13 results on '"J. Fierstein"'
Search Results
2. 136 Retrospective Application of a Low Acuity Emergency Medical Services Triage Protocol to Identify Patients Appropriate for Urgent Care
- Author
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J. Morrison, C. Kong, A. Belachew, Kevin Munjal, G. Ngai, Lynne D. Richardson, K. Ming, A.B. Drake, H. Chapin, J. Fierstein, N. Tan, and M. Redlener
- Subjects
Protocol (science) ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Emergency Medicine ,medicine ,Emergency medical services ,Medical emergency ,medicine.disease ,business ,Triage - Published
- 2015
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3. Complex proximal deposition during the Plinian eruptions of 1912 at Novarupta, Alaska.
- Author
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Bruce F. Houghton, C. J. N. Wilson, J. Fierstein, and W. Hildreth
- Subjects
SEDIMENTATION & deposition ,VOLCANIC eruptions ,VOLCANISM ,STRATIGRAPHIC geology - Abstract
Proximal (<3 km) deposits from episodes II and III of the 60-h-long Novarupta 1912 eruption exhibit a very complex stratigraphy, the result of at least four transport regimes and diverse depositional mechanisms. They contrast with the relatively simple stratigraphy (and inferred emplacement mechanisms) for the previously documented, better known, medial?distal fall deposits and the Valley of Ten Thousand Smokes ignimbrite. The proximal products include alternations and mixtures of both locally and regionally dispersed fall ejecta, and numerous thin complex deposits of pyroclastic density currents (PDCs) with no regional analogs. The locally dispersed component of the fall deposits forms sector-confined wedges of material whose thicknesses halve radially from and concentrically about the vent over distances of 100?300 m (cf. several kilometers for the medial?distal fall deposits). This locally dispersed fall material (and many of the associated PDC deposits) is rich in andesitic and banded pumices and richer in shallow-derived wall-rock lithics in comparison with the coeval medial fall units of almost entirely dacitic composition. There are no marked contrasts in grain size in the near-vent deposits, however, between locally and widely dispersed beds, and all samples of the proximal fall deposits plot as a simple continuation of grain size trends for medial?distal samples. Associated PDC deposits form a spectrum of facies from fines-poor, avalanched beds through thin-bedded, landscape-mantling beds to channelized lobes of pumice-block-rich ignimbrite. The origins of the Novarupta near-vent deposits are considered within a spectrum of four transport regimes: (1) sustained buoyant plume, (2) fountaining with co-current flow, (3) fountaining with counter-current flow, and (4) direct lateral ejection. The Novarupta deposits suggest a model where buoyant, stable, regime-1 plumes characterized most of episodes II and III, but were accompanied by transient and variable partitioning of clasts into the other three regimes. Only one short period of vent blockage and cessation of the Plinian plume occurred, separating episodes II and III, which was followed by a single PDC interpreted as an overpressured "blast" involving direct lateral ejection. In contrast, regimes 2 and 3 were reflected by spasmodic sedimentation from the margins of the jet and perhaps lower plume, which were being strongly affected by short-lived instabilities. These instabilities in turn are inferred to be associated with heterogeneities in the mixture of gas and pyroclasts emerging from the vent. Of the parameters that control explosive eruptive behavior, only such sudden and asymmetrical changes in the particle concentration could operate on time scales sufficiently short to explain the rapid changes in the proximal 1912 products. [ABSTRACT FROM AUTHOR]
- Published
- 2004
4. Feasibility of Conducting Long-term Health and Behaviors Follow-up in Adolescents: Longitudinal Observational Study.
- Author
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Cucchiaro G, Ahumada L, Gray G, Fierstein J, Yates H, Householder K, Frye W, and Rehman M
- Abstract
Background: Machine learning uses algorithms that improve automatically through experience. This statistical learning approach is a natural extension of traditional statistical methods and can offer potential advantages for certain problems. The feasibility of using machine learning techniques in health care is predicated on access to a sufficient volume of data in a problem space., Objective: This study aimed to assess the feasibility of data collection from an adolescent population before and after a posterior spine fusion operation., Methods: Both physical and psychosocial data were collected. Adolescents scheduled for a posterior spine fusion operation were approached when they were scheduled for the surgery. The study collected repeated measures of patient data, including at least 2 weeks prior to the operation and 6 months after the patients were discharged from the hospital. Patients were provided with a Fitbit Charge 4 (consumer-grade health tracker) and instructed to wear it as often as possible. A third-party web-based portal was used to collect and store the Fitbit data, and patients were trained on how to download and sync their personal device data on step counts, sleep time, and heart rate onto the web-based portal. Demographic and physiologic data recorded in the electronic medical record were retrieved from the hospital data warehouse. We evaluated changes in the patients' psychological profile over time using several validated questionnaires (ie, Pain Catastrophizing Scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Pediatric Quality of Life Inventory). Questionnaires were administered to patients using Qualtrics software. Patients received the questionnaire prior to and during the hospitalization and again at 3 and 6 months postsurgery. We administered paper-based questionnaires for the self-report of daily pain scores and the use of analgesic medications., Results: There were several challenges to data collection from the study population. Only 38% (32/84) of the patients we approached met eligibility criteria, and 50% (16/32) of the enrolled patients dropped out during the follow-up period-on average 17.6 weeks into the study. Of those who completed the study, 69% (9/13) reliably wore the Fitbit and downloaded data into the web-based portal. These patients also had a high response rate to the psychosocial surveys. However, none of the patients who finished the study completed the paper-based pain diary. There were no difficulties accessing the demographic and clinical data stored in the hospital data warehouse., Conclusions: This study identifies several challenges to long-term medical follow-up in adolescents, including willingness to participate in these types of studies and compliance with the various data collection approaches. Several of these challenges-insufficient incentives and personal contact between researchers and patients-should be addressed in future studies., (©Giovanni Cucchiaro, Luis Ahumada, Geoffrey Gray, Jamie Fierstein, Hannah Yates, Kym Householder, William Frye, Mohamed Rehman. Originally published in JMIR Formative Research (https://formative.jmir.org), 15.08.2022.)
- Published
- 2022
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5. Determinants of asthma knowledge and practices among caregivers of children with moderate-to-severe persistent asthma.
- Author
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Volerman A, Fierstein J, Boon K, Vojta D, and Gupta R
- Subjects
- Adolescent, Anti-Asthmatic Agents therapeutic use, Child, Child, Preschool, Female, Humans, Male, Surveys and Questionnaires, Asthma drug therapy, Caregivers, Health Knowledge, Attitudes, Practice
- Published
- 2021
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6. Parental quality of life and self-efficacy in pediatric asthma.
- Author
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Kan K, Fierstein J, Boon K, Madeleine Kanaley, Zavos P, Volerman A, Vojta D, and Gupta RS
- Subjects
- Adolescent, Adrenal Cortex Hormones therapeutic use, Asthma ethnology, Bronchodilator Agents administration & dosage, Child, Child, Preschool, Cross-Sectional Studies, Drug Therapy, Combination, Ethnicity, Female, Humans, Male, Mobile Applications, Nebulizers and Vaporizers, Quality of Life, Racial Groups, Respiratory Function Tests, Socioeconomic Factors, Asthma drug therapy, Asthma epidemiology, Bronchodilator Agents therapeutic use, Parents psychology, Self Efficacy
- Abstract
Objective: Self-efficacy is the personal belief that a behavior can produce a desired result; and in asthma, self-efficacy in asthma care has been related to improvements in asthma outcomes and children's quality of life. To appreciate the full burden of asthma on families, the relationship between parental self-efficacy and quality of life also needs further study. We aim to characterize this relationship. Methods: Secondary analysis of measurements of parents of children with persistent asthma ( n = 252; ages 4-17 years) from a large urban area were identified from a randomized trial; the association between baseline assessments of parental quality of life, measured by the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), and parental self-efficacy, measured through the Parental Asthma Management Self-Efficacy Scale (PAMSES), were examined through multivariable linear regression. Results: Parental self-efficacy in asthma was positively associated with quality of life among parents of racially and ethnically diverse children ( p = 0.01). Confidence in using medications correctly ( p = 0.03), having inhalers during a child's serious breathing problem ( p = 0.02), and knowing which medications to use during a child's serious breathing problem ( p = 0.04) were associated with a clinically meaningful difference in parental quality of life. Other significant factors associated with parental quality of life included Hispanic/Latino ethnicity ( p < 0.01) of the child and Asthma Control Test scores ( p < 0.01). Conclusion: The findings suggest that improving parental confidence on when and how to use their child's asthma medications, particularly during an asthma attack, might be clinically meaningful in enhancing parent's quality of life.
- Published
- 2021
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7. Factors associated with effective inhaler technique among children with moderate to severe asthma.
- Author
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Volerman A, Fierstein J, Boon K, Kanaley M, Kan K, Vojta D, and Gupta R
- Subjects
- Administration, Inhalation, Adolescent, Child, Child, Preschool, Female, Humans, Male, Adrenal Cortex Hormones administration & dosage, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Nebulizers and Vaporizers
- Published
- 2019
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8. Left Ventricular Non-Compaction Syndrome Misdiagnosed as Dilated Cardiomyopathy on Several Occasions, Presenting With Recurrent Stroke.
- Author
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Mandaliya R, Boigon M, Nweke N, and Fierstein J
- Abstract
A 57-year-old African American female with a history of ischemic cardiomyopathy and a recent stroke with no residual deficits presented with apraxia and confusion. Non-contrast CT scan of the head revealed multiple embolic strokes in both cerebral hemispheres. Transthoracic echocardiography raised the suspicion for increased trabecular meshwork in the left ventricle. Cardiac MRI confirmed the findings of isolated left ventricular non-compaction (LVNC) syndrome. A contrast-enhanced transesophageal echocardiogram demonstrated the characteristic features of this unusual disease with the additional demonstration of contrast filling the trabecular meshwork. Interestingly multiple transthoracic echocardiograms in the past had failed to identify myocardial non-compaction. The patient was started on warfarin for prophylactic anticoagulation and an implantable defibrillator was placed to lower the risk of sudden death. LVNC is a rare type of genetic cardiomyopathy characterized by excessively prominent trabeculations and deep inter-trabecular recesses in the ventricle wall. Non-compaction remains frequently overlooked even by experienced echocardiographers. Failure to diagnosis may lead to insufficient treatment since it is often associated with a risk of thromboembolism, life-threatening arrhythmias and sudden death. Furthermore, because of the familial association described with ventricular non-compaction, screening of first relatives with echocardiography is recommended.
- Published
- 2014
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9. A comparison of therapeutic modalities of glomus tumors in the temporal bone.
- Author
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Spector GJ, Fierstein J, and Ogura JH
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Glomus Jugulare Tumor radiotherapy, Glomus Jugulare Tumor surgery, Humans, Male, Middle Aged, Missouri, Paraganglioma, Extra-Adrenal radiotherapy, Patient Care Planning, Prognosis, Skull Neoplasms radiotherapy, Paraganglioma, Extra-Adrenal surgery, Skull Neoplasms surgery, Temporal Bone surgery
- Abstract
Seventy-seven patients with glomus tumors involving the temporal bone were treated by surgery, irradiation, and combined therapy. The therapeutic success rate for the surgery group was 91 percent for glomus tympanicum and 78 percent for glomus jugulare tumors. The success rate for radiation therapy was 30% in glomus jugulare tumors. Patients with extensive lesions treated by combined therapy had a therapeutic success rate of 60 percent. The clinical response of glomus jugulare tumors to radiation therapy was 65 percent. Surgery appears to be the best method for eradication of the tumors; however, with large extensive lesions, combined therapy offers a better prognosis than either modality alone.
- Published
- 1976
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10. Low-dose streptokinase in the treatment of celiac and superior mesenteric artery occlusion.
- Author
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Pillari G, Doscher W, Fierstein J, Ross W, Loh G, and Berkowitz BJ
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- Aged, Catheters, Indwelling, Humans, Male, Mesenteric Arteries, Celiac Artery, Embolism drug therapy, Mesenteric Vascular Occlusion drug therapy, Streptokinase administration & dosage
- Abstract
Selective delivery of low-dose streptokinase was effective in the treatment of embolic occlusion of the celiac and superior mesenteric arteries. The two-catheter technique resulted in complete lysis of clot in the celiac artery and improvement in patency of the superior mesenteric artery. The procedure restored effective mesenteric blood flow and provided an alternative to surgery in a very ill patient.
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- 1983
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11. Clinical skills. Quantitative measurement.
- Author
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Wiener SL, Koran L, Mitchell P, Schattner G, Fierstein J, and Hotchkiss E
- Subjects
- New York, Preceptorship, Clinical Competence, Education, Medical, Undergraduate
- Published
- 1976
12. Medullary carcinoma of the thyroid.
- Author
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Fierstein J, Sessions DG, and Thawley SE
- Subjects
- Adult, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Neck Dissection, Neoplasm Metastasis, Neoplasm Recurrence, Local, Carcinoma diagnosis, Carcinoma surgery, Thyroid Neoplasms diagnosis, Thyroid Neoplasms surgery
- Abstract
Medullary carcinoma is an unusual malignant neoplasm. The cell of origin is considered to be the C-cell which is derived from the ultimobranchial body and neural crest. The tumor is solid and has characteristic amyloid in the stroma. The lesion usually presents as a neck mass, and multicentricity is not unusual. In some patients diarrhea may be an important presenting symptom. Serum calcitonin is typically elevated and is important in the diagnostic confirmation. About 10 percent of the cases are part of a familial endocrine syndrome which includes pheochromocytomas, mucosal neuromas, and other endocrine gland adenomas. Frequent multicentricity and early cervical lymphatic and systemic metastases necessitate total thyroidectomy and radical neck dissection. Prognosis varies from a rapid demise to long term survival.
- Published
- 1976
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13. Staphylococcal septicemia with recurrent spontaneous pneumothorax.
- Author
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SCHWEICH A and FIERSTEIN J
- Subjects
- Bacteremia, Medical Records, Micrococcus complications, Micrococcus pathogenicity, Pneumothorax, Sepsis
- Published
- 1959
- Full Text
- View/download PDF
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