Gregory Bledsoe - Academia.edu (original) (raw)

Papers by Gregory Bledsoe

Wilderness & Environmental Medicine, Mar 1, 2007

Objective.-The objective of this study was to determine the incidence and patterns of injury and ... more Objective.-The objective of this study was to determine the incidence and patterns of injury and illness among passengers aboard a cruise ship in Antarctica. Methods.-Demographic data on passengers were collected for all participants aboard Antarctica cruises on a single ship during the Antarctic summer cruise season of November 2004 through March 2005. Medical logs from each of 11 cruise trips were reviewed for presentation of injuries and illnesses. Results.-A total of 1057 passengers were included in the study, of which 47.4% were male. The mean age of the passengers was 54 years (Ϯ16.5 years). The overall incidence rate of injury and illness was 21.7 per 1000 person-days. Motion sickness was the most common condition, comprising 42.3% of all medical encounters by the ship physician, followed by infectious diseases (17.2%) and injury (15.0%). The incidence rate of injury increased significantly with age, whereas the incidence rate of motion sickness decreased significantly with age. There was little variation in the incidence and patterns of injury and illness between genders. Conclusions.-Most illnesses and injuries were due to the motion of the ship, and a large proportion of the passengers aboard the cruise ship in Antarctica were elderly. Injury among older passengers is of special concern.

Springer eBooks, Dec 24, 2008

Mixed martial arts events, bouts that combine various styles of fighting and martial arts, is the... more Mixed martial arts events, bouts that combine various styles of fighting and martial arts, is the fastest growing sport in the country. In Hawai'i, the events are currently permitted under an exemption from the prohibition against no rules combat, or extreme fighting. The 2006 Legislature requested the Auditor to analyze a proposal to license mixed martial arts events as their own sport. The request, contained in Senate Concurrent Resolution No. 37, Senate Draft 1, invokes the Hawai'i Regulatory Licensing Reform Act, Chapter 26H, Hawai'i Revised Statutes, which requires the Auditor to evaluate proposals to regulate previously unregulated professions or vocations. The proposed regulatory scheme is presented in House Bill No. 3223, House Draft 1 of the 2006 session. Mixed martial arts (MMA) events have international origins, with various individuals and organizations establishing their own definitions and rules. Since the first MMA event in the U.S. in 1993, the shows now command large gate and television revenues and significant TV viewership. Mixed martial arts events have become significant revenue sources for states and tribal commissions. Since 2001, promoters have achieved regulatory approval in 24 states. Two main motivations for new regulation were: (1) to protect the fighters' health and remove the stigma of barbaric, no rules brawling, and (2) to provide a satisfying spectacle for viewers.

The Journal of the Arkansas Medical Society, 2004

Arkansas' mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requirin... more Arkansas' mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requiring only those under the age of 21 to wear helmets. The paper examines research conducted at the University of Arkansas that highlights the impact of the helmet law repeal and demonstrated a substantial increase in nonhelmeted motorcycle crash admissions, head injury severity, ICU length of stay and financial loss at the university. In February 2003, a house Bill was submitted to reinstate the mandatory motorcycle helmet law for all motorcycle riders. The bill was killed in committee. The paper argues that it is time to revisit the issue of mandatory helmet law and enact universal motorcycle helmet legislation.

Wilderness & Environmental Medicine, Jun 1, 2004

Since its identification in New York City in 1999, the West Nile virus has spread to 45 states an... more Since its identification in New York City in 1999, the West Nile virus has spread to 45 states and caused human infections in at least 44 states. West Nile virus is difficult to correctly diagnose without a high level of clinical suspicion and can cause severe debilitation or death in those with the most severe symptoms. This paper reviews the epidemiology, surveillance, prevention, clinical features, diagnosis, and treatment of this important emerging infection. Lessons learned from West Nile virus are discussed at the conclusion of the paper.

Wilderness & Environmental Medicine, 2021

When considering medical emergencies that might affect an expedition, urologic emergencies are ty... more When considering medical emergencies that might affect an expedition, urologic emergencies are typically not included. However, the reality is that manageable and prevalent urologic disease processes can pose significant challenges for the wilderness medicine physician and warrant consideration. The purpose of this review is to identify and discuss the most commonly encountered urologic emergencies and diseases in the wilderness setting and to prepare the expedition medicine physician for management of these urgent conditions. A PubMed and Internet search for urologic emergencies and diseases in wilderness conditions was conducted. We also searched bibliographies for useful supplemental literature and material from leading mountain medicine and wilderness medicine societies as well as population-based studies for common urologic diseases. Urologic emergencies and diseases on expeditions and in wilderness conditions have been reported primarily with retrospective case series and case reports. The most commonly reported urologic emergencies in this setting include urologic trauma, renal calculi, and urinary retention. Parasitic infections in the urinary tract also have been reported to cause urinary symptoms and urinary retention in wilderness conditions. Although urologic diseases in such conditions are uncommon, significant morbidity and even potentially life-threatening sequelae to urologic emergencies were found to occur. Major genitourinary emergencies in expedition medicine are uncommon but involve both potentially manageable urgent conditions and serious life-threatening conditions best treated with urgent stabilization and occasionally medical evacuation. The opportunity exists for increased awareness for management strategies for urologic conditions in the often remote or extreme environments of an expedition.

The journal of trauma and acute care surgery, Jan 31, 2018

In 2009, Arkansas implemented a statewide trauma system to address the high rates of mortality an... more In 2009, Arkansas implemented a statewide trauma system to address the high rates of mortality and morbidity due to trauma. The principal objective of the Arkansas Trauma System is to transport patients to the appropriate facility based on the injuries of the patients.This study evaluated four metrics that were crucial to system health. These measures included: treatment location, scene triage, admission to non-designated facilities, and inpatient mortality. Furthermore, the authors sought to quantify how the system is selective towards the severely-injured regarding triage and treatment location. The authors hypothesized that system implementation should increase the proportion of patients, particularly the severely-injured, treated at Level I/II facilities. The system should increase the proportion of patients, especially the severely-injured, admitted to Level I/II facilities directly from the scene. The system should result in fewer patients admitted to non-designated facilities...

The Journal of the Arkansas Medical Society, 2004

Motorcycle helmet laws have a long and colorful history dating back to the original work of Brita... more Motorcycle helmet laws have a long and colorful history dating back to the original work of Britain's Dr. Hugh Cairns during World War II. In Arkansas, the state's mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requiring only those under the age of 21 to wear helmets. Recent work by researchers at the University of Arkansas for Medical Sciences has highlighted the impact of the helmet law repeal and demonstrated an increase in nonhelmeted motorcycle crash admissions, head injury severity, ICU length of stay and financial loss at this institution. In February of 2003, House Bill 1024 was submitted to the Arkansas House Committee on Public Transportation to reinstate the mandatory motorcycle helmet law for all motorcycle riders but was killed in committee. This article is a review of motorcycle helmet laws with particular emphasis on the arguments pro and con and the history of these laws in the state of Arkansas.

Wilderness & Environmental Medicine, 2002

Prehospital and Disaster Medicine, 2005

Objective:A consensus panel of Emergency Physicians with experience in international health has p... more Objective:A consensus panel of Emergency Physicians with experience in international health has published a recommended curriculum for a formal fellowship in International Emergency Medicine. This article reviews the current International Emergency Medicine (IEM) fellowships available to residency-trained Emergency Physicians in the United States.Methods:Every allopathic Emergency Medicine (EM) residency program in the United States was contacted via e-mail or telephone. Programs that reported having an IEM fellowship were asked detailed information about their program, including: (1) the number of years the program has been offered; (2) the duration of the program; (3) the number of fellows taken each year; (4) the number of fellowship graduates from each program and their current practice patterns; (5) how the fellowship is funded; and (6) whether a Masters Degree in Public Health (MPH) is offered.Results:All 127 allopathic EM residency programs responded. Eight (6.8%) of these pr...

Prehospital and Disaster Medicine, 2002

Wilderness & Environmental Medicine, 2003

Journal of Emergency Medicine, 2005

A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and C... more A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and Chinese Ministry of Health has been established to initiate Emergency Medicine (EM) administrative training in Beijing, China. The Emergency Medical Education and Training Center (EMETC) at Chaoyang Red Cross Hospital was opened as a training facility to foster EM administrative curriculum development and training nationwide. A six-step approach with problem identification, needs assessment, goals and objectives, educational strategies, implementation and evaluation was used to form a locally adapted curriculum. With a train-the-trainers model, the EMETC sponsored several EM administration courses, the first of their kind in China. Since its inception, the EMETC has trained 95 persons from throughout China in EM administration. An EM administration curriculum has been developed and refined. In conclusion, an international partnership between academic hospitals, supported by the local Ministry of Health, to develop a national training facility using this six-step approach may be an attractive strategy for dissemination of EM administration principles.

Wilderness & Environmental Medicine, 2004

Since its identification in New York City in 1999, the West Nile virus has spread to 45 states an... more Since its identification in New York City in 1999, the West Nile virus has spread to 45 states and caused human infections in at least 44 states. West Nile virus is difficult to correctly diagnose without a high level of clinical suspicion and can cause severe debilitation or death in those with the most severe symptoms. This paper reviews the epidemiology, surveillance, prevention, clinical features, diagnosis, and treatment of this important emerging infection. Lessons learned from West Nile virus are discussed at the conclusion of the paper.

Wilderness & Environmental Medicine, 2007

Objective.-The objective of this study was to determine the incidence and patterns of injury and ... more Objective.-The objective of this study was to determine the incidence and patterns of injury and illness among passengers aboard a cruise ship in Antarctica.

Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimat... more Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission.

Annals of Emergency Medicine, 2002

Southern Medical Journal, 2005

Although a popular endeavor, boxing has fallen under increased scrutiny because of its associatio... more Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003. Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury. The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.

Academic Emergency Medicine, 2004

Southern Medical Journal, 2005

This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle regist... more This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle registrations, crash and fatality risks, and alcohol involvement in motorcycle crashes. Annual motorcycle registration data for the years 1990 through 2001 were obtained from the Arkansas Department of Finance and Administration. These motorcycle registration data were complemented by the motorcycle crash data from the Arkansas State Police Highway Safety Office and motorcycle fatality data for the state of Arkansas from the Fatality Analysis Reporting System. The impact of the repeal on crash rates, helmet usage, and alcohol involvement was assessed through comparisons of data from before (1993 to 1996) and after (1998 to 2001) the repeal. After the repeal, an increase in motorcycle registrations correlated with a marked rise in the total number of crashes and fatalities; however, fatalities per crash remained virtually the same. The proportion of motorcycle fatalities that were not wearing a helmet increased from 47.0% (47/100) before the repeal to 78.2% (104/133) after the repeal (P = 0.001). The overall percentage of fatal motorcycle crashes involving alcohol use remained unchanged after the repeal (37.6% [29/77] to 38.5% [40/104], P = 0.91), but the percentage of fatal crashes involving drinking nonhelmeted drivers increased from 14.2% (11/77) to 33.6% (35/104) (P = 0.003). Inebriated motorcyclists killed in crashes were overwhelmingly non-helmeted (87.5%, 35/40) after the repeal, up from 37.9% (11/29) before the repeal (P < 0.001). These findings suggest that the repeal of the mandatory helmet law in Arkansas has had a significant adverse effect on road safety.

Journal of Trauma-injury Infection and Critical Care, 2002

On July 1, 1997, Arkansas became the first state in 14 years to repeal their adult helmet law. We... more On July 1, 1997, Arkansas became the first state in 14 years to repeal their adult helmet law. We examined the clinical and financial impact of this repeal. A 6-year retrospective review was conducted of the University of Arkansas for Medical Sciences trauma registry including the 3 years before and the 3 years after the repeal of the helmet law. A head and neck Abbreviated Injury Scale (AIS) score >or= 3 was considered severe. All patients admitted to the hospital or who died in the emergency department were included in the study. The database of the Arkansas Highway and Transportation Department was also used to determine the number of crashes and fatalities occurring statewide (1995-1999). Although total and fatal crashes in Arkansas were not significantly different (1995-1996 vs. 1998-1999), nonhelmeted deaths at the scene of a crash significantly increased from 19 of 48 (39.6%) (1995-1996) to 40 of 53 (75.5%) (1998-1999) (p < 0.0001). Before repeal, 25% of nonfatal crash admissions were nonhelmeted (18 of 73). This significantly increased to 54% (52 of 96, p< 0.001) after repeal. Overall, patients who were nonhelmeted had significantly higher AIS scores for head and neck, significantly more severe head injuries (AIS score >or= 3), 47% (33 of 70) versus 20% (20 of 99), and significantly longer length of intensive care unit stay. Financially, patients without helmets had significantly higher unreimbursed charges compared with their helmeted counterparts, resulting in a total of 982,560 dollars of additional potentially lost revenue over the length of the study. Repeal of the mandatory helmet law was associated with an increase in the nonhelmeted crash scene fatality rate. After the repeal, there was a disproportionately higher admission rate for nonhelmeted motorcycle crash survivors. These patients had an increased use of hospital resources and poorer reimbursement of charges compared with their helmeted counterparts. This resulted in significantly higher unreimbursed charges. States considering repeal of their mandatory adult helmet laws should consider the potential negative financial impact on their health care system and the increased morbidity associated with nonhelmeted motorcycle riders involved in a crash.

Wilderness & Environmental Medicine, Mar 1, 2007

Objective.-The objective of this study was to determine the incidence and patterns of injury and ... more Objective.-The objective of this study was to determine the incidence and patterns of injury and illness among passengers aboard a cruise ship in Antarctica. Methods.-Demographic data on passengers were collected for all participants aboard Antarctica cruises on a single ship during the Antarctic summer cruise season of November 2004 through March 2005. Medical logs from each of 11 cruise trips were reviewed for presentation of injuries and illnesses. Results.-A total of 1057 passengers were included in the study, of which 47.4% were male. The mean age of the passengers was 54 years (Ϯ16.5 years). The overall incidence rate of injury and illness was 21.7 per 1000 person-days. Motion sickness was the most common condition, comprising 42.3% of all medical encounters by the ship physician, followed by infectious diseases (17.2%) and injury (15.0%). The incidence rate of injury increased significantly with age, whereas the incidence rate of motion sickness decreased significantly with age. There was little variation in the incidence and patterns of injury and illness between genders. Conclusions.-Most illnesses and injuries were due to the motion of the ship, and a large proportion of the passengers aboard the cruise ship in Antarctica were elderly. Injury among older passengers is of special concern.

Springer eBooks, Dec 24, 2008

Mixed martial arts events, bouts that combine various styles of fighting and martial arts, is the... more Mixed martial arts events, bouts that combine various styles of fighting and martial arts, is the fastest growing sport in the country. In Hawai'i, the events are currently permitted under an exemption from the prohibition against no rules combat, or extreme fighting. The 2006 Legislature requested the Auditor to analyze a proposal to license mixed martial arts events as their own sport. The request, contained in Senate Concurrent Resolution No. 37, Senate Draft 1, invokes the Hawai'i Regulatory Licensing Reform Act, Chapter 26H, Hawai'i Revised Statutes, which requires the Auditor to evaluate proposals to regulate previously unregulated professions or vocations. The proposed regulatory scheme is presented in House Bill No. 3223, House Draft 1 of the 2006 session. Mixed martial arts (MMA) events have international origins, with various individuals and organizations establishing their own definitions and rules. Since the first MMA event in the U.S. in 1993, the shows now command large gate and television revenues and significant TV viewership. Mixed martial arts events have become significant revenue sources for states and tribal commissions. Since 2001, promoters have achieved regulatory approval in 24 states. Two main motivations for new regulation were: (1) to protect the fighters' health and remove the stigma of barbaric, no rules brawling, and (2) to provide a satisfying spectacle for viewers.

The Journal of the Arkansas Medical Society, 2004

Arkansas' mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requirin... more Arkansas' mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requiring only those under the age of 21 to wear helmets. The paper examines research conducted at the University of Arkansas that highlights the impact of the helmet law repeal and demonstrated a substantial increase in nonhelmeted motorcycle crash admissions, head injury severity, ICU length of stay and financial loss at the university. In February 2003, a house Bill was submitted to reinstate the mandatory motorcycle helmet law for all motorcycle riders. The bill was killed in committee. The paper argues that it is time to revisit the issue of mandatory helmet law and enact universal motorcycle helmet legislation.

Wilderness & Environmental Medicine, Jun 1, 2004

Since its identification in New York City in 1999, the West Nile virus has spread to 45 states an... more Since its identification in New York City in 1999, the West Nile virus has spread to 45 states and caused human infections in at least 44 states. West Nile virus is difficult to correctly diagnose without a high level of clinical suspicion and can cause severe debilitation or death in those with the most severe symptoms. This paper reviews the epidemiology, surveillance, prevention, clinical features, diagnosis, and treatment of this important emerging infection. Lessons learned from West Nile virus are discussed at the conclusion of the paper.

Wilderness & Environmental Medicine, 2021

When considering medical emergencies that might affect an expedition, urologic emergencies are ty... more When considering medical emergencies that might affect an expedition, urologic emergencies are typically not included. However, the reality is that manageable and prevalent urologic disease processes can pose significant challenges for the wilderness medicine physician and warrant consideration. The purpose of this review is to identify and discuss the most commonly encountered urologic emergencies and diseases in the wilderness setting and to prepare the expedition medicine physician for management of these urgent conditions. A PubMed and Internet search for urologic emergencies and diseases in wilderness conditions was conducted. We also searched bibliographies for useful supplemental literature and material from leading mountain medicine and wilderness medicine societies as well as population-based studies for common urologic diseases. Urologic emergencies and diseases on expeditions and in wilderness conditions have been reported primarily with retrospective case series and case reports. The most commonly reported urologic emergencies in this setting include urologic trauma, renal calculi, and urinary retention. Parasitic infections in the urinary tract also have been reported to cause urinary symptoms and urinary retention in wilderness conditions. Although urologic diseases in such conditions are uncommon, significant morbidity and even potentially life-threatening sequelae to urologic emergencies were found to occur. Major genitourinary emergencies in expedition medicine are uncommon but involve both potentially manageable urgent conditions and serious life-threatening conditions best treated with urgent stabilization and occasionally medical evacuation. The opportunity exists for increased awareness for management strategies for urologic conditions in the often remote or extreme environments of an expedition.

The journal of trauma and acute care surgery, Jan 31, 2018

In 2009, Arkansas implemented a statewide trauma system to address the high rates of mortality an... more In 2009, Arkansas implemented a statewide trauma system to address the high rates of mortality and morbidity due to trauma. The principal objective of the Arkansas Trauma System is to transport patients to the appropriate facility based on the injuries of the patients.This study evaluated four metrics that were crucial to system health. These measures included: treatment location, scene triage, admission to non-designated facilities, and inpatient mortality. Furthermore, the authors sought to quantify how the system is selective towards the severely-injured regarding triage and treatment location. The authors hypothesized that system implementation should increase the proportion of patients, particularly the severely-injured, treated at Level I/II facilities. The system should increase the proportion of patients, especially the severely-injured, admitted to Level I/II facilities directly from the scene. The system should result in fewer patients admitted to non-designated facilities...

The Journal of the Arkansas Medical Society, 2004

Motorcycle helmet laws have a long and colorful history dating back to the original work of Brita... more Motorcycle helmet laws have a long and colorful history dating back to the original work of Britain's Dr. Hugh Cairns during World War II. In Arkansas, the state's mandatory motorcycle helmet law was repealed in 1997 and replaced by a law requiring only those under the age of 21 to wear helmets. Recent work by researchers at the University of Arkansas for Medical Sciences has highlighted the impact of the helmet law repeal and demonstrated an increase in nonhelmeted motorcycle crash admissions, head injury severity, ICU length of stay and financial loss at this institution. In February of 2003, House Bill 1024 was submitted to the Arkansas House Committee on Public Transportation to reinstate the mandatory motorcycle helmet law for all motorcycle riders but was killed in committee. This article is a review of motorcycle helmet laws with particular emphasis on the arguments pro and con and the history of these laws in the state of Arkansas.

Wilderness & Environmental Medicine, 2002

Prehospital and Disaster Medicine, 2005

Objective:A consensus panel of Emergency Physicians with experience in international health has p... more Objective:A consensus panel of Emergency Physicians with experience in international health has published a recommended curriculum for a formal fellowship in International Emergency Medicine. This article reviews the current International Emergency Medicine (IEM) fellowships available to residency-trained Emergency Physicians in the United States.Methods:Every allopathic Emergency Medicine (EM) residency program in the United States was contacted via e-mail or telephone. Programs that reported having an IEM fellowship were asked detailed information about their program, including: (1) the number of years the program has been offered; (2) the duration of the program; (3) the number of fellows taken each year; (4) the number of fellowship graduates from each program and their current practice patterns; (5) how the fellowship is funded; and (6) whether a Masters Degree in Public Health (MPH) is offered.Results:All 127 allopathic EM residency programs responded. Eight (6.8%) of these pr...

Prehospital and Disaster Medicine, 2002

Wilderness & Environmental Medicine, 2003

Journal of Emergency Medicine, 2005

A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and C... more A collaborative partnership between the Johns Hopkins Hospital, Chaoyang Red Cross Hospital and Chinese Ministry of Health has been established to initiate Emergency Medicine (EM) administrative training in Beijing, China. The Emergency Medical Education and Training Center (EMETC) at Chaoyang Red Cross Hospital was opened as a training facility to foster EM administrative curriculum development and training nationwide. A six-step approach with problem identification, needs assessment, goals and objectives, educational strategies, implementation and evaluation was used to form a locally adapted curriculum. With a train-the-trainers model, the EMETC sponsored several EM administration courses, the first of their kind in China. Since its inception, the EMETC has trained 95 persons from throughout China in EM administration. An EM administration curriculum has been developed and refined. In conclusion, an international partnership between academic hospitals, supported by the local Ministry of Health, to develop a national training facility using this six-step approach may be an attractive strategy for dissemination of EM administration principles.

Wilderness & Environmental Medicine, 2004

Since its identification in New York City in 1999, the West Nile virus has spread to 45 states an... more Since its identification in New York City in 1999, the West Nile virus has spread to 45 states and caused human infections in at least 44 states. West Nile virus is difficult to correctly diagnose without a high level of clinical suspicion and can cause severe debilitation or death in those with the most severe symptoms. This paper reviews the epidemiology, surveillance, prevention, clinical features, diagnosis, and treatment of this important emerging infection. Lessons learned from West Nile virus are discussed at the conclusion of the paper.

Wilderness & Environmental Medicine, 2007

Objective.-The objective of this study was to determine the incidence and patterns of injury and ... more Objective.-The objective of this study was to determine the incidence and patterns of injury and illness among passengers aboard a cruise ship in Antarctica.

Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimat... more Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission.

Annals of Emergency Medicine, 2002

Southern Medical Journal, 2005

Although a popular endeavor, boxing has fallen under increased scrutiny because of its associatio... more Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003. Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury. The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.

Academic Emergency Medicine, 2004

Southern Medical Journal, 2005

This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle regist... more This study aimed to assess the impact of the 1997 Arkansas helmet law repeal on motorcycle registrations, crash and fatality risks, and alcohol involvement in motorcycle crashes. Annual motorcycle registration data for the years 1990 through 2001 were obtained from the Arkansas Department of Finance and Administration. These motorcycle registration data were complemented by the motorcycle crash data from the Arkansas State Police Highway Safety Office and motorcycle fatality data for the state of Arkansas from the Fatality Analysis Reporting System. The impact of the repeal on crash rates, helmet usage, and alcohol involvement was assessed through comparisons of data from before (1993 to 1996) and after (1998 to 2001) the repeal. After the repeal, an increase in motorcycle registrations correlated with a marked rise in the total number of crashes and fatalities; however, fatalities per crash remained virtually the same. The proportion of motorcycle fatalities that were not wearing a helmet increased from 47.0% (47/100) before the repeal to 78.2% (104/133) after the repeal (P = 0.001). The overall percentage of fatal motorcycle crashes involving alcohol use remained unchanged after the repeal (37.6% [29/77] to 38.5% [40/104], P = 0.91), but the percentage of fatal crashes involving drinking nonhelmeted drivers increased from 14.2% (11/77) to 33.6% (35/104) (P = 0.003). Inebriated motorcyclists killed in crashes were overwhelmingly non-helmeted (87.5%, 35/40) after the repeal, up from 37.9% (11/29) before the repeal (P < 0.001). These findings suggest that the repeal of the mandatory helmet law in Arkansas has had a significant adverse effect on road safety.

Journal of Trauma-injury Infection and Critical Care, 2002

On July 1, 1997, Arkansas became the first state in 14 years to repeal their adult helmet law. We... more On July 1, 1997, Arkansas became the first state in 14 years to repeal their adult helmet law. We examined the clinical and financial impact of this repeal. A 6-year retrospective review was conducted of the University of Arkansas for Medical Sciences trauma registry including the 3 years before and the 3 years after the repeal of the helmet law. A head and neck Abbreviated Injury Scale (AIS) score >or= 3 was considered severe. All patients admitted to the hospital or who died in the emergency department were included in the study. The database of the Arkansas Highway and Transportation Department was also used to determine the number of crashes and fatalities occurring statewide (1995-1999). Although total and fatal crashes in Arkansas were not significantly different (1995-1996 vs. 1998-1999), nonhelmeted deaths at the scene of a crash significantly increased from 19 of 48 (39.6%) (1995-1996) to 40 of 53 (75.5%) (1998-1999) (p < 0.0001). Before repeal, 25% of nonfatal crash admissions were nonhelmeted (18 of 73). This significantly increased to 54% (52 of 96, p< 0.001) after repeal. Overall, patients who were nonhelmeted had significantly higher AIS scores for head and neck, significantly more severe head injuries (AIS score >or= 3), 47% (33 of 70) versus 20% (20 of 99), and significantly longer length of intensive care unit stay. Financially, patients without helmets had significantly higher unreimbursed charges compared with their helmeted counterparts, resulting in a total of 982,560 dollars of additional potentially lost revenue over the length of the study. Repeal of the mandatory helmet law was associated with an increase in the nonhelmeted crash scene fatality rate. After the repeal, there was a disproportionately higher admission rate for nonhelmeted motorcycle crash survivors. These patients had an increased use of hospital resources and poorer reimbursement of charges compared with their helmeted counterparts. This resulted in significantly higher unreimbursed charges. States considering repeal of their mandatory adult helmet laws should consider the potential negative financial impact on their health care system and the increased morbidity associated with nonhelmeted motorcycle riders involved in a crash.