Dr. Raid W. Amin

Liver cancer remains an important issue of public health management in the United States, and the geographical differences in mortality indicators are noticeable. Understanding space-time models and basic risk factors is important for targeted public health mediation.
This study examined liver cancer mortality at the county level across the United States from 2010 to 2019. The disease surveillance software SatScan™ was employed to detect statistically significant purely spatial and temporal clusters of elevated liver cancer mortality counts and rates. The negative binomial regression model was used to assess the connection between the mortality of liver cancer, and various important risk factors such as mortality due to cirrhosis, the prevalence of hepatitis C, and other selected socioeconomic and demographic indicators.
This study shows 20 significant purely spatial clusters and 15 retrospective space-time clusters with high death risk, with the most extreme cluster located in Anderson County, Texas (Relative Risk = 4.04). High risk areas were concentrated in Northwestern United States, Texas, Arizona, New Mexico and the southeastern United States. The regression model pointed out mortality rate due to cirrhosis, excessive alcohol consumption, stomach cancer mortality and the prevalence of hepatitis C as the strongest predictors of liver cancer mortality based on Wald’s chi-square statistic. A covariate adjusted spatial analysis revealed high-risk clusters in parts of Arizona, New Mexico, and Florida, implying the influence of additional unexplained factors.
This study emphasizes specific elevated risk areas that require further epidemiological studies by providing important information on the spatial and temporal distribution of deaths due to liver cancer in the United States. The results highlight the role of biological, behavioral and socioeconomic risk factors in the formation of mortality patterns. These results showcase future research on environmental, medical and lifestyles that support public health plans to promote liver cancer and reduce the mortality of vulnerable population groups.

Most individuals living with Alzheimer's disease and related dementias (ADRD) experience one or more neuropsychiatric symptoms, such as agitation which negatively impacts their quality of life. Adapted dance integrates recorded music and movement that is appropriate for people with cognitive limitations. Adapted dance may be an enjoyable activity for persons living with ADRD and may provide psychological and physical benefits.
The purpose of this pilot study was to assess the feasibility of an adapted dance intervention with persons with ADRD and the impacts of 12 weeks of adapted dancing on agitation, balance, gait, lower extremity strength, and caregiver burden.
This study used an experimental design with repeated measures. Participants with ADRD were randomly assigned to a usual care or adapted line dance group that met 60 min twice a week. At pre-test, 4-, 8-, and 12 weeks of intervention, measures were collected for agitation, balance, gait, lower extremity strength, and caregiver burden.
The sample consisted of 4 males and 12 females (n = 16) with ADRD whose age ranged from 69-97 years. Twelve weeks of adapted line dance was found acceptable by ADRD participants. Participants attended ≥90% of dance sessions and did not experience loss of balance or fall. ADRD participants danced an average of 70 min per week. Both groups had improvements in agitation from baseline to 12 weeks.
Twelve weeks of adapted dance was shown to be feasible and enjoyable for persons living with ADRD. Clinicians should consider adapted dance as part of an exercise prescription.

This study investigates the spatiotemporal variations in jail incarcerations in addition to associations with several risk factors and jail incarceration counts at the county level for the period 2010-2018 in the contiguous USA. The disease surveillance software SaTScanTM was utilized to identify and test purely spatial and spatiotemporal variations in jail incarceration. Significant spatial and space-time clusters with elevated relative risk for jail incarceration were found in analysis. Additionally, a negative binomial regression model was used to predict jail incarcerations counts based on several covariates and found significant and non-random spatial clusters of jail incarceration that are explained after adjusting for these covariates. The results in this study provide useful information on possible associations in geographical areas where jail incarceration rates are higher than expected and demonstrate significant correlations between jail incarceration counts and several covariates. The study and its conclusions provide an epidemiological framework for identifying and addressing geographic patterns of unusually high jail incarceration rates in the U.S. and provide evidence of appropriate locations to further investigate underlying causes of disproportionate incarceration.

This study investigates the likelihood of clusters containing both breast cancer and lung cancer mortality as well as incidence within the female population of the contiguous United States using the geographical surveillance software program SaTScan. With the use of SaTScan we can perform a bivariate analysis of the two cancers using both a spatial and space-time analysis. The existence of clusters is then interpreted as disease cluster alarms for either a spatial analysis outcome or both. For our study, the geographical area was that of the 48 contiguous United States analyzed at the county level from the years 2001 to 2020 for mortality, and 2001 to 2018 for incidence. Covariates were used in a regression analysis to characterize county populations of the existing bivariate clusters as a way of identifying areas with known risk factors and locating areas with other risk factors associated with their clusters. Our results showed the existence of 28 purely spatial significant clusters containing both breast cancer and lung cancer for mortality, and 52 purely spatial significant clusters containing high likelihoods of both breast cancer and lung cancer incidence. Only two clusters contained a high likelihood of breast cancer incidence alone.

We embarked on a quality improvement plan to improve culture care in a school of nursing. The nursing workforce is experiencing escalating occupational stress, leading to high turnover. When faculty role model caring, they empower themselves and the future workforce with strategies for self-care and resilience. A faculty self-assessment of caring behaviors and caring relationships was conducted before a caring science workshop. The workshop used Watson's Caritas Processes to introduce caring micro-practices. Qualitative interviews with faculty after the workshop generated two themes: self-awareness of self-care and caring pedagogy. Themes revealed faculty value this approach for continuous improvement in a caring culture.

•Spatial clusters of suicides are identified.•Space-time clusters of suicides are identified.•Poisson regression tests and identifies covariates associated with suicides.•Bivariate spatial clusters of deaths by suicide and by opioids are identified.
The present study investigates the spatiotemporal variations in suicide mortality and tests associations between several covariates and suicides for the years 20002019 in the contiguous USA. The epidemiological disease surveillance software was used to identify spatiotemporal variations in suicide mortality rates and to test for significant spatial and space-time clusters with elevated relative suicide risk.
The analysis was done with age-adjusted suicide mortality counts data from the Centers for Disease Control (CDC) with International Classification of Diseases (ICD)-10 codes. Specifically, data with codes ICD-10 codes X60-X84.9 and Y87.0, plus ICD-10 113 codes from the CDC, was used. Fourteen significant spatial clusters and five significant space-time clusters of suicide in the contiguous USA were found, including nine significant bivariate spatial clusters of suicide deaths and opioid deaths.
Based on these data, there exist significant and non-random suicide mortality clusters after adjusting for multiple covariates or risk factors. The covariates studied provide evidence to develop a better understanding of possible associations in geographical areas where the suicide mortality rates are higher than expected. In addition, there is a significant association between several of the studied risk factors and suicide mortality. While most suicide clusters are also opioid clusters, there exist some clusters with high opioid deaths that are not suicide clusters.
These results have the potential to provide a scientific framework that is based on surveillance, allowing health agencies to intervene and reduce elevated rates of suicides in selected counties in the U.S. The study is limited due to the resolution of the data at the county level, and some covariate data was unavailable for the entire period of the study.
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Purpose: To describe the socio-demographics and clinical characteristics of children in a pulmonology clinic or admitted to a children's hospital with well-controlled and poorly controlled asthma, and to assess caregiver knowledge of asthma pathogenesis, treatment, and self-management.
Patients and Methods: A cohort of 132 children aged 2-18 years and their caregivers seen in a pediatric pulmonology clinic with a diagnosis of asthma (n=112) or admitted to the hospital with a diagnosis of asthma exacerbation (n=20) were invited to participate in a cross-sectional study. Caregivers completed a survey, which healthcare providers then used to tailor asthma education to the patient and caregiver. Two-tail t-tests and Chi-square tests were used to compare demographics and clinical characteristics of children with well-controlled vs poorly controlled asthma.
Results: Of 132 children, 111 children in this cohort had poorly controlled asthma (84%). Medicaid insurance was associated with poorly controlled asthma versus well-controlled asthma (63% vs 35% p=0.01). Asthma action plans (AAP) had previously been given to 113 caregivers (86%), but caregivers of children with both well-controlled and poorly controlled asthma still reported misconceptions about asthma pathology and management, such as stopping daily medications when asthma is controlled.
Conclusion: This study contributes to the existing evidence that socio-demographics have a significant impact on asthma prevalence and proper management. Our study suggests that caregivers of children with asthma need comprehensive asthma education beyond the AAP focusing on asthma-related misconceptions.

Background: Depression is a risk factor for adult cardiovascular mortality with unclear pathophysiology. The literature on physiologic parameters related to depression is inconsistent and scant in adolescent patients.
Aim of the study: The purpose of this study is to determine if there is a relationship between depression and physiologic parameters including blood pressure (BP) and pulse rate (PR) in adolescents.
Methods: Adolescents with and without depression were compared to controls without depression for systolic BP, diastolic and PR using a two-way type III ANOVA.
Results: In depressed patients, there was significantly higher systolic BP percentiles (57.4 depressed versus 47.8 non-depressed; F (DF 1) = 4.48, p = 0.036), no difference in diastolic BP, and significantly higher PR in depressed males but not females (males depressed 86.7 vs. 72.1; F (DF 1) = 8.61, p =0.003).
Conclusion: Significantly higher systolic blood pressure percentiles in depressed patients vs. non-depressed patients and significantly higher pulse rates in depressed males but not females were found. These findings may lead to a greater understanding of the physiologic correlates of depressive psychopathology that have implications for subsequent development of cardiovascular disease

Background: Pediatric traumatic brain injury (TBI) and abusive head trauma (AHT) are leading causes of morbidity and mortality. Clinicians may not be aware of AHT at presentation to the emergency department (ED).
Objective: The objective of this study was to determine which clinical features associated with head injury in children on initial presentation to the ED trauma bay predict 3 outcomes including clinically important TBI (CiTBI), classification as confirmed abuse by Child Protection Team (CPT), and poor neurologic status on hospital discharge.
Participants and Setting: Inclusion for this study were children 3 years or younger, presenting to the ED with significant TBI. In addition, presentations where the mechanism of injury was not verifiable such as with falls, being struck by object, or no mechanism of injury reported by caregiver were included.
Methods: Researchers used 3 sources of information for this analysis: a regional trauma registry, hospital records, and the CPT database. Clinical features included demographics, mechanisms of injury, physical, radiological findings, and CPT classification.
Results: On pairwise analysis, seizures, apnea, and no mechanism of injury reported by caregiver were the only clinical features related to all 3 outcomes (P < 0.001). Rib fractures (relative risk [RR], 3.3; P < 0.001), long bone fractures (RR, 3.1; P < 0.001), retinal hemorrhages (RR, 3.0; P < 0.001), seizures (RR, 3.6; P < 0.001), apnea (RR, 4.4; P < 0.001), and younger than 6 months (RR, 1.8; P < 0.001) were related to AHT. On multivariable logistic regression, no mechanism of injury reported by caregiver and seizures remained significantly related to CiTBI; seizures and retinal hemorrhage remained significantly related to classification as abuse by CPT, and no mechanism of injury by the caregiver, apnea, and seizures were significantly related to poor outcome on hospital discharge. Conclusions No mechanism of injury reported by the caregiver, seizures, and apnea at the time of presentation to the ED are important features associated with CiTBI, classification as AHT, and poor prognosis. In addition, younger age, retinal hemorrhage, rib, and long bone fractures were found to be important clinical features associated with AHT.

As ecotourists become increasingly interested in snorkeling and diving with sharks, it is important to establish directives for safe interactions. The study considered eye contact between humans and approaching sharks, examining specifically whether an interruption in it owing to, for example, a person glancing at a camera or regarding where to retreat, would affect a shark's behavior. In standardized field tests, divers maintained or interrupted eye contact with approaching Caribbean reef sharks, Carcharhinus perezi. The results showed a significant difference in the sharks' approaches depending on whether the divers maintained or interrupted eye contact with them. More specifically, the analysis revealed that sharks came significantly closer to the divers when eye contact was interrupted and also reduced their speed.