bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Perceptual Study of American English Diphthongs
Authors: Gay Thomas 
Published: July 2017

This study utilized synthetic speech for describing the phonemic boundaries and the effects of formant course on the identification of / i, ai, au/. In the first experiment, synthesized formant transitions appropriate to classes of / i-ai/ and /au-o/ were presented to ten phonetically trained listeners for purposes of phoneme labelling. Results showed that preferred / i/ courses were from [ ] or [u] to [i, y, I], /ai/ courses from [a] to [I] and /au/ from [a] to [ ]. The purpose of the second experiment was to determine whether the phonetic identity of the targets or the absolute course of the second formant transition serves as the primary identifying cue. These features were separated along the time dimension by synthesizing diphthongs whose second formant frequency course remained fixed but whose durations varied. Results of the listening tests showed shifts in perception from simple vowel to diphthong occurring as a function of duration rather than frequency onset or offset positions. Further, in the case of / i-ai/, second formant rate of change serves as the primary distinguishing cue. The results suggest / i, ai, au/ are characterized by an invariant second formant rate of change, whose onset and offset values vary across changes in duration.
Preventing Influenza: Vaccine Systems and Practices in the Southeast
Authors: Gazmararian Julie A. , Orenstein Walter A. , Wortley Pascale , Buehler James W. , Elon Lisa , Koplan Jeffrey P. , Schild Laura , Dixon Tonya , Weiss Paul , Stephens David S. ,   State Working Group
Published: July 2017

Objectives. The purpose of this study was to determine from state and local health departments: ( 1) how they purchase, distribute, and fund influenza vaccine; ( 2) whether they experienced a shortage in 2003/04; ( 3) how the shortages were handled; and ( 4) how they prepared for distribution in 2004/05. Methods. A web-based survey was completed from June to August 2004 in eight Southeastern states. Results. Data were obtained from each state and 222 local health departments. Major differences between and within states were found with regard to purchasing, distributing, and funding influenza vaccine. Although the majority of health departments experienced periods of shortages in 2003/2004, surpluses of vaccine remained at the end of the season. There was little evidence of interaction between the public and private sectors to share vaccine resources in response to shortages. Tracking systems for redistribution of vaccine or follow-up were often not in place. Entering the 2004/05 season, 25% of states and 11% of counties were not developing any special procedures to deal with shortages beyond what was in place earlier. Conclusions. Better systems and funding are needed, especially for adult influenza vaccine delivery and for redistribution of influenza vaccine in response to shortages.
From Competencies to Capacity: Assessing the National Epidemiology Workforce
Authors: Lichtveld Maureen , Boulton Matthew , Lemmings Jennifer , Gale James 
Published: July 2017

Objectives. We determined the competency of the public health epidemiology workforce within state health agencies based on the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs). Methods. The competence level of current state health agency staff and the need for additional training was assessed against 30 mid-level AECs. Respondents used a five-point Likert scale—ranging from “strongly agree” to “strongly disagree”—to designate whether staff was competent in certain areas or whether additional training was needed for each of the competencies. Results. Most states indicated their epidemiology workforce was competent in most of the AECs subject areas. Subject areas with the greatest number of states reporting competency (82%) are creating and managing databases and applying privacy laws. However, at least one-third of the states reported a need for additional training in all competencies assessed. The greatest reported needs were for additional training in surveillance system evaluation and use of knowledge of environmental and behavioral science in epidemiology practice. Conclusions. The results indicate that most epidemiologists mastered the traditional discipline-specific competencies. However, it is unclear how this level of competency was achieved and what strategies are in place to sustain and strengthen it. The results indicate that epidemiologists have lower levels of competence in the nontraditional epidemiologic fields of knowledge. Future steps to ensure a well-qualified epidemiology workforce include assessing the full AECs in a subgroup of Tier 2 epidemiologists and implementing competencies in academic curricula to sustain reported competency achievements.
Epidemiology Competencies and Preventive Medicine Residencies: Do They Mix and Map?
Authors: Boulton Matthew L. , Montgomery JoLynn P. , Beck Angela 
Published: July 2017

Objectives. This article maps the program requirements of the University of Michigan preventive medicine residency (PMR) to the newly established Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) to determine the feasibility and utility of using these competencies to assess the training of physician epidemiologists. Methods. The academic and practicum requirements of the PMR are mapped against the 38 AECs for Tier 2, or mid-level epidemiologists. The process of mapping was done by reviewing academic course syllabi/content and practicum tasks to determine how closely they aligned with the AECs. This process allowed us to identify competencies that are relative training strengths and weaknesses of the residency. Results. Overall, the current program requirements of the PMR generally satisfy the AECs, although one competency was not met in either the academic or practicum year, and another was only met in a single, required academic course. The areas in which AECs were fulfilled by many activities in the residency were in domain 1 (assessment and analysis) and domain 2 (basic public health sciences). The areas in which competencies were met by few activities were primarily in domain 6 (financial and operational planning and management) and domain 7 (leadership and systems thinking). Conclusions. We found that the process of mapping an academically rigorous epidemiology training program (the PMR) to the AEC was feasible and useful. It permitted us to identify training strengths and gaps in our program and consider modifications that will strengthen the level of competency of our physician graduates.
Health and Economic Burden of Traumatic Brain Injury: Missouri, 2001–2005
Authors: Kayani Noaman A. , Homan Sherri , Yun Shumei , Zhu Bao Ping 
Published: July 2017

Objective. We examined the financial and social costs resulting from traumatic brain injury (TBI) in Missouri. Methods. We computed mortality rates from death certificates, the direct cost of TBI from hospital and emergency department (ED) visit charges, the social cost in terms of years of potential life lost (YPLL) using an abridged Missouri life table, and the indirect financial cost in terms of lost productivity due to premature death for all TBI and four major causes of TBI in Missouri. Results. During 2001–2005, a mean of 1,358 lives were lost due to TBI in Missouri. Four major causes—unintentional falls, motor vehicle traffic crashes, motorcycle crashes, and firearms—accounted for 88% of all TBI deaths. We estimated the annual direct medical cost of TBI at $95 million, or about $1.67 million per 100,000 Missourians. This cost increased by about 60% between 2001 and 2005. The four major causes of TBI accounted for 68% of all direct medical costs of TBI. We estimated the cost per hospitalization and ED visit at $6,948 and the indirect social cost at 48,501 YPLL. During this period, the mean age of TBI fatality was 44 years. We determined the lost productivity due to TBI mortality—$1.1 billion, or about $18.8 million per 100,000 Missourians—to be three times as high for males as for females. Conclusions. The types of costs covered in this study underestimated the total cost of TBI in Missouri, as we did not include outpatient care, rehabilitation, and drug costs. Nevertheless, we found the health and economic burden from medical care and mortality related to TBI to be substantial in Missouri.
Pediatricians and Screening for Obesity with Body Mass Index: Does Level of Training Matter?
Authors: Hillman Jennifer B. , Corathers Sarah D. , Wilson Stephen E. 
Published: July 2017

Objectives. Pediatric obesity is increasing at epidemic rates in industrialized nations. It is recommended that pediatricians screen all children annually with the use of body mass index (BMI). However, it is unclear whether this recommendation is followed. This study sought to ( 1) determine the proportion of children screened for obesity with BMI, and ( 2) test whether attending physicians are more likely than resident physicians to document and plot BMI. Methods. We conducted a systematic review of medical records in an urban academic pediatric practice. Participants were children aged 5 to 11 years presenting for health care in 2004. We measured the proportion of subjects with documented and plotted BMI and compared results for attending and resident physicians. We used logistic regression analysis to determine factors associated with documentation of BMI. Results. Of 397 medical records reviewed, 59.7% contained the 2000 Centers for Disease Control and Prevention growth curve with BMI for age; 5.5% documented BMI, and 4.3% plotted BMI. Resident physicians were more likely to document (13.0% vs. 3.0%, p=0.0008) and plot (9.0% vs. 2.7%, p=0.0260) BMI compared with attending physicians. Children with a BMI ≥95% for age were more likely to have their BMI documented (odds ratio [OR] = 10.7, 95% confidence interval [CI] 3.7, 31.5) and plotted (OR=7.1, 95% CI 2.3, 21.6). Conclusion. We found the use of BMI to screen for childhood obesity very poor in this academic pediatric practice. Resident physicians were more likely to document and plot BMI than attending physicians.
Seroprevalence of Hepatitis A Virus Antibodies in the U.S.: Results from the National Health and Nutrition Examination Survey
Authors: Klevens R. Monina , Kruszon-Moran Deanna , Wasley Annemarie , Gallagher Kathleen , McQuillan Geraldine M. , Kuhnert Wendi , Teshale Eyasu H. , Drobeniuc Jan , Bell Beth P. 
Published: July 2017

Objectives. We described seroprevalence of antibody to hepatitis A virus (anti-HAV) in the United States during 1999–2006 and compared it with seroprevalence before the availability of vaccine. Methods. We analyzed data from the 1988–1994 and 1999–2006 National Health and Nutrition Examination Survey (NHANES) to obtain estimates of anti-HAV seroprevalence for the U.S. household population. We grouped region of residence based on the 1999 Advisory Committee on Immunization Practices recommendations into 17 states with any recommendation (vaccinating) and 33 states without any recommendation (non-vaccinating). Results. During 1999–2006, the overall seroprevalence of anti-HAV was 34.9% (95% confidence interval [CI] 33.1, 36.7). During 1999–2006, U.S.-born children living in vaccinating states (33.8%, 95% CI 26.2, 42.2) had a higher seroprevalence than children in non-vaccinating states (11.0%, 95% CI 9.4, 12.8; p<0.001). Seroprevalence among children increased from 8.0% (95% CI 6.3, 10.1) during 1988–1994 to 20.2% (95% CI 16.0, 24.8) during 1999–2006 ( p<0.001). For U.S.-born children aged 6–19 years, the strongest factor associated with seroprevalence was residence in vaccinating states. Among U.S.-born adults aged >19 years, the overall age-adjusted seroprevalence of anti-HAV was 29.9% (95% CI 28.3, 31.5) during 1999–2006, which was not significantly different from the seroprevalence during 1988–1994 (32.2%, 95% CI 30.1, 34.4). Conclusions. Increases in seroprevalence among children in vaccinating states suggest a positive effect of the 1999 vaccination recommendations.
Protecting Newborns by Immunizing Family Members in a Hospital-Based Vaccine Clinic: A Successful Tdap Cocooning Program during the 2010 California Pertussis Epidemic
Authors: Rosenblum Elizabeth , McBane Sarah , Wang Wendy , Sawyer Mark 
Published: July 2017

Objective. Infants are at greatest risk for mortality from pertussis infection. Since 2005, the Advisory Committee on Immunization Practices has recommended a cocooning strategy of vaccinating all close contacts of infants with tetanus, diptheria, and acellular pertussis (Tdap) vaccine to reduce the risk of transmitting pertussis. Difficulties in establishing a complete cocoon have been reported in the literature. We determined whether families of newborns could be fully immunized against pertussis, thereby providing a complete cocoon of protection. Methods. Tdap vaccine was offered during visiting hours to contacts aged 7 years and older and to postpartum patients who had not received Tdap vaccine during pregnancy. We then conducted retrospective phone interviews with randomly selected mothers (or other family members) to assess vaccination rates. We compared household vaccination rates during intervention and control periods and the demographic factors associated with Tdap vaccination of all members within the households. Results. During the intervention period, 243 postpartum patients and 1,287 other family members of newborns were immunized, with 84.8% of all family members receiving Tdap vaccination. Seventy-six percent of households reported a complete cocoon. In the control group, 52.2% of all family members received Tdap vaccination, and 29.3% of households had a complete cocoon. In the control group, fewer family members completed Tdap vaccination in the larger households than in the smaller households ( p=0.008). Conclusion. A cocooning strategy can be successfully implemented, such that the majority of newborns leave the hospital with their families fully immunized against pertussis.
Disparities in Current Cigarette Smoking Prevalence by Type of Disability, 2009–2011
Authors: Courtney-Long Elizabeth , Stevens Alissa , Caraballo Ralph , Ramon Ismaila , Armour Brian S. 
Published: July 2017

Objectives. Smoking, the leading cause of disease and death in the United States, has been linked to a number of health conditions including cancer and cardiovascular disease. While people with a disability have been shown to be more likely to report smoking, little is known about the prevalence of smoking by type of disability, particularly for adults younger than 50 years of age. Methods. We used data from the 2009–2011 National Health Interview Survey to estimate the prevalence of smoking by type of disability and to examine the association of functional disability type and smoking among adults aged 18–49 years. Results. Adults with a disability were more likely than adults without a disability to be current smokers (38.8% vs. 20.7%, p<0.001). Among adults with disabilities, the prevalence of smoking ranged from 32.4% (self-care difficulty) to 43.8% (cognitive limitation). When controlling for sociodemographic characteristics, having a disability was associated with statistically significantly higher odds of current smoking (adjusted odds ratio = 1.57, 95% confidence interval 1.40, 1.77). Conclusions. The prevalence of current smoking for adults was higher for every functional disability type than for adults without a disability. By understanding the association between smoking and disability type among adults younger than 50 years of age, resources for cessation services can be better targeted during the ages when increased time for health improvement can occur.
Gastric Acid Secretion and Vitamin B 12 Absorption After Vertical Ronx‐en‐Y Gastric Bypass for Morbid Obesity
Authors: Sax Harry C. 
Published: July 2017

It is difficult to imagine that the morbidly obese patient suffers from nutritional deficiencies. Nonetheless, severe obesity can lead to hepatic steatosis and cirrhosis, which may significantly alter protein synthesis and immune response. Early surgical therapy for morbidly obese patients involved creating a short gut by performing a jejunoileal bypass. Many of these patients developed malabsorption and blind‐loop syndrome, with significant metabolic abnormalities, and some died.1 Recently, the vertical‐banded gastric bypass has been shown to be effective in morbidly obese patients, not only by reducing the volume of food eaten, but also by discouraging the consumption of concentrated sweets by causing dumping. A small upper‐gastric pouch is created that is completely excluded from the distal stomach and duodenum. A Roux‐en‐Y limb of jejunum is then anastomosed to this pouch to restore intestinal continuity.2 Although weight loss is significant, many of these patients develop pernicious anemia. It is unclear whether this is caused by a lack of intrinsic factor from the stomach itself, inasmuch as the large parietal cell mass remains intact, or by hypoacidity of the proximal pouch. Pernicious anemia is seen in other states of hypoacidity, which are recreated by these small pouches.Ten patients who had undergone vertical Roux‐en‐Y gastric bypass were compared with 15 healthy volunteers. Gastric tubes were positioned in the stomach or proximal pouch to assess acid production. The patients underwent a Schilling test using either free or food‐bound 57Co‐labeled cyanocobalamin (Vitamin B12). Twenty‐four hours later, urine was collected, and the percentage of labeled B12 that was detected represented gastrointestinal tract absorption.Acid secretion from the proximal gastric pouch was markedly less than the acid output in the total stomach of age‐matched hospital controls (0 ± 0 vs 5 ± 0.7 mEq/h; p <.001). This may explain the incidental fmding of few anastomotic gastrojejunal ulcers. Crystalline Vitamin B12 absorption was normal in both groups, suggesting that intrinsic factor continued to be produced and bound with the B12 in the jejunum before its absorption. However, when food‐bound Vitamin B12 was given, uptake was significantly decreased in the bypass patients (0.8% ± 0.2% vs 3.7% ± 0.5%; p <.01).