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2.  Long-term outcomes after a strategy of percutaneous coronary intervention of the infarct-related artery with drug-eluting stents or bare metal stents vs medical therapy alone in the Occluded Artery Trial (OAT) 
American heart journal  2012;163(6):1011-1018.
Background
The OAT, a randomized study of routine percutaneous coronary intervention or optimal medical therapy (MED) alone for the treatment of a totally occluded infarct-related artery in the subacute phase after myocardial infarction, showed similar rates of death, reinfarction and congestive heart failure (CHF) between study groups. Although most percutaneous coronary intervention patients were treated with bare metal stents (BMS), drug-eluting stents (DES) were also implanted in the latter part of the study. The aim of the study was to conduct an exploratory analysis of long-term outcomes for DES vs. BMS deployment vs. MED in the OAT.
Methods
Patients enrolled after February 2003 (when first DES was implanted) were followed (DES n = 79, BMS n = 393, MED n = 552) up to a maximum of 6 years (mean survivor follow-up 5.1 years).
Results
The 6-year occurrence of the composite end point of death, reinfarction and class IV CHF was similar [20.4% of DES, 18.9% of BMS and 18.4% of MED (P = .66)] as were the rates of the components of the primary end point. During the follow-up period, 33.4% of DES, 44.4% of BMS and 48.1% of MED patients, developed angina (P = .037). The rate of revascularization during follow up was 11.3%, 20.5% and 22.5% among these groups, respectively (P = .045).
Conclusions
There is no suggestion of reduced long-term risk of death, reinfarction or class IV CHF with DES usage compared to BMS or medical treatment alone. An association between DES use and freedom from angina and revascularization relative to medical therapy is suggested.
doi:10.1016/j.ahj.2012.03.008
PMCID: PMC3735135  PMID: 22709754
3.  Short- and Long-Term Effects of Interleukin-2 Treatment on the Sensitivity of Periadolescent Female Mice to Interleukin-2 and Dopamine Uptake Inhibitor 
PLoS ONE  2013;8(5):e64473.
Interleukin (IL)-2, a T-helper 1 (Th1) cell-derived cytokine, which potently modulates dopamine activity and neuronal excitability in mesolimbic structures, is linked with pathological outcomes (e.g., schizophrenia, depression, etc.) that at least partly reflect alterations in central dopaminergic processes. It has been suggested that dopamine neurons undergo pruning during adolescence and abnormalities in pruning predispose individuals to behavioral disorders. Since IL-2 is known as a neurodevelopmental factor affecting associated behavioral processes, the present study tested whether IL-2 can modulate stereotypic behaviors in both the periadolescent and adult periods. This study determined whether IL-2 treatment would produce long-lasting changes in sensitivity to a later challenge with IL-2 or GBR 12909, a highly selective dopamine uptake inhibitor. Four experiments were conducted. Firstly, a decrease in novelty-induced stereotypic behavior was observed in BALB/c periadolescent mice (38 days of age) following IL-2 administration (0.4 µg/2 ml) relative to vehicle control. In the second experiment, an initial dose of IL-2 was given in the periadolescent period, but did not affect rearing responses. A second dose of IL-2 given to the animals 30 days later as adults, resulted in a significant increase in rearing behaviors relative to control animals. In the third experiment, separate groups of experimental and control mice were administered GBR 12909, a highly selective dopamine reuptake inhibitor, 30 days following treatment with either IL-2 or vehicle. It was noted that this experimental group, which initially received IL-2, exhibited stereotypy, as evidenced by increased sniffing behavior. A fourth experiment revealed that IL-2 administered in periadolesecence and adulthood had no effect on other motor responses, indicating that IL-2 selectively modulates selective stereotypic behaviors. The results provide evidence, for the first time, that long-term changes in stereotypy in periadolescent mice are linked to an IL-2 mechanism, possibly utilizing dopamine.
doi:10.1371/journal.pone.0064473
PMCID: PMC3663806  PMID: 23717619
4.  The Independent Association of Serum Retinol and β-Carotene Levels with Hyperuricemia – A National Population Study 
Arthritis care & research  2012;64(3):389-396.
Objective
Use of synthetic vitamin A derivatives (e.g. isotretinoin used for severe acne) and high doses of preformed vitamin A have been implicated in the pathogenesis of hyperuricemia and gout, whereas a trial reported that β-carotene may lower serum uric acid (SUA) levels. We evaluated the potential population impact of these factors on SUA in a nationally representative sample of US adults.
Methods
Using data from 14,349 participants aged 20 years and older in the Third National Health and Nutrition Examination Survey (1988–1994), we examined the relation between serum retinol, β-carotene, and uric acid levels using weighted linear regression. Additionally, we examined the relation with hyperuricemia using weighted logistic regression.
Results
SUA levels increased linearly with increasing serum retinol levels, whereas SUA levels decreased with increasing serum β-carotene levels. After adjusting for age, sex, dietary factors, and other potential confounders, the SUA level differences from the bottom (referent) to top quintiles of serum retinol levels were 0, 0.16, 0.31, 0.43, 0.71mg/dL (P for trend < 0.001) and for β-carotene were 0, −0.15, −0.29, −0.27, −0.40 mg/dL (P for trend < 0.001). Similarly, the multivariate odds ratios of hyperuricemia from the bottom (referent) to top quintiles of serum retinol levels were 1.00, 1.30, 1.83, 2.09, and 3.22 (P for trend <0.001) and for β-carotene were 1.00, 0.85, 0.68, 0.73, and 0.54 (P for trend <0.001). The graded associations persisted across subgroups according to cross-classification by both serum retinol and β-carotene levels.
Conclusions
These nationally representative data raise concerns that vitamin A supplementation and food fortification may contribute to the high frequency of hyperuricemia in the US population, whereas β-carotene intake may be beneficial against hyperuricemia. The use of β-carotene as a novel preventive treatment for gout deserves further investigation.
doi:10.1002/acr.20692
PMCID: PMC3288639  PMID: 22076806
Uric acid; gout; vitamin A; retinol; β-carotene; NHANES III
5.  Long Term Effects of Percutaneous Coronary Intervention of the Totally Occluded Infarct-Related Artery in the Subacute Phase after Myocardial Infarction 
Circulation  2011;124(21):2320-2328.
Background
Despite observations suggesting a benefit for late opening of occluded infarct-related arteries (IRA) post-myocardial infarction (MI), the Occluded Artery Trial (OAT) demonstrated no reduction in the composite of death, reinfarction and class IV heart failure (HF) over 2.9-yearmean follow-up. Follow-up was extended to determine whether late trends would favor either treatment group.
Methods and Results
OAT randomized 2201 stable patients with IRA occlusion >24hours (calendar days3-28) after MI. Severe inducible ischemia, rest angina, class III-IV HF and 3-vessel/left main disease were excluded. We conducted extended followed up of enrolled patients for an additional 3 years for the primary endpoint and angina (6-year median survivor follow up, longest 9 years, 12,234 patient-years).Rates of the primary endpoint (HR 1.06, 95% CI 0.88-1.28), fatal and nonfatal MI (HR 1.25, 95% CI 0.89-1.75), death and class IV HF were similar for PCI vs. MED groups. No interaction between baseline characteristics and treatment group on outcomes were observed. The vast majority of patients at each follow-up visit did not report angina. There was less angina in the PCI group through early in follow-up; by 3 years the between group difference was consistently <4 patients per 100 treated and not significantly different though there was a trend toward less angina in the PCI group at 3 and 5 years. The 7-year rate of PCI of the IRA during follow up was 11.1% for the PCI group compared to 14.7% for the MED group (HR 0.79, 95% CI 0.61-1.01. p=0.06).
Conclusions
Extended follow up of the OAT cohort provides robust evidence for no reduction of long-term rates of clinical events after routine PCI in stable patients with an occluded IRA and without severe inducible ischemia in the subacute phase post-MI.
doi:10.1161/CIRCULATIONAHA.111.041749
PMCID: PMC3235739  PMID: 22025606
myocardial infarction; stents; trials
6.  Bifurcation analysis applied to a model of motion integration with a multistable stimulus 
A computational study into the motion perception dynamics of a multistable psychophysics stimulus is presented. A diagonally drifting grating viewed through a square aperture is perceived as moving in the actual grating direction or in line with the aperture edges (horizontally or vertically). The different percepts are the product of interplay between ambiguous contour cues and specific terminator cues. We present a dynamical model of motion integration that performs direction selection for such a stimulus and link the different percepts to coexisting steady states of the underlying equations. We apply the powerful tools of bifurcation analysis and numerical continuation to study changes to the model’s solution structure under the variation of parameters. Indeed, we apply these tools in a systematic way, taking into account biological and mathematical constraints, in order to fix model parameters. A region of parameter space is identified for which the model reproduces the qualitative behaviour observed in experiments. The temporal dynamics of motion integration are studied within this region; specifically, the effect of varying the stimulus gain is studied, which allows for qualitative predictions to be made.
doi:10.1007/s10827-012-0409-5
PMCID: PMC3558671  PMID: 22870848
Motion; Perception; Multistability; Visual cortex; Barber pole; Bifurcation
7.  Characterizing Dynamic Interactions between Ultradian Glucocorticoid Rhythmicity and Acute Stress Using the Phase Response Curve 
PLoS ONE  2012;7(2):e30978.
The hypothalamic-pituitary-adrenal (HPA) axis is a dynamic oscillatory hormone signalling system that regulates the pulsatile secretion of glucocorticoids from the adrenal glands. In addition to regulation of basal levels of glucocorticoids, the HPA axis provides a rapid hormonal response to stress that is vitally important for homeostasis. Recently it has become clear that glucocorticoid pulses encode an important biological signal that regulates receptor signalling both in the central nervous system and in peripheral tissues. It is therefore important to understand how stressful stimuli disrupt the pulsatile dynamics of this system. Using a computational model that incorporates the crucial feed-forward and feedback components of the axis, we provide novel insight into experimental observations that the size of the stress-induced hormonal response is critically dependent on the timing of the stress. Further, we employ the theory of Phase Response Curves to show that an acute stressor acts as a phase-resetting mechanism for the ultradian rhythm of glucocorticoid secretion. Using our model, we demonstrate that the magnitude of an acute stress is a critical factor in determining whether the system resets via a Type 1 or Type 0 mechanism. By fitting our model to our in vivo stress-response data, we show that the glucocorticoid response to an acute noise stress in rats is governed by a Type 0 phase-resetting curve. Our results provide additional evidence for the concept of a deterministic sub-hypothalamic oscillator regulating the ultradian glucocorticoid rhythm, which constitutes a highly responsive peripheral hormone system that interacts dynamically with hypothalamic inputs to regulate the overall hormonal response to stress.
doi:10.1371/journal.pone.0030978
PMCID: PMC3283588  PMID: 22363526
8.  Loss of Short Term Symptomatic Benefit in Patients with an Occluded Infarct Artery is Unrelated to Non-Protocol Revascularization: Results from the Occluded Artery Trial (OAT) 
American heart journal  2011;161(1):84-90.
Background
The Occluded Artery Trial found that routine late (3–28d post-MI) percutaneous coronary intervention (PCI) of an occluded infarct-related artery (IRA) did not reduce death, re-infarction or heart failure relative to medical treatment (MED). Angina rates were lower in PCI early, but the advantage over MED was lost by 3 years.
Methods
Angina and revascularization status were collected at 4 months, then annually. We assessed whether non-protocol revascularization procedures in MED accounted for loss of the early symptomatic advantage of PCI.
Results
Seven per 100 more PCI patients were angina-free at 4 months (p<0.001) and 5 per 100 at 12 months (p=.005) with the difference narrowing to 1 per 100 at 3 years (p=.34). Non-protocol revascularization was more frequent in MED (5-yr rate 22% vs. 19% PCI, p=.05). Indications for revascularization included acute coronary syndromes (39% PCI vs. 38% MED), stable angina/inducible ischemia (39% in each group), and physician preference (17% PCI vs. 15% MED). Revascularization rates among patients with angina at any time during follow up (35% of cohort) did not differ by treatment group (5-year rates 26% PCI vs. 28% MED). Most symptomatic patients were treated without revascularization during follow-up (77%).
Conclusions
In a large randomized clinical trial of stable post-MI patients, the modest benefit on angina from PCI of an occluded IRA was lost by 3 years. Revascularization was slightly more common in MED during follow up but was not driven by acute ischemia, and almost one in five procedures were attributed to physician preference alone.
doi:10.1016/j.ahj.2010.09.009
PMCID: PMC3004529  PMID: 21167338
9.  Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction 
World journal of cardiology  2010;2(1):13-18.
AIM
To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).
METHODS
Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF.
RESULTS
Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181).
CONCLUSION
A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF.
doi:10.4330/wjc.v2.i1.13
PMCID: PMC2946261  PMID: 20885993
Heart failure; Myocardial infarction; Kidney disease
10.  Angiographic and Clinical Outcomes of Drug-Eluting Versus Bare Metal Stent Deployment in the Occluded Artery Trial 
Background
The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS.
Methods
TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina.
Results
In-segment late loss was 0.14 ± 0.45 mm for DES and 0.75 ± 0.86 mm for BMS (P < 0.001). Corresponding binary restenosis rates were 13.0% and 44.3% (P = 0.005). Occlusion at 1 year was observed in 4.0 and 12.1%, respectively (P = 0.23). The 3-year cumulative primary event rate was 13.8% with DES and 12.5% with BMS (hazard ratio 1.08, 99% confidence intervals 0.44, 2.64; P = 0.83). Angina over time occurred less frequently in the DES group (P = 0.01).
Conclusions
Although the reduction of late loss and trend to reduction in reocclusion with the use of DES for PCI of persistently occluded IRA 3–28 days post myocardial infarction did not translate into a signal for reduction in death, reinfarction, or Class IV heart failure, DES use was associated with less angina over time. Further follow-up is warranted.
doi:10.1002/ccd.21930
PMCID: PMC2819385  PMID: 19309733
open artery hypothesis; percutaneous coronary intervention; drug-eluting stent; bare metal stent; angina
11.  Renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction 
World Journal of Cardiology  2010;2(1):13-18.
AIM: To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).
METHODS: Patients with occluded infarct-related arteries (IRAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFR). Rates of early post-MI HF were compared among eGFR groups. Logistic regression was used to explore independent predictors of HF.
RESULTS: Reduced eGFR was present in 71.1% of 2160 patients, with significant renal impairment (eGFR < 60 mL/min every 1.73 m2) in 14.8%. The prevalence of HF was higher with worsening renal function: 15.5%, 17.8% and 29.4% in patients with CKD stages 1, 2 and 3 or 4, respectively (P < 0.0001), despite a small absolute difference in mean EF across eGFR groups: 48.2 ± 10.0, 47.9 ± 11.3 and 46.2 ± 12.1, respectively (P = 0.02). The prevalence of HF was again higher with worsening renal function among patients with preserved EF: 10.1%, 13.6% and 23.6% (P < 0.0001), but this relationship was not significant among patients with depressed EF: 27.1%, 26.2% and 37.9% (P = 0.071). Moreover, eGFR was an independent correlate of HF in patients with preserved EF (P = 0.003) but not in patients with depressed EF (P = 0.181).
CONCLUSION: A significant proportion of post-MI patients with occluded IRAs have impaired renal function. Impaired renal function was associated with an increased rate of early post-MI HF, the association being strongest in patients with preserved EF. These findings have implications for management of peri-infarct HF.
doi:10.4330/wjc.v2.i1.13
PMCID: PMC2946261  PMID: 20885993
Heart failure; Myocardial infarction; Kidney disease
12.  Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function 
Circulation  2006;114(23):2449-2457.
Background
In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function.
Methods and Results
Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (n=332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy–only patients had a patent IRA (P<0.001). LV ejection fraction increased significantly (P<0.001) in both groups, with no between-group difference: PCI 4.2±8.9 (n=150) versus medical therapy 3.5±8.2 (n=136; P=0.47). Median change (interquartile range) in LV end-systolic volume index was −0.5 (−9.3 to 5.0) versus 1.0 (−5.7 to 7.3) mL/m2 (P=0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (−8.2 to 13.3) versus 5.3 (−4.6 to 23.2) mL/m2 (P=0.07) in the PCI (n=86) and medical therapy–only (n=76) groups, respectively.
Conclusions
PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI.
doi:10.1161/CIRCULATIONAHA.106.669432
PMCID: PMC2785021  PMID: 17105848
myocardial infarction; occlusion; angioplasty; remodeling; cardiac volume; stents
13.  Cortisol Concentrations in Human Skeletal Muscle Tissue After Phonophoresis With 10% Hydrocortisone Gel 
Journal of Athletic Training  2006;41(3):321-324.
Context: The delivery of hydrocortisone through phonophoresis is a widely prescribed technique for the treatment of various musculoskeletal inflammatory conditions. However, limited scientific evidence exists to support the efficacy of phonophoresis in delivering hydrocortisone to skeletal muscle tissue in humans.
Objective: To determine hydrocortisone (cortisol) concentrations in human skeletal muscle tissue after a phonophoresis treatment using 10% hydrocortisone gel.
Design: Randomized design in which 12 subjects were randomly assigned to either an ultrasound (sham) treatment or a 10% hydrocortisone phonophoresis treatment.
Setting: Laboratory.
Patients or Other Participants: Twelve healthy subjects (8;thwomen, 4 men: age = 22.3 ± 2.64 years, height = 168.28 ± 8.19 cm, mass = 69.58 ± 9.05 kg) with no history of musculoskeletal disease, preexisting inflammatory conditions, or recent orthopaedic injuries.
Intervention(s): Ultrasound at 1.0 MHz, 1.0 W/cm 2, at a continuous setting for 7 minutes was applied to a standardized area of the vastus lateralis muscle in both groups. The contralateral limb served as the control (no treatment) for both the sham and the phonophoresis groups.
Main Outcome Measure(s): Vastus lateralis muscle biopsies were taken from both legs immediately after treatment, and cortisol concentrations were analyzed using an enzyme-linked immunosorbent assay.
Results: We observed no significant difference in muscle cortisol concentration between the contralateral control limb and the treatment limb in either the sham or the phonophoresis group ( P > .05). No significant difference was noted when the treatment limbs in the sham and phonophoresis groups were compared ( P > .05).
Conclusions: Our data suggest that a 10% hydrocortisone-based phonophoresis treatment did not increase cortisol concentrations in human skeletal muscle tissue.
PMCID: PMC1569565  PMID: 17043701
ultrasound; ELISA; inflammation; biopsy; hydrocortisone
15.  Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak 
BMC Public Health  2005;5:2.
Background
Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States.
Methods
We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks.
Results
Ninety-seven physicians completed the survey. Sixty-four (66%) respondents had received requests from patients for anthrax prophylaxis; 16 (25%) of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline.
Conclusion
During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events.
doi:10.1186/1471-2458-5-2
PMCID: PMC546188  PMID: 15634353
18.  Automatic Electronic Laboratory-Based Reporting of Notifiable Infectious Diseases 
Emerging Infectious Diseases  2002;8(7):685-691.
Electronic laboratory-based reporting, developed by the University of Pittsburgh Medical Center (UPMC) Health System, was evaluated to determine if it could be integrated into the conventional paper-based reporting system. We reviewed reports of 10 infectious diseases from 8 UPMC hospitals that reported to the Allegheny County Health Department in southwestern Pennsylvania during January 1–November 26, 2000. Electronic reports were received a median of 4 days earlier than conventional reports. The completeness of reporting was 74% (95% confidence interval [CI] 66% to 81%) for the electronic laboratory-based reporting and 65% (95% CI 57% to 73%) for the conventional paper-based reporting system (p>0.05). Most reports (88%) missed by electronic laboratory-based reporting were caused by using free text. Automatic reporting was more rapid and as complete as conventional reporting. Using standardized coding and minimizing free text usage will increase the completeness of electronic laboratory-based reporting.
doi:10.3201/eid0807.010493
PMCID: PMC2730325  PMID: 12095435
bioterrorism; electronic laboratory-based reporting; Health Level 7 (HL7); real-time; capture-recapture; National Electronic Disease Surveillance System (NEDSS)
19.  A 3-Dimensional Analysis of Face-Mask Removal Tools in Inducing Helmet Movement 
Journal of Athletic Training  2002;37(2):178-184.
Objective: To evaluate the performance of specific face-mask removal tools during football helmet face-mask retraction using 3-dimensional (3-D) video.
Design and Setting: Four different tools were used: the anvil pruner (AP), polyvinyl chloride pipe cutters (PVC), Face Mask (FM) Extractor (FME), and Trainer's Angel (TA). Subjects retracted a face mask once with each tool.
Subjects: Eleven certified athletic trainers served as subjects and were recruited from among local sports medicine professionals.
Measurements: We analyzed a sample of movement by 3-D techniques during the retraction process. Movement of the head in 3 planes and time to retract the face mask were also assessed. All results were analyzed with a simple repeated-measures one-way multivariate analysis of variance. An overall efficiency score was calculated for each tool.
Results: The AP allowed subjects to perform the face-mask removal task the fastest. Face mask removal with the AP was significantly faster than with the PVC and TA and significantly faster with the TA than the PVC. The PVC and AP created significantly more movement than the FME and TA when planes were combined. No significant differences were noted among tools for flexion-extension, rotation, or lateral flexion. The AP had an efficiency score of 14; FME, 15; TA, 18; and PVC, 35.
Conclusions: The subjects performed the face-mask removal task in the least amount of time with the AP. They completed the task with the least amount of combined movement using the FME. The AP and FME had nearly identical overall efficiency scores for movement and time.
PMCID: PMC164342  PMID: 12937432
football equipment; cervical spine injury; axial load
20.  Financial Resources for Conducting Athletic Training Programs in the Collegiate and High School Settings 
Journal of Athletic Training  1992;27(4):344-349.
The distribution of resources to athletic training programs varies greatly, depending on the size and scope of the athletic program. No research has been found that assesses the differences in dollars allocated within various athletic training settings or assesses whether the different program levels allocate similar proportions of their resources to like categories of expenditures. In this study, I assessed the financial resources available to athletic training programs at major football NCAA Division IA schools, small football NCAA Division IA schools, NCAA Division IAA schools, NCAA Division II schools, NCAA Division III schools, and high schools. All schools had men's and women's sports and football programs. Categories assessed included: size and scope of the athletic program, supplies and equipment, operating expenses, medical expenses, salaries and benefits, malpractice insurance, and use of competitive bids in purchasing. Data supported the conclusion of wide disparities within many categories and in total expenses. Large-scale football NCAA Division IA programs spent $925.86 per athlete, while NCAA Division III programs spent $181.22, and high school programs spent $95.62. However, athletic trainers at all levels are conducting athletic training programs governed by the same professional competencies and standards of care.
PMCID: PMC1317285  PMID: 16558190

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