A pilot retrospective study of a physician-directed and genomics-based model for precision lifestyle medicine.

Precision lifestyle medicine is a relatively new field in primary care, based on the hypothesis that genetic predispositions influence an individual's response to specific interventions such as diet, exercise, and prescription medications. Despite the increase in commercially available genomic testing, few studies have investigated effects of a physician-directed program to optimize chronic disease using genomics-based precision medicine. We performed an pilot, observational cohort study to evaluate effects of the Wild Health program, a physician and health coach service offering genomics-based lifestyle and medical interventions, on biomarkers indicative of chronic disease.

Investigation of polyethylene terephthalate (PET) drinking bottles as marine reservoirs for fecal bacteria and phytoplankton.

Polyethylene terephthalate (PET) is frequently used in the food and beverage industry and therefore contributes greatly to plastic marine debris. The fecal pollution indicator bacteria Enterococcus is used for marine water contamination assessments and is regularly found in storm water discharge. In order to examine if PET drinking bottles act as refuges for Enterococcus, a study was conducted within euhaline tidal waters of Wrightsville Beach, NC, USA via the deployment of bottle floats positioned nearby two stormwater outfall pipes.

Successful mitigation of stormwater-driven nutrient, fecal bacteria and suspended solids loading in a recreational beach community.

Marine and estuarine waterways adjacent to urban areas are often the final recipient of polluted stormwater runoff. Microbial degradation of coastal water quality is a direct threat to human health through fecal contamination of bathing waters and shellfish, as well as distressing local economies through the loss of waterways to commercial (shellfishing) and recreational use. In coastal waters reduction of nitrogen loading is a key strategy for prevention of noxious and toxic algal blooms.

Tracing nutrient pollution from industrialized animal production in a large coastal watershed.

One of the highest concentrations of swine and poultry concentrated animal feeding operations (CAFOs) in North America is located on the Coastal Plain of North Carolina, in which the Cape Fear River basin is located. The CAFOs produce vast amounts of manure causing loading of nutrients and other pollutants to receiving waters. With the Cape Fear River basin vulnerable to nutrient pollution, as are many other watersheds with CAFOs, δC and δN stable isotopic signatures were identified from water samples collected within the Northeast Cape Fear, Black, and lower Cape Fear River watersheds to trace nutrient sources and their distribution downstream.

Waste nutrients from U.S. animal feeding operations: Regulations are inconsistent across states and inadequately assess nutrient export risk.

Livestock production in the United States has been transformed over the past several decades, largely as a result of widespread development of industrial-scale mass production facilities, termed Animal Feeding Operations (AFOs). These facilities generate massive amounts of animal waste that can concentrate in small areas. Animal wastes from AFOs have led to high levels of nutrients and other pollutants in nearby surface waters, as well as groundwater.

Transesophageal Echocardiography During Cardiopulmonary Resuscitation Is Associated With Shorter Compression Pauses Compared With Transthoracic Echocardiography.

Study Objective: Point-of-care ultrasonography provides diagnostic information in addition to visual pulse checks during cardiopulmonary resuscitation (CPR). The most commonly used modality, transthoracic echocardiography, has unfortunately been repeatedly associated with prolonged pauses in chest compressions, which correlate with worsened neurologic outcomes. Unlike transthoracic echocardiography, transesophageal echocardiography does not require cessation of compressions for adequate imaging and provides the diagnostic benefit of point-of-care ultrasonography.

Downstream Effects of Upstream Causes.

The United States Environmental Protection Agency considers nutrient pollution in stream ecosystems one of the U.S.' most pressing environmental challenges.

Does the Addition of M-Mode to B-Mode Ultrasound Increase the Accuracy of Identification of Lung Sliding in Traumatic Pneumothoraces?

Objectives: It is unknown whether the addition of M-mode to B-mode ultrasound (US) has any effect on the overall accuracy of interpretation of lung sliding in the evaluation of a pneumothorax by emergency physicians. This study aimed to determine what effect, if any, this addition has on US interpretation by emergency physicians of varying training levels.

Methods: One hundred forty emergency physicians were randomized via online software to receive a quiz with B-mode clips alone or B-mode with corresponding M-mode images and asked to identify the presence or absence of lung sliding.

Season matters when sampling streams for swine CAFO waste pollution impacts.

Concentrated (or confined) animal feed operations (CAFOs) are the principal means of livestock production in the United States, and such facilities pollute nearby waterways because of their waste management practices; CAFO waste is pumped from the confinement structure into a cesspit and sprayed on a field. Stocking Head Creek is located in eastern North Carolina, a state with >9,000,000 head of swine confined in CAFOs. This watershed contains 40 swine CAFOs; stream water quality was investigated at seven sites during 2016, with five sampling dates in early spring and five in summer.

Transesophageal Echocardiography: Guidelines for Point-of-Care Applications in Cardiac Arrest Resuscitation.

Cardiac arrest is one of the most challenging patient presentations managed by emergency care providers, and echocardiography can be instrumental in the diagnosis, prognosis, and treatment guidance in these critically ill patients. Transesophageal echocardiography has many advantages over transthoracic echocardiography in a cardiac arrest resuscitation. As transesophageal echocardiography is implemented more widely at the point of care during cardiac arrest resuscitations, guidelines are needed to assist emergency providers in acquiring the equipment and skills necessary to successfully incorporate it into the management of cardiac arrest victims.

Micro-zooplankton grazing as a means of fecal bacteria removal in stormwater BMPs.

A priority for environmental managers is control of stormwater runoff pollution, especially fecal microbial pollution. This research was designed to determine if fecal bacterial grazing by micro-zooplankton is a significant control on fecal bacteria in aquatic best management practices (BMPs); if grazing differs between a wet detention pond and a constructed wetland; and if environmental factors enhance grazing. Both 3-day grazing tests and 24-h dilution assays were used to determine grazing differences between the two types of BMP.

Medical expulsive therapy use in emergency department patients diagnosed with ureteral stones.

Objective: Recent studies have clarified the role of alpha-blockers, such as tamsulosin, for patients diagnosed with ureteral stones <10mm not requiring an urgent intervention. Prior studies have reported low rates of use of MET by emergency physicians. We sought to describe patterns of alpha-blocker use and to determine factors associated with utilization in patients diagnosed with ureterolithiasis in the ED.

Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program.

Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a 12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization.

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).

Purpose: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.

Methods: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.

Emergency physician-performed transesophageal echocardiography for extracorporeal life support vascular cannula placement.

Introduction: There is growing interest and application of extracorporeal membrane oxygenation (ECMO) as a life-saving procedure for out-of-hospital cardiac arrest (OHCA), also called extracorporeal life support (ECLS). Extracorporeal membrane oxygenation cannulation with ongoing chest compressions is challenging, and transesophageal echocardiography (TEE) is an invaluable tool with which to guide ECMO wire guidance and cannula positioning.

Methods: We describe our protocol for TEE guidance by emergency physicians in our hospital.

Assessing hog lagoon waste contamination in the Cape Fear Watershed using Bacteroidetes 16S rRNA gene pyrosequencing.

Hog lagoons can be major sources of waste and nutrient contamination to watersheds adjacent to pig farms. Fecal source tracking methods targeting Bacteroidetes 16S rRNA genes in pig fecal matter may underestimate or fail to detect hog lagoon contamination in riverine environments. In order to detect hog lagoon wastewater contamination in the Cape Fear Watershed, where a large number of hog farms are present, we conducted pyrosequencing analyses of Bacteroidetes 16S rRNA genes in hog lagoon waste and identified new hog lagoon-specific marker sequences.

The role of ultrasound in the emergency department evaluation of the acutely painful pediatric hip.

Children presenting with hip pain or a limp are a diagnostic challenge for the clinician. The differential diagnosis is extensive, and the workup can be broad. This review focuses on differentiating between transient synovitis and septic arthritis of the hip.

Diagnosis of appendicitis by bedside ultrasound in the ED.

Background: Computed tomography (CT) has largely become standard of care for diagnosing appendicitis at the expense of increased patient radiation exposure, cost, and time to surgical intervention. To date, there are very limited data on the accuracy of bedside ultrasound (BUS) for the diagnosis of appendicitis in adults.

Objective: The objective of this study is to evaluate test characteristics of BUS for diagnosis of acute appendicitis in the emergency department.

First "glass" education: telementored cardiac ultrasonography using Google Glass- a pilot study.

Objectives: The objective of this study was to determine the feasibility of telementored instruction in bedside ultrasonography (US) using Google Glass. The authors sought to examine whether first-time US users could obtain adequate parasternal long axis (PSLA) views to approximate ejection fraction (EF) using Google Glass telementoring.

Methods: This was a prospective, randomized, single-blinded study.

Ultrasonography versus computed tomography for suspected nephrolithiasis.

Background: There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.

Methods: In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician.

False-positive rates of provocative cardiac testing in chest pain patients admitted to an emergency department observation unit.

Emergency department observation units (EDOUs) typically perform routine cardiac stress testing or coronary computed tomography (CCTA) to rule out ischemic cardiac chest pain. Some have questioned the utility of routine stress testing and advanced anatomic imaging in the low-risk chest pain patients. EDOU chest pain patients undergoing stress testing or CCTA prior to cardiac catheterization between June 1, 2009 and May 31, 2012 were studied in a prospective, observational manner.

Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation.

Background: Interest in the use of dynamic ultrasound (US) for cricothyrotomy has sparked a debate regarding its applicability in a crash airway situation. Ultrasound-guided marking of the cricothyroid membrane (CTM) as a preintubation procedure may be better than the dynamic method. No prior study has evaluated the accuracy of using US to premark the CTM before attempted intubation.

Microcystins and two new micropeptin cyanopeptides produced by unprecedented Microcystis aeruginosa blooms in North Carolina's Cape Fear River.

The Cape Fear River is the largest river system in North Carolina. It is heavily used as a source of drinking water for humans and livestock as well as a source of irrigation water for crops, and production water for industry. It also serves as a major fishery for both commercial and recreational use.

Web-based emergency department patient satisfaction surveys may introduce potential for bias.

Background: Emergency departments (ED) have proposed utilizing a Web-based format to distribute patient satisfaction surveys, but the potential for bias in this distribution method has not been assessed.

Objective: The aim of this study was to evaluate the characteristics of ED patients who have access to the Internet to better understand potential bias in Web-based patient satisfaction surveys.

Methods: We distributed a 20-question survey to consenting, English-speaking adult patients presenting to the ED from December 2010 to March 2012.

Prospective evaluation of a simplified risk stratification tool for patients with chest pain in an emergency department observation unit.

Background: The Thrombolysis in Myocardial Infarction score has been validated as a risk stratification tool in the emergency department (ED) setting, but certain aspects of the scoring system may not be applicable when applied to patients with chest pain selected for ED observation unit (EDOU) stay. We evaluated a simplified, 3-point risk stratification tool for patients in EDOU, which we termed the CARdiac score: Coronary disease [previous myocardial infarction (MI), stent, or coronary artery bypass graft (CABG)], Age (65 years or older), and Risk factors (at least 3 of 5 cardiac risk factors).

Methods: We performed a prospective, observational study with 30-day phone follow-up for all patients with chest pain admitted to our EDOU over a 36-month period.