Energy Balance,Eating Disorder Risk,and Pathogenic Behaviors Among Athletic Trainers

ContextResearch exists on energy balances (EBs) and eating disorder (ED) risks in physically active populations and occupations by settings, but the EB and ED risk in athletic trainers (ATs) have not been investigated.ObjectiveTo assess ATs'' energy needs, including the macronutrient profile, and examine ED risk and pathogenic behavioral differences between sexes (men, women) and job statuses (part time or full time) and among settings (college or university, high school, nontraditional).DesignCross-sectional study.SettingFree living in job settings.Patients or Other ParticipantsAthletic trainers (n = 46; male part-time graduate assistant ATs = 12, male full-time ATs = 11, female part-time graduate assistant ATs = 11, female full-time ATs = 12) in the southeastern United States.Main Outcome Measure(s)Anthropometric measures (sex, age, height, weight, body composition), demographic characteristics (job status [full- or part-time AT], job setting [college/university, high school, nontraditional], years of AT experience, exercise background, alcohol use), resting metabolic rate, energy intake (EI), total daily energy expenditure (TDEE), EB, exercise energy expenditure, macronutrients (carbohydrates, protein, fats), the Eating Disorder Inventory-3, and the Eating Disorder Inventory-3 Symptom Checklist.ResultsThe majority of participants (84.8%, n = 39) had an ED risk, with 26.1% (n = 12) engaging in at least 1 pathogenic behavior, 50% (n = 23) in 2 pathogenic behaviors, and 10.8% (n = 5) in >2 pathogenic behaviors. Also, 82.6% of ATs (n = 38) presented in negative EB (EI < TDEE). Differences were found in resting metabolic rate for sex and job status (F_1,45 = 16.48, P = .001), EI (F_1,45 = 12.01, P = .001), TDEE (F_1,45 = 40.36, P < .001), and exercise energy expenditure (F_1,38 = 5.353, P = .026). No differences were present in EB for sex and job status (F_1,45 = 1.751, P = .193); χ² analysis revealed no significant relationship between ATs'' sex and EB (= 0.0, P = 1.00) and job status and EB ( = 2.42, P = .120). No significant relationship existed between Daily Reference Intakes recommendations for all macronutrients and sex or job status.ConclusionsThese athletic trainers experienced negative EB, similar to other professionals in high-demand occupations. Regardless of sex or job status, ATs had a high ED risk and participated in unhealthy pathogenic behaviors. The physical and mental concerns associated with these findings indicate a need for interventions targeted at ATs'' health behaviors.     

The role of race/ethnicity in cerclage efficacy

Objective: To measure the impact of race/ethnicity on cerclage efficacy, as measured by the prevalence of spontaneous preterm birth (PTB), in a cohort of patients with history-indicated, ultrasound-indicated and physical-exam indicated cerclages.

Methods: We conducted a retrospective cohort study of patients undergoing history-indicated, ultrasound-indicated and physical-exam indicated cerclage placement from January 2003 to July 2013 at a tertiary care hospital. Patients’ race/ethnicity was self-declared. Our primary outcome was spontaneous preterm birth (SPTB) Results: One hundred and eighty-one subjects met inclusion criteria. Forty-seven percent self-identified as non-Hispanic black (NHB), 12% as Hispanic and 41% as non-Hispanic white (NHW). There was no significant difference in the prevalence of SPTB p?=?0.22), nor for SPTB less than 34 or 28 weeks. Finally, there was no difference in SPTB prevalence by race after controlling for smoking, history of CKC/LEEP, and 17-OHPC with logistic regression.

Conclusion: Race/ethnicity does not appear to be associated with cerclage efficacy, as measured by the risk of SPTB, in a cohort of patients with history-indicated, ultrasound-indicated and physical-exam indicated cerclages.     

Analysis of Research and Scholarship Criteria Within Promotion and Tenure Documents of US Pharmacy Schools

Objective. To describe criteria for evaluating faculty scholarship within the promotion and tenure guidance documents of US schools and colleges of pharmacy.Methods. Promotion and tenure documents were obtained from the websites of US pharmacy schools or requested via electronic mail, and institutional characteristics were collected from publicly available online data. A qualitative content analysis was conducted to systematically catalogue document characteristics and criteria for promotion and tenure.Results. Promotion and tenure guidance documents from 121 (85%) of 142 pharmacy schools were analyzed. Institutions were 55% public and equally distributed across Carnegie institutional classifications as well as geographic and extramural funding stratifications. Publications (94%) and grants and contracts (87%) were the most frequently included criteria for faculty advancement. More than 50% of schools recognized the criteria within promotion and tenure guidance documents but did not explicitly require faculty to achieve them before receiving promotion and/or tenure. For institutions that required publications for advancement, the most frequently required criterion was publication in peer-reviewed journals (47%). Few schools (22%) documented a specific number of required publications.Conclusion. This analysis provides a comprehensive review of scholarship criteria in academic pharmacy promotion and tenure guidance documents. There was wide variability among scholarship criteria, and documents often lacked specific language defining scholarship requirements. As a result, faculty may find the documents less helpful for self-assessment and preparation toward promotion and/or tenure. These benchmark data can assist pharmacy faculty and administrators in developing and revising promotion and tenure guidance documents to include clear criteria and better align with peer institutions.     

Implementing Point-of-Care Troponin Testing in the Emergency Department: Impact on Time to Result

IntroductionIn the emergency department, troponin assays are commonly used and essential in the evaluation of chest pain and diagnosis of acute coronary syndrome. This study was designed to assess the potential impact of implementing point-of-care troponin testing by comparing the time to point-of-care laboratory result and time to conventional laboratory result.MethodsThe study enrolled 60 ED patients deemed to need a troponin test in the evaluation of low-risk chest pain (HEART score <4 based on history, electrocardiogram, age, risk factors). Point-of-care troponin testing was performed with the same blood sample obtained for a conventional troponin assay. If the provider determined that the patient required 2 troponin tests, the second laboratory draw was used in the data collection. This was to correlate the time of laboratory result to time of disposition.ResultsOf the 60 subjects enrolled, 2 subjects were excluded because of user errors with the point-of-care testing equipment and 2 others for not meeting inclusion criteria on later review. The median times for the point-of-care troponin and conventional troponin assays were 11:00 minutes (interquartile range 10:00-15:30) and 40:00 minutes (interquartile range 31:30-52:30), respectively; P < 0.001. There were 3 extreme outliers from the conventional troponin assay that significantly skewed the distribution of the mean, making the median the more accurate assessment of the central tendency.DiscussionPoint-of-care troponin testing provided results in a median time 29 minutes quicker than the conventional troponin assay. This result is statistically significant and has the potential to greatly improve time to disposition in all patients with chest pain requiring a troponin assay.     

Evaluation of a multi-layer adipose-derived stem cell sheet in a full-thickness wound healing model

Cell sheet technology has been studied for applications such as bone, ligament and skin regeneration. There has been limited examination of adipose-derived stem cells (ASCs) for cell sheet applications. The specific aim of this study was to evaluate ASC sheet technology for wound healing. ASCs were isolated from discarded human abdominal subcutaneous adipose tissue, and ASC cell sheets were created on the surface of fibrin-grafted culture dishes. In vitro examination consisted of the histochemical characterization of the ASC sheets. In vivo experiments consisted of implanting single-layer cell sheets, triple-layer cell sheets or non-treated control onto a full-thickness wound defect (including epidermis, dermis, and subcutaneous fat) in nude mice for 3 weeks. Cell sheets were easily peeled off from the culture dishes using forceps. The single- and triple-layer ASC sheets showed complete extracellular structure via hematoxylin & eosin staining. In vivo, the injury area was measured 7, 10, 14 and 21 days post-treatment to assess wound recovery. The ASC sheet-treated groups’ injury area was significantly smaller than that of the non-treated control group at all time points except day 21. The triple-layer ASC sheet treatment significantly enhanced wound healing compared to the single-layer ASC sheet at 7, 10 and 14 days. The density of blood vessels showed that ASC cell sheet treatment slightly enhanced total vessel proliferation compared to the empty wound injury treatment. Our studies indicate that ASC sheets present a potentially viable matrix for full-thickness defect wound healing in a mouse model. Consequently, our ASC sheet technology represents a substantial advance in developing various types of three-dimensional tissues.     

Sex Differences in Interpersonal Violence in Malawi: Analysis of a Hospital-Based Trauma Registry

Background

Although interpersonal violence (“assault”) exists in every society, the World Health Organization (WHO) estimated that 90 % of the exposure burden occurs in low- and middle-income countries. The objectives of this study were to define the incidence of assault-related injuries among subjects presenting for emergency room care secondary to sustained trauma in Lilongwe, Malawi; to measure the impact of sex on incidence, injury type, and care received; and to measure the effect of both sex and geographic location of the injury on time to presentation for medical care.

Methods

This is a retrospective cohort analysis of data prospectively collected in the Kamuzu Central Hospital Trauma Surveillance Registry from July 2008 to December 2010 (n = 23,625). We used univariate, bivariate, and logistic regression analyses to measure association of sex with variables of interest, and geospatial mapping to evaluate the association of location of assault on time to presentation for care.

Results

The mean age of our trauma cohort was 27.7 years. Assaults accounted for 26.8 % of all injuries. Of those assaulted, 21.0 % (1299) were female, who were younger (26.2 vs. 28.1 years, p < 0.001), more likely to arrive to the hospital by minibus (p < 0.001), and less likely to arrive by police (p < 0.001). Altogether 62 % of the females were assaulted in their homes—much more often than their male counterparts (p < 0.001). Females were more likely to sustain contusions (p < 0.001) and males more likely to have lacerations and penetrating stab wounds (p < 0.001) or head injury (p < 0.001). Females had delayed hospital presentation following assault (p = 0.001) and were more likely to be treated as outpatients after adjusting for age, injury type, and injury location (adjusted odds ratio 1.74, 95 % CI 1.3–2.3, p < 0.001). Assaults clustered geographically in the Lilongwe district. Delayed presentation of females occurred irrespective of proximity to the hospital.

Conclusions

This study brings attention to sex differences in assault victims. A prevention strategy focusing on sex roles and domestic abuse of women is paramount. Efforts are needed to stop dischargin female assault victims back into a potentially unsafe, abusive environment.