Department of Health Science

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Absolute Oxygen R-1e Imaging In Vivo with Pulse Electron Paramagnetic Resonance
(Wiley-Blackwell, 2014) Epel, Boris; Bowman, Michael K.; Mailer, Colin; Halpern, Howard J.; University of Chicago; University of Alabama Tuscaloosa
Purpose: Tissue oxygen (O-2) levels are among the most important and most quantifiable stimuli to which cells and tissues respond through inducible signaling pathways. Tumor O-2 levels are major determinants of the response to cancer therapy. Developing more accurate measurements and images of tissue O-2 partial pressure (pO(2)), assumes enormous practical, biological, and medical importance. Methods: We present a fundamentally new technique to image pO(2) in tumors and tissues with pulse electron paramagnetic resonance (EPR) imaging enabled by an injected, nontoxic, triaryl methyl (trityl) spin probe whose unpaired electron's slow relaxation rates report the tissue pO(2). Heretofore, virtually all in vivo EPR O-2 imaging measures pO(2) with the transverse electron spin relaxation rate, R-2e, which is susceptible to the self-relaxation confounding O-2 sensitivity. Results: We found that the trityl electron longitudinal relaxation rate, R-1e, is an order of magnitude less sensitive to confounding self-relaxation. R-1e imaging has greater accuracy and brings EPR O-2 images to an absolute pO(2) image, within uncertainties. Conclusion: R-1e imaging more accurately determines oxygenation of cancer and normal tissue in animal models than has been available. It will enable enhanced, rapid, noninvasive O-2 images for understanding oxygen biology and the relationship of oxygenation patterns to therapy outcome in living animal systems. (C) 2013 Wiley Periodicals, Inc.
Acute exposure to ultraviolet-B radiation modulates sex steroid hormones and receptor expression in the skin and may contribute to the sex bias of melanoma in a fish model
(Wiley, 2014) Mitchell, David L.; Fernandez, Andre A.; Garcia, Rachel; Paniker, Lakshmi; Lin, Kevin; Hanninen, Amanda; Zigelsky, Kyle; May, Matthew; Nuttall, Mark; Lo, Herng-Hsiang; Person, Maria D.; Earley, Ryan; UTMD Anderson Cancer Center; University of Texas Health Science Center Houston; University of Alabama Tuscaloosa
Using the Xiphophorus fish melanoma model, we show a strong male bias for sunlight-induced malignant melanoma, consistent with that seen in the human population. To examine underlying factors, we exposed adult X.couchianus fish to a single, sublethal dose of UVB and measured circulating sex steroid hormones and expression of associated hormone receptor genes over a 24-h period. We found that a single exposure had profound effects on circulating levels of steroid hormones with significant decreases for all free sex steroids at 6 and 24h and increases in conjugated 2-estradiol and 11-ketotestosterone at 6 and 24h, respectively. Whereas AR expression increased in male and female skin, neither AR nor either of the ERs showed significant responses to UVB in either sex. The rapid response of male androgens and their receptors in the skin after UVB irradiation implicates hormones in the male bias of skin cancer and suggests that the photoendocrine response immediately after UV exposure may be relevant to melanomagenesis.
Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop
(Mary Ann Liebert, 2016) Batey, D. Scott; Whitfield, Samantha; Mulla, Mazheruddin; Stringer, Kristi L.; Durojaiye, Modupeoluwa; McCormick, Lisa; Turan, Bulent; Nyblade, Laura; Kempf, Mirjam-Colette; Turan, Janet M.; University of Alabama Birmingham; University of Alabama Tuscaloosa; Research Triangle Institute
HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre-post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop "excellent'' and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, wellorganized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH(p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.
Adherence and Retention in Clinical Trials: A Community-Based Approach
(Wiley-Blackwell, 2014) Fouad, Mona N.; Johnson, Rhoda E.; Nagy, M. Christine; Person, Sharina D.; Partridge, Edward E.; University of Alabama Birmingham; University of Alabama Tuscaloosa; Western Kentucky University; University of Massachusetts Worcester
BACKGROUNDThe Community Health Advisor (CHA) model has been widely used to recruit rural and low-income, mostly African American women into clinical and behavioral research studies. However, little is known about its effectiveness in promoting retention and adherence of such women in clinical trials. METHODSThe Community-Based Retention Intervention Study evaluated the effectiveness of a community-based intervention strategy using the CHA model and the empowerment theory to improve the retention and adherence of minority and low-income women in clinical trials. The research strategy included the training and use of the volunteer CHAs as research partners. The target population included women participating in the University of Alabama at Birmingham clinical site of the Atypical Squamous Cells of Undetermined Significance-Low-Grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study (ALTS), a multicenter, randomized clinical trial. Two communities in Jefferson County, Alabama, that were matched according to population demographics were identified and randomly assigned to either an intervention group or a control group. Thirty community volunteers were recruited to be CHAs and to implement the intervention with the ALTS trial participants. In total, 632 ALTS participants agreed to participate in the project, including 359 in the intervention group, which received CHA care, and 273 in the control group, which received standard care. RESULTSAdherence rates for scheduled clinic visits were significantly higher in the intervention group (80%) compared with the control group (65%; P<.0001). CONCLUSIONSThe results indicate that volunteer CHAs can be trained to serve as research partners and can be effective in improving the retention and adherence of minority and low-income women in clinical trials. Cancer 2014;120(7 suppl):1106-12. (c) 2014 American Cancer Society. In the Community-Based Retention Intervention Study (CRIS), the effectiveness of a community-based intervention strategy is evaluated using Community Health Advisors (CHAs). The results indicate that volunteer CHAs can be trained as research partners to improve the retention and adherence of minority and low-income women in clinical trials.
Adult weight gain accelerates the onset of breast cancer
(Springer, 2019) Azrad, Maria; Blair, Cindy K.; Rock, Cheryl L.; Sedjo, Rebecca L.; Wolin, Kathleen Y.; Demark-Wahnefried, Wendy; University of Alabama Tuscaloosa; University of New Mexico; University of California San Diego; University of Colorado Anschutz Medical Campus; University of Alabama Birmingham
PurposeWeight gain in adulthood is a risk factor for breast cancer; however, the impact on age of onset is unknown. The objective of this study was to investigate whether weight gain from early- to mid-adulthood influenced the timing of breast cancer onset.MethodsIncrease in body mass index (BMI) from lowest adult BMI to BMI at diagnosis and age at which these events occurred were calculated from breast cancer survivors enrolled in a weight loss trial (n=660). Quartiles (Q) of the average increase in BMI were determined and associations between weight gain and age at disease onset were analyzed using analysis of covariance and spline regression models.ResultsA significant linear trend was observed across the quartiles of BMI change for earlier age at diagnosis [Q1 52.3 (0.73), Q2 51.9 (+/- 0.70), Q3 49.6 (+/- 0.66), Q4 47.3 (+/- 0.67), p<0.0001] after adjusting for potential confounders. In analyses that stratified by tumor subtype and menopausal status, significant linear trends continued to be observed for earlier age at diagnosis across quartiles of BMI for ER +/-, PR +/-, HER2+, as well as pre- and postmenopausal status (p-values<0.001).Conclusions Women who gain excess weight during adulthood are not only at risk for breast cancer, but also may experience earlier onset of disease and reduced cancer-free years.
African American Clergy Recommendations to Enhance the Federal Plan to End the HIV Epidemic: A Qualitative Study
(Springer, 2022) Arnold, Trisha; Haynes, Tiffany; Foster, Pamela; Parker, Sharon; Monger, Mauda; Malyuta, Yelena; Cain, Othor; Coats, Cassie Sutten; Murphy, Matthew; Thomas, Gladys; Sockwell, Latunja; Klasko-Foster, Lynne; Galipeau, Drew; Dobbs, Thomas E.; Smith, Michelle; Mena, Leandro; Nunn, Amy; Brown University; Lifespan Health Rhode Island; Rhode Island Hospital; University of Arkansas Medical Sciences; University of Alabama Tuscaloosa; University of North Carolina; North Carolina A&T State University; University of Mississippi; University of Mississippi Medical Center; University of Pennsylvania; Miriam Hospital
African Americans in the southern United States continue to be disproportionately affected by HIV. Although faith-based organizations (FBOs) play important roles in the social fabric of African American communities, few HIV screening, care, and PrEP promotion efforts harness the power of FBOs. We conducted 11 focus groups among 57 prominent African American clergy from Arkansas, Mississippi, and Alabama. We explored clergy knowledge about the Ending the HIV Epidemic: A Plan for America (EHE); normative recommendations for how clergy can contribute to EHE; and how clergy can enhance the HIV care continua and PrEP. We explored how clergy have responded to the COVID-19 crisis, and lessons learned from pandemic experiences that are relevant for HIV programs. Clergy reported a moral obligation to participate in the response to the HIV epidemic and were willing to support efforts to expand HIV screening, treatment, PrEP and HIV care. Few clergy were familiar with EHE, U = U and TasP. Many suggested developing culturally tailored messages and were willing to lend their voices to social marketing efforts to destigmatize HIV and promote uptake of biomedical interventions. Nearly all clergy believed technical assistance with biomedical HIV prevention and care interventions would enhance their ability to create partnerships with local community health centers. Partnering with FBOs presents important and unique opportunities to reduce HIV disparities. Clergy want to participate in the EHE movement and need federal resources and technical assistance to support their efforts to bridge community activities with biomedical prevention and care programs related to HIV. The COVID-19 pandemic presents opportunities to build important infrastructure related to these goals.
African-Caribbean Cancer Consortium Scientific and Training Conference 2017
(Multimed, 2019) Ragin, C.; Oliver, J. S.; Cabral, D. N.; Harlemon, M.; Louden, D.; Morrison-Blidgen, B. F.; Alleyne-Mike, K.; Ashing, K.; Butler, R.; Gathere, S.; George, S.; Halliday, D.; Jackson, M.; Odero-Marah, V.; Roach, V.; Roberts, R.; Slewion, S.; University of Alabama Tuscaloosa; California State University Monterey Bay; Clark Atlanta University; City of Hope; University of Miami; University West Indies Mona Jamaica; University of the West Indies Open Campus
The sixth International African-Caribbean Cancer Consortium (AC3) Conference was held 6-9 October2017 in Miami, Florida, U.S.A. The conference was open to all researchers, trainees, clinical and public health professionals, and community members, and served as an international hub for the United States, the Caribbean, and Africa. Sessions included AC3 collaboration meetings, cancer surveillance and research skills training workshops, and a community cancer prevention conference.
Age-dependent impairment of disease tolerance is associated with a robust transcriptional response following RNA virus infection in Drosophila
(Oxford University Press, 2021) Sheffield, Lakbira; Sciambra, Noah; Evans, Alysa; Hagedorn, Eli; Goltz, Casey; Delfeld, Megan; Kuhns, Haley; Fierst, Janna L.; Chtarbanova, Stanislava; University of Alabama Tuscaloosa; University of Alabama Birmingham
Advanced age in humans is associated with greater susceptibility to and higher mortality rates from infections, including infections with some RNA viruses. The underlying innate immune mechanisms, which represent the first line of defense against pathogens, remain incompletely understood. Drosophila melanogaster is able to mount potent and evolutionarily conserved innate immune defenses against a variety of microorganisms including viruses and serves as an excellent model organism for studying host-pathogen interactions. With its relatively short lifespan, Drosophila also is an organism of choice for aging studies. Despite numerous advantages that this model offers, Drosophila has not been used to its full potential to investigate the response of the aged host to viral infection. Here, we show that, in comparison to younger flies, aged Drosophila succumb more rapidly to infection with the RNA-containing Flock House virus due to an age-dependent defect in disease tolerance. Relative to younger individuals, we find that older Drosophila mount transcriptional responses characterized by differential regulation of more genes and genes regulated to a greater extent. We show that loss of disease tolerance to Flock House virus with age associates with a stronger regulation of genes involved in apoptosis, some genes of the Drosophila immune deficiency NF-kappa B pathway, and genes whose products function in mitochondria and mitochondrial respiration. Our work shows that Drosophila can serve as a model to investigate host-virus interactions during aging and furthermore sets the stage for future analysis of the age-dependent mechanisms that govern survival and control of virus infections at older age.
Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?
(Oxford University Press, 2011) Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald; University of Alabama Tuscaloosa
Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated primarily for murder. Design and Methods: Inmates over the age of 45 who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7; SD = 10.68). Results: We found a 3-way interaction indicating that the effect of parole expectation on desire for life-sustaining treatment varied by race/ethnicity and treatment. Minority inmates desired cardiopulmonary resuscitation or feeding tubes only if they believed that they would be paroled. The model predicting desire for palliative care was not significant. Future days of desired life were related to prospective health condition, fear of death, negative affect, and trust in prison health care. Caucasian inmates expressed a desire for more days of life out of prison, whereas minority inmates did not differ in days of desired life either in or out of prison. Minorities wanted more days of life than Caucasians but only if they believed that they would be paroled. Implications: End-of-life care for the burgeoning inmate population is costly, and active life-sustaining treatments may not be desired under certain conditions. Specifically, expectation of parole but not current functional ability interacts with future illness condition in explaining inmates' desire for active treatment or days of desired life in the future.
ANALYZING FACTORS OF BREAST CANCER SCREENING ADHERENCE AMONG KOREAN AMERICAN WOMEN USING ANDERSEN'S BEHAVIORAL MODEL OF HEALTHCARE SERVICES UTILIZATION
(Ethnicity & Disease, 2019) Jin, Seok Won; Lee, Hee Yun; Lee, Jongwook; University of Memphis; University of Alabama Tuscaloosa; University of Minnesota Twin Cities
Objectives: Regular uptake of mammography screening reduces the risk of advanced stage diagnosis of breast cancer (BC). However, BC screening rates remain suboptimal among Korean American (KA) women. Using the Andersen's Behavioral Model of Healthcare Services Utilization, this study examined factors associated with mammography screening among KA women aged 50 to 80 years in the state of Georgia, USA. Methods: We used purposive sampling to recruit study participants in the Atlanta metropolitan area from May 2015 to February 2016. A total of 303 KA women completed a cross-sectional, self-report survey about their sociodemographics, health care access information, knowledge, self-efficacy, decisional balance, and mammography history. Results: Descriptive analyses confirmed low rates of mammography screening in the participants. Multiple logistic regression analyses showed that having a mammogram within the past year was associated with greater BC knowledge, higher scores of decisional balance and fewer annual health check-ups among KA women without any cancer history. Conclusions: The findings offer implications for health policy aimed at increasing BC screening by leveraging enabling factors among medically underserved KA women at both structural and cultural levels.
Antismoking Mass Media Campaigns and Support for Smoke-Free Environments, Mobile County, Alabama, 2011-2012
(Centers for Disease Control and Prevention, 2014) Fosson, Gabriel H.; McCallum, Debra M.; Conaway, Michael B.; University of Alabama Tuscaloosa
Introduction In 2011, the Mobile County Health Department began a 12-month antismoking educational media campaign to educate citizens on the dangers of secondhand smoke. The campaign overlapped with the Centers for Disease Control and Prevention's 3-month national antismoking Tips from Former Smokers media campaign. We aimed to evaluate the effect of these campaigns on support for smoke-free environments and knowledge of the dangers of secondhand smoke. Methods Cross-sectional precampaign and postcampaign telephone surveys collected data from a random sample of Mobile County adults in the summers of 2011 and 2012. Outcome measures included changes in support for smoke-free environments and knowledge of the dangers of secondhand smoke. The participation rate among the households that were successfully reached was 45% in 2011 and 44% in 2012. Results On the postcampaign survey, 80.9% of respondents reported seeing a television advertisement, 29.9% reported hearing a radio advertisement, and 49.0% reported seeing a billboard. Overall, support for smoke-free bars increased significantly after the intervention (38.1% to 43.8%; P = .01) but not for workplaces or restaur-ants. Self-reported exposure to the media campaign was associated with higher levels of support for smoke-free workplaces, restaurants, and bars. Conclusion Educational mass media campaigns have the potential to increase support for smoke-free protections and may increase knowledge about the dangers of secondhand smoke among certain populations.
Antiviral therapy: Valacyclovir Treatment of Alzheimer's Disease (VALAD) Trial: protocol for a randomised, double-blind,placebo-controlled, treatment trial
(BMJ, 2020) Devanand, D. P.; Andrews, Howard; Kreisl, William C.; Razlighi, Qolamreza; Gershon, Anne; Stern, Yaakov; Mintz, Akiva; Wisniewski, Thomas; Acosta, Edward; Pollina, Julianna; Katsikoumbas, Mariasofia; Bell, Karen L.; Pelton, Gregory H.; Deliyannides, Deborah; Prasad, K. M.; Huey, Edward D.; Columbia University; New York University; University of Alabama Tuscaloosa; University of Pittsburgh
Introduction After infection, herpes simplex virus-1 (HSV1) becomes latent in the trigeminal ganglion and can enter the brain via retrograde axonal transport. Recurrent reactivation of HSV1 may lead to neurodegeneration and Alzheimer's disease (AD) pathology. HSV1 (oral herpes) and HSV2 (genital herpes) can trigger amyloid beta-protein (A beta) aggregation and HSV1 DNA is common in amyloid plaques. Anti-HSV drugs reduce A beta and phosphorylated tau accumulation in cell-culture models. Cognitive impairment is greater in patients with HSV seropositive, and antiviral drugs show robust efficacy against peripheral HSV infection. Recent studies of electronic health records databases demonstrate that HSV infections increase dementia risk, and that antiviral medication treatment reduces this risk. The generic antiviral drug valacyclovir was superior to placebo in improving memory in a schizophrenia pilot trial but has not been tested in AD. Methods and analysis In patients with mild AD who test positive for HSV1 or HSV2 serum antibodies, valacyclovir, repurposed as an anti-AD drug, will be compared with placebo (lactose pills) in 130 patients (65 valacyclovir and 65 placebo) in a randomised, double-blind, 78-week phase II proof-of-concept trial. Patients on valacyclovir, dose-titrated from 2 g to a targeted oral dose of 4 g daily, compared with placebo, are hypothesised to show smaller cognitive and functional decline, and, using F-18-Florbetapir positron emission tomography (PET) and F-18-MK-6240 PET imaging, to show less amyloid and tau accumulation, respectively. In the lumbar puncture subsample, cerebrospinal fluid acyclovir will be assayed to assess central nervous system valacyclovir penetration. Ethics and dissemination The trial is being overseen by the New York State Psychiatric Institute Institutional Review Board (protocol 7537), the National Institute on Ageing, and the Data Safety Monitoring Board. Written informed consent is obtained for all subjects. Results will be disseminated via publication, clinicaltrials.gov, media and conferences.
ANXIETY AND DEPRESSION IN FEMALE PATIENTS WITH TYPE 2 DIABETES RESPONDS
(American Public Health Association, 2016) Weaver, Lesley Jo; University of Alabama Tuscaloosa
Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
(University of Alabama Libraries, 2009) Tucker, Melanie Tara; Higginbotham, John C.; University of Alabama Tuscaloosa
The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.
Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model
(Oxford University Press, 2018) Mills, Whitney L.; Pimentel, Camilla B.; Palmer, Jennifer A.; Snow, A. Lynn; Wewiorski, Nancy J.; Allen, Rebecca S.; Hartmann, Christine W.; Baylor College of Medicine; University of Massachusetts Worcester; University of Alabama Tuscaloosa; Boston University
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
Artificial Intelligence in Health Care: Bibliometric Analysis
(JMIR Publications, 2020) Guo, Yuqi; Hao, Zhichao; Zhao, Shichong; Gong, Jiaqi; Yang, Fan; University of North Carolina; University of North Carolina Charlotte; University of Alabama Tuscaloosa; Dongbei University of Finance & Economics; University of Maryland Baltimore
Background: As a critical driving power to promote health care, the health care-related artificial intelligence (AI) literature is growing rapidly. Objective: The purpose of this analysis is to provide a dynamic and longitudinal bibliometric analysis of health care-related AI publications. Methods: The Web of Science (Clarivate PLC) was searched to retrieve all existing and highly cited AI-related health care research papers published in English up to December 2019. Based on bibliometric indicators, a search strategy was developed to screen the title for eligibility, using the abstract and full text where needed. The growth rate of publications, characteristics of research activities, publication patterns, and research hotspot tendencies were computed using the HistCite software. Results: The search identified 5235 hits, of which 1473 publications were included in the analyses. Publication output increased an average of 17.02% per year since 1995, but the growth rate of research papers significantly increased to 45.15% from 2014 to 2019. The major health problems studied in AI research are cancer, depression, Alzheimer disease, heart failure, and diabetes. Artificial neural networks, support vector machines, and convolutional neural networks have the highest impact on health care. Nucleosides, convolutional neural networks, and tumor markers have remained research hotspots through 2019. Conclusions: This analysis provides a comprehensive overview of the AI-related research conducted in the field of health care, which helps researchers, policy makers, and practitioners better understand the development of health care-related AI research and possible practice implications. Future AI research should be dedicated to filling in the gaps between AI health care research and clinical applications.
Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review
(JMIR Publications, 2022) Norton, Jenna M.; Ip, Alex; Ruggiano, Nicole; Abidogun, Tolulope; Camara, Djibril Souleymane; Fu, Helen; Hose, Bat-Zion; Miran, Saadia; Hsiao, Chun-Ju; Wang, Jing; Bierman, Arlene S.; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK); George Washington University; University of Alabama Tuscaloosa; Centers for Disease Control & Prevention - USA; Agency for Healthcare Research & Quality; Indiana University-Purdue University Indianapolis; Regenstrief Institute Inc; University of Pennsylvania; Pennsylvania Medicine; Florida State University
Background: Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans-which typically are difficult to share across care settings and care team members-poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. Objective: To review the landscape of e-care plans and care plan-related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. Methods: We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. Results: We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. Conclusions: A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision.
Association between hypertension and cognitive function: A cross-sectional study in people over 45 years old in China
(Wiley, 2018) Wei, Jiate; Yin, Xin; Liu, Qi; Tan, Libo; Jia, Chongqi; Shandong University; University of Alabama Tuscaloosa
This cross-sectional study aimed to evaluate the associations of characteristics of hypertension, including hypertension status, duration, blood pressure (BP), and pulse pressure (PP), with two cognitive functions-episodic memory and executive function, in people aged over 45 years. Using 2013 survey of the China Health and Retirement Longitudinal Study (CHARLS) and weighted multiple linear regression, data from 6,732 participants were utilized. After fully adjusted in full sample, a significantly (P 0.05) negative association was found between treated but uncontrolled hypertension and cognition. In people aged 45-59 years, there was no significant association between hypertension and cognition. However, in people aged >= 60 years, the systolic blood pressure (SBP) and PP showed significantly adverse correlations to cognition. The negative association of untreated, treated but uncontrolled hypertension, and elevated PP with cognition increased with aging. In conclusion, this study shows the correlation between hypertension and cognition was age-dependent with greater correlation in older people; uncontrolled hypertension and PP may be used as predictors of the cognitive decline in people >= 75 years.
Association between physical activity and activity space in different farming seasons among rural Lao PDR residents
(BMC, 2021) Jiang, Hongwei; Lin, Lin; Yonto, Daniel Anthony; Pongvongsa, Tiengkham; Kounnavong, Sengchanh; Moji, Kazuhiko; Research Institute for Humanity & Nature (RIHN); University of Alabama Tuscaloosa; Nagasaki University
Background Southeast Asia is experiencing a health transition, where non-communicable diseases (NCD) are exceeding communicable diseases. Despite NCDs accounting for roughly 60-85% of deaths in the region, many developing Southeast Asian countries are beginning to address the impacts of a physically inactive lifestyle for the first time. Our study aims to bridge this gap by objectively measuring physical activity in rural Lao PDR to reveal the association among physical activity, activity space, and seasonal variation. Methods Multiple waves of survey data were collected in Songkhon District, Lao PDR between March 2010 and March 2011. Adults aged between 18 and 65 were recruited (n = 48). A portable GPS recorded participants' activity and farmland locations and an accelerometer recorded participants' physical activity level and daily steps for seven consecutive days. Using a directional distribution tool in ArcGIS 10.5, the activity space area of each participant in each wave was calculated. Concurrently, participants recorded time spent on each daytime activity. Linear mixed models with the fixed effects as the observations from different waves and the random effects as individual participants were developed to identify factors associated with areas of activity space and counts of daily steps, respectively. Results A total of 48 respondents aged between 19 and 57 took part in the study. Half of the participants were females. Walking was found to be the most frequent travel mode. Females were physically less active, with a smaller activity space, and were more overweight than the males in the study. Participants were physically less active during the off-farming seasons. Conclusions Findings contribute to the surveillance of risk factors needed to create healthy living environments. Our research is also one of the first to use empirical evidence demonstrating seasonal variations of rural residents' activities in mainland Southeast Asia.
Association Between Proteomic Blood Biomarkers and DTI/NODDI Metrics in Adolescent Football Players: A Pilot Study
(Frontiers, 2020) Kawata, Keisuke; Steinfeldt, Jesse A.; Huibregtse, Megan E.; Nowak, Madeleine K.; Macy, Jonathan T.; Kercher, Kyle; Rettke, Devin J.; Shin, Andrea; Chen, Zhongxue; Ejima, Keisuke; Newman, Sharlene D.; Cheng, Hu; Indiana University Bloomington; University of Alabama Tuscaloosa
While neuroimaging and blood biomarker have been two of the most active areas of research in the neurotrauma community, these fields rarely intersect to delineate subconcussive brain injury. The aim of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football players at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players were enrolled in the study. MRI measures and blood samples were obtained during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Five players were ineligible for MRIs, and three serum samples were excluded due to hemolysis, resulting in 17 completed set of diffusion metrics and blood biomarker levels for association analysis. Our permutation-based regression model revealed that serum tau levels were significantly associated with MD and NDI in various axonal tracts; specifically, elevated serum tau levels correlated to elevated MD (p = 0.0044) and reduced NDI (p = 0.016) in the corpus callosum and surrounding white matter tracts (e.g., longitudinal fasciculus). Additionally, there was a negative association between NfL and ODI in the focal area of the longitudinal fasciculus. Our data suggest that high school football players may develop axonal microstructural abnormality in the corpus callosum and surrounding white matter tracts, such as longitudinal fasciculus. A future study is warranted to determine the longitudinal multimodal relationship in response to repetitive exposure to sports-related head impacts.

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