Brice J.H.,University of North Carolina at Chapel Hill |
Moss C.,University of North Carolina at Chapel Hill |
Purpura P.,Eastside Emergency Physicians |
Delbridge T.R.,Eastern Carolina University
Prehospital Emergency Care | Year: 2013
Background. Outcomes of patients who fall from bridges lower than 160 feet above water have been poorly characterized. Pittsburgh offers a unique setting in which to study these patients as the city has 41 major bridges, only four of which are above 70 feet. Objective. This study examined patients who fell or jumped from Pittsburgh bridges over a 10-year period for their characteristics, injury patterns, and the effects of prehospital care on outcomes. Methods. We conducted a retrospective cohort study of patients who jumped or fell from bridges in Pittsburgh, Pennsylvania, over a 10-year period. Subjects were identified through manual searches of three data repositories: City of Pittsburgh Bureau of Emergency Medical Services (EMS), Pittsburgh River Rescue, and Allegheny County Medical Examiner records. Data abstracted included patient name, age, gender, date of birth, and address; incident date, time, location, and river conditions; prehospital interventions; emergency department intervention; hospital disposition; evidence of prior or subsequent psychiatric admission; toxicology results or evidence of substance involvement; and causes of death. Results. Seventy-four subjects were identified. Most were male (80%) young adults (mean age 34.3 years) who lived near the bridges from which they jumped or fell. Mortality from bridges less than 50 feet high was 18%; mortality from bridges 180 feet high was 75%. All patients who required prehospital interventions beyond warming or intravenous (IV) fluids died. Injury patterns were similar to those described for high-bridge patients, concentrated in the trunk or skull, but low-bridge injuries were milder and less common. Cause of death was predominantly drowning (84%). More than a third (47.3%) of the patients had previous psychiatric histories, but evidence of a previous attempt to jump was uncommon (5.4%). Conclusions. People who jump from low- to medium-rise bridges may suffer injuries, but most often die from drowning. EMS interventions beyond water rescue are typically not helpful, emphasizing the importance of prevention and a water rescue plan. Copyright © 2012 Informa Plc.
Ferris M.,University of North Carolina at Chapel Hill |
Iglesia E.,Johnson University |
Ko Z.,Eastern Carolina University |
Amamoo A.,University of North Carolina at Chapel Hill |
And 4 more authors.
Renal Failure | Year: 2014
A workforce crisis for many pediatric specialties, particularly nephrology, is due to growing retirement rates, attrition during training, and retention difficulties. To obtain specific information regarding pediatric nephrology trainee shortages, we administered two cross-sectional surveys to non-renal pediatric subspecialty fellows and pediatric nephrology program directors. We characterized the fellows' experiences with nephrology and the program directors' experiences with their fellows as well as their outcomes in the last 10 years. We analyzed responses from 531 non-renal fellows (14.4% response rate). Overall, 317 (60%) fellows rated nephrology as difficult, particularly women (65.4% vs. 49.5%, p < 0.001), with American women medical graduates rating nephrology as more difficult compared to all others (p = 0.001). More men than women (24% vs. 8%, p < 0.001) considered the monetary benefit as not adequate. Program directors (25; 64% response rate) represented 57% of all USA fellows in training, and 15 (60%) found it difficult to recruit qualified applicants. Of the 183 graduates in the past 10 years, 35 (19%) were reported as not in the USA pediatric nephrology workforce. These findings support our belief that a strong effort needs to be made by the academic community to teach nephrology in more interesting and understandable formats. While these are national samples, we were unable to contact non-nephrology fellows directly and program directors from larger programs were underrepresented. Difficulties in attracting/retaining trainees (particularly women) to nephrology must be addressed systematically, identifying incentives to practice in this field. Bold concerted efforts are required and we propose seven steps to achieve this goal. © 2014 Informa Healthcare USA, Inc. All rights reserved.
PubMed | University of Indianapolis, Eastern Carolina University, St Francis Health System and Concordia University at Saint Paul
Type: Journal Article | Journal: International journal of sports physical therapy | Year: 2014
Objective, reliable, and valid functional tests may assist with the decision-making process for rehabilitation as well as assist in pre-participation screening for targeted interventions to prevent noncontact lower extremity injuries. The purpose of this study was to determine normative values in high school and college basketball and soccer players for four hop tests: the single hop for distance, the triple hop for distance, the crossover hop for distance, and the 6-m timed hop.A sample of convenience of 372 (185 females, 187 males) healthy high school and collegiate student-athletes were included in the study (mean age 17.37 years, range 14-24): 200 were soccer players and 172 were basketball players. Limb dominance was determined based on which extremity participants would choose to kick a ball for distance. A coin flip was used to determine which limb was tested first. Hop test order was randomized using a Latin square design. Participants performed one practice hop and three measured hops for each hop test on each limb. The average hop score for each limb was used for calculations.Significant differences in test performance were found between sexes and levels of competition, p < 0.0005, with males performing better than females and collegiate athletes performing better than high school athletes for all hop tests. There were no clinically relevant differences between dominant sports. There were also no clinically relevant differences between dominant and non-dominant limbs. Normative values for each hop test were proposed, based on sex and level of competition.These findings indicate that separate hop test standards should be used based on participant sex and level of competition. While some statistically significant differences were found between limbs, these differences did not appear to be functionally relevant. Further studies are needed to determine if sport-specific normative hop test values should be utilized and to examine normal limb symmetry indices in specific populations.2A.
Bush G.,National-Louis University |
Jones J.L.,Eastern Carolina University
School Library Media Research | Year: 2010
This article reports the findings of an exploratory study to identify professional dispositions of school librarians. The authors employed the Delphi method, a qualitative research method that emphasizes expert knowledge and consensus within a particular field. The Delphi panel consisted of members of the editorial boards of nationally recognized school library journals in the United States. Panelists independently forecasted and described the identified professional dispositions, commented on eleven prominent dispositions that received the most responses, and ranked and combined categories of dispositions. The results of this study provide a foundation for further exploration of professional dispositions, leading to the design of signature pedagogies for use in school library education, appropriate assessment measures for both school library education and practicing school librarians, and thoughtful and reflective consideration of the acquisition and nurturance of these dispositions.
Vora A.,Chesapeake Urology Assoct. |
Agarwal V.,Cleveland Clinic |
Singh P.,Cleveland Clinic |
Patel R.,Eastern Carolina University |
And 3 more authors.
Prostate International | Year: 2016
Background Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments. Methods From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment. Results Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy. Conclusion While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity.
PubMed | Washington University in St. Louis, Eastern Carolina University, Saint Louis University and Johns Hopkins University
Type: Journal Article | Journal: Transplant international : official journal of the European Society for Organ Transplantation | Year: 2016
We examined integrated national transplant registry, pharmacy fill, and medical claims data for Medicare-insured kidney transplant recipients in 2000-2011 (n = 45 164) from the United States Renal Data System to assess the efficacy and safety endpoints associated with seven early (first 90 days) immunosuppression (ISx) regimens. Risks of clinical complications over 3 years according to IS regimens were assessed with multivariate regression analysis, including the adjustment for covariates and propensity for receipt of a nonreference ISx regimen. Compared with the reference ISx (thymoglobulin induction with tacrolimus, mycophenolate, and prednisone maintenance), sirolimus-based ISx was associated with significantly higher three-year risks of pneumonia (adjusted hazard ratio, aHR 1.45; P < 0.0001), sepsis (aHR 1.40; P < 0.0001), diabetes (aHR 1.21; P < 0.0001), acute rejection (AR; adjusted odds ratio, aOR 1.33; P < 0.0001), graft failure (aHR 1.78; P < 0.0001), and patient death (aHR 1.40; P < 0.0001), but reduced skin cancer risk (aHR 0.71; P < 0.001). Cyclosporine-based IS was associated with increased risks of pneumonia (aHR 1.17; P < 0.001), sepsis (aHR 1.16; P < 0.001), AR (aOR 1.43; P < 0.001), and graft failure (aHR 1.39; P < 0.001), but less diabetes (aHR 0.83; P < 0.001). Steroid-free ISx was associated with the reduced risk of pneumonia (aHR 0.89; P = 0.002), sepsis (aHR 0.80; P < 0.001), and diabetes (aHR 0.77; P < 0.001), but higher graft failure (aHR 1.35; P < 0.001). Impacts of ISx over time warrant further study to better guide ISx tailoring to balance the efficacy and morbidity.
Whitson H.E.,Duke University |
Steinhauser K.,Duke University |
Ammarell N.,Duke University |
Whitaker D.,Duke University |
And 4 more authors.
Journal of the American Geriatrics Society | Year: 2011
Objectives To identify generalizable ways that comorbidity affects older adults' experiences in a health service program directed toward an index condition and to develop a framework to assist clinicians in approaching comorbidity in the design, delivery, and evaluation of such interventions. Design A qualitative data content analysis of interview transcripts to identify themes related to comorbidity. Setting An outpatient low-vision rehabilitation program for macular disease. Participants In 2007/08, 98 individuals undergoing low-vision rehabilitation and their companions provided 624 semistructured interviews that elicited perceptions about barriers and facilitators of successful program participation. Results The interviews revealed five broad themes about comorbidity: (i) "good days, bad days," reflecting participants' fluctuating health status during the program because of concurrent medical problems; (ii) "communication barriers." which were sometimes due to participant impairments and sometimes situational; (iii) "overwhelmed," which encompassed pragmatic and emotional concerns of participants and caregivers; (iv) "delays," which referred to the tendency of comorbidities to delay progress in the program and to confer added inconvenience during lengthy appointments; and (v) value of companion involvement in overcoming some barriers imposed by comorbid conditions. Conclusion This study provides a taxonomy and conceptual framework for understanding consequences of comorbidity in the experience of individuals receiving a health service. If confirmed in individuals receiving interventions for other index diseases, the framework suggests actionable items to improve care and facilitate research involving older adults. © 2011, The American Geriatrics Society.
Foltz S.L.,Virginia Polytechnic Institute and State University |
Ross A.E.,Virginia Polytechnic Institute and State University |
Laing B.T.,Virginia Polytechnic Institute and State University |
Laing B.T.,Eastern Carolina University |
And 4 more authors.
Behavioral Ecology | Year: 2015
Urban animals often show differences in aggression relative to their rural counterparts, but the ultimate and proximate origins of these differences are poorly understood. Here, we compared urban and rural song sparrows (Melospiza melodia), a species for which higher levels of aggression in urban populations have previously been reported. First, we confirmed elevated territorial aggression levels in urban birds relative to rural birds over multiple years. To begin to identify the environmental variables contributing to these differences, we related aggression to features of the social and physical environment, specifically population density and the availability of suitable nesting vegetation. Population distribution and the availability of suitable nest vegetation were not correlated with territorial aggression levels. Subsequently, we conducted a food supplementation experiment to determine whether potential differences in the relative availability of food between the 2 habitats might drive differences in aggression. Food supplementation increased territorial aggression significantly, particularly in rural birds. Thus, it appears that the availability of food could play a role in determining territorial aggression in song sparrows. The specific combination of these features found in urban areas may cause the increased levels of territorial aggression seen in these populations. © 2015 The Author 2015. Published by Oxford University Press on behalf of the International Society for Behavioral Ecology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Pickard J.,Eastern Carolina University |
Patrick A.Y.,Eastern Carolina University |
Robinson A.,Nephos6 Inc.
Conference Proceedings - IEEE SOUTHEASTCON | Year: 2015
IPv4 is now a legacy protocol and all future growth and innovation on the Internet will occur over IPv6. It is necessary that enterprise organizations take immediate action to develop strategies for IPv6 adoption or risk compromising business agility and continuity - especially those organizations with public-facing content that rely on the Internet. © 2015 IEEE.
Say E.A.T.,University of North Carolina at Chapel Hill |
Knupp C.L.,Eastern Carolina University |
Gertsch K.R.,University of North Carolina at Chapel Hill |
Chavala S.H.,University of North Carolina at Chapel Hill
Oncology Letters | Year: 2012
Intraocular lymphoma is a rare ocular malignancy that may occur in the retina or the uvea. Retina or vitreoretinal lymphoma accounts for the majority of cases and is often secondary to diffuse large B-cell lymphoma. In the present study, a 66-year-old Caucasian male with a history of Waldenstrom's macroglobulinemia with diffuse large B-cell lymphoma, presented with blurred vision in the left eye one month following cycle 4 of an R-CHOP regimen. At the time of onset, the patient was being treated for bacterial pneumonia. Visual acuity was 20/25 in his right eye (OD) and 20/30 in the left (OS). Ophthalmologic examination showed intraretinal white infiltrates associated with hemorrhage in the superotemporal midperiphery of the retina and vitritis OS. Initial diagnostic considerations included infectious (cytomegalovirus retinitis, syphilis, toxoplasmosis, tuberculosis), inflammatory (retinal vasculitis associated with autoimmune disease or hypercoagulable states) or malignant (intraocular lymphoma) diseases. The patient did not respond to intravitreal injection of foscarnet and oral valgancyclovir. Systemic work-up and aqueous fluid biopsy were inconclusive. Diagnostic vitrectomy yielded inconclusive results and the patient continued to have progressive loss of vision. A repeat diagnostic vitrectomy with retinal and subretinal biopsy confirmed large B cells consistent with metastatic B-cell lymphoma. A concomitant PET/CT scan was performed that revealed bilateral new pulmonary nodules resulting in additional chemotherapy. Our case shows the diagnostic dilemmas in patients with systemic lymphoma and the possible role of concurrent systemic restaging in patients with ocular complaints, even when in systemic remission.