loss with noise masking. This study looked at possible differences in loudness recruitment with age, noise level, and frequency. Participants from two age groups were tested. Group A included participants aged 18 to 30 years and Group B included participants aged 50 to 75 years. Participants practiced the Alternate Binaural Loudness Balance (ABLB) test without noise present. They then repeated the tests with …

Re-Framing Informal Family Caregiving, Magdalena T. Ornstein-Sloan

Dissertations, Theses, and Capstone Projects

Informal family caregivers are the backbone of the long-term care system, providing an estimated 80% of the long-term care in the United States. Caregivers provide care to people with disabilities, the ill and older adults, often with little to no outside assistance from the formal long-term care system. Although caregivers receive attention in the academic literature, mainstream media and within public policy and services development, caregiver services continue to remain underutilized. The focus on service provision has various goals, including the desire to lessen the burden caregivers experience by providing services so they can provide care at home longer than …

Highlighting Trust In The Provision Of Cancer Care, Elizabeth Lazzara, Joseph Keebler, Soosi Day, Deborah Diazgranados, Minngui Pan, Mike King, Shin-Ping Tu

Publications

Slides:

• Patient Case
• Definition & Explanation of Trust
• Application of Trust to Cancer Case
• Implications for Clinical Care
• Implications for Research

Patients’ Perspectives On Health Care In The United States: Florida, R. J. Blendon, J. M. Benson, Caitlin L. Mcmurtry, J. M. Sayde

Brown School Faculty Publications

The landscape and experience of health care in the United States has changed dramatically in the last two years. January 2014 saw insurance purchased on state exchanges and the federal marketplace go into effect, the start of the Affordable Care Act’s individual mandate and its accompanying subsidies and tax credits for qualifying Americans, discrimination protections, including pre-existing conditions, for those seeking to buy health insurance, and the implementation of essential health benefits for all plans sold through the insurance marketplace.

The Impact Of E-Learning On Physical Therapy Students’ Clinical Skill Development, Taylor Majerus, Marissa Johnson, Betsy J. Becker

Posters and Presentations: Physical Therapy

Purpose: The purpose of this special interest report is to review the effectiveness of e-learning in comparison to traditional classroom learning by exploring different methods of implementation of e-learning into PT curriculum

Description: Education delivery via e-Learning is becoming a common teaching mode that appeals to students because it can be completed asynchronously at a self-directed pace and reviewed anytime, anywhere and as often as necessary for understanding. Translating knowledge from eLearning materials to skill performance is important to consider for PT students due to the requirements of psychomotor performance and demonstration of appropriate affective professional behaviors.

Literature review: A …

Using Active Learning Strategies To Teach Dpt Students How To Assertively Address Inappropriate Patient Sexual Behavior (Ipsb), Betsy J. Becker, Kathleen G. Volkman, Robin R. High

Posters and Presentations: Physical Therapy

PURPOSE/HYPOTHESIS

Inappropriate sexual behavior is defined as a “verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out.” In a survey of U.S. PTs, 86% of the respondents reported experiencing at least one type of IPSB. PT education programs are required to teach concepts of professional duty, communication skills, and cultural competency, however, management techniques of IPSB in the clinic are not uniformly taught in schools. The use of active learning methods such as role play simulation and small group discussion has been successful with other …

Feasibility Of Mhealth Technology Use Among A Sample Of Isolated Rural Men At High Risk For Cardiovascular Disease, Betsy J. Becker, Christine M. Eisenhauer, Carol H. Pullen, Paul J. Dizona, Patricia A. Hageman

Posters and Presentations: Physical Therapy

Purpose/Hypothesis: Isolated rural men are considered a health disparities group at high risk for cardiovascular disease. The increasing availability of technologies for self-monitoring for healthy eating, activity and weight loss (ie mHealth) may show promise for engaging rural men in lifestyle modification. This study investigated the feasibility of men from rural isolated areas to use a fitness monitor with text messaging support over a 3- week period. The study examined the men’s daily monitor use for tracking activity and eating, and assessed via written survey, their perspectives about mHealth.

Number of Subjects: Twelve men, ages 40 to 69, from …

An Examination Of Private Payer Reimbursements To Primary Care Providers For Healthcare Services Using Telehealth, United States 2009–2013, Fernando A. Wilson, Kate Elizabeth Trout, Sankeerth Rampa, Jim P. Stimpson

Reports: Center for Health Policy

• Half of telehealth-related state policies were implemented in the last five years.
• Although many states permit reimbursements for telehealth services, only seven states have passed statutes mandating parity with reimbursements for non-telehealth services.
• Despite an increasing number of telehealth policies, claims for telehealth services to private insurers are rare.
• Lower average reimbursements for telehealth billings may discourage adoption of telehealth technologies.
• Surveillance of claims data will help identify whether telehealth policies are having their intended impact on the healthcare system.

Durability Of The Starr-Edwards Heart Valve: Early Decisions Led To Successful Results, Albert Starr, Gary L Grunkemeier

The Texas Heart Institute Journal

No abstract provided.

A Nursing Approach To Self-Management Education For Individuals With Mental Illness And Diabetes, Edna Fuentes-Casiano, Martha Sajatovic

Faculty Scholarship

Patients with serious mental illness (SMI) and diabetes often seek care in primary care settings and have worse health outcomes than patients who have either illness alone. Individual, provider, and system-level barriers present challenges to addressing both psychiatric and medical comorbidities. This article describes the feasibility, acceptability, and implementation of Targeted Training and Illness Management (TTIM), a self-management intervention delivered by trained nurse educators and peer educators to groups of individuals with SMI and diabetes to improve self-management of both diseases. TTIM is intended to be delivered in a primary care setting. Findings are intended to support the future development …