Josh Lospinoso

We propose a Mahalanobis distance–based Monte Carlo goodness of fit testing procedure for the family of stochastic actor-oriented models for social network evolution. A modified model distance estimator is proposed to help the researcher identify model extensions that will remediate poor fit. A limited simulation study is provided to establish baseline legitimacy for the Mahalanobis distance–based Monte Carlo test and modified model distance estimator. A forward model selection workflow is… Show more

We propose a Mahalanobis distance–based Monte Carlo goodness of fit testing procedure for the family of stochastic actor-oriented models for social network evolution. A modified model distance estimator is proposed to help the researcher identify model extensions that will remediate poor fit. A limited simulation study is provided to establish baseline legitimacy for the Mahalanobis distance–based Monte Carlo test and modified model distance estimator. A forward model selection workflow is proposed, and this procedure is demonstrated on a real data set. Show less

C++ is one of the most widely used languages for real-world software. Wherever performance matters, C++ is the de facto standard. It's the language behind operating systems, embedded devices, games, web browsers, and virtual reality systems. As a C++ developer, you can program efficient software on virtually any platform.

C++ Crash Course cuts through the weeds to get you straight to the core of C++17, the most modern revision of the ISO standard. In Part I, you'll learn about all of the… Show more

C++ is one of the most widely used languages for real-world software. Wherever performance matters, C++ is the de facto standard. It's the language behind operating systems, embedded devices, games, web browsers, and virtual reality systems. As a C++ developer, you can program efficient software on virtually any platform.

C++ Crash Course cuts through the weeds to get you straight to the core of C++17, the most modern revision of the ISO standard. In Part I, you'll learn about all of the essential core language features. Part II introduces you to the C++ Standard Library and Boost Libraries, where you'll learn about high-quality, fully-featured facilities immediately available to you. Show less

A safe, easy-to-use, permanently bonded antiseptic that does not require post-exposure bioload reduction but maintains effectiveness over time would have far-reaching implications across multiple industries. Health care is one such arena, particularly in austere military settings where resources are at a premium. MicrobeCare XLP (MicrobeCare, Buffalo Grove, IL, USA) is a commercially available spray-on agent that is advertised to covalently bond to surfaces and provide a long-lasting… Show more

A safe, easy-to-use, permanently bonded antiseptic that does not require post-exposure bioload reduction but maintains effectiveness over time would have far-reaching implications across multiple industries. Health care is one such arena, particularly in austere military settings where resources are at a premium. MicrobeCare XLP (MicrobeCare, Buffalo Grove, IL, USA) is a commercially available spray-on agent that is advertised to covalently bond to surfaces and provide a long-lasting antimicrobial coating inhospitable to >99.99% of surface microorganisms. A pilot study was devised to gather baseline data regarding product efficacy and laboratory parameters before consideration of extended investigations and military utilization. The product manufacturer recommends bioload reductions before product application, following product application, and after each pathogenic exposure. To investigate the product’s efficacy in circumstances more closely simulating a military operational setting in which post-pathogenic exposure bioload reduction would not be possible, this step was deliberately excluded from the test sequences. Show less

Introduction

Obstructive sleep apnea (OSA) affects 1–5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA.

Methods

A prospective study was conducted in children, ages 2–17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies… Show more

Introduction

Obstructive sleep apnea (OSA) affects 1–5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA.

Methods

A prospective study was conducted in children, ages 2–17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies on two subsequent nights to compare the home monitor and the laboratory polysomnogram (PSG).
Results

Thirty-three subjects completed simultaneous laboratory polysomnogram with portable monitoring. Twenty patients completed home studies, with 16 completing 2 nights of monitoring. The measurement of AHI by the portable monitor was different than that obtained by the PSG with statistical significance for the comparisons of PSG vs. In-Lab (p = 0.0026), PSG vs. Home 1 (p = 0.033), and PSG vs. Home 2 (p = 0.033). The sensitivity of the portable monitor for diagnosing OSA was best for the In-lab use at 81%, but only 69% and 70% for the uses at home on the 2 nights respectively. Interestingly, the comparison of AHI and lowest oxygen saturation measurements from the home sleep test in children age 6 and older did not differ significantly from the PSG.
Conclusions

This pilot study demonstrated differences between home sleep testing and in-lab polysomnography for the diagnosis of pediatric sleep apnea. These differences were predominantly found to exist in younger children. Larger prospective studies are needed prior to widespread use, but home studies may alleviate issues of access to care and higher costs of laboratory polysomnography. Show less

We establish a strong, positive relationship between the Ultraviolet Index and Google search engine activity for sunburn-related terms in the United States. Using the Google Trends utility and data available from the National Weather service, we combine data from a twelve-year period to produce panel data for each state. We fit a time-series regression model of search activity and perform statistical tests on the resulting parameter estimates. This study lays the groundwork for using… Show more

We establish a strong, positive relationship between the Ultraviolet Index and Google search engine activity for sunburn-related terms in the United States. Using the Google Trends utility and data available from the National Weather service, we combine data from a twelve-year period to produce panel data for each state. We fit a time-series regression model of search activity and perform statistical tests on the resulting parameter estimates. This study lays the groundwork for using search-related data to assess the prevalence of, and attitudes about sunburn. By tracking the frequency of searches about preventative measures like “sunscreen” or “protective clothing” versus treatment measures like “sunburn relief,” researchers could measure the effectiveness of awareness and prevention programs. Show less

Introduction
Limb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has been discussed in the literature. However, to date, psychosocial reactions for individuals with upper extremity (UE) limb salvage have not been examined.

Purpose of the Study
To determine which factors may influence psychosocial adaptation to UE limb salvage.

Methods
Participants (n = 30; 28 males)… Show more

Introduction
Limb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has been discussed in the literature. However, to date, psychosocial reactions for individuals with upper extremity (UE) limb salvage have not been examined.

Purpose of the Study
To determine which factors may influence psychosocial adaptation to UE limb salvage.

Methods
Participants (n = 30; 28 males) were adults (mean, 30.13; range, 18-61) who sustained an UE limb salvage from a traumatic event. Adaptation was measured using a modified version of the Reactions to Impairment and Disability Inventory.

Results
A linear mixed-effects regression found that worse psychosocial adaptation was associated with having less than a college degree, being less than 6 months post-injury, being older than 23 years, and having more pain. Dominant hand injuries were found to influence poor adaptation on the denial Reactions to Impairment and Disability Inventory subscale only.

Discussion
The results of this study indicate that there is potential for nonadaptive reactions and psychological distress with certain variables in UE limb salvage. Therapists may use these results to anticipate which clients may be at risk for poor psychosocial outcomes.

Conclusions
This study indicates the need for early consideration to factors that affect psychological prognosis for the UE limb salvage population. However, future research is indicated to better understand the unique psychosocial challenges and needs of these individuals. Show less

Objective
We evaluated a soft tissue oxygen saturation (Sto2) measurement at triage for predicting admission to the hospital in adults presenting to the emergency department (ED) in addition to data routinely gathered at triage.

Methods
This was a prospective, observational, single center study of adults presenting to the ED for evaluation. Research assistants obtained thenar eminence Sto2 measurements on subjects in ED triage. ED providers not involved in the study then made all… Show more

Objective
We evaluated a soft tissue oxygen saturation (Sto2) measurement at triage for predicting admission to the hospital in adults presenting to the emergency department (ED) in addition to data routinely gathered at triage.

Methods
This was a prospective, observational, single center study of adults presenting to the ED for evaluation. Research assistants obtained thenar eminence Sto2 measurements on subjects in ED triage. ED providers not involved in the study then made all management and disposition decisions. We prospectively collected data on each subject's final ED disposition (admission versus discharge). We identified the optimal Sto2 cutoff value for predicting admission. We then used logistic regression modeling to describe the added predictive value of Sto2 beyond routinely collected triage data including Emergency Severity Index level, age, and vital signs.

Results
We analyzed 2588 adult (>17 years) subjects with 743 subjects (28.7%) admitted to the hospital. Sto2 < 76% was the optimal diagnostic cutoff for predicting admission. Of subjects with Sto2 < 76%, 158 of 384 (41.1%) underwent admission versus 585 of 2204 (26.5%) subjects with Sto2 ≥ 76. After controlling for age, vital signs, and ESI level in the logistic regression analysis, Sto2 < 76% had an odds ratio of 1.54 (95% confidence interval (CI), 1.19 to 1.98) for predicting admission.

Conclusions
Sto2 may provide additional prognostic data to routine triage assessment regarding the disposition for undifferentiated adult patients presenting to the ED. Show less

Eighteen surveys were distributed to San Antonio Uniformed Services Health Education Consortium Obstetric/Gynecology (OB/GYN) residents. The survey was a five point Likert scale that focused on the opinions of residents regarding the availability of needed equipment, and their ability to evaluate and manage patients outside regular clinic hours. A comprehensive kit was then developed with essential supplies and made readily accessible to residents in the OB/GYN clinic and the emergency… Show more

Eighteen surveys were distributed to San Antonio Uniformed Services Health Education Consortium Obstetric/Gynecology (OB/GYN) residents. The survey was a five point Likert scale that focused on the opinions of residents regarding the availability of needed equipment, and their ability to evaluate and manage patients outside regular clinic hours. A comprehensive kit was then developed with essential supplies and made readily accessible to residents in the OB/GYN clinic and the emergency department. The same five point Likert scale survey was redistributed a year later. Statistical analysis was conducted by modeling survey responses with a cumulative (ordinal) logistic model. Cumulative logistic regression assessed whether Gynecologic call kit availability increased resident satisfaction while controlling for respondent year level and question-level idiosyncrasy. Show less

Significant concern exists regarding the respiratory health of military personnel deployed to Southwest Asia, given their exposures to numerous environmental hazards. Although the deployed military force is generally assumed to be fit, the pre-deployment respiratory health of these individuals is largely unknown.

Soldiers deploying to Southwest Asia were recruited from the pre-deployment processing center at Fort Hood, Texas. Participants completed a general and respiratory health… Show more

Significant concern exists regarding the respiratory health of military personnel deployed to Southwest Asia, given their exposures to numerous environmental hazards. Although the deployed military force is generally assumed to be fit, the pre-deployment respiratory health of these individuals is largely unknown.

Soldiers deploying to Southwest Asia were recruited from the pre-deployment processing center at Fort Hood, Texas. Participants completed a general and respiratory health questionnaire and performed baseline spirometry.

One thousand six hundred ninety-three pre-deployment evaluations were completed. The average age of the participants was 32.2 y, and 83.1% were male. More than one third of surveyed solders had a smoking history, 73% were overweight or obese, and 6.2% reported a history of asthma. Abnormal spirometry was found in 22.3% of participants. Soldiers with abnormal spirometry reported more asthma (10.1% vs 5.1%, P < .001), failed physical fitness tests (9.0% vs 4.6%, P = .02), and respiratory symptoms (32.8% vs 24.3%, P = .001).

This is the first prospective pre-deployment evaluation of military personnel that delineates factors potentially associated with the development of pulmonary symptoms and/or disease. This study suggests that deploying soldiers are older, heavier, frequently smoke, and may have undiagnosed pre-deployment lung disease. Abnormal spirometry is common but may not represent underlying disease. Self-reported asthma, wheezing, and slower 2-mile run times were predictive of abnormal spirometry.

Pre-deployment evaluation of military personnel identified numerous soldiers with active pulmonary symptoms and abnormal spirometry. When combined with questions regarding asthma history, wheezing and exercise intolerance, spirometry may identify individuals at risk for deployment-related respiratory complaints. Show less

Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography. Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with… Show more

Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography. Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with a linear array transducer at 4 cm of depth. After collection of baseline images, we placed a chest tube, injected air into the pleural space in 250 mL increments, and repeated the ultrasonography for pneumothorax volumes of 250 mL, 500 mL, 750 mL, and 1000 mL. We confirmed pneumothorax with intrapleural digital manometry and ultrasound by expert sonographers. We exported collected images for interpretation by the software. We treated each individual scan as a single test for interpretation by the software. Show less

Genetic polymorphisms have been linked to an increased predisposition to developing certain diseases. For example, patients of Han-Chinese descent carrying the HLA-B*1502 allele are at an increased risk of developing Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) if given carbamazepine. Given the complexity of in vivo drug metabolism, it is plausible that the activity of enzyme systems unrelated to specific drug metabolism may be important. Although multiple biomarkers have… Show more

Genetic polymorphisms have been linked to an increased predisposition to developing certain diseases. For example, patients of Han-Chinese descent carrying the HLA-B*1502 allele are at an increased risk of developing Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) if given carbamazepine. Given the complexity of in vivo drug metabolism, it is plausible that the activity of enzyme systems unrelated to specific drug metabolism may be important. Although multiple biomarkers have been identified in unique ethnic groups, there has yet to be a study investigating the presence of the slow metabolizing allele of CYP2C19, denoted CYP2C19*2, in diverse groups and the risk of developing SJS/TEN. Show less

Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization… Show more

Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care. Show less

Objectives: Limited literature exists on the sonographic appearance of the posterior tibialis (PTT) and the peroneus brevis (PBT) tendon entheses. We determined the anatomic features and best imaging techniques of normal PTT and PBT using musculoskeletal ultrasound and compared these findings to subjects with inflammatory arthritis.

Methods: Adult subjects were enrolled as: healthy controls (HC), rheumatoid arthritis (RA), and spondyloarthropathy (SpA). Bilateral PTT and PBT entheses… Show more

Objectives: Limited literature exists on the sonographic appearance of the posterior tibialis (PTT) and the peroneus brevis (PBT) tendon entheses. We determined the anatomic features and best imaging techniques of normal PTT and PBT using musculoskeletal ultrasound and compared these findings to subjects with inflammatory arthritis.

Methods: Adult subjects were enrolled as: healthy controls (HC), rheumatoid arthritis (RA), and spondyloarthropathy (SpA). Bilateral PTT and PBT entheses were imaged longitudinally, comparing two angles of insonation: perpendicular to the skin surface and 45˚ cephalad. Images were scored on semi-quantitative scales assessing pathology.

Results: Eighty-eight subjects were enrolled: HC (n=37), RA (n=21), and SpA (n=20). Complete enthesis visualization was achieved more frequently in the perpendicular than in the cephalad view for the PBT (76.3% versus 58.7%), but more frequently in the cephalad view for the PTT (58.0% versus 19.6%). RA and SpA subjects had higher rates of PTT fiber disruption (p< 0.001), PTT tenosynovial effusion (p< 0.001), and Doppler signal (p< 0.001) than HC. No significant differences existed at the PBT enthesis. Multivariate analysis demonstrated that RA and SpA subjects were 5.1 times (p< 0.001) and 3.6 times (p< 0.001) more likely to exhibit ultrasound detected pathology than healthy controls.

Conclusions: Perpendicular transducer aim is optimal for imaging the PBT, while cephalad transducer orientation was more effective for evaluation of the PTT. Unlike distal PBT imaging, PTT imaging distinguished HC from disease state, with both RA and SpA patients showing features of PTT enthesopathy. Distal PTT imaging is a useful technique for musculoskeletal ultrasound. Show less

Purpose: To evaluate the effects of electrolyte replacement protocol (ERP) implementation in the medical intensive care unit (MICU) setting. We hypothesized that a protocol would reduce the time of replacement dose administration and increase provider satisfaction with the process of electrolyte replacement.

Results: Median time from abnormal laboratory result to time of documented dose administration for potassium decreased from 180 to 98 minutes (P < .01), phosphorus decreased from… Show more

Purpose: To evaluate the effects of electrolyte replacement protocol (ERP) implementation in the medical intensive care unit (MICU) setting. We hypothesized that a protocol would reduce the time of replacement dose administration and increase provider satisfaction with the process of electrolyte replacement.

Results: Median time from abnormal laboratory result to time of documented dose administration for potassium decreased from 180 to 98 minutes (P < .01), phosphorus decreased from 190 to 135 minutes (P < .01), calcium decreased from 95 to 61 minutes (P < .01), and magnesium decreased from 155 to 149 minutes (P < .01). Overall, there was a significant reduction in time to electrolyte repletion from 146 to 98 minutes (P < .01) for all electrolytes. Nursing satisfaction for autonomy, timeliness, effectiveness, and the need to seek orders was all improved (P < .01), and physicians saved 4.4 minutes/patient/day (P = .04). Show less

In this cohort study with intervention, using the situation, background, assessment, and review/recommendations (SBAR) tool allowed for a significant improvement in resident M&M presentations over time. In addition, the integration of patient safety reports, otolaryngology-specific quality metrics, plan, do, study, act cycles, and evaluation of M&M cases with regard to the core competencies, provided a comprehensive M&M curriculum that is well-received by faculty and residents and emphasizes… Show more

In this cohort study with intervention, using the situation, background, assessment, and review/recommendations (SBAR) tool allowed for a significant improvement in resident M&M presentations over time. In addition, the integration of patient safety reports, otolaryngology-specific quality metrics, plan, do, study, act cycles, and evaluation of M&M cases with regard to the core competencies, provided a comprehensive M&M curriculum that is well-received by faculty and residents and emphasizes the importance of QI/PS. Show less

This was an in vivo study involving 24 pigs with blinded pathologist review of specimens. Six groups were created, with four subjects in each group. Each subject received 10 or 20 mg of either cidofovir or bevacizumab alone, or in combination, injected into the right vocal cord. The left vocal fold was used as a saline control. Three separate injections were made at 2-week intervals. Larynges were harvested at 8 and 12 weeks, stained with hematoxylin and eosin and trichrome stain, and reviewed… Show more

This was an in vivo study involving 24 pigs with blinded pathologist review of specimens. Six groups were created, with four subjects in each group. Each subject received 10 or 20 mg of either cidofovir or bevacizumab alone, or in combination, injected into the right vocal cord. The left vocal fold was used as a saline control. Three separate injections were made at 2-week intervals. Larynges were harvested at 8 and 12 weeks, stained with hematoxylin and eosin and trichrome stain, and reviewed for histologic changes by two blinded pathologists. Minimal inflammation, edema, and atypia were noted with all treatments. Increased glandular inflammation was noted with 10 mg bevacizumab, which decreased when combined with 10 mg cidofovir. No lamina propria or muscle fibrosis was observed. Drug duration had no statistically significant histologic impact. Show less

To date, there is minimal literature discussing quality improvement curricula in Otolaryngology. Herein, we present our program including didactic, web-based, and experiential learning, developed in the setting of a pre-existing institutional quality and safety policy. Nine Otolaryngology residents were evaluated using assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed rank test for matched pairs… Show more

To date, there is minimal literature discussing quality improvement curricula in Otolaryngology. Herein, we present our program including didactic, web-based, and experiential learning, developed in the setting of a pre-existing institutional quality and safety policy. Nine Otolaryngology residents were evaluated using assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed rank test for matched pairs was used to compare results. A significant change in the Quality Improvement Knowledge Application Tool-Revised was found (p < 0.05). Our comprehensive quality improvement curriculum can serve as a resource to other programs, which can be adapted to fit within the context of variable training environments. Furthermore, it is imperative to consider continuous assessment and refinement of any educational program, using the same quality improvement principles that we are endeavoring to teach. Show less

Mountain Cedar pollen counts spanning the periods from 2011 to 2014 were collected for San Antonio, Dallas–Ft Worth, and Houston metro regions (Texas). Google search data for the corresponding period and regions were also obtained for the search terms pollen and mountain cedar. Data were analyzed through time series plots and autoregressive integrated moving average.

Google search trend data from the Dallas–Fort Worth metro region for the years 2012 and 2013 were collected from www.google.com/trends for terms related to sinusitis based on literature outlining the most important symptoms for diagnosis. Additional terms were selected based on common English language terms used to describe the disease. Twelve months of data from the same time period and location for common pollutants (nitrogen dioxide, ozone, sulfur dioxide, and particulates), pollen and mold… Show more

Google search trend data from the Dallas–Fort Worth metro region for the years 2012 and 2013 were collected from www.google.com/trends for terms related to sinusitis based on literature outlining the most important symptoms for diagnosis. Additional terms were selected based on common English language terms used to describe the disease. Twelve months of data from the same time period and location for common pollutants (nitrogen dioxide, ozone, sulfur dioxide, and particulates), pollen and mold counts, and influenza-like illness were also collected. Statistical analysis was performed using Pearson correlation coefficients, and potential search activity predictors were assessed using autoregressive integrated moving average. Show less

Objective: to compare through validated objective wrinkle scales that the combining of facial plastic surgery with fractionated CO2 lasers in the perioperative setting is superior to CO2 laser-only in the treatment of rhytidosis.

Design and Setting: Data were gathered and reviewed from two patient groups who were treated with either combined facial plastic surgery with fractionated CO2 lasers or laser-only therapy. Surgeries were performed by the senior author (J.B.) at a level 1 trauma… Show more

Objective: to compare through validated objective wrinkle scales that the combining of facial plastic surgery with fractionated CO2 lasers in the perioperative setting is superior to CO2 laser-only in the treatment of rhytidosis.

Design and Setting: Data were gathered and reviewed from two patient groups who were treated with either combined facial plastic surgery with fractionated CO2 lasers or laser-only therapy. Surgeries were performed by the senior author (J.B.) at a level 1 trauma center from July 2009 through May 2014. Preoperative and postoperative photographs were gathered for all patients, and distributed in random order to a facial plastic surgeon and a dermatologist who objectively rated them. Both raters were blinded to patient data and treatment information.

Participants and Exposures: 32 patients were included in the study, 30 females and 2 males. 19 patients received adjunctive fractionated CO2 laser resurfacing in the setting of facial plastic surgery, the second group consisting of 13 patients was treated with fractionated CO2 laser only. Surgeries performed include blepharoplasty, deep plane rhytidectomy, forehead rhytidectomy, submental liposuction, and rhinoplasty.

Main Outcome Measure(s): Raters used validated scales to objectively assess the two patient groups. These included the Glogau, Fitzpatrick, and Modified Fitzpatrick scales. Numerical values were assigned to before and after pictures of patients in the frontal and profile views.

Results: Patients treated with the combination of laser plus facial plastic surgery showed a greater decrease in wrinkles than patients treated with laser-only therapy (estimate= -0.78, p = 0.07) when evaluated with the Glogau scale. Additionally, younger patients and patients with darker pigmentation showed a greater reduction in wrinkles compared to their counterparts (p values both <0.001). Show less

Objective. To investigate the correlation between the change in regional aeroallergen levels and Internet search activity related to allergies.

Study Design. A retrospective time series analysis using a graphical analytical approach and statistical modeling was used.

Subjects and Methods. There were no specific enrolled subjects. Data from Google Trends were obtained for the following search terms: allergy, allergies, pollen, runny nose, congestion, and post nasal… Show more

Objective. To investigate the correlation between the change in regional aeroallergen levels and Internet search activity related to allergies.

Study Design. A retrospective time series analysis using a graphical analytical approach and statistical modeling was used.

Subjects and Methods. There were no specific enrolled subjects. Data from Google Trends were obtained for the following search terms: allergy, allergies, pollen, runny nose, congestion, and post nasal drainage.

Daily pollen and mold spore count data were obtained for the same period from throughout Texas. Graphical analysis, correlation, and autoregressive integrated moving average (ARIMA) were employed to assess the relationship between aeroallergens on Google search activity.

Results. A strong positive correlation was observed between observed pollen counts and search activity for the terms allergies, allergy, and pollen. Symptom term searches were weakly correlated with pollen and mold counts. Also, ARIMA modeling supported the relationships indicated by the correlations.

Conclusion. Search activities for surrogate terms such as allergy, allergies, and pollen correlate strongly with observed pollen counts but not mold counts. These data demonstrate the usefulness of Google Trends search data in assessing regional disease burdens and offer insight into how the public seeks information about their own illness. Show less

The study of social network dynamics has become an increasingly important component of many disciplines in the social sciences. In the past decade, statistical models and methods have been proposed which permit researchers to draw statistical inference on these dynamics. This thesis builds on one such family of models, the stochastic actor oriented model (SAOM) proposed by Snijders [2001]. Goodness of fit for SAOMs is an area that is only just beginning to be filled in with appropriate methods.… Show more

The study of social network dynamics has become an increasingly important component of many disciplines in the social sciences. In the past decade, statistical models and methods have been proposed which permit researchers to draw statistical inference on these dynamics. This thesis builds on one such family of models, the stochastic actor oriented model (SAOM) proposed by Snijders [2001]. Goodness of fit for SAOMs is an area that is only just beginning to be filled in with appropriate methods. This thesis proposes a Mahalanobis distance based, Monte Carlo goodness of fit test that can depend on arbitrary features of the observed network data and covariates. As remediating poor fit can be a difficult process, a modified model distance (MMD) estimator is devised that can help researchers to choose among a set of model elaborations. In practice, panel data is typically used to draw SAOM-based inference. This thesis also proposes a score-type test for time heterogeneity between the waves in the panel that is computationally cheap and fits into a convenient, forward model selecting workflow. Next, this thesis proposes a rigorous method for aggregating so-called relational event data (e.g. emails and phone calls) by extending the SAOM family to a family of hidden Markov models that suppose a latent social network is driving the observed relational events. Finally, this thesis proposes a measurement model for SAOMs inspired by error-in-variables (EiV) models employed in an array of disciplines. Like the relational event aggregation model, the measurement model is a hidden Markov model extension to the SAOM family. These models allow the researcher to specify the form of the mesurement error and buffer against potential attenuating biases and other problems that can arise if the errors are ignored. Show less

This paper explores time heterogeneity in stochastic actor oriented models (SAOM) proposed by Snijders (Sociological methodology. Blackwell, Boston, pp 361–395, 2001) which are meant to study the evolution of networks. SAOMs model social networks as directed graphs with nodes representing people, organizations, etc., and dichotomous relations representing underlying relationships of friendship, advice, etc. We illustrate several reasons why heterogeneity should be statistically tested and… Show more

This paper explores time heterogeneity in stochastic actor oriented models (SAOM) proposed by Snijders (Sociological methodology. Blackwell, Boston, pp 361–395, 2001) which are meant to study the evolution of networks. SAOMs model social networks as directed graphs with nodes representing people, organizations, etc., and dichotomous relations representing underlying relationships of friendship, advice, etc. We illustrate several reasons why heterogeneity should be statistically tested and provide a fast, convenient method for assessment and model correction. SAOMs provide a flexible framework for network dynamics which allow a researcher to test selection, influence, behavioral, and structural properties in network data over time. We show how the forward-selecting, score type test proposed by Schweinberger (Chapter 4: Statistical modeling of network panel data: goodness of fit. PhD thesis, University of Groningen 2007) can be employed to quickly assess heterogeneity at almost no additional computational cost. One step estimates are used to assess the magnitude of the heterogeneity. Simulation studies are conducted to support the validity of this approach. The ASSIST dataset (Campbell et al. In Lancet 371(9624):1595–1602, 2008) is reanalyzed with the score type test, one step estimators, and a full estimation for illustration. These tools are implemented in the RSiena package, and a brief walkthrough is provided. Show less

Spirometry is an easy-to-perform test for evaluating pulmonary symptoms but has several limitations to include adequate test performance for valid results. Spirometry is not recommended to screen a general population for evidence of pulmonary disease unless symptoms are present or longitudinal screening is done for potential occupational exposures.

METHODS
A single-spirometry examination was performed on 900 active duty Army soldiers, ages 18–35 yr, without documented respiratory… Show more

Spirometry is an easy-to-perform test for evaluating pulmonary symptoms but has several limitations to include adequate test performance for valid results. Spirometry is not recommended to screen a general population for evidence of pulmonary disease unless symptoms are present or longitudinal screening is done for potential occupational exposures.

METHODS
A single-spirometry examination was performed on 900 active duty Army soldiers, ages 18–35 yr, without documented respiratory disease. Abnormal studies were identified (obstructive, restrictive, mixed, and flow volume loop abnormalities) and compared with reported respiratory symptoms, smoking history, prior diagnosis of asthma, and failure of the Army physical fitness test 2-mile run using generalized linear modeling techniques.

RESULTS
The cohort population had spirometry values comparable with published NHANES III reference values. Ninety-eight subjects (10.9%) were identified with abnormal spirometry included 33 obstructive, 44 restrictive, 3 mixed, and 18 isolated flow volume loop abnormalities. Historical features (smoking, exertional dyspnea, cough, asthma, or APFT failure) had no effect on the probability of an abnormal spirometry result (p = 0.56). Although APFT failure probability is strongly affected by exertional dyspnea (p = 0.00) and current smoking (p = 0.01), abnormal spirometry results did not have a statistically significant effect (p = 0.38). Show less

Spirometry is an easy-to-perform test for evaluating pulmonary symptoms but has several limitations to include adequate test performance for valid results. Spirometry is not recommended to screen a general population for evidence of pulmonary disease unless symptoms are present or longitudinal screening is done for potential occupational exposures.

METHODS
A single-spirometry examination was performed on 900 active duty Army soldiers, ages 18–35 yr, without documented respiratory… Show more

Spirometry is an easy-to-perform test for evaluating pulmonary symptoms but has several limitations to include adequate test performance for valid results. Spirometry is not recommended to screen a general population for evidence of pulmonary disease unless symptoms are present or longitudinal screening is done for potential occupational exposures.

METHODS
A single-spirometry examination was performed on 900 active duty Army soldiers, ages 18–35 yr, without documented respiratory disease. Abnormal studies were identified (obstructive, restrictive, mixed, and flow volume loop abnormalities) and compared with reported respiratory symptoms, smoking history, prior diagnosis of asthma, and failure of the Army physical fitness test 2-mile run using generalized linear modeling techniques.

RESULTS
The cohort population had spirometry values comparable with published NHANES III reference values. Ninety-eight subjects (10.9%) were identified with abnormal spirometry included 33 obstructive, 44 restrictive, 3 mixed, and 18 isolated flow volume loop abnormalities. Historical features (smoking, exertional dyspnea, cough, asthma, or APFT failure) had no effect on the probability of an abnormal spirometry result (p = 0.56). Although APFT failure probability is strongly affected by exertional dyspnea (p = 0.00) and current smoking (p = 0.01), abnormal spirometry results did not have a statistically significant effect (p = 0.38). Show less

This study illustrates the importance of assessing and accounting for time heterogeneity in longitudinal social network analysis. We apply the time heterogeneity model selection procedure of [1] to a dataset collected on social tie formation for university freshman in the Netherlands by [2]. Within the context of analyzing selection effects for smoking homophily to understand the implications of tobacco policy at a university, we show that failing to account for time heterogeneity yields quite… Show more

This study illustrates the importance of assessing and accounting for time heterogeneity in longitudinal social network analysis. We apply the time heterogeneity model selection procedure of [1] to a dataset collected on social tie formation for university freshman in the Netherlands by [2]. Within the context of analyzing selection effects for smoking homophily to understand the implications of tobacco policy at a university, we show that failing to account for time heterogeneity yields quite different results substantively from the model arrived at using [1]. While the results are limited by the small scope of the dataset, the paper motivates the testing of time heterogeneity within longitudinal studies of social network behavior and further study of tobacco policy within university settings. Show less