Rebecca is a biostatistician in the Quantitative Sciences Unit (QSU) with areas of study including developmental behavioral pediatrics (autism, ADHD, anxiety, and depression), school readiness in preschoolers, oncology, reproductive endocrinology & infertility, and natural language processing. She completed her MS in Statistics at Brigham Young University in 2016, where she collaborated with cardiologists to develop a new approach to diagnose rheumatic heart disease in pediatric patients in Samoa for her Master's thesis. Prior to joining the QSU, she provided statistical support in the Pediatric Critical Care division at the University of Utah. Rebecca moderates a local book club and writes poetry and short stories in her spare time.
Online Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies
MOSBY-ELSEVIER. 2021: AB7
View details for Web of Science ID 000629158000021
Diagnosis of Language Delay in the Primary Care Setting: An Electronic Health Record Investigation
LIPPINCOTT WILLIAMS & WILKINS. 2021: S1-S2
View details for Web of Science ID 000656627200016
Shared Decision Making in Neurosurgery Clinic Visits: General Descriptions and a Randomized Controlled Trial
LIPPINCOTT WILLIAMS & WILKINS. 2021: S6
View details for Web of Science ID 000656627200029
Continuity of Care by Primary Care Provider in Young Children with Autism
LIPPINCOTT WILLIAMS & WILKINS. 2021: S2
View details for Web of Science ID 000656627200017
Tobacco Smoking and Risk of Second Primary Lung Cancer.
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
Lung cancer survivors are at high risk of a second primary lung cancer (SPLC). However, SPLC risk factors have not been established and the impact of tobacco smoking remains controversial. We examined risk factors for SPLC across multiple epidemiologic cohorts and assessed the impact of smoking cessation on reducing SPLC risk.We analyzed data from 7,059 participants in the Multiethnic Cohort (MEC) diagnosed with an initial primary lung cancer (IPLC) between 1993 and 2017. Cause-specific proportional hazards models estimated SPLC risk. We conducted validation studies using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO, N=3,423 IPLC cases) and European Prospective Investigation into Cancer and Nutrition (EPIC, N=4,731 IPLC cases) cohorts and pooled the SPLC risk estimates using random effects meta-analysis.Overall, 163 (2.3%) MEC cases developed a SPLC. Smoking pack-years (HR 1.18 per 10 pack-years; P<0.001) and smoking intensity (HR 1.30 per 10 cigarettes per day (CPD); P<0.001) were significantly associated with increased SPLC risk. Individuals who met the 2013 U.S. Preventive Services Task Force's (USPSTF) screening criteria at IPLC diagnosis also had an increased SPLC risk (HR 1.92; P<0.001). Validation studies with PLCO and EPIC showed consistent results. Meta-analysis yielded pooled HRs of 1.16 per 10 pack-years (Pmeta<0.001), 1.25 per 10 CPD (Pmeta<0.001), and 1.99 (Pmeta<0.001) for meeting the USPSTF criteria. In MEC, smoking cessation after IPLC diagnosis was associated with an 83% reduction in SPLC risk (HR 0.17; P<0.001).Tobacco smoking is a risk factor for SPLC. Smoking cessation after IPLC diagnosis may reduce the risk of SPLC. Additional strategies for SPLC surveillance and screening are warranted.
View details for DOI 10.1016/j.jtho.2021.02.024
View details for PubMedID 33722709
The impact of timing modified natural cycle frozen embryo transfer based on spontaneous luteinizing hormone surge.
Journal of assisted reproduction and genetics
PURPOSE: To evaluate whether adjusting timing of modified natural cycle frozen embryo transfer (mNC-FET) 1day earlier in the setting of a spontaneous LH surge has an impact on pregnancy outcomes.METHODS: This retrospective cohort study evaluated all mNC-FET with euploid blastocysts from May 1, 2016 to March 30, 2019, at a single academic institution. Standard protocol for mNC-FET included ultrasound monitoring and hCG trigger when the dominant follicle and endometrial lining were appropriately developed. Patients had serum LH, estradiol, and progesterone checked on day of trigger. If LH was ≥20 mIU/mL, trigger was given that day and FET was performed 6days after surge (LH/HCG+6), with the intent of transferring 5days after ovulation. If LH was <20 mIU/mL, FET was performed 7days after trigger (hCG+7). Primary outcomes included clinical pregnancy and live birth rates. To account for correlation between cycles, a generalized estimating equation (GEE) method for multivariable logistic regression was used.RESULTS: Four hundred fifty-three mNC-FET cycles met inclusion criteria, of which 205 were in the LH/HCG+6 group and 248 were in the HCG+7 group. The overall clinical pregnancy rate was 64% and clinical miscarriage rate was 4.8%, with similar rates between the two groups. The overall live birth rate was 60.9% (61.0% in LH/HCG+6 group and 60.9% in HCG+7 group). After implementing GEE, the odds of CP (aOR 0.97, 95% CI [0.65-1.45], p=0.88) and LB (aOR 0.98, 95% CI [0.67-1.45], p=0.93) were similar in both groups.CONCLUSIONS: In our study cohort, mNC-FET based on LH/HCG+6 versus HCG+7 had similar pregnancy outcomes.
View details for DOI 10.1007/s10815-020-01994-1
View details for PubMedID 33230616
- Is smoking a risk factor for second primary lung cancer AMER ASSOC CANCER RESEARCH. 2020
Comparative Seasonal Respiratory Virus Epidemic Timing in Utah
2020; 12 (3)
Previous studies have found evidence of viral interference between seasonal respiratory viruses. Using laboratory-confirmed data from a Utah-based healthcare provider, Intermountain Health Care, we analyzed the time-specific patterns of respiratory syncytial virus (RSV), influenza A, influenza B, human metapneumovirus, rhinovirus, and enterovirus circulation from 2004 to 2018, using descriptive methods and wavelet analysis (n = 89,462) on a local level. The results showed that RSV virus dynamics in Utah were the most consistent of any of the viruses studied, and that the other seasonal viruses were generally in synchrony with RSV, except for enterovirus (which mostly occurs late summer to early fall) and influenza A and B during pandemic years.
View details for DOI 10.3390/v12030275
View details for Web of Science ID 000525486800054
View details for PubMedID 32121465
View details for PubMedCentralID PMC7150790
Prevalence of Bone Metastases in Neuroendocrine Neoplasms by 68Ga DOTATATE PET Scan
LIPPINCOTT WILLIAMS & WILKINS. 2020: 486
View details for Web of Science ID 000526823600114
Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience.
To assess (1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, (2) documented PCP adherence to ADHD clinical practice guidelines, and (3) patient factors influencing PCP variation in diagnosis and management.Retrospective cohort study of electronic health records from all office visits of children aged 2-5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary healthcare network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in (1) comorbidity documentation at or after ADHD diagnosis, (2) ADHD medication choice, and (3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics.Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (e.g., hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4-5-year-olds (40/195 (21%)); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (OR 1.94; 95% CI 1.40-2.66; OR 3.17; 95% CI 1.93-4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32-0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13-9.58).PCPs in this network frequently used symptom-level ADHD diagnoses in 2-5-year-olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low.
View details for DOI 10.1016/j.acap.2020.04.009
View details for PubMedID 32360494
- Impact of dual-eligible status on survival in Medicare patients with lung cancer. AMER SOC CLINICAL ONCOLOGY. 2019
Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation.
The New England journal of medicine
2019; 381 (20): 1909–17
BACKGROUND: Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.METHODS: Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatch-based irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days. Surveys were administered 90 days after notification of the irregular pulse and at the end of the study. The main objectives were to estimate the proportion of notified participants with atrial fibrillation shown on an ECG patch and the positive predictive value of irregular pulse intervals with a targeted confidence interval width of 0.10.RESULTS: We recruited 419,297 participants over 8 months. Over a median of 117 days of monitoring, 2161 participants (0.52%) received notifications of irregular pulse. Among the 450 participants who returned ECG patches containing data that could be analyzed - which had been applied, on average, 13 days after notification - atrial fibrillation was present in 34% (97.5% confidence interval [CI], 29 to 39) overall and in 35% (97.5% CI, 27 to 43) of participants 65 years of age or older. Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram. Of 1376 notified participants who returned a 90-day survey, 57% contacted health care providers outside the study. There were no reports of serious app-related adverse events.CONCLUSIONS: The probability of receiving an irregular pulse notification was low. Among participants who received notification of an irregular pulse, 34% had atrial fibrillation on subsequent ECG patch readings and 84% of notifications were concordant with atrial fibrillation. This siteless (no on-site visits were required for the participants), pragmatic study design provides a foundation for large-scale pragmatic studies in which outcomes or adherence can be reliably assessed with user-owned devices. (Funded by Apple; Apple Heart Study ClinicalTrials.gov number, NCT03335800.).
View details for DOI 10.1056/NEJMoa1901183
View details for PubMedID 31722151
A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease
CARDIOLOGY IN THE YOUNG
2017; 27 (8): 1599–1605
Echocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.We performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.Echocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.We successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period - 28 days of screening over a 3-year time period - to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.
View details for DOI 10.1017/S1047951117000907
View details for Web of Science ID 000417419400020
View details for PubMedID 28857729