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.

Objective: The use of complimentary and integrative medicines has emerged as significant area of research both in the United States and internationally. However, much remains to be learned about the true magnitude of these products/this practice and the rationale for their use, especially among persons with a combination of health problems. The purpose of our study is twofold: 1) estimate the prevalence of CAM use in menopausal women with a concurrent cancer diagnosis.

Methods: Data was for 19,241 adult American women from the 2012 National Health Interview Survey (NHIS) and CAM supplement. The outcome variable was ever use of CAM and CAM use in the women who reported either menopausal problems in 12 months prior, cancer diagnosis or both. Data were weighted and analyzed using Stata software version 14 for Windows. In addition to descriptive and bivariate statistics, multivariate logistic regression was performed to estimate the odds of CAM use by selected covariates and disease dyads.

Results: The average age of the women in the study was 48.9 years (SD = 18.58). Approximately 35.7% of the women experienced menopausal problems in the preceding 12 months, 9% of them had a cancer diagnosis. Overall CAM use was reported in 30.7% of respondents. At the multivariate level, age, race, marital status, education, income, region of residence, high cholesterol, having insurance, smoking, and alcohol consumption were significant (p <0.05). However, the concurrent presence of menopausal problems and cancer diagnosis did not appear to influence CAM use, when adjusting for other covariates (p>0.05).

Conclusion: Health care professionals should be aware of CAM use in this segment of the population due to potential for treatment compliance challenges such as potential drug/CAM interaction.

Snakes have been widely used for object tracking, shape detection, and segmentation of an area of interest within image data. A snakes algorithm uses an energy minimization approach to deform an initial boundary or curve so that it traces along the contour of a shape in an image. However, a major disadvantage of the algorithm is that it requires users to draw the initial boundary in the image of an object, which is not feasible when large number of images need to be processed or when user-introduced bias in the selection of the initial boundary may influence the accurate detection of objects. This paper reports on an algorithm for the automatic detection of a region of interest that utilizes a snakes algorithm for image segmentation. It specifically combines multiple image processing and screening techniques to build a pipeline of processing steps that produces the initial boundary of a region in an image for the initialization of a snakes algorithm. The approach has been evaluated on X-ray images of the striped burrfish to detect the swimbladder as a region of interest. Results from the fully automated algorithm are compared against ground truth values and semi-automated algorithm results.

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.