Faculty Bibliography

[Ted Morgan] finds much to admire about the young Senator [Joe McCarthy], including compassion and generosity. But as McCarthy rose in politics, he abandoned whatever scruples he may have had and gave in to expediency, Morgan writes, continuing, He was like a character in a medieval morality play, fought over by an angel and a devil. The devil won. Morgan's narrative provides ample evidence of the damage done to individuals and institutions by McCarthy. But Morgan is right, I think, to portray the senator and the Communist Party as equal partners in the soiling of American politics. By 1946 the worst was over. A host of factors, including the defection of top U.S. agents and the FBI's successful infiltration of the Communist Party, severely weakened Soviet espionage abilities inside the United States. The wartime secrets had been stolen, Morgan writes, but the networks had been dismantled. As the Communist problem faded, the Communist issue took its place. The Cold War was now in full swing. Soviet takeovers in Eastern Europe, the fall of China to communism, the news that Russia had tested an atomic bomb, all sent shock waves through the United States

If the man has SARS now and had it before, his would be the first known case of reactivated SARS, adding a new problem for doctors and health officials in diagnosing and controlling SARS. Reactivated or recurrent SARS ''is among the theories we are considering'' in the case of the man, who is recuperating well in a hospital in Guangdong, said Dr. Julie L. Hall, the SARS team leader in Beijing for the World Health Organization. The man's illness last winter, when SARS was spreading, and the results of current tests have raised the theory of reactivated SARS. At China's invitation, the World Health Organization has sent three experts to Guangdong to find more details about his case and to search for other cases. One aim is to determine what medical care the man sought last winter and whether blood or other specimens taken then remain for tests that may yield clues now

We consider generalized linear models with a coarsened covariate. The term 'coarsened' is used here to refer to the case where the exact value of the covariate of interest is not fully observed. Instead, only some set or grouping that contains the exact value is observed. In particular, we propose a likelihood-based method for estimating regression parameters in a generalized linear model relating the mean of the outcome to covariates. We outline Newton-Raphson and EM algorithms for obtaining maximum likelihood estimates of the regression parameters. We also compare and contrast this likelihood-based approach with two somewhat ad hoc procedures: a complete-case analysis in which individuals with coarsened data are excluded and estimation is based on the remaining 'complete cases', and a coarsened data regression model in which the covariate values for all the complete cases are coarsened and then included in a regression model relating the mean to the coarsened covariate. The methodology that is presented is motivated by coarsened data on the racial-ethnicity categorization of patients in the US's National Ambulatory Medical Care Survey, a study to examine the medical care that is provided to a patient in a physician's office. In this study, the outcome of interest is the level of tests (none, non-invasive tests or invasive tests) ordered for the patient at the doctor's visit. One of the covariates of interest is the patient's four-level discrete covariate comprised of four racial-ethnicity categories: white-Hispanic, white-non-Hispanic, African-American-Hispanic and African-American-non-Hispanic. However, of the 19 095 patients in the sample, 14 955 (or 78%) have the exact category of race-ethnicity recorded and 4140 (or 22%) have race-ethnicity coarsened. For the latter group of 4140 individuals, the ethnicity is not recorded, but we know that 3683 are white and 457 are African-American

BACKGROUND: The risk for psychiatric and neurocognitive disorders among middle-aged and older individuals with HIV infection has not been well characterized. METHODS: The Veterans Aging Cohort 5-Site Study enrolled 1803 patients (1047 HIV-positive) from VA infectious disease and general medicine clinics from September 2001 to June 2002. A convenience subset of 10 patients from each site (n = 50) was consented for formal neurocognitive and psychiatric (NCP) testing. Data from this subset were linked to the larger sample. RESULTS: Kappa scores for agreement beyond chance were fair for available measures when compared with formal NCP testing. Using available measures, depressive symptoms (PHQ-9 and provider reported), alcohol abuse or dependence (ICD-9 codes), and drug abuse or dependence (DAST-10) decreased with age in HIV-negative subjects (P trend <0.05) but did not among HIV-positive subjects (P > 0.05). HIV-positive subjects demonstrated higher prevalence of these conditions with increasing age when compared to HIV-negative subjects. Patient report of memory problems increased with age among both groups after excluding those reporting symptoms of depression (PHQ-9e > or = 10). CONCLUSION: Available measures were no substitute for formal NCP testing. Older HIV-positive veterans demonstrate greater prevalence of depressive symptoms, alcohol abuse or dependence, and drug abuse or dependence than age-matched, HIV-negative veterans. Both groups reported increased memory problems with advancing age. This preliminary work suggests a substantial prevalence of psychiatric and neurocognitive problems among middle-aged and older HIV-infected individuals

BACKGROUND: Tracheotomies are routinely performed for severely ill and elderly patients with respiratory failure. This intervention is questioned, given the poor survival rate in this group. Outcomes analysis is performed after tracheotomy. METHODS: This is a retrospective study of 78 elderly patients, who received tracheotomies for respiratory failure. Pretracheotomy data (age, length of oral intubation, and DNR status) were collected. Outcomes analyzed during the same admission as the tracheotomy included death versus discharge, ventilator dependence, vocal function, route of feeding, decannulation, and ICU discharge disposition. RESULTS: The mean age was 77.6 +/- 11 years (median, 79 years) and patients were intubated for 16.7 +/- 9 days. Forty-two percent (n = 33) obtained DNR orders after tracheotomy, and 8% (n = 6) before tracheotomy. Seventy-one percent of patients (n = 55) had gastrostomy tubes placed. Fifty-six percent of patients (n = 44) died after tracheotomy; median time from tracheotomy to death was 31 days. After tracheotomy, 53 % (n = 41) remained at least partially ventilator dependent, 18 % (n = 14) regained consistent vocal function, and 13 % (n = 10) were decannulated. For those who died, 27 % (n = 12) died without leaving the ICU. CONCLUSION: These data demonstrate that a large proportion of elderly, severely ill patients with respiratory failure suffer poor outcomes after tracheotomy. More stringent criteria are necessary for performing the tracheotomy in this patient population

This paper introduces a novel method for ultrasound (US) probe calibration based on closed-form formulation and using minimal US imaging allowing for an immediate result. Prior to calibration, a position sensor is used to track each image in 3D space while the US image is used to determine target location within the image. The calibration procedure uses these two pieces of information to determine the transformation (translation, rotation, and scaling) of the scan plane with respect to the position sensor. We utilize a closed form solution from two motions of the US probe relying on optical digitization with a calibrated pointer to replace with a great extent the traditional segmentation of points/planes in US images. The tracked pointer appeared to introduce significantly less error than the resolution of the US image caused in earlier approaches. Our method also uses significantly fewer US images and requires only minimal image segmentation, or none with a special probe attachment.