An Interactive Web-Based Lethal Means Safety Decision Aid for Suicidal Adults (Lock to Live): Pilot Randomized Controlled Trial

BACKGROUND: Counseling to reduce access to lethal means such as firearms and medications is recommended for suicidal adults but does not routinely occur. We developed the Web-based Lock to Live (L2L) decision aid to help suicidal adults and their families choose options for safer home storage. OBJECTIVE: This study aimed to test the feasibility and acceptability of L2L among suicidal adults in emergency departments (EDs). METHODS: At 4 EDs, we enrolled participants (English-speaking, community-dwelling, suicidal adults) in a pilot randomized controlled trial. Participants were randomized in a 13:7 ratio to L2L or control (website with general suicide prevention information) groups and received a 1-week follow-up telephone call. RESULTS: Baseline characteristics were similar between the intervention (n=33) and control (n=16) groups. At baseline, many participants reported having access to firearms (33/49, 67%), medications (46/49, 94%), or both (29/49, 59%). Participants viewed L2L for a median of 6 min (IQR 4-10 min). L2L also had very high acceptability; almost all participants reported that they would recommend it to someone in the same situation, that the options felt realistic, and that L2L was respectful of values about firearms. In an exploratory analysis of this pilot trial, more participants in the L2L group reported reduced firearm access at follow-up, although the differences were not statistically significant. CONCLUSIONS: The L2L decision aid appears feasible and acceptable for use among adults with suicide risk and may be a useful adjunct to lethal means counseling and other suicide prevention interventions. Future large-scale studies are needed to determine the effect on home access to lethal means. TRIAL REGISTRATION: ClinicalTrials.gov NCT03478501; https://clinicaltrials.gov/ct2/show/NCT03478501

Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135085/1/epi13557_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135085/2/epi13557.pd

Recurrent event studies: efficient panel designs and joint modeling of events and severities

Recently there has been tremendous growth in the use and interest of longitudinal data, particularly because of the development of large scale investigations which are conducted to study different aspects of the dynamics of a population over time (for instance, the Canadian National Longitudinal Study of Children and Youth (Statistics Canada, 1996)). Recurrent event data are a type of longitudinal data which occur in many fields. Such data arise when an event repeats over time, and are common especially in medicine and reliability. Sometimes, in addition to the occurrence of the event, there is also information which reflects the severity of the event; this is called a mark. In this thesis, we develop efficient designs for longitudinal recurrent event studies, and we also develop methods to model recurrent events with marks. In longitudinal recurrent event studies, sometimes partial information on the counting process, such as the number of events occurring in specific intervals, called panel data, provides nearly the same precision for estimation of treatment effects as full information based on data from continuous observation of the process. We compare the efficiency of the analysis of such panel data with respect to the analysis of data recorded as times of recurrences, and we articulate conditions for efficient panel designs where the focus is on estimation of a treatment effect when adjusting for other covariates. We model the recurrent intensity through the common proportional intensity framework, with the treatment effect modeled flexibly as piecewise constant over panels, or groups of panels. We provide some important considerations for the design of efficient panel studies. The thesis also develops methods for situations where marks, denoting a measure of prognostic factors or severity of the event, are also recorded. Often, there is an association between the recurring processes of events and their marks. We model these outcomes jointly through the use of shared or linking random effects, and investigate biases resulting in analyses of the outcomes when they are not modeled jointly. This analysis of joint outcomes is motivated by a study of healthy menstruating women prior to hysterectomy/ovariectomy for benign disease

Biomarkers of Exposure to Polycyclic Aromatic Hydrocarbons and Cognitive Function among Elderly in the United States (National Health and Nutrition Examination Survey: 2001-2002).

Recent studies report a link between common environmental exposures, such as particulate matter air pollution and tobacco smoke, and decline in cognitive function. The purpose of this study was to assess the association between exposure to polycyclic aromatic hydrocarbons (PAHs), a selected group of chemicals present in particulate matter and tobacco smoke, and measures of cognitive performance among elderly in the general population. This cross-sectional analysis involved data from 454 individuals aged 60 years and older from the 2001-2002 National Health and Nutrition Examination Survey. The association between PAH exposures (as measured by urinary biomarkers) and cognitive function (digit symbol substitution test (DSST)) was assessed using multiple linear regression analyses. After adjusting for age, socio-economic status and diabetes we observed a negative association between urinary 1-hydroxypyrene, the gold standard of PAH exposure biomarkers, and DSST score. A one percent increase in urinary 1-hydroxypyrene resulted in approximately a 1.8 percent poorer performance on the digit symbol substitution test. Our findings are consistent with previous publications and further suggest that PAHs, at least in part may be responsible for the adverse cognitive effects linked to tobacco smoke and particulate matter air pollution

Probabilistic Linkage of Two National Databases to Study Emergency Care and Hospital Readmission in Children who Survive Traumatic Injury

ABSTRACT Objectives Trauma and, in particular, traumatic brain injury (TBI) cause enormous morbidity and mortality worldwide. Children who survive trauma have many health burdens, but how often those burdens lead to emergency care or hospital readmission is unknown. Readmissions occur frequently in adult TBI survivors: approximately 21-28% within one year. No single existing U.S. database contains the necessary variables to study readmissions of children hospitalized after trauma. We previously demonstrated that probabilistic linkage with Markov chain Monte Carlo parameter refinement could accurately link records of children with severe TBI without using protected health information. That work was presented at the IHDLN Conference in 2014. The objectives of this study are to 1) expand the previous linkage to include children with any type of trauma and 2) to determine the 1-year rates of Emergency Department (ED) visit and hospital readmission in children with TBI versus other trauma. Approach Using the algorithm we reported previously, we linked the records of children hospitalized after trauma during 2007-2012 in the U.S. National Trauma Data Bank (NTDB) with the Pediatric Health Information System (PHIS) database.  The NTDB contains the Glasgow Coma Scale (GCS), necessary to categorize TBI. The PHIS database contains a unique identifier for each patient at each hospital, making longitudinal studies possible. Probabilistic linkage was performed using LinkSolv (Strategic Matching, Inc., Morrisonville, NY). We identified ED visits and hospital readmissions of the index cohort in the PHIS database through March 31, 2015. Results Among children hospitalized after acute trauma for >= 2 days, we found that 83% of NTDB records linked accurately. Of the children hospitalized at 28 U.S. hospitals in 19 states, 49,477 were discharged alive; 15,438 had TBI. This represents approximately 10% of U.S. pediatric TBI hospitalizations during that period. The median age was 8 years and 64% were male. The 1-year hospital readmission rate was higher (12.2%, 283/2,306) in those with both TBI and other injuries than those with isolated TBI (8.5%, 1,120/13,132) or non-TBI injuries (8.1%, 2,790/34,039, p < 0.01 across groups). The 1-year ED visit rate differed only modestly between those three groups (14.1% versus 15.4% versus 14.2%, p < 0.01). Conclusions This study leverages two linked national datasets to investigate emergency care and hospital readmission in children who survive trauma. Multivariable analyses are ongoing and will be completed by August 2016. We will generate hypotheses about potentially modifiable causes of emergency care and readmission

A randomized, controlled, pragmatic trial of an iPad-based, tailored messaging intervention to increase human papillomavirus vaccination among Latinos

Human papillomavirus (HPV) causes a number of cancers that disproportionally affect Latinos yet there is a paucity of research on interventions to increase HPV vaccination among this population. We sought to evaluate the efficacy of a web-based, individually customizable intervention, called CHICOs (Combatting HPV Infection and Cancers, tailored intervention) for its impact on HPV vaccine utilization. We conducted a three-armed, randomized, controlled trial in the waiting rooms of five family medicine practices from June 2014-February 2016 where CHICOS was compared to an iPad-based version of the Vaccine Information Sheet from the Centers for Disease Control and Prevention (untailored intervention), and usual care. Pair-wise comparisons between study arms of 6 different measures of HPV vaccine uptake were assessed, with analyses stratified by adolescents versus young adults. Of the 1,294 participants enrolled in the study, 1,013 individuals could be assessed for vaccination. Across study arms, 265 adolescents, but only 18 young adults, received an HPV vaccine dose during the study period. In both intention-to-treat and per-protocol analyses there were essentially no differences between the CHICOS and untailored arms in any vaccination measure, or between the untailored or CHICOS arms and usual care. Our study suggests that a tailored educational intervention may not be effective for increasing HPV vaccine uptake among Latino adolescents or young adults. However, the higher than expected baseline levels of positive vaccination attitudes of study participants could have diminished the statistical power of the study. Trial Registration Number: ClinicalTrials.gov (NCT02145156)

The Wilcoxon–Mann–Whitney Procedure Fails as a Test of Medians

<p>To illustrate and document the tenuous connection between the Wilcoxon–Mann–Whitney (WMW) procedure and medians, its relationship to mean ranks is first contrasted with the relationship of a <i>t</i>-test to means. The quantity actually tested: <math><mrow><mi> Pr </mi><mo>^</mo><mrow><mo>(</mo><msub><mi>X</mi><mn>1</mn></msub><mo><</mo><msub><mi>X</mi><mn>2</mn></msub><mo>)</mo></mrow><mo>+</mo><mi> Pr </mi><mo>^</mo><mrow><mo>(</mo><msub><mi>X</mi><mn>1</mn></msub><mo>=</mo><msub><mi>X</mi><mn>2</mn></msub><mo>)</mo></mrow><mo>/</mo><mn>2</mn></mrow></math> is then described and recommended as the basis for an alternative summary statistic that can be employed instead of medians. In order to graphically represent an estimate of the quantity: Pr(<i>X</i>₁ < <i>X</i>₂) + Pr(<i>X</i>₁ = <i>X</i>₂)/2, use of a bubble plot, an ROC curve and a dominance diagram are illustrated. Several counter-examples (real and constructed) are presented, all demonstrating that the WMW procedure fails to be a test of medians. The discussion also addresses another, less common and perhaps less clear cut, but potentially even more important misconception: that the WMW procedure requires continuous data in order to be valid. Discussion of other issues surrounding the question of the WMW procedure and medians is presented, along with the authors' teaching experience with the topic. SAS code used for the examples is included as supplementary material.</p