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Using the Electronic Health Record in Nursing Research: Challenges and Opportunities. - Western journal of nursing research
Changes in the patient record from the paper to the electronic health record format present challenges and opportunities for the nurse researcher. Current use of data from the electronic health record is in a state of flux. Novel data analytic techniques and massive data sets provide new opportunities for nursing science. Realization of a strong electronic data output future relies on meeting challenges of system use and operability, data presentation, and privacy. Nurse researchers need to rethink aspects of proposal development. Joining ongoing national efforts aimed at creating usable data output is encouraged as a means to affect system design. Working to address challenges and embrace opportunities will help grow the science in a way that answers important patient care questions.Â© The Author(s) 2015.
National Survey of Providers Treating Patients With Metabolic Disorders Identified by Newborn Screening Demonstrates Challenges Faced by Clinical Care Systems. - Clinical pediatrics
To evaluate care processes for infants who are identified by newborn screening (NBS) and diagnosed with metabolic disorders during their first year of life.A survey instrument was used to assess the scope and intensity of services needed to provide quality health care for patients from birth to 1 year of age who have a metabolic disorder identified by NBS. Significance testing was not performed; descriptive analyses are reported.Providers spend significant amounts of time on activities that are not direct patient care. The most challenging aspect of their work was the lack of reimbursement for care.Provision of genetics services for patients with a metabolic disorder is time and labor intensive, and insurance coverage and reimbursement for these services remain inadequate. Health care payment and/or system reform is necessary to provide optimal care to patients with metabolic disorders identified by NBS.Â© The Author(s) 2014.
Sex offender modus operandi stability and relationship with actuarial risk assessment. - Journal of interpersonal violence
Three studies conducted in Vermont yielded data on 82 sexual recidivists' index offenses (Time 1) and sexual reoffenses (Time 2) across 16 modus operandi (MO) characteristics. The current study examines the stability of these 16 characteristics between Time 1 and Time 2 offenses. Probabilities of Time 1-Time 2 characteristic combinations are reported, including when controlling for static risk as measured by the Static-99R and Vermont Assessment of Sex Offender Risk-2 (VASOR-2). Overall, considerable stability of offenders' MO was evident between Time 1 and Time 2 offenses. Victim characteristics and offense behaviors were the most stable MO characteristics, and degree of force used and victim injury were less stable and trended toward less forceful and less injurious reoffenses. Controlling for static risk had little impact on the patterns of MO stability.Â© The Author(s) 2014.
Development of Vermont assessment of sex offender risk-2 (VASOR-2) reoffense risk scale. - Sexual abuse : a journal of research and treatment
The present study aimed to revise the Vermont Assessment of Sex Offender Risk (VASOR) Reoffense Risk Scale, a commonly used sex offender risk assessment tool. The revised tool was named the VASOR-2. Among models tested to revise the scale, a logistic regression model showed the best balance between simplicity of use, goodness of fit, and internal validity (as tested with K-10 cross-validation), and maximized predictive accuracy. Predictive accuracy was tested using four meta-analytically combined data sets drawn from Canada and Vermont (N = 1,581). At 5-year fixed follow-up, the predictive accuracy for sexual recidivism for VASOR-2 (AUC = .74) was similar to the VASOR (AUC = .71). The findings show the VASOR-2 is well calibrated with observed recidivism rates for all but the highest risk sex offenders. The instrument showed good interrater reliability (ICC = .88). An advantage of the VASOR-2 is that it has fewer items and simpler scoring instructions than the VASOR. Norms are presented for a contemporary, nonselected, routine sample of Vermont sex offenders (n = 887).
Prescribing in integrated primary care: a path forward. - Journal of clinical psychology in medical settings
McGrath and Sammons (2011) have suggested prescriptive authority and involvement in integrated primary care represent complementary paths for the future of psychology. The articles in this special section of the Journal of Clinical Psychology in Medical Settings describing models of psychologists prescribing in primary care demonstrate that convergence of paths has already begun. This commentary on the papers in this special section addresses a variety of issues raised in the preceding articles, including the benefits of combined prescribing and primary care practice for psychologists and patients, the challenges likely to be faced by psychologists in integrated primary care if we do not also pursue prescriptive authority, obstacles associated with breaking out of our traditional mold, the importance of training specifically for working in primary care settings, and billing obstacles. Several topics are also raised that will need to be addressed by future studies of prescribing psychologists in primary care.
Scale- and item-level factor analyses of the VIA inventory of strengths. - Assessment
The VIA Inventory of Strengths (VIA-IS) has emerged as the primary instrument for gauging individual strengths and virtues. Prior studies have generated inconsistent results concerning the latent structure of the VIA-IS. The present study attempted to address some of these inconsistencies. VIA-IS results from a large sample (N = 458,998) of U.S. adults who completed the inventory online were subjected to a series of principal components and factor analyses. The sample was 66.46% female with a mean age of 34.36 years (SD = 14.13 years) and consistent with the general U.S. population in terms of geographic distribution. Information on ethnicity was not available. The size of the sample permitted both scale- and item-level analyses. The scale-level analyses produced findings similar to those of previous studies, but raised concerns about multidimensionality in the scales. Item-level analyses suggested an alternate set of 24 scales, 20 of which overlapped substantially with existing VIA-IS scales. A second-order analysis suggested five factors, including a new one labeled Future Orientation, versus the original six virtues proposed in the development of the VIA-IS. The results were used to speculate about elements of a second-generation model of strengths.
The role of family variables in fruit and vegetable consumption in pre-school children. - Journal of public health research
Most Americans, including children, continue to eat fewer fruit and vegetables than is recommended, putting themselves at increased risk of various health conditions. The aim of this study was to evaluate the relative importance of several family environment variables (food availability and accessibility, modelling of food consumption, parenting style, and family mealtime environment) in predicting children's consumption of fruit and vegetables in a sample of pre-school children from low income, predominantly ethnic minority families. Two hundred and twenty-nine primary caregivers and their pre-school children were recruited from Head Start programmes in New York and New Jersey. Caregivers gave their consent to the study, completed a series of paper and pencil questionnaires, and had both their height and weight and their children's height and weight measured. Higher availability, accessibility, and parental modelling were associated with higher consumption of fruit and vegetables in children. Availability and Accessibility were the best predictors, but Parental Modelling significantly enhanced prediction over the other variables. Public health interventions should be geared toward helping poorer families increase the availability of fruit and vegetables in their homes, advising parents on how to make them accessible, and encouraging parents to model their consumption.RLG receives research funding from Covidien.
The sex offender treatment intervention and progress scale (SOTIPS): psychometric properties and incremental predictive validity with static-99R. - Sexual abuse : a journal of research and treatment
The Sex Offender Treatment Intervention and Progress Scale (SOTIPS) is a 16-item rating scale designed to assess dynamic risk among adult male sex offenders and degree of change at 6-month intervals during treatment. The purpose of the present study was to examine the psychometric properties of the SOTIPS in a construction sample of 759 adult male sex offenders who were under correctional supervision and enrolled in cognitive-behavioral community treatment in Vermont between 2001 and 2007. The scale showed acceptable interrater reliability. SOTIPS scores at 1, 7, and 13 months after participants began treatment predicted sexual, violent, and any recidivism, and return to prison at fixed 1- and 3-year follow-up periods (AUCs = .60 to .85). Combined SOTIPS and Static-99R scores predicted all recidivism types (AUCs = .67 to .89) and outperformed either instrument alone when both instruments had similar predictive power. Participants who demonstrated treatment progress, as reflected by reductions in SOTIPS scores, showed lower rates of recidivism than those who did not.
Taxometric analysis as a general strategy for distinguishing categorical from dimensional latent structure. - Psychological methods
Statistical analyses investigating latent structure can be divided into those that estimate structural model parameters and those that detect the structural model type. The most basic distinction among structure types is between categorical (discrete) and dimensional (continuous) models. It is a common, and potentially misleading, practice to apply some method for estimating a latent structural model such as factor analysis without first verifying that the latent structure type assumed by that method applies to the data. The taxometric method was developed specifically to distinguish between dimensional and 2-class models. This study evaluated the taxometric method as a means of identifying categorical structures in general. We assessed the ability of the taxometric method to distinguish between dimensional (1-class) and categorical (2-5 classes) latent structures and to estimate the number of classes in categorical datasets. Based on 50,000 Monte Carlo datasets (10,000 per structure type), and using the comparison curve fit index averaged across 3 taxometric procedures (Mean Above Minus Below A Cut, Maximum Covariance, and Latent Mode Factor Analysis) as the criterion for latent structure, the taxometric method was found superior to finite mixture modeling for distinguishing between dimensional and categorical models. A multistep iterative process of applying taxometric procedures to the data often failed to identify the number of classes in the categorical datasets accurately, however. It is concluded that the taxometric method may be an effective approach to distinguishing between dimensional and categorical structure but that other latent modeling procedures may be more effective for specifying the model.(c) 2012 APA, all rights reserved
National profile of children with Down syndrome: disease burden, access to care, and family impact. - The Journal of pediatrics
To measure the co-morbidities associated with Down syndrome compared with those in other children with special health care needs (CSHCN). Additionally, to examine reported access to care, family impact, and unmet needs for children with Down syndrome compared with other CSHCN.An analysis was conducted on the nationally representative 2005 to 2006 National Survey of Children with Special Health Care Needs. Bivariate analyses compared children with Down syndrome with all other CSHCN. Multivariate analyses examined the role of demographic, socioeconomic, and medical factors on measures of care receipt and family impact.An estimated 98,000 CSHCN have Down syndrome nationally. Compared with other CSHCN, children with Down syndrome had a greater number of co-morbid conditions, were more likely to have unmet needs, faced greater family impacts, and were less likely to have access to a medical home. These differences become more pronounced for children without insurance and from low socioeconomic status families.Children with Down syndrome disproportionately face greater disease burden, more negatively pronounced family impacts, and greater unmet needs than other CSHCN. Promoting medical homes at the practice level and use of those services by children with Down syndrome and other CSHCN may help mitigate these family impacts.Copyright Â© 2011 Mosby, Inc. All rights reserved.
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