The national burden of orthopedic injury: Cross-sectional estimates for trauma system planning and optimization

Background: Management of orthopedic injuries is a critical component of comprehensive trauma care. As patterns of injury incidence and recovery change in the face of emerging injury prevention efforts and technologies and an aging US population, assessment of the burden of orthopedic injury is essential to optimize trauma system planning. We sought to estimate the incidence of orthopedic injury requiring emergency orthopedic surgery in the United States.Methods: Using nationally representative samples from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, we estimated the incidence of orthopedic injury, polytrauma with orthopedic injury, and emergency operative orthopedic procedures performed for the management of traumatic injury. We used multivariable logistic regression to identify patient, injury, and hospital characteristics associated with odds of emergency orthopedic surgery.Results: A total of 7,214,915 patients were diagnosed with orthopedic injury in 2013-2014, resulting in 1,167,656 emergency orthopedic surgical procedures. Fall-related injuries accounted for 51% of health care encounters and 61% of emergency orthopedic surgical procedures. Odds of emergency orthopedic surgery were 2.04 times greater for patients with polytrauma, compared with isolated orthopedic injury (P \u3c 0.001).Conclusions: The total burden or orthopedic injury in the United States is substantial, and there is considerable heterogeneity in demand for care and practice patterns in the orthopedic trauma community. Population-based trauma system planning and tailored care delivery models would likely optimize initial treatment, recovery, and health outcomes for orthopedic trauma patients

The Latino community in Johnston County, North Carolina : an action-oriented community diagnosis

From September 2005 – April 2006, five Masters of Public Health students from the University of North Carolina School of Public Health, Department of Health Behavior and Health Education conducted an Action Oriented Community Diagnosis (AOCD) with the Latino Community of Johnston County. The AOCD examined the Latino community’s quality of life, strengths, challenges and needs through community-based, participatory research with Latino community members and service providers assisting the Latino community. Two preceptors from Johnston County assisted the student team throughout the AOCD process by providing an orientation to the community and identifying key informants. The student team interviewed 22 service providers, 15 community members and conducted two community member focus groups. The student team supplemented information acquired through these interviews with secondary data and student observations in the form of field notes. Five overarching themes resulting from this process were presented at a Community Forum, held in Smithfield, Johnston County on April 30, 2006. Topics that were discussed are as follows: education; employment; leadership; health; and housing. Below is a list of the themes and the action steps generated at the Community Forum to address each issue: There are difficulties providing education to Latinos due to policies that restrict how ESL classes are taught, lack of information about educational services and the inability of many Latino students to continue to university-level studies. 1. Education services will be publicized through radio and newspaper advertisements and communications between community members. 2. Community members will volunteer to teach classes in the Johnston Community College mobile ESL unit. 3. Community members will organize groups to meet regularly for classes at the mobile unit. 4. Community members and service providers will meet again in May to discuss progress and continue addressing this and other issues concerning education. Despite the fact that Latinos are moving from migrant work to more permanent, stable employment, Latinos still suffer from employer abuse, insufficient living wages and unemployment. 1. Contact the Spanish language television channel, Univision, and ask them to advertise information about services and employment issues as part of a specific weekly program. 2. Contact Johnston Community College about advertising the continuing education services that they offer in Spanish to increase awareness of available services to improve employment preparedness in the Latino community. 3. Contact the local churches about advertising the ESL and childcare services that they offer to support working parents. There is a need for leadership and sustainable collaboration within the Latino community. 1. Contact and speak with Latino communities in Siler City and Sanford to find out how they fostered and encourage leadership within the community. 2. Make a connection with El Pueblo in Raleigh and solicit advice on how to encourage advocacy and leadership within the community. 3. Send a letter to the local Hispanic radio station, encouraging Latinos in Johnston County to voice their concerns and opinions concerning their community. 4. Create and advertise training for the community on basic leadership and community organizing skills. Lack of interpreters and high quality interpretation hinders Latino patient-provider communication. Lack of insurance, substandard housing conditions and heightened susceptibility to occupational injuries and other health concerns place Latinos at greater health risk. 1. Publicize assistance programs available to the Latino community to subsidize cost of medications and health services. 2. Register complaints about lack of interpreters and health department funding through a community petition and submittal of Non-Compliance with Title XI Forms to the North Carolina State Government. 3. Coordinate a Latino Health Fair to provide information on health services available to the Latino community. Poor housing conditions and landlord abuse are serious issues facing the Latino community. 1. Contact Housing Assistance to collect information on Renter Rights. 2. Form an action committee on Housing, which will meet later in May at the Johnston Community College (JCC). 3. Invite a representative from Housing Assistance to the committee meeting at the JCC.Master of Public Healt

A structural and physical study of sol–gel methacrylate–silica hybrids: intermolecular spacing dictates the mechanical properties

Sol–gel hybrids are inorganic/organic co-networks with nanoscale interactions between the components leading to unique synergistic mechanical properties, which can be tailored, via a selection of the organic moiety. Methacrylate based polymers present several benefits for class II hybrids (which exhibit formal covalent bonding between the networks) as they introduce great versatility and can be designed with a variety of chemical side-groups, structures and morphologies. In this study, the effect of high cross-linking density polymers on the structure–property relationships of hybrids generated using poly(3-trimethoxysilylpropyl methacrylate) (pTMSPMA) and tetraethyl orthosilicate (TEOS) was investigated. The complexity and fine scale of the co-network interactions requires the development of new analytical methods to understand how network evolution dictates the wide-ranging mechanical properties. Within this work we developed data manipulation techniques of acoustic-AFM and solid state NMR output that provide new approaches to understand the influence of the network structure on the macroscopic elasticity. The concentration of pTMSPMA in the silica sol affected the gelation time, ranging from 2 h for a hybrid made with 75 wt% inorganic with pTMSPMA at 2.5 kDa, to 1 minute for pTMSPMA with molecular weight of 30 kDa without any TEOS. A new mechanism of gelation was proposed based on the different morphologies derived by AC-AFM observations. We established that the volumetric density of bridging oxygen bonds is an important parameter in structure/property relationships in SiO2 hybrids and developed a method for determining it from solid state NMR data. The variation in the elasticity of pTMSPMA/SiO2 hybrids originated from pTMSPMA acting as a molecular spacer, thus decreasing the volumetric density of bridging oxygen bonds as the inorganic to organic ratio decreased

Treading Water: Tools to Help US Coastal Communities Plan for Sea Level Rise Impacts

As communities grapple with rising seas and more frequent flooding events, they need improved projections of future rising and flooding over multiple time horizons, to assist in a multitude of planning efforts. There are currently a few different tools available that communities can use to plan, including the Sea Level Report Card and products generated by a United States. Federal interagency task force on sea level rise. These tools are a start, but it is recognized that they are not necessarily enough at present to provide communities with the type of information needed to support decisions that range from seasonal to decadal in nature, generally over relatively small geographic regions. The largest need seems to come from integrated models and tools. Agencies need to work with communities to develop tools that integrate several aspects (rainfall, tides, etc.) that affect their coastal flooding problems. They also need a formalized relationship with end users that allows agency products to be responsive to the various needs of managers and decision makers. Existing boundary organizations can be leveraged to meet this need. Focusing on addressing these needs will allow agencies to create robust solutions to flood risks, leading to truly resilient communities

Zebrafish Globin Switching Occurs in Two Developmental Stages and Is Controlled by the LCR

Globin gene switching is a complex, highly regulated process allowing expression of distinct globin genes at specific developmental stages. Here, for the first time, we have characterized all of the zebrafish globins based on the completed genomic sequence. Two distinct chromosomal loci, termed major (chromosome 3) and minor (chromosome 12), harbor the globin genes containing α/β pairs in a 5′–3′ to 3′–5′ orientation. Both these loci share synteny with the mammalian α-globin locus. Zebrafish globin expression was assayed during development and demonstrated two globin switches, similar to human development. A conserved regulatory element, the locus control region (LCR), was revealed by analyzing DNase I hypersensitive sites, H3K4 trimethylation marks and GATA1 binding sites. Surprisingly, the position of these sites with relation to the globin genes is evolutionarily conserved, despite a lack of overall sequence conservation. Motifs within the zebrafish LCR include CACCC, GATA, and NFE2 sites, suggesting functional interactions with known transcription factors but not the same LCR architecture. Functional homology to the mammalian α-LCR MCS-R2 region was confirmed by robust and specific reporter expression in erythrocytes of transgenic zebrafish. Our studies provide a comprehensive characterization of the zebrafish globin loci and clarify the regulation of globin switching.Stem Cell and Regenerative Biolog

Assaying the regulatory potential of mammalian conserved non-coding sequences in human cells

The fraction of experimentally active conserved non-coding sequences within any given cell type is low, so classical assays are unlikely to expose their potential

Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system

BackgroundMeaningful Use (MU) provides financial incentives for electronic health record (EHR) implementation. EHR implementation holds promise for improving healthcare delivery, but also requires substantial changes for providers and staff. Establishing readiness for these changes may be important for realizing potential EHR benefits. Our study assesses whether provider/staff perceptions about the appropriateness of MU and their departments’ ability to support MU-related changes are associated with their reported readiness for MU-related changes.MethodsWe surveyed providers and staff representing 47 ambulatory practices within an integrated delivery system. We assessed whether respondent’s role and practice-setting type (primary versus specialty care) were associated with reported readiness for MU (i.e., willingness to change practice behavior and ability to document actions for MU) and hypothesized predictors of readiness (i.e., perceived appropriateness of MU and department support for MU). We then assessed associations between reported readiness and the hypothesized predictors of readiness.ResultsIn total, 400 providers/staff responded (response rate approximately 25%). Individuals working in specialty settings were more likely to report that MU will divert attention from other patient-care priorities (12.6% vs. 4.4%, p = 0.019), as compared to those in primary-care settings. As compared to advanced-practice providers and nursing staff, physicians were less likely to have strong confidence in their department’s ability to solve MU implementation problems (28.4% vs. 47.1% vs. 42.6%, p = 0.023) and to report strong willingness to change their work practices for MU (57.9% vs. 83.3% vs. 82.0%, p < 0.001). Finally, provider/staff perceptions about whether MU aligns with departmental goals (OR = 3.99, 95% confidence interval (CI) = 2.13 to 7.48); MU will divert attention from other patient-care priorities (OR = 2.26, 95% CI = 1.26 to 4.06); their department will support MU-related change efforts (OR = 3.99, 95% CI = 2.13 to 7.48); and their department will be able to solve MU implementation problems (OR = 2.26, 95% CI = 1.26 to 4.06) were associated with their willingness to change practice behavior for MU.ConclusionsOrganizational leaders should gauge provider/staff perceptions about appropriateness and management support of MU-related change, as these perceptions might be related to subsequent implementation