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Search Results: 1 - 10 of 230747 matches for " Alan R. Schwartz "
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A survey of individual preference for colorectal cancer screening technique
Richard L Nelson, Alan Schwartz
BMC Cancer , 2004, DOI: 10.1186/1471-2407-4-76
Abstract: A cross-sectional survey was performed of healthy ambulatory adults in a pediatrics primary care office and neighboring church. Overall preference was ranked for each of four colorectal cancer screening modalities: Faecal Occult Blood, Fiberoptic Sigmoidoscopy, Barium Enema and Colonoscopy. Four additional domains of preference also were ranked: suspected discomfort, embarrassment, inconvenience and danger of each exam.80 surveys were analyzed, 57 of which were received from participants who had experienced none of the screening tests. Fecal Occult Blood Testing is significantly preferred over each other screening modality in overall preference and every domain of preference, among all subjects and those who had experienced none of the tests.Efforts to increase public participation in colorectal cancer screening may be more effective if undertaken in the context of public perceptions of screening choices.Screening for colorectal cancer lessens the risk of dying from that disease [1]. Knowledge of this fact has not solved all the problems related to screening. The optimal modality of screening is still the subject of debate [1-3]. More problematic is the very low participation of the general public in recommended screening [4]. In contrast to breast cancer screening, in which the Healthy People 2000 Goal of the U.S. National Institutes of Health was surpassed, at 64% participation by women over 40 years of age, only 20% of Americans over age 50 had fecal occult blood testing within the past year (This is the best estimate of actual screening, rather than diagnostic endeavors for symptoms for which endoscopy or radiologic imaging might be done.), and 34% had a sigmoidoscopy within the past 5 years [5,6] Even if screening is appropriately performed, it is far from certain that a positive screen will be followed by appropriate diagnostic testing, as has been shown in follow-up surveys of fecal occult blood testing [7].Most publication concerning colorectal cancer screen
Sleep apnea predicts distinct alterations in glucose homeostasis and biomarkers in obese adults with normal and impaired glucose metabolism
Maria Pallayova, Kimberley E Steele, Thomas H Magnuson, Michael A Schweitzer, Nathan R Hill, Shannon Bevans-Fonti, Alan R Schwartz
Cardiovascular Diabetology , 2010, DOI: 10.1186/1475-2840-9-83
Abstract: Forty-five severely obese adults (36 women) without certain comorbidities/medications underwent anthropometric measurements, polysomnography, and blood tests. We measured fasting serum glucose, insulin, selected cytokines, and calculated homeostasis model assessment estimates of insulin sensitivity (HOMA-IS) and pancreatic beta-cell function (HOMA-B).Both increases in apnea-hypopnea index (AHI) and the presence of prediabetes/diabetes were associated with reductions in HOMA-IS in the entire cohort even after adjustment for sex, race, age, and BMI (P = 0.003). In subjects with NGM (n = 30), OSA severity was associated with significantly increased HOMA-B (a trend towards decreased HOMA-IS) independent of sex and adiposity. OSA-related oxyhemoglobin desaturations correlated with TNF-α (r=-0.76; P = 0.001) in women with NGM and with IL-6 (rho=-0.55; P = 0.035) in women with IGM (n = 15) matched individually for age, adiposity, and AHI.OSA is independently associated with altered glucose homeostasis and increased basal beta-cell function in severely obese adults with NGM. The findings suggest that moderate to severe OSA imposes an excessive functional demand on pancreatic beta-cells, which may lead to their exhaustion and impaired secretory capacity over time. The two distinct biomarker profiles linking sleep apnea with NGM and IGM via TNF-α and IL-6 have been discerned in our study to suggest that sleep apnea and particularly nocturnal oxyhemoglobin desaturations are associated with chronic metabolic fluxes and specific cytokine stressors that reflect links between sleep apnea and glucose metabolism. The study may help illuminate potential mechanisms for glucose dysregulation in OSA, and resolve some controversy over the associations of OSA with TNF-α and IL-6 in previous studies.Obstructive sleep apnea (OSA) and impaired glucose metabolism (IGM) are closely linked to an epidemic of obesity in Western society, and both are associated with a significantly increased cardi
A web-based library consult service for evidence-based medicine: Technical development
Alan Schwartz, Gregory Millam, the UIC LCS Investigators
BMC Medical Informatics and Decision Making , 2006, DOI: 10.1186/1472-6947-6-16
Abstract: To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system.A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.Despite the growing availability of evidence-based medicine (EBM) training programs for practicing physicians and increasing emphasis on EBM in medical student and resident education, research indicates that even those clinicians who are most enthusiastic about EBM generally rely more on traditional information sources, such as consultation with respected colleagues, than on EBM-related sources [1]. In reviewing the teaching of EBM as an educational endeavor, several reviews have concluded that evidence-based practice may be difficult for physicians [2-6].EBM requires that clinicians learn new skills, including how to formulate questions about their patients that can be answered in the medical literature, how to search the clinical research literature for potentially relevant research reports, how to critically appraise the research design and analysis methods in order to determine the validity of reported results and their applicability to their patients, and how to use valid results appropriately in making clinical decisions. Such skills, the foundations of which lie in biostatistics, epidemiology, and library and in
Assessment of the usefulness of a diagnostic test: A survey of patient preference for diagnostic techniques in the evaluation of intestinal inflammation
Richard L Nelson, Alan Schwartz, Dan Pavel
BMC Medical Research Methodology , 2001, DOI: 10.1186/1471-2288-1-5
Abstract: Significant differences were seen in overall preference for white cell scan over barium enema and colonoscopy (p < 0.01) in both survey groups. Perceived discomfort and embarrassment demonstrated similar rankings.This patient preference combined with the reported accuracy of white cell scanning further establishes the usefulness of this means of IBD diagnosis.The radio labeled white cell scan has been shown to be an accurate means of detecting intestinal inflammation [1]. Our initial report of the use of Indium111 radiolabeled white cell scanning in the diagnosis of inflammatory bowel disease described a sensitivity and specificity of 97% and 100% respectively in 49 scans in 39 patients in all of whom confirmatory studies were done. Since that time, 1130 scans have been performed at our institution. Clinical follow-up of these patients has revealed only three cases of confirmed false negative scans. No cases of false positive scans have been encountered. This accuracy, it should be stressed, is not in the grading of disease activity, but in the dichotomous determination of disease presence and its anatomic location. The lack of confirmatory testing of all subsequent patients certainly results in the overestimation of accuracy [2], but not greatly so, since all patients have been available for clinical follow-up and diagnostic errors would become apparent with the passage of time. Even if it is a ten fold overestimate, the white cell scan still compares well with other diagnostic modalities. In 1993 Indium111 became unavailable in Chicago and we switched to the use of Technetium99. We found that the higher radiation dose of Technetium injected (20 mCI versus 0.5 mCI Indium) resulted in clearer images with less motion artifact, yet its shorter half life resulted in the total radiation dose to the patient being similar to Indium111. First images are available within 5 hours from the patient's arrival using Technetium, compared with 30 hours for Indium, making this appl
Prospect theory, reference points, and health decisions
Alan Schwartz,Julie Goldberg,Gordon Hazen
Judgment and Decision Making , 2008,
Abstract: In preventative health decisions, such as the decision to undergo an invasive screening test or treatment, people may be deterred from selecting the test because its perceived disutility relative to not testing is greater than the utility associated with prevention of possible disease. The prospect theory editing operation, by which a decision maker's reference point is determined, can have important effects on the disutility of the test. On the basis of the prospect theory value function, this paper develops two approaches to reducing disutility by directing the decision maker's attention to either (actual) past or (expected) future losses that result in shifted reference points. After providing a graphical description of the approaches and a mathematical proof of the direction of their effect on judgment, we briefly illustrate the potential value of these approaches with examples from qualitative research on prostate cancer treatment decisions.
Sleep Disordered Breathing, Fatigue, and Sleepiness in HIV-Infected and -Uninfected Men
Susheel P. Patil, Todd T. Brown, Lisa P. Jacobson, Joseph B. Margolick, Alison Laffan, Lisette Johnson-Hill, Rebecca Godfrey, Jacquett Johnson, Sandra Reynolds, Alan R. Schwartz, Philip L. Smith
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099258
Abstract: Study Objectives We investigated the association of HIV infection and highly active antiretroviral therapy (HAART) with sleep disordered breathing (SDB), fatigue, and sleepiness. Methods HIV-uninfected men (HIV?; n = 60), HIV-infected men using HAART (HIV+/HAART+; n = 58), and HIV-infected men not using HAART (HIV+/HAART?; n = 41) recruited from two sites of the Multicenter AIDS cohort study (MACS) underwent a nocturnal sleep study, anthropometric assessment, and questionnaires for fatigue and the Epworth Sleepiness Scale. The prevalence of SDB in HIV- men was compared to that in men matched from the Sleep Heart Health Study (SHHS). Results The prevalence of SDB was unexpectedly high in all groups: 86.7% for HIV?, 70.7% for HIV+/HAART+, and 73.2% for HIV+/HAART?, despite lower body-mass indices (BMI) in HIV+ groups. The higher prevalence in the HIV? men was significant in univariate analyses but not after adjustment for BMI and other variables. SDB was significantly more common in HIV? men in this study than those in SHHS, and was common in participants with BMIs <25 kg/m2. HIV+ men reported fatigue more frequently than HIV? men (25.5% vs. 6.7%; p = 0.003), but self-reported sleepiness did not differ among the three groups. Sleepiness, but not fatigue, was significantly associated with SDB. Conclusions SDB was highly prevalent in HIV? and HIV+ men, despite a normal or slightly elevated BMI. The high rate of SDB in men who have sex with men deserves further investigation. Sleepiness, but not fatigue, was related to the presence of SDB. Clinicians caring for HIV-infected patients should distinguish between fatigue and sleepiness when considering those at risk for SDB, especially in non-obese men.
Expression of PKC Iota Affects Neuronal Differentiation of PC12 Cells at Least Partly Independent of Kinase Function  [PDF]
Alana Doonachar, Alan R. Schoenfeld
CellBio (CellBio) , 2014, DOI: 10.4236/cellbio.2014.31001
Abstract: Atypical PKC (aPKC) plays a role in establishing cell polarity and has been indicated in neuronal differentiation and polarization, including neurite formation in rat pheochromocytoma PC12 cells, albeit by unclear mechanisms. Here, the role of the aPKC isoform, PKC iota (PKCι), in the early neuronal differentiation of PC12 cells, was investigated. NGF-treated PC12 cells with stably expressed exogenous wild-type PKCι showed decreased expression of a neuroendocrine marker, increased expression of a neuronal marker and increased neurite formation. Stable expression of a kinase-inactive PKCι, but not constitutively active PKCι lacking a regulatory domain, had similar though less potent effects. Pharmacological inhibition of endogenous aPKC kinase activity in parental PC12 cells did not inhibit neurite formation, suggesting that some of the observed effects of PKCι expression on neuronal differentiation are kinase-independent. Interestingly, exogenous expression of wild-type and kinase-inactive PKCι had little effect on overall PKCι activity, but caused a decrease in PKC zeta (PKCζ) kinase activity, suggesting an interplay between the two isoforms that may underlie the observed results. Overall, these findings suggest that in PC12 and perhaps other neuroendocrine precursor cells, PKCι influences an early differentiation decision between the neuroendocrine (chromaffin) and sympathetic neuron cell lineages, potentially by affecting PKCζ function.
Using Sports Wagering Markets to Evaluate and Compare Team Winning Streaks in Sports  [PDF]
R. Alan Bowman, Thomas Ashman, James Lambrinos
American Journal of Operations Research (AJOR) , 2015, DOI: 10.4236/ajor.2015.55029
Abstract: Point spreads and money lines from sports wagering markets are used to evaluate the impressiveness of team streaks. Sports wagering data have previously been useful in assessing competitive balance in sports. Our approach was motivated by the amount of media scrutiny that accompanied the winning streak of the NBA’s Miami Heat and the point streak of the NHL’s Chicago Blackhawks which occurred simultaneously for the most part in 2013. The topic came to the forefront again with the 2014-2015 winning streak of the Atlanta Hawks. Three streaks are highlighted in our paper. The length of the streaks, the quality of the competition, injuries, and a variety of other factors were mentioned in the media but the discussion was limited to subjective opinions as no way of properly weighing relative influence of the factors was identified. Wagering markets provide an excellent source of information for making these judgments. Several complementary measures are described and the most impressive team streaks within and across professional baseball, basketball, football, and ice hockey are identified.
Planting Geometry Effects on the Growth and Yield of Dryland Cotton  [PDF]
R. L. Baumhardt, R. C. Schwartz, G. W. Marek, J. M. Bell
Agricultural Sciences (AS) , 2018, DOI: 10.4236/as.2018.91008
Abstract: The declining Ogallala Aquifer beneath the Southern High Plains may necessitate dryland crop production and cotton (Gossypium hirsutum L.) is a well-adapted and potentially profitable alternative crop. The limited growing season duration of the Texas Panhandle and southwestern Kansas, however, imposes significant production risk due to incomplete boll maturation. Emphasizing earlier boll production that is usually confined to sites on lower fruiting branches may reduce risk, but offsetting high planting densities are needed to maintain desirable lint yield. Our objectives were to quantify planting: 1) row width and 2) in-row spacing effects on growth, yield, and fiber quality of dryland cotton. Field tests of row widths from 0.25 to 0.76 m and plant densities with in-row spacing ranging from 0.075 to 0.15 m were conducted from 1999 to 2005 on a nearly level Pullman clay loam (fine, mixed, superactive, thermic Torrertic Paleustoll) managed in a wheat (Triticum aestivum L.), cotton, fallow (W-Ctn-F) rotation. To expand the basis of comparison, cotton growth and yields were simulated using GOSSYM and long-term (1958-2000) weather records from Bushland, TX, as input for all combinations of 0.38 or 0.76 m row widths and plant spacing of 0.075, 0.10 and 0.15 m. Experimental and computer simulated plant height and harvested boll number increased significantly with increased row spacing and, occasionally, in-row plant spacing. Modeled lint yield for 0.38 m rows decreased by approximately 50% compared with the 582 kg·ha-1 yield for conventional row spacing, which was practically duplicated by field observations in 2001 and 2004. Measured fiber quality occasionally improved with conventional row spacing over ultra-narrow rows, but was unaffected by plant spacing. Because narrow rows and frequent plant spacing did not improve lint yield or fiber quality of dryland cotton, we do not recommend this strategy to overcome a thermally limited growing season.
The Rhetoric of Begin: Leadership in Changing Times  [PDF]
David Schwartz
Open Journal of Leadership (OJL) , 2016, DOI: 10.4236/ojl.2016.53008
A precise examination of Menachem Begin’s speeches and history over the years reveals that Begin’s rhetoric constituted a political instrument that he knew to change according to the circumstances. Begin’s rhetoric was controversial, as he went from the leader of a terrorist organization, was awarded a Nobel Peace Prize, and was the Prime Minister who signed the peace treaty with Egypt. This quality study claims that begin’s rhetoric is integral part of his personality and of his leadership. The assumption is that like a typical politician his leadership changed according the winds of times. His charisma and transformational leadership made him a great leader. His rhetoric constituted just instrument for justification his political actions. Begin was revealed to be pragmatic, in contrast to the militant images that his political rivals attempted to affix to him.
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