Shore-Long Island Research Articles

Several Reasons Keep Clinicians From Reporting Child Abuse

Several Reasons Keep Clinicians From Reporting Child Abuse

Parenchymal Echo Texture Predicts Testicular Salvage After Torsion: Potential Impact on the Need for Emergent Exploration

In the setting of signs and symptoms of testicular torsion the absence of diastolic flow and/or color flow on Doppler ultrasound has traditionally prompted emergent scrotal exploration. This practice emanates largely from the difficulty on ultrasound of distinguishing salvageable torsed testes from those that are not salvageable. We identified ultrasound findings predictive of testicular viability or the lack thereof. We retrospectively reviewed the charts of all boys who underwent scrotal exploration for signs and symptoms of torsion during a 4-year period. In those who underwent preoperative Doppler ultrasound of the scrotum ultrasound findings were reviewed, as were the operative dictations. In patients who underwent orchiectomy the pathology reports were also reviewed. In patients in whom the torsed testis appeared viable and who underwent orchiopexy followup data were reviewed when available. Emergency room charts were also reviewed to ascertain, when documented, the duration of pain before presentation to the emergency room and the interval between ultrasound and operating room. During this period 55 boys underwent exploration after preoperative scrotal Doppler ultrasound revealed absent diastolic flow and/or color flow Doppler in the symptomatic testis. Assessment of parenchymal echogenicity revealed heterogeneity in 37 testes (67%), of which none were deemed viable at exploration. Orchiectomy was performed in 34 of 37 cases. Pathological examination revealed necrosis in all 34 cases, a finding consistent with late torsion. The remaining 3 testes underwent orchiopexy by parental directive despite nonviability, as confirmed by biopsy and subsequent atrophy. Thus, heterogeneity on preoperative ultrasound was universally predictive of organ loss (chi-square p <0.001). Of the 18 symptomatic testes (33%) demonstrating homogeneity and isoechogenicity on ultrasound 16 (89%) were deemed viable at exploration. Boys in whom the torsed testicle was nonviable on exploration experienced an average of 27.5 hours of pain preoperatively (range 5 to 72), whereas boys in whom the torsed testis was salvaged experienced an average of 20.5 hours of pain (range 2 to 96) (p = 0.073). The nonviable group underwent surgery an average of 49 minutes after ultrasound, whereas the viable group underwent surgery 52 minutes after ultrasound (p = 0.92). None of the 55 patients experienced any surgical or anesthetic complications and no pathological condition was noted intraoperatively in the contralateral asymptomatic testis. In the setting of Doppler proven testicular torsion heterogeneous parenchymal echo texture indicates late torsion and testicular nonviability. Therefore, the case may not require emergent scrotal exploration. On the other hand, homogeneous echo texture portends extremely well for testicular viability. Thus, such testes should be explored emergently.

Third Annual Nursing Leadership Congress "Designing Frameworks for Patient Safety" Conference Proceedings

In September 2007, more than 125 nurse executives from around the country met in Chicago, Ill., to develop practical tools and recommendations for "Designing Frameworks for Patient Safety," the theme of the Third Annual Nursing Leadership Congress. The Congress is sponsored by McKesson and Intel in collaboration with the American Organization of Nurse Executives, Institute for Safe Medication Practices, National Patient Safety Foundation, and Joint Commission Resources. Plenary speakers included Ann Hendrich, RN, MS, FAAN, vice president, Clinical Excellence Operations, Ascension Health, who shared her large health system's progress toward their goal of eliminating preventable errors by 2008. Executives from Virginia Mason Medical Center explained how the organization is seeking perfection in health care by applying the Toyota Production System to medicine. Maureen White, RN, MBA, CNAA, senior vice president and chief nursing executive of North Shore-Long Island Jewish Health System, described how participation in Transforming Care at the Bedside, a national project funded by the Robert Wood Johnson Foundation in collaboration with the Institute for Healthcare Improvement, has challenged staff to "stop, look, and rethink what they are doing and why they are doing it"-leading to remarkable results. Dale Beatty, RN, MS, vice president for Patient Care Services and chief nursing officer for Northwest Community Healthcare, outlined the framework for safety used at his 511-bed community hospital. The cornerstone of the Nursing Leadership Congress is the roundtables. This year, participants broke into groups to brainstorm around 6 topics: the role of the patient and family, external partnerships, physical design and workflow of an organization to support patient safety, measurement for patient safety, leadership competencies for effecting change, and strategic planning and organizational structure. Kevin Carroll, founder of the Katalyst Consultancy, ended the Congress on a high note with his inspiring stories about how to overcome adversity to achieve ambitious goals.

Simulation of storm-induced barrier island morphodynamics and flooding

Prediction of coupled storm hydrodynamics and morphodynamics is essential for accurately designing coastal flood protection measures. A numerical simulation methodology was developed and implemented to evaluate and assess engineering design solutions for storm damage reduction along the south shore of Long Island, New York, USA. This simulation methodology was applied to compute bay water levels for two major coastal storms taking into account contributions from storm surge, waves, wind, and barrier island overwash and breaching. Simulation results for breaching and bay flooding compare well to historically documented barrier island morphological change and bay high water marks.

Craftsteak, New York

AbstractThe most chic and beloved restaurants in New York are designed, not by black‐garbed hipsters in a downtown loft, but by a family firm of suburban intellectuals on the North Shore of Long Island, over an hour from Manhattan. Craftsteak is the latest in their portfolio which includes Gramercy Tavern, Tabla, Eleven Madison Park, Bluesmoke, Craft, Craftbar, 'Wichcraft, Medi, and the restaurants at the Museum of Modern Art. Jayne Merkel discusses the challenges of restaurant design with architects at Bentel &amp; Bentel, whose once largely local practice is now taking them all over the world, even to Heathrow's new Terminal 5 where they are designing a restaurant for Gordon Ramsay. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Cheilitis Granomatosa

*Long Island Jewish Medical Center †Department of Medicine, Long Island Jewish Medical Center ‡Department of Gastroenterology, North Shore-Long Island Jewish Medical Center, New Hyde Park, NY

Interview with a Quality Leader: Bernard Rosof on the State of Medical Quality

Bernard Rosof, MD MACP, is senior vice president for corporate relations and health affairs at the North Shore-Long Island Jewish Health System and clinical professor of medicine at New York University School of Medicine. Before assuming a full-time hospital position, Rosof was in the private practice of internal medicine and gastroenterology for 29 years. He has chaired committees and task forces in New York and for the Institute of Medicine, National Quality Forum, the American Medical Association (AMA), and various specialty societies. He has achieved national recognition for his contributions in the areas of healthcare quality and clinical practice guidelines and is the current chair of the Physician Consortium for Performance Improvement convened by the AMA. He is a member of the editorial board of the American Journal of Medical Quality and chair of the committee on quality assurance in office based-surgery for the Commissioner of Health of New York State. Rosof is a former member of the board of directors of the National Alliance of Autism Research and was instrumental in the development of the North Shore-Long Island Jewish Health System's Center for Autism. He is a master of the American College of Physicians and chair emeritus and president emeritus of the Board of Regents of the American College of Physicians.

Hotchkiss and MacLeod: An Historical Perspective

Hotchkiss and MacLeod: An Historical Perspective

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The effects of fine-scale surface roughness and grain size on 300 kHz multibeam backscatter intensity in sandy marine sedimentary environments

High-frequency acoustic backscatter intensity that is returned from sediment is affected by a number of seabed characteristics including sediment grain size distribution, the nature and magnitude of seabed surface roughness, and volume scattering by subsurface scatterers. In order to develop quantitative remote sediment classification techniques, it is important to determine the relative and combined effects of the dominant variables to which the acoustic signal is sensitive. Data used in this study were collected at two sandy sites off the south shore of Long Island, New York, and include 300 kHz multibeam (Simrad EM 3000) backscatter intensity data as well as grab samples and stereo bottom photographs. Multivariate statistical analyses were used to investigate the relationships between grain size properties, seabed roughness, and backscatter intensity at a number of sample locations at each study site encompassing a moderate range of backscatter intensities from − 32.5 to − 24 dB. The results of this study demonstrate that the relative importance of variables that affect backscatter intensity varies at different sites, suggesting that backscatter intensity alone cannot be used to quantitatively predict seabed characteristics. However, our study indicates that in sandy sediments, the median grain size, the standardized magnitude of seabed roughness, and the sorting of sediment can together be used to predict 300 kHz backscatter intensity with high significance, and that the relative importance of these variables varies from site to site. We present an empirical model derived from a combined dataset that includes two sites of similar sedimentary and hydrodynamic conditions to predict the magnitude of seabed roughness based on backscatter intensity and sediment grain size characteristics. The spatially coherent patterns in predicted seabed surface roughness revealed through the use of this kind of model greatly improve our understanding of variations in backscatter intensity in sandy marine sedimentary environments. As a result, the multivariate statistical approach that we employ improves our overall ability to remotely assess the details of the sedimentary environment that are significant with respect to benthic habitats and physical processes, and are applicable to other geophysical datasets including sidescan sonar data.

Overweight and obesity in bipolar disorders

a Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Room 2117, Stanford, CA 94305-5723, United States b Massachusetts General Hospital, United States c National Institute of Mental Health, United States d Baylor College of Medicine, United States e Case Western Reserve University School of Medicine, United States f Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, United States g University of Missouri, Kansas City, United States h Epidemiology Data Center, University of Pittsburgh, United States i Stanford University School of Medicine, United States

Treatment of Eating Disorders in Children, Adolescents, and Young Adults

1. Martin Fisher, MD* 1. *Chief, Division of Adolescent Medicine, Schneider Childrens Hospital, North Shore-Long Island Jewish Health System; Professor of Pediatrics, New York University School of Medicine, New York, NY After completing this article, readers should be able to: 1. Describe the demographics and pathogenesis of eating disorders. 2. Delineate the criteria for the diagnosis of anorexia and bulimia nervosa. 3. Detect the presence of an eating disorder and evaluate its severity. 4. Outline the medical complications of eating disorders. 5. Organize a treatment or referral plan for patients who have eating disorders. A 16-year-old girl who initially was underweight has been dieting and lost 20 pounds in the last 3 months. A 19-year-old girl has been sent home from college because she was found vomiting every night in her dormitory room. A 14-year-old boy has been exercising 3 hours a day and eliminated all fat from his diet to “increase my muscle mass and decrease my fat.” An 11-year-old girl has grown 2 inches but gained no weight since her last check-up 1 year ago. A 15-year-old girl is found to have empty boxes of laxatives hidden under her bed but denies they are hers. In January 2003, the American Academy of Pediatrics (AAP) published a policy statement entitled “Identifying and Treating Eating Disorders.” Written by the Committee on Adolescence, it outlined the roles of the pediatrician in the identification, evaluation, and management of eating disorders in children, adolescents, and young adults. The statement provided recommendations for treatment in outpatient, inpatient, and day programs and suggested roles for the pediatrician in the areas of prevention and advocacy. Also included were some specifics relevant to particular recommendations, but not a detailed overview of the topic. This article provides that overview and, together with the policy statement, offers a state-of-the-art review of the eating disorders anorexia nervosa and bulimia nervosa. Included in this review are discussions of diagnosis and demographics; pathogenesis and presentation; evaluation and complications; medical, nutritional, and psychological management; and prognosis and prevention. It …

Influence of freshwater flow, ocean exchange, and seasonal cycles on phytoplankton – nutrient dynamics in a temporarily open estuary

Mecox Bay is a shallow, closed embayment, located on the south shore of Long Island, NY, which has an inlet that is periodically opened by natural and anthropogenic processes, allowing for tidal exchange with the coastal Atlantic Ocean. The aim of this study was to characterize the phytoplankton community and water chemistry of Mecox Bay, while assessing the impact of inlet openings and freshwater flow on these characteristics. Results indicated that groundwater and tributaries entering Mecox were an important source of nitrogen (N) to the bay, being enriched in dissolved inorganic nitrogen (DIN = 140 ± 20 μM). Inlet openings yielded increased salinity and chlorophyll a levels, but decreased depths and diatom densities in Mecox Bay. Other parameters, such as nutrient concentrations (N, P), pico- and nanophytoplankton densities, and the nutrient limitation of phytoplankton communities were more strongly influenced by seasonal changes associated with temperature. Dissolved inorganic nitrogen-to-phosphorus ratios decreased from above 100 during winter to below one during summer, as concentrations of DIN and freshwater flow rates in Mecox Bay declined and DIP levels concurrently increased. In concert with changes in the nutrient regime, field experiments indicated that growth rates of the phytoplankton community in Mecox Bay shifted from P-limited during winter and spring to N-limited during summer and fall. Finally, the abundance of phytoplankton (mean annual chlorophyll a concentration ∼10 μg L −1) and the temporarily closed nature of Mecox Bay may both contribute toward enhanced secondary productivity of resident shellfish populations.

The Treatment of Children Impacted by the World Trade Center Attack

This article presents, from a developmental perspective, the authors' experiences treating children and families who were traumatized by and who lost relatives in the World Trade Center attack. The treatments took place within the Trauma Treatment Development Center, National Child Traumatic Stress Network (NCTSN) of the Division of Child and Adolescent Psychiatry, North Shore University Hospital, Manhasset, New York, of the North Shore-Long Island Jewish Health System. Case vignettes address treatments for toddlers, preschool, and school-age children and adolescents. Family, individual cognitive-behavioral, school, social, and parenting treatment strategies utilized are discussed.

More Quality Bang for Your Healthcare Buck

The quality management department at North Shore-Long Island Jewish Health System has designed a collaborative process that improves patient safety, is accountable to the public, and increases efficiency on the basis of sound data management. By forging strategic alliances between the quality, finance, and materials support services departments at the health system level, a quality economic business model was developed that led to greater efficiencies in length-of-stay management, improved resource utilization in critical care, and standardization of skin care products and equipment. This article describes these quality initiatives.

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness

Women's Encounters With the Mental Health Establishment: Escaping the Yellow Wallpaper Voices of Hope: Conversations With Helen L. Shore Diagnosis: Schizophrenia: A Comprehensive Resource for Patients, Families, and Helping Professionals Children of Jonah: Personal Stories by Survivors of Suicide Attempts Walk With Me Nothing to Hide: Mental Illness in the Family Changing Minds: Our Lives and Mental Illness

Imaging of Total Hip Arthroplasty

Dr. Miller is Associate Professor of Radiology, New York University School of Medicine, New York, NY; and Chief, Division of Musculoskeletal Imaging, Department of Radiology, North Shore-Long Island Jewish Health System, 825 Northern Boulevard, Great Neck, NY 11021; E-mail: [email protected]. The author has disclosed that he has no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity.

HMGBI AS A LATE MEDIATOR AND THERAPEUTIC TARGET IN SEPSIS

Laboratory of Biomedical Science, North Shore-Long Island Jewish Research Institute, 350 Community Drive, Manhasset, NY 11030, USA (Supported in part by a grant from NIGMS, to KJT).

Development of a regional neural network for coastal water level predictions

This paper presents the development of a Regional Neural Network for Water Level (RNN_WL) predictions, with an application to the coastal inlets along the South Shore of Long Island, New York. Long-term water level data at coastal inlets are important for studying coastal hydrodynamics sediment transport. However, it is quite common that long-term water level observations may be not available, due to the high cost of field data monitoring. Fortunately, the US National Oceanographic and Atmospheric Administration (NOAA) has a national network of water level monitoring stations distributed in regional scale that has been operating for several decades. Therefore, it is valuable and cost effective for a coastal engineering study to establish the relationship between water levels at a local station and a NOAA station in the region. Due to the changes of phase and amplitude of water levels over the regional coastal line, it is often difficult to obtain good linear regression relationship between water levels from two different stations. Using neural network offers an effective approach to correlate the non-linear input and output of water levels by recognizing the historic patterns between them. In this study, the RNN_WL model was developed to enable coastal engineers to predict long-term water levels in a coastal inlet, based on the input of data in a remote NOAA station in the region. The RNN_WL model was developed using a feed-forwards, back-propagation neural network structure with an optimized training algorithm. The RNN_WL model can be trained and verified using two independent data sets of hourly water levels. The RNN_WL model was tested in an application to Long Island South Shore. Located about 60–100 km away from the inlets there are two permanent long-term water level stations, which have been operated by NOAA since the1940s. The neural network model was trained using hourly data over a one-month period and validated for another one-month period. The model was then tested over year-long periods. Results indicate that, despite significant changes in the amplitudes and phases of the water levels over the regional study area, the RNN_WL model provides very good long-term predictions of both tidal and non-tidal water levels at the regional coastal inlets. In order to examine the effects of distance on the RNN_WL model performance, the model was also tested using water levels from other remote NOAA stations located at longer distances, which range from 234 km to 591 km away from the local station at the inlets. The satisfactory results indicate that the RNN_WL model is able to supplement long-term historical water level data at the coastal inlets based on the available data at remote NOAA stations in the coastal region.

Asthma Outcomes in North Shore-Long Island Jewish Health System (NS-LIJ Health System

PURPOSE: Asthma mortality have increased in the last decade leading to the development of the NAEP Guidelines for asthma treatment. Asthma outcomes are reported for our Health System and compared to the counties served by the Health System before and after the Guidelines.