Published Studies

Air Pollution and its relationship to respiratory problems in Cleveland

Description: This was a federally funded study in conjunction with a year-long EPA measurement of the types of particulate air pollution in various parts of Cleveland. The study look at the addresses of patients admitted to area hospitals to learn the associations between geographic or temporal patterns of air pollution, and if they predict presentation to hospitals for acute asthma and/or acute coronary syndrome. It also aims to answer which characteristics of air pollutants exacerbate pulmonary or cardiac health in Cleveland. Data analysis was done using cluster analysis using medical records on patients presenting with respiratory symptoms.

Current Progress:This study is complete and the first article has been written for publication.

Future Goals: to publish several more papers from the data.

"Quality Assurance Project Plan: Associations of Air Quality with Respiratory and Cardiovascular Outcomes in Cleveland, OH During the Cleveland Multiple Air Pollutant Study (CMAPS)" Xin Chen, Department of Biology ; Layla Sankari, Department of Biology; Sumita B. Khatri, MD MS, Cleveland Clinic Respiratory Institute / CCLCM; Cynthia Newman, RN BSN, MHMC Pulmonary Research Coordinator; Vicken Totten, MD, UHCMC, Department of Emergency Medicine Project Mentors: Dr. Sumita B. Khatri, Cleveland Clinic Respiratory Institute / CCLCM; Cynthia Newman, RN BSN, MHMC, Pulmonary Research Coordinator; Dr. Vicken Totten, UHCMC, Department of Emergency Medicine

Presentation: Khatri SB, Hammel J, Van Laere J. Mukerjee S. Holstein A, Newman C. Rose J, Ross L, Totten V, Norris G. "Role Of Air Quality And Mixing Height In Population-Adjusted Pediatric Emergency Department Visits For Asthma In Cleveland Ohio". : Poster #45236 -2013 at ATS International Conference in Philadelphia, Pennsylvania. Sunday, May 19, 2013@ 2:00 PM-4:30

Members Involved:Cindy Xin, Sumita Khatri MD, Cindy Newman RN, Jerri Rose MD, Kristie Ross MD, Manju Pillai MD, Ann Holstein MS, Shamit Tailor MD, Davyda Hammond PhD, Gary Norris PhD

Human Immunodeficiency Virus Intiative

Description:This Initiative began in 2006 with the goal of normalizing HIV testing in the ED at UHCMC. At the time, Ohio was an “opt-in” state, which required extensive counseling prior to and after testing. There were several parts to the Initiative. First we gathered stakeholders and changed UH policy to make it as liberal as the State. Second, we conducted attitude surveys for patients and staff. Third, we piloted universal testing in Rapid Care (old ED). Fourth, we tested the prevalence of HIV at UHCMC in the ED. Fifth; we implemented ED-based HIV testing with mechanisms for following up the positives. Finally, we were able to get Rapid HIV into the EMR as a regular test, with verbal opt-out consent as permitted by (changed) state law. Incidentally we learned there was a high prevalence of believing HIV transmission risks in our population. These were briefly mentioned in an early publication; a later survey has looked at if they have changed since first evaluation.

Grant Support: Small grants were received from AFR and from manufacturers.

Current Progress:Several papers are in progress.

Future Goals: To continue to monitor ED-based HIV testing and continue to keep physicians aware of the need for testing persons with either symptoms or high risk.



Haukoos JS, White DA, Lyons MS, Hopkins E, Calderon Y, Kalish B, Rothman RE; National Emergency Department HIV Testing Consortium.(incl. Totten VY) "Operational methods of HIV testing in emergency departments: a systematic review". Ann Emerg Med. 2011 Jul;58 (1 Suppl 1):S96-103. Review. PMID: 21684417

Hecht CR, Smith MD, Radonich K, Kozlovskaya O, Totten VY. "A comparison of patient and staff attitudes about emergency department-based HIV testing in 2 urban hospitals". Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S28-32.e1-4. PMID: 21684404

Kecojevic A, Lindsell CJ, Lyons MS, Holtgrave D, Torres G, Heffelfinger J, Brown J, Couture E, Jung J, Connell S, Rothman RE; National Emergency Department HIV Testing Consortium.(incl. Totten VY) "Public health and clinical impact of increasing emergency department-based HIV testing: perspectives from the 2007 conference of the National Emergency Department HIV Testing Consortium". Ann Emerg Med. 2011 Jul;58 (1 Suppl 1):S151-9.e1. PMID: 21684395

Lyons MS, Lindsell CJ, Haukoos JS, et al, (including Totten V,). "Nomenclature and definitions for emergency department human immunodeficiency virus (HIV) testing: report from the 2007 conference of the National Emergency Department HIV Testing Consortium". Acad Emerg Med. 2009 Feb;16(2):168-77. Epub 2008 Dec 6.


Totten VY, Chandar AK. Bryant TK. Kumar S. Burgess KR. "Did an ED-based culture change initiative influence staff attitudes around HIV testing?" ICEM 2012, June 2012 in Dublin, Ireland

Smarsch R, Totten VY, Aggarwal MN, O’Reilly E, and EMRD. "HIV Testing in the ED: Summer Pilot Study". Poster: Research ShowCASE April 2009

Bankwitz B. Totten VY and EMRD. "HIV Testing in the ED: Patient Attitudes" - Poster at Research ShowCASE April 2009

Kozlovskaya O. Totten VY and EMRD. "HIV Testing in the ED: Staff Attitudes" –Poster at Research ShowCASE April 2009

Radonich K, Sandhaus S, Natali R, Aggarwal M, Totten VY. "HIV Testing in the ED: Population Prevalence". Poster Presentation at the Research ShowCASE April 2009

Totten VY, Aggarwal MN, Kador H, Radonich K, Kozlovskaya O, Shkraba P: "Staff Attitudes Towards Human Immunodeficiency Virus Testing in the Emergency Department". Poster at the 2008 National Summit on HIV Diagnosis, Prevention, and Access to Care (November 19-21, 2008, Arlington, VA.

Totten VY, Aggarwal MN, Kador H, Wang W. "Patient Attitudes versus Staff Attitudes about Human Immunodeficiency Virus Testing in the Emergency Department". Poster at the 2008 National Summit on HIV Diagnosis, Prevention, and Access to Care (November 19-21, 2008, Arlington, VA.

Totten VY, Kador H, Aggarwal M, Radonich K. "Patient Attitudes towards Human Immune Virus (HIV) Testing in the Emergency Department (ED)" Poster at ACEP Research Forum, Chicago, IL. September 2008

Members Involved:Totten VY, Kador H, Aggarwal M, Radonich K, Wang W. Kozlovskaya O, Shkraba P. Smarsch R, O’Reilly E, Harry Owusu-Dapaah, Anna Calvo Rosenstone, Dr. Scott Frank, Dr. Erika Trapl, Sabina Kumar

Implications of Catheterization Lab Activation with Variation in Transmission and Emergency Department Receipt Times of Prehospital Electrocardiograms

Description: The objective of this study is to address the timeliness in evaluation of pre-hospital EMS performed EKGs. We are measuring the time interval between EMS recording an EKG in the field and the arrival of the EKG to providers in the UH ED. We are collecting this data for patients presenting via ambulance at the UH ED.

We will use a retrospective convenience sample of EKGs performed by EMS and transmitted by the LifeNet Systems™ web based server. All pre-hospital EKGs transmitted by 13 EMS agencies through LifeNet Systems™ to the University Hospitals ED between January 2013 and June 2013 will be analyzed for EMS documented EKG performed times and corresponding ED received times.

Current Progress: We have submitted this study to NAEMSP.

Future Goals: We have no future goals currently.



Timothy J. Lenz, MD; Jeffrey H. Luk, MD, MS; Matthew Wollerman, BS; Edward A. Michelson, MD, FACEP "Catheterization Lab Activation: From Transmission to Receipt. Prehospital Electrocardiograms take time".

Members Involved:Jeffery Luk, MD (PI), Edward Michelson, MD (PI), Vicken Totten (PI), Matthew Wollerman (RA), Sabina Kumar (RA), Wyatt Hoch (RA)

Effects of Visitors on Emergency Department Patients

Description: There has been no published work to date on the effects of Emergency Department (ED) visitors on patient outcomes. Existing literature on the effects of patient visitors is sparse, and hitherto has focused on premature infants in the NICU, on psychiatric patients and on resuscitations. If it can be shown that the presence of ED visitors positively affect patient outcomes, then it may be advantageous to encourage the presence of patient visitors or their surrogates.

Outcomes of interest include length-of-stay (LOS), health outcomes including morbidity and mortality, total charges in the ED and in the hospital, and patient dispositions: to hospital, to home, to extended care facilities. The justification for the current study comes from previous research on the relationship between social support, health outcomes, and length-of-stay.

Current Progress: We have submitted and been accepted to JEM. The second part of the study is being written for submission to JEM.

Future Goals:To submit part 2 to JEM.



"Perspectives on Visitors in the ED: Their Role and Importance". Vicken Y. Totten, MD, FACEP, FAAFP, Tara K. Bryant, BA, Apoorva K. Chandar, MBBS, MPH, Stephanie L. Hunter MD, Wyatt B. Hoch, Nikita J. Patel, Barry E. Brenner MD, PHD. Manuscript accepted for e-publication in the Journal of Emergency Medicine on May 25th 2013. Manuscript ID JEM-D-13-00164

Totten V, Bryant T, Chandar A, Hoch W, Patel N, Hunter S, Brenner B. American Public Health Association (APHA). Do emergency department patients value visitors?

Members Involved:Vicken Totten, MD (PI), Barry Brenner (PI), Tara Bryant (RA), Joseph Lai (RA)

Initial Patient Evaluation of Physicians Base Solely on Attire

Description: The study objectives were to understand if patient preference for physician attire is related to medical television viewing habits and to determine if patients’ initial evaluation of physicians in the emergency department is related to physician attire.

Current Progress: We are finishing up the poster for presentation

Future Goals: We will start writing the paper after the ACEP 2013 conference.



The abstract was accepted into ACEP.

Members Involved: Anthony Burgess MD (PI), Mary Lee (study head) Sabina Kumar (statistical analysis)

Child Sexual Abuse

Description: This research was a doctoral dissertation describing the characteristics of children and perpetrators, taken from the UH sexual abuse database.

Current Progress: We have produced several publications and a PhD.

Future Goals: To continue this topic as a career.



Hassan M, Gary F. Totten VY. Child Maltreatment. J. Holistic Nursing. (JHN-13-Feb-0023) Revision requested Feb 2013.


Hassan M. Gary F. Totten VY, et al. Could We Have Known? Young Children's Self-Reported Experiences About Sexual Abuse, 41th Annual NBNA Institute and Conference at Hyatt Regency New Orleans Hotel Louisiana. 7-31, 8-4, 2013.

Hassan M, Gary F. Totten VY. "Patterns Of Sexual Abuse Among Children Who Received Care In An Emergency Department In A Midwestern Emergency Department," Poster. 6th Health Disparities Conference March 7-9, 2013 in New Orleans, Louisiana.

Members Involved: Totten VY, Hassan M (RN). Gary F. (RN, PhD)