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Halcon L.,University of MinnesotaMinneapolis | Lillehei A.,Health and Healing Consultant | Melin M.M.,Wound Clinic | Shapiro A.,Park Nicollet Health Services and Institute | Robinson C.,Medical Center
Advances in Skin and Wound Care | Year: 2016

OBJECTIVES: The aims of this study were to determine a sound recruitment strategy for multisite wound studies to address the rising prevalence and incidence of chronic wounds and to identify appropriate adult patient populations with wounds of interest and establish partnerships with their clinicians and clinical services as a model for a multisite wound care feasibility study. DESIGN: A pilot multisite recruitment feasibility study. SETTING: Three wound clinics located in a large, Midwestern metropolitan area. PARTICIPANTS AND INTERVENTION: A convenience sample of 3 staff and 3 patients with lower-extremity wounds from each clinic was interviewed. Medical records of all patients with lower-extremity wounds seen during 1 week at each clinic were reviewed. Outcome measures included characteristics of patients being treated at the 3 wound care clinics (patient demographics and wound characteristics) and wound treatments used. Barriers and opportunities that could be addressed in recruitment and other research strategies were identified. MAIN RESULTS: Barriers and facilitators for future research were identified and varied within and between clinics. Patients reported they were willing to participate in future research, although fewer were willing if the study was blinded. Patients received a variety of treatments within and across clinics. Medical record reviews provided further information about wound clinic patients, wound characteristics, and barriers and facilitators for future study. CONCLUSIONS: Characteristics of wound clinic patients and their wounds were found to vary by site, suggesting tailored recruitment methods by site within multisite wound care studies may be most productive. This study suggests successful recruitment strategies for future wound care intervention research. © Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.

Ellis D.,University of Mary | Sen A.,University of MinnesotaMinneapolis
Random Structures and Algorithms | Year: 2015

We show that if A⊂[k]n, then A is ε{lunate}-close to a junta depending upon at most exp(O(|∂A|/(kn-1ε{lunate}))) coordinates, where ∂A denotes the edge-boundary of A in the ℓ1-grid. This bound is sharp up to the value of the absolute constant in the exponent. This result can be seen as a generalisation of the Junta theorem for the discrete cube, from [6], or as a characterisation of large subsets of the ℓ1-grid whose edge-boundary is small. We use it to prove a result on the structure of Lipschitz functions between two discrete tori; this can be seen as a discrete, quantitative analogue of a recent result of Austin [1]. We also prove a refined version of our junta theorem, which is sharp in a wider range of cases. © 2015 Wiley Periodicals, Inc.

Belanger H.G.,James A. Haley VA | Belanger H.G.,University of South Florida | Belanger H.G.,Defense and Veterans Brain Injury Center | Vanderploeg R.D.,James A. Haley VA | And 4 more authors.
Journal of Head Trauma Rehabilitation | Year: 2016

Objective: The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen. Methods: All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA). Results: The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used. Conclusion: Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI. © 2016 Wolters Kluwer Health, Inc.

Yuan J.-M.,University of Pittsburgh | Nelson H.H.,University of MinnesotaMinneapolis | Butler L.M.,University of Pittsburgh | Carmella S.G.,University of MinnesotaMinneapolis | And 3 more authors.
International Journal of Cancer | Year: 2016

Cytochrome P450 2A6 (CYP2A6) catalyzes nicotine metabolism and contributes to the metabolism of the tobacco-specific lung carcinogen, NNK. Genetic variation in CYP2A6 may affect smoking behavior and contribute to lung cancer risk. A nested case-control study of 325 lung cancer cases and 356 controls was conducted within a prospective cohort of 18,244 Chinese men in Shanghai, China. Quantified were 4 allelic variants of CYP2A6 [*1(+51A), *4, *7, and *9] and urinary total nicotine, total cotinine, total trans-3'-hydroxycotinine (3HC) and total NNAL (an NNK metabolite). Calculated were total nicotine equivalents (TNE), the sum of total nicotine, total cotinine and total 3HC and the total 3HC:total cotinine ratio as a measure of CYP2A6 activity. The nicotine metabolizer status (normal, intermediate, slow and poor) was determined by CYP2A6 genotypes. The smoking-adjusted odds ratios (95% confidence intervals) of lung cancer for the highest vs lowest quartile of total nicotine, total cotinine, total 3HC, TNE and total NNAL were 3.03 (1.80-5.10), 4.70 (2.61-8.46), 4.26 (2.37-7.68), 4.71 (2.61-8.52), and 3.15 (1.86-5.33) (all Ptrend<0.001), respectively. Among controls CYP2A6 poor metabolizers had a 78% lower total 3HC:total cotinine ratio and 72% higher total nicotine (Ptrend≤0.002). Poor metabolizers had an odds ratio of 0.64 (95% confidence interval=0.43-0.97) for lung cancer, which was statistically nonsignificant (odds ratio=0.74, 95% confidence interval=0.48-1.15) after adjustment for urinary TNE and smoking intensity and duration. The lower lung cancer risk observed in CYP2A6 poor metabolizers is partially explained by the strong influence of CYP2A6 genetic polymorphisms on nicotine uptake and metabolism. © 2015 UICC.

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