Sarah S. Knox

West Virginia University | WVU · School of Public Health

This philosophy of science book is written by a biomedical scientist for a lay audience but is well-referenced for use by scientific readers and college course curricula. Its thesis is that the current paradigm in the biological and medical sciences,which is responsible for rejecting the existence of a Divine Being, is outdated. There is no factual...

The current approach to treatment in oncology is to replace the generally cytotoxic chemotherapies with pharmaceutical treatment which inactivates specific molecular targets associated with cancer development and progression. The goal is to limit cellular damage to pathways perceived to be directly responsible for the malignancy. Its underlying ass...

Scientific literature that directly addresses the underlying framework or paradigm of biomedical research is sparse. We consider ourselves objective scientists in well-defined scientific disciplines and design our studies based on state-of-the-art evidence in our respective fields. However, there is a pervasive underlying assumption that remains un...

The purpose of this article is to begin a dialogue concerning the consequences for research design and data interpretation of outdated assumptions underpinning current biomedical research.

This paper reviews underlying assumptions that have become the basis for our current conceptual approach to clinical medicine and the study of consciousness. The author’s hypothesis, based on current data, is that major progress in the effective treatment of chronic diseases such as cancer and cardiovascular diseases will require a fundamental chan...

Objectives: To evaluate the patterns and potential risk factors associated with mental health treatment dropout in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a face-to-face community-based epidemiological survey in a nationally representative household sample of respondents aged 15–65 in the Kingdom of Saudi Arabia (KSA)...

Background Blood pressure (BP) measured in the office setting increases from early through later adulthood. However, it is unknown to what extent out-of-office BP derived via ambulatory BP monitoring (ABPM) increases over time, and which participant characteristics and risk factors might contribute to these increases. Methods We assessed 25-year c...

Purpose To examine the patterns and correlates of 12-month mental health service use among those who do not have a diagnosed mental health disorder during that period in the Kingdom of Saudi Arabia. Methods The Saudi National Mental Health Survey used the World Health Organization Composite International Diagnostic Interview to ascertain mental he...

Objectives: To examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a community-based epidemiological survey in a nationally representative household sample of respondents aged 15–65 in the Kingdom of Saudi Arabia. The Wo...

BACKGROUND Our aim was to identify sex‐ and location‐specific risk factors for suicide ideation/planning and attempts among American Indian youth. METHODS Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled ye...

Actigraphy, a method for inferring sleep/wake patterns based on movement data gathered using actigraphs, is increasingly used in population-based epidemiologic studies because of its ability to monitor activity in natural settings. Using special software, actigraphic data are analyzed to estimate a range of sleep parameters. To date, despite extens...

Background Perfluoroalkyl substances (PFASs) have been associated with decreased immunity to childhood tetanus and diphtheria immunizations. If these vaccinations are vulnerable to influence from PFASs, questions arise about associations with other common inoculations. Objective To examine whether serum PFASs were associated with reduced immunity...

Objective: The goal of this study was to investigate the role of leisure time physical activity (LTPA) on the association between sleep quality and the cortisol awakening response (CAR) in people with an occupation that exposes them to high levels of stress. Methods: Participants were 275 police officers (age = 42 years ± 8.3, 27% women) enrolle...

Animal borne rabies virus is a source of infection in humans, and raccoons (Procyon lotor) are the primary terrestrial reservoir in West Virginia (WV). To assess the behavior and status of raccoon variant rabies virus (RRV) cases in WV, a longitudinal analysis for the period 2000–2015 was performed, using data provided by the state Bureau of Public...

Melt file for use in preparing Fig. 2

R code used for data analysis

Raw data as used for the study

This supplementary material supports the initial project description by Frisbee et al.

Animal borne rabies is a source of infection in humans, and raccoons ( Procyon lotor ) are the primary terrestrial reservoir in West Virginia (WV). To assess the behavior and status of raccoon variant rabies virus (RRV) in WV, a longitudinal analysis for the period 2000-2015 was performed, using data provided by the state Bureau of Public Health. A...

Animal borne rabies is a source of infection in humans, and raccoons ( Procyon lotor ) are the primary terrestrial reservoir in West Virginia (WV). To assess the behavior and status of raccoon variant rabies virus (RRV) in WV, a longitudinal analysis for the period 2000-2015 was performed, using data provided by the state Bureau of Public Health. A...

Abstract: The etiology and progression of the chronic diseases that account for the highest rates of mortality in the US, namely, cardiovascular diseases and cancers, involve complex gene x environment interactions. Yet despite the general agreement in the medical community given to this concept, there is a widespread lack of clarity as to what the...

The strong focus on genetics in carcinogenesis research has somewhat obscured the important role of the microenvironment in regulating gene expression and controlling mutations. The membranes of all cells and mitochondria contain multiple ion channels that create a voltage gradient across the cell membrane, and combined with gap junctional currents...

We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999–2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/...

Historically, cancer has been thought of as a cell-autonomous phenomenon involving a renegade cell that proliferates and becomes invasive. Accumulating data, however, strongly support the concept that cancer develops as a process in the context of interactions with the surrounding microenvironment and is not driven by individual cells. The fact tha...

The rural area of Appalachia in the U. S. encompasses 13 states that extend along the spine of the Appalachian mountain range. For reasons that are still not fully understood, this region has some of the highest rates of cancer mortality in the U.S. The article discusses cancer as a complex, systemic disease with emergent properties that develops o...

The rural area of Appalachia in the U. S. encompasses 13 states that extend along the spine of the Appalachian mountain range. For reasons that are still not fully understood, this region has some of the highest rates of cancer mortality in the U.S. The article discusses cancer as a complex, systemic disease with emergent properties that develops o...

Animal borne rabies virus is a source of infection in humans, and raccoons (Procyon lotor) are the primary terrestrial reservoir in West Virginia (WV). To assess the behavior and status of raccoon variant rabies virus (RRV) cases in WV, a longitudinal analysis for the period 2000�2015 was performed, using data provided by the state Bureau of Public...

Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome. Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820)...

The mainstream view of cancer as a mutated cell that has become dysfunctional and multiplies out of control (the somatic mutation model) is much less consistent with extant data than the context dependent model. The latter focuses on interactions between the cell and its surrounding environment as the initiator and driver of malignancy. The genome...

One of the goals of the NIH Toolbox for Assessment of Neurological and Behavioral Function was to identify or develop brief measures of emotion for use in prospective epidemiologic and clinical research. Emotional health has significant links to physical health and exerts a powerful effect on perceptions of life quality. Based on an extensive liter...

Perfluoroalkyl substances are manmade chemicals used in many consumer products and have become ubiquitous in the environment. Animal studies and a limited number of human studies have demonstrated developmental effects in offspring exposed to perfluoroalkyl substances in utero, but the implications of timing of in utero exposure have not been syste...

We report on the selection of self-report measures for inclusion in the NIH Toolbox that are suitable for assessing the full range of negative affect including sadness, fear, and anger. The Toolbox is intended to serve as a "core battery" of assessment tools for cognition, sensation, motor function, and emotional health that will help to overcome t...

Because depression is a multidimensional construct and few studies have compared the relative importance of its facets in predicting cardiovascular risk, we evaluated the utility of depressive symptom clusters in predicting the 5-year incidence of coronary artery calcification (CAC). Participants were 2171 middle-aged adults (58% female; 43% black)...

Policing is one of the most dangerous and stressful occupations and such stress can have deleterious effects on health. The purpose of this study was to examine the association between depressive symptoms and metabolic syndrome (MetSyn) in male and female police officers from two study populations, Buffalo, NY and Spokane, WA. Depressive symptoms w...

Perfluorocarbons from common household products such as food containers, stain- resistant protection for clothing, furniture and carpets, paints, and fire-fighting foams are found in soil, water, plants, animal and human serum worldwide. Previous research has shown a significant association between these chemicals and thyroid disease in women. The...

To examine the association between metabolic syndrome (MetSyn) and carotid intima media thickness (IMT) separately in male and female police officers. MetSyn was defined using 2005 guidelines. B-mode ultrasound was used to measure mean and maximum (12 and 36 segments) carotid artery thickness. Analysis of covariance was used to compare mean IMT val...

Perfluorocarbons (PFC) are man-made chemicals used in numerous household products. They have a long half-life in humans and complex animal toxicity, and accumulating evidence points toward associations with multiple human health endpoints. Our objective was to investigate whether PFC are associated with endocrine disruption in women. Cross-sectiona...

The purpose of this study was to examine the association of police officer stress with metabolic syndrome (MetSyn) and its individual components. Participants included 288 men and 102 women from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. Police stress was measured using the Spielberger police stress survey. MetSyn was de...

Both anxiety and elevated heart rate (HR) have been implicated in the development of hypertension. The HyperGen cohort, consisting of siblings with severe and mild hypertension, an age-matched random sample of persons from the same base populations, and unmedicated adult offspring of the hypertensive siblings (N = 1,002 men and 987 women), was anal...

Perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS) are man-made compounds with widespread presence in human sera. In previous occupational and adult studies, PFOA and PFOS were positively associated with serum lipid levels. To interrogate associations between PFOA and PFOS and serum lipids in children and adolescents. Cross-sectional...

Cancer is a complex disease that involves a sequence of gene-environment interactions in a progressive process that cannot occur without dysfunction in multiple systems, including DNA repair, apoptotic and immune functions. Epigenetic mechanisms, responding to numerous internal and external cues in a dynamic ongoing exchange, play a key role in med...

The C8 Health Project was created, authorized, and funded as part of the settlement agreement reached in the case of Jack W. Leach, et al. v. E.I. du Pont de Nemours & Company (no. 01-C-608 W.Va., Wood County Circuit Court, filed 10 April 2002). The settlement stemmed from the perfluorooctanoic acid (PFOA, or C8) contamination of drinking water in...

Background: Although attempted suicide is an important public health problem among American Indian (AI) teens, little research focuses on this population. The objective of this study was to examine associations between risk behaviors, victimization and risk for attempted suicide among Montana AI teens. Methods: Data for AI youth were extracted fr...

This supplement presents some of the methodological issues that arose during the early phases of protocol development for the National Children's Study (NCS), a probability sample of 100,000 children that will be followed prospectively from pregnancy through 21 years of age, and to share some of the challenges and solutions that were discussed. The...

This paper provides a strategy for the assessment of brain function in longitudinal cohort studies of children. The proposed strategy invokes both domain-specific and omnibus intelligence test approaches. In order to minimise testing burden and practice effects, the cohort is divided into four groups with one-quarter tested at 6-monthly intervals i...

This paper proposes an approach to the implementation of a large-scale epidemiological study of child development. It addresses specifically how one might assess gross motor development longitudinally in a large population-based study of children, and recommends a three-phase process. Phase I, applied at key ages with the entire population, involve...

This paper provides an overview of methodological challenges related to the epidemiological assessment of social-emotional development in children. Because population-based studies involve large cohorts and are usually multicentre in structure, they have cost, participant burden and other specific issues that affect the feasibility of the types of...

An assessment protocol for the longitudinal measurement of developmental psychopathology in a population-based study of children and adolescents is proposed. The protocol is designed for use in a large cohort of up to 100,000 individuals followed from early gestation to 21 years of age. Although the protocol was constrained by specified methodologi...

The goal was to investigate the relation of alcohol consumption to the presence of calcified atherosclerotic plaque in the coronary arteries (CAC) and aorta. Previous results have been conflicting, showing increases, decreases, or no effect of alcohol on risk of calcified plaque. We evaluated the relation of alcohol intake to presence of CAC and ca...

Though previous data indicate a positive association between depression and coronary heart disease, the mechanisms mediating these associations remain unclear. These prospective analyses assessed the association between history of Center for Epidemiologic Studies Depression Scale depression and possible mediators of cardiovascular risk at Year 15 o...

The use of digitalis is recommended for the treatment of heart failure to reduce hospitalization. Recent data suggest that digitalis treatment may adversely affect survival in women but not in men. We studied patients with left ventricular dysfunction enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) to determine whether there was a g...

The present analyses investigated possible pathways for earlier reported associations in the National Heart, Lung, and Blood Institute Family Heart Study between hostility and coronary and carotid end points. The cross-sectional design recruited 535 women and 491 men with average familial risk for coronary heart disease and 1950 women and 1667 men...

While genetic factors are major determinants of high-density lipoprotein cholesterol (HDL-C), environmental factors also play a role. The latter include 3 modifiable lifestyle factors: alcohol consumption, physical activity, and smoking. We compared the relative effects of alcohol, physical activity, and smoking on HDL-C levels, using data from 230...

This study investigated genetic linkage for three Cook-Medley hostility subscales plus a total hostility score. Genotyping on 387 autosomal short-tandem-repeat polymorphisms was performed on 508 of the larger white families from randomly selected and high CVD risk groups, composed of 2662 subjects. The number of individuals per family with hostilit...

BACKGROUND: The present analyses investigated possible pathways for earlier reported associations in the National Heart, Lung, and Blood Institute Family Heart Study between hostility and coronary and carotid end points. METHODS: The cross-sectional design recruited 535 women and 491 men with average familial risk for coronary heart disease and 1...

This study investigated the association between cardiovascular reactivity and subsequent ambulatory blood pressure in 316 black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Cardiovascular laboratory reactivity was examined in subjects 20 to 33 years old, and ambulatory blood pressure and heart rate...

Objective: IGF-I has important actions on cell division, apoptosis, differentiation and metabolism, as well as on cell proliferation in vascular smooth muscle. Deficiency of GH, an important regulator of IGF-I, is associated with reduced well-being. IGF-I levels have been related to cognitive function in older individuals. The aim of the present s...

A full understanding of the biology and behavior of humans cannot be complete without the collective contributions of the social sciences, cognitive sciences, and neurosciences. This book collects eighty-two of the foundational articles in the emerging discipline of social neuroscience. The book addresses five main areas of research: multilevel int...

The etiology of cardiovascular diseases is complex, involving the interaction of genetic, biologic, behavioral and psychosocial factors. The role played by psychosocial factors in the etiology and progression of cardiovascular diseases stems from several sources: their influence on behaviors that either promote health or increase risk, the neuroend...

his study investigated the association between cardiovascular reactivity and subsequent ambulatory blood pressure in 316 black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Cardiovascular laboratory reactivity was examined in subjects 20 to 33 years old, and ambulatory blood pressure and heart rate...

Objective: Depression and low social support are risk factors for medical morbidity and mortality after acute MI. The ENRICHD study is a multicenter, randomized, controlled clinical trial of a cognitive-behavioral treatment for depression and low social support in post-MI patients. A total of 2481 patients were recruited (26% with low social suppor...

OBJECTIVE: These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and...

During the past decade, the incidence ofcoronary heart disease (CHD) has declined in the United States and in Western Europe, but has increased in Eastern Europe and in many non-European countries. This study is a baseline comparison of psychosocial factors in a random sample of 35-year-old and 55-year-old men and women from Tartu, Estonia and Soll...

This cross-sectional study investigates the association of hostility and social support (measured by standardized instruments) to carotid artery atherosclerosis in men and women with a high familial risk for coronary heart disease (CHD) and those with low to medium risk. The hypothesis was that high hostility and low social support would have a str...

The purpose of this study was to examine whether several aspects of hostility as measured by the Cook-Medley Hostility Scale (ie, aggressive responding, hostile affect, cynicism, and overall hostility score) were determined in part by family factors (ie, genes and/or familial environments). Analyses were based on 680 European-American families (252...

This cross-sectional study investigates the association of hostility and social support (measured by standardized instruments) to carotid artery atherosclerosis in men and women with a high familial risk for coronary heart disease (CHD) and those with low to medium risk. The hypothesis was that high hostility and low social support would have a str...

Objective: The purpose of this study was to examine whether several aspects of hostility as measured by the Cook-Medley Hostility Scale (ie, aggressive responding, hostile affect, cynicism, and overall hostility score) were determined in part by family factors (ie, genes and/or familial environments). Methods: Analyses were based on 680 European-Am...

Abstract Although interest in alternative medical treatment modalities has greatly increased during recent years, the focus of published research has been primarily on clinical outcome. The dearth of basic research has resulted in a plethora of highly divergent treatments being lumped into one undifferentiated, “complementary and alternative medici...

Psychosocial factors, particularly depression and tack of social support, are important predictors of morbidity and mortality in patients with coronary heart disease, This article describes the design and methods of the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study, a multicenter, randomized clinical trial involving 3000 pat...

It is generally assumed that familial aggregation of lipids relates to both genetic and shared environmental factors. To determine the degree to which familial similarities in lifestyle habits explain familial aggregation of high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, the authors analyzed 1994–1996 data from 2,284...

This paper outlines two pathways through which social support can influence the prevention or progression of cardiovascular disease: health behaviors and neuroendocrine mechanisms. Its primary focus is on neuroendocrine pathways, reviewing data which suggest that lack of social support is etiologically related to coronary artery lesion development...

This cross-sectional study investigated the association of hostility and social support to coronary heart disease (CHD) in 2 groups of men and women: those with a familial predisposition for CHD (high-risk sample) and a randomly selected group. The hypothesis was that hostility and low social support would be associated with CHD, and would have a g...

This cross-sectional study investigated the association of hostility and social support to coronary heart disease (CHD) in 2 groups of men and women: those with a familial predisposition for CHD (high-risk sample) and a roup. The hypothesis was that hos-support would be associated with CHD, and would have a greater effect in the high-risk group. Th...

This paper outlines two pathways through which social support can influence the prevention or progression of cardiovascular disease: health behaviors and neuroendocrine mechanisms. Its primary focus is on neuroendocrine pathways, reviewing data which suggest that lack of social support is etiologically related to coronary artery lesion development...

Previous studies have suggested that low plasma cholesterol levels or cholesterol lowering may increase the risk of suicide and violent death. Increased aggression, risk-taking behavior, or depression has been associated with low cholesterol levels in some studies. A total of 4240 subjects of the Coronary Artery Risk Development in Young Adults stu...