Health care in high school athletics in West Virginia.

INTRODUCTION: The purpose of this study was to determine the level of implementation of emergency preparedness procedures and administrative procedures to provide appropriate medical coverage to high school athletics in the predominantly rural US state of West Virginia. Particular attention was given to determine the extent to which the schools provided the recommendations for best practice in the National Athletic Trainers Association consensus statement outlining appropriate medical coverage for high school athletics. METHODS: A listing of all public schools participating in the state high school athletic association with at least one team participating in interscholastic competition was obtained from the state Department of Education office. An electronic survey was sent to the principal at each high school with instructions that an administrator or sports medicine professional complete the survey. A total of 62 respondents completed the survey (49.6% response rate). Most respondents were principals (92%), followed by athletic administrators (8%). The majority of schools reported a rural zip code at the school level based on the Rural Urban Community Area Codes. Measures assessed the school demographics, including size and rurality. Additional measures assessed the development and implementation of a comprehensive athletic healthcare administrative system, and the development and implementation of a comprehensive emergency action plan. RESULTS: The majority of respondents reported that there was a consent form on file for student athletes (91%) and comprehensive insurance was required for participation (80%). A third of the respondents (33%) reported that all members of the coaching staff were certified in first aid and cardiac pulmonary resuscitation (CPR) and 31% reported 'never' when asked if all coaches were required to be certified in CPR and first aid. When asked if there was a written emergency action plan (EAP) that outlines procedures to follow in emergency situations during athletic participation, 36% responded 'never' and 38% responded 'always'. When asked about specific limitations for health care to athletes the three main themes identified in qualitative analysis were lack of funding, lack of certified medical personnel, and the inability to locate certified medical personnel in a rural area. CONCLUSIONS: This study confirmed expected barriers to health care for high school athletes in West Virginia, specifically the lack of funding and resources available to rural schools. In order to prevent a life threatening emergency or possibly sudden cardiac death, preparing and planning for emergencies should be an essential part of high school athletic programs. Rural areas face significant challenges in regards to funding and qualified personnel. Requiring first aid and CPR certification for coaches and requiring an EAP are two steps that could improve the health care provided to athletes. These are inexpensive and achievable steps that could be taken to improve the safety for athletes at high schools in both rural and non-rural areas.

Surface electrostimulation of acupuncture points for sedation of critically ill patients in the intensive care unit--a pilot study.

BACKGROUND: This is a pilot study to investigate the effects of electrostimulation of acupuncture points on sedation and the dose of sedatives in the Intensive Care Unit. METHODS: Electrostimulation of acupuncture points was performed on 12 critically ill patients requiring sedation for mechanical ventilation. Electrostimulation was applied by point surface electrodes at LI4, ST36, HT7 and LR3 points for 20 minutes every hour for 12 hours using dense dispersed mode with a current frequency of 10-100 Hz and maximum intensity of 10 mA. All patients were sedated with propofol and alfentanil as required. The dose of propofol was reduced by 10mg/hour provided the patient remained sedated according to our guidelines. Sedation and analgesia scores, dose of sedative and analgesics drugs, respiratory rate, heart rate, mean arterial blood pressure and compliance with the ventilator were recorded before electrostimulation of acupuncture points, and hourly thereafter for 12 hours. RESULTS: There was significant reduction in the median propofol consumption from 145 mg/hour (range 30-250) to 15 mg/hour (range 0-250) (P<0.05), without any significant change in sedation scores or analgesia scores. The haemodynamic and respiratory variables remained stable. All patients were compliant with the ventilator. CONCLUSIONS: This pilot study showed significant reduction in the dose of propofol required for sedation in critically ill patients following surface electrostimulation of acupuncture points, without any adverse effects. A randomised controlled trial is warranted.

High-throughput automated microfluidic sample preparation for accurate microbial genomics.

Low-cost shotgun DNA sequencing is transforming the microbial sciences. Sequencing instruments are so effective that sample preparation is now the key limiting factor. Here, we introduce a microfluidic sample preparation platform that integrates the key steps in cells to sequence library sample preparation for up to 96 samples and reduces DNA input requirements 100-fold while maintaining or improving data quality. The general-purpose microarchitecture we demonstrate supports workflows with arbitrary numbers of reaction and clean-up or capture steps. By reducing the sample quantity requirements, we enabled low-input (∼10,000 cells) whole-genome shotgun (WGS) sequencing of Mycobacterium tuberculosis and soil micro-colonies with superior results. We also leveraged the enhanced throughput to sequence ∼400 clinical Pseudomonas aeruginosa libraries and demonstrate excellent single-nucleotide polymorphism detection performance that explained phenotypically observed antibiotic resistance. Fully-integrated lab-on-chip sample preparation overcomes technical barriers to enable broader deployment of genomics across many basic research and translational applications.

Barriers to Parent Support for Physical Activity in Appalachia.

BACKGROUND: Parent support for child physical activity is a consistent predictor of increased childhood activity. Little is known about factors that prevent or facilitate support. The purpose of this research was to identify barriers to parent support for child physical activity in Appalachian parents. METHODS: A cross-sectional study assessed parents whose children participated in Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) screenings in a rural Appalachian state. Barriers to parental support for physical activity, demographics, geographic location, and parental support for activity were measured. RESULTS: A total of 475 parents completed surveys. The majority were mothers (86.7%), parents of kindergarteners (49.5%), white (89.3%), and living in a nonrural area (70.5%). Community-level factors were most frequently cited as barriers, particularly those related to the built environment. Rural and low-income parents reported significantly higher barriers. Community, interpersonal, and intrapersonal barriers were negatively correlated with parent support for child physical activity. Parents of girls reported a higher percentage of barriers related to safety. CONCLUSIONS: Reported barriers in this sample differed from those reported elsewhere (Davison, 2009). Specific groups such as low-income and rural parents should be targeted in intervention efforts. Future research should explore gender differences in reported barriers to determine the influence of cultural stereotypes.

Parent health risk and support for child physical activity.

OBJECTIVES: To explore the influence of health risk on support for physical activity in parents of boys and parents of girls. METHODS: The influence of parent BMI, physical activity, smoking, and fruit and vegetable consumption was explored in child gender-specific hierarchical linear regression models. RESULTS: Positive predictors of support included physical activity in parents of boys and parents of girls. In parents of girls, child BMI and parent BMI were also significant. CONCLUSION: Higher BMI in parents of girls and higher BMI in girls predicted higher levels of parental supportive behavior.

Gender differences in cigarette smoking, social correlates and cessation among adolescents.

BACKGROUND: Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations. METHOD: The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association's Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors. RESULTS: Females were more likely to have parents, siblings and romantic partners who smokes, perceive that those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes. CONCLUSIONS: Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.

The maternal experience of having diabetes in pregnancy.

PURPOSE: To describe the maternal experience of having type 2 or gestational diabetes in pregnancy using focus groups and individual telephone interviews. DATA SOURCES: Eight women who had type 2 or gestational diabetes in at least one pregnancy and participated in the qualitative study addressing the open-ended guiding questions on their experience. CONCLUSIONS: This phenomenological study gave voice to the women's experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified. IMPLICATIONS FOR PRACTICE: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion of diabetes self-management in pregnancy.