Dr. Melanie A Sutton

Background: Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mindbody interventions, energy therapies, and alternative medical systems.

Methods: Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463).

Results: Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p<0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2–4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23–27%, p < 0.05) and energy therapies (0.2–0.3%, p<0.05). Use of biological treatments (0.04%, p<0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001).

Conclusions: These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

Some sea snakes and sea kraits (family Elapidae) can dive for upward of two hours while foraging or feeding, largely because they are able to absorb a significant percentage of their oxygen demand across their skin surfaces. Although cutaneous oxygen uptake is a common adaptation in marine elapids, whether its uptake can be manipulated in response to conditions that might alter metabolic rate is unclear. Our data strongly suggest that Yellow-Lipped Sea Kraits, Laticauda colubrina (Schneider, 1799), can modify cutaneous uptake in response to changing pulmonary oxygen saturation levels.When exposed to stepwise 20% decreases in aerial oxygen saturation from 100% to 40%, Yellow-Lipped Sea Kraits spent more time emerged but breathed less frequently. A significant graded increase in cutaneous uptake was seen between 100% and 60% saturation, likely attributable to subcutaneous capillary recruitment. The additional increase in oxygen uptake between 60% and 40% was not significant, indicating capillary recruitment is likely complete at pulmonary saturations of 60%. During a pilot trial, a single Yellow-Lipped Sea Krait exposed to an aerial saturation of 25% became severely stressed after 20 min, suggesting a lower saturation tolerance level between 40% and 25% for the species. Reducing subcutaneous perfusion could optimize swimming performance during foraging, whereas redirecting blood to skin surfaces would maximize dive times when subduing prey or avoiding aerial predators.

Objectives: The Centers for Disease Control and Prevention estimates that 50 million Americans have been diagnosed with arthritis and other musculoskeletal diseases. The purpose of the current study was to (1) estimate the prevalence of overall complementary and alternative medicine (CAM) use and (2) examine the role of body mass index (BMI) on CAM use among normal weight, overweight, and obese persons with chronic lower back pain, chronic neck pain, chronic/rheumatoid arthritis, or musculoskeletal diseases, while controlling for other covariates.

Design: Cross-sectional design using secondary data for 9724 adults from the 2007 National Health Interview Survey. Data were weighted and analyzed by using Stata 12 for Windows (Stata Corp., College Station, TX). Descriptive, bivariate, and multivariate logistic regression statistics were computed.

Participants: The participants were randomly surveyed from U.S. households.

Outcome measures: CAM use was measured as reported use of any modality within the five National Center for Complementary and Integrative Health domains.

Results: CAM use was statistically significantly associated with female sex; race/ethnicity; having chronic neck pain, lower back pain, or chronic/rheumatoid arthritis; having limitations due to chronic disease; and geographic region ( p < 0.05). Factors significantly associated with decreased odds of CAM use included age 50–64 years, income categorized as ‘‘other/missing,’’ and having musculoskeletal diseases. Stratification by body mass index suggested increased odds of CAM use among normal/underweight persons with chronic neck pain but decreased odds for those with chronic musculoskeletal diseases. For overweight patients, increased odds of CAM use were significant for chronic lower back pain, musculoskeletal diseases, and chronic/rheumatoid arthritis.

Conclusions: Musculoskeletal diseases and arthritis represent important public health problems with economic implications for the well-being of individuals and society. Identifying CAM use trends by patient weight can be used to improve strategies to increase awareness and access to CAM as part of comprehensive and costeffective approaches for the management and treatment of these conditions.

Beachrock formations on Loggerhead Key in Dry Tortugas National Park, USA are an important nursery for many juvenile reef fishes. Wide variations in temperature are common in these areas and can markedly influence fish metabolism and thermal tolerance. We determined routine resting metabolic rate and temperature quotient (Q₁₀) at 24 and 32°C. Thermal tolerance (measured as critical thermal maximum, CTmax) was also measured for sergeant major (Abudefduf saxitilis) and cocoa damselfish (Stegastes variabilis) acclimatized to beachrock nursery temperatures. Sergeant majors occupied shallow rockpool margins that experience rapid, extreme temperature changes. These fish exhibited relatively low metabolic rates, reduced Q₁₀ values (2.40), and relatively high levels of temperature tolerance (CTmax = 40.0°C). Cocoa damselfish selected deeper, more thermally stable rockpool areas. These fish had higher metabolic rates, were more sensitive to temperature increase (Q₁₀ = 2.84), and were less tolerant of high temperatures (CTmax = 38.6°C) than sergeant majors. Metabolic and temperature tolerance adaptations of juvenile sergeant majors and cocoa damselfish allow these fishes to exploit a variety of microhabitats found in beachrock areas on Loggerhead Key.

Beachrock formations in Dry Tortugas National Park, USA, function as important nursery habitats for many reef fishes. During low tide, the northeast Loggerhead Key nursery is reduced to a series of small rockpools exposing fish to rapid and sometimes extreme temperature
changes. We estimated the critical thermal maximum (CTmax) of juvenile frillfin goby, Bathygobius soporator, sergeant major, Abudefduf saxatilis, cocoa damselfish, Stegastes variabilis, and sailors choice, Haemulon parra, collected from nursery pools. Frillfin goby exhibited the highest CTmax (40.1 ± 0.20°C) followed by sergeant major (39.0 ± 0.11 °C), cocoa damselfish (38.3 ± 0.09°C), and sailors choice (36.8 ± 0.42 °C). All CTmax measures were statistically distinct and when compared to likely rockpool temperatures, suggest that juvenile fishes may depend on both physiological and behavioral adaptations to cope with rapidly fluctuating nursery temperatures.

Yellow-lipped Sea Kraits (Laticauda colubrina) are tropical amphibious snakes that divide their time between land and sea. When moving between habitats, the kraits experience rapid and sometimes extreme shifts in body temperature that can have profound metabolic effects. We quantified cutaneous and pulmonary oxygen uptake in sea kraits from Hoga Island, southeast Sulawesi, Indonesia, at temperatures commonly encountered in aquatic (27.6''G) and aerial (35.2°G) habitats. Total oxygen uptake rate was 49.14 mL Kg⁻¹ h⁻¹ at 27.6°C and 115.27 mL Kg⁻¹ h⁻¹ at 35.2°C. Pulmonary and cutaneous uptake rates were 44.58 and 104.70, and 4.56 and 10.57 mL Kg⁻¹ h⁻¹, at 27.6 and 35.2°C, respectively. Sea kraits had a temperature coefficient (Q₁₀) of approximately 3, suggesting that metabolic rates triple with every 10°C
temperature increase. High Q₁₀ values may minimize time on land by increasing digestion and nutrient absorption rates as well as promoting faster healing and injury recovery times. Cooler reef temperatures would decrease metabolic demand, thus increasing submergence and foraging times.

This article describes the use of assessment in the design and implementation stages of launching online courses and programs. While use of assessment for improving student engagement in both face-to-face and online courses has been commonly used, the authors augmented the strategic planning of programs to include assessment as a tool for designing faculty/adjunct training sessions to simultaneously improve faculty engagement. Employed initiatives were based on the hypothesis that high faculty engagement during training
would yield higher quality courses, leading to greater course satisfaction and engagement by both students and faculty. Results are provided -from two online programs in the School of Allied Health and Life Sciences at the University of West Florida. To demonstrate these strategies. a case example is also provided on the use of Second Life as an instructional tool to improve faculty and student engagement, and to development a sense of online community. Outcomes were tracked along four criteria: (a) quality enhancement, (b) accountability,
(c) marketability, and (d) productivity. Results included improved student and faculty satisfaction with engagement in developed courses, low operational costs due to low turnover rate in trained faculty/adjuncts, and improved tracking of quality enhancement data for accreditation efforts.

The Internet is an affordable and easily accessible technology that has many potential applications to psychology. Interactive technologies engage users psychologically and may facilitate adaptive and maladaptive behaviors. This research explored the Internet-use patterns, psychological characteristics, and negative consequences associated with online activities of 393 college students using the Internet Use Survey (IUS), a self-report instrument designed to administer online. Results indicated that participants spent an average of 3.3 total hours per day on the Internet during the past 12 months and used the medium for multiple purposes. Although participants reported the occurrence of some potentially negative consequences related to Internet use, the prevalence rates for most problematic behaviors were generally low. Exploratory principal component analysis of the IUS subscale that attempts to measure Internet-related impairment revealed four factors: absorption, negative consequences, disrupted sleep, and deception. All of these factors were then significantly related to a measure of boredom proneness. This research supports the necessity for multidimensional assessment (e.g., frequency and context) of Internet usage to enhance our understanding of how this new technology interfaces with users psychologically and behaviorally.

This study investigates interpersonal attraction and the use of forewarning messages on the Internet. Male and female participants observed four photographs of the opposite sex on-line. Half of the participants were given a forewarning about the use of deception on the Internet
before they rated the person depicted in the target photo. The control group was not exposed to the forewarning but instead read a general statement describing the Internet. Participants rated the photos for attractiveness, how likely they would be to engage in an on-line conversation with the person in the photo, and how likely they would be to accept a date with the person in the photo. The target photo’s attractiveness and socioeconomic status were varied. The results indicated that a forewarning message might induce cautiousness among those using the Internet. Experimental group participants rated target photos as less attractive compared to those who were not shown a forewarning message, and were less likely to want to converse with or date the people depicted in the on-line photos. The implications of these findings in regard to Internet social behavior are discussed.

This article explores the development and utility of computer-assisted interpretation of mammograms with use of an academically developed mass enhancement system and the R2 ImageChecker M1000 System, a commercial mass detector system. This exploratory pilot study examines five mammogram views, three with abnormalities and two without, that were extracted from the public database known as the Digital were analyzed by an academic system (producing 25 different enhancement images) and original films were analyzed by the commercial R2 system (producing a set of five output views with region-of-interest prompts). Quantitative assessment was derived from radiologist-marked database ground truth information,
whereas qualitative evaluation relied on a 210-question survey presented to two radiologists active in a breast cancer screening program. Academically developed segmentation-based enhancements appeared useful in aiding interpretation for the mass-prompting system by enhancing medically relevant features in prompt areas. Dual feature–based enhancements were preferred to single feature enhancements.
Edge-based features appeared useful for facilitating clinical interpretation of possible spicules and for differentiating abnormal and normal tissues. This provisional study does not allow direct comparisons of the R2 system to other commercial or academic systems. However, this research does help to provide a framework for presenting medically relevant issues that can impact the development of digital mass-prompting systems and suggest alternative visualization techniques.