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Posterior Reversible Encephalopathy Syndrome in Chronic Kidney Disease: Incidence, Outcomes, and Risk Factors in a National Cohort
No full textRationale & Objective
Posterior reversible encephalopathy syndrome (PRES) is an acute neurological condition that, if untreated, can result in severe complications, such as intracerebral hemorrhage. Patients with chronic kidney disease (CKD) are at an increased risk of developing PRES; however, it is unclear whether this risk is primarily driven by comorbid conditions or if renal dysfunction itself is an independent risk factor. This study aimed to evaluate the incidence, outcomes, and resource utilization of PRES across CKD stages compared with patients without kidney disease.
Study Design
A retrospective study using the Nationwide Inpatient Sample Database.
Setting & Participants
Adult patients nonelectively admitted with PRES from 2016 to 2019.
Exposures
Different stages of CKD versus no kidney disease
Outcomes
All-cause in-hospital mortality, Incidence of PRES hospitalizations, in-hospital morbidity (intracerebral hemorrhage, ischemic stroke, brain herniation, and status epilepticus), and health care resource utilization (length of hospital stay and total hospitalization charges)
Analytical Approach
Multivariate logistic and linear regression analyses were conducted using survey design methods.
Results
The cohort included 12,605 patients, representing 0.014% of all admissions. PRES incidence increased from 0.013% in 2016 to 0.015% in 2019 (P = 0.01) and demonstrated a dose-response relationship with CKD stage progression. Key risk factors for PRES included female sex, White race, hypertension, metastatic cancer, solid organ transplantation, rheumatologic disorders, substance use disorders, carotid artery stenosis, migraines, and cerebral atherosclerosis. Kidney failure (KF) was strongly associated with in-hospital mortality (aOR 5.12, 95% CI, 2.09-12.53, P < 0.001). The length of stay, total hospitalization charge, and rates of neurological complications were similar between CKD/KF and patients without kidney disease.
Limitations
The use of administrative data limits access to detailed clinical information. Residual confounding factors remain possible.
Conclusions
This is the largest study to date on PRES in CKD populations. CKD is strongly associated with PRES, with a dose-response relationship, and KF is an independent risk factor for in-hospital mortality, emphasizing the need for heightened clinical vigilance in this population.
Plain-Language Summary
Posterior Reversible Encephalopathy Syndrome (PRES) is a serious brain condition that can cause seizures, confusion, and even death if not recognized and treated in time. However, it is often overlooked because its symptoms can be vague. While PRES is commonly linked to high blood pressure and immune system diseases, its connection to chronic kidney disease (CKD) has been unclear. This study used a large national database to examine how often PRES occurs in people with CKD and its impact on their health. The findings show that the risk of PRES increases as kidney disease worsens, with patients in kidney failure being the most vulnerable. These results highlight the need for early recognition and close monitoring of patients with CKD to improve their care.Lewis Katz School of MedicineMedicineTemple University Libraries Open Access Publishing Fund, 2024-2025 (Philadelphia, Pa.
Safe in the Home: Development of a Training Manual for Home Modifications for People Experiencing Homelessness
No full text"Safe in the Home" is a training manual that outlines home modification strategies to support individuals transitioning from homelessness to permanent housing. The project was developed through an immersive collaboration with Pathways to Housing (PTH), an organization that provides housing and services for individuals experiencing chronic homelessness. Chronic homeless is defined as being homeless for at least one year while living with a disabling condition such as chronic illness, mental health, and substance use disorder (National Alliance to End Homelessness, 2023). The transition from being unhoused to residing in a home can come with many challenges, including participation in household management, activities of daily living, and ambulating safely within the home. To address the challenges faced by this population, the manual was developed to support positive outcomes for individuals transitioning from chronic homelessness to stable housing. The manual provides guidance, recommendations, and education to support the adjustment to stable housing.Temple University. College of Public HealthHealth and Rehabilitation Science
Syllabus: Local Government Law, LAW 0574, Spring 2025
No full textTemple University. James E. Beasley School of LawLawThis course will explore the legal structure of local governments, including the sources of local government authority, limits on local government actions, the tension between state and local control, and the internal decision-making structures of local governments. Our non-exclusive focus will be on urban government. We will read cases and draw on examples from around the country, with an emphasis on Pennsylvania and Philadelphia.Temple University Libraries Textbook Affordability Project, 2025 (Philadelphia, Pa.
Environmental justice implications of NFIP pricing reforms: A case study of Miami-Dade County
No full textThe National Flood Insurance Program (NFIP) faces mounting financial difficulties in the era of climate change. To increase revenue and reduce their debts, the NFIP recently introduced a new pricing methodology called Risk Rating 2.0, claiming that this new approach more accurately assesses flood risk and distributes prices more equitably. The equitability of Risk Rating 2.0 is worth investigating, as environmental justice scholars have long criticized the NFIP for disproportionately benefitting wealthy homeowners over more vulnerable flood zone residents. This study utilizes Miami-Dade County, Florida as a case study to examine the environmental justice implications of Risk Rating 2.0. On average, wealthier zip codes are experiencing greater price increases than low- and middle-income neighborhoods. However, lower-income and higher-poverty zip codes still face an elevated cost burden compared to wealthier neighborhoods. These findings suggest that, although the NFIP’s new pricing methodology distributes prices more equitably than it has in the past, it does not address environmental justice concerns, as flood insurance premiums are rising across the board and still disproportionately burden low- and middle-income zip codes. In particular, Miami-Dade County’s lower-income zip codes near the Everglades face substantial rate increases due to their severe flood vulnerability, meaning flood insurance will likely become unaffordable for many residents.Livingstone Undergraduate Research Award in HumanitiesTemple University. College of Liberal ArtsPolitical ScienceEnvironmental Studie
Understanding the perceived experiences of the collaboration between Temple OT Level I students and UUH Outreach clients
No full textThe Level I Occupational Therapy (OT) Fieldwork (FW) experience is defined by Accreditation Council for Occupational Therapy Education (ACOTE) as providing students with experience to apply knowledge to practice (Accreditation Council for Occupational Therapy Education [ACOTE], 2018). One Level I FW experience offered to Temple University’s Occupational Therapy students is an opportunity to collaborate with clients of UUH Outreach. UUH Outreach is a non-profit organization in Northwest Philadelphia promoting aging in place.
“Aging in place” refers to older adults aged 55+ who prefer to stay in their own homes and maintain independence as they age (National Institute on Aging, 2023). An expectation for this community-based Level I FW is for students to apply their knowledge of home modifications and quality of life recommendations to promote independence and safety. A qualitative study was conducted to gather data on the perceptions of clients who previously participated in this collaborative Level I FW regarding their experience. Twelve participants, aged 65-84, engaged in focus group interviews. Thematic analysis of the focus group interviews highlighted three primary themes and several subthemes. While the clients largely reported satisfaction with the experience, the findings also supported the need for further student education regarding funding sources to acquire home modifications and increased frequency of communication between students and clients would be beneficial.Temple University. College of Public HealthHealth and Rehabilitation Science
The Impact of Contemporary Emerging Resistant Fungal Infections in Vulnerable Populations and Methods for Treatment
No full textOver the past decade emerging resistant fungal infections have become apparent as the next healthcare threat. These infections are opportunistic and affect immunocompromised or hospitalized populations and with the development of modern medicine the rates of these populations are rising. There are only four classes of antifungals: azoles, polyenes, antimetabolites, and echinocandins. The concern is with multidrug resistant fungi’s the mortality rate for these infections has been increasing with a large surge seen during the Covid pandemic. The Candida and Aspergillus species of fungus are considered the biggest threats as they have multidrug resistant strains, and they can cause lethal complications. Resistance is caused by overuse of the antifungals and selective pressure causing the fungi to develop genetic mutations to avoid the drug’s therapeutic effects. To tackle this problem new treatments or intervention methods must be introduced. It has been difficult to produce new treatments as fungi are very similar to humans and pharmaceutical companies are struggling in finding unique pathway or targets that won’t be toxic to humans. However, there are some known targets that require more testing before they can be developed into an approved drug.Livingstone Undergraduate Research Award in STEM DisciplinesTemple University. College of EngineeringBioengineerin
Terry Rey: Crossing the Water and Keeping the Faith [Audio interview]
No full textTemple religion professor Terry Rey and Alex Stepick, director of the Immigration and Ethnicity Institute at Florida International University, have produced a history and ethnography of Haitian religion in Miami. By surveying the religious institutions in Miami’s Little Haiti and surrounding areas, interviewing community members, and investigating the primary and secondary literatures, Rey and Stepick explain what happened to Haitian religion when it “crossed the water” to the shores of Florida. They describe Notre Dame de Haiti Catholic Church, the epicenter of support for Haitian immigrants, the shrines in and around Miami that Haitians visit for spiritual sustainance, and the annual festivals that bring the Haitian community together in celebration. Protestant churches small and large, both storefront operations and established denominations, have filled in around Notre Dame de Haiti, along with the less prevalent Vodou botanicas, to create a religious marketplace for Haitian Americans in search of salvation goods. Unlike the Africans who originally came to Saint Domingue, Miami’s Haitian residents stay in frequent contact with their place of birth, through modern communications and transportation technologies. Fred Rowland spoke with Terry Rey and recorded this interview on January 13, 2014.Temple University. College of Liberal ArtsTemple University. LibrariesLearning & Research ServicesReligionAudacityAudacit
Know Your Rights Fact Sheet - Living with HIV
No full textBarnett College of Public HealthThis fact sheet provides information on the rights of people who are living with HIV, specifically in Philadelphia
The geometry of end-periodic mapping tori
No full textLet be a boundaryless infinite-type surface with finitely many ends and consider an end-periodic homeomorphism of S. The end-periodicity of ensures that , its associated mapping torus, has a compactification as a -manifold with boundary; further, if is atoroidal, then admits a hyperbolic metric. Such maps admit invariant \emph{positive and negative Handel-Miller laminations}, , , whose leaves naturally project to the arc and curve complex of a given compact subsurface .
As an end-periodic analogy to work of Minsky in the finite-type setting, we show that for every there exists (depending only on and the \emph{capacity} of ) for which implies . Here denotes the total geodesic length of in , and the infimum is taken over all hyperbolic structures on .
This work produces the following: given a closed surface , we provide a family of closed, fibered hyperbolic manifolds in which is totally geodesically embedded, (almost) transverse to the pseudo-Anosov flow, with arbitrarily small systole.Mathematic