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Plumb T.R.,VA Salt Lake City Health Care System | Peachey J.T.,Alliant International University | Zelman D.C.,Alliant International University
Psychological Services | Year: 2014

Sleep routines that develop as an adaptation or reaction to deployment can persist upon return stateside. Sleep problems intensify and are intensified by psychiatric distress. This research presents the findings of a comprehensive survey of sleep impairment in relation to demographic data, military history, combat exposure, and mental illness symptoms among a general sample of 375 servicemembers and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) at a wide range of times postdeployment. Sleep impairment was assessed with the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for PTSD. Posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were evaluated, with the PTSD Checklist-Military, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7. Sleep problems were common across the sample, with 45.4% of participants reporting sleep onset greater than 30 minutes, 21.4% typically achieving less than 4.5 hours of total sleep time, and 56% reporting being awake in bed more than 15% of the night. Global PSQI scores classified 89% of the sample as "poor sleepers." Sleep problems were more severe among servicemembers with less education, from lower ranks (E1-E3), with greater combat exposure, and greater depression, anxiety, and PTSD symptoms. These findings suggest the need for routine screening of sleep problems among veterans and increased professional training in interventions for insomnia and nightmares. For individuals experiencing sleep problems with concurrent psychiatric symptoms, addressing sleep concerns may be one less-stigmatizing way to transition servicemembers and veterans into needed mental health services. © 2013 American Psychological Association.

Gundlapalli A.V.,University of Utah | Gundlapalli A.V.,VA Salt Lake City Health Care System | Beekmann S.E.,University of Iowa | Graham D.R.,Springfield Clinic | Polgreen P.M.,University of Iowa
Diagnostic Microbiology and Infectious Disease | Year: 2013

Antimicrobial shortages have made treating certain infections more difficult. A web-based survey asking about experience with antimicrobial drug shortages was distributed in 2011 to 1328 infectious diseases physician members of the Emerging Infectious Diseases Network of the Infectious Diseases Society of America. A majority (78%) of 627 respondents reported needing to modify antimicrobial choices because of drug shortages within the past 2 years. Antimicrobials most often reported as not available or available but in short supply were trimethoprim-sulfamethoxazole injection (by 65% of respondents), amikacin (by 58%), aztreonam (by 31%), and foscarnet (by 22%). Most respondents (55%) reporting a shortage indicated that the shortage adversely affected patient outcomes and that they were forced to use alternative and second line agents which were either less effective, more toxic, or more costly. Most (70%) indicated that they learned about the shortage from contact with the pharmacy after trying to prescribe a drug in short supply. More effective means of informing physicians about drug shortages is critical to lessen the impact on patient care. © 2013.

Wambaugh J.L.,University of Utah | Mauszycki S.,University of Utah | Wright S.,VA Salt Lake City Health Care System
Aphasiology | Year: 2014

Background: Despite advances in the development and testing of therapies for verb retrieval impairments in aphasia, generalisation effects of treatment remain a challenge. Semantic Feature Analysis (SFA) is a word retrieval treatment that has been reported to result in generalised responding to untrained object names with persons with aphasia. The theorised therapeutic mechanisms of SFA appeared to be appropriate for facilitating retrieval of trained and untrained action names.Aims: This investigation was designed to extend pilot research in which SFA was applied to verb retrieval. The primary purpose of the current study was to examine the acquisition and response generalisation effects of SFA applied to action naming with four persons with chronic aphasia. Additional purposes were to examine changes in production of content in discourse and to explore the correspondence of accuracy of naming during treatment to probe performance.Methods & Procedures: SFA was modified slightly to be appropriate for application to action naming as opposed to object naming; several feature categories were changed, but all other procedures were retained. Treatment was applied sequentially to two sets of action names in the context of multiple baseline designs across behaviours and participants. Accuracy of naming of trained and untrained actions in probes was measured repeatedly throughout all phases of the design. Production of correct information units (CIUs) in discourse was measured prior to and following treatment. The relationship of probe-naming performance to naming performance during treatment sessions was examined using correlational analyses.Outcomes & Results: Increased accuracy of naming of trained action names was associated with treatment for three of the four participants. The remaining participant did not demonstrate improvement in naming on probes, despite some gains during treatment. Generalisation to untrained action names did not occur for any of the participants. Increases in CIU production were observed for only one of the participants. For the participants with positive naming outcomes, probe performance correlated well with naming performance during treatment. For the participant who demonstrated some improvements in treatment, but did not show gains in naming on probes, weak correlations were obtained.Conclusions: SFA appears to have potential for promoting improved action naming in aphasia. However, more research is warranted to explore treatment modifications to promote generalisation. Correlational analyses indicated that gains in naming during treatment may not always be reflected in probe performance and thus, require verification through probing in non-treatment conditions. © 2013 This work was authored as part of Contributor's official duties as an employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105 no copyright protection is available for such works under U.S. law.

Uzuner O.,Albany State University | South B.R.,VA Salt Lake City Health Care System | South B.R.,University of Utah | Shen S.,VA Salt Lake City Health Care System | And 3 more authors.
Journal of the American Medical Informatics Association | Year: 2011

The 2010 i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records presented three tasks: a concept extraction task focused on the extraction of medical concepts from patient reports; an assertion classification task focused on assigning assertion types for medical problem concepts; and a relation classification task focused on assigning relation types that hold between medical problems, tests, and treatments. i2b2 and the VA provided an annotated reference standard corpus for the three tasks. Using this reference standard, 22 systems were developed for concept extraction, 21 for assertion classification, and 16 for relation classification. These systems showed that machine learning approaches could be augmented with rule-based systems to determine concepts, assertions, and relations. Depending on the task, the rule-based systems can either provide input for machine learning or post-process the output of machine learning. Ensembles of classifiers, information from unlabeled data, and external knowledge sources can help when the training data are inadequate.

Bui D.D.A.,University of Utah | Bui D.D.A.,VA Salt Lake City Health Care System | Zeng-Treitler Q.,University of Utah | Zeng-Treitler Q.,VA Salt Lake City Health Care System
Journal of the American Medical Informatics Association | Year: 2014

Objectives: Natural language processing (NLP) applications typically use regular expressions that have been developed manually by human experts. Our goal is to automate both the creation and utilization of regular expressions in text classification. Methods: We designed a novel regular expression discovery (RED) algorithm and implemented two text classifiers based on RED. The RED+ALIGN classifier combines RED with an alignment algorithm, and RED +SVM combines RED with a support vector machine (SVM) classifier. Two clinical datasets were used for testing and evaluation: the SMOKE dataset, containing 1091 text snippets describing smoking status; and the PAIN dataset, containing 702 snippets describing pain status. We performed 10-fold cross-validation to calculate accuracy, precision, recall, and F-measure metrics. In the evaluation, an SVM classifier was trained as the control. Results: The two RED classifiers achieved 80.9-83.0% in overall accuracy on the two datasets, which is 1.3-3% higher than SVM's accuracy (p<0.001). Similarly, small but consistent improvements have been observed in precision, recall, and F-measure when RED classifiers are compared with SVM alone. More significantly, RED+ALIGN correctly classified many instances that were misclassified by the SVM classifier (8.1-10.3% of the total instances and 43.8-53.0% of SVM's misclassifications). Conclusions: Machine-generated regular expressions can be effectively used in clinical text classification. The regular expression-based classifier can be combined with other classifiers, like SVM, to improve classification performance.

DuVall S.L.,VA Salt Lake City Health Care System | DuVall S.L.,University of Utah | Fraser A.M.,University of Utah | Rowe K.,University of Utah | And 3 more authors.
Journal of the American Medical Informatics Association | Year: 2012

Objective: Electronically linked datasets have become an important part of clinical research. Information from multiple sources can be used to identify comorbid conditions and patient outcomes, measure use of healthcare services, and enrich demographic and clinical variables of interest. Innovative approaches for creating research infrastructure beyond a traditional data system are necessary. Materials and methods: Records from a large healthcare system's enterprise data warehouse (EDW) were linked to a statewide population database, and a master subject index was created. The authors evaluate the linkage, along with the impact of missing information in EDW records and the coverage of the population database. The makeup of the EDW and population database provides a subset of cancer records that exist in both resources, which allows a cancerspecific evaluation of the linkage. Results: About 3.4 million records (60.8%) in the EDW were linked to the population database with a minimum accuracy of 96.3%. It was estimated that approximately 24.8% of target records were absent from the population database, which enabled the effect of the amount and type of information missing from a record on the linkage to be estimated. However, 99% of the records from the oncology data mart linked; they had fewer missing fields and this correlated positively with the number of patient visits. Discussion and conclusion: A general-purpose research infrastructure was created which allows disease-specific cohorts to be identified. The usefulness of creating an index between institutions is that it allows each institution to maintain control and confidentiality of their own information.

Movsesian M.,VA Salt Lake City Health Care System | Movsesian M.,University of Utah
Pharmacology and Therapeutics | Year: 2016

Inhibitors of PDE3, a family of dual-specificity cyclic nucleotide phosphodiesterases, are used clinically to increase cardiac contractility by raising intracellular cAMP content in cardiac myocytes and to reduce vascular resistance by increasing intracellular cGMP content in vascular smooth muscle myocytes. When used in the treatment of patients with heart failure, PDE3 inhibitors are effective in the acute setting but increase sudden cardiac death with long-term administration, possibly reflecting pro-apoptotic and pro-hypertrophic consequences of increased cAMP-mediated signaling in cardiac myocytes. cAMP-mediated signaling in cardiac myocytes is highly compartmentalized, and different phosphodiesterases, by controlling cAMP content in functionally discrete intracellular microcompartments, regulate different cAMP-mediated pathways. Four variants/isoforms of PDE3 (PDE3A1, PDE3A2, PDE3A3, and PDE3B) are expressed in cardiac myocytes, and new experimental results have demonstrated that these isoforms, which are differentially localized intracellularly through unique protein-protein interactions, control different physiologic responses. While the catalytic regions of these isoforms may be too similar to allow the catalytic activity of each isoform to be selectively inhibited, targeting their unique protein-protein interactions may allow desired responses to be elicited without the adverse consequences that limit the usefulness of existing PDE3 inhibitors. © 2016 Published by Elsevier Inc.

Nelson R.E.,VA Salt Lake City Health Care System | Nelson R.E.,University of Utah | Saltzman G.M.,Albion College | Saltzman G.M.,University of Michigan | And 3 more authors.
Neurology | Year: 2011

Objective: To conduct a cost-effectiveness analysis of telestroke-a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients-compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts). Methods: A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed. Results: In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs <$50,000/QALY, a ratio commonly considered acceptable in the United States. Conclusion: When a lifetime perspective is taken, telestroke appears cost-effective compared to usual care, since telestroke costs are upfront but benefits of improved stroke care are lifelong. If barriers to use such as low reimbursement rates and high equipment costs are reduced, telestroke has the potential to diminish the striking geographic disparities of acute stroke care in the United States. Copyright © 2011 by AAN Enterprises, Inc.

Tanner W.D.,University of Utah | Toth D.J.A.,University of Utah | Toth D.J.A.,VA Salt Lake City Health Care System | Gundlapalli A.V.,University of Utah | Gundlapalli A.V.,VA Salt Lake City Health Care System
Epidemiology and Infection | Year: 2015

Summary In March 2013 the first cases of human avian influenza A(H7N9) were reported to the World Health Organization. Since that time, over 650 cases have been reported. Infections are associated with considerable morbidity and mortality, particularly within certain demographic groups. This rapid increase in cases over a brief time period is alarming and has raised concerns about the pandemic potential of the H7N9 virus. Three major factors influence the pandemic potential of an influenza virus: (1) its ability to cause human disease, (2) the immunity of the population to the virus, and (3) the transmission potential of the virus. This paper reviews what is currently known about each of these factors with respect to avian influenza A(H7N9). Currently, sustained human-to-human transmission of H7N9 has not been reported; however, population immunity to the virus is considered very low, and the virus has significant ability to cause human disease. Several statistical and geographical modelling studies have estimated and predicted the spread of the H7N9 virus in humans and avian species, and some have identified potential risk factors associated with disease transmission. Additionally, assessment tools have been developed to evaluate the pandemic potential of H7N9 and other influenza viruses. These tools could also hypothetically be used to monitor changes in the pandemic potential of a particular virus over time. © Cambridge University Press 2015.

Movsesian M.,VA Salt Lake City Health Care System
Current Opinion in Cardiology | Year: 2015

Purpose of review The most extensively studied inotropic agents in patients with heart failure are phosphodiesterase (PDE) 3 inhibitors, which increase contractility by raising intracellular cyclic adenosine monophosphate content. In clinical trials, the inotropic benefits of these agents have been outweighed by an increase in sudden cardiac death. Here, I review recent findings that help explain what are likely to be distinct mechanisms involved in the beneficial and adverse effects of PDE3 inhibition. Recent findings The proapoptotic consequences of PDE3 inhibition are becoming more apparent. Moreover, it has also become clear that individual PDE3 isoforms in cardiac myocytes are selectively regulated to interact with different proteins in different intracellular compartments. The beneficial and adverse effects of PDE3 inhibition may thus be attributable to the inhibition of different isoforms in different intracellular domains. In particular, PDE3A1 has been shown to interact directly with sarcoplasmic/endoplasmic reticulum Ca 2+ ATPase (SERCA2) in the sarcoplasmic reticulum through a phosphorylation of a site in its unique N-terminal domain, making it possible that this isoform can be selectively targeted to increase intracellular Ca 2+ cycling. Summary Conventional PDE3 inhibitors target several functionally distinct isoforms of these enzymes. Isoform-selective and/or compartment-selective targeting of PDE3, through its protein-protein interactions, may produce the inotropic benefits of PDE3 inhibition without the adverse consequences. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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