Hines Veterans Administration Hospital
Hines Veterans Administration Hospital
Ruben M.A.,Hines Veterans Administration Hospital
Medical care | Year: 2017
BACKGROUND: The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of sexual or gender minority identities among active duty personnel, Veterans may be reluctant to respond to SOGI questions.OBJECTIVES: This population-based study assesses item nonresponse to SOGI questions by Veteran status.RESEARCH DESIGN: This is a secondary analysis of data from a population-based sample of adults in 20 US states that elected to administer a SOGI module in the 2014 Behavioral Risk Factor Surveillance System survey. Prevalence of SOGI refusals and responses of "don't know" were compared for Veterans and non-Veterans.SUBJECTS: Veterans (n=22,587) and non-Veterans (n=146,475) were surveyed.RESULTS: Nearly all Veteran respondents (≥98%) completed the SOGI questions, with 95.4% identifying as heterosexual, 1.2% as gay or lesbian, 1.2% as bisexual, and 0.59% as transgender. A significantly lower proportion of Veterans than non-Veterans refuse to answer sexual orientation (1.5% vs. 1.9%). There was no difference between Veterans and non-Veterans in responses for gender identity.CONCLUSIONS: Veterans are just as likely as non-Veterans to complete SOGI items in survey research. Asking Veterans about SOGI is unlikely to yield significant nonresponse. These data suggest that future research should investigate Veterans' perspectives on being asked about SOGI in research settings and as part of routine clinical care.
Napier T.C.,Rush University |
Herrold A.A.,Hines Veterans Administration Hospital |
De Wit H.,University of Chicago
Neuroscience and Biobehavioral Reviews | Year: 2013
Stimuli, including contexts, which predict the availability or onset of a drug effect, can acquire conditioned incentive motivational properties. These conditioned properties endure after withdrawal, and can promote drug-seeking which may result in relapse. Conditioned place preference (CPP) assesses the associations between drugs and the context in which they are experienced. Here, we review the potential utility of CPP procedures in rodents and humans to evaluate medications that target conditioned drug-seeking responses. We discuss the translational potential of the CPP procedure from rodents to humans, and review findings with FDA-approved treatments that support the use of CPP to develop relapse-reduction medications. We also discuss challenges and methodological questions in applying the CPP procedure to this purpose. We argue that an efficient and valid CPP procedure in humans may reduce the burden of full clinical trials with drug-abusing patients that are currently required for testing promising treatments. © 2013 Elsevier Ltd.
Simons L.E.,Boston Childrens Hospital |
Simons L.E.,Harvard University |
Elman I.,Hines Veterans Administration Hospital |
Borsook D.,Boston Childrens Hospital |
Borsook D.,Harvard University
Neuroscience and Biobehavioral Reviews | Year: 2014
Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluatesome of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology. © 2014 Elsevier Ltd.
Venkatachalam M.A.,University of Texas Health Science Center at San Antonio |
Weinberg J.M.,University of Michigan |
Kriz W.,University of Heidelberg |
Bidani A.K.,Hines Veterans Administration Hospital
Journal of the American Society of Nephrology | Year: 2015
The transition of AKI to CKDhasmajor clinical significance. As reviewed here, recent studies show that a subpopulation of dedifferentiated, proliferating tubules recovering from AKI undergo pathologic growth arrest, fail to redifferentiate, and become atrophic. These abnormal tubules exhibit persistent, unregulated, and progressively increasing profibrotic signaling along multiple pathways. Paracrine products derived therefrom perturb normal interactions between peritubular capillary endothelium and pericyte-like fibroblasts, leading to myofibroblast transformation, proliferation, and fibrosis as well as capillary disintegration and rarefaction. Although signals from injured endothelium and inflammatory/immune cells also contribute, tubule injury alone is sufficient to produce the interstitial pathology required for fibrosis. Localized hypoxia produced by microvascular pathology may also prevent tubule recovery. However, fibrosis is not intrinsically progressive, and microvascular pathology develops strictly around damaged tubules; thus, additional deterioration of kidney structure after the transition of AKI to CKD requires new acute injury or other mechanisms of progression. Indeed, experiments using an acute-on-chronic injury model suggest that additional loss of parenchyma caused by failed repair of AKI in kidneys with prior renal mass reduction triggers hemodynamically mediated processes that damage glomeruli to cause progression. Continued investigation of these pathologic mechanisms should reveal options for preventing renal disease progression after AKI. © 2015 by the American Society of Nephrology.
Gerding D.N.,Hines Veterans Administration Hospital |
Gerding D.N.,Loyola University Chicago
Infection Control and Hospital Epidemiology | Year: 2010
The past decade has been characterized by an epidemic of Clostridium difficile infection in North America and Europe that threatens to extend to the rest of the world. The epidemic is due in part to the emergence of a previously rare and now more lethal C. difficile strain variously named group BI, ribotype 027, and North American pulsed-field gel electrophoresis type 1. © 2010 by The 5th Decennial on Healthcare-Associated Infections, LLC. All rights reserved.
Gerding D.N.,Hines Veterans Administration Hospital |
Johnson S.,Loyola University Chicago
Clinical Infectious Diseases | Year: 2010
Treatment of Clostridium difficile infection (CDI) has relied on 2 antimicrobial agents, metronidazole and vancomycin, since the recognition of this disease entity. While effective, these "inside the box" approaches to CDI management have the disadvantage of further microbial disruption of the host indigenous microflora. "Outside the box" therapies use non-antimicrobial approaches to management and are theoretically less prone to causing recurrent CDI episodes. Recent advances in understanding of "inside the box" approaches include appreciation of the decreased efficacy of metronidazole overall and the superior efficacy of vancomycin for treatment of severe CDI, as well as a new agent under development, fidaxomicin, which appears to be equal in efficacy to vancomycin but with less risk of subsequent CDI recurrences. Several "outside the box" approaches have also entered clinical development, including use of monoclonal antibodies, active vaccination, luminal toxin binders, and nontoxigenic C. difficile. These reports provide optimism that more-effective management of CDI is forthcoming. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Langert K.A.,Hines Veterans Administration Hospital
ASN neuro | Year: 2013
Recruitment and trafficking of autoreactive leucocytes across the BNB (blood-nerve barrier) is an early pathological insult in GBS (Guillain-Barré syndrome), an aggressive autoimmune disorder of the PNS (peripheral nervous system). Whereas the aetiology and pathogenesis of GBS remain unclear, pro-inflammatory cytokines, including TNFα (tumour necrosis factor α), are reported to be elevated early in the course of GBS and may initiate nerve injury by activating the BNB. Previously, we reported that disrupting leucocyte trafficking in vivo therapeutically attenuates the course of an established animal model of GBS. Here, PNMECs (peripheral nerve microvascular endothelial cells) that form the BNB were harvested from rat sciatic nerves, immortalized by SV40 (simian virus 40) large T antigen transduction and subsequently challenged with TNFα. Relative changes in CCL2 (chemokine ligand 2) and ICAM-1 (intercellular adhesion molecule 1) expression were determined. We report that TNFα elicits marked dose- and time-dependent increases in CCL2 and ICAM-1 mRNA and protein content and promotes secretion of functional CCL2 from immortalized and primary PNMEC cultures. TNFα-mediated secretion of CCL2 promotes, in vitro, the transendothelial migration of CCR2-expressing THP-1 monocytes. Increased CCL2 and ICAM-1 expression in response to TNFα may facilitate recruitment and trafficking of autoreactive leucocytes across the BNB in autoimmune disorders, including GBS.
Alhosaini M.,Hines Veterans Administration Hospital |
Leehey D.J.,Hines Veterans Administration Hospital
American Journal of Kidney Diseases | Year: 2015
Disorders of magnesium homeostasis are very common in dialysis patients but have received scant attention. In this review, we address measurement of plasma magnesium, magnesium balance and the factors that affect magnesium flux during dialysis, the prevalence of hypo- and hypermagnesemia in dialysis patients, and the potential clinical significance of hypo- and hypermagnesemia in dialysis patients. Many factors can affect plasma magnesium concentration, including diet, nutritional status (including plasma albumin level), medications (such as proton pump inhibitors), and dialysis prescription. Further interventional studies to determine the effect of normalization of plasma magnesium concentration on clinical outcomes are needed. At the present time, we recommend that predialysis plasma magnesium be measured on a regular basis, with the dialysate magnesium concentration adjusted to maintain plasma magnesium concentration within the normal range.
Jubran A.,Hines Veterans Administration Hospital |
Jubran A.,Loyola University Chicago
Critical Care | Year: 2015
Pulse oximetry is universally used for monitoring patients in the critical care setting. This article updates the review on pulse oximetry that was published in 1999 in Critical Care. A summary of the recently developed multiwavelength pulse oximeters and their ability in detecting dyshemoglobins is provided. The impact of the latest signal processing techniques and reflectance technology on improving the performance of pulse oximeters during motion artifact and low perfusion conditions is critically examined. Finally, data regarding the effect of pulse oximetry on patient outcome are discussed. © 2015 Jubran.
Humensky J.L.,Hines Veterans Administration Hospital
Substance Abuse: Treatment, Prevention, and Policy | Year: 2010
Background: Previous literature has shown a divergence by age in the relationship between socioeconomic status (SES) and substance use: adolescents with low SES are more likely to engage in substance use, as are adults with high SES. However, there is growing evidence that adolescents with high SES are also at high risk for substance abuse. The objective of this study is to examine this relationship longitudinally, that is, whether wealthier adolescents are more likely than those with lower SES to engage in substance use in early adulthood.Methods: The study analyzed data from the National Longitudinal Survey of Adolescent Health (AddHealth), a longitudinal, nationally-representative survey of secondary school students in the United States. Logistic regression models were analyzed examining the relationship between adolescent SES (measured by parental education and income) and substance use in adulthood, controlling for substance use in adolescence and other covariates.Results: Higher parental education is associated with higher rates of binge drinking, marijuana and cocaine use in early adulthood. Higher parental income is associated with higher rates of binge drinking and marijuana use. No statistically significant results are found for crystal methamphetamine or other drug use. Results are not sensitive to the inclusion of college attendance by young adulthood as a sensitivity analysis. However, when stratifying by race, results are consistent for white non-Hispanics, but no statistically significant results are found for non-whites. This may be a reflection of the smaller sample size of non-whites, but may also reflect that these trends are driven primarily by white non-Hispanics.Conclusions: Previous research shows numerous problems associated with substance use in young adults, including problems in school, decreased employment, increases in convictions of driving under the influence (DUI) and accidental deaths. Much of the previous literature is focused on lower SES populations. Therefore, it is possible that teachers, parents and school administrators in wealthier schools may not perceive as great to address substance abuse treatment in their schools. This study can inform teachers, parents, school administrators and program officials of the need for addressing drug abuse prevention activities to this population of students. © 2010 Humensky; licensee BioMed Central Ltd.