troy abell | Baylor University (original) (raw)

Papers by troy abell

PubMed, 1991

A prospective cohort study was undertaken to evaluate the relationship of family functioning to i... more A prospective cohort study was undertaken to evaluate the relationship of family functioning to infant birthweight adjusted for length of gestation. The mother's perception of family functioning was assessed at the initial prenatal visit using the Family Adaptability and Cohesion Evaluation Scales (FACES II). All obstetric patients at four family medicine clinics from April 1984 through April 1987 whose initial prenatal visits occurred by the 28th week of gestation were invited to participate; 95% chose to do so. Information was obtained on 833 mother-infant pairs. Listwise deletion on any one variable reduced the sample to 772 with no apparent bias in the dependent or predetermined variables. Twelve percent of the families were considered to be dysfunctional by scoring on the extremes of both the cohesion and adaptability continua of the self-report FACES II questionnaire. Infant birthweight was regressed on length of gestation and other known biomedical, anthropometric, risk-behavior, and sociodemographic determinants, as well as family functioning. Women who perceived their families as dysfunctional were delivered of infants who weighed on the average 126.4 g (95% CI 37.4, 215.4) less than infants born to women from functional families (P = .0055), after adjusting for other known determinants. Family functioning also was found to modify the effects of prepregnancy weight and infant sex on infant birthweight.

PubMed, Jun 1, 1986

A prospective study was undertaken to evaluate the relationship of family functioning, family str... more A prospective study was undertaken to evaluate the relationship of family functioning, family structure, and life events with pregnancy outcome. Family functioning was assessed utilizing the Family Adaptability and Cohesion Evaluation Scales (FACES) and the Family APGAR. One hundred twenty-five infants were delivered with a mean birth weight of 3,283 g and a mean gestational age of 281.2 days. Listwise deletion of missing data reduced the study sample to 102 mother-infant pairs with no bias in the dependent or predetermined variables in the subsample. Birth weight was regressed on medical, anthropometric, risk-behavior, sociodemographic, and life-events variables, which together explained 42 percent of the variance. Family functioning was found to contribute an additional 7 percent of the variance (adjusted R2 = 0.49). Family structure accounted for 4.5 percent of the variance in birth weight, and life events added 5 percent. As a complementary analysis, infant birth weight was regressed on the medical, anthropometric, sociodemographic, risk-behavior, and life-events variables, and the residuals from this equation were then regressed on the measures of family functioning. Again, abnormal family functioning proved to be a powerful and significant contributor to the explained variance.

PubMed, May 1, 1989

A prospective cohort study was designed to study the effects of family functioning and stress on ... more A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was significantly associated with both cohesion and adaptability as measured by FACES II. Neither the Family APGAR nor the SRRS was associated with influenza B infection. It was concluded that family functioning affects the frequency of influenza B infection within families. This finding raises the possibility that family dysfunction may lead to altered immune responses, which increases susceptibility to infection.

International Urogynecology Journal, Jul 29, 2004

Study designs and other criteria for inclusion in the review The primary studies were identified ... more Study designs and other criteria for inclusion in the review The primary studies were identified from a review of the literature, although it was unclear whether it was a systematic review. No information on the design of the primary studies was provided. Data on life expectancy and the average age of first-time mothers in the USA were derived from national statistics. Sources searched to identify primary studies MEDLINE was searched from 1980 to identify relevant studies. The bibliographic references of retrieved articles were also checked. Criteria used to ensure the validity of primary studies The authors stated that, whenever possible, data from randomised clinical trials were used. Otherwise, less robust studies were used to provide data. Methods used to judge relevance and validity, and for extracting data Not stated. Number of primary studies included Twenty-four studies provided the evidence used in the decision model. Methods of combining primary studies It appears that a narrative method has been used to combine the primary estimates. Investigation of differences between primary studies Not stated.

Psycho-oncology, 2005

Many patients play an active role in determining their cancer treatments, and the communication o... more Many patients play an active role in determining their cancer treatments, and the communication of medical information influences patient decision-making. This study examined participants' preferences between various methods of communicating quantitative risks and benefits of adjuvant chemotherapy. Using clinical vignettes, participants were first asked to decide whether or not to endorse chemotherapy and were subsequently asked about their preferences for the methods used to communicate the risks and benefits. Participants preferred the absolute survival benefit method over negatively framed methods, such as relative or absolute risk reduction. We also present analysis of qualitative data which supports the conclusions drawn from quantitative analyses. In summary, the absolute survival benefit was shown to be the superior method of communicating quantitative risks and benefits of chemotherapy. Failure to use clear and concise methods of communicating quantitative risk and benefit information may compromise efforts to obtain informed consent for treatment.

Pacific sociological review, Apr 1, 1979

The National Longitudinal Surveys of young males provi data for the construction of causal models... more The National Longitudinal Surveys of young males provi data for the construction of causal models of occupation bility for both black and white workers. These NLS dat several methodological variations from previous occup mobility research, including longitudinal design, less rel retrospective techniques, and a more precise time fram annual models indicate that beyond years of education, very variables available to most surveys have a statistically signif effect on variation in occupational prestige and incom these longitudinal surveys show a growing racial gap in tional rewards. Much of this increase in the black-white reward differences is found to be related to labor market racial discrimination in advancement rather than to different levels of family background and labor market entry. Policy implications are drawn based on the importance of education and the racial discrimination in occupational mobility.

Breast Journal, 2003

Previous studies have shown that independent of tumor size, palpable breast tumors have a higher ... more Previous studies have shown that independent of tumor size, palpable breast tumors have a higher incidence of lymph node metastasis compared with nonpalpable tumors. This study further examines this phenomenon using a large sentinel lymph node (SLN) database. Data from a prospective, institutional review board (IRB)-approved, multi-institutional study from the University of Louisville Breast Cancer Sentinel Lymph Node Study Group was used. From August 1997 through December 2001, 3192 patients with clinical T1 and T2 N0 breast cancer underwent SLN biopsy, most with a combined technique of radioactive colloid and blue dye, followed by level I/II axillary dissection. Patients with palpable tumors tended to be younger (mean age 58 years) compared with nonpalpable tumors (mean age 61 years). The incidence of positive axillary metastasis was significant between palpable and nonpalpable tumors (43% and 23%, respectively), independent of tumor size by logistic regression (p = 0.0001). The SLN identification rate was significantly different between palpable and nonpalpable tumors (95% versus 91%, respectively; p < 0.0001). A unifying theory to explain the phenomenon that palpable tumors, stage for stage, are associated with a higher rate of nodal metastasis is that palpable tumors are, on average, closer to the skin and the rich network of dermal lymphatics. We believe that the dermal lymphatics of the breast represent a clinically relevant metastatic pathway to the axilla.

American Surgeon, Mar 1, 2004

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life.

Pediatric Infectious Disease Journal, Jun 1, 1988

In a randomized, double-blind placebo-controlled clinical trial, we evaluated the prophylactic ef... more In a randomized, double-blind placebo-controlled clinical trial, we evaluated the prophylactic effectiveness of rimantadine in children (ages 1 to 18 years) against infection with influenza A (H3N2) and associated illness and the prevention of transmission of infection to adult members of the child's family. One hundred ten volunteers from 29 families completed this study during a naturally occurring outbreak of influenza A (H3N2). Influenza infections, defined as a positive viral throat culture or a 4-fold increase in antibody titer, occurred in 31.0% of children in the placebo group and 7.4% in the rimantadine group (P = 0.026). Clinical illness with laboratory evidence of influenza infection occurred in 24.1% of children in the placebo group and none in the rimantadine group (P = 0.007). Rimantadine was well-tolerated by the children, with no significant difference in reported adverse effects between the placebo and rimantadine groups. A combined analysis by families of these data and those of our similarly designed 1984 study, revealed that families in whom the children were given rimantadine had a significantly lower rate of influenza A infection and influenza-like illness compared with the families in whom the children were given placebo (68.8% vs. 18.8%, P less than 0.001) and (56.3% vs. 12.5%, P less than 0.001), respectively. We conclude that rimantadine prophylaxis of children appears to be an effective method to prevent influenza A (either H1N1 or H3N2) infection and illness in children.

Open Journal of Obstetrics and Gynecology, 2013

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uter... more Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse; erosion; infection; transfusion; cystotomy; chronic pain; lower urinary tract symptoms; and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of 22,657perQALY.Thecosts(22,657 per QALY. The costs (22,657perQALY.Thecosts(14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of 15,995perQALY.TheincrementalcostperQALYsforroboticsurgerywas15,995 per QALY. The incremental cost per QALYs for robotic surgery was 15,995perQALY.TheincrementalcostperQALYsforroboticsurgerywas207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn't cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Social Problems, Jun 1, 1982

This paper constructs racially and sexually comparative models of labor market entry to assess th... more This paper constructs racially and sexually comparative models of labor market entry to assess the effects of individual differences and labor market discrimination. Traditional measures of racial discrimination in the labor market are of relatively small importance in ...

European Journal of Obstetrics & Gynecology and Reproductive Biology, Nov 1, 2016

Background: The specialization of human fat deposits is an inquiry of special importance in the s... more Background: The specialization of human fat deposits is an inquiry of special importance in the study of fetal growth. It has been theorized that maternal lower-body fat is designated specifically for lactation and not for the growth of the fetus. Objective: Our goal was to compare the contributions of maternal upper-body versus lower-body adiposity to infant birth weight. We hypothesized that upper-body adiposity would be strongly associated with infant birth weight and that lower-body adiposity would be weakly or negligibly associated with infant birth weight-after adjusting for known determinants. Study design: In this prospective cohort study, 355 women initiated medical pre-natal care during the first trimester of pregnancy at The University of Oklahoma Health Sciences Center during 1990-1993. Maternal anthropometric measurements were assessed at the first clinic visit: (a) height; (b) weight; (c) circumferences of the upper arm, forearm, and thigh; and, (d) skin-fold measurements of the bicep, subscapular region, and thigh. Results: Infant birth weight was regressed on known major determinants to create the foundational model. Maternal anthropometric variables subsequently were added one at a time into this multiple regression model. The highest contribution by a single anthropometric variable to infant birthweight was, in order: subscapular skin-fold, forearm circumference, and thigh circumference. With one upperbody (subscapular skin-fold) and one lower-body (circumference of the thigh) adiposity measure in the model, the z-score regression coefficient (s.e.) was 85.7 g (30.8) [p = 0.0057] for maternal subscapular skin-fold and 19.0 g (31.6) [p = 0.5477] for circumference of the thigh. When the second-best upperbody contributor to infant birthweight (circumference of the forearm) was entered with one lowerbody measure into the model, the z-score regression coefficient (s.e.) was 77.5 g (38.5) [p = 0.0451] for maternal forearm circumference and 14.1 g (38.5) [p = 0.7146] for circumference of the thigh. When both subscapular skinfold and forearm circumference were added to the model in place of BMI, the explained variance (r 2 = 0.5478) was similar to the model using BMI (r 2 = 0.5487). Conclusion: Upper-body adipositywhether operationalized by subscapular skin-fold or circumference of the forearmwas a markedly larger determinant of infant birth weight than lower-body adiposity. 2016 Elsevier Ireland Ltd. All rights reserved.

American Ethnologist, Aug 1, 1979

At the heart of Lewis's (1966) conceptualization of a "culture of poverty" is his assertion that ... more At the heart of Lewis's (1966) conceptualization of a "culture of poverty" is his assertion that certain segments of the poor pass their values, attitudes, and behaviors t o their offspring and consequently perpetuate poverty from one generation t o the next. Despite the basic longitudinal nature of Lewis's hypothesis, little poverty research has been generational in scope, leaving the debate t o be developed in primarily theoretical/politicaI terms or, when empirical data have been used, almost entirely in synchronic research designs.

The American surgeon, 2004

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to cho...

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to cho...

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Annals of Internal Medicine, Aug 1, 1988

Family Systems Medicine, 1986

The Journal of family practice, 1989

A prospective cohort study was designed to study the effects of family functioning and stress on ... more A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was signifi...

Open Journal of Obstetrics and Gynecology, 2013

PubMed, 1991

A prospective cohort study was undertaken to evaluate the relationship of family functioning to i... more A prospective cohort study was undertaken to evaluate the relationship of family functioning to infant birthweight adjusted for length of gestation. The mother's perception of family functioning was assessed at the initial prenatal visit using the Family Adaptability and Cohesion Evaluation Scales (FACES II). All obstetric patients at four family medicine clinics from April 1984 through April 1987 whose initial prenatal visits occurred by the 28th week of gestation were invited to participate; 95% chose to do so. Information was obtained on 833 mother-infant pairs. Listwise deletion on any one variable reduced the sample to 772 with no apparent bias in the dependent or predetermined variables. Twelve percent of the families were considered to be dysfunctional by scoring on the extremes of both the cohesion and adaptability continua of the self-report FACES II questionnaire. Infant birthweight was regressed on length of gestation and other known biomedical, anthropometric, risk-behavior, and sociodemographic determinants, as well as family functioning. Women who perceived their families as dysfunctional were delivered of infants who weighed on the average 126.4 g (95% CI 37.4, 215.4) less than infants born to women from functional families (P = .0055), after adjusting for other known determinants. Family functioning also was found to modify the effects of prepregnancy weight and infant sex on infant birthweight.

PubMed, Jun 1, 1986

A prospective study was undertaken to evaluate the relationship of family functioning, family str... more A prospective study was undertaken to evaluate the relationship of family functioning, family structure, and life events with pregnancy outcome. Family functioning was assessed utilizing the Family Adaptability and Cohesion Evaluation Scales (FACES) and the Family APGAR. One hundred twenty-five infants were delivered with a mean birth weight of 3,283 g and a mean gestational age of 281.2 days. Listwise deletion of missing data reduced the study sample to 102 mother-infant pairs with no bias in the dependent or predetermined variables in the subsample. Birth weight was regressed on medical, anthropometric, risk-behavior, sociodemographic, and life-events variables, which together explained 42 percent of the variance. Family functioning was found to contribute an additional 7 percent of the variance (adjusted R2 = 0.49). Family structure accounted for 4.5 percent of the variance in birth weight, and life events added 5 percent. As a complementary analysis, infant birth weight was regressed on the medical, anthropometric, sociodemographic, risk-behavior, and life-events variables, and the residuals from this equation were then regressed on the measures of family functioning. Again, abnormal family functioning proved to be a powerful and significant contributor to the explained variance.

PubMed, May 1, 1989

A prospective cohort study was designed to study the effects of family functioning and stress on ... more A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was significantly associated with both cohesion and adaptability as measured by FACES II. Neither the Family APGAR nor the SRRS was associated with influenza B infection. It was concluded that family functioning affects the frequency of influenza B infection within families. This finding raises the possibility that family dysfunction may lead to altered immune responses, which increases susceptibility to infection.

International Urogynecology Journal, Jul 29, 2004

Study designs and other criteria for inclusion in the review The primary studies were identified ... more Study designs and other criteria for inclusion in the review The primary studies were identified from a review of the literature, although it was unclear whether it was a systematic review. No information on the design of the primary studies was provided. Data on life expectancy and the average age of first-time mothers in the USA were derived from national statistics. Sources searched to identify primary studies MEDLINE was searched from 1980 to identify relevant studies. The bibliographic references of retrieved articles were also checked. Criteria used to ensure the validity of primary studies The authors stated that, whenever possible, data from randomised clinical trials were used. Otherwise, less robust studies were used to provide data. Methods used to judge relevance and validity, and for extracting data Not stated. Number of primary studies included Twenty-four studies provided the evidence used in the decision model. Methods of combining primary studies It appears that a narrative method has been used to combine the primary estimates. Investigation of differences between primary studies Not stated.

Psycho-oncology, 2005

Many patients play an active role in determining their cancer treatments, and the communication o... more Many patients play an active role in determining their cancer treatments, and the communication of medical information influences patient decision-making. This study examined participants' preferences between various methods of communicating quantitative risks and benefits of adjuvant chemotherapy. Using clinical vignettes, participants were first asked to decide whether or not to endorse chemotherapy and were subsequently asked about their preferences for the methods used to communicate the risks and benefits. Participants preferred the absolute survival benefit method over negatively framed methods, such as relative or absolute risk reduction. We also present analysis of qualitative data which supports the conclusions drawn from quantitative analyses. In summary, the absolute survival benefit was shown to be the superior method of communicating quantitative risks and benefits of chemotherapy. Failure to use clear and concise methods of communicating quantitative risk and benefit information may compromise efforts to obtain informed consent for treatment.

Pacific sociological review, Apr 1, 1979

The National Longitudinal Surveys of young males provi data for the construction of causal models... more The National Longitudinal Surveys of young males provi data for the construction of causal models of occupation bility for both black and white workers. These NLS dat several methodological variations from previous occup mobility research, including longitudinal design, less rel retrospective techniques, and a more precise time fram annual models indicate that beyond years of education, very variables available to most surveys have a statistically signif effect on variation in occupational prestige and incom these longitudinal surveys show a growing racial gap in tional rewards. Much of this increase in the black-white reward differences is found to be related to labor market racial discrimination in advancement rather than to different levels of family background and labor market entry. Policy implications are drawn based on the importance of education and the racial discrimination in occupational mobility.

Breast Journal, 2003

Previous studies have shown that independent of tumor size, palpable breast tumors have a higher ... more Previous studies have shown that independent of tumor size, palpable breast tumors have a higher incidence of lymph node metastasis compared with nonpalpable tumors. This study further examines this phenomenon using a large sentinel lymph node (SLN) database. Data from a prospective, institutional review board (IRB)-approved, multi-institutional study from the University of Louisville Breast Cancer Sentinel Lymph Node Study Group was used. From August 1997 through December 2001, 3192 patients with clinical T1 and T2 N0 breast cancer underwent SLN biopsy, most with a combined technique of radioactive colloid and blue dye, followed by level I/II axillary dissection. Patients with palpable tumors tended to be younger (mean age 58 years) compared with nonpalpable tumors (mean age 61 years). The incidence of positive axillary metastasis was significant between palpable and nonpalpable tumors (43% and 23%, respectively), independent of tumor size by logistic regression (p = 0.0001). The SLN identification rate was significantly different between palpable and nonpalpable tumors (95% versus 91%, respectively; p < 0.0001). A unifying theory to explain the phenomenon that palpable tumors, stage for stage, are associated with a higher rate of nodal metastasis is that palpable tumors are, on average, closer to the skin and the rich network of dermal lymphatics. We believe that the dermal lymphatics of the breast represent a clinically relevant metastatic pathway to the axilla.

American Surgeon, Mar 1, 2004

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life.

Pediatric Infectious Disease Journal, Jun 1, 1988

In a randomized, double-blind placebo-controlled clinical trial, we evaluated the prophylactic ef... more In a randomized, double-blind placebo-controlled clinical trial, we evaluated the prophylactic effectiveness of rimantadine in children (ages 1 to 18 years) against infection with influenza A (H3N2) and associated illness and the prevention of transmission of infection to adult members of the child's family. One hundred ten volunteers from 29 families completed this study during a naturally occurring outbreak of influenza A (H3N2). Influenza infections, defined as a positive viral throat culture or a 4-fold increase in antibody titer, occurred in 31.0% of children in the placebo group and 7.4% in the rimantadine group (P = 0.026). Clinical illness with laboratory evidence of influenza infection occurred in 24.1% of children in the placebo group and none in the rimantadine group (P = 0.007). Rimantadine was well-tolerated by the children, with no significant difference in reported adverse effects between the placebo and rimantadine groups. A combined analysis by families of these data and those of our similarly designed 1984 study, revealed that families in whom the children were given rimantadine had a significantly lower rate of influenza A infection and influenza-like illness compared with the families in whom the children were given placebo (68.8% vs. 18.8%, P less than 0.001) and (56.3% vs. 12.5%, P less than 0.001), respectively. We conclude that rimantadine prophylaxis of children appears to be an effective method to prevent influenza A (either H1N1 or H3N2) infection and illness in children.

Open Journal of Obstetrics and Gynecology, 2013

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uter... more Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse; erosion; infection; transfusion; cystotomy; chronic pain; lower urinary tract symptoms; and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of 22,657perQALY.Thecosts(22,657 per QALY. The costs (22,657perQALY.Thecosts(14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of 15,995perQALY.TheincrementalcostperQALYsforroboticsurgerywas15,995 per QALY. The incremental cost per QALYs for robotic surgery was 15,995perQALY.TheincrementalcostperQALYsforroboticsurgerywas207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn't cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Social Problems, Jun 1, 1982

This paper constructs racially and sexually comparative models of labor market entry to assess th... more This paper constructs racially and sexually comparative models of labor market entry to assess the effects of individual differences and labor market discrimination. Traditional measures of racial discrimination in the labor market are of relatively small importance in ...

European Journal of Obstetrics & Gynecology and Reproductive Biology, Nov 1, 2016

Background: The specialization of human fat deposits is an inquiry of special importance in the s... more Background: The specialization of human fat deposits is an inquiry of special importance in the study of fetal growth. It has been theorized that maternal lower-body fat is designated specifically for lactation and not for the growth of the fetus. Objective: Our goal was to compare the contributions of maternal upper-body versus lower-body adiposity to infant birth weight. We hypothesized that upper-body adiposity would be strongly associated with infant birth weight and that lower-body adiposity would be weakly or negligibly associated with infant birth weight-after adjusting for known determinants. Study design: In this prospective cohort study, 355 women initiated medical pre-natal care during the first trimester of pregnancy at The University of Oklahoma Health Sciences Center during 1990-1993. Maternal anthropometric measurements were assessed at the first clinic visit: (a) height; (b) weight; (c) circumferences of the upper arm, forearm, and thigh; and, (d) skin-fold measurements of the bicep, subscapular region, and thigh. Results: Infant birth weight was regressed on known major determinants to create the foundational model. Maternal anthropometric variables subsequently were added one at a time into this multiple regression model. The highest contribution by a single anthropometric variable to infant birthweight was, in order: subscapular skin-fold, forearm circumference, and thigh circumference. With one upperbody (subscapular skin-fold) and one lower-body (circumference of the thigh) adiposity measure in the model, the z-score regression coefficient (s.e.) was 85.7 g (30.8) [p = 0.0057] for maternal subscapular skin-fold and 19.0 g (31.6) [p = 0.5477] for circumference of the thigh. When the second-best upperbody contributor to infant birthweight (circumference of the forearm) was entered with one lowerbody measure into the model, the z-score regression coefficient (s.e.) was 77.5 g (38.5) [p = 0.0451] for maternal forearm circumference and 14.1 g (38.5) [p = 0.7146] for circumference of the thigh. When both subscapular skinfold and forearm circumference were added to the model in place of BMI, the explained variance (r 2 = 0.5478) was similar to the model using BMI (r 2 = 0.5487). Conclusion: Upper-body adipositywhether operationalized by subscapular skin-fold or circumference of the forearmwas a markedly larger determinant of infant birth weight than lower-body adiposity. 2016 Elsevier Ireland Ltd. All rights reserved.

American Ethnologist, Aug 1, 1979

At the heart of Lewis's (1966) conceptualization of a "culture of poverty" is his assertion that ... more At the heart of Lewis's (1966) conceptualization of a "culture of poverty" is his assertion that certain segments of the poor pass their values, attitudes, and behaviors t o their offspring and consequently perpetuate poverty from one generation t o the next. Despite the basic longitudinal nature of Lewis's hypothesis, little poverty research has been generational in scope, leaving the debate t o be developed in primarily theoretical/politicaI terms or, when empirical data have been used, almost entirely in synchronic research designs.

The American surgeon, 2004

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to cho...

In the absence of data from randomized trials, a formal decision analysis was undertaken to quant... more In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to cho...

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Annals of Internal Medicine, Aug 1, 1988

Family Systems Medicine, 1986

The Journal of family practice, 1989

A prospective cohort study was designed to study the effects of family functioning and stress on ... more A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was signifi...

Open Journal of Obstetrics and Gynecology, 2013