Clinical Epidemiology Commons^™

Double-Blinded Randomized Control Trial Investigating The Efficacy Of Probiotic Mouth Rinse In Enhancing Oral Health, Sudeep C B Prof. Dr., Sunil P M Prof. Dr.

Annual Research Symposium

The efficacy of probiotic mouth rinse in enhancing oral health was investigated through a double-blinded randomized controlled trial involving 45 children aged 12 to 15 over a two-week period. Comparing probiotic mouth rinse, chlorhexidine mouth rinse, and a control group, plaque and gingival accumulation were assessed using established indices. Results indicated both probiotic and chlorhexidine groups exhibited reduced plaque compared to the control, with the probiotic group showing superior reduction in gingival inflammation. These findings suggest the potential of probiotic mouth rinse in improving oral hygiene and overall oral health.

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

The Dose-Response Effect Of Aerobic Exercise On Inflammation In Colon Cancer Survivors, Justin C. Brown, Stephanie L.E. Compton, Jeffrey A. Meyerhardt, Guillaume Spielmann, Shengping Yang

School of Medicine Faculty Publications

Background; Physical activity after surgical resection for colon cancer is associated with significantly longer disease-free survival. Inflammation is hypothesized to mediate the association between physical activity and disease-free survival in colon cancer. Methods; In this exploratory analysis of a randomized dose-response trial, 39 colon cancer survivors who completed standard therapy were stratified by cancer stage and randomized in a 1;1;1 ratio to one of three treatment groups for 24 weeks of usual-care control, 150 min/wk of moderate-intensity aerobic exercise (low-dose), or 300 min/wk of moderate-intensity aerobic exercise (high-dose). Inflammation outcomes included high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL6), and soluble tumor …

Infrastructure Development For Personalized Risk Prediction To Reduce Cardiovascular Disease In Childhood Cancer Survivors, Suman Shrestha

Dissertations and Theses (Open Access)

Although childhood cancer survivors have lengthy life expectancies, they run the risk of experiencing long-term health issues as a result of their treatment. The most frequent non-cancerous cause of morbidity and mortality for these survivors is cardiac disease. Radiation therapy (RT) has been linked in numerous cohort studies to a higher chance of developing a late cardiac disease in these survivors, and this risk rises with higher mean heart doses and increased RT exposure to larger cardiac volumes. Since, the heart is a heterogeneous organ made up of several distinct substructures, RT dose received by the entire heart does not …

A Novel Nonparametric Test For Heterogeneity Detection And Assessment Of Fluid Removal Among Crrt Patients In Icu, Shaowli Kabir

Theses and Dissertations--Epidemiology and Biostatistics

Over the past decade acute kidney injury (AKI) has been occurring among 20%-50% of patients admitted to the intensive care unit (ICU) in United States. Continuous renal replacement therapy (CRRT) has become a popular treatment method among these critically ill patients. But there are multiple complications in implementing this treatment, including discrepancies in practiced and prescribed fluid removal, possibly related to the heterogeneity among these patients. With mixture modeling there have been several techniques in detecting heterogeneity with their specific limitations. In this dissertation a novel nonparametric ‘d test’ will be used to detect heterogeneity among CRRT patients in ICU. …

A Keyword-Enhanced Approach To Handle Class Imbalance In Clinical Text Classification, Andrew E. Blanchard, Shang Gao, Hong Jun Yoon, J. Blair Christian, Eric B. Durbin, Xiao Cheng Wu, Antoinette Stroup, Jennifer Doherty, Stephen M. Schwartz, Charles Wiggins, Linda Coyle, Lynne Penberthy, Georgia D. Tourassi

School of Public Health Faculty Publications

Recent applications ofdeep learning have shown promising results for classifying unstructured text in the healthcare domain. However, the reliability of models in production settings has been hindered by imbalanced data sets in which a small subset of the classes dominate. In the absence of adequate training data, rare classes necessitate additional model constraints for robust performance. Here, we present a strategy for incorporating short sequences of text (i.e. keywords) into training to boost model accuracy on rare classes. In our approach, we assemble a set of keywords, including short phrases, associated with each class. The keywords are then used as …

A Participatory Group Process To Collect And Disseminate Covid-19 Needs Assessment Data, Areebah Ahmed

UROP Posters

The Richmond, VA COVID-19 Needs Assessment Survey (RVA CoNA) was created in March 2020 to identify behaviors and needs related to COVID-19 in Richmond area adults ages 18 and over. Results are being used to inform support, strategic efforts, and educational outreach of local community organizations. The purpose of this study is to (1) summarize the process used to develop the RVA CoNA, (2) summarize preliminary survey results from a second phase of data collection as well as initial feedback from community partners, and (3) summarize initial conclusions and results dissemination strategies.Community partners and researchers at Virginia Commonwealth University jointly …

Protocol For A National Probability Survey Using Home Specimen Collection Methods To Assess Prevalence And Incidence Of Sars-Cov-2 Infection And Antibody Response, Aaron J. Siegler, Patrick S. Sullivan, Travis Sanchez, Ben Lopman, Mansour Fahimi, Charles Sailey, Martin Frankel, Richard Rothenberg, Colleen F. Kelley, Heather Bradley

Publications and Research

Purpose: The U.S. response to the SARS-CoV-2 epidemic has been hampered by early and ongoing delays in testing for infection; without data on where infections were occurring and the magnitude of the epidemic, early public health responses were not data-driven. Understanding the prevalence of SARSCoV- 2 infections and immune response is critical to developing and implementing effective public health responses. Most serological surveys have been limited to localities that opted to conduct them and/or were based on convenience samples. Moreover, results of antibody testing might be subject to high false positive rates in the setting of low prevalence of immune …

Trends And Disparities In Self-Reported And Measured Osteoporosis Among Us Adults, 2007-2014., Qing Wu, Yingke Xu, Ge Lin

Environmental & Global Health Faculty Research

(1) Background: Studies examining osteoporosis trends among US adults by different socioeconomic status (SES) are limited. The prevalence of self-reported osteoporosis in the US is rarely reported. (2) Methods: Data from the National Health and Nutritional Examination Survey (NHANES) between 2007–2008 and 2013–2014 cycles were analyzed. Age-adjusted prevalence of self-reported and that of measured osteoporosis were calculated overall and by sex, race/ethnicity, education attainment, and SES. (3) Results: The prevalence of self-reported osteoporosis was higher than that of measured osteoporosis in all three survey cycles for women, and in 2007–2008 and 2009–2010 for men. Participants with high school/GED or higher …

Dietary Inflammatory Index And Sleep Quality In Southern Italian Adults, Justyna Godos, Raffaele Ferri, Filippo Caraci, Filomena I. I. Cosentino, Sabrina Castellano, Nitin Shivappa, James R. Hébert, Fabio Galvano, Giuseppe Grosso

Faculty Publications

Background: Current evidence supports the central role of a subclinical, low-grade inflammation in a number of chronic illnesses and mental disorders; however, studies on sleep quality are scarce. The aim of this study was to test the association between the inflammatory potential of the diet and sleep quality in a cohort of Italian adults. Methods: A cross-sectional analysis of baseline data of the Mediterranean healthy Eating, Aging, and Lifestyle (MEAL) study was conducted on 1936 individuals recruited in the urban area of Catania during 2014-2015 through random sampling. A food frequency questionnaire and other validated instruments were used to calculate …

Safety Constraint Optimization Of Combination Drug Therapy In Hypertension Clinical Trials, Victor Chukwu

College of Graduate Studies: Theses & Dissertations

In Clinical Practice, combination drug therapy has become common in treating many disease conditions. The purpose of these combinations is often to ensure optimal efficacy and to reduce adverse effects that may arise from monotherapy. Clinical trials have also been conducted to ensure efficacy and safety of these combinations before they are introduced into the market. However, adverse effects still occur with combination therapies. The objective of this study is to (1) To determine a region of optimum doses of Drug A and Drug B in combination while focusing on efficacy alone (2) To determine a region of optimum doses …

Risk Behaviors And Hiv Care Continuum Outcomes Among Criminal Justice-Involved Hiv-Infected Transgender Women And Cisgender Men: Data From The Seek, Test, Treat, And Retain Harmonization Initiative., Curt G Beckwith, Irene Kuo, Rob J Fredericksen, Lauren Brinkley-Rubinstein, William E Cunningham, Sandra A Springer, Kelsey B Loeliger, Julie Franks, Katerina Christopoulos, Jennifer Lorvick, Shoshana Y Kahana, Rebekah Young, David W Seal, Chad Zawitz, Joseph A Delaney, Heidi M Crane, Mary L Biggs

Epidemiology Faculty Publications

BACKGROUND: Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system.

METHODS: To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine …

Aggressive Diuresis And Severity-Adjusted Length Of Hospital Stay In Acute Congestive Heart Failure Patients, Muhammad U. Butt

Theses and Dissertations--Clinical Research Design

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in …

Gender Differences In Hiv Care Among Criminal Justice-Involved Persons: Baseline Data From The Care+ Corrections Study., Curt Beckwith, Breana Uhrig Castonguay, Claudia Trezza, Lauri Bazerman, Rudy Patrick, Alice Cates, Halli Olsen, Ann Kurth, Tao Liu, James Peterson, Irene Kuo

Epidemiology Faculty Publications

BACKGROUND: HIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender.

METHODS: We recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance …

Total Versus Partial Splenectomy In Pediatric Hereditary Spherocytosis: A Systematic Review And Meta-Analysis, Leonardo Guizzetti

Epidemiology and Biostatistics Publications

To compare the clinical effectiveness of total (TS) or partial (PS) splenectomy in pediatric hereditary spherocytosis, a systematic review and meta-analysis was performed (PROSPERO registration CRD42015030056). There were 14 observational studies comparing pre- and post- operative hematologic parameters. Secondary outcomes include in-hospital infections, surgical complications, symptomatic recurrence and biliary disease. TS is more effective than PS to increase hemoglobin (3.6 g/dL vs 2.2 g/dL) and reduce reticulocytes (12.5% vs 6.5%) after one year; outcomes following PS are stable for at least 6 years. There were no cases of overwhelming post-splenectomy sepsis. A population-based patient registry is needed for long-term follow-up.

Models For Hsv Shedding Must Account For Two Levels Of Overdispersion, Amalia Magaret

UW Biostatistics Working Paper Series

We have frequently implemented crossover studies to evaluate new therapeutic interventions for genital herpes simplex virus infection. The outcome measured to assess the efficacy of interventions on herpes disease severity is the viral shedding rate, defined as the frequency of detection of HSV on the genital skin and mucosa. We performed a simulation study to ascertain whether our standard model, which we have used previously, was appropriately considering all the necessary features of the shedding data to provide correct inference. We simulated shedding data under our standard, validated assumptions and assessed the ability of 5 different models to reproduce the …

A Machine Learning Approach To Post-Market Surveillance Of Medical Devices, Jonathan Bates, Shu-Xia Li, Craig Parzynski, Ronald Coifman, Harlan Krumholz, Joseph Ross

Yale Day of Data

Post-market surveillance is a collection of processes and activities used by product manufacturers and regulators, such as the U.S. Food and Drug Administration (FDA) to monitor the safety and effectiveness of medical devices once they are available for use “on the market”. These activities are designed to generate information to identify poorly performing devices and other safety problems, accurately characterize real-world device performance and clinical outcomes, and facilitate the development of new devices, or new uses for existing devices. Typically, a device is monitored by comparing adverse events in the exposed population to a matched unexposed population. This research considers …

Preparedness Of Hospitals In The Republic Of Ireland For An Influenza Pandemic, An Infection Control Perspective, Mary Reidy, Fiona Ryan, Dervla Hogan, Seán Lacey, Claire Buckley

Department of Mathematics Publications

When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective.

Genetic Predictors Of Metabolic Side Effects Of Diuretic Therapy, Jorge L. Del Aguila

Dissertations and Theses (Open Access)

Thiazide diuretics are a recommended first-line monotherapy for hypertension (i.e.SBP>140 mmHg or DBP>90 mmHg). Even so, diuretics are associated with adverse metabolic side effects, such as hyperlipidemia, hyperglycemia and hypokalemia which increase the risk of developing type II diabetes. This thesis used three analytical strategies to identify and quantify genetic factors that contribute to the development of adverse metabolic effects due to thiazide diuretic treatment. I performed a genome-wide association study (GWAS) and meta-analysis of the change in fasting plasma glucose and triglycerides in response to HCTZ from two different clinical trials: the Pharmacogenomic Evaluation of Antihypertensive Responses …

Computational Model For Survey And Trend Analysis Of Patients With Endometriosis : A Decision Aid Tool For Ebm, Salvo Reina, Vito Reina, Franco Ameglio, Mauro Costa, Alessandro Fasciani

COBRA Preprint Series

Endometriosis is increasingly collecting worldwide attention due to its medical complexity and social impact. The European community has identified this as a “social disease”. A large amount of information comes from scientists, yet several aspects of this pathology and staging criteria need to be clearly defined on a suitable number of individuals. In fact, available studies on endometriosis are not easily comparable due to a lack of standardized criteria to collect patients’ informations and scarce definitions of symptoms. Currently, only retrospective surgical stadiation is used to measure pathology intensity, while the Evidence Based Medicine (EBM) requires shareable methods and correct …

Net Reclassification Index: A Misleading Measure Of Prediction Improvement, Margaret Sullivan Pepe, Holly Janes, Kathleen F. Kerr, Bruce M. Psaty

UW Biostatistics Working Paper Series

The evaluation of biomarkers to improve risk prediction is a common theme in modern research. Since its introduction in 2008, the net reclassification index (NRI) (Pencina et al. 2008, Pencina et al. 2011) has gained widespread use as a measure of prediction performance with over 1,200 citations as of June 30, 2013. The NRI is considered by some to be more sensitive to clinically important changes in risk than the traditional change in the AUC (Delta AUC) statistic (Hlatky et al. 2009). Recent statistical research has raised questions, however, about the validity of conclusions based on the NRI. (Hilden and …

Net Reclassification Indices For Evaluating Risk Prediction Instruments: A Critical Review, Kathleen F. Kerr, Zheyu Wang, Holly Janes, Robyn Mcclelland, Bruce M. Psaty, Margaret S. Pepe

UW Biostatistics Working Paper Series

Background Net Reclassification Indices (NRI) have recently become popular statistics for measuring the prediction increment of new biomarkers.

Methods In this review, we examine the various types of NRI statistics and their correct interpretations. We evaluate the advantages and disadvantages of the NRI approach. For pre-defined risk categories, we relate NRI to existing measures of the prediction increment. We also consider statistical methodology for constructing confidence intervals for NRI statistics and evaluate the merits of NRI-based hypothesis testing.

Conclusions Investigators using NRI statistics should report them separately for events (cases) and nonevents (controls). When there are two risk categories, the …

The Net Reclassification Index (Nri): A Misleading Measure Of Prediction Improvement With Miscalibrated Or Overfit Models, Margaret Pepe, Jin Fang, Ziding Feng, Thomas Gerds, Jorgen Hilden

UW Biostatistics Working Paper Series

The Net Reclassification Index (NRI) is a very popular measure for evaluating the improvement in prediction performance gained by adding a marker to a set of baseline predictors. However, the statistical properties of this novel measure have not been explored in depth. We demonstrate the alarming result that the NRI statistic calculated on a large test dataset using risk models derived from a training set is likely to be positive even when the new marker has no predictive information. A related theoretical example is provided in which a miscalibrated risk model that includes an uninformative marker is proven to erroneously …

The Morbidity & Mortality Of Prevalent Heart Failure, Jennifer Kwon

Loma Linda University Electronic Theses, Dissertations & Projects

The first study population included 292 unselected consecutive patients from the LLUMC heart failure clinic who were enrolled in the study from January to July 2006 and were followed up through the end of December 2010. The treatment policy at the clinic was to uptitrate dosages of beta-adrenergic blockade (β-blockers), angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) to the most tolerable levels in order to reach target dosages, as recommended by the Heart Failure Society of America (HFSA). Patients were classified into systolic heart failure (ejection fraction (EF) < 40%) or diastolic heart failure (EF≥40%). All dosages of β-blockers, ACEi and ARB were extracted through chart reviews and were used as the main predictors of the patients' survival. Results from analyses showed that reaching target dosages of β-blockers and ACEi/ARB may increase survival when compared to not reaching target among the systolic HF population (HR_{β_biockers}= 0.64, 95% CI 0.26-1.56 and HR_ACEi/ARB=0.50, …

Race And Hepatitis C Management Within The Veterans Administration, Joahd Toure, Joshua Metlay, Sandford Schwartz, Knashawn Morales, David Kaplan, Peter Groeneveld

Journal of Health Disparities Research and Practice

Objective: To examine black-white differences in hepatitis C treatment within the Veterans Administration (VA) and determine whether racial variation in specialty consultation explains differences in hepatitis C treatment between blacks and whites.

Methods: We performed a retrospective cohort study of 1040 veterans meeting VA eligibility criteria for hepatitis C treatment. We used multiple imputation to handle missing race data. Specialty consultation was determined from the VA outpatient medical dataset and hepatitis C treatment was determined from the VA decision support system. Conditional logistic regression was used to examine the association between race and hepatitis C treatment as well as race …

Evaluating Retention In Medical Care And Its Impact On The Health Outcomes Of Individuals Living With Human Inmmunodeficiency Virus, Timothy N. Crawford

Theses and Dissertations--Epidemiology and Biostatistics

In the last few years, engagement in medical care among individuals living with HIV has become a major priority among HIV medical providers and public health researchers. Engagement in medical care is an important concept as it involves the process of linking newly diagnosed individuals into medical care and retaining those individuals in care throughout the course of their infection. Although there have been major advances in the management of HIV, like the advent of Highly Active Antiretroviral Therapy, morbidity and mortality due to HIV cannot be fully reduced if the individual does not optimally retain in care. Retention in …

Landmark Prediction Of Survival, Layla Parast, Tianxi Cai

Harvard University Biostatistics Working Paper Series

No abstract provided.

Improving Statistical Analysis Of Prospective Clinical Trials In Stem Cell Transplantation. An Inventory Of New Approaches In Survival Analysis, Aurelien Latouche

COBRA Preprint Series

The CLINT project is an European Union funded project, run as a specific support action, under the sixth framework programme. It is a 2 year project aimed at supporting the European Group for Blood and Marrow Transplantation (EBMT) to develop its infrastructure for the conduct of trans-European clinical trials in accordance with the EU Clinical Trials Directive, and to facilitate International prospective clinical trials in stem cell transplantation. The initial task is to create an inventory of the existing biostatistical literature on new approaches to survival analyses that are not currently widely utilised. The estimation of survival endpoints is introduced, …

Nonparametric Regression With Missing Outcomes Using Weighted Kernel Estimating Equations, Lu Wang, Andrea Rotnitzky, Xihong Lin

Harvard University Biostatistics Working Paper Series

No abstract provided.

Calibrating Parametric Subject-Specific Risk Estimation, Tianxi Cai, Lu Tian, Hajime Uno, Scott D. Solomon, L. J. Wei

Harvard University Biostatistics Working Paper Series

No abstract provided.