Epidemiology Commons^™

Antimicrobial Stewardship In Hospitalized Patients With Respiratory Infections: Ten-Year Experience From The Robley Rex Louisville Va Medical Center, Leslie A. Beavin, Forest W. Arnold, Paula Peyrani, Anupama Raghuram, David Newman, Ronald Smith, Carmen Sciortino, Stephen P. Furmanek, Ruth M. Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

Rationale: Antibiotic stewardship has been defined as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents. Respiratory infections are the most common infectious reason for hospitalization in the United States. Therefore, one could extrapolate that respiratory infections are then also the most common reason for hospital antibiotic use and possess the highest potential for hospital antibiotic misuse. The primary objective of this article was to evaluate the role of antimicrobial stewardship on improving antibiotic use for respiratory infections in hospitalized patients on intravenous (IV) antibiotics at the Robley Rex Louisville VAMC over a 10-year period.

Methods: …

Rationale And Methods Of The Study Protocol: Streptococcus Pneumoniae Serotypes In Adults 18 Years And Older With Radiographically-Confirmed Community-Acquired Pneumonia (Cap), Ronika Alexander, Paula Peyrani, Julio A. Ramirez, Wesley H. Self Md, Mph, Carlos Grijalva, Francis Counselman, Gregory A. Volturo, Heidi Kabler, Luis Ostrosky-Zeichner, Richard Wunderink, Robert L. Sherwin, Senen Pena, Thomas File, Timothy L. Wiemken, Sharon Gray, Michael Pride, Kimbal D. Ford, Qin Jiang, Raul Isturiz

The University of Louisville Journal of Respiratory Infections

This study was an active, prospective surveillance study of adults 18 years and older hospitalized with community-acquired pneumonia (CAP) due to Streptococcus pneumoniae conducted at 21 hospitals in ten cities across the United States. This report describes the surveillance methodology applied between October 7, 2013 and September 30, 2016, including the identification and description of surveillance areas and populations at-risk for CAP hospitalization for estimation of incidence rates for selected study sites.

Pneumonia Pathogenesis And The Lung Microbiome: Back To The Drawing Board, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Lung Cytokines And Systemic Inflammation In Patients With Copd, Alessandra Morello Gearhart, Rodrigo Cavallazzi, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Umair Gauhar, Hiram Rivas-Perez, Jesse Roman, Julio A. Ramirez, Rafael Fernandez-Botran

The University of Louisville Journal of Respiratory Infections

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by lung and systemic inflammation. The role of cytokines in local and systemic inflammation in COPD is not well understood. This study aimed to compare plasma and bronchoalveolar lavage (BAL) fluid cytokine levels in COPD and non-COPD subjects with the intent of better understand their potential roles in driving local and systemic inflammation.

Methods: This cross-sectional study analyzed data from 65 subjects: 31 with COPD confirmed by spirometry and 34 non-COPD controls. All subjects underwent spirometry, plasma sample collection, and bronchoscopy/BAL. Levels of 21 inflammatory cytokines were measured in the plasma (systemic …

Using Steroids In Patients With Community-Acquired Pneumonia At The University Of Louisville Hospital: Who, What, And When, Rodrigo Cavallazzi, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Lung Cytokines And Systemic Inflammation In Patients With Copd., Alessandra Morello Gearhart, Rodrigo Cavallazzi, Paula Peyrani, Timothy L. Wiemken, Stephen P. Furmanek, Andrea Reyes-Vega, Umair Gauhar, Hiram Rivas-Perez, Jesse Roman, Julio A. Ramirez, Rafael Fernandez-Botran

Faculty and Staff Scholarship

Rationale: Chronic obstructive pulmonary disease (COPD) is characterized by lung and systemic inflammation. The role of cytokines in local and systemic inflammation in COPD is not well understood. This study aimed to compare plasma and bronchoalveolar lavage (BAL) fluid cytokine levels in COPD and non-COPD subjects with the intent of better understand their potential roles in driving local and systemic inflammation.

Methods: This cross-sectional study analyzed data from 65 subjects: 31 with COPD confirmed by spirometry and 34 non-COPD controls. All subjects underwent spirometry, plasma sample collection, and bronchoscopy/BAL. Levels of 21 inflammatory cytokines were measured in the plasma (systemic …

First Trimester Medication Abortion Practice In The United States And Canada, Heidi E. Jones, Katharine O'Connell White, Wendy V. Norman, Edith Guilbert, E. Steve Lichtenberg, Maureen Paul

Publications and Research

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were …

Persistent Organic Pollutants And Mortality In The United States, Nhanes 1999-2011., Kristiann Fry, Melinda C Power

Epidemiology Faculty Publications

Background

Persistent organic pollutants (POPs) are environmentally and biologically persistent chemicals that include polybrominated diphenyl ethers (PBDEs), per- and polyfluoroalkyl substances (PFASs), polychlorinated biphenyls (PCBs), and organochlorine (OC) pesticides. Currently, data on the associations between exposure to POPs and the risk of mortality in the U.S. population is limited.

Our objective was to determine if higher exposure to POPs is associated with greater risk of all-cause, cancer, heart/cerebrovascular disease, or other-cause mortality.

Methods

Analyses included participants aged 60 years and older from the 1999–2006 National Health and Nutrition Examination Surveys (NHANES). We included 483 participants for analyses of PBDEs, 1043 …

Adversity And Academic Performance Among Adolescent Youth: A Community-Based Participatory Research Study, Sukhdip Purewal Boparai, Tiffani Marie, Eduardo Aguayo, Jordan Brooks, Estefany Juarez, Sheana Soriano, Alasia Waters, Jaquez Donaldson, Joseph Reagans, Gracee Anguiano, Allison Ipsen

Journal of Adolescent and Family Health

Researchers and youth stakeholders devised a survey on 27 adversities based on youth expertise, clinical practice, and adversity literature. The aim of the study was to understand the prevalence of individual and cumulative adversities, and association of adversities to age, gender, race/ethnicity and academic performance among a community sample of urban high school students. All participants experienced two or more adversities and experienced greater overall adversity than youth in population-based studies. Youth-proposed stressors were among the most prevalent, and females, older youth, and African American youth reported disproportionately greater number of adversities. Specific types of adversities were endorsed differentially based …

Drawbacks Of Utilizing The Logit Link In Propensity Score Weighting Adjustment, Evrim Oral

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

A Stochastic Epidemiological Model Of The Response Of American Chestnut Populations To Fungal Blight, Kelsey Lieberman, Rebecca Rouleau, Anita Davelos Baines, Martin Allen

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Gender Differences In Virologic Response After Antiretroviral Therapy In Treatment-Naïve Hiv-Infected Individuals: Results From The 550 Clinic Hiv Cohort Study., Andrea Reyes-Vega, Alejandra Loban, Kavitha Srinivasan, Stephen P. Furmanek, Conner English, Mary Bishop, Cathy Spencer, Daniel Truelove, Julio A. Ramirez, Anupama Raghuram, Paula Peyrani

Faculty and Staff Scholarship

Background

Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods

This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results

A total of 70 women and 90 men were included …

Utilization Of Lung Cancer Screening And Molecular Testing To Improve Lung Cancer Outcomes, Jennifer Lynne Ersek

Theses and Dissertations

Despite progress in detection and treatment, lung cancer remains the leading cause of cancer-related death in the United States. The United States Preventive Services Task Force (USPSTF) recommends adults at high risk for lung cancer undergo annual low-dose computed tomography (LDCT) screening, however, lung cancer screening (LCS) uptake remains low. Qualitative research on family physician (FP) perceptions and experiences with LCS has been limited since USPSTF publication and Centers for Medicare and Medicaid Services (CMS) decision memo. We conducted a qualitative study to assess FP knowledge and perceptions of LCS and gain insight into their current experiences with LDCT. A …

Healthcare Outcomes And Resource Utilization Associated With Neonatal Hypoglycemia: Analysis Of Data From The Hcup Kid’S Inpatient Database, Brook T. Alemu

Health Services Research Dissertations

Neonatal hypoglycemia is the most common metabolic abnormality in infants and is associated with neurological damage and death. The risk of developing hypoglycemia among infants born from diabetic mothers is even higher. Although much work has been performed addressing issues for treatment and care, research related to neonatal hypoglycemia has been focused on the clinical or individual level risk factors. Contextual risk factors such as hospital characteristics, neighborhood economic status, and regional variations were not considered in earlier studies. Additionally, although healthcare resources utilization of hypoglycemia has been adequately addressed in the adult population, this topic has not been studied …

Epidemiology News, Georgia Southern University

Biostatistics, Epidemiology & Environmental Health Sciences: News & Publications (2011-2018)

• Georgia Southern Examines Sociocultural Factors Associated With Mammography

Epidemiology News, Georgia Southern University

Biostatistics, Epidemiology & Environmental Health Sciences: News & Publications (2011-2018)

• Georgia Southern Examines Utilization of Cervical Cancer Screenings

Dietary Inflammatory Index And Colorectal Cancer Risk – A Meta-Analysis, Nitin Shivappa, Justyna Godos, James R. Hébert, Michael David Wirth, Gabriele Piuri, Attilio Speciani, Giuseppe Grosso

Faculty Publications

Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus …

Challenges In Modeling Complexity Of Neglected Tropical Diseases: A Review Of Dynamics Of Visceral Leishmaniasis In Resource Limited Settings, Swati Debroy, Olivia F. Prosper, Austin Mishoe, Anuj Mubayi

Mathematics Faculty Publications

Objectives: Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects …

Stress Exposure And Physical, Mental, And Behavioral Health Among American Indian Adults With Type 2 Diabetes, Melissa L. Walls, Kelley J. Sittner, Benjamin D. Aronson, Angie K. Forsberg, Les B. Whitbeck, Mustafa Al'absi

Pharmacy Faculty Scholarship

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after …

Prevalence And Trends In Transmitted And Acquired Antiretroviral Drug Resistance, Washington, Dc, 1999-2014., Annette M Aldous, Amanda D Castel, David M Parenti

Epidemiology Faculty Publications

Background

Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC.

Methods

We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, …