Lisa M Klesges | University of Memphis (original) (raw)

Papers by Lisa M Klesges

Research paper thumbnail of The influence of race, sex, and social disadvantage on self-reported health in patients presenting with chronic musculoskeletal pain

American Journal of Physical Medicine & Rehabilitation

Research paper thumbnail of Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study

Journal of Thoracic Oncology

Research paper thumbnail of Society of Behavioral Medicine (SBM) urges Congress to ensure efforts to increase and enhance broadband internet access in rural areas

Translational Behavioral Medicine

The Society for Behavioral Medicine (SBM) recommends expanding access to high-speed, high-definit... more The Society for Behavioral Medicine (SBM) recommends expanding access to high-speed, high-definition internet and increasing broadband width for rural communities in the USA to increase telehealth opportunities for populations facing geographic barriers to accessing quality healthcare. High-speed telehealth will allow healthcare providers to care for patients in “real time” and will expand access to specialty providers thereby increasing timely follow-up, improving health outcomes, and reducing rural health disparities. Moreover, SBM recommends that the current National Broadband Plan legislation be protected and enhanced to ensure high-quality, but also affordable, internet services in rural areas. Several legislative bills have been put forth but are not fully funded or enacted by individual states. In addition, further mechanisms and supplemental funding are needed to address the continued lack of resources to enhance rural broadband including infrastructure, research, and regula...

Research paper thumbnail of The sickle cell disease implementation consortium: Translating evidence-based guidelines into practice for sickle cell disease

American Journal of Hematology

the centrifugation-based washing did not translate into the corresponding changes in key metrics ... more the centrifugation-based washing did not translate into the corresponding changes in key metrics of RBC in vitro quality, including deformability (see Supporting Information). This finding suggests that the probability of each individual RBCs to be damaged by centrifugation is likely independent of the cell's properties, and therefore hemolysis of damaged cells during the 24-h storage does not affect the overall quality of the sample. In contrast, our earlier work has shown that selective lysis of RBCs irreversibly damaged during hypothermic storage (sphero-echinocytes and spherocytes) via hypotonic washing produced a modest, but statistically significant improvement in the overall deformability of the sample. 5 Further studies are needed to gain additional insight into how centrifugation and other types of processing affect stored RBCs at the single-cell level, and how the extent of resulting mechanical damage may depend on the individual cell properties. Although centrifugation-free washing drastically reduced the rate at which potassium and free Hb increased in the supernatant, it could not completely eliminate their buildup (Figure 1). It is therefore likely that other parts of the washing process besides centrifugation may also be damaging to stored RBCs. One possible source of mechanical damage in our centrifugation-free washing system is the contact of relatively fragile stored RBCs with the surfaces of the coiled tubing and the membrane-hydrogel component of the system. 1 Another potential source of damage is the difference between osmolality of the storage medium in a typical RBC unit (~360 mmol/kg) and osmolality of saline used for washing stored RBCs (~285 mmol/kg). The reduction in osmolality of the suspending medium during washing causes mild swelling of washed RBCs, which ultimately leads to selective lysis of most spherical cells (sphero-echinocytes, spherocytes). 5 Finally, the use of normal saline (0.9% NaCl solution) as the washing solution may by itself be damaging to cells, causing significantly more hemolysis than balanced, buffered crystalloid solutions (such as Plasma-Lyte A). 6 The vast majority of low birth weight infants receive RBC transfusions during the first few weeks of life (typically, 10-20 mL/kg transfused over 4 h), and washing of stored RBCs in normal saline is one of the strategies currently used for reducing the amount of potentially toxic contaminants contained in the storage medium being transfused to neonates. The prototype of the centrifugation-free washing system we used in this study operated at 300 mL/h, a throughput already sufficient for washing small volumes of stored RBCs in a reasonable amount of time (eg, a 50 mL aliquot washed with 250 mL of saline in less than an hour). Such a simple, inexpensive, disposable washing system could therefore be particularly useful in the neonatal and pediatric transfusion settings. Further research and development will be needed, however, to convert our latest prototype into a fully "closed system" format, and enable proper validation in the clinical settings.

Research paper thumbnail of Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results

Translational lung cancer research, 2018

Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenge... more Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care. We established a co-located multidisciplinary clinic to study the implementation of this care-delivery model. We identified and engaged key stakeholders from the onset, used their input to develop the program structure, processes, performance benchmarks, and study endpoints (outcome-related process measures, patient- and caregiver-reported outcomes, survival). In this report, we describe the study design, process of implementatio...

Research paper thumbnail of PS01.39: Reach and Adoption of a Surgical Intervention to Improve Pathologic Nodal Staging Across Healthcare Systems within the US Mid-South: Topic: Surgery

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2016

The patient was started on treatment for TC comprising temozolomide + capecitabine, octreotide lo... more The patient was started on treatment for TC comprising temozolomide + capecitabine, octreotide long-acting repeatable, and denosumab. Everolimus will be considered upon disease progression. Conclusion: The indolent disease behavior throughout the course of several treatments for high-grade lung NET without an impressive response led to a suspicion, then confirmed diagnosis, of a low-grade TC in this patient. While lung NET differentiation can be challenging, early suspicion in patients who neither respond nor progress on a platinum + etoposide-based doublet therapy can avoid unnecessary toxicity and the associated poor quality of life.

Research paper thumbnail of Family context as it relates to weight-related behaviors in preadolescent African American girls

American Journal of Health Behavior, May 1, 2011

To examine family context in relation to body image, weight concerns, and weight control behavior... more To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls. Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial. Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls' body image and weight control behaviors. A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

Research paper thumbnail of Symptomatology across the menstrual cycle in smoking and nonsmoking women

Addict Behav, 1995

Recent studies suggest that both smoking rates and general menstrual symptomatology increase in w... more Recent studies suggest that both smoking rates and general menstrual symptomatology increase in women premenstrually; however. no study has investigated the changes in menstrual symptomatology and smoking behavior in both smoking and nonsmoking women over an entire menstrual cycle. Thirty premenopausal women completed daily symptom checklists over an entire menstrual cycle. Smokers also recorded their smoking behavior. Results indicated that symptom severity was greatest during menses for both smoking and nonsmoking women. For cigarette consumption. analyses indicated that women smokers appear to smoke more during menses and the luteal phases than ovulation and that variability in smoking was greatest premenstrually. In summary, results indicated that general menstrual symptomatology increases during menses and the late luteal phase and that smoking-deprivation symptomatology increase in both smokers and nonsmokers. This suggests that smokers may have a difficult time quitting during menses or the luteal phase of their cycle.

Research paper thumbnail of The relationship between caffeine and blood pressure in preadolescent African American girls

Ethnicity Disease, Feb 1, 2008

Background: While high caffeine consumption has been shown to be associated with increased blood ... more Background: While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8-to 10-year-old African American girls who eat an unrestricted diet. Methods: Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models. Results: Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P5.33 and P5.36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P,.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P5.01 and P5.02, respectively). Conclusions: Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8-to 10-year-old African American girls who eat an unrestricted diet.

Research paper thumbnail of Measuring improvement in populations: implementing and evaluating successful change in lung cancer care

Translational lung cancer research, 2015

Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the ... more Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the United States, is a major public health challenge. Such improvement requires accurate and meaningful measurement of quality of care. Preliminary indicators have been derived from clinical practice guidelines and expert opinions, but there are few standard sets of quality of care measures for lung cancer in the United States or elsewhere. Research to develop validated evidence-based quality of care measures is critical in promoting population improvement initiatives in lung cancer. Furthermore, novel research designs beyond the traditional randomized controlled trials (RCTs) are needed for wide-scale applications of quality improvement and should extend into alternative designs such as quasi-experimental designs, rigorous observational studies, population modeling, and other pragmatic study designs. We discuss several study design options to aid the development of practical, actionable, a...

Research paper thumbnail of Predictors of waist circumference change in healthy young adults

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1995

To identify predictors of a change in waist circumference in a group of healthy young adults. Cau... more To identify predictors of a change in waist circumference in a group of healthy young adults. Caucasian, 121 women and 109 men, participating in a longitudinal investigation of cardiovascular risk factors in parents and their young children. Evaluations of body weight, waist and hip circumferences, dietary intake, physical activity, cigarette smoking, and alcohol intake were performed annually. Age was recorded and family history of disease was assessed. For women, covariates and modifiable predictors accounted for 67% of the variance in waist circumference change from Year 1 to Year 3. Women with lower baseline waist girths, lower baseline hip girths, higher baseline body weight, and a greater change in body weight had larger increases in waist girth. For men, covariates and modifiable predictors accounted for 72% of the variance in waist circumference change. Men with lower baseline waist girth, a greater change in hip girth, higher baseline body weight, greater increases in body ...

Research paper thumbnail of Diabetes and energy intake

The American journal of clinical nutrition, 1993

Research paper thumbnail of Effects of alcohol intake on resting energy expenditure in young women social drinkers

The American journal of clinical nutrition, 1994

This investigation evaluated the effects of alcohol consumption, controlled for the energy in alc... more This investigation evaluated the effects of alcohol consumption, controlled for the energy in alcohol and chronic effects of smoking, on resting energy expenditure (REE) in college-aged social drinkers. Sixteen women who both smoked and drank alcohol were administered, on 4 separate days in a counterbalanced order, 1) cigarettes alone, 2) alcohol alone, 3) alcohol plus cigarettes, or 4) cigarettes with an energetic control. Each session consisted of a 25-min REE baseline, treatment in a randomly assigned order, and a 105-min assessment of REE. Analysis indicated that alcohol significantly (P < 0.05) increased REE for up to 95 min after ingestion [increases of 29.6-68.4 kJ (124-287 kcal)/24 h], increases that could not be accounted for by the energy content of the drink alone. Smoking and alcohol together also raised REE above baseline but not more than alcohol alone. It was concluded that alcohol intake raises REE, potentially explaining why alcohol interferes with energy utiliza...

Research paper thumbnail of Response from the Behavior Change Consortium Representatives and Translation Work Group: the issue is one of impact, not of world view or preferred approach

Health education research, 2002

Research paper thumbnail of “Must-See” Websites

Childhood Obesity (Formerly Obesity and Weight Management), 2011

The objective of this study was to determine the longitudinal prevalence and predictors of dietar... more The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS). Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prediction equation, and caloric underreporting was based on the Goldberg equation. We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI. Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Research paper thumbnail of 1. Title: Prevalence and Clustering of Multiple Behavioral Risk Factors in Adult Survivors of Childhood Cancer: Implications for Prevention 2. Writing Group

Research paper thumbnail of Measurement characteristics of activity-related psychosocial measures in 8- to 10-year-old African-American girls in the Girls health Enrichment Multisite Study (GEMS)

Preventive Medicine, 2004

Background. This paper presents reliability and validity analyses of physical activity-related ps... more Background. This paper presents reliability and validity analyses of physical activity-related psychosocial questionnaires completed by 8to 10-year-old African-American girls at baseline and follow-up assessments of pilot intervention studies in the Girls health Enrichment Multi-site Study (GEMS). Methods. Two hundred ten girls participated in the GEMS 12-week pilot studies and had their height and weight measured, wore an accelerometer for 3 days and completed a measure of their usual physical activity (PA) at baseline and after the 12-week intervention. Subgroups of girls also completed physical activity-related psychosocial measures at these two time points including: (a) self-concept; (b) self-efficacy; (c) outcome expectancies; and d) preferences. Principal components analysis was conducted on the psychosocial measures obtained at baseline. Cronbach's alpha and test-retest reliability were computed. Convergent validity was assessed by correlating the baseline psychosocial measures with baseline physical activity measures and body mass index (BMI). Results. The following sub-scales were derived: Activity Preference, Positive Expectancies and Negative Expectancies for physical activity. Physical Performance Self-Concept and Self-Efficacy for physical activity were kept as single dimensional scales. Sub-scales, derived from principal components analyses, were Activity Preference, Positive Expectancies, and Negative Expectancies for physical activity. Internal consistency estimates for the various scales were substantial to excellent (0.67-0.85), while test-retest reliability estimates were fair to moderate (0.22-0.56). Correlations between the PA psychosocial sub-scales and measured levels of activity measures showed evidence of convergent validity for the Activity Preference sub-scale, although social desirability may have influenced the significant associations observed. Conclusions. The Activity Preference was a fairly reliable and valid measure. Further studies are needed to examine the utility of activityrelated psychosocial measures in interventions to increase physical activity among preadolescent African-American girls.

Research paper thumbnail of Social desirability bias in self-reported dietary, physical activity and weight concerns measures in 8- to 10-year-old African-American girls: results from the Girls health Enrichment Multisite Studies (GEMS)

Preventive Medicine, 2004

Background. Social desirability (SocD) may bias children's self-reported health behaviors and att... more Background. Social desirability (SocD) may bias children's self-reported health behaviors and attitudes and confound relationships with health outcome measures. Methods. Ninety-five, 8-to 10-year-old African-American girls completed dietary recalls, a physical activity checklist, psychosocial questionnaires related to diet, and physical activity; and 3 days of physical activity monitoring. Potential SocD construct bias was investigated by comparing designated criterion measures of physical activity, beverage intake, and body mass index (BMI) with respective self-reported measures related to activity, beverage preferences, and body image and weight concerns in cross-sectional regression models. Potential confounding by SocD of associations between self-reported behaviors with BMI was assessed using change-in-coefficient regression analyses. Results. Controlling for age and BMI, overestimates of self-reported activity (P = 0.02), underestimates of sweetened beverage preferences (P = 0.02), and lower ratings of weight concerns and dieting behaviors (P's < 0.05) were related to SocD. Confounding by SocD of associations between self-reported physical activity and energy intake with BMI was found. Conclusions. In 8-to 10-year-old African-American girls, SocD was found to bias self-reports of diet and physical activity and confound associations between BMI and self-reported physical activity and energy intake. Methods to measure and control SocD bias are needed to reduce potential distortion of relationships between diet and physical activity and health outcomes.

Research paper thumbnail of African-American Girls’ Dietary Intake while Watching Television

Obesity, 2004

American girls' dietary intake while watching television. Obes Res. 2004;12:32S-37S. Objective: T... more American girls' dietary intake while watching television. Obes Res. 2004;12:32S-37S. Objective: Television viewing has been associated with childhood obesity, although the mechanisms that link television viewing to higher BMI have not been established. Therefore, our objectives, in this report, were to describe the amount and types of foods that African-American girls consume while watching television and to examine the associations between African-American girls' BMI and the food they consume while watching television. Research Methods and Procedures: Data were collected from 210 8-to 10-year-old African-American girls at four field centers by trained and certified nutritionists. Two nonconsecutive 24-hour dietary recalls were collected from each girl. For each eating episode reported, the girls were asked if they had been watching television while eating. Height and weight were collected using standard methods and used to calculate BMI. Results: The data were analyzed separately by field center. The proportion of average daily energy intake that the girls consumed while watching television ranged from 26.9% to 35.0%. At all field centers, 40% to 50% of evening meals were consumed while watching television. None of the Spearman correlations between girls' BMI and the amount and type of foods consumed while watching television or at other times during the day were statistically significant (p Ͼ 0.05). Discussion: This research revealed that a significant proportion of African-American girls' daily energy intake is consumed while watching television. Interventions that target reductions in food consumption while watching television or reducing television viewing may be effective strategies to decrease children's energy intakes. These results support a need for research to test the efficacy of these approaches.

Research paper thumbnail of Anthropometric, Parental, and Psychosocial Correlates of Dietary Intake of African-American Girls

Obesity, 2004

Objective: This paper identifies the anthropometric, parental, and psychosocial characteristics a... more Objective: This paper identifies the anthropometric, parental, and psychosocial characteristics and meal practices (e.g., breakfast skipping and number of meals and snacks consumed) associated with consumption of total energy, percent energy from fat, fruit, 100% fruit juice, vegetables, sweetened beverages, and water among 8-to 10-year-old African-American girls. Research Methods and Procedures: This study included 114 8-to 10-year-old African-American girls and a parent or primary caregiver. Girls and a parent or primary caregiver completed several dietary questionnaires. Two 24hour dietary recalls were conducted with each girl. Height and weight were measured. Separate hierarchical regression analyses were conducted for each dependent dietary variable; potential field center differences were examined. Results: The number of meals and snacks consumed was correlated with energy intake. Lower BMI was related to higher vegetable consumption, and the number of snacks consumed was positively related to sweetened beverage consumption. Greater low-fat food preparation practices reported by parents were related to lower consumption of fat as a percentage of total energy. Discussion: Dietary behavior differed across geographic areas. Low-fat food preparation practices in the home seemed to be an important influence on the percentage of energy consumed from fat. Greater vegetable consumption was associated with lower BMI. Interventions to prevent excessive weight gain in African-American girls should encourage low-fat food preparation in the home and greater consumption of vegetables.

Research paper thumbnail of The influence of race, sex, and social disadvantage on self-reported health in patients presenting with chronic musculoskeletal pain

American Journal of Physical Medicine & Rehabilitation

Research paper thumbnail of Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study

Journal of Thoracic Oncology

Research paper thumbnail of Society of Behavioral Medicine (SBM) urges Congress to ensure efforts to increase and enhance broadband internet access in rural areas

Translational Behavioral Medicine

The Society for Behavioral Medicine (SBM) recommends expanding access to high-speed, high-definit... more The Society for Behavioral Medicine (SBM) recommends expanding access to high-speed, high-definition internet and increasing broadband width for rural communities in the USA to increase telehealth opportunities for populations facing geographic barriers to accessing quality healthcare. High-speed telehealth will allow healthcare providers to care for patients in “real time” and will expand access to specialty providers thereby increasing timely follow-up, improving health outcomes, and reducing rural health disparities. Moreover, SBM recommends that the current National Broadband Plan legislation be protected and enhanced to ensure high-quality, but also affordable, internet services in rural areas. Several legislative bills have been put forth but are not fully funded or enacted by individual states. In addition, further mechanisms and supplemental funding are needed to address the continued lack of resources to enhance rural broadband including infrastructure, research, and regula...

Research paper thumbnail of The sickle cell disease implementation consortium: Translating evidence-based guidelines into practice for sickle cell disease

American Journal of Hematology

the centrifugation-based washing did not translate into the corresponding changes in key metrics ... more the centrifugation-based washing did not translate into the corresponding changes in key metrics of RBC in vitro quality, including deformability (see Supporting Information). This finding suggests that the probability of each individual RBCs to be damaged by centrifugation is likely independent of the cell's properties, and therefore hemolysis of damaged cells during the 24-h storage does not affect the overall quality of the sample. In contrast, our earlier work has shown that selective lysis of RBCs irreversibly damaged during hypothermic storage (sphero-echinocytes and spherocytes) via hypotonic washing produced a modest, but statistically significant improvement in the overall deformability of the sample. 5 Further studies are needed to gain additional insight into how centrifugation and other types of processing affect stored RBCs at the single-cell level, and how the extent of resulting mechanical damage may depend on the individual cell properties. Although centrifugation-free washing drastically reduced the rate at which potassium and free Hb increased in the supernatant, it could not completely eliminate their buildup (Figure 1). It is therefore likely that other parts of the washing process besides centrifugation may also be damaging to stored RBCs. One possible source of mechanical damage in our centrifugation-free washing system is the contact of relatively fragile stored RBCs with the surfaces of the coiled tubing and the membrane-hydrogel component of the system. 1 Another potential source of damage is the difference between osmolality of the storage medium in a typical RBC unit (~360 mmol/kg) and osmolality of saline used for washing stored RBCs (~285 mmol/kg). The reduction in osmolality of the suspending medium during washing causes mild swelling of washed RBCs, which ultimately leads to selective lysis of most spherical cells (sphero-echinocytes, spherocytes). 5 Finally, the use of normal saline (0.9% NaCl solution) as the washing solution may by itself be damaging to cells, causing significantly more hemolysis than balanced, buffered crystalloid solutions (such as Plasma-Lyte A). 6 The vast majority of low birth weight infants receive RBC transfusions during the first few weeks of life (typically, 10-20 mL/kg transfused over 4 h), and washing of stored RBCs in normal saline is one of the strategies currently used for reducing the amount of potentially toxic contaminants contained in the storage medium being transfused to neonates. The prototype of the centrifugation-free washing system we used in this study operated at 300 mL/h, a throughput already sufficient for washing small volumes of stored RBCs in a reasonable amount of time (eg, a 50 mL aliquot washed with 250 mL of saline in less than an hour). Such a simple, inexpensive, disposable washing system could therefore be particularly useful in the neonatal and pediatric transfusion settings. Further research and development will be needed, however, to convert our latest prototype into a fully "closed system" format, and enable proper validation in the clinical settings.

Research paper thumbnail of Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results

Translational lung cancer research, 2018

Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenge... more Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care. We established a co-located multidisciplinary clinic to study the implementation of this care-delivery model. We identified and engaged key stakeholders from the onset, used their input to develop the program structure, processes, performance benchmarks, and study endpoints (outcome-related process measures, patient- and caregiver-reported outcomes, survival). In this report, we describe the study design, process of implementatio...

Research paper thumbnail of PS01.39: Reach and Adoption of a Surgical Intervention to Improve Pathologic Nodal Staging Across Healthcare Systems within the US Mid-South: Topic: Surgery

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2016

The patient was started on treatment for TC comprising temozolomide + capecitabine, octreotide lo... more The patient was started on treatment for TC comprising temozolomide + capecitabine, octreotide long-acting repeatable, and denosumab. Everolimus will be considered upon disease progression. Conclusion: The indolent disease behavior throughout the course of several treatments for high-grade lung NET without an impressive response led to a suspicion, then confirmed diagnosis, of a low-grade TC in this patient. While lung NET differentiation can be challenging, early suspicion in patients who neither respond nor progress on a platinum + etoposide-based doublet therapy can avoid unnecessary toxicity and the associated poor quality of life.

Research paper thumbnail of Family context as it relates to weight-related behaviors in preadolescent African American girls

American Journal of Health Behavior, May 1, 2011

To examine family context in relation to body image, weight concerns, and weight control behavior... more To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls. Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial. Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; body image and weight control behaviors. A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

Research paper thumbnail of Symptomatology across the menstrual cycle in smoking and nonsmoking women

Addict Behav, 1995

Recent studies suggest that both smoking rates and general menstrual symptomatology increase in w... more Recent studies suggest that both smoking rates and general menstrual symptomatology increase in women premenstrually; however. no study has investigated the changes in menstrual symptomatology and smoking behavior in both smoking and nonsmoking women over an entire menstrual cycle. Thirty premenopausal women completed daily symptom checklists over an entire menstrual cycle. Smokers also recorded their smoking behavior. Results indicated that symptom severity was greatest during menses for both smoking and nonsmoking women. For cigarette consumption. analyses indicated that women smokers appear to smoke more during menses and the luteal phases than ovulation and that variability in smoking was greatest premenstrually. In summary, results indicated that general menstrual symptomatology increases during menses and the late luteal phase and that smoking-deprivation symptomatology increase in both smokers and nonsmokers. This suggests that smokers may have a difficult time quitting during menses or the luteal phase of their cycle.

Research paper thumbnail of The relationship between caffeine and blood pressure in preadolescent African American girls

Ethnicity Disease, Feb 1, 2008

Background: While high caffeine consumption has been shown to be associated with increased blood ... more Background: While high caffeine consumption has been shown to be associated with increased blood pressure in controlled experiments, the relationship between caffeine consumption and blood pressure in preadolescent (ages 6-11 years) and adolescent (ages 12-19 years) children has not been well studied. The primary objective of this study was to assess the cross-sectional relationship between caffeine intake and blood pressure in 8-to 10-year-old African American girls who eat an unrestricted diet. Methods: Demographic, 24-hour dietary recall, and blood pressure data collected at baseline from 303 African American girls aged 8-10 years in the Girls health Enrichment Multisite Studies (GEMS) cohort were analyzed by using linear and multiple regression models. Results: Dietary caffeine intake was not associated with either systolic or diastolic blood pressure (P5.33 and P5.36, respectively). However, consistent with the literature, height and body mass index were each positively and independently associated with systolic blood pressure (both P,.0001). Height and amount of sodium intake were positively associated with diastolic blood pressure (P5.01 and P5.02, respectively). Conclusions: Dietary caffeine intake in low amounts is not associated with elevated blood pressure in 8-to 10-year-old African American girls who eat an unrestricted diet.

Research paper thumbnail of Measuring improvement in populations: implementing and evaluating successful change in lung cancer care

Translational lung cancer research, 2015

Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the ... more Improving quality of care in lung cancer, the leading cause of cancer death worldwide and in the United States, is a major public health challenge. Such improvement requires accurate and meaningful measurement of quality of care. Preliminary indicators have been derived from clinical practice guidelines and expert opinions, but there are few standard sets of quality of care measures for lung cancer in the United States or elsewhere. Research to develop validated evidence-based quality of care measures is critical in promoting population improvement initiatives in lung cancer. Furthermore, novel research designs beyond the traditional randomized controlled trials (RCTs) are needed for wide-scale applications of quality improvement and should extend into alternative designs such as quasi-experimental designs, rigorous observational studies, population modeling, and other pragmatic study designs. We discuss several study design options to aid the development of practical, actionable, a...

Research paper thumbnail of Predictors of waist circumference change in healthy young adults

International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 1995

To identify predictors of a change in waist circumference in a group of healthy young adults. Cau... more To identify predictors of a change in waist circumference in a group of healthy young adults. Caucasian, 121 women and 109 men, participating in a longitudinal investigation of cardiovascular risk factors in parents and their young children. Evaluations of body weight, waist and hip circumferences, dietary intake, physical activity, cigarette smoking, and alcohol intake were performed annually. Age was recorded and family history of disease was assessed. For women, covariates and modifiable predictors accounted for 67% of the variance in waist circumference change from Year 1 to Year 3. Women with lower baseline waist girths, lower baseline hip girths, higher baseline body weight, and a greater change in body weight had larger increases in waist girth. For men, covariates and modifiable predictors accounted for 72% of the variance in waist circumference change. Men with lower baseline waist girth, a greater change in hip girth, higher baseline body weight, greater increases in body ...

Research paper thumbnail of Diabetes and energy intake

The American journal of clinical nutrition, 1993

Research paper thumbnail of Effects of alcohol intake on resting energy expenditure in young women social drinkers

The American journal of clinical nutrition, 1994

This investigation evaluated the effects of alcohol consumption, controlled for the energy in alc... more This investigation evaluated the effects of alcohol consumption, controlled for the energy in alcohol and chronic effects of smoking, on resting energy expenditure (REE) in college-aged social drinkers. Sixteen women who both smoked and drank alcohol were administered, on 4 separate days in a counterbalanced order, 1) cigarettes alone, 2) alcohol alone, 3) alcohol plus cigarettes, or 4) cigarettes with an energetic control. Each session consisted of a 25-min REE baseline, treatment in a randomly assigned order, and a 105-min assessment of REE. Analysis indicated that alcohol significantly (P < 0.05) increased REE for up to 95 min after ingestion [increases of 29.6-68.4 kJ (124-287 kcal)/24 h], increases that could not be accounted for by the energy content of the drink alone. Smoking and alcohol together also raised REE above baseline but not more than alcohol alone. It was concluded that alcohol intake raises REE, potentially explaining why alcohol interferes with energy utiliza...

Research paper thumbnail of Response from the Behavior Change Consortium Representatives and Translation Work Group: the issue is one of impact, not of world view or preferred approach

Health education research, 2002

Research paper thumbnail of “Must-See” Websites

Childhood Obesity (Formerly Obesity and Weight Management), 2011

The objective of this study was to determine the longitudinal prevalence and predictors of dietar... more The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS). Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s prediction equation, and caloric underreporting was based on the Goldberg equation. We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI. Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Research paper thumbnail of 1. Title: Prevalence and Clustering of Multiple Behavioral Risk Factors in Adult Survivors of Childhood Cancer: Implications for Prevention 2. Writing Group

Research paper thumbnail of Measurement characteristics of activity-related psychosocial measures in 8- to 10-year-old African-American girls in the Girls health Enrichment Multisite Study (GEMS)

Preventive Medicine, 2004

Background. This paper presents reliability and validity analyses of physical activity-related ps... more Background. This paper presents reliability and validity analyses of physical activity-related psychosocial questionnaires completed by 8to 10-year-old African-American girls at baseline and follow-up assessments of pilot intervention studies in the Girls health Enrichment Multi-site Study (GEMS). Methods. Two hundred ten girls participated in the GEMS 12-week pilot studies and had their height and weight measured, wore an accelerometer for 3 days and completed a measure of their usual physical activity (PA) at baseline and after the 12-week intervention. Subgroups of girls also completed physical activity-related psychosocial measures at these two time points including: (a) self-concept; (b) self-efficacy; (c) outcome expectancies; and d) preferences. Principal components analysis was conducted on the psychosocial measures obtained at baseline. Cronbach's alpha and test-retest reliability were computed. Convergent validity was assessed by correlating the baseline psychosocial measures with baseline physical activity measures and body mass index (BMI). Results. The following sub-scales were derived: Activity Preference, Positive Expectancies and Negative Expectancies for physical activity. Physical Performance Self-Concept and Self-Efficacy for physical activity were kept as single dimensional scales. Sub-scales, derived from principal components analyses, were Activity Preference, Positive Expectancies, and Negative Expectancies for physical activity. Internal consistency estimates for the various scales were substantial to excellent (0.67-0.85), while test-retest reliability estimates were fair to moderate (0.22-0.56). Correlations between the PA psychosocial sub-scales and measured levels of activity measures showed evidence of convergent validity for the Activity Preference sub-scale, although social desirability may have influenced the significant associations observed. Conclusions. The Activity Preference was a fairly reliable and valid measure. Further studies are needed to examine the utility of activityrelated psychosocial measures in interventions to increase physical activity among preadolescent African-American girls.

Research paper thumbnail of Social desirability bias in self-reported dietary, physical activity and weight concerns measures in 8- to 10-year-old African-American girls: results from the Girls health Enrichment Multisite Studies (GEMS)

Preventive Medicine, 2004

Background. Social desirability (SocD) may bias children's self-reported health behaviors and att... more Background. Social desirability (SocD) may bias children's self-reported health behaviors and attitudes and confound relationships with health outcome measures. Methods. Ninety-five, 8-to 10-year-old African-American girls completed dietary recalls, a physical activity checklist, psychosocial questionnaires related to diet, and physical activity; and 3 days of physical activity monitoring. Potential SocD construct bias was investigated by comparing designated criterion measures of physical activity, beverage intake, and body mass index (BMI) with respective self-reported measures related to activity, beverage preferences, and body image and weight concerns in cross-sectional regression models. Potential confounding by SocD of associations between self-reported behaviors with BMI was assessed using change-in-coefficient regression analyses. Results. Controlling for age and BMI, overestimates of self-reported activity (P = 0.02), underestimates of sweetened beverage preferences (P = 0.02), and lower ratings of weight concerns and dieting behaviors (P's < 0.05) were related to SocD. Confounding by SocD of associations between self-reported physical activity and energy intake with BMI was found. Conclusions. In 8-to 10-year-old African-American girls, SocD was found to bias self-reports of diet and physical activity and confound associations between BMI and self-reported physical activity and energy intake. Methods to measure and control SocD bias are needed to reduce potential distortion of relationships between diet and physical activity and health outcomes.

Research paper thumbnail of African-American Girls’ Dietary Intake while Watching Television

Obesity, 2004

American girls' dietary intake while watching television. Obes Res. 2004;12:32S-37S. Objective: T... more American girls' dietary intake while watching television. Obes Res. 2004;12:32S-37S. Objective: Television viewing has been associated with childhood obesity, although the mechanisms that link television viewing to higher BMI have not been established. Therefore, our objectives, in this report, were to describe the amount and types of foods that African-American girls consume while watching television and to examine the associations between African-American girls' BMI and the food they consume while watching television. Research Methods and Procedures: Data were collected from 210 8-to 10-year-old African-American girls at four field centers by trained and certified nutritionists. Two nonconsecutive 24-hour dietary recalls were collected from each girl. For each eating episode reported, the girls were asked if they had been watching television while eating. Height and weight were collected using standard methods and used to calculate BMI. Results: The data were analyzed separately by field center. The proportion of average daily energy intake that the girls consumed while watching television ranged from 26.9% to 35.0%. At all field centers, 40% to 50% of evening meals were consumed while watching television. None of the Spearman correlations between girls' BMI and the amount and type of foods consumed while watching television or at other times during the day were statistically significant (p Ͼ 0.05). Discussion: This research revealed that a significant proportion of African-American girls' daily energy intake is consumed while watching television. Interventions that target reductions in food consumption while watching television or reducing television viewing may be effective strategies to decrease children's energy intakes. These results support a need for research to test the efficacy of these approaches.

Research paper thumbnail of Anthropometric, Parental, and Psychosocial Correlates of Dietary Intake of African-American Girls

Obesity, 2004

Objective: This paper identifies the anthropometric, parental, and psychosocial characteristics a... more Objective: This paper identifies the anthropometric, parental, and psychosocial characteristics and meal practices (e.g., breakfast skipping and number of meals and snacks consumed) associated with consumption of total energy, percent energy from fat, fruit, 100% fruit juice, vegetables, sweetened beverages, and water among 8-to 10-year-old African-American girls. Research Methods and Procedures: This study included 114 8-to 10-year-old African-American girls and a parent or primary caregiver. Girls and a parent or primary caregiver completed several dietary questionnaires. Two 24hour dietary recalls were conducted with each girl. Height and weight were measured. Separate hierarchical regression analyses were conducted for each dependent dietary variable; potential field center differences were examined. Results: The number of meals and snacks consumed was correlated with energy intake. Lower BMI was related to higher vegetable consumption, and the number of snacks consumed was positively related to sweetened beverage consumption. Greater low-fat food preparation practices reported by parents were related to lower consumption of fat as a percentage of total energy. Discussion: Dietary behavior differed across geographic areas. Low-fat food preparation practices in the home seemed to be an important influence on the percentage of energy consumed from fat. Greater vegetable consumption was associated with lower BMI. Interventions to prevent excessive weight gain in African-American girls should encourage low-fat food preparation in the home and greater consumption of vegetables.