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Biomedical subjects

Elizabeth Bradley

Publications and source records attributed to Elizabeth Bradley.

10 recordsLinked to original sources
PubMed2005

Barriers to Medicaid enrollment: who is at risk?

OBJECTIVES: We identified factors associated with levels of knowledge about Medicaid eligibility rules and perceived Medicaid enrollment barriers. METHODS: Community health center patients who were parents of children potentially eligible for Medicaid (n=901) were interviewed in person during their clinic visit between April and December 1999. RESULTS: Individuals reporting physical health problems were more likely to be misinformed as were non-Hispanic Black individuals, compared with non-Hispanic White individuals. In states where more policies had been enacted to simplify Medicaid enrollment procedures, individuals were less likely to be misinformed. Individuals reporting mental health problems, those with less education, and women were more likely to perceive Medicaid enrollment barriers. Prior experience in Medicaid was associated with both a reduced risk of perceiving Medicaid enrollment barriers and being misinformed. CONCLUSIONS: Findings highlight target groups for whom additional outreach and additional simplification policies may be most needed.

Adolescent↗
PubMed2004

Management of implantable cardioverter defibrillators in end-of-life care.

BACKGROUND: Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing. OBJECTIVE: To describe the frequency, timing, and correlates of discussions about deactivating ICDs. DESIGN: Retrospective cohort study. SETTING: Telephone survey. PARTICIPANTS: Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated. MEASUREMENTS: Incidence of discussions about deactivating ICDs and timing of last shock from ICD. RESULTS: Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death. LIMITATIONS: This retrospective survey relied on the reports of next of kin. CONCLUSIONS: Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.

Aged↗
PubMed2004

At the crossroads: making the transition to hospice.

OBJECTIVE: Previous studies reveal that many terminally ill patients never receive hospice care. Among those who do receive hospice, many enroll very close to the time of death. Nationally, between 1992 and 1998, the median length of stay at hospice declined 27%, from 26 to 19 days. In our prior study of 206 patients diagnosed with terminal cancer and using hospice, we found that one-third enrolled with hospice within 1 week prior to death. Late hospice enrollment can have deleterious effects on patients and their family members. The aim of the present study was to characterize common experiences of patients and primary family caregivers as they transition to hospice, focusing on caregiver perceptions of factors that might contribute to delays in hospice enrollment. METHODS: We conducted in-depth interviews with a purposive sample of 12 caregivers selected from a population of primary family caregivers of patients with terminal cancer who enrolled with hospice in Connecticut between September 2000 and September 2001. Respondents represented different ages, genders, and kinship relationships with patients. Respondents were asked about the patient's care trajectory, how they first learned about hospice, and their experiences as they transitioned to hospice. NUD*IST software was used for qualitative data coding and analysis. RESULTS: Constant comparative analysis identified three themes common to the experience of transitioning to hospice: (1) caregivers' acceptance of the impending death, (2) challenges in negotiating the health care system across the continuum of care, and (3) changing patient-family dynamics. SIGNIFICANCE OF RESULTS: Identification of these themes from the caregivers' perspective generates hypotheses about potential delays in hospice and may ultimately be useful in the design of interventions that are consistent with caregivers' needs.

Adult↗
PubMed2004

Implications of systems dynamic models and control theory for environmental approaches to the prevention of alcohol- and other drug use-related problems.

The approach described in this article is premised on the idea that drug and alcohol use-related problems are heterogeneously distributed with respect to population and geography, and therefore, are essentially local problems. More specifically, it is argued that viewing a local community as an interacting set of systems that support or buffer the occurrence of specific substance misuse outcomes, opens up to research two important prospects. The first of these involves creating adequate systems models that can capture the primary community structures and relationships that support public health problems such as alcohol and drug misuse and related outcomes. The second entails rationally testing control strategies that have the potential to moderate or reduce these problems. Understanding and controlling complex dynamic systems models nowadays pervades all scientific disciplines, and it is to research in areas such as biology, ecology, engineering, computer sciences, and mathematics that researchers in the field of addictions must turn to in order to better study the complexity that confronts them as they try to understand and prevent problems resulting from alcohol and drug use and misuse. Here we set out what such a systems-based understanding of alcohol- and drug use-related problems will require and discuss its implications for public policy and prevention programming.

Humans↗
PubMed2003

Phosphatidylinositol 3-kinase coordinately activates the MEK/ERK and AKT/NFkappaB pathways to maintain osteoclast survival.

We have examined highly purified osteoclasts that were generated in vitro from murine co-culture of marrow precursors with stromal support cells and have found evidence of activation of the MEK/ERK and AKT/NFkappaB survival pathways. Many mature marrow-derived osteoclasts survived for at least 48 h in culture whether or not they are maintained with stromal cells. Moreover, supplementing purified osteoclasts with RANKL and/or M-CSF had no impact on their survival pattern. In addition, spleen-derived osteoclasts generated with RANKL and M-CSF treatment exhibited a similar survival pattern. Blocking MEK, AKT, or NFkappaB activity resulted in apoptosis of many, but not all, of the osteoclasts in purified marrow-derived osteoclasts, marrow-derived osteoclasts co-cultured with stromal cells, and spleen-derived osteoclasts maintained with RANKL and M-CSF. These data support that both the MEK/ERK and AKT/NFkappaB pathways contribute to osteoclast survival. Since PI3K has been shown to activate either of these pathways, we have examined its role in osteoclast survival. PI3K inhibition caused apoptosis of nearly all osteoclasts in purified and co-cultured marrow-derived osteoclasts and spleen-derived osteoclasts maintained with RANKL and M-CSF. Interestingly, in marrow-derived co-cultures, the apoptotic response was restricted to osteoclasts as there was no evidence of stromal support cell apoptosis. PI3K inhibition also blocked MEK1/2, ERK1/2, and AKT phosphorylation and NFkappaB activation in purified osteoclasts. Simultaneous blockage of both AKT and MEK1/2 caused rapid apoptosis of nearly all osteoclasts, mimicking the response to PI3K inhibition. These data reveal that PI3K coordinately activates two distinct survival pathways that are both important in osteoclast survival.

Animals↗
PubMed2002

Recurrence plots and unstable periodic orbits.

A recurrence plot is a two-dimensional visualization technique for sequential data. These plots are useful in that they bring out correlations at all scales in a manner that is obvious to the human eye, but their rich geometric structure can make them hard to interpret. In this paper, we suggest that the unstable periodic orbits embedded in a chaotic attractor are a useful basis set for the geometry of a recurrence plot of those data. This provides not only a simple way to locate unstable periodic orbits in chaotic time-series data, but also a potentially effective way to use a recurrence plot to identify a dynamical system. (c) 2002 American Institute of Physics.

Journal Article↗
PubMed1998

Using chaos to generate variations on movement sequences.

We describe a method for introducing variations into predefined motion sequences using a chaotic symbol-sequence reordering technique. A progression of symbols representing the body positions in a dance piece, martial arts form, or other motion sequence is mapped onto a chaotic trajectory, establishing a symbolic dynamics that links the movement sequence and the attractor structure. A variation on the original piece is created by generating a trajectory with slightly different initial conditions, inverting the mapping, and using special corpus-based graph-theoretic interpolation schemes to smooth any abrupt transitions. Sensitive dependence guarantees that the variation is different from the original; the attractor structure and the symbolic dynamics guarantee that the two resemble one another in both aesthetic and mathematical senses. (c) 1998 American Institute of Physics.

Journal Article↗
PubMed1998

Recurrence plots of experimental data: To embed or not to embed?

A recurrence plot is a visualization tool for analyzing experimental data. These plots often reveal correlations in the data that are not easily detected in the original time series. Existing recurrence plot analysis techniques, which are primarily application oriented and completely quantitative, require that the time-series data first be embedded in a high-dimensional space, where the embedding dimension d(E) is dictated by the dimension d of the data set, with d(E)>/=2d+1. One such set of recurrence plot analysis tools, recurrence quantification analysis, is particularly useful in finding locations in the data where the underlying dynamics change. We have found that for certain low-dimensional systems the same results can be obtained with no embedding. (c) 1998 American Institute of Physics.

Journal Article↗