The ScholarShip

The ScholarShip is a digital archive for the scholarly output of the ECU community. Its mission is to capture, preserve, and make available the intellectual output of East Carolina University's faculty, staff, and students.

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Now showing 1 - 8 of 8

Recent Submissions

Access status: Metadata only ,
The 2023 WSES guidelines on the management of trauma in elderly and frail patients
(2024-09-11)
The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
Access status: Metadata only ,
Identification of SLC22A17 DNA methylation hotspot as a potential biomarker in cutaneous melanoma
(2024-10-02)
Cancer onset and progression are driven by genetic and epigenetic alterations leading to oncogene activation and the silencing of tumor suppressor genes. Among epigenetic mechanisms, DNA methylation (methDNA) is gaining growing interest in cancer. Promoter hypomethylation is associated with oncogene activation while intragenic methDNA can be involved in transcriptional elongation, alternative spicing, and the activation of cryptic start sites. Several genes involved in the modulation of the tumor microenvironment are regulated by methDNA, including the Solute Carrier Family 22 Member 17 (SLC22A17), which is involved in iron trafficking and extracellular matrix remodeling cooperating with the Gelatinase-Associated Lipocalin (NGAL) ligand. However, the exact role of intragenic methDNA in cancer has not been fully investigated. Therefore, the aim of the present study is to explore the role of methDNA in the regulation of SLC22A17 in cutaneous melanoma (CM), used as a tumor model. Methods Correlation and differential analyses between SLC22A17 expression and methDNA were performed using the data contained in The Cancer Genome Atlas and Gene Expression Omnibus databases. Functional studies on melanoma cell lines treated with 5-Azacytidine (5-Aza) were conducted to assess the correlation between methDNA and SLC22A17 expression. A validation study on the diagnostic potential of the in silico-identified SLC22A17 methDNA hotspot was finally performed by analyzing tissue samples obtained from CM patients and healthy controls. Results: The computational analyses revealed that SLC22A17 was significantly downregulated in CM, and its expression was related to promoter hypomethylation and intragenic hypermethylation. Moreover, SLC22A17 overexpression and hypermethylation of two intragenic methDNA hotspots were associated with a better clinical outcome in CM patients. The correlation between SLC22A17 methDNA and expression was confirmed in 5-Aza-treated cells. In agreement with in silico analyses, the SLC22A17 promoter methylation hotspot showed higher methDNA levels in CM samples compared to nevi. In addition, the methDNA levels of this hotspot were positively correlated with advanced CM. Conclusions: The SLC22A17 methDNA hotspot could represent a promising biomarker for CM, highlighting the regulatory role of methDNA on SLC22A17 expression. These results pave the way for the identification of novel epigenetic biomarkers and therapeutic targets for the management of CM patients.
Access status: Metadata only ,
Evidence on the performance of nature-based solutions interventions for coastal protection in biogenic, shallow ecosystems: a systematic map
(2024-12-01)
Combined impacts from anthropogenic pressures and climate change threaten coastal ecosystems and their capacity to protect communities from hazards. One approach towards improving coastal protection is to implement “nature-based solutions” (NBS), which are actions working with nature to benefit nature and humans. Despite recent increases in global implementation of NBS projects for coastal protection, substantial gaps exist in our understanding of NBS performance. To help fill this gap, we systematically mapped the global evidence base on the ecological, physical, economic, and social performance of NBS interventions related to coastal protection. We focused on active NBS interventions, such as restoring or creating habitat, adding structure, or modifying sediment in six shallow biogenic ecosystems: salt marsh, seagrass, kelp forest, mangrove, coral reef, and shellfish reef. Methods: We identified potentially relevant articles on the performance of NBS for coastal protection using predefined and tested search strategies across two indexing platforms, one bibliographic database, two open discovery citation indexes, one web-based search engine, and a novel literature discovery tool. We also searched 45 organizational websites for literature and solicited literature from 66 subject matter experts. Potentially relevant articles were deduplicated and then screened by title and abstract with assistance from a machine learning algorithm. Following title and abstract screening, we conducted full text screening, extracted relevant metadata into a predefined codebook, and analyzed the evidence base to determine the distribution and abundance of evidence and answer our research questions on NBS performance. Results: Our search captured > 37,000 articles, of which 252 met our eligibility criteria for relevance to NBS performance for coastal protection and were included in the systematic map. Evidence stemmed from 31 countries and increased from the 1980s through the 2020s. Active NBS interventions for coastal protection were most often implemented in salt marshes (45%), mangrove forests (26%), and shellfish reefs (20%), whereas there were fewer NBS studies in seagrass meadows (4%), coral reefs (4%), or kelp beds (< 1%). Performance evaluations of NBS were typically conducted using observational or experimental methods at local spatial scales and over short temporal scales (< 1 year to 5 years). Evidence clusters existed for several types of NBS interventions, including restoration and addition of structures (e.g., those consisting of artificial, hybrid, or natural materials), yet evidence gaps existed for NBS interventions like alteration of invasive species. Evaluations of NBS performance commonly focused on ecological (e.g., species and population, habitat, community) and physical (e.g., waves, sediment and morphology) outcomes, whereas pronounced evidence gaps existed for economic (e.g., living standards, capital) and social (e.g., basic infrastructure, health) outcomes. Conclusions: This systematic map highlights evidence clusters and evidence gaps related to the performance of active NBS interventions for coastal protection in shallow, biogenic ecosystems. The synthesized evidence base will help guide future research and management of NBS for coastal protection so that active interventions can be designed, sited, constructed, monitored, and adaptively managed to maximize co-benefits. Promising avenues for future research and management initiatives include implementing broad-scale spatial and temporal monitoring of NBS in multidisciplinary teams to examine not only ecological and physical outcomes but also economic and social outcomes, as well as conducting further synthesis on evidence clusters that may reveal measures of effect for specific NBS interventions. Since NBS can deliver multiple benefits, measuring a diverse suite of response variables, especially those related to ecosystem function, as well as social and economic responses, may help justify and improve societal benefits of NBS. Such an approach can help ensure that NBS can be strategically harnessed and managed to meet coastal protection goals and provide co-benefits for nature and people.
Access status: Open Access ,
Opening Digital Humanities to All: Approaches to Supporting Accessible Omeka Projects
(2026-05-27) Kaefring, Allison; Hoover, Jeanne K.; Daugherty, Jennifer
In 2024, the Department of Justice issued revised Title II regulations under the American Disabilities Act, requiring that all government institutions make their digital content accessible and in compliance with WCAG 2.1 AA guidelines. In response, the Digital Humanities Working Group at a public institution is navigating the procedural changes needed to ensure our future digital humanities projects are fully accessible, while also exploring technical and ethical ways to make our past projects accessible. Using tools like WAVE, we have evaluated common accessibility barriers in our past digital humanities projects based in Omeka. The working group is developing solutions to our future digital humanities tool trainings, workflows, and user agreements. In this presentation, we will share our process, the challenges encountered, and recommendations for supporting students and faculty in creating digital humanities projects that are accessible to all users. This presentation will address both common accessibility issues we have identified in digital humanities projects and ways to make our commitment to accessibility sustainable.
Access status: Open Access ,
Data-Driven Insights for Coastal Water Infrastructure Resilience in North Carolina
(2026-05-20) Wagner, Katie