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Humphreys M.K.,University of California at Davis | Panacek E.,University of California at Davis | Green W.,University of California at Berkeley | Albers E.,CA Capital
Journal of Forensic Sciences | Year: 2013

Protocols for determining postmortem submersion interval (PMSI) have long been problematic for forensic investigators due to the wide variety of factors affecting the rate of decomposition of submerged carrion. Likewise, it has been equally problematic for researchers to develop standardized experimental protocols to monitor underwater decomposition without artificially affecting the decomposition rate. This study compares two experimental protocols: (i) underwater in situ evaluation with photographic documentation utilizing the Heaton et al. total aquatic decomposition (TAD) score and (ii) weighing the carrion before and after submersion. Complete forensic necropsies were performed as a control. Perinatal piglets were used as human analogs. The results of this study indicate that in order to objectively measure decomposition over time, the human analog should be examined at depth using the TAD scoring system rather than utilizing a carrion weight evaluation. The acquired TAD score can be used to calculate an approximate PMSI. © 2012 American Academy of Forensic Sciences.


Brook R.A.,The JeSTARx Group | Kleinman N.L.,CA Capital | Melkonian A.K.,Cheyenne Capital | Smeeding J.E.,The JeSTARx Group
Clinical Gastroenterology and Hepatology | Year: 2010

Background & Aims: Functional dyspepsia (FD) is a common morbid condition but data are limited on the direct and indirect costs for employees with FD or on its impact on productivity. Few data on absenteeism and no objective information are available. This study aimed to assess the impact of FD on costs and effects on absenteeism and work output (productivity). Methods: We performed a retrospective analysis of payroll data and adjudicated health insurance medical and prescription claims collected over a 4-year study period (January 1, 2001 to December 31, 2004) from more than 300,000 employees. Data from employees with and without (controls) FD were compared using 2-part regression techniques. Outcome measures included medical (total and by place of service) and prescription costs, absenteeism, and objectively measured productivity output. Results: Employees with FD (N = 1669) had greater average annual medical and prescription drug costs and indirect costs (owing to sick leave and short- and long-term disability absences) than controls (N = 274,206). Compared with controls, the FD employees incurred costs that were $5138 greater and had greater costs for each place of service (all P < .0001). The employees with FD had an additional 0.83 absence days per year and produced 12% fewer units per hour than controls (both P < .05). Conclusions: Employees with FD have greater costs at all places of service and lower productivity than employees without FD. © 2010 AGA Institute.


Luskin A.T.,University of Wisconsin - Madison | Chipps B.E.,CA Capital | Rasouliyan L.,Late Phase and Outcomes Research | Miller D.P.,Late Phase and Outcomes Research | And 2 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2014

Background: Few data are available that evaluate the relationship among asthma exacerbations, asthma triggers, and asthma-related quality of life (QoL). Objective: To evaluate the impact of asthma exacerbations and asthma triggers on QoL. Methods: Patients with severe or difficult-to-treat asthma, ages ≥13 years (n= 2679) from the TENOR (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens) 3-year observational study were included. Exacerbations were defined hierarchically in descending order of severity (hospitalization, emergency department [ED] visit, steroid burst, no exacerbation) by using data from months 6 and 12. The total number (frequency) of exacerbations was assessed. Asthma-related QoL was measured at month 12 by using the Mini-Asthma QoL Questionnaire (Mini-AQLQ); self-reported asthma triggers were collected at baseline and annually. We used 1-way ANOVA to test for differences in Mini-AQLQ domain scores across asthma exacerbation severity, the total number of asthma exacerbations, and the number of asthma triggers. Results: A significant decrease (. P < .001) in Mini-AQLQ domain scores was seen with increasing severity of asthma exacerbation (no exacerbation, steroid burst, ED visit, and hospitalization); symptom (5.5, 4.8, 4.3, and 4.2), activity (5.8, 5.2, 4.6, and 4.4), emotional (5.6, 5.0, 4.4, and 4.2), exposure (5.0, 4.5, 4.0, and 3.9); and overall (5.5, 4.9, 4.3, and 4.1). Increasing exacerbation frequency and the number of baseline asthma triggers also were associated with significant decreases in Mini-AQLQ domain scores. An increasing number of asthma triggers were associated with an increase in severity and frequency of exacerbations. Conclusion: Avoidance of asthma triggers may reduce exacerbation rates and improve asthma-related QoL in patients with severe or difficult-to-treat asthma. Interventional studies are warranted to further explore these outcomes. © 2014 American Academy of Allergy, Asthma & Immunology.


Schatz M.,Kaiser Permanente | Hsu J.-W.Y.,Kaiser Permanente | Zeiger R.S.,Kaiser Permanente | Chen W.,Kaiser Permanente | And 3 more authors.
Journal of Allergy and Clinical Immunology | Year: 2014

Background Asthma phenotyping can facilitate understanding of disease pathogenesis and potential targeted therapies. Objective To further characterize the distinguishing features of phenotypic groups in difficult-to-treat asthma. Methods Children ages 6-11 years (n = 518) and adolescents and adults ages ≥12 years (n = 3612) with severe or difficult-to-treat asthma from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study were evaluated in this post hoc cluster analysis. Analyzed variables included sex, race, atopy, age of asthma onset, smoking (adolescents and adults), passive smoke exposure (children), obesity, and aspirin sensitivity. Cluster analysis used the hierarchical clustering algorithm with the Ward minimum variance method. The results were compared among clusters by χ2 analysis; variables with significant (P <.05) differences among clusters were considered as distinguishing feature candidates. Associations among clusters and asthma-related health outcomes were assessed in multivariable analyses by adjusting for socioeconomic status, environmental exposures, and intensity of therapy. Results Five clusters were identified in each age stratum. Sex, atopic status, and nonwhite race were distinguishing variables in both strata; passive smoke exposure was distinguishing in children and aspirin sensitivity in adolescents and adults. Clusters were not related to outcomes in children, but 2 adult and adolescent clusters distinguished by nonwhite race and aspirin sensitivity manifested poorer quality of life (P <.0001), and the aspirin-sensitive cluster experienced more frequent asthma exacerbations (P <.0001). Conclusion Distinct phenotypes appear to exist in patients with severe or difficult-to-treat asthma, which is related to outcomes in adolescents and adults but not in children. The study of the therapeutic implications of these phenotypes is warranted. © 2014 American Academy of Allergy, Asthma & Immunology.


Gopal A.,University of Maryland University College | Gosain S.,CA Capital
Information Systems Research | Year: 2010

Past research has studied how the selection and use of control portfolios in software projects is based on environmental and task characteristics. However, little research has examined the consequences of control mode choices on project performance. This paper reports on a study that addresses this issue in the context of outsourced software projects. In addition, we propose that boundary-spanning activities between the vendor and the client enable knowledge sharing across organizational and knowledge domain boundaries. This is expected to lead to facilitation of control through specific incentives and performance norms that are suited to client needs as well as the vendor context. Therefore, we argue that boundary spanning between the vendor and client moderates the relationship between formal controls instituted by the vendor on the development team and project performance. We also hypothesize the effect of collaboration as a clan control on project performance. We examine project performance in terms of software quality and project efficiency. The research model is empirically tested in the Indian software industry setting on a sample of 96 projects. The results suggest that formal and informal control modes have a significant impact on software project outcomes, but need to be finely tuned and directed toward appropriate objectives. In addition, boundary-spanning activities significantly improve the effectiveness of formal controls. Finally, we find that collaborative culture has provided mixed benefits by enhancing quality but reducing efficiency. © 2010 INFORMS.


Beigelman A.,University of Washington | Chipps B.E.,CA Capital | Bacharier L.B.,University of Washington
Allergy and Asthma Proceedings | Year: 2015

Background: Corticosteroids, delivered systemically and by inhalation, are widely used for the treatment of multiple acute respiratory illnesses in children. However, the level of evidence to support the utility of this therapy varies between these different acute respiratory illnesses. Objective: To summarize the evidence regarding the utility of corticosteroids in the management of common acute pediatric respiratory conditions and to highlights the controversies regarding their use. Methods: Literature search of manuscripts describing the evidence regarding the efficacy of corticosteroids (systemic and inhaled) in the management of: acute asthma exacerbation among school age children, acute episodic wheeze among preschool children, viral croup, and acute viral bronchiolitis. Results: Current evidence indicates that systemic corticosteroids provide benefits for the treatment of acute asthma exacerbations in school age children, mainly in the acute care setting. In addition, high dose inhaled corticosteroid therapy administered in the Emergency Department appears to have comparable effect for the prevention of asthma-related hospital admission as systemic corticosteroids in this age group. In contrast, most available studies have not shown benefit for systemic corticosteroids during acute wheezing episodes in preschool children. Systemic corticosteroids decrease symptoms and the rate of hospital admissions in patients with severe croup; however, corticosteroids have no role in the treatment of acute bronchiolitis and their use in this condition should be discouraged. Conclusion: Corticosteroids treatment response varies between the acute respiratory illnesses presented in this review. Future research should aim to fill the current gaps-of-knowledge regarding the utility this intervention such as the identification of specific wheezing phenotypes among preschool children which might benefit from systemic corticosteroids as a treatment for acute viral wheeze. Copyright © 2015, OceanSide Publications, Inc., U.S.A.


Parada L.M.,CA Capital | Liang X.,University of Pittsburgh
Advances in Water Resources | Year: 2010

In this paper, we present a novel paradigm for inference of streamflow for ungauged basins. Our innovative procedure fuses concepts from both kernel methods and data assimilation. Based on the modularity and flexibility of kernel techniques and the strengths of the variational Bayesian Kalman filter and smoother, we can infer streamflow for ungauged basins whose hydrological and system properties and/or behavior are non-linear and non-Gaussian. We apply the proposed approach to two watersheds, one in California and one in West Virginia. The inferred streamflow signals for the two watersheds appear promising. These preliminary and encouraging validations demonstrate that our new paradigm is capable of providing accurate conditional estimates of streamflow for ungauged basins with unknown and non-linear dynamics. © 2010 Elsevier Ltd.


Chipps B.E.,CA Capital
Clinical Pediatrics | Year: 2013

Anaphylaxis is common in children and has many differences across age groups. A systematic review of the literature from the past 5 years was conducted with the goal of updating the pediatrician. Food is the most common trigger in children, but insect venom and drugs are other typical causes. Clinical diagnostic criteria include dermatological, respiratory, cardiovascular, and gastrointestinal manifestations. A biphasic reaction is seen in some, with recurrence usually within 8 hours of the initial episode. Epinephrine is the drug of choice for acute reactions and the only medication shown to be lifesaving when administered promptly, but it is underutilized. Patients should have ready access to ≥2 doses of an epinephrine autoinjector, with thorough training regarding correct use of a given device and an emergency action plan. Management of anaphylaxis in schools presents distinct challenges. Pediatricians are in a unique position to assess and treat these patients chronically. © The Author(s) 2013.


Chipps B.E.,CA Capital
Annals of Allergy, Asthma and Immunology | Year: 2010

Objective: To define the diagnostic possibilities for young children who present with recurrent wheeze. Data Sources: Review of medical literature and 30 years of practice experience. Study Selection: Relevant medical literature. Results: When evaluating an infant or child presenting with recurrent respiratory symptoms, several diagnoses must be considered. The workup should include assessment of the risk factors for asthma and careful investigation into the specific symptoms. Recurrent or persistent wheezing and/or coughing often result in a diagnosis of asthma with therapeutic trials of asthma treatment. When the therapy is ineffective, other diagnoses should be considered, including gastroesophageal reflux, protracted bacterial bronchitis, tracheobronchomalacia, and cystic fibrosis. Appropriate testing should be performed in these pediatric patients. Conclusion: In young children with recurrent lower airway symptoms who have a negative modified Asthma Predictive Index result, the described diagnostic possibilities should be considered. © 2010 American College of Allergy, Asthma & Immunology.


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