2,158 research outputs found

    Summer Institute in Public Health at Lakenau Medical Center

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    Economic Impact and Health Disparities of Firearm Injuries Treated within the Thomas Jefferson University Health System

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    Introduction: Firearms are a significant cause of morbidity and mortality in the United States. In 2015, firearms killed over 36,000 Americans (CDC, 2017), and in 2013 were responsible for $229 billion in healthcare and other costs (Cerdá 2016). On an average day in Philadelphia, 4 people are injured or killed by firearms (Beard 2017). This purpose of this project is to further investigate these trends in the context of the Thomas Jefferson University Health System. Objective: To date, no research exists to examine firearm violence within the Thomas Jefferson University Hospital (TJUH) System. The purpose of this study is to fill that gap by exploring the geographic distribution, demographics, and cost associated with firearm injuries at TJUH. This information could help identify high-risk patient groups, and contribute to targeted interventions, education, and policy in the future. Methods: This study is a 10-year retrospective analysis of TJUH medical records. ICD codes were used to identify patients treated between January 2008 and December 2017 for firearm-related injuries. Information such as patient zip code, age, ethnicity, insurance, and past medical history are being collected. This data is being entered into REDCap for analysis. Results: There were 505 cases of firearm injuries recorded at TJUH between January 2008 and December 2017. Data are still being collected, so final results are forthcoming. Conclusion: Firearms are a pervasive and deadly threat to public health across the United States. Data collection is ongoing, so firm conclusions cannot yet be drawn. However, there were more cases of firearm violence within the study period than were expected. This stresses the importance of quantifying and studying this problem, so we may be better informed and better prepared to address it

    The Use of Wearable Technology in the Detection of Operator Fatigue

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    Introduction: Operator fatigue is a prevalent cause of injury and death. Many studies have proven reliable ways of determining operator fatigue through the use of engineering and technological advances including blink rate, lid lag, respiratory rate, cardiac rate, chest expansion, etc. However the implementation of these advances has yet to be utilized. This systematic literature review seeks to elucidate the need for implementation of wearable technology for those who suffer from operator fatigue. Methods: The target population includes anyone who operates a vehicle including drivers, aviation pilots, train conductors/engineers, marine pilots, operators of heavy machinery, fishermen and professional/overnight drivers. All technological and engineering interventions used in the detection of operator fatigue will be analyzed with successful detection of driver fatigue being the outcome. Data is being compiled form PubMed, Scopus, Cochrane Library and TRID. Results: We are in the process of publishing a preferred reporting items for systematic review and meta-analyses protocol (PRISMA-P). In addition, the results from each database suggest wearable technology is successful in detecting operator fatigue. Discussion: The PRISMA-P is a necessary step to provide validity for a systematic literature review to show we aren’t manipulating parameters to skew our results. Upon publishing this, we anticipate that our PRISMA P will further support the need for a systematic literature review on the use of wearable technology in the detection of operator fatigue

    Conjugated linoleic acid (CLA)-enriched milk fat inhibits growth and modulates CLA-responsive biomarkers in MCF-7 and SW480 human cancer cell lines

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    Milk enriched in conjugated linoleic acid (CLA) was obtained from cows on pasture supplemented with full-fat rapeseeds (FFR; 2·26g cis 9, trans 11 (c9, t11)-CLA/100g fatty acid methyl esters) and full-fat soyabeans (1·83g c9, t11-CLA/100g fatty acid methyl esters). A control milk fat (1·69g c9, t11-CLA/100g fatty acid methyl esters) was obtained from cows fed on pasture only. The present study assessed the potency of the CLA-enriched milk fats to modulate biomarkers that had previously been observed to respond to c9, t11-CLA in the MCF-7 and SW480 cell lines. Cell numbers decreased (P<0·05) by up to 61 and 58% following the incubation of MCF-7 and SW480 cells, respectively, for 4d with milk fats (yielding CLA concentrations between 60·2 and 80·6μM). The FFR milk fat, containing the highest CLA content, increased (P<0·05) [14C]arachidonic acid (AA) uptake into the monoacylglycerol fraction of MCF-7 and SW480 cells while it decreased (P<0·05) uptake into the phospholipid fraction of the latter. This milk fat also decreased (P<0·05) [14C]AA conversion to prostaglandin (PG) E2 while increasing conversion to PGF2α in both cell lines. All milk-fat samples increased (P<0·05) lipid peroxidation as measured by 8-epi-PGF2α in both cell lines. In SW480 cells the milk-fat samples decreased (P<0·05) bcl-2 and cytosolic glutathione levels while increasing (P<0·05) membrane-associated annexin V levels. All milk-fat samples decreased (P<0·05) the expression of ras in SW480 cells. These data suggest that milk-fat CLA was effective at modulating synthetic CLA-responsive biomarkers

    Falls and Traumatic Brain Injury in the Elderly on Aspirin or Anticoagulant Therapy

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    Introduction: Traumatic brain injury (TBI) after a fall in individuals aged 65 and older is a leading cause of morbidity and mortality, but the effect of aspirin and anticoagulant therapy on TBI severity is not fully understood. This study evaluated whether the severity of TBI is associated with use of aspirin or anticoagulant therapy or in combination. Methods: Using retrospective chart review, we identified patients age 65 or older who fell and sustained head trauma that were admitted to Thomas Jefferson University Hospital trauma service from 2017-2018. Based on final diagnosis, patients were classified into three groups of TBI in order of increasing severity: mild TBI, extra-axial hemorrhage, and intra-axial hemorrhage. ANOVA and regression analysis will be used to compare use of aspirin, anticoagulant therapy, both in combination, or neither in the three groups. Results: We hypothesize that patients with more severe head trauma will have increased use of aspirin or anticoagulant therapy or both in combination compared to patients who are on neither aspirin nor anticoagulant therapy. Preliminary results show patients with any diagnosis of TBI were more likely to be on aspirin compared to controls (OR 1.74, p\u3c0.001). Patients with any diagnosis of TBI and anticoagulant therapy had no statistical significant association compared to controls (OR 1.25, p=0.25). Discussion: These findings will guide the understanding of how aspirin and anticoagulant therapy affect severity of TBI. Judicious use of aspirin and anticoagulant therapy in the elderly who are at risk of falling may reduce the incidence of severe TBI

    Hierarchical task analysis: Developments, applications and extensions

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    Hierarchical Task Analysis (HTA) is a core ergonomics approach with pedigree of over thirty years continuous use. At its heart, HTA is based upon a theory of performance and has only three governing principles. Originally developed as a means of determining training requirements, there was no way the initial pioneers of HTA could have foreseen the extent of its success. HTA has endured as a way of representing a system sub-goal hierarchy for extended analysis. It has been used for a range of applications, including interface design and evaluation, allocation of function, job aid design, error prediction, and workload assessment. Ergonomists are still developing new ways of using HTA which has assured the continued use of the approach for the foreseeable future

    Long-path quantum cascade laser–based sensor for methane measurements

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    Author Posting. © American Meteorological Society, 2016. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Atmospheric and Oceanic Technology 33 (2016): 2373-2384, doi:10.1175/JTECH-D-16-0024.1.A long-path methane (CH4) sensor was developed and field deployed using an 8-μm quantum cascade laser. The high optical power (40 mW) of the laser allowed for path-integrated measurements of ambient CH4 at total pathlengths from 100 to 1200 m with the use of a retroreflector. Wavelength modulation spectroscopy was used to make high-precision measurements of atmospheric pressure–broadened CH4 absorption over these long distances. An in-line reference cell with higher harmonic detection provided metrics of system stability in rapidly changing and harsh environments. The system consumed less than 100 W of power and required no consumables. The measurements intercompared favorably (typically less than 5% difference) with a commercial in situ methane sensor when accounting for the different spatiotemporal scales of the measurements. The sensor was field deployed for 2 weeks at an arctic lake to examine the robustness of the approach in harsh field environments. Short-term precision over a 458-m pathlength was 10 ppbv at 1 Hz, equivalent to a signal from a methane enhancement above background of 5 ppmv in a 1-m length. The sensor performed well in a range of harsh environmental conditions, including snow, rain, wind, and changing temperatures. These field measurements demonstrate the capabilities of the approach for use in detecting large but highly variable emissions in arctic environments.The authors gratefully acknowledge funding for this work by MIRTHE through NSF-ERC Grant EEC-0540832. D. J. Miller acknowledges support by the National Science Foundation Graduate Research Fellowship under Grant DGE-0646086. K. Sun acknowledges support by the NASA Earth and Space Science Fellowship IIP-1263579.2017-05-0

    Clinical assessment of hand oedema: A systematic review

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    Introduction: Assessment of oedema after trauma or surgery is important to determine whether treatment is effective and to detect change over time. Volumetry is referred to as the ‘gold standard’ method of measuring volume. However, this has practical limitations and other methods are available. The aim of this systematic review was to evaluate the psychometric properties of alternative methods used to assess hand oedema. Methods: A search of electronic bibliographic databases was undertaken for any studies published in English reporting the psychometric evaluation of a method for measuring hand oedema, in an adult population with hand swelling from surgery, trauma or stroke. The Consensus‐based Standards for the Selection of health Measurement Instruments (COSMIN) checklist was used to evaluate the methodological quality. Results: Six studies met the inclusion criteria. Three methods were identified assessing hand oedema: perometry, visual inspection and the figure-of-eight tape measure, all were compared to volumetry. Four different psychometric properties were assessed. Studies scored fair or poor on COSMIN criteria. There is low-quality evidence supporting the use of the figure-of-eight tape measure to assess hand volume. The perometer systematically overestimated volume and visual estimation had poor sensitivity and specificity. Discussion: The figure-of-eight tape measure is the best alternative to volumetry for hand oedema. Benefits include reduced cost and time while having comparable reliability to the ‘gold standard’. Further research is needed to compare methods in patients with greater variability of conditions and with isolated digit oedema. Visual estimation of hand oedema is not recommended

    Constitutively Enhanced Lymphatic Pumping in the Upper Limbs of Women Who Later Develop Breast Cancer-Related Lymphedema.

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    BACKGROUND: It has previously been shown that the lymph drainage rate in both upper limbs is greater in women destined to develop breast cancer-related lymphedema (BCRL) than in those who do not develop BCRL, indicating a constitutive predisposition. We explored constitutive differences further by measuring the maximum lymphatic pump pressure (Ppump) and the rate of (99m)Tc-Nanocoll transport generated by the contractile upper limb lymphatics before and after breast cancer surgery in a group of women who were followed for 2 years to determine their eventual BCRL or non-BCRL status. METHODS AND RESULTS: Ppump and tracer transport rate were measured by lymphatic congestion lymphoscintigraphy in the ipsilateral upper limb in 26 women pre- and post-breast cancer surgery. BCRL occurred in 10/26 (38.5%) cases. Ppump in the women who later developed BCRL (40.0 ± 8.2 mmHg) was 1.7-fold higher than in those who did not develop BCRL (23.1 ± 10.8 mmHg, p = 0.001). Moreover, the rate of lymph tracer transport into the forearm was 2.2-fold greater in the women who later developed BCRL (p = 0.052). Surgery did not significantly reduce Ppump measured 21 weeks postsurgery, but impaired forearm tracer transport in pre-BCRL women by 58% (p = 0.047), although not in those who did not develop BCRL. CONCLUSIONS: Women destined to develop BCRL have higher pumping pressures and lymph transport, indicating harder-working lymphatics before cancer treatment. Axillary lymphatic damage from surgery appears to compromise lymph drainage in those women constitutively predisposed to higher lymphatic pressures and lymph transport
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