James Dziura

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (131)861.84 Total impact

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    ABSTRACT: Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide "sentinel" information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pennsylvania (USA). There were a total of 127 reported health conditions, most commonly among dogs. When reports from all animals were considered, there were no significant associations between reported health condition and household proximity to natural gas wells. When dogs were analyzed separately, we found an elevated risk of 'any' reported health condition in households less than 1km from the nearest gas well (OR = 3.2, 95% CI 1.07-9.7), with dermal conditions being the most common of canine disorders. While these results should be considered hypothesis generating and preliminary, they suggest value in ongoing assessments of pet dogs as well as other animals to better elucidate the health impacts of natural gas extraction on nearby communities.
    Journal of Environmental Science and Health Part A Toxic/Hazardous Substances & Environmental Engineering 04/2015; 50(5):473-81. DOI:10.1080/10934529.2015.992666
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    ABSTRACT: Objective Fructose consumption has risen alongside obesity and diabetes. Gut hormones involved in hunger and satiety (ghrelin and PYY) may respond differently to fructose compared with glucose ingestion. This study evaluated the effects of glucose and fructose ingestion on ghrelin and PYY in lean and obese adolescents with differing insulin sensitivity.Methods Adolescents were divided into lean (n = 14), obese insulin sensitive (n = 12) (OIS), and obese insulin resistant (n = 15) (OIR). In a double-blind, cross-over design, subjects drank 75 g of glucose or fructose in random order, serum was obtained every 10 minutes for 60 minutes.ResultsBaseline acyl-ghrelin was highest in lean and lowest in OIR (P = 0.02). After glucose ingestion, acyl-ghrelin decreased similarly in lean and OIS but was lower in OIR (vs. lean, P = 0.03). Suppression differences were more pronounced after fructose (lean vs. OIS, P = 0.008, lean vs. OIR, P < 0.001). OIS became significantly hungrier after fructose (P = 0.015). PYY was not significantly different at baseline, varied minimally after glucose, and rose after fructose.Conclusions Compared with lean, OIS adolescents have impaired acyl-ghrelin responses to fructose but not glucose, whereas OIR adolescents have blunted responses to both. Diminished suppression of acyl-ghrelin in childhood obesity, particularly if accompanied by insulin resistance, may promote hunger and overeating.
    Obesity 02/2015; DOI:10.1002/oby.21019 · 4.39 Impact Factor
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    ABSTRACT: BACKGROUND Hospitalized patients with diabetes have experienced a disproportionate reduction in mortality over the past decade.OBJECTIVE To examine whether this differential decrease affected all patients with diabetes, and to identify explanatory factors.DESIGNSerial, cross-sectional observational study.SETTINGAcademic medical center.PATIENTSAll adult, nonobstetric patients with an inpatient discharge between January 1, 2000 and December 31, 2010.MEASUREMENTWe assessed in-hospital mortality; inpatient glycemic control (percentage of hospital days with glucose below 70, above 299, and between 70 and 179 mg/dL, and standard deviation of glucose measurements), and outpatient glycemic control (hemoglobin A1c).RESULTSWe analyzed 322,938 admissions, including 76,758 (23.8%) with diabetes. Among 54,645 intensive care unit (ICU) admissions, there was a 7.8% relative reduction in the odds of mortality in each successive year for patients with diabetes, adjusted for age, race, payer, length of stay, discharge diagnosis, comorbidities, and service (odds ratio [OR]: 0.923, 95% confidence interval [CI]: 0.906-0.940). This was significantly greater than the 2.6% yearly reduction for those without diabetes (OR: 0.974, 95% CI: 0.963-0.985; P < 0.001 for interaction). In contrast, the greater decrease in mortality among non-ICU patients with diabetes did not reach significance. Results were similar among medical and surgical patients. Among ICU patients with diabetes, the significant decline in mortality persisted after adjustment for inpatient and outpatient glucose control (OR: 0.953, 95% CI: 0.914-0.994).CONCLUSIONS Patients with diabetes in the ICU have experienced a disproportionate reduction in mortality that is not explained by glucose control. Potential explanations include improved cardiovascular risk management or advances in therapies for diseases commonly affecting patients with diabetes. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine
    Journal of Hospital Medicine 01/2015; DOI:10.1002/jhm.2321 · 2.08 Impact Factor
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    Journal of the American College of Cardiology 10/2014; 64(14):1533-4. DOI:10.1016/j.jacc.2014.07.959 · 15.34 Impact Factor
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    ABSTRACT: The Initiative for Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has reported diminished assay sensitivity in pain treatment trials and recommended investigation of the causes. Specific recommendations included examination of outcome measure reliability and lengthening the baseline measurement period to allow more measurements to be collected. This secondary data analysis evaluated the minimum number of daily pain intensity ratings required to obtain a reliability of at least 0.90 and whether a composite of this smaller number of ratings was interchangeable with the composite of all ratings. Veterans Affairs (VA) medical center patients made 14 daily calls to an automated telephone system to report their average daily pain intensity rating. A single daily rating produced less than adequate reliability (ICC=0.65), but a composite of the average of five ratings resulted in reliability above 0.90. A Bland-Altman analysis revealed that the differences between a five-day composite and the composite of all ratings were small (mean 0.09 points, SD = 0.45; 95% confidence interval = -0.05 to 0.23) and below the threshold for a clinically meaningful difference, indicating the two measurements are interchangeable. Our results support IMMPACT recommendations for improving assay sensitivity by collecting a multi-day baseline of pain intensity ratings.
    Journal of Pain 10/2014; 15(12). DOI:10.1016/j.jpain.2014.09.012 · 4.22 Impact Factor
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    ABSTRACT: Background Despite American Heart Association recommendations of diet/lifestyle modification and statin therapy to achieve low-density lipoprotein cholesterol (LDL) control, women are less likely than men to be screened and achieve treatment goals. This study determined whether the provider and patient response to electronic medical record (EMR) notification of an elevated LDL varied by patient sex in veterans. Methods Provider responses to EMR clinical reminders for an elevated LDL (≥100 mg/dL) were assessed in men (n = 40,738) and women (n = 1,025) veterans with ischemic heart disease or diabetes between October 2008 and September 2009. Responses were classified into four types: 1) Whether the patient refused medication, 2) the provider ordered or adjusted medication, 3) treatment was deferred/medications were not changed, or 4) medications were contraindicated. Logistic regression with generalized estimating equations was used to compare clinical reminder responses between men and women patients. Findings Providers were less likely to order or adjust medications for women (adjusted odds ratio [OR], 0.75; 95% CI, 0.63, 0.88) and women were more likely than men to refuse medication (adjusted OR, 1.71; 95% CI, 1.34, 2.17). These associations were not modified by degree of LDL elevation or use of lipid-lowering medications. Conclusion These results indicate that poorer cholesterol control in at risk women is likely a consequence of both provider and patient factors.
    Women s Health Issues 10/2014; 24(5):575–580. DOI:10.1016/j.whi.2014.06.004 · 1.61 Impact Factor
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    ABSTRACT: Background: Little is known about the environmental and public health impact of unconventional natural gas extraction activities including hydraulic fracturing that occur near residential areas. Objectives: To assess the relationship between household proximity to natural gas wells and reported health symptoms. Methods: We conducted a hypothesis generating health symptom survey of 492 persons in 180 randomly selected households with ground-fed wells in an area of active natural gas drilling. Gas well proximity for each household was compared to the prevalence and frequency of reported dermal, respiratory, gastrointestinal, cardiovascular, and neurological symptoms. Results: The number of reported health symptoms per person was higher among residents living <1 km (mean 3.27 ± 3.72) compared with >2 km from the nearest gas well (mean 1.60 ± 2.14, p=0.02). In a model that adjusted for age, gender, household education, smoking, awareness of environmental risk, work type, and animals in house, reported skin conditions were more common in households <1 km compared with >2 km from the nearest gas well (OR= 4.1; 95% CI: 1.4, 12.3; p=0.01). Upper respiratory symptoms were also more frequently reported in persons living in households less than 1 km from gas wells (39%) compared to households 1-2 km or >2 km from the nearest well (31 and 18%, respectively) (p=0.004). No equivalent correlation was found between well proximity and other reported groups of respiratory, neurological, cardiovascular, or gastrointestinal conditions. Conclusion: While these results should be viewed as hypothesis generating, and the population studied was limited to households with a ground fed water supply, proximity of natural gas wells may be associated with the prevalence of health symptoms including dermal and respiratory conditions in residents living near natural gas extraction activities. Further study of these associations, including the role of specific air and water exposures, is warranted.
    Environmental Health Perspectives 09/2014; DOI:10.1289/ehp.1307732 · 7.03 Impact Factor
  • JAMA Internal Medicine 05/2014; 174(7). DOI:10.1001/jamainternmed.2014.1803 · 13.25 Impact Factor
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    ABSTRACT: Background The ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), are biomarkers of recent alcohol consumption that provide objective measures of abstinence. Our goals are to better understand the impact of cutoff concentration on test interpretation, the need for measuring both metabolites, and how best to integrate test results with self-reports in clinical trials.Methods Subjects (n = 18) were administered, 1 week apart, 3 alcohol doses calibrated to achieve blood concentrations of 20, 80, and 120 mg/dl, respectively. Urinary EtG/EtS was measured at timed intervals during a 24-hour hospitalization and twice daily thereafter. In addition, participants from 2 clinical trials provided samples for EtG/EtS and drinking histories. Cutoffs for EtG/EtS of 100/50, 200/100, and 500/250 ng/ml were evaluated.ResultsTwelve hours following each challenge, EtG was always positive at the 100 and 200 cutoffs, but at 24 hours sensitivity was poor at all cutoffs following the low dose, and poor after 48 hours regardless of dose or cutoff. Similarly, in the clinical trials EtG sensitivity was good for detecting any drinking during the last 24 hours at the 2 lowest cutoffs, but under 40% during the last 24 to 48 hours. Sensitivity was reduced at the 500 ng/ml cutoff. Discrepancies between EtG and EtS were few. Comparison of self-reports of abstinence and EtG-confirmed abstinence indicated underreporting of drinking.Conclusions Any drinking the night before should be detectable the following morning with EtG cutoffs of 100 or 200 ng/ml. Twenty-four hours after drinking, sensitivity is poor for light drinking, but good for heavier consumption. At 48 hours, sensitivity is low following 6 drinks or less. Increasing the cutoff to 500 ng/ml leads to substantially reduced sensitivity. Monitoring both EtG and EtS should usually be unnecessary. We recommend EtG-confirmed self-reports of abstinence for evaluation of outcomes in clinical trials.
    Alcoholism Clinical and Experimental Research 04/2014; DOI:10.1111/acer.12407 · 3.31 Impact Factor
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    ABSTRACT: Background The United Arab Emirates (UAE) was certified by the World Health Organization to be free of endemic malaria transmission in 2007. There continued to be, however, a substantial number of imported malaria cases.MethodsA retrospective laboratory and chart review was performed to describe the epidemiological, clinical, and laboratory characteristics of imported malaria in Dubai, UAE. Laboratory records were reviewed at the largest public hospital in Dubai to identify cases of peripheral blood smear-positive malaria from January 1, 2008 to December 31, 2010. Predefined demographic, clinical, and laboratory information was extracted from the electronic medical record system.ResultsA total of 629 cases of malaria were identified including 493, 122, and 14 cases of Plasmodium vivax, Plasmodium falciparum, and mixed P. vivax/P. falciparum infections, respectively. Of these, 567 (90.1%) cases were either from India or Pakistan and 7% from sub-Saharan Africa. There were no cases among the local Emirati population. There were 162 hospitalizations, including 8 requiring intensive care support and 1 death. More than 10% of P. vivax infections required hospitalization. The interval between arrival in the UAE and diagnosis was 3 months or longer for 25% of P. vivax cases.Conclusions Imported malaria remains an important cause of morbidity in the UAE. Clinicians need to be aware that P. vivax is not benign and can cause severe disease and that malaria cases may present to health facilities several months after arrival from malaria-endemic regions.
    Journal of Travel Medicine 03/2014; DOI:10.1111/jtm.12110 · 1.68 Impact Factor
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    ABSTRACT: Prior studies indicate that an elevated creatinine kinase (CK)-MB imparts poor prognosis in patients with acute coronary syndrome despite a normal troponin. Its prognosis in the undifferentiated chest pain observation unit (CPU) population remains undefined. To compare rates and predictors of 30-day adverse cardiac events in 2 cohorts (CK±/MB+ vs. normal [CK±/MB-]) in low-moderate-risk CPU patients. Consecutive CPU patients were followed in a retrospective cohort study for primary outcome (acute coronary syndrome, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, abnormal stress test, cardiac hospitalization, or death within 30 days) by using standardized chart reviews and national death registry. Exclusions were: those aged 30 years or younger, positive troponin, ischemic electrocardiogram, hemodynamic instability, heart failure, or dialysis. Between January 2006 and April 2009, 2979 patients were eligible, of which 350 excluded and 2629 analyzed. MB+ compared with normal patients were more likely to be: older (mean, 53.4 ± 14 vs. 51.5 ± 12 years; P = 0.04); male (71% vs. 40%; P = 0.01); renal insufficient (5% vs. 2%; P = 0.01); hypertensive (50% vs. 44%; P = 0.04); dyslipidemic (44% vs. 33%; P = 0.01) obese (55% vs. 43%; P = 0.01); and with known coronary artery disease (14% vs. 5%; P < 0.01). Composite adverse events were 213 (8%) and did not significantly differ for either initial MB+ vs. normal (9.1%, 8.0%; odds ratio, 1.1, 0.7-1.9) or serial MB+ vs. normal (7.5%, 7.4%; odds ratio, 1.0, 0.5-1.8). In a multiple logistic regression model, male sex, diabetes, and prior CAD predicted adverse events, whereas CK-MB along with race, hypertension, smoking, dyslipidemia, family history, and obesity did not. Elevated CK-MB does not add value to serial troponin testing in low-moderate-risk CPU patients.
    Critical pathways in cardiology 03/2014; 13(1):14-9. DOI:10.1097/HPC.0000000000000001
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    ABSTRACT: We examined the complex relationship between depression, anxiety, and seizure control and quality of life (QOL) outcomes after epilepsy surgery. Seven epilepsy centers enrolled 373 patients and completed a comprehensive diagnostic workup and psychiatric and follow-up QOL evaluation. Subjects were evaluated before surgery and then at 3, 6, 12, 24, 48, and 60 months after surgery. Standardized assessments included the Quality of Life in Epilepsy Inventory-89, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A mixed-model repeated-measures analysis was used to analyze associations of depression, anxiety, seizure outcome, and seizure history with overall QOL score and QOL subscores (cognitive distress, physical health, mental health, epilepsy-targeted) prospectively. The groups with excellent and good seizure control showed a significant positive effect on the overall QOL compared to the groups with fair and poor seizure control. The BDI and BAI scores were both highly and negatively associated with overall QOL; increases in BDI and BAI scores were associated with decreased overall QOL score. Depression and anxiety are strongly and independently associated with worse QOL after epilepsy surgery. Interestingly, even partial seizure control, controlling for depression and anxiety levels, improved QOL. Management of mood and anxiety is a critical component to postsurgical care.
    Neurology 01/2014; 82(10). DOI:10.1212/WNL.0000000000000183 · 8.30 Impact Factor
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    ABSTRACT: To compare three statistical strategies for classifying positive treatment response based on a dimensional measure (Yale Global Tic Severity Scale [YGTSS]) and a categorical measure (Clinical Global Impression-Improvement [CGI-I]). Subjects (N=232; 69.4% male; ages 9-69years) with Tourette syndrome or chronic tic disorder participated in one of two 10-week, randomized controlled trials comparing behavioral treatment to supportive therapy. The YGTSS and CGI-I were rated by clinicians blind to treatment assignment. We examined the percent reduction in the YGTSS-Total Tic Score (TTS) against Much Improved or Very Much Improved on the CGI-I, computed a signal detection analysis (SDA) and built a mixture model to classify dimensional response based on the change in the YGTSS-TTS. A 25% decrease on the YGTSS-TTS predicted positive response on the CGI-I during the trial. The SDA showed that a 25% reduction in the YGTSS-TTS provided optimal sensitivity (87%) and specificity (84%) for predicting positive response. Using a mixture model without consideration of the CGI-I, the dimensional response was defined by 23% (or greater) reduction on the YGTSS-TTS. The odds ratio (OR) of positive response (OR=5.68, 95% CI=[2.99, 10.78]) on the CGI-I for behavioral intervention was greater than the dimensional response (OR=2.86, 95% CI=[1.65, 4.99]). A twenty five percent reduction on the YGTSS-TTS is highly predictive of positive response by all three analytic methods. For trained raters, however, tic severity alone does not drive the classification of positive response. Clinicaltrials.gov Identifiers: NCT00218777; NCT00231985.
    Contemporary clinical trials 11/2013; 36(2):414-420. DOI:10.1016/j.cct.2013.08.012 · 1.51 Impact Factor
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    ABSTRACT: Background The childhood obesity epidemic has been accompanied by an increasing prevalence of type 2 diabetes (T2D), particularly in minority children. 20-30% of obese youth have "pre-diabetes" a precursor to diabetes marked by insulin resistance, β-cell dysfunction and impaired glucose tolerance (IGT). The Diabetes Prevention Program (DPP) demonstrated that T2D could be prevented/delayed by intensive lifestyle modification in adults with pre-diabetes, but efficacy of similar interventions in youth has not been established. Therefore, we evaluated the effects of the Bright Bodies Healthy Lifestyle Program on 2-hr OGTT glucose in comparison to adolescents receiving standard of care.Methods Parallel-group randomized controlled trial comparing Bright Bodies (BB) with standard clinical care (CC) in obese adolescents (10-16 yo, Tanner stage >2) with elevated OGTT 2-hr blood glucose (130-199 mg/dl) from a racial/ethnically diverse population. OGTTs, including cardiovascular and anthropometric assessments, were conducted at baseline and 6 months. Children attended BB twice per week for exercise and nutrition/behavior modification and CC group received clinical care from their pediatrician. Primary outcome was change in 2-hr OGTT glucose and % conversion from elevated 2-hr blood glucose to non-elevated (<130 mg/dl) 2-hr blood glucose. Changes in outcomes were compared between groups using an analysis of covariance with adjustment for baseline outcome and multiple imputation for missing data.ResultsReductions in 2-hr glucose were more favorable in BB compared to CC (-27.2 vs. -10.1 mg/dl; diff=-17.1, 95% CI ;p= 0.005). Moreover, greater conversion to <130 mg/dl 2-hr glucose occurred in BB than CC (p=0.003) and other insulin sensitivity indices were significantly improved.Conclusions Compared to standard of care, the Yale Bright Bodies Program is a more effective means of reducing the risk of T2D in obese adolescents with elevated 2-hour glucose levels.
    Diabetes care 09/2013; 37(2). DOI:10.2337/dc13-1571 · 7.74 Impact Factor
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    ABSTRACT: Resident physicians are at risk for increasing weight status given their changes in environment, resources, and stress level. To describe body mass index (BMI), blood pressure, eating habits, and physical activity during postgraduate training and to compare the findings to data for nationally matched controls. This was a combined cross-sectional study and longitudinal cohort, with a comparison to matched controls in 2 academic hospital centers in the eastern and western United States. BMI and blood pressure were objectively measured, and an eating and exercise habits recall was obtained for 375 enrolled medical and surgical residents (93 longitudinally) at the onset of each postgraduate year (PGY) in 2006, 2007, and 2008. Nearly half (43%) of overweight residents described themselves as normal weight. Residents were more likely to be overweight (BMI ≥25) at the beginning of PGY-3 than at the beginning of PGY-1 (49% versus 30%; odds ratio 2.26; 95% confidence interval 1.19-4.28). The average BMI of residents at PGY-1 was lower than that of their matched controls, but the magnitude of this difference decreased with increasing PGY (P = .02). Overweight status is underacknowledged by overweight residents and increases by PGY of training. These changes differ significantly from that of controls and may affect overweight physicians' long-term health.
    09/2013; 5(3):405-411. DOI:10.4300/JGME-D-12-00289.1
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    ABSTRACT: In patients with pulmonary embolism (PE), right ventricular strain (RVS) on transthoracic echocardiography by Cardiology has been shown to be an independent predictor of 30-day adverse outcomes. However, it is not known how emergency practitioner-performed point-of-care focused cardiac ultrasound (FOCUS) with assessment for RVS compares with other prognostic methods in the Emergency Department (ED). To determine whether RVS on FOCUS is a significant predictor of in-hospital adverse outcomes when compared to other risk factors and scoring systems. Retrospective chart review of patients who were diagnosed with PE and had a FOCUS examination during January 1, 2007 through January 1, 2011 in an urban, academic center with a well-developed ultrasound program. Adverse outcomes were defined as shock, respiratory failure requiring intubation, death, recurrent venous thromboembolism, transition to higher level of care, or major bleeding during hospital admission. Statistical analysis included univariate and multivariate analysis to assess for prognostic significance. One hundred sixty-one patients were included in the final analysis. A total of 25 (16%) patients had an adverse outcome during hospitalization. On univariate analysis, only the presence of altered mental status conferred a higher positive likelihood ratio (6.4 vs. 4.0) than RVS, whereas absence of RVS had the lowest negative likelihood ratio (0.45). On multivariate analysis, RVS and cardiopulmonary disease were the only predictors of adverse outcomes that achieved statistical significance, with odds ratio of 9.2 and 3.4, respectively. In this retrospective chart review, a FOCUS examination for RVS performed by emergency care practitioners of varying experience level was a significant predictor of in-hospital adverse outcomes among patients diagnosed with PE in the ED. Future research should be directed at exploring ways to incorporate RVS assessment into ED prognostic models for pulmonary embolism.
    Journal of Emergency Medicine 07/2013; 45(3). DOI:10.1016/j.jemermed.2013.04.014 · 1.18 Impact Factor
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    ABSTRACT: Objectives. We compared the likelihood that a tobacco user would receive treatment with the likelihood that an adult with another common chronic condition would receive treatment for that condition at an office visit. Methods. We analyzed data from the 2005-2007 National Ambulatory Medical Care Survey to compare the proportion of US office visits at which tobacco users and individuals with hypertension, hyperlipidemia, diabetes, asthma, or depression received condition-specific treatment. We calculated the odds that a visit for a comparison condition would result in treatment relative to a visit for tobacco dependence. Results. From 2005 to 2007, 38 004 patient visits involved at least 1 study condition. Tobacco users received medication at fewer visits (4.4%) than individuals with hypertension (57.4%), diabetes (46.2%), hyperlipidemia (47.1%), asthma (42.6%), and depression (53.3%). In multivariate analyses, the odds for pharmacological treatment of these disorders relative to tobacco use were, for hypertension, 32.8; diabetes, 20.9; hyperlipidemia, 16.5; asthma, 22.1; and depression, 24.0 (all Ps < .001). Patients with hypertension, diabetes, or hyperlipidemia were also more likely to receive behavioral counseling. Conclusions. Alternate models of engagement may be needed to enhance use of effective treatments for tobacco use. (Am J Public Health. Published online ahead of print June 13, 2013: e1-e7. doi:10.2105/AJPH.2012.301112).
    American Journal of Public Health 06/2013; DOI:10.2105/AJPH.2012.301112 · 3.93 Impact Factor
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    ABSTRACT: A Structured Observational Analog Procedure (SOAP), an analogue measure of parent-child interactions, was used to assess treatment outcome in children with Autism Spectrum Disorder and serious behavior problems. It served as a secondary outcome measure in a 24-week, randomized trial of risperidone (MED; N=49) versus risperidone plus parent training (COMB; n=75) (ages 4-13 years). At 24-weeks, there was 28 % reduction in child inappropriate behavior during a Demand Condition (p=.0002) and 12 % increase in compliance to parental requests (p=.004) for the two treatment conditions combined. Parents displayed 64 % greater use of positive reinforcement (p=.001) and fewer repeated requests for compliance (p<.0001). In the analysis of covariance (ANCOVA), COMB parents used significantly more positive reinforcement (p=.01) and fewer restrictive statements (p<.05) than MED parents. The SOAP is sensitive to change in child and parent behavior as a function of risperidone alone and in combination with PMT and can serve as a valuable complement to parent and clinician-based measures.
    Journal of Developmental and Physical Disabilities 06/2013; 25(3):355-371. DOI:10.1007/s10882-012-9316-y · 0.89 Impact Factor
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    ABSTRACT: BACKGROUND: Cell phone use while driving is common and can result in driver distraction. However, data on the frequency of this behavior with other occupants in the vehicle are lacking. This study investigates whether adult drivers engage in cell phone use with passengers in the car and determines whether the frequency of these behaviors was modified if the passenger was a child. METHODS: Subjects (N = 539) who have driven children during the previous 30 days were recruited to complete a survey regarding their cell phone usage while driving. The inclusion criteria of participants were as follows: 18 years or older with a valid driver's license, owns/uses a cell phone, drives with children, and reads English. Results were reported on a 4-point Likert scale (always, often, rarely, and never). RESULTS: Eighty percent of respondents reported cell phone use in some way while driving with children. As compared with similar behaviors when driving alone or with adult passengers, the odds of reporting "always" compared with "often, rarely, or never" of holding a cell phone in hand was 0.66 when driving with children. No significant differences were noted for the following variables: use of a blue tooth device or use of a cell phone to speak or text when parked. CONCLUSION: Cell phone use while driving is common. Distracted driving behaviors, although less frequent, persist when children are passengers in the vehicle. Further research into the effect of cell phone-related distracted driving behaviors of adults with child passengers is needed to address this public health concern.
    05/2013; DOI:10.1097/TA.0b013e3182924200
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    ABSTRACT: Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to reduce chronic inflammation and risk of many cancers, but their effect on risk of hepatocellular carcinoma (HCC) and death due to chronic liver disease (CLD) has not been investigated. Methods We analyzed prospective data on 300 504 men and women aged 50 to 71 years in the National Institutes of Health-AARP Diet and Health Study cohort and linked self-reported aspirin and non-aspirin NSAID use with registry confirmed diagnoses of HCC and death due to CLD. We calculated hazard rate ratios (RRs) and their two-sided 95% confidence intervals (CIs) using Cox proportional hazard regression models with adjustment for age, sex, race/ethnicity, cigarette smoking, alcohol consumption, diabetes, and body mass index. All tests of statistical significance were two-sided. Results Aspirin users had statistically significant reduced risks of incidence of HCC (RR = 0.59; 95% CI = 0.45 to 0.77) and mortality due to CLD (RR = 0.55; 95% CI = 0.45 to 0.67) compared to those who did not use aspirin. In contrast, users of non-aspirin NSAIDs had a reduced risk of mortality due to CLD (RR = 0.74; 95% CI= 0.61 to 0.90) but did not have lower risk of incidence of HCC (RR = 1.08; 95% CI = 0.84 to 1.39) compared to those who did not use non-aspirin NSAIDs. The risk estimates did not vary in statistical significance by frequency (monthly, weekly, daily) of aspirin use, but the reduced risk of mortality due to CLD was statistically significant only among monthly users of non-aspirin NSAIDs compared to non-users. Conclusions Aspirin use was associated with reduced risk of developing HCC and of death due to CLD whereas nonaspirin NSAID use was only associated with reduced risk of death due to CLD. (HEPATOLOGY 2013.).
    Hepatology 05/2013; 58(2). DOI:10.1002/hep.26498 · 11.19 Impact Factor

Publication Stats

5k Citations
861.84 Total Impact Points


  • 2003–2015
    • Yale-New Haven Hospital
      • • Emergency Medicine Program
      • • Department of Ophthalmology and Visual Science
      • • Department of Laboratory Medicine
      New Haven, Connecticut, United States
    • University of New Haven
      New Haven, Connecticut, United States
  • 2004–2014
    • Yale University
      • • Department of Public Health
      • • Department of Nursing
      • • School of Medicine
      • • Child Study Center
      • • Department of Pediatrics
      New Haven, Connecticut, United States
  • 2013
    • Emory University
      • Department of Family and Preventive Medicine
      Atlanta, Georgia, United States
  • 2003–2007
    • Howard Hughes Medical Institute
      Ashburn, Virginia, United States