Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions

ContextThe “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices.ObjectiveTo identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions.DesignCross-sectional study.SettingWeb-based survey.ResultsThe survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14).ConclusionsThe majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.Key Words: burnout, work-life balance, staffing, full-time equivalent, medical coverage

Key Points

• Most National Collegiate Athletic Association Football Bowl Subdivision-level institutions did not have an adequate number of full-time equivalent (FTE) athletic training personnel for football. Adding 1–3 FTEs would bring many of these institutions into compliance with the “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) recommendations. However, 1 athletic trainer is not equal to 1 FTE.
• Institutions used the AMCIA guidelines inconsistently. Financial or administrative constraints were among the reasons cited for not using them.
• The majority of those who have used the AMCIA attest that it helped them to justify current or proposed staffing quantities.
• The profession needs to promote a standardized definition of FTE and a realistic valuation of the time and effort required to provide athletic training services.

Over the last 2 decades, participation in collegiate sports has consistently increased.¹ In the 2012–2013 academic year, collegiate sport participation reached an all-time high, with more than 450 000 student-athletes competing in National Collegiate Athletic Association (NCAA) sports.¹ Over 70 000 of those athletes participated in football, making it the largest NCAA sport by total athlete count,¹ with 14 367 of those athletes participating in the Football Bowl Subdivision (FBS). The increase in collegiate athletes should be associated with increased medical personnel to ensure delivery of quality services.In collegiate sports, it is common to have a collaborative health care team that includes athletic trainers (ATs), physical therapists, physicians, and physician assistants. However, these health care professionals are often in short supply in relation to the needs of the institution. Some variables that must be considered in determining an institution''s need for athletic medical services are the number of athlete-exposures, number and types of sponsored athletic teams and athletes to be covered, overlap of seasons, length of seasons, and frequency and duration of practices, training sessions, and competitions.² A mismatch between workload and number of personnel may have detrimental effects on members of the health care team.Emerging research on the psychological syndrome burnout has identified this problem among ATs^3–5 and has shown that too few personnel can cause ATs to develop emotional exhaustion, depersonalization, and a reduced feeling of personal accomplishment, all symptoms of burnout.³ Specifically, ATs who work with multiple sports^3,6 and for long hours^3,5 may be more prone to developing burnout symptoms, which may compromise the quality of care they provide to athletes.³ Inadequate staffing patterns and long, inflexible hours can also create conflicts when trying to balance professional and personal lives.^7–9 Work-life conflict,^10,11 role overload,¹¹ and role strain¹⁰ have been cited as common reasons ATs leave the profession to pursue other avenues.The National Athletic Trainers'' Association (NATA) recognized the increasing demands on NCAA sports medicine programs and subsequent detrimental effects on the wellbeing of ATs and their ability to deliver a consistent level of care to athletes. This concern prompted the creation of the Task Force to Establish Appropriate Medical Coverage for Intercollegiate Athletics, which developed “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA),² a document that can be used to estimate the personnel resources required to provide appropriate medical care to athletes. The report operationalizes variables such as quantity of athlete-exposures, number and types of sponsored athletic teams and athletes, overlap of seasons, length of seasons, frequency and duration of activities, and ATs'' administrative duties to provide “recommended athletic trainer full-time equivalents (FTEs).”²The NATA noted that numerous athletic training services influence the health and wellbeing of student-athletes and that the provision of appropriate medical care extends beyond emergency care during athletic events.² Appropriate medical care includes a variety of responsibilities, ranging from day-to-day operations to activities that occur without direct student-athlete contact. The aim of the AMCIA document was to allow institutions to quantify the athletic training personnel required to provide appropriate medical care, in all forms, including event coverage, organization of preparticipation examinations, development and implementation of injury-prevention programs, evaluation and treatment of injuries and illnesses, creation and direction of rehabilitation programs, administrative tasks, nutrition consultation, and maintenance of continuing education.²Although the original AMCIA document was published more than 10 years ago,² few researchers have investigated its use or whether institutions typically meet the FTE recommendations. Two dissertations addressing university compliance with the AMCIA recommendations were narrowly focused; 1 looked at universities in Indiana¹² and the other at a single conference in the Football Championship Subdivision (FCS).¹³ Both authors found all institutions (n = 12 and n = 9, respectively) fell short of their minimum FTE recommendation.^12,13 These studies had small sample sizes from very specific populations, but the findings establish a discrepancy between the NATA''s recommendations for appropriate medical care and current employment characteristics of NCAA sports medicine programs.The primary purpose of our study was to identify the staffing and employment characteristics of athletic health care services at FBS-level institutions. Specifically, our aim was to capture the FTE assignment practices of universities for football at the highest level within the NCAA and to determine if these FBS institutions met FTE recommendations for football as indicated by the AMCIA method.     

Elevated serum levels of interferon- gamma -inducible protein-10 in patients coinfected with hepatitis C virus and HIV

Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is associated with an accelerated course of HCV infection and a faster progression to severe liver disease. We have investigated whether the development of liver disease in coinfected patients is associated with specific chemokine and cytokine production. Four cohorts--HCV/HIV-coinfected patients, HCV-monoinfected patients, HIV-monoinfected patients, and healthy control subjects--were studied. Serum levels of the 10-kDa interferon- gamma -inducible protein (IP-10) were higher in all 3 groups of infected patients than in control subjects (P<.0001). HCV/HIV-coinfected patients had significantly higher IP-10 levels than monoinfected patients. In HCV-monoinfected patients, liver fibrosis scores and liver enzyme levels were positively correlated with IP-10 levels. Elevated IP-10 levels are associated with and may contribute to liver damage in both HCV-monoinfected and HCV/HIV-coinfected patients.     

The history of neurosurgery at Emory University in Atlanta, Georgia

The development of neurosurgery at Emory University has paralleled the evolution of the science and practice of neurosurgery during the 20th century. This article features those individuals who have influenced and nurtured neurosurgery at Emory. It discusses the contributions of Crawford W. Long and further traces the development of the Emory University School of Medicine and Grady Memorial Hospital. Those individuals who have led neurosurgery at Emory are emphasized. Finally, the current Emory Department of Neurosurgery is featured, including facilities, faculty, and areas of subspecialty expertise.     

Modified circumferential torsoplasty for the massive-weight-loss patient

BACKGROUND: Obesity is an increasing national public health issue that has reached epidemic proportions over the past several decades. With new surgical advances in bariatric surgery, the massive-weight-loss patient population is on the rise. The generalized redundancy of skin following massive weight-loss, including lateral flank rolls, abdominal excesses, and buttock ptosis, is a problem amenable only by surgical excision. The circumferential torsoplasty has enabled the plastic surgeon to dramatically help this patient population. However, a problem exists in a size mismatch of the abdomen between the upper and lower circumferential flaps, leading to contour deformities. METHODS: This study reports on 3 cases of circumferential torsoplasty, with modified lateral skin wedge resection treated by a single surgeon. The preoperative markings, technical aspects of the surgery, postoperative care, and outcomes are reviewed. RESULTS: Patients in all 3 cases achieved improved body contour. To date, there have been no postoperative complications of the study participants. CONCLUSION: We propose a new modification to the circumferential torsoplasty that simultaneously eliminates the lateral dog-ears and prevents recurrence of saddlebag deformities commonly encountered in the traditional circumferential torsoplasty. A wedge excision of lateral thigh skin to deep investing fascia is primarily closed and simultaneously equalizes flap length and tightens the thigh area. The scars are well accepted by patients.     

Bone quality associated with daily intake of coffee: a biochemical, radiographic and histometric study

Caffeine induces loss of calcium and influences the normal development of bone. This study investigated the effects of coffee on bone metabolism in rats by biochemical measurement of calcium, bone densitometry and histometry. Male rats, born of female treated daily with coffee and with coffee intake since born, were anesthetized, subjected to extraction of the upper right incisor, and sacrificed 7, 21 and 42 days after surgery. Blood and urine samples were taken, and their maxilla radiographed and processed to obtain 5-μm-thick semi-serial sections stained with hematoxylin and eosin. The volume and bone quality were estimated using an image-analysis software. The results showed significantly greater amount of calcium in the plasma (9.40 ± 1.73 versus 9.80 ± 2.05 mg%) and urine (1.00 ± 0.50 versus 1.25 ± 0.70 mg/24 h) and significantly less amount in bone (90.0 ± 1.94 versus 86.0 ± 2.12 mg/mg bone), reduced bone mineral density (1.05 ± 0.11 versus 0.65 ± 0.15 mmAL), and lower amount of bone (76.19 ± 1.6 versus 53.41 ± 2.1 %) (ANOVA; p≤0.01) in animals treated with coffee sacrificed after 42 days. It may be concluded that coffee/caffeine intake caused serious adverse effects on calcium metabolism in rats, including increased levels of calcium in the urine and plasma, decreased bone mineral density and lower volume of bone, thus delaying the bone repair process.     

Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?

OBJECTIVE

To evaluate screening cystoscopy as the long‐term follow up in patients with an enterocystoplasty for ≥10 years.

PATIENTS AND METHODS

We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow‐up. This is performed for all patients with cystoplasty performed at our institute after 10 years. The data were recorded on patient demographics, original diagnosis and type of cystoplasty. In all, 53 of these patients consented to undergo bladder biopsies at the same time.

RESULTS

The median (range) follow‐up was 15 (10–33) years. No cancer was identified with either surveillance cystoscopy or on routine biopsies. Chronic inflammation was identified in 25 biopsies (27%). Villous atrophy was present in 12 (55%) ileal patch and three (12.5%) colonic patch biopsies. During this study, the first and only case of malignancy in a cystoplasty at our institution was diagnosed in a symptomatic patient. She had intermittent haematuria and recurrent urinary tract infections (UTIs). She previously had a normal surveillance cystoscopy.

CONCLUSIONS

We feel that it is not necessary to perform yearly check cystoscopies in patients with augmented bladders at least in the first 15 years, as cancer has not yet been detected with surveillance cystoscopy in this patient group. However, if the patient develops haematuria or other worrisome symptoms including suprapubic pain and recurrent unexplained UTIs a full evaluation, including cystoscopy and computerized tomography should be undertaken.     

Dysphoria and the Immediate Interpretation of Ambiguity: Evidence for a Negative Interpretive Bias in Error Rates But Not Response Latencies

Cognitive theories of depression (Beck, Journal of Cognitive Psychotherapy: An International Quarterly. 1:5–37, 1987) predict that depressed individuals will have an increased tendency to interpret ambiguous information in a negative manner. Researchers have observed a negative interpretive bias in a variety of situations, but much of the evidence has come from studies that relied on participants’ self-reports and other tasks that are highly susceptible to response biases. Studies that have used semantic priming tasks to covertly probe participants’ immediate interpretations of ambiguity, and thereby avoid response biases, have not observed an interpretive bias (Lawson and MacLeod, Behaviour Research and Therapy. 37:463–474, 1999; Bisson and Sears, Cognition and Emotion. 21:614–645, 2007). The present study used a task better suited to measure interpretive biases in the immediate interpretation of ambiguity: the semantic relatedness decision task. Participants listened to self-referent ambiguous prime sentences (e.g., My boyfriend said that I am unlike his past girlfriends) and responded to visually presented target words related to a negative (jealous), positive (attractive), or neutral (relationship) interpretation of the sentence. The task was to quickly indicate whether or not the target was related to the ambiguous prime (a yes or no response). The expectation was that dysphoric participants would respond more quickly to targets related to the negative interpretations of the primes because they would be more likely to impose negative interpretations on the ambiguity. This was not the case. On the other hand, the error data revealed that dysphoric participants made fewer errors to targets related to the negative interpretations of the primes (i.e., fewer “no” responses to negatively-related targets) and made more errors to targets related to the positive interpretations of the primes, a pattern consistent with a negative interpretive bias. These findings demonstrate that the semantic relatedness task is a promising tool for the study of interpretive biases in dysphoria and depression.