Medical Specialties Commons^™

Anemia And Blood Transfusion In The Critically Ill Patient: Role Of Erythropoietin, Howard L. Corwin

Dartmouth Scholarship

Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least 1 red blood cell (RBC) unit during their stay, and the average is close to 5 RBC units. RBC transfusion is not risk free. There is little evidence that 'routine' transfusion of stored allogeneic RBCs is beneficial to critically ill patients. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been n demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients with multiple organ failure, rHuEPO therapy will also stimulate …

Multiple Testing Methods For Chip-Chip High Density Oligonucleotide Array Data, Sunduz Keles, Mark J. Van Der Laan, Sandrine Dudoit, Simon E. Cawley

U.C. Berkeley Division of Biostatistics Working Paper Series

Cawley et al. (2004) have recently mapped the locations of binding sites for three transcription factors along human chromosomes 21 and 22 using ChIP-Chip experiments. ChIP-Chip experiments are a new approach to the genome-wide identification of transcription factor binding sites and consist of chromatin (Ch) immunoprecipitation (IP) of transcription factor-bound genomic DNA followed by high density oligonucleotide hybridization (Chip) of the IP-enriched DNA. We investigate the ChIP-Chip data structure and propose methods for inferring the location of transcription factor binding sites from these data. The proposed methods involve testing for each probe whether it is part of a bound sequence …

The Anti-Proliferation Effects Of Lycopene On Breast Cancer Cells, Tixieanna Dissmore

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The incidence and deaths from breast cancer represent the most cause of all cancer deaths among women. Lycopene, the carotenoid in tomatoes has been associated with decreasing risk of prostate, breast, and digestive tract cancers. Various mechanisms of lycopene action have been proposed, including antioxidant activity and pro-differentiation activities. Identifying changes in the expression of proteins modified by lycopene can provide information to study the modulating effects of lycopene carcinogenesis and tumorigenesis development.

Objective: The objective was to study the anti-proliferative effects of lycopene on MCF- 7 human breast cancer cells and to identify changes in protein expression patterns. …

Binary Isotonic Regression Procedures, With Application To Cancer Biomarkers, Debashis Ghosh, Moulinath Banerjee, Pinaki Biswas

The University of Michigan Department of Biostatistics Working Paper Series

There is a lot of interest in the development and characterization of new biomarkers for screening large populations for disease. In much of the literature on diagnostic testing, increased levels of a biomarker correlate with increased disease risk. However, parametric forms are typically used to associate these quantities. In this article, we specify a monotonic relationship between biomarker levels with disease risk. This leads to consideration of a nonparametric regression model for a single biomarker. Estimation results using isotonic regression-type estimators and asymptotic results are given. We also discuss confidence set estimation in this setting and propose three procedures for …

Semiparametic Models And Estimation Procedures For Binormal Roc Curves With Multiple Biomarkers, Debashis Ghosh

The University of Michigan Department of Biostatistics Working Paper Series

In diagnostic medicine, there is great interest in developing strategies for combining biomarkers in order to optimize classification accuracy. A popular model that has been used for receiver operating characteristic (ROC) curve modelling when one biomarker is available is the binormal model. Extension of the model to accommodate multiple biomarkers has not been considered in this literature. Here, we consider a multivariate binormal framework for combining biomarkers using copula functions that leads to a natural multivariate extension of the binormal model. Estimation in this model will be done using rank-based procedures. We show that the Van der Waerden rank score …

Evaluating Markers For Selecting A Patient's Treatment, Xiao Song, Margaret S. Pepe

UW Biostatistics Working Paper Series

Selecting the best treatment for a patient's disease may be facilitated by evaluating clinical characteristics or biomarker measurements at diagnosis. We consider how to evaluate the potential of such measurements to impact on treatment selection algorithms. For example, magnetic resonance neurographic imaging is potentially useful for deciding whether a patient should be treated surgically for carpal tunnel syndrome or if he/she should receive less invasive conservative therapy. We propose a graphical display, the selection impact (SI) curve, that shows the population response rate as a function of treatment selection criteria based on the marker. The curve can be useful for …

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Gerontology Institute Publications

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …

Consumer Perspectives On Quality In Adult Day Care, Amy Leventhal Stern, Francis G. Caro

Gerontology Institute Publications

Purpose: The purpose of this project was to gain insight into the quality of care and services provided through adult day care from the user’s perspective. Design and Methods: The project utilized 13 focus groups to explore aspects associated with user needs, preferences, and satisfaction with adult day care centers. Results: Focus group participants described aspects of adult day care that are important in delivering quality care, program features that are effective, and key areas in need of improvement. Ensuring the safety of clients; having caring, friendly, and compassionate staff available to provide one-on-one attention; engaging clients in stimulating activities; …

Cancer Among Arab Americans In The Metropolitan Detroit Area, Kendra L. Schwartz, Anahid Kulwicki, Linda K. Weiss, Haifa Fakhouri, Wael Sakr, Gregory Kau, Richard K. Severson

FMPHS Faculty Publications

Detroit is home to one of the largest populations of Arab Americans outside of the Middle East, yet little is known about the cancer distribution in this ethnic group. The authors of this study created an Arab/Chaldean surname list and matched it with the Detroit SEER Registry to identify cancer cases of probable Arabic descent. We then determined proportional incidence ratios (PIR) for specific cancer sites among metropolitan Detroit Arab Americans as compared to non-Arab Whites, and contrasted the results with Middle Eastern data. Arab/Chaldean men had greater proportions of leukemia (29%), multiple myeloma (46%), liver (64%), kidney (33%), and …

Patient Expectations Of Full Body Ct Screening, Carole Tanenbaum Kolber

Seton Hall University Dissertations and Theses (ETDs)

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Perceptions Of Pediatric Overweight And Weight Management: A Comparison Of Parents And Physicians, Lisa K. Thomason

Masters Theses & Specialist Projects

Pediatric overweight is of paramount importance in Kentucky, as studies show prevalence rates are higher in the state than the national average. Research suggests that comprehensive treatments involving diet training, exercise training, and psychological counseling are most effective at reducing overweight in children. Little research has been done, however, to compare parents' and physicians' perceptions of obesity, its treatment, or barriers to weight management.

The purpose of this study is to examine differences in attitudes toward pediatric obesity and weight management among parents and physicians, specifically related to the importance of diet training, exercise training, and psychological counseling. Surveys were …

Healing Wounds, Instilling Hope: The Tanzanian Partnership Against Obstetric Fistula, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

Guérir Les Blessures, Faire Naître L’Espoir: Le Partenariat Tanzanien Contre La Fistule Obstétricale, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

Back To The Future: The Future Of Long-Term Care In Massachusetts, Deborah H. Thomson, John J. Ford

Gerontology Institute Publications

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care.

Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our …

Human Chorionic Gonadotropin Administration Is Associated With High Pregnancy Rates During Ovarian Stimulation And Timed Intercourse Or Intrauterine Insemination, Mohamed F. Mitwally, Sonya Abdel-Razeq, Robert F. Casper

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

There are different factors that influence treatment outcome after ovarian stimulation and timed-intercourse or intrauterine insemination (IUI). After patient age, it has been suggested that timing of insemination in relation to ovulation is probably the most important variable affecting the success of treatment. The objective of this study is to study the value of human chorionic gonadotropin (hCG) administration and occurrence of luteinizing hormone (LH) surge in timing insemination on the treatment outcome after follicular monitoring with timed-intercourse or intrauterine insemination, with or without ovarian stimulation.

Methods

Retrospective analysis of 2000 consecutive completed treatment cycles (637 timed-intercourse and …

Testing The Effectiveness Of Integrating Community-Based Approaches For Encouraging Abandonment Of Female Genital Cutting Into Care's Reproductive Health Programs In Ethiopia And Kenya, Jane Chege, Ian Askew, Susan Igras, Jacinta Muteshi-Strachan

Reproductive Health

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change.

Experience From A Community-Based Education Program In Burkina Faso: The Tostan Program, Djingri Ouoba, Zakari Congo, Nafissatou J. Diop, Molly Melching, Baya Banza, Georges Guiella, Inge Baumgarten

Reproductive Health

This study describes a project that tested the feasibility and effectiveness of replicating the village empowerment program (VEP) developed by the Senegalese NGO, TOSTAN, in Burkina Faso. Although originally developed for empowering women, the program implemented in Burkina Faso also involved men because of their key role in such decisions. Frontiers in Reproductive Health, with funding from USAID and the GTZ Supra Regional Project for the Elimination of FGC, supported the adaptation, implementation, and evaluation of the VEP model in 23 villages in the province of Bazega/Zoundwéogo. In the existing social climate among the Burkinabé, where there is widespread awareness …

Medicalization Of Female Genital Cutting Among The Abagusii In Nyanza Province, Kenya, Carolyne Njue, Ian Askew

Reproductive Health

This study sought to understand the role that health providers play in the medicalization of female genital cutting (FGC) among the Abagusii community in western Kenya, among whom the practice continues to be almost universal. Interviews with service providers and their clients revealed an overwhelming belief that FGC fulfills a traditional cultural obligation among the Abagusii, and that it limits a woman’s sexual desire and confers respect on girls. New approaches are needed within this community to present FGC as violating human rights and national laws, as well as threatening girls’ and women’s health. The study recommends measures such as …

Encuestas De Voluntad De Pago Para Fijar Precios De Productos Y Servicios De Salud Reproductiva: Manual De Usuarios, Karen G. Fleischman Foreit, James R. Foreit

Reproductive Health

Social programs need to balance volume (coverage) and income (sustainability). The law of supply and demand states that we can not obtain coverage and support at the same time, because when prices rise, demand decreases. This manual presents willingness-to-pay (WTP) surveys that allow program managers to simulate changes in demand related to price, without actually changing prices. The Population Council, with The Futures Group International, developed these surveys that can be used for existing and new products and services, collect responses from clients with no formal education with sensitivity to their individual characteristics, and provide conservative estimates that accurately predict …

Female Circumcision In Indonesia. Extent, Implications And Possible Interventions To Uphold Women's Health Rights, Meiwita P. Budiharsana, Lila Amaliah, Budi Utomo

Reproductive Health

In Indonesia, the practice of female circumcision (FC) has long existed, but information concerning where and how it is carried out has been limited. The specific aims of the study conducted by the Population Council Jakarta were to provide research-based information on FC customary practices and their socio-cultural determinants, and if possible, to assess any long-term physical and psychological consequences. Study findings indicate that in general Muslim communities support the continuation of FC practice, because they perceive it as both a societal custom and a religious duty. The report strongly recommends that key donor agencies pressure the Ministry of Health …

Attitudes Of Preventive Care Specialists And Registered Dietitians Toward Their Obese Patients, Maryanna Gabriel

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to compare preventive care specialists and registered dietitians regarding attitudes toward obese patients, to compare both groups with Canadian and American nurses previously studied, and to determine whether relationships exist between personal characteristics and attitudes toward obese patients. Questionnaires were sent to members of the American Preventive Care Association and 1,000 randomly selected members of the California Dietetic Association. Sixty-seven preventive care specialists and 579 registered dietitians participated in the study. A modified version of the Attitudes Toward Obesity scale, developed by Bagley, et al. was used to measure attitudes. Preventive care specialists and …

Traumatic Deep Vein Thrombosis In A Soccer Player: A Case Study, Paul S. Echlin, Ross Eg Upshur, Douglas B. Mckeag, Harsha P. Jayatilake

Wayne State University Associated BioMed Central Scholarship

Abstract

A 42 year-old male former semi-professional soccer player sustained a right lower extremity popliteal contusion during a soccer game. He was clinically diagnosed with a possible traumatic deep vein thrombosis (DVT), and sent for confirmatory tests. A duplex doppler ultrasound was positive for DVT, and the patient was admitted to hospital for anticoagulation (unfractionated heparin, warfarin). Upon discharge from hospital the patient continued oral warfarin anticoagulation (six months), and the use of compression stockings (nine months). He followed up with his family doctor at regular intervals for serial coagulation measurements, and ultrasound examinations. The patient's only identified major thrombotic …

Uncertainty And The Value Of Diagnostic Information With Application To Axillary Lymph Node Dissection In Breast Cancer, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

In clinical decision making, it is common to ask whether, and how much, a diagnostic procedure is contributing to subsequent treatment decisions. Statistically, quantification of the value of the information provided by a diagnostic procedure can be carried out using decision trees with multiple decision points, representing both the diagnostic test and the subsequent treatments that may depend on the test's results. This article investigates probabilistic sensitivity analysis approaches for exploring and communicating parameter uncertainty in such decision trees. Complexities arise because uncertainty about a model's inputs determines uncertainty about optimal decisions at all decision nodes of a tree. We …

Optimization Of Breast Cancer Screening Modalities, Yu Shen, Giovanni Parmigiani

Johns Hopkins University, Dept. of Biostatistics Working Papers

Mathematical models and decision analyses based on microsimulations have been shown to be useful in evaluating relative merits of various screening strategies in terms of cost and mortality reduction. Most investigations regarding the balance between mortality reduction and costs have focused on a single modality, mammography. A systematic evaluation of the relative expenses and projected benefit of combining clinical breast examination and mammography is not at present available. The purpose of this report is to provide methodologic details including assumptions and data used in the process of modeling for complex decision analyses, when searching for optimal breast cancer screening strategies …

The Relationship Of Health Beliefs And Health Value In Cardiovascular Outcomes, Kimberley Schaub

All-Inclusive List of Electronic Theses and Dissertations

Despite extensive theoretical information regarding Schwarzer's Health Action Process Approach the utility of the model pas yet to be explored within a chronic illness population. Using Schwarzer's Health Action Process Approach (Schwarzer, 1992), the purpose of this study was to investigate cardiovascular outcomes based on health beliefs and health value. Participants were eighty-one adults ages 42-87 with cardiovascular disease recruited from a cardiac rehabilitation program in Central Indiana. Participants completed instruments that assessed (a) health beliefs, (b) health value and, (c), quality of life. Measurements of physiological outcome (resting heart rate, distance walked, and metabolic equivalent) were also obtained. A …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Ua61/6 Newsletter, Issue 2, Wku Institute For Rural Health Development & Research

WKU Administration Documents

Newsletter created by and about the Institute for Rural Health Development & Research. This issue contains:

• College of Health & Human Services Has New Dean – John Bonaguro
• Simpson, Staci. Institute Aims to Improve Oral Health of Children
• Whitfield, Beth. WKU Mobile Unit KICS Off Dental Event with Webster County – Kentucky Interdisciplinary Community Screening
• Stone, Glynda. TEACH KY: Teachers Exploring & Advocating Careers in Health in Kentucky
• Institute Sponsors Hispanic Health Fair
• HIV Prevention Counseling & Testing Training Program Initiated at WKU
• New Web-based Course Offered Through Communications Disorders Department at WKU
• Lashley, Donita. Child Passenger Safety Training
• Handy, …

The Relationship Between Health Status And Hope In Individuals With Hiv Disease, Celine Meera Chohan

All-Inclusive List of Electronic Theses and Dissertations

This study examined the relationship between hope and health status over a two-year period in individuals who were HIV -infected. One hundred and three individuals completed the surveys at entry into the study, at 12 months, and at 24 months. The Health Status Questionnaire (Wu et.al., 1991) measured Cognitive Functioning, Emotional Functioning, and Physical Functioning. Additionally, the Hope Scale (Snyder, 1991) and the Client Information Form were used to collect data. Results suggested hope at entry into the study was a significant predictor of physical functioning initially, at 12 months, and at 24 months. This finding suggests a link between …

Prevalence Of Overweight In Preschool Children And The Association With Dietary And Lifestyle Factors, Anthony H. Ng

All-Inclusive List of Electronic Theses and Dissertations

For the past several decades, there has been a steady increase in obesity in the United States. National surveys indicate that 64% of American adults are overweight or obese and more than 1 0% of preschool children are overweight. This study determined the prevalence of overweight in a group of preschool children aged between three and five years at a Head Start Center and evaluated the relationship of specific lifestyle factors between caregivers and their children and the relationship of these patterns to the development of overweight. The caregivers were asked to complete a questionnaire, which assessed specific dietary and …

Predictors That Affect The Caregiver's Health Status And The Role Of Social Support On The Caregiver's Health Status, Hong Wang

All-Inclusive List of Electronic Theses and Dissertations

This study examines whether the caregiver's self-rated health status is affected by the caregiver's demographic characteristics (age, education level, and income), caregiver's stressor (the number of ADL and IADL), mediating variables of the caregiver's appraisal (willingness to help non-family members, level satisfaction with life, and financial burden), of and mediating variable of social support (information and/or advice from other family members or friends). Data were drawn from Chronic Illness and Caregiving, a national telephone survey conducted by Harris Interactive Inc. on behalf of The Robert Wood Johnson Foundation, Johns Hopkins University, and Partnership for Solutions. The sample size of caregivers …