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Search Results: 1 - 10 of 27446 matches for " Robert Brownell "
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Rapid Molecular Testing for TB to Guide Respiratory Isolation in the U.S.: A Cost-Benefit Analysis
Alexander J. Millman, David W. Dowdy, Cecily R. Miller, Robert Brownell, John Z. Metcalfe, Adithya Cattamanchi, J. Lucian Davis
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079669
Abstract: Background Respiratory isolation of inpatients during evaluation for TB is a slow and costly process in low-burden settings. Xpert MTB/RIF (Xpert) is a novel molecular test for tuberculosis (TB) that is faster and more sensitive but substantially more expensive than smear microscopy. No previous studies have examined the costs of molecular testing as a replacement for smear microscopy in this setting. Methods We conducted an incremental cost–benefit analysis comparing the use of a single negative Xpert versus two negative sputum smears to release consecutive adult inpatients with presumed TB from respiratory isolation at an urban public hospital in the United States. We estimated all health-system costs and patient outcomes related to Xpert implementation, diagnostic evaluation, isolation, hospitalization, and treatment. We performed sensitivity and probabilistic uncertainty analyses to determine at what threshold the Xpert strategy would become cost-saving. Results Among a hypothetical cohort of 234 individuals undergoing evaluation for presumed active TB annually, 6.4% had culture-positive TB. Compared to smear microscopy, Xpert reduced isolation bed utilization from an average of 2.7 to 1.4 days per patient, leading to a 48% reduction in total annual isolation bed usage from 632 to 328 bed-days. Xpert saved an average of $2,278 (95% uncertainty range $1582–4570) per admission, or $533,520 per year, compared with smear microscopy. Conclusions Molecular testing for TB could provide substantial savings to hospitals in high-income countries by reducing respiratory isolation usage and overall length of stay.
Thinking Forward: The Quicksand of Appeasing the Food Industry
Kelly D. Brownell
PLOS Medicine , 2012, DOI: 10.1371/journal.pmed.1001254
Abstract:
Lessons from a small country about the global obesity crisis
Kelly D Brownell, Derek Yach
Globalization and Health , 2006, DOI: 10.1186/1744-8603-2-11
Abstract: Statistics from country after country show increasing prevalence of obesity, with extreme prevalence in some areas. A cascade of diseases follows from overnutrition, inactivity, and obesity, including major killers such as heart disease, cancer, and diabetes. These chronic diseases were once the worry of the developed world but are now a chief health concern in developing countries. Figure 1 shows the alarming increases in diabetes expected in developed vs. developing countries [1].One can be numb to obesity statistics, but it is difficult to ignore 88% of adults of Kosrae, one of four districts in Micronesia, being overweight and 53% being obese. Such tragedies are magnified if we ignore their lessons. Cassels [2] offers an excellent analysis of the Kosrae experience, noting that "...the recent development of a wage-based economy has upset traditional eating habits and made them dependent on imported food from developed countries. Whereas previously individuals relied heavily on local foods such as fresh tuna, increasingly men and women use cash to buy nutrient poor packaged food." A major shift occurred in 1993 when the Federated States of Micronesia sold fishing rights to Japan.Globalization changes many features of modern life, including diets. As trade changes, diets can become more secure (hunger becomes less of a problem), but the cheapening of calories, the reliance on imported food, and the influence of food marketing drive up consumption and drive down nutrient density. Obesity, diabetes, and other chronic diseases are not far behind. Fully 11% of global trade is in food [3]. Its impact is so profound that it has changed the relationship between income and fat consumption. Whereas fat intake was once higher in those with higher incomes, the reverse is now true [4].One hopes there is still time for countries to see this coming and take preventive action, but history offers a depressing picture. Smoking is a key example. It took America decades to mobilize a
A randomized, double blind, placebo and active comparator controlled pilot study of UP446, a novel dual pathway inhibitor anti-inflammatory agent of botanical origin
John S Sampalis, Lidia Brownell
Nutrition Journal , 2012, DOI: 10.1186/1475-2891-11-21
Abstract: A randomized, double blind, placebo and active controlled pilot study of a novel dual pathway, COX1/2 and LOX, inhibitor anti-inflammatory agent of botanical origin, UP446 was conducted. Sixty subjects (age 40-75) with symptomatic OA of the hip or knee were assigned to 4 treatment groups (n = 15); Group A0 (Placebo, CMC capsule), Group A1 (UP446 250 mg/day), Group A2 (UP446 500 mg/day) and Group A3 (Celecoxib, 200 mg/day). MOS-SF-36 and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) data were collected at baseline and after 30, 60 and 90 days of treatment as a measure of efficacy. Erythrocyte sedimentation rate, C-reactive protein, plasma thrombin time (PTT), fructosamine, Hematology, clinical chemistry and fecal occult blood were monitored for safety.Statistically significant decrease in WOMAC pain score were observed for Group A1 at day 90, Group A2 at 30 and 90 days and Group A3 at 60 and 90 days. Statistically significant decrease in WOMAC stiffness score were observed for Group A1 and Group A2 at 30, 60 and 90 days; but not for Group A0 and Group A3. The mean change in WOMAC functional impairment scores were statistically significant for Group A1 and Group A2 respectively at 30 days (p = 0.006 and p = 0.006), at 60 days (p = 0.016 and p = 0.002) and at 90 days (p = 0.018 and p = 0.002), these changes were not significant for Group A0 and Group A3. Based on MOS -SF-36 questionnaires, statistically significant improvements in physical function, endurance and mental health scores were observed for all active treatment groups compared to placebo. No significant changes suggestive of toxicity in routine hematologies, serum chemistries, liver enzymes or PTT were noted in any of the treatment groups.Based on current findings UP446 is safe and efficacious alternative to established anti-inflammatory medications for alleviating OA symptoms as measured by the WOMAC Index.Osteoarthritis (OA) is the most common form of joint disorder and the most freq
Spatio-Temporal Patterns of Beaked Whale Echolocation Signals in the North Pacific
Simone Baumann-Pickering, Marie A. Roch, Robert L. Brownell Jr, Anne E. Simonis, Mark A. McDonald, Alba Solsona-Berga, Erin M. Oleson, Sean M. Wiggins, John A. Hildebrand
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086072
Abstract: At least ten species of beaked whales inhabit the North Pacific, but little is known about their abundance, ecology, and behavior, as they are elusive and difficult to distinguish visually at sea. Six of these species produce known species-specific frequency modulated (FM) echolocation pulses: Baird’s, Blainville’s, Cuvier’s, Deraniyagala’s, Longman’s, and Stejneger’s beaked whales. Additionally, one described FM pulse (BWC) from Cross Seamount, Hawai’i, and three unknown FM pulse types (BW40, BW43, BW70) have been identified from almost 11 cumulative years of autonomous recordings at 24 sites throughout the North Pacific. Most sites had a dominant FM pulse type with other types being either absent or limited. There was not a strong seasonal influence on the occurrence of these signals at any site, but longer time series may reveal smaller, consistent fluctuations. Only the species producing BWC signals, detected throughout the Pacific Islands region, consistently showed a diel cycle with nocturnal foraging. By comparing stranding and sighting information with acoustic findings, we hypothesize that BWC signals are produced by ginkgo-toothed beaked whales. BW43 signal encounters were restricted to Southern California and may be produced by Perrin’s beaked whale, known only from Californian waters. BW70 signals were detected in the southern Gulf of California, which is prime habitat for Pygmy beaked whales. Hubb’s beaked whale may have produced the BW40 signals encountered off central and southern California; however, these signals were also recorded off Pearl and Hermes Reef and Wake Atoll, which are well south of their known range.
The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers
Ann M. Dozier,Alice Nelson,Elizabeth Brownell
Advances in Preventive Medicine , 2012, DOI: 10.1155/2012/902487
Abstract:
Acute and 26-Week Repeated Oral Dose Toxicity Study of UP446, a Combination of Scutellaria Extract and Acacia Extract in Rats  [PDF]
Young Chul Lee, Eujin Hyun, Mesfin Yimam, Lidia Brownell, Qi Jia
Food and Nutrition Sciences (FNS) , 2013, DOI: 10.4236/fns.2013.47A003
Abstract: UP446 has been used in both joint supplements and prescription medical food. The purpose of this study was to evaluate the pharmaceutical safety of UP446 via acute and 26-week repeated oral dose toxicity study in SD rats. In acute toxicity study, UP446 was administered by oral gavage to Sprague-Dawley rats (5 males and 5 females) at a dose of 5000 mg/kg. In 26-week repeated oral dose toxicity study, UP446 at doses of 500, 1000 and 2000 mg/kg/day were given orally to groups of rats (10 rats/dose/sex) for 26-week. UP446 at a dose of 5000 mg/kg produced no treatment-related acute toxicity or mortality in any of the animals tested during 14 days of the study. In 26-week repeated dose toxicity study, there was no significant difference in body weight between the control and all treatment groups. Blackish stool and soft stool was observed in one male in the 1000 mg/kg group and in some males and females of 2000 mg/kg group. However, these changes of stool were not considered to be toxic effects because neither histopathological change in gastrointestinal tracks (GIT) nor body weight change were detected. No drug induced abnormalities were found as of body weights, food consumption, ophthalmological examinations, urinalysis, hematology, clinical chemistry, organ weights and gross necropsy in any animals in the dosing groups. These results suggest that the oral lethal dose of UP446 for male and female rats is in excess of 5000 mg/kg and the no observed adverse effect level (NOAEL) of the UP446 for both male and female rats is considered to be greater than 2000 mg/kg/day.
Family structure histories and high school completion: Evidence from a population based registry.
Lisa Strohschein,Noralou Roos,Marni Brownell
The Canadian Journal of Sociology , 2009,
Abstract: This paper uses a life course approach to investigate the association between family structure histories and high school completion. Using data from a population-based data registry for the 1984 Manitoba birth cohort, we selected a sample of children born or adopted at birth into a married two-parent household (n = 9,403) and derived family structure histories for each child to the age of 18. Marital disruption occurred for 1,834 children (19.5%), with 337 children (3.6% of the total sample) experiencing multiple changes in family structure. Logistic regression models showed that children who experienced marital dissolution before the age of 18 were significantly less likely to complete high school than children in intact households, and that children who were younger at the time of a first transition were more vulnerable than children who were older when their parents’ marriage ended. Further work is needed to
The Relationship between Life Stress and Breastfeeding Outcomes among Low-Income Mothers
Ann M. Dozier,Alice Nelson,Elizabeth Brownell
Advances in Preventive Medicine , 2012, DOI: 10.1155/2012/902487
Abstract: Stressful life events during pregnancy negatively affect maternal and infant outcomes including breastfeeding initiation. Their impact on breastfeeding duration is uncertain. Given breastfeeding's important health benefits we analyzed stressful life event types and cessation of any and exclusive breastfeeding by 4 and 13 weeks. Methods. We collected self-administered survey data at 5–7 months postpartum from over 700 primarily urban low-income US mothers. Data covered prepregnancy, prenatal, and postpartum periods including 14 stressful life events (categorized into financial, emotional, partner-associated, traumatic). Analyses included only mothers initiating breastfeeding ( ). Logistic regressions controlled for maternal characteristics including a breastfeeding plan. Results. All four stress categories were associated with shorter duration of any and exclusive breastfeeding. In the adjusted models, statistically significant relationships remained for financial stress (4 weeks cessation of any breastfeeding duration) and traumatic stress (13 weeks exclusive breastfeeding cessation). Controlling for stress, a longer breastfeeding plan was significantly associated with a shorter breastfeeding duration (all models) as was depression during pregnancy and current smoking (several models). Conclusions. Among low-income women, impact of stressful life events on cessation of breastfeeding may differ by stress type and interfere with achievement of breastfeeding goal. Among these stressed mothers, breastfeeding may serve as a coping mechanism. 1. Introduction Optimal breastfeeding duration and exclusivity practices contribute to significant short- and long-term health benefits for both mother and baby [1, 2]. Current professional associations, including the World Health Organization recommend exclusive breastfeeding for 6 months and continued breastfeeding for at least a year [3, 4]. In the USA, efforts by professional, government, and health and human service organizations to increase breastfeeding rates resulted in increasing initiation rates [5, 6]. Duration and exclusivity remain well below national goals, especially among low-income mothers [7]. Numerous factors influence breastfeeding outcomes from institutional practices to individual characteristics and actions [8–10]. The latter include demographic and maternal factors such as maternal race/ethnicity (non-white and/or Hispanic) [11], less education [12], elevated prepregnancy Body Mass Index (BMI) [13], language (English speaking) [14], and younger age [11], all of which are associated with early
What Caused the UK's Largest Common Dolphin (Delphinus delphis) Mass Stranding Event?
Paul D. Jepson, Robert Deaville, Karina Acevedo-Whitehouse, James Barnett, Andrew Brownlow, Robert L. Brownell Jr., Frances C. Clare, Nick Davison, Robin J. Law, Jan Loveridge, Shaheed K. Macgregor, Steven Morris, Sinéad Murphy, Rod Penrose, Matthew W. Perkins, Eunice Pinn, Henrike Seibel, Ursula Siebert, Eva Sierra, Victor Simpson, Mark L. Tasker, Nick Tregenza, Andrew A. Cunningham, Antonio Fernández
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060953
Abstract: On 9 June 2008, the UK's largest mass stranding event (MSE) of short-beaked common dolphins (Delphinus delphis) occurred in Falmouth Bay, Cornwall. At least 26 dolphins died, and a similar number was refloated/herded back to sea. On necropsy, all dolphins were in good nutritive status with empty stomachs and no evidence of known infectious disease or acute physical injury. Auditory tissues were grossly normal (26/26) but had microscopic haemorrhages (5/5) and mild otitis media (1/5) in the freshest cases. Five lactating adult dolphins, one immature male, and one immature female tested were free of harmful algal toxins and had low chemical pollutant levels. Pathological evidence of mud/seawater inhalation (11/26), local tide cycle, and the relative lack of renal myoglobinuria (26/26) suggested MSE onset on a rising tide between 06:30 and 08:21 hrs (9 June). Potential causes excluded or considered highly unlikely included infectious disease, gas/fat embolism, boat strike, by-catch, predator attack, foraging unusually close to shore, chemical or algal toxin exposure, abnormal weather/climatic conditions, and high-intensity acoustic inputs from seismic airgun arrays or natural sources (e.g., earthquakes). International naval exercises did occur in close proximity to the MSE with the most intense part of the exercises (including mid-frequency sonars) occurring four days before the MSE and resuming with helicopter exercises on the morning of the MSE. The MSE may therefore have been a “two-stage process” where a group of normally pelagic dolphins entered Falmouth Bay and, after 3–4 days in/around the Bay, a second acoustic/disturbance event occurred causing them to strand en masse. This spatial and temporal association with the MSE, previous associations between naval activities and cetacean MSEs, and an absence of other identifiable factors known to cause cetacean MSEs, indicates naval activity to be the most probable cause of the Falmouth Bay MSE.
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