Medicine and Health Sciences Commons^™

Analysis On Addiction And Opioid Crisis: Implications And Solutions, Bhavika Korat

Electronic Theses, Projects, and Dissertations

Opioids have become a popular way of pain management treatment over the past decades and although they have proven to be very successful to treat pain, they require serious attention as they have become the cause of addiction and overdose deaths. Opioid overdose costs the US government $78.5 billion each year. This project exhibits the background on opioids, the different types of opioids and their role in the addiction and overdose epidemic. The objective behind this project was to demonstrate what kind of people are more vulnerable to addiction and overdose.

This project shows the statistics of opioid overdose deaths …

Cost-Effectiveness Analysis Of Ocriplasmin Versus Watchful Waiting For Treatment Of Symptomatic Vitreomacular Adhesion In The Us, Arshad M Khanani, Pravin U Dugel, Julia A Haller, Alan L Wagner, Benedicte Lescrauwaet, Ralph Schmidt, Craig Bennison

Wills Eye Hospital Papers

Aim: Evaluate the cost-effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care.

Methods: A state-transition model simulated a cohort through disease health states; assignment of utilities to health states reflected the distribution of visual acuity. Efficacy of ocriplasmin was derived from logistic regression models using Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole trial data. Model inputs were extracted from Phase III trials and published literature. The analysis was conducted from a US Medicare perspective.

Results: Lifetime incremental cost-effectiveness ratio was US$4887 per quality-adjusted life year gained …

Evidence For Gene-Smoking Interactions For Hearing Loss And Deafness In Japanese American Families, Jia Y Wan, Christina Cataby, Andrew Liem, Emily Jeffrey, Trina M Norden-Krichmar, Deborah Goodman, Stephanie A Santorico, Karen L Edwards

Faculty, Staff and Student Publications

BACKGROUND: This study investigated the relationship between smoking and hearing loss and deafness (HLD) and whether the relationship is modified by genetic variation. Data for these analyses was from the subset of Japanese American families collected as part of the American Diabetes Association Genetics of Non-insulin Dependent Diabetes Mellitus study. Logistic regression with generalized estimating equations assessed the relationship between HLD and smoking. Nonparametric linkage analysis identified genetic regions harboring HLD susceptibility genes and ordered subset analysis was used to identify regions showing evidence for gene-smoking interactions. Genetic variants within these candidate regions were then each tested for interaction with …

Probable African Tick Bite Fever In The United States, Kami Lowery, Theodore Rosen

Faculty, Staff and Students Publications

African tick bite fever (ATBF) is a tick-borne rickettsial disease most often observed in North American and European tourists returning home from the southern portion of Africa. Ticks infected with Rickettsia africae transmit this parasitic bacterium to humans, who subsequently develop an influenza-like illness, one or more inoculation eschars, and in some cases, a cutaneous rash. Because ATBF often presents with non-specific symptoms that suggest other infectious diseases, establishing the diagnosis may be difficult. Confirmatory assays, including serology and nucleic acid amplification, may take weeks to return and cannot help with acute treatment decisions. We present a case of a …

Thoroughbred Racehorse Welfare Through The Lens Of ‘Social License To Operate—With An Emphasis On A U.S. Perspective, Camie Heleski, C. Jill Stowe, Julie Fiedler, Michael L. Peterson, Colleen Brady, Carissa Wickens, James N. Macleod

Agricultural Economics Faculty Publications

This review addresses the question of whether Thoroughbred horse racing is sustainable in the context of current social values. A recently acknowledged framework, known as ‘Social License to Operate’ (SLO), provides us with a lens through which to view and assess racehorse welfare. In multiple surveys of the general public, the horse owning public, and university students, the primary topics of concern regarding Thoroughbred racing show considerable concordance: concern about catastrophic injuries—particularly as related to track surfaces, concern over the racing of two-year-olds, whip use by jockeys, drug/medication policies, and aftercare opportunities for retired Thoroughbred racehorses. Legitimacy of an industry, …

Congenital Chagas Disease In The United States: The Effect Of Commercially Priced Benznidazole On Costs And Benefits Of Maternal Screening, Victoria Perez-Zetune, Stephanie R. Bialek, Susan P. Montgomery, Eileen Stillwaggon

Economics Faculty Publications

Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and …

A Ten-Year Retrospective Evaluation Of Acute Flaccid Myelitis At 5 Pediatric Centers In The United States, 2005-2014., Margaret M. Cortese, Anita K. Kambhampati, Jennifer E. Schuster, Zaid Alhinai, Gary R. Nelson, Gloria J. Guzman Perez-Carrillo, Arastoo Vossough, Michael A. Smit, Robert C. Mckinstry, Timothy Zinkus, Kevin R. Moore, Jeffrey M. Rogg, Meghan S. Candee, James J. Sejvar, Sarah E. Hopkins

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Acute flaccid myelitis (AFM) is a severe illness similar to paralytic poliomyelitis. It is unclear how frequently AFM occurred in U.S. children after poliovirus elimination. In 2014, an AFM cluster was identified in Colorado, prompting passive US surveillance that yielded 120 AFM cases of unconfirmed etiology. Subsequently, increased reports were received in 2016 and 2018. To help inform investigations on causality of the recent AFM outbreaks, our objective was to determine how frequently AFM had occurred before 2014, and if 2014 cases had different characteristics.

METHODS: We conducted a retrospective study covering 2005-2014 at 5 pediatric centers in 3 …

Prognostic Value Of 6-Minute Walk Distance In Patients Undergoing Percutaneous Coronary Intervention: A Veterans Affairs Prospective Study, Tarun W Dasari, Bhavin Patel, Siddharth A Wayangankar, David Alexander, Yan D Zhao, Joann Schlegel, Cheuk Leung, Pedro Lozano, Faisal Latif, Udho Thadani

The Texas Heart Institute Journal

The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown.

In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention. The primary endpoint was major adverse cardiovascular events (MACE) (death, acute coronary syndrome, and heart failure admission) at one year. Receiver operating characteristic curves and area under the curve were used to determine the 6MWD test's predictive power, and the Youden index was used to measure its effectiveness.

A total of 212 patients were enrolled (98% men; mean age, 65 …

Final Two-Year Outcomes For The Sentry Bioconvertible Inferior Vena Cava Filter In Patients Requiring Temporary Protection From Pulmonary Embolism., Michael D Dake, Timothy P Murphy, Albrecht H Krämer, Michael D Darcy, Luke E Sewall, Michael A Curi, Matthew S Johnson, Frank Arena, James L Swischuk, Gary M Ansel, Mitchell J Silver, Souheil Saddekni, Jayson S Brower, Robert Mendes, Sentry Trial Investigators

Heart and Vascular Articles

PURPOSE: To report final 2-year outcomes with the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

MATERIALS AND METHODS: In a prospective multicenter trial, the Sentry filter was implanted in 129 patients with documented deep vein thrombosis (DVT) and/or PE (67.5%) or who were at temporary risk of developing DVT/PE (32.6%). Patients were monitored and bioconversion status ascertained by radiography, computed tomography (CT), and CT venography through 2 years.

RESULTS: The composite primary 6-month endpoint of clinical success was achieved in 97.4% (111/114) of patients. The rate of new symptomatic PE was …

Rationale And Design Of The Steroids To Reduce Systemic Inflammation After Infant Heart Surgery (Stress) Trial, Kevin D Hill, H Scott Baldwin, David P Bichel, Ryan J Butts, Reid C Chamberlain, Alicia M Ellis, Eric M Graham, Jesse Hickerson, Christoph P Hornik, Jeffrey P Jacobs, Marshall L Jacobs, Robert Db Jaquiss, Prince J Kannankeril, Sean M O'Brien, Rachel Torok, Joseph W Turek, Jennifer S Li, Stress Network Investigators

Faculty, Staff and Students Publications

For decades, physicians have administered corticosteroids in the perioperative period to infants undergoing heart surgery with cardiopulmonary bypass (CPB) to reduce the postoperative systemic inflammatory response to CPB. Some question this practice because steroid efficacy has not been conclusively demonstrated and because some studies indicate that steroids could have harmful effects. STRESS is a randomized, placebo-controlled, double-blind, multicenter trial designed to evaluate safety and efficacy of perioperative steroids in infants (age < 1 year) undergoing heart surgery with CPB. Participants (planned enrollment = 1,200) are randomized 1:1 to methylprednisolone (30 mg/kg) administered into the CPB pump prime versus placebo. The trial is nested within the existing infrastructure of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The primary outcome is a global rank score of mortality, major morbidities, and hospital length of stay with components ranked commensurate with their clinical severity. Secondary outcomes include several measures of major postoperative morbidity, postoperative hospital length of stay, and steroid-related safety outcomes including prevalence of hyperglycemia and postoperative infectious complications. STRESS will be one of the largest trials ever conducted in children with heart disease and will answer a decades-old question related to safety and efficacy of perioperative steroids in infants undergoing heart surgery with CPB. The pragmatic "trial within a registry" design may provide a mechanism for conducting low-cost, high-efficiency trials in a heretofore-understudied patient population.

A Retrospective Matched-Cohort Study Of 3994 Lower Extremity Wounds Of Multiple Etiologies Across 644 Institutions Comparing A Bioactive Human Skin Allograft, Theraskin, Plus Standard Of Care, To Standard Of Care Alone, Geoff C Gurtner, Aimee D Garcia, Katie Bakewell, Jason B Alarcon

Faculty, Staff and Students Publications

Most chronic wounds are related to comorbidities, for which no clinical trials are performed. This retrospective propensity matched-cohort study examined data from 2 074 000 lower extremity wounds across 644 institutions to determine the effectiveness of TheraSkin plus standard of care (SOC; n = 1997) versus SOC alone (n = 1997). Multivariate modelling comparing outcomes such as healing rates, percent area reductions (PARs), amputations, recidivism, treatment completion, and medical transfers were evaluated. A higher proportion of wounds in the treatment group compared with the controls were more likely to close (68.3% versus 60.3%), particularly wounds with exposed structures (64% versus …

What Is "Safe Sex"? Understanding The Need For Sex Education Reform, Julianne Baker

Gettysburg Social Sciences Review

Currently, the United States has no standardized requirement for sex education. This has precipitated a large gap in knowledge about safe sex and a lack of consensus in current social and educational policy. Debates about abstinence-only and comprehensive sex education have reached a standstill. In an effort to advance the discussion, this paper reveals that the neuroscience behind adolescent sexual risk taking provides underutilized evidence for comprehensive sex education programs. Research shows that adolescents have biological differences in their brain structure that result in a decision-making process different from that of adults, one that can preference rash decisions and potentially …

Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among The Insured Elderly, Minjee Lee, M Mahmud Khan, Heather M. Brandt, Ramzi G. Salloum, Brian Chen

Faculty Publications

BACKGROUND: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. METHODS: Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the …

Toward Improving Practices For Submission Of Diagnostic Tissue Blocks For National Cancer Institute Clinical Trials, Hala Makhlouf, Mark A Watson, Heather A Lankes, Carol Weil, Maura Dickler, Michael Birrer, Christopher Moskaluk, Nilsa C Ramirez, Nader Okby, Edgar Alonsozana, Mark Barnes, Edward B Goldman, Rebecca Enos, Irina Lubensky

2020-Current year OA Pubs

OBJECTIVES: The National Cancer Institute (NCI) National Clinical Trials Network performs phase II and III clinical trials, which increasingly rely on the submission of diagnostic formalin-fixed, paraffin-embedded tissue blocks for biomarker assessment. Simultaneously, advances in precision oncology require that clinical centers maintain diagnostic specimens for ancillary, standard-of-care diagnostics. This has caused tissue blocks to become a limited resource for advancing the NCI clinical trial enterprise and the practice of modern molecular pathology.

METHODS: The NCI convened a 1-day workshop of multidisciplined experts to discuss barriers and strategic solutions to facilitate diagnostic block submission for clinical trial science, from the perspective …

Primary Healthcare Policy And Vision For Community Pharmacy And Pharmacists In The United States, Teresa M. Salgado, Meagen M. Rosenthal, Antoinette B. Coe, Tana N. Kaefer, Dave L. Dixon, Karen B. Farris

Faculty and Student Publications

© 2020, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved. The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians …

The Value Driven Pharmacist: Basics Of Access, Cost, And Quality 2nd Edition, Carriann Smith, Annette Mcfarland, Chad Knoderer, Joseph Jordan, Trish Devine, Jessica Wilhoite

Butler University Books

No abstract provided.

Uninsured/Underinsured: Who's Problem Is It?, Manpreet Kaur

Student Research Poster Presentations 2020

The problem of uninsured and underinsured in terms of health care was implored in the population of the United States of America. Other developed nations have implemented universal health care whereas the United States have fallen behind. It is an ongoing problem in the nation, and it is not only the problem of the people who face being uninsured and underinsured. It is everyone’s problem because it affects the economy as a whole and every person is affected by the way the country decides to treat health care. Nurses, as health care professionals, have the opportunity to help patients access …

The Protection Of Children And Their Rights: A Comparison Between The United States And Costa Rica, Abigail Rothweiler

Undergraduate Research Symposium

Abstract:

Introduction: In Missouri, there are over 13,000 children who are currently receiving care through the state foster care system. Because being removed from their families causes life-long trauma and decreased quality of life for many children, it is important that the situation is approached in the best way. While there are differences between St. Louis, Missouri and San Jose, Costa Rica, the Costa Rican child welfare system, El Patronato Nacional de Infancia (PANI), uses several strategies that may be beneficial in St. Louis.

Purpose: To examine the current policies and programs in San Jose, Costa Rica to …

The President's Emergency Plan For Aids Relief And Adult Mortality: A Replication Study Of Hiv Development Assistance Effects In Sub-Saharan African Countries, Nicholas A. Hein, Danstan Bagenda, Jiangtao Luo

Journal Articles: Anesthesiology

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President's Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis …

Comparative Analysis Of Covid-19 Guidelines From Six Countries: A Qualitative Study On The Us, China, South Korea, The Uk, Brazil, And Haiti, Ji Youn Yoo, Samia Valeria Ozorio Dutra, Dany Fanfan, Sarah Sniffen, Hao Wang, Jamile Siddiqui, Hyo-Suk Song, Sung Hwan Bang, Dong Eun Kim, Shihoon Kim, Maureen Groer

All publications

Background: In late January, a worldwide crisis known as COVID-19 was declared a Public Health Emergency of International Concern by the WHO. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. It was a significant issue to prevent and control COVID-19 on both national and global scales due to the dramatic increase in confirmed cases worldwide. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals on how to take action to decrease …

Opioid And Non-Opioid Prescribing Rates For Ankle Fractures In Emergency Departments Across The United States Between 2006 And 2015, Lucy C. Bowers, Kyle B. Kosik, Alejandro G. Villasante Tezanos, Matthew C. Hoch, Phillip A. Gribble

Posters-at-the-Capitol Presentations

This presentation describes the percentage of patients prescribed a controlled and non-controlled medication in an United States Emergency Department for a diagnosed ankle fracture.

Motor Vehicle Fatalities During Memorial Day Weekends, 1981-2016, Yuni Tang, Kendra Ratnapradipa, Henry Xiang, Motao Zhu

Journal Articles: Epidemiology

OBJECTIVE: Motor vehicle crashes are a leading cause of injury death in the United States, and Memorial Day weekend is one of six holiday periods with an increased number of motor vehicle fatalities in the United States. However, few motor vehicle fatality comparisons were made between Memorial Day weekend and non-holiday periods. Our aims were to determine which day(s) during the holiday had highest motor vehicle fatality risk compared to non-holiday travel and to identify potential risk factors.

RESULTS: Of 43,457 traffic fatalities studied, 15,292 (35%) occurred during the holiday, with Saturday being deadliest but Monday having highest odds of …

The Impact Of Body Mass Index And Sociodemographic Factors On Moderate-To-Vigorous Physical Activity And Sedentary Behaviors Of Women With Young Children: A Cross-Sectional Examination, Danae M. Dinkel, Nicholas Hein, Kailey Snyder, Mohammad Siahpush, Shannon I. Maloney, Lynette M. Smith, Evi A. Farazi, Corrine K. Hanson

Journal Articles: Epidemiology

OBJECTIVES: Moderate-to-vigorous physical activity provides multiple benefits to women after childbirth. To achieve these benefits, the recommendation that adults obtain, 150 min of moderate-to-vigorous physical activity per week and reduce sedentary behaviors, also applies to women in the post-partum phase of the life span. However, research examining the moderate-to-vigorous physical activity and sedentary behaviors of women with young children (0-2 years) is limited. A greater understanding of these behaviors from a nationally representative sample is needed. Therefore, the primary objective of this study was to determine the levels of moderate-to-vigorous physical activity and sedentary behaviors of a nationally representative sample …

Online Availability Of Fish Antibiotics And Documented Intent For Self-Medication, Weiwei Zhang, Austin Williams, Nicole Griffith, Jessica Gaskins, P Brandon Bookstaver

Faculty Publications

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of …

On The Proposed Legalization Of Commercial Surrogacy: I Thought We Had Abolished The Sale Of Human Beings, Phyllis Chesler

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

Correlation Between Copd And Physical Activity In The United States, Ellie Ganz

Scholarship in Medicine - All Papers

Objective: My objective of this project is to determine whether there is a correlation between COPD and physical activity in the United States by looking at all 50 states. Also, to determine if there is a difference between the prevalence of COPD in different regions of the US.

Methods: Data was collected and analyzed using the publicly available data set from the CDC Wonder database (wonder.cdc.gov). A Pearson correlation test and an ANOVA with post hoc tests were used to determine correlations and differences between variables to answer research questions.

Results: There is a significant negative correlation between physical activity …

Know Before You Play: Associations Between Race, Education, And Hiv Susceptibility, Anfa Mohamed Diiriye

All Graduate Theses, Dissertations, and Other Capstone Projects

Black women are disproportionately affected by HIV in the United States. This paper analyzes the associations between race, education, and HIV susceptibility, furthering previous research to understand if educational attainment reduces HIV susceptibility and if reduction patterns are similar for Black and White women. The CDC’s National Survey of Family Growth 2015-2017 was used to analyze associations using binary logistic and multiple regression models. HIV susceptibility was operationalized through four measures: condom use, having a partner with concurrent sexual relationships, having had an STD, and age at first sex. Black women were not found to be significantly more susceptible to …

Mitigating A Covid-19 Outbreak Among Major League Baseball Players - United States, 2020, Meghan T. Murray, Margaret A. Riggs, David M. Engelthaler, Caroline Johnson, Sharon Watkins, Allison Longenberger, David Brett-Major, John Lowe, M. Jana Broadhurst, Chandresh N. Ladva, Julie M. Villanueva, Adam Macneil, Shoukat Qari, Hannah L. Kirking, Michael Cherry, Ali S. Khan

Journal Articles: Epidemiology

Mass gatherings have been implicated in higher rates of transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), and many sporting events have been restricted or canceled to limit disease spread (1). Based on current CDC COVID-19 mitigation recommendations related to events and gatherings (2), Major League Baseball (MLB) developed new health and safety protocols before the July 24 start of the 2020 season. In addition, MLB made the decision that games would be played without spectators. Before a three-game series between teams A and B, the Philadelphia Department of Public Health was notified of a team A …

The Importance Of Doctor Liability In Medical Malpractice Law: China Versus The United States, Vincent R. Johnson

St. Mary's Journal on Legal Malpractice & Ethics

Medical malpractice law in China does not work. Disappointed patients and their families, or the gangs they hire, frequently resort to physical violence, beating up doctors and disrupting hospital activities in order to extort settlements. This happens because Chinese law has failed to provide viable remedies to many victims of medical malpractice.

This dysfunctional situation (medical chaos or yinao) has persisted for more than two decades. Today, parents in China discourage their children from attending medical school because practicing medicine is too dangerous.

Reforming Chinese medical malpractice law will be difficult. Many factors contribute to the public’s lack of confidence …

Black Vulture Conflict And Management In The United States: Damage Trends, Management Overview, And Research Needs, Bryan M. Kluever, Morgan Pfeiffer, Scott C. Barras, Brett Dunlap, Lee A. Humberg

United States Department of Agriculture Wildlife Services: Staff Publications

Contrary to rapid declines of many vulture (Accipitridae, Cathartidea) species worldwide, black vulture (Coragyps atratus) populations are increasing and expanding their range in North America. Vultures exhibit complex behaviors and can adapt to any human-dominated landscape or land use. These traits, combined with population growth and range expansion, have contributed to increased human–vulture conflicts. Our goal was to summarize the current status and trends in human–black vulture conflicts (hereafter human– vulture conflicts), review available management strategies, identify knowledge gaps, and provide recommendations to enhance management and understanding of this species and the associated conflicts. We found human–vulture conflicts …