Biomedical subjects

Kevin W Smith

Publications and source records attributed to Kevin W Smith.

13 recordsLinked to original sources

PubMed2006

Relationship between crystallization behavior, microstructure, and macroscopic properties in trans containing and trans free coating fats and coatings.

The objective of this study is to gain further understanding into the relationship between crystallization behavior, microstructure, and macroscopic properties in coating fats. The isothermal crystallization behavior of two coating fats (one trans containing and one trans free) was examined, both as pure fats and in coatings, by DSC and microscopy. Furthermore, the hardness of the samples was examined after cooling in a water bath at two different temperatures and at three different storage times. Both fats seemed to show an alpha-mediated beta' crystallization at lower temperatures and a direct beta' crystallization at higher temperatures. The trans free coating fat clearly crystallized faster and in smaller crystals. The hardness was governed not only by the amount of solid fat present in the network but also by the structure of this network. The coating matrix components seem to have a pronounced influence on the microstructure and thus on the macroscopic properties.

Calorimetry, Differential Scanning↗

PubMed2006

Factors associated with participation in breast cancer treatment clinical trials.

PURPOSE: It is well established that recruitment to clinical trials (CTs) is difficult and time consuming. This article reports on factors related to CT participation among women who were invited to participate in a CT for breast cancer. PATIENTS AND METHODS: Breast cancer patients who were eligible for a CT were identified by 16 different cancer centers. After their invitation to participate in a trial, patients who were undecided about participation in a CT were recruited into the present study at that time. After a patient made a decision about trial participation, a telephone interview was conducted to assess knowledge of CTs, perceived benefits and drawbacks of CTs, and personal factors affecting the women's decision regarding participation. RESULTS: A total of 208 patients participated in the study. Fifty-eight percent of the patients decided to participate in a trial. Logistic regression analyses showed that the factors best explaining participation were trial phase, perceived drawbacks, time and travel considerations, therapeutic benefit of trial, and physician recommendation. Participation rates were similar for both phase I and phase III trials. However, a higher percentage of women recruited to phase II trials accepted. CONCLUSION: This study suggests that reducing drawbacks of CT participation, particularly travel time, and improving physician communication of trials are needed to increase trial participation.

Adult↗

PubMed2006

The impact of publicly funded managed care on adolescent substance abuse treatment outcomes.

This study compares the 12-month changes in substance use following admission to substance abuse treatment in Massachusetts between adolescents enrolled in Medicaid managed care and other publicly funded adolescents. Two hundred and fifty-five adolescents were interviewed as they entered substance abuse treatment and at 6 and 12 month follow-ups. Medicaid enrollment data were used to determine the managed care enrollment status. One hundred forty two (56%) adolescents were in the managed care group and 113 (44%) comprise the comparison group. Substance use outcomes include a count of negative consequences of substance use, days of alcohol use, days of cannabis use, and days of any substance use in the previous 30 days. Repeated measures analysis of covariance (ANCOVA) was used to assess change with time of measurement and managed care status as main effects and the interaction of time and managed care included to measure differences between the groups over time. Although several changes across time were detected for all four outcomes, we found no evidence of an impact of managed care for any of the outcomes. The results of our study do not support the fears that behavioral managed care, by imposing limits on services provided, would substantially reduce the effectiveness of substance abuse treatment for adolescents. At the same time, the results do not support those who believe that the continuity of care and improved resource utilization claimed for managed care would improve outcomes.

Adolescent↗

PubMed2005

Kinetic analysis of nonisothermal differential scanning calorimetry of 1,3-dipalmitoyl-2-oleoylglycerol.

The crystallization of fats has been extensively studied because of its importance in the processing of food and food ingredients. Differential scanning calorimetry (DSC) is widely used in such studies. The aim of this study was to examine the determination of kinetic parameters from nonisothermal DSC crystallization of a model fat, 1,3-dipalmitoyl-2-oleoylglycerol. We applied peak and isoconversional methods to determine activation energies and compared these techniques with a nonparametric method, which separates the temperature dependence and degree of crystallization dependence of the crystallization rate. The Johnson-Mehl-Avrami-Erofeyev-Kolmogorov (JMAEK) model provided the best fit to the data, while the temperature dependence of the rate constant was best explained by a Vogel-Fulcher relationship, where the reference temperature was the melting point of the crystallizing species.

Calorimetry, Differential Scanning↗

PubMed2005

Assessing quality of life in adult cancer survivors (QLACS).

This article describes development of a quality of life measure designed to assess issues relevant to long-term cancer survivors. In-depth semi-structured interviews were conducted with 58 long-term cancer survivors to identify domains most relevant to long-term survivors (> or = 5 years post-diagnosis). Self-report items were developed from these interviews and administered to a second sample of 242 long-term survivors. Domains and items were selected from the item pool by a combination of factor analysis and criterion-based item selection. Five cancer-specific domains were identified (appearance concerns, financial problems, distress over recurrence, family-related distress, and benefits of cancer) along with seven generic QOL domains (negative feelings, positive feelings, cognitive problems, sexual problems, physical pain, fatigue, and social avoidance). Cronbach's alpha was 0.72 or greater for each domain. Correlations between domain scores and criterion measures were 0.72 or higher in all but one generic domain (social avoidance), but somewhat lower on cancer-specific domains. The new multidimensional measure has good internal consistency and validity and is appropriate for comparisons between cancer and non-cancer populations, as well as long-term follow-up of cancer patients.

Aged↗

PubMed2005

Adoption of naltrexone to treat alcohol dependence.

Three surveys (1997, 1999, and 2001) of outpatient substance abuse treatment centers in Connecticut, Massachusetts, Rhode Island, Maine, Vermont, and New Hampshire examined organizational characteristics that influenced the adoption of naltrexone. Structural equation modeling with manifest variables assessed predictors related to the use of naltrexone. Use of naltrexone increased over time from 14% in 1997 to 25% in 2001. In 1997, programs funded by managed care were more likely, and clinics that provided only substance abuse services were less likely to use psychiatric medication and naltrexone. In subsequent years, counselor education level and organization size also influenced use of naltrexone.

Alcohol-Related Disorders↗

PubMed2005

Evaluating the performance of medicare fee-for-service providers using the health outcomes survey: a comparison of two methods.

BACKGROUND: Health status measures are now being used for evaluating the performance of health care organizations. Trends in SF-36 component scores have previously been examined for Medicare-managed care plans but not for providers serving Medicare fee-for-service (FFS) beneficiaries. We compared 2 methods for evaluating the performance of Medicare FFS providers, the Research Triangle Institute (RTI) and Health Assessment Laboratory (HAL) methods. METHODS: Data were collected from 6547 Medicare FFS beneficiaries in 10 cohorts. SF-36 Physical Health (PCS) and Mental Health (MCS) component scores were computed at baseline and after a 2-year follow-up. The RTI approach predicts follow-up scores based on a standard care regression model. The HAL approach determines the percentage of beneficiaries whose status is the "same or better" at follow-up. Both approaches then compare observed to expected scores for each cohort. RESULTS: The HAL method did not detect any statistically significant differences for the PCS; the RTI method detected a small PCS difference for one cohort. The HAL method identified 4 cohorts that had significantly higher MCS scores; the RTI approach identified one cohort with significantly lower scores. CONCLUSIONS: The 2 approaches provided consistent assessments of provider performance for the PCS but not for the MCS. The differences in the MCS results may have been affected by differing treatment of deaths during follow-up. The HAL approach disregards deaths for the MCS, whereas the RTI method imputes values for death. Implications of using self-reported health status for monitoring provider performance are discussed.

Aged↗

PubMed2004

Nature and composition of fat bloom from palm kernel stearin and hydrogenated palm kernel stearin compound chocolates.

Palm kernel stearin and hydrogenated palm kernel stearin can be used to prepare compound chocolate bars or coatings. The objective of this study was to characterize the chemical composition, polymorphism, and melting behavior of the bloom that develops on bars of compound chocolate prepared using these fats. Bars were stored for 1 year at 15, 20, or 25 degrees C. At 15 and 20 degrees C the bloom was enriched in cocoa butter triacylglycerols, with respect to the main fat phase, whereas at 25 degrees C the enrichment was with palm kernel triacylglycerols. The bloom consisted principally of solid fat and was sharper melting than was the fat in the chocolate. Polymorphic transitions from the initial beta' phase to the beta phase accompanied the formation of bloom at all temperatures.

Cacao↗

PubMed2004

Increasing mammography screening among women over age 50 with a videotape intervention.

BACKGROUND: A randomized trial was conducted to test the effectiveness of a videotape for increasing mammography screening among a multiethnic sample of older women. METHODS: A multiethnic sample of Caucasian, African-American, and Hispanic women between the ages of 50 and 70 was recruited from Resident Lists compiled by the State of Massachusetts. After completing a baseline questionnaire, women were randomized to receive either a videotape or pamphlet about mammography and recontacted at 2 and 12 months after baseline to assess attitudes, beliefs, and mammography screening. A total of 581 women completed questionnaires at all three time points. RESULTS: At baseline, approximately 75% of women reported having a mammogram in the past year and 90% reported having one in the past 2 years. Rates did not differ between groups. At the 12-month follow-up, mammography rates, adjusted for baseline screening, were 80.4% in the video and 74.8% in the pamphlet group. Logistic regression analysis of mammography at 12 months (within past year vs. >1 year ago) controlling for baseline mammogram produced an odds ratio of 1.48 for the video group that was not significantly different from unity (95% CI = 0.95-2.28). CONCLUSIONS: The videotape had a small effect on increasing mammography screening. Although the effect was smaller than more intensive interventions, the video is a convenient, low cost, and easily implemented method to increase mammography screening.

Black or African American↗

PubMed2003

Quality of life assessments by adult substance abusers receiving publicly funded treatment in Massachusetts.

PURPOSE: Quality of life (QOL) has become an important endpoint in clinical trials and studies of medical interventions for many chronic diseases, but has not been widely studied in the substance abuse field. The purpose of this study was to measure QOL in a large sample of adult substance abusers (SA), to compare QOL ratings with those for other chronic diseases, and to assess factors influencing QOL levels in this population. METHODS: Hour-long personal interviews were administered to 570 randomly selected substance abuse clients in six detoxification centers and seven outpatient facilities in Massachusetts. Two QOL instruments--the Multidimensional Index of Life Quality (MILQ) and the SF-12--were used to measure QOL. Substance use problems were measured by the Addiction Severity Index Drug and Alcohol composite scores. QOL scores were compared to those for patients with other chronic diseases. Multivariable regression analysis was used to estimate the influence of demographic characteristics, co-morbidities, and substance use on QOL summary scores. RESULTS: SA clients reported significantly lower QOL scores than patients about to undergo heart surgery on seven of the nine MILQ domains as well as the MILQ QOL summary index. SA clients also had much lower mean scores than the general population on both the SF-12's Mental Health (ES = -1.80) and Physical Health (ES = -0.58) component scales. SF-12 physical component scores were similar to those for other chronic diseases, but mental component scores were markedly lower and comparable on average to clinically depressed groups. In the regression model, MILQ Index scores were significantly lower for dual diagnosis and detoxification cases. Index scores were negatively associated with ASI drug composite scores, but not with ASI alcohol scores. IMPLICATIONS: The results of this study suggest that the physical functioning of adult substance abusers is similar to the levels for patients diagnosed with other serious chronic diseases, but that mental functioning is much lower. QOL provides information about functioning and well-being that is not captured by traditional measures of substance use, and may soon begin to play a more prominent role in evaluating the effectiveness of treatment services for substance abusers.

Adult↗

PubMed2002

Developing a responsive measure of change for paediatric brain injury inpatient rehabilitation.

PRIMARY OBJECTIVE: To describe conceptual and methodological issues to be addressed in developing a responsive clinical performance measure for paediatric brain injury inpatient rehabilitation. Selected statistical approaches used to examine responsiveness of two functional activity scales (daily and social behavioural activity) of a prototype measure are presented to illustrate these issues. RESEARCH DESIGN: Retrospective chart review. METHODS AND PROCEDURES: Data on 65 children, aged 6 months to 18 years (X = 9.5 years) were collected during 1998 and 1999 from eight sites in the USA. Responsiveness was examined using effect sizes and a number of parametric and non-parametric tests. MAIN OUTCOMES AND RESULTS: Significant improvements from admission to discharge were found on all item and scale scores (p < 0.001). Moderate significant relationships were found between activity scale change scores and external ratings of change. CONCLUSIONS: Findings provide evidence that the activity scales have the potential to be responsive and point to issues that will need to be addressed in future measurement development.

Activities of Daily Living↗

PubMed2002

Help-seeking behaviors of blacks and whites dying from coronary heart disease.

OBJECTIVES: This study sought to determine whether blacks and whites with life-threatening cardiac events differ in likelihood of help seeking, types of help sought, or likelihood of reaching the hospital before death. DESIGN: Death certificates were used to identify all coronary heart disease-related deaths occurring in 1988-89 among 45- to 74-year-old, black and white, non-institutionalized residents of three contiguous inner-city districts in Boston, Massachusetts, USA. An informant was interviewed about the decedent's health status, access to care and pre-mortal help-seeking behaviors. RESULTS: Among the 232 decedents analyzed, there were no racial differences in the likelihood of help seeking. Among those who sought help, there were no racial differences in the likelihood of reaching the hospital. However, blacks were more likely than whites to engage in two specific help-seeking behaviors: calling the 911 emergency system, and trying to reach an emergency room. CONCLUSION: In an area where blacks and whites were similar with respect to socioeconomic status and access to care, race did not affect the likelihood of help seeking or the likelihood of succeeding in reaching the hospital before death.

Black or African American↗

PubMedDate not supplied

Participation readiness at discharge from inpatient rehabilitation in children and adolescents with acquired brain injuries.

OBJECTIVE: To describe the extent of readiness for participation in home, school and community life at discharge from inpatient rehabilitation and selected factors associated with participation readiness in children and adolescents with acquired brain injuries. METHODS: Staff from eight sites used retrospective review to complete a prototype clinical performance measure on up to 10 of their most recent discharges. Data were obtained on 65 children and adolescents, aged 6 months to 18 years (X = 9.5 years). The extent of participation readiness was analysed descriptively. Associations between selected variables and participation readiness were examined using correlation and multiple regression analyses. RESULTS: Only 3-27% of the children were deemed ready for age-expected participation at discharge in 15 domains of home, school and community life. Social behavioural activity performance at discharge explained 74% of the variance associated with participation readiness at discharge. CONCLUSIONS: The low percentage of children deemed ready for age-expected participation has implications for post-discharge programming, since 82% of the children were discharged home. Participation readiness may not be an easily achievable goal or may not be fully addressed during inpatient rehabilitation. Preliminary findings suggest that social-behavioural activity performance is a key variable to be considered in efforts to promote participation readiness.

Activities of Daily Living↗