Epidemiology Commons^™

Clinical Research: Educational Videos - The Process Of Clinical Research: Step-By-Step From Idea To Publication, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Clinical research can be defined as the creation and dissemination of new knowledge with the goal to improve outcomes in patients with a particular health problem. In this short video, Dr. Julio Ramirez, from the University of Louisville, offers an overview of the process of clinical research and describe how an investigator moves from the generation of an idea to the publication of study findings.

The Effect Of Caffeine On Fecundability : Differences In Coffee, Tea, And Cola Consumption., Emily Kathleen Steinmetz

Electronic Theses and Dissertations

This study examined whether intake of caffeinated beverages (coffee, tea, and cola) was associated with fecundability (time to pregnancy) in a prospective cohort study. Data from 470 women from the Mount Sinai Study of Women Office Workers (1990-1994) were analyzed. Intake of coffee, tea, cola, and other variables were recorded in daily diaries and calculated as menstrual cycle level means for up to 20 cycles. Pregnancy was assayed using hCG and confirmed by physician diagnosis. The associations of caffeinated beverages with the probability of becoming pregnant during a given cycle were determined using discrete survival analysis, adjusted for potential confounders. …

Pediatric Anxiety And/Or Depression Problems : Associations With Pm10, Fly Ash, And Metal Exposure., Abby Nicole Burns Hagemeyer

Electronic Theses and Dissertations

Background: In the last several decades, the use of coal has become more prevalent in turn increasing the amount of coal ash being produced. Coal ash, the by-product of coal combustion, is composed of small particles that contain essential elements, hazardous metals, polycyclic aromatic hydrocarbons, and radioactive material. While a small proportion of coal ash is reused, the majority gets discarded in open-air landfills and ash ponds. Fly ash, the major component of coal ash, can become emitted into the air and potentially contribute to the air pollution and metal exposure in the surrounding community. Few studies, particularly in the …

Prenatal Depression Screening Among A Diverse Healthy Start Population., Evangeline Pierce

Electronic Theses and Dissertations

Prenatal depression has been associated with adverse outcomes for both pregnant women and infants. Data was studied from Healthy Start (n=1093). Healthy Start participants were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Data reported included birthweight, gestational length, ethnicity, and sociodemographic variables. No statistically significant association was found between a positive EPDS screen and birthweight-low/normal (OR 1.02 [95% CI 0.53, 1.70]), birthweight-abnormal (OR 1.02 [95% CI 0.53, 1.70], or gestation-preterm/term (OR 1.29 [95% CI 0.68, 2.45]). An association was observed between a positive screen and race, ethnicity by region of origin, immigrant status, English as …

The Particulars About Particulates : Metal Exposure And Self-Regulation Of Children Living Near Coal Ash., Clara G. Sears

Electronic Theses and Dissertations

The use of coal combustion for electricity and the storage of coal combustion by-products known as coal ash occur across the United States and around the world. The most abundant type of coal ash, fly ash, contains small particles with metals, some of which are known neurotoxins. Fly ash is currently stored in open-air landfills and surface impoundments that allow fugitive dust to escape into surrounding communities, potentially exposing children to small neurotoxic particles. This dissertation uses preliminary data from a larger cross-sectional study to investigate the relationship between particulate matter exposure, metal exposure, and problems with self-regulation. Recruitment of …

Clinical & Translational Research In Pneumonia: Defining A Research Agenda For Today And Tomorrow, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

From the Editor in Chief

The reason for this special supplement of the Journal is to inform readers of a scientific research conference supported by the National Institutes of Health (NHI). The NIH Research Conference Grant (R13) supports high quality scientific conferences in areas that are important to the NIH's mission and to the public health. We just received notification that the National Heart, Lung, and Blood Institute (NHLBI) has approved the application for an international research conference entitled: DzClinical & Translational Research in Pneumonia: Defining a Research Agenda for Today and Tomorrowdz. The conference will be held on Wednesday, …

Clinical Outcomes Of Community-Acquired Pneumonia In Patients With Diabetes Mellitus, Siddartha Bandhary, Bolivar Y. Contreras-Mora, Ruby Gupta, Patricia Fernandez, Patricio Jimenez, Paula Peyrani, Timothy L. Wiemken, Steven Burdette, Julio A. Ramirez, Hadi Harati, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Background: Studies have found admission hyperglycemia as a predictor of poor outcomes in Community acquired Pneumonia (CAP), whereas others have not. The objective of this study was to evaluate the impact of diabetes mellitus (DM) on mortality as well as Length of stay (LOS) and Time to clinical stability (TCS) of hospitalized patients with CAP.

Materials and Methods: Adult patients hospitalized with CAP enrolled at Community-Acquired Pneumonia Organization (CAPO) database with DM were categorized as admission blood glucose ≥ 250 mg/dL (diabetes mellitus blood sugar (BG) > 250) and admission blood glucose ≤ 250 mg/dL (DM BG ≤ 250). CAP outcomes …

Why A New Journal?, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

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Time To Clinical Stability In Patients With Ventilator-Associated Pneumonia Due To Methicillin-Resistant Staphylococcus Aureus Treated With Linezolid Versus Vancomycin: Results From The Impact-Hap Study, Paula Peyrani, Timothy L. Wiemken, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary E. Stein, Kimbal D. Ford, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Background: Time to clinical stability is a well-defined early clinical outcome in hospitalized patients with community-acquired pneumonia, but it has not been evaluated in patients with ventilator-associated pneumonia (VAP). The objective of this study was to compare time to clinical stability in patients with MRSA VAP treated with linezolid versus vancomycin.

Methods: This was a secondary analysis of the IMPACT-HAP study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. A patient was considered to reach clinical stability the day that the following four criteria were …

A Review Of Macrolide Based Regimens For Community-Acquired Pneumonia, Forest W. Arnold, Leslie A. Beavin

The University of Louisville Journal of Respiratory Infections

Community-acquired pneumonia (CAP) has significant morbidity and mortality. The Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines recommend two antimicrobial regimens for hospitalized patients with CAP, one of which includes a macrolide, and one of which does not. Both regimens have antimicrobial properties, but macrolides also possess immunomodulatory properties. Macrolides, however, may also have potential arrhythmia adverse effects. The purpose of this review is to provide an update of studies evaluating outcomes for patients with CAP treated with or without a macrolide-based regimen. Two recent randomized controlled trials conflict with each other regarding the benefit versus noninferiority of including …

Memory And Fine Motor Skill Test Performance Among Children Living Near Coal Ash Storage Sites., Lindsay Koloff Tompkins

Electronic Theses and Dissertations

Coal ash, a byproduct of coal combustion,is reduced in 47 U.S. states andfrequently contains heavy metals, some of which are known neurotoxins. An estimated 1.5 million children live near sites where coal ash is produced andstored, yet there have been no studies assessing coal ash exposure and children’s neuro behavioral health. This study is part of a larger cross-sectional study, Coal Ash and Neuro behavioral Symptoms in Children Aged 6- 14 Years Old, and aimed to determine the relationship between children’s memory and fine motor skill test performance and the proximity of the home to coal ash storage sites, the …

The Impact Of Preconception Maternal Stress On Fecundability And Adverse Pregnancy Outcomes., Shekufe Akhter

Electronic Theses and Dissertations

It has been commonly hypothesized (and widely believed) that maternal stress either prior to or during pregnancy can adversely affect fertility and pregnancy outcomes. However, surprisingly few epidemiologic studies have rigorously tested these hypotheses. The current study evaluated the effects of pre-conception self-reported stress on fecundability and spontaneous abortion. The study population was derived from the Mount Sinai Study of Woman Office Workers with 487 women included. Women recorded stress (scale from 1 to 4) and covariate information in a daily diary for 12 cycles or until pregnant. Results indicated a significantly increased risk of spontaneous abortion for women with …

Markers And Mechanisms Of Metabolic Aging., Peter Dziewornu Ahiawodzi

Electronic Theses and Dissertations

Oxidative stress has been implicated in aging and age-related diseases. Using three distinct studies, this dissertation examines associations between lifestyle factors and oxidative stress, and their effects on advanced glycation end products, telomere length, and type II diabetes. Carboxymethyl-lysine (CML), an advanced glycation end-product, has been linked to oxidative stress, cardiovascular and other age-related diseases. The first study investigates the association between sleep disordered breathing (SDB), a source of oxidative stress, and CML. 1002 participants with sleep data from the Cardiovascular Health Study (CHS) were analyzed. SDB was not significantly associated with CML, but after stratification by gender and hemoglobin …

The Performance Of The K6 Scale In A Large Adolescent Sample., Nicholas Chalmer Peiper 1982-

Electronic Theses and Dissertations

This dissertation is an applied research study to examine the performance of the K6 scale that measures serious emotional disturbance (SED) among adolescents. As the K6 was included in the 2012 administration of the Kentucky Incentives for Prevention Survey (KIP), three specific aims are included: 1) confirm the unidimensional structure of the K6 among adolescents using factor analysis; 2) define the prevalence and correlates of adolescent SED among Kentucky students; and 3) utilize latent class analysis (LCA) to empirically derive clinically relevant subtypes of adolescents with SED. Of the 122,718 students who completed the KIP in 2012, approximately 89% provided …

Effectiveness Of Chronic Obstructive Pulmonary Disease (Copd) Management Program At The University Of Louisville., Malhar Anantbhai Jhaveri

Electronic Theses and Dissertations

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease of the respiratory system characterized by airflow limitation that is not completely reversible and is associated with systemic effects especially of the cardiovascular system. COPD is frequently complicated by acute exacerbations that contribute to physical impairment and increased health care use. As COPD is a chronic lung disease with significant systemic manifestations, it is important to have chronic disease management programs specifically targeting individuals with COPD designed to improve their overall quality of life, reduce the burden of disease and decrease the impact of COPD on daily life. Chronic disease …

Coal Ash And Children's Sleep : A Community-Based Study., Clara G. Sears

Electronic Theses and Dissertations

Kentucky is the fifth largest producer of coal ash, a by-product of coal combustion. The small spherical coal ash particles contain heavy metals like arsenic, lead, mercury, and cadmium. Coal ash is currently classified as nonhazardous by the EPA, which allows it to be stored in open-air impoundments near low-income communities. The primary object of the study is to determine the prevalence of sleep disruptive behaviors in children exposed to coal ash, compared to a group of demographically similar non-exposed children. Parents or guardians from five neighborhoods surrounding a coal ash storage facility, and one non-exposed community, participated in a …

Cognitive Decline And Polypharmacy In An Elderly Population., Ximena A. Oyarzun Gonzalez

Electronic Theses and Dissertations

Aging is associated with increased risk of chronic disease, comorbidities, and greater medication use. Polypharmacy, the concomitant use of 5 or more medications, has been associated with adverse health effects, and potentially cognitive decline. The proposed hypothesis is that polypharmacy increases the risk of cognitive decline in elderly people. Using longitudinal data from 572 participants from the New Mexico Aging Process Study cohort, the impact of polypharmacy on the Mini Mental State Examination (MMSE) scores and Mild Cognitive Impairment (MCI) was studied. The statistical analyses were performed using mixed linear regression multivariable models and generalized estimating equations, adjusting for important …

Cardiovascular Disease Among Diabetic Women With Bilateral Oophorectomy., Duke Appiah

Electronic Theses and Dissertations

Cardiovascular Disease (CVD) is the leading cause of death in women and the risk is increased threefold in diabetics. In postmenopausal diabetics, the ovary responds to hyperinsulinemia by increasing secretion of testosterone precursors which increases the risk of CVD. Data from the National Health and Nutrition Examination Survey (1988-2010) and the Study of Osteoporotic Fractures were used to test the hypothesis that a history of bilateral oophorectomy -surgical removal of both ovaries-would decrease the risk of CVD among postmenopausal diabetic women due to reduced androgen levels. Logistic regression, discrete time logit model, B-Spline regression and Cox proportional hazards models were …