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1.  Providing adolescent sexual health care in the pediatric emergency department: views of health care providers 
Pediatric emergency care  2014;30(2):84-90.
The purpose of this study was to explore health care providers’ (HCPs) attitudes and beliefs about adolescent sexual health care provision in the emergency department (ED) and to identify barriers to a role of a health educator-based intervention.
We conducted focused, semi-structured interviews of HCPs from the ED and Adolescent Clinic of a children’s hospital. The interview guide was based on the Theory of Planned Behavior and its constructs: attitudes, subjective norms, perceived behavioral control, and intention to facilitate care. We used purposive sampling and enrollment continued until themes were saturated. Interviews were recorded and transcribed. Transcripts were analyzed using directed content analysis.
Twenty-nine interviews were required for saturation. Participants were 12 physicians, 12 nurses, 3 nurse practitioners and 2 social workers; the majority (83%) were female. Intention to facilitate care was influenced by HCP perception of 1) their professional role, 2) the role of the ED (focused vs. expanded care), and 3) need for patient safety. HCPs identified three practice referents: patients/families, peers and administrators, and professional organizations. HCPs perceived limited behavioral control over care delivery because of time constraints, confidentiality issues, and comfort level. There was overall support for a health educator and many felt the educator could help overcome barriers to care.
Despite challenges unique to the ED, HCPs were supportive of the intervention and perceived the health educator as a resource to improve adolescent care and services. Future research should evaluate efficacy and costs of a health educator in this setting.
PMCID: PMC4266236  PMID: 24457494
3.  Can the use of multiple stop signals reduce the disinhibiting effects of alcohol? 
Alcoholism, clinical and experimental research  2013;37(11):10.1111/acer.12166.
Research has consistently demonstrated that alcohol impairs the ability to divide attention across two or more stimuli. However, under certain circumstances, the presentation of multiple stimuli can actually facilitate performance. The “redundant signal effect” (RSE) refers to the phenomenon by which individuals respond more quickly and accurately when information is presented as redundant, bimodal stimuli (e.g., visually and aurally), rather than as a single stimulus presented to either modality alone. Recent work has shown that response time (RT) to redundant signals is hastened under alcohol, ameliorating the slowing effects of the drug. However, no research has examined whether RSE can reduce the impairing effects of alcohol on the ability to inhibit behavior.
This study examined whether the impairing effects of alcohol on inhibitory control might be altered by the presentation of redundant inhibitory signals. Inhibitory control was assessed by a go/no-go task which included single and redundant inhibitory signals. Performance was tested following placebo (0.0 g/kg) and alcohol (0.65 g/kg). The effect of redundant activation signals on alcohol impairment of response activation was also measured.
The results showed evidence for RSE on the activation of behavior, but not for inhibitory control. Compared with placebo, alcohol slowed RT and reduced response inhibition. Redundant signals had a robust speeding effect on RT, even following alcohol. By contrast, redundant signals failed to improve inhibitory control following placebo or alcohol.
These findings have important implications for understanding how drinkers respond to multimodal signals in their everyday environments and highlight the vulnerability of inhibitory control to alcohol’s impairing effects.
PMCID: PMC3812342  PMID: 23906541
alcohol; redundant signal effect; inhibitory control; behavioral impairment
4.  Developing Emergency Department–based Education About Emergency Contraception: Adolescent Preferences 
The objective was to identify adolescent preferences for emergency department (ED)-based education about emergency contraception.
This was a cross-sectional computerized survey, using adaptive conjoint analysis (ACA). Patients were eligible if they were females ages 14 through 19 years old and were seeking care in one of two urban EDs. Patients were excluded if they were too ill to participate in the survey or if they were non-English speaking. Participants completed a computerized survey that used ACA, a technique that can be used to assess patients’ relative preferences for services. ACA uses the individual’s answers to update and refine questions through trade-off comparisons, so that each respondent answers a customized set of questions. The survey assessed preferences for the following attributes of emergency contraception education: who should deliver the education, if anyone (e.g., nurse, doctor); how the education should be delivered (e.g., by a person or via video); how often the education should be offered if patients were to frequent the ED (e.g., every time or only when asking for it); length (e.g., 5 minutes, 10 minutes); and chief complaint that would trigger the education (e.g., headache or stomach pain).
A total of 223 patients were enrolled (37.2% at Hospital 1 and 62.8% at Hospital 2). The mean (±SD) age of the participants was 16.1 (±1.3) years. Just over half (55%) reported a history of sexual activity; 8% reported a history of pregnancy. Overall, the participants preferred education that was delivered by a person, specifically a doctor or nurse. They preferred a slightly longer education session and preferred education directed at patients seeking care in the ED for complaints potentially related to sexual activity.
Adolescents have specific preferences for how education about emergency contraception would best serve their needs. This information can inform clinicians as they work to improve adolescents’ knowledge about pregnancy prevention and emergency contraception in particular.
PMCID: PMC4047822  PMID: 24238320
5.  Sexual Health Behaviors, Preferences for Care, and Use of Health Services Among Adolescents in Pediatric Emergency Departments 
Pediatric emergency care  2013;29(8):907-911.
To describe sexual health behaviors, as well as prior use of and preferences for sexual health services among adolescents in the pediatric Emergency Department (ED).
In this cross-sectional study, subjects aged 14-19 years who presented to an urban or suburban ED from a single Midwestern area completed a written survey. The survey included questions on previous sexual activity (PSA), high-risk behaviors (1st sex before age 15, no condom at last sex, substance use at last sex, >3 partners in past 3 months, and >4 lifetime partners) and sexual health service use and preferences. Comparisons of responses between subgroups were analyzed using Chi-square test. Multiple logistic regression was used to identify factors associated with high-risk behaviors. Care preferences were scored using a four-point Likert scale; mean scores were ranked.
Subjects included 306 adolescents (85% of approached). The mean age was 15.5 years. Almost half (45%) reported PSA and, of those, 63% reported ≥1 high-risk behavior (most commonly 1st sex before age 15 [43%] and no condom at last sex [29%]). Almost all wanted to prevent pregnancy, but only one-third received birth control counseling before sexual debut and 14% reported no contraception at last sex. Younger age was associated with ≥1 high-risk behavior (odds ratio = 3.7; confidence interval = 1.39-9.84). Preferences for care included caring, knowledgeable providers and low/no cost.
Due to high prevalence of high-risk behaviors among adolescents presenting in the ED, strategies should be developed to link these patients to comprehensive sexual health care.
PMCID: PMC4184037  PMID: 23903671
adolescent sexual health; health risk behaviors; emergency department
6.  Rickettsia parkeri and Rickettsia montanensis, Kentucky and Tennessee, USA 
Emerging Infectious Diseases  2014;20(10):1750-1752.
We found that 14.3% (15/105) of Amblyomma maculatum and 3.3% (10/299) of Dermacentor variabilis ticks collected at 3 high-use military training sites in west-central Kentucky and northern Tennessee, USA, were infected with Rickettsia parkeri and Rickettsia montanensis, respectively. These findings warrant regional increased public health awareness for rickettsial pathogens and disease.
PMCID: PMC4193168  PMID: 25271771
Amblyomma maculatum; Dermacentor variabilis; ticks; Rickettsia parkeri; Rickettsia montanensis; rickettsia; bacteria; military training sites; Kentucky; Tennessee
7.  Utilization of computer processed high definition video imaging for measuring motility of microscopic nematode stages on a quantitative scale: “The Worminator” 
Graphical abstract
•An objective, easy-to-use and inexpensive system for quantifying motility.•Measured motility response for 3 nematodes and 3 life stages with 7 anthelmintics.•Consistent parasite hyper-motility at sub-paralytic concentrations.•Motility may not be assay of choice for macrocyclic lactones.
A major hindrance to evaluating nematode populations for anthelmintic resistance, as well as for screening existing drugs, new compounds, or bioactive plant extracts for anthelmintic properties, is the lack of an efficient, objective, and reproducible in vitro assay that is adaptable to multiple life stages and parasite genera. To address this need we have developed the “Worminator” system, which objectively and quantitatively measures the motility of microscopic stages of parasitic nematodes. The system is built around the computer application “WormAssay”, developed at the Center for Discovery and Innovation in Parasitic Diseases at the University of California, San Francisco. WormAssay was designed to assess motility of macroscopic parasites for the purpose of high throughput screening of potential anthelmintic compounds, utilizing high definition video as an input to assess motion of adult stage (macroscopic) parasites (e.g. Brugia malayi). We adapted this assay for use with microscopic parasites by modifying the software to support a full frame analysis mode that applies the motion algorithm to the entire video frame. Thus, the motility of all parasites in a given well are recorded and measured simultaneously. Assays performed on third-stage larvae (L3) of the bovine intestinal nematode Cooperia spp., as well as microfilariae (mf) of the filarioid nematodes B. malayi and Dirofilaria immitis, yielded reproducible dose responses using the macrocyclic lactones ivermectin, doramectin, and moxidectin, as well as the nicotinic agonists, pyrantel, oxantel, morantel, and tribendimidine. This new computer based-assay is simple to use, requires minimal new investment in equipment, is robust across nematode genera and developmental stage, and does not require subjective scoring of motility by an observer. Thus, the “Worminator” provides a relatively low-cost platform for developing genera- and stage-specific assays with high efficiency and reproducibility, low labor input, and yields objective motility data that is not subject to scorer bias.
PMCID: PMC4266792  PMID: 25516834
Anthelmintic resistance; Brugia malayi; Dirofilaria immitis; Trichostrongyle; Microfilaria; Motility measurement
8.  Diverse Attitudes to and Understandings of Spontaneous Awakening Trials (SAT): Results from a Statewide Quality Improvement Collaborative 
Critical care medicine  2013;41(8):1976-1982.
Spontaneous awakening trials (SATs) improve outcomes in mechanically ventilated patients, but implementation remains erratic. We examined variation in reported practice, prevalence of attitudes and fears regarding SATs, and organizational practices associated with routine implementation of SATs in an ICU quality improvement collaborative.
Written survey.
Michigan Health and Hospital Association’s Keystone ICU, a quality improvement collaborative of 73 hospitals.
Attendees of the yearly Keystone ICU meeting, January 2011, including nurses, physicians, hospital administrators, and other healthcare professionals.
Respondents were asked about institutional characteristics, SAT practice, attitudes and barriers regarding SATs, and organizational cultural characteristics that might influence SAT practice. The association of organizational cultural characteristics and attitudes with reported SAT use was evaluated using logistic regression.
Measurements and Main Results
319 participants attended the meeting. The survey response rate was 83.4%. Respondents reported wide variation in approach to SAT performance and patient selection. 48.6% of respondents reported regular SAT use, defined as >75% of mechanically ventilated patients undergoing SATs each day. In bivariable analysis, addressing sedation goals routinely in rounds and having SATs as part of unit culture were positively associated with regular SAT use, while the perception that SATs increased short term adverse effects, staff fears of SATs, and the perception that SATs are hard work were negatively associated with regular SAT use. In multivariable analysis, only addressing sedation in rounds (OR 2.85 [95%CI 1.55–5.23]), incorporation of SATs into unit culture (OR 3.36 [95% CI 1.75–6.43]), and the perception that SATs are hard work (OR 0.53 [95% CI 0.30–0.96]) remained statistically significantly associated with regular SAT use. Respondents in managerial positions were less likely to perceive SATs as hard work (OR 0.44 [95% CI 0.22–0.85]).
Even in a motivated state-wide quality improvement collaborative, SAT practice varies widely and concerns persist regarding SATs. Cultural practices may counteract the effect of concerns regarding SATs and are associated with increased performance of this beneficial intervention. Patient selection should be a focus for continuing medical education. Differences in perception of work between management and staff may also be a focus for improved communication.
PMCID: PMC3716863  PMID: 23782968
Organizational Culture; Conscious Sedation; Intensive Care; Mechanical Ventilators
9.  A novel eukaryotic Na+ Methionine selective symporter is essential for mosquito development 
AeNAT5 (NCBI, ABZ81822), an orphan member of the insect-specific Nutrient Amino acid Transporter subfamily of SoLute Carrier family 6 (NAT-SLC6) and the first representative of a novel eukaryotic methionine-selective transport system (M), was cloned from cDNA of the vector mosquito, Aedes aegypti. It has orphan orthologs throughout several mosquito genomes, but not in Drosophila or outside Diptera. It shows the highest apparent affinity to L-Met (K0.5 = 0.021 mM) and its metabolites Homocysteine and Cysteine (K0.5 = 0.89 and 2.16 mM), but weakly interact with other substrates. It has a Na+ - coupled mechanism (K0.5 Na+ ~ 46 mM) with 1AA:1Na+ stoichiometry that maintains ~ 60% activity in Cl− - free media. In situ hybridization showed accumulation of AeNAT5 transcript in the absorptive and secretory epithelia, as well as in specific peripheral neurons and the central ganglia of mosquito larvae. The labeling pattern is distinct from that of the previously characterized AeNAT1. RNAi of AeNAT5 increases larval mortality during ecdysis and dramatically suppresses adult emergence. Our results showed that in addition to previously characterized broad spectra and aromatic amino acid selective transport systems, the mosquito NAT-SLC6 subfamily evolved a unique mechanism for selective absorption of sulfur-containing substrates. We demonstrated specific patterns of alimentary and neuronal transcription of AeNAT5 in mosquito larvae that is collateral with the indispensable function of this transporter in mosquito development.
PMCID: PMC3746589  PMID: 23748165
amino acids transport; methionine; hatching induced RNA interference (hiRNAi); epithelial cell; neurons; mosquito; larvae; SLC6
10.  Clinical Outcomes with Rapid Detection of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Routine Blood Cultures 
Journal of Clinical Microbiology  2013;51(12):4126-4129.
Staphylococcus aureus is a common cause of bacteremia, with a substantial impact on morbidity and mortality. Because of increasing rates of methicillin-resistant Staphylococcus aureus, vancomycin has become the standard empirical therapy. However, beta-lactam antibiotics remain the best treatment choice for methicillin-susceptible strains. Placing patients quickly on the optimal therapy is one goal of antimicrobial stewardship. This retrospective, observational, single-center study compared 33 control patients utilizing only traditional full-susceptibility methodology to 22 case patients utilizing rapid methodology with CHROMagar medium to detect and differentiate methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains hours before full susceptibilities were reported. The time to targeted therapy was statistically significantly different between control patients (mean, 56.5 ± 13.6 h) and case patients (44.3 ± 17.9 h) (P = 0.006). Intensive care unit status, time of day results emerged, and patient age did not make a difference in time to targeted therapy, either singly or in combination. Neither length of stay (P = 0.61) nor survival (P = 1.0) was statistically significantly different. Rapid testing yielded a significant result, with a difference of 12.2 h to targeted therapy. However, there is still room for improvement, as the difference in time to susceptibility test result between the full traditional methodology and CHROMagar was even larger (26.5 h). This study supports the hypothesis that rapid testing plays a role in antimicrobial stewardship by getting patients on targeted therapy faster.
PMCID: PMC3838081  PMID: 24088861
11.  Using Molecular Epidemiology to Track Toxoplasma gondii from Terrestrial Carnivores to Marine Hosts: Implications for Public Health and Conservation 
Environmental transmission of the zoonotic parasite Toxoplasma gondii, which is shed only by felids, poses risks to human and animal health in temperate and tropical ecosystems. Atypical T. gondii genotypes have been linked to severe disease in people and the threatened population of California sea otters. To investigate land-to-sea parasite transmission, we screened 373 carnivores (feral domestic cats, mountain lions, bobcats, foxes, and coyotes) for T. gondii infection and examined the distribution of genotypes in 85 infected animals sampled near the sea otter range.
Methodology/Principal Findings
Nested PCR-RFLP analyses and direct DNA sequencing at six independent polymorphic genetic loci (B1, SAG1, SAG3, GRA6, L358, and Apico) were used to characterize T. gondii strains in infected animals. Strains consistent with Type X, a novel genotype previously identified in over 70% of infected sea otters and four terrestrial wild carnivores along the California coast, were detected in all sampled species, including domestic cats. However, odds of Type X infection were 14 times higher (95% CI: 1.3–148.6) for wild felids than feral domestic cats. Type X infection was also linked to undeveloped lands (OR = 22, 95% CI: 2.3–250.7). A spatial cluster of terrestrial Type II infection (P = 0.04) was identified in developed lands bordering an area of increased risk for sea otter Type II infection. Two spatial clusters of animals infected with strains consistent with Type X (P≤0.01) were detected in less developed landscapes.
Differences in T. gondii genotype prevalence among domestic and wild felids, as well as the spatial distribution of genotypes, suggest co-existing domestic and wild T. gondii transmission cycles that likely overlap at the interface of developed and undeveloped lands. Anthropogenic development driving contact between these cycles may increase atypical T. gondii genotypes in domestic cats and facilitate transmission of potentially more pathogenic genotypes to humans, domestic animals, and wildlife.
Author Summary
Toxoplasma gondii, a global parasite shed by domestic and wild felids, can cause severe disease in people and animals. In coastal California, USA, many sea otters have died due to T. gondii. Because T. gondii is shed by felids on land, otter infection suggests that this extremely hardy parasite is transported in freshwater runoff to aquatic environments, where animals and humans can become exposed. Molecular characterization of T. gondii strains infecting terrestrial and marine hosts can provide clues about parasite transmission cycles and sources of otter infection. By testing 373 and characterizing T. gondii infection in 85 terrestrial carnivores (domestic cats and wild carnivores) sharing the California coast, we found that Type X, the type previously identified in over 70% of infected sea otters tested, was more common in wild felids than domestic cats. However, discovery of Type X in domestic cats in this region suggests that they may play an important role in marine infection, as their populations are larger than those of wild felids. Differences in types of T. gondii among carnivores and in urban and agricultural vs. undeveloped areas suggest that there are separate, but overlapping domestic and wild cycles of T. gondii transmission in coastal California.
PMCID: PMC4038486  PMID: 24874796
12.  A Polyurethane Cuffed Endotracheal Tube (PUC-ETT) is Associated with Decreased Rates of Ventilator-Associated Pneumonia 
Journal of critical care  2010;26(3):280-286.
To determine whether the use of a polyurethane-cuffed endotracheal tube would result in a decrease in ventilator-associated pneumonia rate.
Materials and Methods
We replaced conventional endotracheal tube with a polyurethane-cuff endotracheal tube (Microcuff, Kimberly-Clark Corporation, Rosewell, Georgia) in all adult mechanically ventilated patients throughout our large academic hospital from July 2007–June 2008. We retrospectively compared the rates of ventilator-associated pneumonia before, during, and after the intervention year by interrupted time-series analysis.
Ventilator-associated pneumonia rates decreased from 5.3 per 1000 ventilator days prior to the use of the polyurethane-cuffed endotracheal tube to 2.8 per 1000 ventilator days during the intervention year (p = 0.0138). During the first three months after return to conventional tubes, the rate of ventilator-associated pneumonia was 3.5/1000 ventilator days. Use of the polyurethane-cuffed endotracheal tube was associated with an incidence risk ratio of ventilator-associated pneumonia of 0.572 (95% CI 0.340–0.963). In statistical regression analysis controlling for other possible alterations in the hospital environment, as measured by rate of tracheostomy-ventilator-associated pneumonia, the incidence rate ratio of ventilator-associated pneumonia in patients intubated with polyurethane-cuffed endotracheal tube was 0.565 (p=0.032, 95% CI 0.335–0.953).
Use of a polyurethane-cuffed endotracheal tube was associated with a significant decrease in the rate of ventilator-associated pneumonia in our study.
PMCID: PMC4009728  PMID: 20655698
Pneumonia; Ventilator-associated; Nosocomial Infections; Ventilators; Mechanical; Endotracheal tube
13.  Development of a Treatment Algorithm for Streptococci and Enterococci from Positive Blood Cultures Identified with the Verigene Gram-Positive Blood Culture Assay 
Journal of Clinical Microbiology  2013;51(11):3869-3871.
Seventy-eight blood cultures with a Gram stain result of Gram-positive cocci in pairs and/or chains were evaluated with the Nanosphere Verigene Gram-positive blood culture (BC-GP) assay. The overall concordance of the assay with culture was 89.7% (70/78 cultures), allowing for the development of a targeted treatment algorithm.
PMCID: PMC3889785  PMID: 23985910
14.  Comparison of Matrix-Assisted Laser Desorption Ionization–Time of Flight (MALDI-TOF) Mass Spectrometry Platforms for the Identification of Gram-Negative Rods from Patients with Cystic Fibrosis 
Journal of Clinical Microbiology  2013;51(11):3852-3854.
We evaluated the performance of the Bruker Biotyper and the bioMérieux Vitek MS with both the SARAMIS v4.09 and Knowledge Base v2.0 databases for the identification of 203 non-glucose-fermenting Gram-negative rods that had previously been identified by 16S rRNA gene sequencing. Including those that underwent repeat testing, 96.6%, 90.1%, and 93.6% of isolates, respectively, had identifications that agreed with the previous identification.
PMCID: PMC3889780  PMID: 23966494
15.  Organizational Characteristics Associated with the Use of Daily Interruption of Sedation in US Hospitals: A National Study 
BMJ quality & safety  2011;21(2):145-151.
Daily interruption of sedation (DIS) has multiple proven benefits, but implementation is erratic. Past research on sedative interruption utilization focused on individual clinicians, ignoring the role of organizations in shaping practice. We test the hypothesis that specific hospital organizational characteristics are associated with routine use of DIS.
Design & Setting
National, mailed survey to stratified random sample of United States (US) hospitals in 2009. Respondents were the lead infection control professionals at each institution.
Survey items inquired about DIS use, institutional structure, and organizational culture. Multivariable analysis was used to evaluate the independent association of these factors with DIS use.
A total of 386 hospitals formed our final analytic sample; the response rate was 69.4%. Hospitals ranged in size from 25 to 1359 beds. 26% of hospitals were associated with a medical school. Almost 80% reported regular use of DIS for ventilated patients. While 75.4% of hospitals reported having leadership focus on safety culture, only 42.7% reported that their staff were receptive to changes in practice. In a multivariable logistic regression model, structural characteristics such as size and academic affiliation were not associated with use of DIS. However, leadership emphasis on safety culture (p=0.04), staff receptivity to change (p=0.02) and involvement in an infection prevention collaborative (p=0.04) were significantly associated with regular DIS use.
Several elements of hospital organizational culture were associated with regular use of DIS in US hospitals. Our findings emphasize the importance of combining specific administrative approaches with strategies to encourage receptivity to change among bedside clinicians in order to successfully implement complex evidence-based practices in the intensive care setting.
PMCID: PMC4005254  PMID: 21949434
Organizational Culture; Conscious Sedation; Intensive Care; Mechanical Ventilators
16.  Variant in the 3′ Region of the IκBα Gene Associated With Insulin Resistance in Hispanic Americans: The IRAS Family Study 
Obesity (Silver Spring, Md.)  2009;18(3):555-562.
The IKKβ/NF-κB pathway is known to play an important role in inflammatory response and has also recently been implicated in the process of insulin resistance. We hypothesized that one or more variants in the IκBα gene (NFKBIA) or surrounding untranslated regions would be associated with insulin sensitivity (SI) in Hispanic-American families. We tested for association between 25 single-nucleotide polymorphisms (SNPs) in and near NFKBIA and SI in 981 individuals in 90 Hispanic-American families from the Insulin Resistance Atherosclerosis (IRAS) Family Study. SNP rs1951276 in the 3′ flanking region of NFKBIA was associated with SI in the San Antonio (SA) sample after adjusting for age, gender, and admixture (uncorrected P = 1.69 × 10−5; conservative Bonferroni correction P = 3.38 × 10−4). Subjects with at least one A allele for NFKBIA rs1951276 had ~29% lower SI compared to individuals homozygous for the G allele in the SA sample. Although not statistically significant, the effect was in the same direction in the San Luis Valley (SLV) sample alone (P = 0.348) and was significant in the combined SA and SLV samples (P = 5.37 × 10−4; presence of A allele associated with ~20% lower SI). In SA, when adjusted for subcutaneous adipose tissue area (SAT, cm2), the association was modestly attenuated (P = 1.25 × 10−3), but the association remained highly significant after adjustment for visceral adipose tissue area (VAT, cm2; P = 4.41 × 10−6). These results provide corroborating evidence that the NF-κB/IKKβ pathway may mediate obesity-induced insulin resistance in humans.
PMCID: PMC3992855  PMID: 19798070
17.  Consumer experience with and attitudes toward health information technology: a nationwide survey 
Electronic health records (EHR) are becoming more common because of the federal EHR incentive programme, which is also promoting electronic health information exchange (HIE). To determine whether consumers' attitudes toward EHR and HIE are associated with experience with doctors using EHR, a nationwide random-digit-dial survey was conducted in December 2011. Of 1603 eligible people contacted, 1000 (63%) participated. Most believed EHR and HIE would improve healthcare quality (66% and 79%, respectively). Respondents whose doctor had an EHR were more likely to believe that these technologies would improve quality (for EHR, OR 2.3; for HIE, OR 1.7). However, experience with physicians using EHR was not associated with privacy concerns. Consumers whose physicians use EHR were more likely to believe that EHR and HIE will improve healthcare when compared to others. However, experience with a physician using an EHR had no relationship with privacy concerns.
PMCID: PMC3555333  PMID: 22847306
Electronic health records; health information exchange; health information technology; privacy and security; public attitudes and perceptions
18.  Lack of tolerance to the disinhibiting effects of alcohol in heavy drinkers 
Psychopharmacology  2012;224(4):511-518.
Alcohol tolerance is observed as a diminished response to a given dose as a function of repeated administrations of the drug. Research has consistently shown that heavier drinkers display reduced reactions to alcohol (i.e., tolerance) compared with lighter drinkers. However, the majority of this work has focused primarily on measures of motor performance, whereas the development of tolerance to alcohol’s impairing effects on cognitive processes, such as inhibitory mechanisms of behavioral control, remains relatively unexplored.
The purpose of the present study was to examine the relationship between drinking habits and the degree to which alcohol affects drinkers’ inhibitory control and motor coordination.
Fifty-two non-dependent drinkers reported their recent drinking patterns. Their inhibitory control and motor coordination were measured in response to placebo and 0.65 g/kg alcohol.
Alcohol significantly impaired inhibitory control and motor coordination compared with placebo. Moreover, greater quantity and frequency of recent consumption predicted less alcohol impairment of motor coordination. However, there was no relationship between recent drinking habits and the degree of impairment of inhibitory control.
These findings suggest that tolerance to the disinhibiting effects of alcohol might not readily develop as a result of recent, heavy drinking.
PMCID: PMC3593342  PMID: 22763668
Alcohol; Tolerance; Inhibitory control; Motor coordination
19.  Comparison of the Biofire FilmArray RP, Genmark eSensor RVP, Luminex xTAG RVPv1, and Luminex xTAG RVP Fast Multiplex Assays for Detection of Respiratory Viruses 
Journal of Clinical Microbiology  2013;51(5):1528-1533.
There are several U.S. FDA-cleared molecular respiratory virus panels available today, each with advantages and disadvantages. This study compares four multiplex panels, the BioFire Diagnostics FilmArray RP (respiratory panel), the GenMark Dx eSensor RVP (respiratory viral panel), the Luminex xTAG RVPv1, and the Luminex xTAG RVP fast. Three hundred specimens (200 retrospective and 100 consecutive) were tested using all four platforms to determine performance characteristics. The overall sensitivity and specificity, respectively, and 95% confidence interval (CI; in parentheses) for each panel were as follows: FilmArray RP, 84.5% (79.2, 88.6) and 100% (96.2, 100); eSensor RVP, 98.3% (95.5, 99.5) and 99.2% (95.4, 100); xTAG RVPv1, 92.7% (88.5, 95.4) and 99.8% (96.0, 100); and xTAG RVP fast, 84.4% (78.5, 88.9) and 99.9% (96.1, 100). The sensitivity of each assay fluctuated by viral target, with the greatest discrepancies noted for adenovirus and influenza virus B detection. Hands-on time and time to result were recorded and ease of use was assessed to generate a complete profile of each assay.
PMCID: PMC3647947  PMID: 23486707
20.  Hydrologic and Vegetative Removal of Cryptosporidium parvum, Giardia lamblia, and Toxoplasma gondii Surrogate Microspheres in Coastal Wetlands 
Constructed wetland systems are used to reduce pollutants and pathogens in wastewater effluent, but comparatively little is known about pathogen transport through natural wetland habitats. Fecal protozoans, including Cryptosporidium parvum, Giardia lamblia, and Toxoplasma gondii, are waterborne pathogens of humans and animals, which are carried by surface waters from land-based sources into coastal waters. This study evaluated key factors of coastal wetlands for the reduction of protozoal parasites in surface waters using settling column and recirculating mesocosm tank experiments. Settling column experiments evaluated the effects of salinity, temperature, and water type (“pure” versus “environmental”) on the vertical settling velocities of C. parvum, G. lamblia, and T. gondii surrogates, with salinity and water type found to significantly affect settling of the parasites. The mesocosm tank experiments evaluated the effects of salinity, flow rate, and vegetation parameters on parasite and surrogate counts, with increased salinity and the presence of vegetation found to be significant factors for removal of parasites in a unidirectional transport wetland system. Overall, this study highlights the importance of water type, salinity, and vegetation parameters for pathogen transport within wetland systems, with implications for wetland management, restoration efforts, and coastal water quality.
PMCID: PMC3592235  PMID: 23315738
21.  Canine Cyanotoxin Poisonings in the United States (1920s–2012): Review of Suspected and Confirmed Cases from Three Data Sources 
Toxins  2013;5(9):1597-1628.
Cyanobacteria (also called blue-green algae) are ubiquitous in aquatic environments. Some species produce potent toxins that can sicken or kill people, domestic animals, and wildlife. Dogs are particularly vulnerable to cyanotoxin poisoning because of their tendency to swim in and drink contaminated water during algal blooms or to ingestalgal mats.. Here, we summarize reports of suspected or confirmed canine cyanotoxin poisonings in the U.S. from three sources: (1) The Harmful Algal Bloom-related Illness Surveillance System (HABISS) of the National Center for Environmental Health (NCEH), Centers for Disease Control and Prevention (CDC); (2) Retrospective case files from a large, regional veterinary hospital in California; and (3) Publicly available scientific and medical manuscripts; written media; and web-based reports from pet owners, veterinarians, and other individuals. We identified 231 discreet cyanobacteria harmful algal bloom (cyanoHAB) events and 368 cases of cyanotoxinpoisoning associated with dogs throughout the U.S. between the late 1920s and 2012. The canine cyanotoxin poisoning events reviewed here likely represent a small fraction of cases that occur throughout the U.S. each year.
PMCID: PMC3798876  PMID: 24064718
anatoxin; dog; canine; cyanotoxin; hepatotoxin; microcystin; neurotoxin poisoning; cyanobacteria; blue-green algae
22.  Love Hurts (in More Ways Than One): Specificity of Psychological Symptoms as Predictors and Consequences of Romantic Activity Among Early Adolescent Girls* 
Journal of clinical psychology  2012;68(4):373-381.
Research has linked adolescent romantic and sexual activities to depressive symptoms. The current study examines whether such activities are uniquely linked to depressive symptoms versus symptoms of other disorders (including anxiety, externalizing, and eating disorders), and whether co-occurring symptoms more precisely account for the association between depressive symptoms and romantic involvement.
Early adolescent girls (N = 83; mean age = 13.45) participated in baseline and 1-year follow up data collection.
Romantic (i.e., dating and sexual) activities were longitudinally related to numerous types of symptoms. The association between depressive symptoms and romantic variables remained when considering co-occurring symptoms. Girls with more comorbid disorders reported more romantic activities.
Results suggest that the maladaptive consequences and precipitants of adolescent romantic activities extend beyond depression, but also imply that this association is not secondary to comorbid symptoms. Future work should clarify causal pathways.
PMCID: PMC3494752  PMID: 22307747
adolescence; romantic involvement; sexual activity; depression; specificity
23.  Autonomous Transmembrane Segment S4 of the Voltage Sensor Domain Partitions into the Lipid Membrane 
Biochimica et biophysica acta  2012;1818(7):10.1016/j.bbamem.2012.03.011.
The S4 transmembrane segment in voltage-gated ion channels, a highly basic α helix, responds to changes in membrane potential and induces channel opening. Earlier work by others indicates that the S4 segment interacts with lipids in plasma membrane, but its mechanism is unclear. Working with synthetic tryptophan-labeled S4 peptides, we characterized binding of autonomous S4 to lipid membranes. The binding free energy (5.2 ± 0.2 kcal/mol) of the peptide-lipid interaction was estimated from the apparent dissociation constants, determined from the changes in anisotropy of tryptophan fluorescence induced by addition of lipid vesicles with 30 mol% phosphatidylglycerol. The results are in good agreement with the prediction based on the Wimley-White hydrophobicity scale for interfacial (IF) binding of an alpha-helical peptide to the lipid bilayer (6.98 kcal/mol). High salt inhibited the interaction, thus indicating that the peptide/membrane interaction has both electrostatic and non-electrostatic components. Furthermore, the synthetic S4 corresponding to the Shaker potassium channel was found to spontaneously penetrate into the negatively charged lipid membrane to a depth of about 9 Å. Our results revealed important biophysical parameters that influence the interaction of S4 with the membrane: they include fluidity, surface charge, and surface pressure of the membrane, and the α helicity and regular spacing of basic amino-acid residues in the S4 sequence.
PMCID: PMC3412939  PMID: 22465069
Potassium channel; voltage sensor domain; S4; fluorescence spectroscopy; resonance energy transfer; small unilamellar vesicles
24.  Comparative Evaluation of the Nanosphere Verigene RV+ Assay and the Simplexa Flu A/B & RSV Kit for Detection of Influenza and Respiratory Syncytial Viruses 
Journal of Clinical Microbiology  2013;51(1):352-353.
Using retrospective (n = 200) and prospective (n = 150) nasopharyngeal specimens, we evaluated the Nanosphere Verigene RV+ and the Focus Diagnostics Simplexa Flu A/B & RSV tests. Overall, RV+ demonstrated sensitivities and specificities of 96.6% and 100% for influenza A virus, 100% and 99.7% for influenza B virus, and 100% and 100% for respiratory syncytial virus (RSV), while the Simplexa test sensitivities and specificities were 82.8 and 99.7%, 76.2 and 100%, and 94.6 and 100%, respectively.
PMCID: PMC3536264  PMID: 23152547
25.  Prevalence, Environmental Loading, and Molecular Characterization of Cryptosporidium and Giardia Isolates from Domestic and Wild Animals along the Central California Coast 
Applied and Environmental Microbiology  2012;78(24):8762-8772.
The risk of disease transmission from waterborne protozoa is often dependent on the origin (e.g., domestic animals versus wildlife), overall parasite load in contaminated waterways, and parasite genotype, with infections being linked to runoff or direct deposition of domestic animal and wildlife feces. Fecal samples collected from domestic animals and wildlife along the central California coast were screened to (i) compare the prevalence and associated risk factors for fecal shedding of Cryptosporidium and Giardia species parasites, (ii) evaluate the relative importance of animal host groups that contribute to pathogen loading in coastal ecosystems, and (iii) characterize zoonotic and host-specific genotypes. Overall, 6% of fecal samples tested during 2007 to 2010 were positive for Cryptosporidium oocysts and 15% were positive for Giardia cysts. Animal host group and age class were significantly associated with detection of Cryptosporidium and Giardia parasites in animal feces. Fecal loading analysis revealed that infected beef cattle potentially contribute the greatest parasite load relative to other host groups, followed by wild canids. Beef cattle, however, shed host-specific, minimally zoonotic Cryptosporidium and Giardia duodenalis genotypes, whereas wild canids shed potentially zoonotic genotypes, including G. duodenalis assemblages A and B. Given that the parasite genotypes detected in cattle were not zoonotic, the public health risk posed by protozoan parasite shedding in cattle feces may be lower than that posed by other animals, such as wild canids, that routinely shed zoonotic genotypes.
PMCID: PMC3502930  PMID: 23042185

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