Article List
API Endpoint for journals.
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{ "count": 38488, "next": "https://eartharxiv.org/api/articles/?format=api&limit=100&offset=17000", "previous": "https://eartharxiv.org/api/articles/?format=api&limit=100&offset=16800", "results": [ { "pk": 55018, "title": "Spring 2018 Cover", "subtitle": null, "abstract": "", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [], "section": "Forematter", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/8bd146qs", "frozenauthors": [ { "first_name": "BUJC", "middle_name": "", "last_name": "Administrator", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-04-05T03:30:53+02:00", "date_accepted": "2018-04-05T03:30:53+02:00", "date_published": "2018-04-04T09:00:00+02:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/ucbclassics_bujc/article/55018/galley/41467/download/" } ] }, { "pk": 55019, "title": "Spring 2018 Letter from the Editors", "subtitle": null, "abstract": "", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [], "section": "Forematter", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/42w2d01s", "frozenauthors": [ { "first_name": "Katie", "middle_name": "", "last_name": "Berlin", "name_suffix": "", "institution": "", "department": "" }, { "first_name": "Robert", "middle_name": "", "last_name": "Higgs", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-04-05T03:57:50+02:00", "date_accepted": "2018-04-05T03:57:50+02:00", "date_published": "2018-04-04T09:00:00+02:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/ucbclassics_bujc/article/55019/galley/41468/download/" } ] }, { "pk": 55011, "title": "The Rape of Persephone in Children’s Media: Feminist Receptions of Classical Mythology", "subtitle": null, "abstract": "In contemporary academic contexts, the ‘Rape of Persephone’ myth is a source of insight into the powerlessness of women in patriarchal, Greco-Roman society. In popular culture, however, the myth has found a surprising second life amongst children’s media as the story of two unlikely, star-crossed lovers. Instead of simply rephrasing the myth as it is found in ancient sources, some Western authors and artists have changed the myth’s plot and characterization of Hades and Persephone in order to transform this rape myth into a love story. In this paper, I explore the ways in which each adaptation deviates from the source material and reveals contemporary views of gender politics. On the one hand, there are some adaptations in which the ‘Rape of Persephone’ is altered just enough to be deemed appropriate for children. On the other hand, there are retellings in which the changes appear to not simply censor the myth, but to subvert the sexism inherent in the myth itself. I argue that this latter phenomenon is an act of feminist resistance against centuries of reception to the Classical myths that perpetuate the sexist gender constructs of ancient society. Ultimately, I believe these adaptations will draw young audiences to study Classical mythology and will also open up new discussions of Classical material and the ways it is received by modern society.", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "reception" }, { "word": "Feminism" }, { "word": "Rape of Persephone" }, { "word": "Hades" }, { "word": "Persephone" }, { "word": "Demeter" }, { "word": "gender politics" }, { "word": "children's media" } ], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/510508bs", "frozenauthors": [ { "first_name": "Sierra", "middle_name": "", "last_name": "Schiano", "name_suffix": "", "institution": "UC Berkeley", "department": "" } ], "date_submitted": "2018-01-28T09:32:00+01:00", "date_accepted": "2018-01-28T09:32:00+01:00", "date_published": "2018-04-04T09:00:00+02:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/ucbclassics_bujc/article/55011/galley/41464/download/" } ] }, { "pk": 44477, "title": "A Rare Case of a Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposition", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2787633d", "frozenauthors": [ { "first_name": "Karo", "middle_name": "", "last_name": "Arzoo", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Maurice", "middle_name": "", "last_name": "Berkowitz", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-04-01T19:58:29+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44477/galley/33270/download/" } ] }, { "pk": 44476, "title": "A Rare Case of Sinonasal Chondroblastoma", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6n82c79k", "frozenauthors": [ { "first_name": "Karo", "middle_name": "", "last_name": "Arzoo", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Marurice", "middle_name": "", "last_name": "Berkowitz", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-04-01T19:54:36+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44476/galley/33269/download/" } ] }, { "pk": 44487, "title": "Acute Renal Failure, Anemia, and Back Pain: Not to be Taken Lightly", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/08r732z7", "frozenauthors": [ { "first_name": "Alan", "middle_name": "S", "last_name": "Chu", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Emily", "middle_name": "", "last_name": "Huang", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-29T22:07:37+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44487/galley/33280/download/" } ] }, { "pk": 33503, "title": "Cool Trading", "subtitle": null, "abstract": "Financial algorithms have smoothed the vagaries of overheated markets. Christian Borch shows how algorithmic trading produces its own set of new chokepoints.", "language": null, "license": { "name": "Creative Commons Attribution-ShareAlike 4.0", "short_name": "CC BY-SA 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-sa/4.0" }, "keywords": [], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9333519x", "frozenauthors": [ { "first_name": "Christian", "middle_name": "", "last_name": "Borch", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-29T19:00:00+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/limn/article/33503/galley/24564/download/" } ] }, { "pk": 33502, "title": "How pipelines constrict oil flows", "subtitle": null, "abstract": "Christopher Jones explores how oilmen have used conduits as weapons to crush competitors, maintain industry dominance, and rake in huge profits.", "language": null, "license": { "name": "Creative Commons Attribution-ShareAlike 4.0", "short_name": "CC BY-SA 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-sa/4.0" }, "keywords": [], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2rj6w0d0", "frozenauthors": [ { "first_name": "Christopher F.", "middle_name": "", "last_name": "Jones", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-29T19:00:00+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/limn/article/33502/galley/24563/download/" } ] }, { "pk": 44486, "title": "Complete Adult-Onset Kawasaki Disease: Case Report", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5qw7p76g", "frozenauthors": [ { "first_name": "Jonas", "middle_name": "", "last_name": "Quach", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Michael", "middle_name": "", "last_name": "Yang", "name_suffix": "", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-26T22:05:03+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44486/galley/33279/download/" } ] }, { "pk": 44485, "title": "Acute Kidney Injury: When to Start Renal Replacement Therapy in the Non-Critical Inpatient", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5h21h551", "frozenauthors": [ { "first_name": "Ridwa", "middle_name": "", "last_name": "Abdi", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Hamid", "middle_name": "", "last_name": "Hajmomenian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Catherine", "middle_name": "P", "last_name": "Khoo", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-25T22:03:07+02:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44485/galley/33278/download/" } ] }, { "pk": 44478, "title": "Acute Fatty Liver of Pregnancy – A Case Report", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2mc1q915", "frozenauthors": [ { "first_name": "Albert", "middle_name": "", "last_name": "Lee", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Hamid", "middle_name": "", "last_name": "Hajmomenian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-20T21:00:46+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44478/galley/33271/download/" } ] }, { "pk": 44464, "title": "Development of a Chronic T Cell Leukemia in a Patient with B Cell Hairy Leukemia: Does One Lymphoid Malignancy Predispose to Another?", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6dp9n56r", "frozenauthors": [ { "first_name": "Alexander", "middle_name": "C", "last_name": "Black", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-20T18:10:48+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44464/galley/33257/download/" } ] }, { "pk": 33505, "title": "Strangling the Internet", "subtitle": null, "abstract": "Every network has its chokepoints. Nicole Starosielski brings us under the ocean to explore the hidden ones along the information superhighway.", "language": null, "license": { "name": "Creative Commons Attribution-ShareAlike 4.0", "short_name": "CC BY-SA 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-sa/4.0" }, "keywords": [], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9nm589t2", "frozenauthors": [ { "first_name": "Nicole", "middle_name": "", "last_name": "Starosielski", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-20T18:00:00+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/limn/article/33505/galley/24566/download/" } ] }, { "pk": 33504, "title": "The Funnel Effect", "subtitle": null, "abstract": "In the docks of Sicily, surveillance and humanitarianism mingle with traces of lives and deaths beyond the point of entry. Cristiana Giordano explores what happens when migrants rescued at sea arrive at Europe’s shores.", "language": null, "license": { "name": "Creative Commons Attribution-ShareAlike 4.0", "short_name": "CC BY-SA 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-sa/4.0" }, "keywords": [], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4sv6m05r", "frozenauthors": [ { "first_name": "Cristiana", "middle_name": "", "last_name": "Giordano", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-20T18:00:00+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/limn/article/33504/galley/24565/download/" } ] }, { "pk": 41668, "title": "Western Association of Vertebrate Paleontologists Annual Meeting", "subtitle": null, "abstract": "The 2018 Program with Abstracts volume for the Western Association of Vertebrate Paleontologists 52nd Annual Meeting held at Dixie State University, St. George, Utah, USA.", "language": "en", "license": null, "keywords": [ { "word": "2018 WAVP, vertebrate, fossils, Utah, St. George" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1935d40d", "frozenauthors": [ { "first_name": "Tracy", "middle_name": "J.", "last_name": "Thomson", "name_suffix": "", "institution": "University of California, Davis", "department": "None" }, { "first_name": "Jerry", "middle_name": "", "last_name": "Harris", "name_suffix": "", "institution": "Dixie State University", "department": "None" }, { "first_name": "Andrew", "middle_name": "R.C.", "last_name": "Milner", "name_suffix": "", "institution": "St. George Dinosaur Discovery Site at Johnson Farm", "department": "None" }, { "first_name": "Jim", "middle_name": "", "last_name": "Kirkland", "name_suffix": "", "institution": "Utah State Geological Survey", "department": "None" } ], "date_submitted": "2018-03-20T18:58:27+01:00", "date_accepted": "2018-03-20T18:58:27+01:00", "date_published": "2018-03-20T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/ucmp_paleobios/article/41668/galley/31179/download/" } ] }, { "pk": 44475, "title": "Improvement in Cognitive Function Post Cardiac Pacemaker", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/938325zp", "frozenauthors": [ { "first_name": "Maryum", "middle_name": "", "last_name": "White", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Sarah", "middle_name": "", "last_name": "Tubbesing", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-18T18:51:33+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44475/galley/33268/download/" } ] }, { "pk": 44474, "title": "Fever of Unknown Origin as a Manifestation of Acute Ebstein-Barr Infection: A Case Report", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1vc220vn", "frozenauthors": [ { "first_name": "Jonas", "middle_name": "", "last_name": "Aharoni", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-16T18:48:01+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44474/galley/33267/download/" } ] }, { "pk": 44473, "title": "Symptomatic Glomangioma of the Trachea in a 33-Year-Old Man Initially Managed by Minimally Invasive Bronchoscopic Interventions", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/42j4871q", "frozenauthors": [ { "first_name": "Chidinma", "middle_name": "", "last_name": "Chima-Melton", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-15T18:43:33+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44473/galley/33266/download/" } ] }, { "pk": 44472, "title": "Heraclitus Redux: Clinical Consequences of Licorice Ingestion, Once an Ancient Survival Strategy, Now Linked to Overindulgence in Modern Society", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9pm095zh", "frozenauthors": [ { "first_name": "Susan", "middle_name": "", "last_name": "Ahern", "name_suffix": "DO", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "George", "middle_name": "", "last_name": "Mitchell", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-15T18:41:05+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44472/galley/33265/download/" } ] }, { "pk": 531, "title": "Ultrasound-guided Placement of a Foley Catheter Using a Hydrophilic Guide Wire", "subtitle": null, "abstract": "Acute urinary retention is a common problem in the emergency department. Patients can present in significant distress, necessitating the placement of a urinary catheter. Foley catheter placementcan be difficult to accomplish depending on the etiology of the retention and the degree of the obstruction. In the case presented here, we used ultrasound guidance, a guidewire, and a Foley catheter to successfully relieve a patient’s urinary retention after multiple failed attempts.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/73b4343z", "frozenauthors": [ { "first_name": "Ryan", "middle_name": "", "last_name": "Joseph", "name_suffix": "", "institution": "Texas A&M University, Department of Emergency Medicine, Corpus Christi, Texas", "department": "None" }, { "first_name": "Mark", "middle_name": "", "last_name": "Huber", "name_suffix": "", "institution": "Texas A&M University, Department of Emergency Medicine, Corpus Christi, Texas", "department": "None" }, { "first_name": "Ben", "middle_name": "", "last_name": "Leeson", "name_suffix": "", "institution": "Texas A&M University, Department of Emergency Medicine, Corpus Christi, Texas", "department": "None" }, { "first_name": "Kimberly", "middle_name": "", "last_name": "Leeson", "name_suffix": "", "institution": "Texas A&M University, Department of Emergency Medicine, Corpus Christi, Texas", "department": "None" } ], "date_submitted": "2018-03-14T19:41:01+01:00", "date_accepted": "2018-03-14T19:41:01+01:00", "date_published": "2018-03-14T20:27:52+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/531/galley/294/download/" } ] }, { "pk": 511, "title": "Scurvy: Dietary Discretion in a Developed Country", "subtitle": null, "abstract": "Although the causes have changed, scurvy (vitamin C deficiency) is still diagnosed in developed countries. We report a case of an 18-year-old female who presented to our emergency department with thrombocytopenia, sinus tachycardia, hypotension, fatigue, gingival hyperplasia, knee effusion, petechiae and ecchymosis in lower extremities. The differential diagnosis included hematologic abnormalities, infectious etiologies, vasculitis and vitamin deficiency. A brief dietary history was performed revealing poor fruit and vegetable intake, thus increasing our suspicion for vitamin C deficiency. This experience illustrates the importance of a dietary history and reminds us to keep scurvy in the differential diagnosis.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2f23s7q7", "frozenauthors": [ { "first_name": "Megan", "middle_name": "E.", "last_name": "Perry", "name_suffix": "", "institution": "Wake Forest School of Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Nathan", "middle_name": "", "last_name": "Page", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "David", "middle_name": "E.", "last_name": "Manthey", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Joshua", "middle_name": "M.", "last_name": "Zavitz", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" } ], "date_submitted": "2018-03-14T16:30:27+01:00", "date_accepted": "2018-03-14T16:30:27+01:00", "date_published": "2018-03-14T20:11:55+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/511/galley/274/download/" } ] }, { "pk": 530, "title": "An Unlikely Cause of Abdominal Pain", "subtitle": null, "abstract": "Cecal bascule is a rare subtype of cecal volvulus where the cecum folds anterior to the ascending colon causing intestinal obstruction. It is a challenging diagnosis to make in the emergency department, as the mobile nature of the cecum leads to a great deal of variation in its clinical presentation. Our discussion of a 78-year-old female who presented with abdominal pain and was found to have a cecal bascule requiring right hemicolectomy, demonstrates how emergency physicians must expand their differential diagnosis for patients reporting signs of intestinal obstruction. Though cecal bascule does not present often, the need for early surgical intervention necessitates a high level of clinical suspicion to prevent life-threatening complications.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7h92r1wg", "frozenauthors": [ { "first_name": "Norah", "middle_name": "", "last_name": "Kairys", "name_suffix": "", "institution": "Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" }, { "first_name": "Keegan", "middle_name": "", "last_name": "Skidmore", "name_suffix": "", "institution": "Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" }, { "first_name": "Jennifer", "middle_name": "", "last_name": "Repanshek", "name_suffix": "", "institution": "Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" }, { "first_name": "Wayne", "middle_name": "", "last_name": "Satz", "name_suffix": "", "institution": "Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" } ], "date_submitted": "2018-03-14T19:37:36+01:00", "date_accepted": "2018-03-14T19:37:36+01:00", "date_published": "2018-03-14T20:02:13+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/530/galley/293/download/" } ] }, { "pk": 529, "title": "Latest Considerations in Diagnosis and Treatment of Appendicitis During Pregnancy", "subtitle": null, "abstract": "Pregnancy can obscure signs and symptoms of acute appendicitis, making diagnosis challenging. Furthermore, avoiding radiation-based imaging due to fetal risk limits the diagnostic options clinicians have. Once appendicitis has been diagnosed, performing appendectomies has been the more commonly accepted course of action, but conservative, nonsurgical approaches are now being considered. This report describes the latest recommendations from different fields and organizations for the diagnosis and treatment of appendicitis during pregnancy.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/39c7f0wp", "frozenauthors": [ { "first_name": "Shahram", "middle_name": "", "last_name": "Lotfipour", "name_suffix": "", "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" }, { "first_name": "Max", "middle_name": "", "last_name": "Jason", "name_suffix": "", "institution": "University of California, Irvine, Department of Emergency Medicine,\nOrange, California", "department": "None" }, { "first_name": "Vincent", "middle_name": "J.", "last_name": "Liu", "name_suffix": "", "institution": "Taipei Medical University, College of Medicine, Taipei, Taiwan", "department": "None" }, { "first_name": "Mohammad", "middle_name": "", "last_name": "Helmy", "name_suffix": "", "institution": "University of California, Irvine, Department of Radiological Sciences, Orange, California", "department": "None" }, { "first_name": "Wirachin", "middle_name": "", "last_name": "Hoonpongsimanont", "name_suffix": "", "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" }, { "first_name": "C.", "middle_name": "Eric", "last_name": "McCoy", "name_suffix": "", "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" }, { "first_name": "Bharath", "middle_name": "", "last_name": "Chakravarthy", "name_suffix": "", "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" } ], "date_submitted": "2018-03-14T19:34:27+01:00", "date_accepted": "2018-03-14T19:34:27+01:00", "date_published": "2018-03-14T20:01:23+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/529/galley/292/download/" } ] }, { "pk": 528, "title": "Facial Baroparesis Mimicking Stroke", "subtitle": null, "abstract": "We report a case of a 55-year-old male who experienced unilateral facial muscle paralysis upon ascent to altitude on a commercial airline flight, with resolution of symptoms shortly after descent. The etiology was determined to be facial nerve barotrauma, or facial baroparesis, which is a known but rarely reported complication of scuba diving, with even fewer cases reported related to aviation. The history and proposed pathogenesis of this unique disease process are described.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/45h3k76n", "frozenauthors": [ { "first_name": "Diann", "middle_name": "M.", "last_name": "Krywko", "name_suffix": "", "institution": "Medical University of South Carolina, Department of Emergency Medicine, Charleston, South Carolina", "department": "None" }, { "first_name": "D.", "middle_name": "Tyler", "last_name": "Clare", "name_suffix": "", "institution": "Medical University of South Carolina, Department of Emergency Medicine, Charleston, South Carolina", "department": "None" }, { "first_name": "Mohammad", "middle_name": "", "last_name": "Orabi", "name_suffix": "", "institution": "Medical University of South Carolina, Department of Neurology, Charleston, South Carolina", "department": "None" } ], "date_submitted": "2018-03-14T19:29:40+01:00", "date_accepted": "2018-03-14T19:29:40+01:00", "date_published": "2018-03-14T20:00:23+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/528/galley/291/download/" } ] }, { "pk": 527, "title": "Diagnosis of Hand Infections in Intravenous Drug Users by Ultrasound and Water Bath: A Case Series", "subtitle": null, "abstract": "We present three cases of hand injury by intravenous drug users in which point-of-care ultrasound, using a specific water bath technique, was able to quickly and efficiently delineate severity of injury. This technique benefited these patients by allowing a painless assessment of their injury for soft tissue injury vs. abscess formation and allowed providers to determine at the bedside whether these patients required immediate surgical intervention.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3cb8q23j", "frozenauthors": [ { "first_name": "John", "middle_name": "", "last_name": "DeAngelis", "name_suffix": "", "institution": "University at Buffalo Jacobs School of Medicine and Biomedical Sciences,\nDepartment of Emergency Medicine, Buffalo, New York\nCambridge Health Alliance, Department of Emergency Medicine, Cambridge,\nMassachusetts", "department": "None" }, { "first_name": "Erika", "middle_name": "", "last_name": "St. James", "name_suffix": "", "institution": "University at Buffalo Jacobs School of Medicine and Biomedical Sciences,\nDepartment of Emergency Medicine, Buffalo, New York", "department": "None" }, { "first_name": "Penelope", "middle_name": "C.", "last_name": "James", "name_suffix": "", "institution": "University at Buffalo Jacobs School of Medicine and Biomedical Sciences,\nDepartment of Emergency Medicine, Buffalo, New York", "department": "None" } ], "date_submitted": "2018-03-14T19:25:47+01:00", "date_accepted": "2018-03-14T19:25:47+01:00", "date_published": "2018-03-14T19:59:35+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/527/galley/290/download/" } ] }, { "pk": 526, "title": "Significant Lactic Acidosis from Albuterol", "subtitle": null, "abstract": "Lactic acidosis is a clinical entity that demands rapid assessment and treatment to prevent significant morbidity and mortality. With increased lactate use across many clinical scenarios, lactate values themselves cannot be interpreted apart from their appropriate clinical picture. The significance of Type B lactic acidosis is likely understated in the emergency department (ED). Given the mortality that sepsis confers, a serum lactate is an important screening study. That said, it is with extreme caution that we should interpret and react to the resultant elevated value. We report a patient with a significant lactic acidosis. Though he had a high lactate value, he did not require aggressive resuscitation. A different classification scheme for lactic acidosis that focuses on the bifurcation of the “dangerous” and “not dangerous” causes of lactic acidosis may be of benefit. In addition, this case is demonstrative of the potential overuse of lactates in the ED.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0qx8w8nz", "frozenauthors": [ { "first_name": "Maxwell", "middle_name": "", "last_name": "Hockstein", "name_suffix": "", "institution": "University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas", "department": "None" }, { "first_name": "Deborah", "middle_name": "", "last_name": "Diercks", "name_suffix": "", "institution": "University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas", "department": "None" } ], "date_submitted": "2018-03-14T19:22:10+01:00", "date_accepted": "2018-03-14T19:22:10+01:00", "date_published": "2018-03-14T19:58:46+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/526/galley/289/download/" } ] }, { "pk": 525, "title": "Man with Total Knee Arthroplasty Now Unable to Extend the Joint", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Images in Emergency Medicine", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4989d4dd", "frozenauthors": [ { "first_name": "Matthias", "middle_name": "", "last_name": "Barden", "name_suffix": "", "institution": "Eisenhower Medical Center, Department of Emergency Medicine, Rancho Mirage, California", "department": "None" }, { "first_name": "Julie", "middle_name": "K. A.", "last_name": "Kasarjian", "name_suffix": "", "institution": "Eisenhower Medical Center, Department of Emergency Medicine, Rancho Mirage, California", "department": "None" } ], "date_submitted": "2018-03-14T19:19:47+01:00", "date_accepted": "2018-03-14T19:19:47+01:00", "date_published": "2018-03-14T19:57:47+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/525/galley/288/download/" } ] }, { "pk": 505, "title": "Intra-abdominal Rupture of a Live Cervical Pregnancy with Placenta Accreta but Without Vaginal Bleeding", "subtitle": null, "abstract": "We describe an unusual ruptured ectopic pregnancy. The unique features of the case include abdominal pain without vaginal bleeding; cervical implantation and a placenta accreta; and the late presentation at 16 weeks of gestation without prior symptoms. Both the initial point-of-care ultrasound and the formal ultrasound were interpreted as showing an intrauterine pregnancy. The clinical presentation was misleading; the correct diagnosis was made by magnetic resonance imaging. We show the ultrasonic images. We discuss cervical ectopic pregnancies, their diagnosis and management. The woman survived but required emergency hysterectomy and many units of blood.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4jc0769q", "frozenauthors": [ { "first_name": "Asma", "middle_name": "", "last_name": "Tariq", "name_suffix": "", "institution": "Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, California", "department": "None" }, { "first_name": "Maria", "middle_name": "", "last_name": "O’Rourke", "name_suffix": "", "institution": "Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, California", "department": "None" }, { "first_name": "Steven", "middle_name": "J.", "last_name": "Carstens", "name_suffix": "", "institution": "Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, California", "department": "None" }, { "first_name": "Vicken", "middle_name": "Y.", "last_name": "Totten", "name_suffix": "", "institution": "Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, California", "department": "None" } ], "date_submitted": "2018-01-05T20:13:49+01:00", "date_accepted": "2018-01-05T20:13:49+01:00", "date_published": "2018-03-14T19:56:12+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/505/galley/269/download/" } ] }, { "pk": 510, "title": "Trigeminal Trophic Syndrome Leading to Orbital Cellulitis", "subtitle": null, "abstract": "Trigeminal trophic syndrome is a rare condition that develops from trigeminal nerve damage causing dysesthesias that result in self-mutilation. Facial and nasal destruction develops from self-destructive behavior (repetitive picking or scratching) secondary to the altered skin sensation created by the damaged trigeminal nerve. Early recognition of this condition is crucial to the prevention of the detrimental complications of facial ulceration and nasal tissue necrosis that can lead to corneal ulcerations, full-thickness eyelid defect, and canthal lesions. This case demonstrates a previously unreported complication: orbital cellulitis.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3c06m4r6", "frozenauthors": [ { "first_name": "Linda", "middle_name": "B.", "last_name": "Thompson", "name_suffix": "", "institution": "University of Alabama School of Medicine, Department of Emergency Medicine,\nBirmingham, Alabama", "department": "None" }, { "first_name": "Stephen", "middle_name": "L.", "last_name": "Powell", "name_suffix": "", "institution": "University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama", "department": "None" } ], "date_submitted": "2018-03-14T16:19:38+01:00", "date_accepted": "2018-03-14T16:19:38+01:00", "date_published": "2018-03-14T19:55:31+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/510/galley/273/download/" } ] }, { "pk": 523, "title": "Hyperkalemia Brugada Sign - When Catheterization Lab Is not the Answer", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Images in Emergency Medicine", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0qc1v5p1", "frozenauthors": [ { "first_name": "Rene", "middle_name": "M.", "last_name": "Kukkamalla", "name_suffix": "", "institution": "Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona", "department": "None" }, { "first_name": "Eric", "middle_name": "", "last_name": "Katz", "name_suffix": "", "institution": "Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona", "department": "None" } ], "date_submitted": "2018-03-14T19:12:57+01:00", "date_accepted": "2018-03-14T19:12:57+01:00", "date_published": "2018-03-14T19:55:05+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/523/galley/286/download/" } ] }, { "pk": 524, "title": "Papilledema: Point-of-Care Ultrasound Diagnosis in the Emergency Department", "subtitle": null, "abstract": "Point-of-care ultrasound (POCUS) has the potential to diagnose papilledema, a sign of increased intracranial pressure, through optic disc elevation as well as optic nerve sheath diameter measurements. Idiopathic intracranial hypertension (IIH) is a syndrome resulting in increased intracranial pressure. We present a case of IIH where the emergency physician diagnosed papilledema by POCUS via presence of both optic disc elevation and a widened optic nerve sheath diameter.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Case Reports", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4cg7r0g2", "frozenauthors": [ { "first_name": "Joseph", "middle_name": "R.", "last_name": "Sinnott", "name_suffix": "", "institution": "University of Missouri School of Medicine, Department of Emergency Medicine,\nColumbia, Missouri", "department": "None" }, { "first_name": "Mohammad", "middle_name": "R.", "last_name": "Mohebbi", "name_suffix": "", "institution": "University of Missouri School of Medicine, Department of Emergency Medicine,\nColumbia, Missouri", "department": "None" }, { "first_name": "Tomothy", "middle_name": "", "last_name": "Koboldt", "name_suffix": "", "institution": "University of Missouri School of Medicine, Department of Emergency Medicine,\nColumbia, Missouri", "department": "None" } ], "date_submitted": "2018-03-14T19:17:18+01:00", "date_accepted": "2018-03-14T19:17:18+01:00", "date_published": "2018-03-14T19:53:34+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/uciem_cpcem/article/524/galley/287/download/" } ] }, { "pk": 11058, "title": "Comparing Quick Sequential Organ Failure Assessment Scores to End-tidal Carbon Dioxide as Mortality Predictors in Prehospital Patients with Suspected Sepsis", "subtitle": null, "abstract": "Introduction: \nEarly identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO2) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients. \n \nMethods:\n We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis. \nResults:\n By comparison of receiver operator characteristic curves, ETCO2 had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA. \nConclusion:\n Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO2 performing slightly better as an outcome predictor.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "qSOFA, ETCO2, sepsis, prehospital" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/13t079pw", "frozenauthors": [ { "first_name": "Christopher", "middle_name": "L.", "last_name": "Hunter", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida\nUniversity of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida", "department": "None" }, { "first_name": "Salvatore", "middle_name": "", "last_name": "Silvestri", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida\nUniversity of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida", "department": "None" }, { "first_name": "George", "middle_name": "", "last_name": "Ralls", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida", "department": "None" }, { "first_name": "Amanda", "middle_name": "", "last_name": "Stone", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida", "department": "None" }, { "first_name": "Ayanna", "middle_name": "", "last_name": "Walker", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida\nUniversity of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida", "department": "None" }, { "first_name": "Neal", "middle_name": "", "last_name": "Mangalat", "name_suffix": "", "institution": "St Mary’s Hospital, Department of Emergency Medicine, St. Louis, Missouri", "department": "None" }, { "first_name": "Linda", "middle_name": "", "last_name": "Papa", "name_suffix": "", "institution": "Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, Florida\nUniversity of Central Florida College of Medicine, Department of Emergency Medicine, Orlando, Florida", "department": "None" } ], "date_submitted": "2017-07-06T23:54:26+02:00", "date_accepted": "2017-07-06T23:54:26+02:00", "date_published": "2018-03-13T20:36:46+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11058/galley/5956/download/" } ] }, { "pk": 44471, "title": "The Sequelae of Larsen Syndrome", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6b0198k7", "frozenauthors": [ { "first_name": "Sonya", "middle_name": "", "last_name": "Heitmann", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Rauz", "middle_name": "", "last_name": "Eshraghi", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-13T18:38:40+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44471/galley/33264/download/" } ] }, { "pk": 44470, "title": "Palpitations with a Cause", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9w74t3d0", "frozenauthors": [ { "first_name": "Michael", "middle_name": "", "last_name": "Estes", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Melkon", "middle_name": "", "last_name": "Hacovian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-13T18:35:44+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44470/galley/33263/download/" } ] }, { "pk": 11469, "title": "Predictors of Short-Term Outcomes after Syncope: A Systematic Review and Meta-Analysis", "subtitle": null, "abstract": "Introduction:\n We performed a systematic review and meta-analysis to identify predictors of serious clinical outcomes after an acute-care evaluation for syncope.\nMethods: \nWe identified studies that assessed for predictors of short-term (≤30 days) serious clinical events after an emergency department (ED) visit for syncope. We performed a MEDLINE search (January 1, 1990 - July 1, 2017) and reviewed reference lists of retrieved articles. The primary outcome was the occurrence of a serious clinical event (composite of mortality, arrhythmia, ischemic or structural heart disease, major bleed, or neurovascular event) within 30 days. We estimated the sensitivity, specificity, and likelihood ratio of findings for the primary outcome. We created summary estimates of association on a variable-by-variable basis using a Bayesian random-effects model.\nResults:\n We reviewed 2,773 unique articles; 17 met inclusion criteria. The clinical findings most predictive of a short-term, serious event were the following: 1) An elevated blood urea nitrogen level (positive likelihood ratio [LR+]: 2.86, 95% confidence interval [CI] [1.15, 5.42]); 2); history of congestive heart failure (LR+: 2.65, 95%CI [1.69, 3.91]); 3) initial low blood pressure in the ED (LR+: 2.62, 95%CI [1.12, 4.9]); 4) history of arrhythmia (LR+: 2.32, 95%CI [1.31, 3.62]); and 5) an abnormal troponin value (LR+: 2.49, 95%CI [1.36, 4.1]). Younger age was associated with lower risk (LR-: 0.44, 95%CI [0.25, 0.68]). An abnormal electrocardiogram was mildly predictive of increased risk (LR+ 1.79, 95%CI [1.14, 2.63]).\nConclusion: \nWe identified specific risk factors that may aid clinical judgment and that should be considered in the development of future risk-prediction tools for serious clinical events after an ED visit for syncope.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "syncope" }, { "word": "meta-analysis" } ], "section": "Health Outcomes", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4w28875w", "frozenauthors": [ { "first_name": "Thomas", "middle_name": "A.", "last_name": "Gibson", "name_suffix": "", "institution": "University of California, Los Angeles, Department of Biostatistics, Los Angeles, California", "department": "None" }, { "first_name": "Robert", "middle_name": "E.", "last_name": "Weiss", "name_suffix": "", "institution": "University of California, Los Angeles, Department of Biostatistics, Los Angeles, California", "department": "None" }, { "first_name": "Benjamin", "middle_name": "C.", "last_name": "Sun", "name_suffix": "", "institution": "Oregon Heath & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon", "department": "None" } ], "date_submitted": "2017-11-21T02:09:03+01:00", "date_accepted": "2017-11-21T02:09:03+01:00", "date_published": "2018-03-13T17:14:48+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11469/galley/6199/download/" } ] }, { "pk": 11396, "title": "The Uphill Battle of Performing Education Scholarship: Barriers Educators and Education Researchers Face", "subtitle": null, "abstract": "Introduction:\n Educators and education researchers report that their scholarship is limited by lack of time, funding, mentorship, expertise, and reward. This study aims to evaluate these groups’ perceptions regarding barriers to scholarship and potential strategies for success.\nMethods:\n Core emergency medicine (EM) educators and education researchers completed an online survey consisting of multiple-choice, 10-point Likert scale, and free-response items in 2015. Descriptive statistics were reported. We used qualitative analysis applying a thematic approach to free-response items.\nResults:\n A total of 204 educators and 42 education researchers participated. Education researchers were highly productive: 19/42 reported more than 20 peer-reviewed education scholarship publications on their curricula vitae. In contrast, 68/197 educators reported no education publications within five years. Only a minority, 61/197 had formal research training compared to 25/42 education researchers. Barriers to performing research for both groups were lack of time, competing demands, lack of support, lack of funding, and challenges achieving scientifically rigorous methods and publication. The most common motivators identified were dissemination of knowledge, support of evidence-based practices, and promotion. Respondents advised those who seek greater education research involvement to pursue mentorship, formal research training, collaboration, and rigorous methodological standards. \nConclusion:\n The most commonly cited barriers were lack of time and competing demands. Stakeholders were motivated by the desire to disseminate knowledge, support evidence-based practices, and achieve promotion. Suggested strategies for success included formal training, mentorship, and collaboration. This information may inform interventions to support educators in their scholarly pursuits and improve the overall quality of education research in EM.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "education, research, barriers, scholarship" } ], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/96j0z1vd", "frozenauthors": [ { "first_name": "Jaime", "middle_name": "", "last_name": "Jordan", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California", "department": "None" }, { "first_name": "Wendy", "middle_name": "C.", "last_name": "Coates", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California", "department": "None" }, { "first_name": "Samuel", "middle_name": "", "last_name": "Clarke", "name_suffix": "", "institution": "UC Davis Medical Center, Department of Emergency Medicine, Sacramento, California", "department": "None" }, { "first_name": "Daniel", "middle_name": "", "last_name": "Runde", "name_suffix": "", "institution": "University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Emilie", "middle_name": "", "last_name": "Fowlkes", "name_suffix": "", "institution": "University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Jaqueline", "middle_name": "", "last_name": "Kurth", "name_suffix": "", "institution": "UCLA Ronald Reagan/Olive View, Department of Emergency Medicine, Los Angeles, California", "department": "None" }, { "first_name": "Lalena", "middle_name": "", "last_name": "Yarris", "name_suffix": "", "institution": "Oregon Health and Sciences University Medical Center, Department of Emergency Medicine, Portland, Oregon", "department": "None" } ], "date_submitted": "2017-10-13T23:05:35+02:00", "date_accepted": "2017-10-13T23:05:35+02:00", "date_published": "2018-03-13T17:14:09+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11396/galley/6172/download/" } ] }, { "pk": 11558, "title": "In the U.S. “Healthcare” Is Now Strictly a Business Term", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Emergency Department Administration", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4gt4q3bp", "frozenauthors": [ { "first_name": "Nick", "middle_name": "T.", "last_name": "Sawyer", "name_suffix": "", "institution": "University of California, Davis, Department of Emergency Medicine, Sacramento, California \nCalifornia American College of Emergency Physicians Board of Directors", "department": "None" } ], "date_submitted": "2018-01-11T00:22:02+01:00", "date_accepted": "2018-01-11T00:22:02+01:00", "date_published": "2018-03-13T17:13:33+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11558/galley/6229/download/" } ] }, { "pk": 11650, "title": "The Opioid Crisis in America: Too much, too little, too late", "subtitle": null, "abstract": "N/A", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5652m1c0", "frozenauthors": [ { "first_name": "Kristi", "middle_name": "L.", "last_name": "Koenig", "name_suffix": "", "institution": "County of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, California\nUniversity of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" } ], "date_submitted": "2018-03-01T01:07:21+01:00", "date_accepted": "2018-03-01T01:07:21+01:00", "date_published": "2018-03-13T17:13:05+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11650/galley/6267/download/" } ] }, { "pk": 11591, "title": "Modification of Daly’s Do-it-yourself, Ultrasound-guided Pericardiocentesis Model for Added External Realism", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "education" }, { "word": "Simulation" }, { "word": "Pericardiocentesis" } ], "section": "Technology in Emergency Medicine", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0676t4fp", "frozenauthors": [ { "first_name": "Timothy", "middle_name": "P.", "last_name": "Young", "name_suffix": "", "institution": "Loma Linda University Medical Center and Children’s Hospital, Department of Emergency Medicine, Loma Linda, California", "department": "None" }, { "first_name": "Heather", "middle_name": "M.", "last_name": "Kuntz", "name_suffix": "", "institution": "Loma Linda University Medical Center and Children’s Hospital, Department of Emergency Medicine, Loma Linda, California", "department": "None" } ], "date_submitted": "2018-01-27T07:12:01+01:00", "date_accepted": "2018-01-27T07:12:01+01:00", "date_published": "2018-03-13T17:12:39+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11591/galley/6241/download/" } ] }, { "pk": 11328, "title": "Occult Suicidality and Psychiatric Disease Among Emergency Department Patients with Low-acuity Chief Complaints", "subtitle": null, "abstract": "Introduction:\n Patients presenting to emergency departments (ED) are often screened for suicidality, even when their chief complaint does not involve mental health concerns. Patient receptiveness to ED-based mental health screening and intervention is unknown, particularly among patients with low-acuity chief complaints, who often prioritize rapid evaluation and discharge. \nMethods:\n This cross-sectional study included adults with low-acuity chief complaints presenting to an urban, academic ED in the Northeastern United States during daytime and evening hours, from 2015 to 2016. Participants completed validated mental health screening instruments, including the Suicide Behaviors Questionnaire-Revised and the Patient Health Questionnaire-4. Participants were also asked to rate the importance of addressing mental health concerns during their ED visit. \nResults: \nWe approached 1,688 patients, and 816 (48.4%) consented to participate in the study. Of these, 27% screened positive for anxiety and 25% screened positive for depression. Even among patients with no prior depression history, 17% were at high risk of depression. Eleven percent of participants were at high risk for suicidal behavior, including 5% of those with no reported history of depression or bipolar disorder. Thirty-five percent of patients at risk for suicide and 53% of those at high risk of depression thought it was important or very important to address these issues during the ED visit. \nConclusion:\n Symptoms of mental health disorders were common among this group of ED patients presenting with low-acuity chief complaints. Patients often desired to address these mental health concerns as part of their ED visit.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Depression" }, { "word": "Mental Health" }, { "word": "low-acuity" }, { "word": "Suicide" }, { "word": "non-urgent" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7rc5h7vh", "frozenauthors": [ { "first_name": "Stephen", "middle_name": "M.", "last_name": "McBride", "name_suffix": "", "institution": "Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey", "department": "None" }, { "first_name": "Valerie", "middle_name": "A.", "last_name": "Braz", "name_suffix": "", "institution": "Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey", "department": "None" }, { "first_name": "Christopher", "middle_name": "W.", "last_name": "Jones", "name_suffix": "", "institution": "Cooper Medical School of Rowan University, Department of Emergency Medicine, Camden, New Jersey", "department": "None" } ], "date_submitted": "2017-09-14T17:33:11+02:00", "date_accepted": "2017-09-14T17:33:11+02:00", "date_published": "2018-03-13T17:11:59+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11328/galley/6147/download/" } ] }, { "pk": 11421, "title": "Comments on “Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms”", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "pulmonary embolism" }, { "word": "Risk-stratification" }, { "word": "CTA" }, { "word": "D-dimer" } ], "section": "Resource Utilization", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3sj56495", "frozenauthors": [ { "first_name": "Jeff", "middle_name": "", "last_name": "Dubin", "name_suffix": "", "institution": "MedStar Emergency Physicians, MedStar Washington Hospital Center/Georgetown Department of Emergency Medicine, Washington, District of Columbia", "department": "None" }, { "first_name": "Matt", "middle_name": "", "last_name": "Wilson", "name_suffix": "", "institution": "MedStar Emergency Physicians, MedStar Washington Hospital Center/Georgetown Department of Emergency Medicine, Washington, District of Columbia", "department": "None" }, { "first_name": "William", "middle_name": "", "last_name": "Frohna", "name_suffix": "", "institution": "MedStar Emergency Physicians, MedStar Washington Hospital Center/Georgetown Department of Emergency Medicine, Washington, District of Columbia", "department": "None" } ], "date_submitted": "2017-10-27T17:53:54+02:00", "date_accepted": "2017-10-27T17:53:54+02:00", "date_published": "2018-03-13T17:11:32+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11421/galley/6183/download/" } ] }, { "pk": 11423, "title": "Clinical Ultrasound Is Safe and Highly Specific for Acute Appendicitis in Moderate to High Pre-test Probability Patients", "subtitle": null, "abstract": "Introduction:\n Clinical ultrasound (CUS) is highly specific for the diagnosis of acute appendicitis but is operator-dependent. The goal of this study was to determine if a heterogeneous group of emergency physicians (EP) could diagnose acute appendicitis on CUS in patients with a moderate to high pre-test probability. \nMethods:\n This was a prospective, observational study of a convenience sample of adult and pediatric patients with suspected appendicitis. Sonographers received a structured, 20-minute CUS training on appendicitis prior to patient enrollment. The presence of a dilated (>6 mm diameter), non-compressible, blind-ending tubular structure was considered a positive study. Non-visualization or indeterminate studies were considered negative. We collected pre-test probability of acute appendicitis based on a 10-point visual analog scale (moderate to high was defined as >3), and confidence in CUS interpretation. The primary objective was measured by comparing CUS findings to surgical pathology and one week follow-up.\nResults:\n We enrolled 105 patients; 76 had moderate to high pre-test probability. Of these, 24 were children. The rate of appendicitis was 36.8% in those with moderate to high pre-test probability. CUS were recorded by 33 different EPs. The sensitivity, specificity, and positive and negative likelihood ratios of EP-performed CUS in patients with moderate to high pre-test probability were 42.8% (95% confidence interval [CI] [25-62.5%]), 97.9% (95% CI [87.5-99.8%]), 20.7 (95% CI [2.8-149.9]) and 0.58 (95% CI [0.42-0.8]), respectively. The 16 false negative scans were all interpreted as indeterminate. There was one false positive CUS diagnosis; however, the sonographer reported low confidence of 2/10.\nConclusion:\n A heterogeneous group of EP sonographers can safely identify acute appendicitis with high specificity in patients with moderate to high pre-test probability. This data adds support for surgical consultation without further imaging beyond CUS in the appropriate clinical setting.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Clinical Ultrasound, Appendicitis, Sonography" } ], "section": "Technology in Emergency Medicine", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2jd383sw", "frozenauthors": [ { "first_name": "Daniel", "middle_name": "", "last_name": "Corson-Knowles", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Frances", "middle_name": "M.", "last_name": "Russell", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" } ], "date_submitted": "2017-10-27T19:03:54+02:00", "date_accepted": "2017-10-27T19:03:54+02:00", "date_published": "2018-03-13T17:10:48+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11423/galley/6185/download/" } ] }, { "pk": 60777, "title": "\"Cultured Meat\": Lab-Grown Beef and Regulating the Future Meat Market", "subtitle": null, "abstract": "Livestock production accounts for 19 percent of greenhouse gas (GHG) emissions and 9 percent of anthropogenic GHG emissions. It requires up to 30 percent of all land surface area on earth, 33 percent of all arable land, and 70 percent of agricultural land. It contributes to climate change in a myriad of ways, including land erosion, water contamination, and abundant resource use. Current practices are not sustainable for a rapidly growing population. Lab-grown meat, also known as cultured meat, provides an alternative that may address many of the environmental harms stemming from livestock production. Cultured meat requires 99 percent less land, 90 percent less water, and 45 percent less energy, which would help accommodate population growth while lowering food-based ecological impacts, including climate change. It can also be placed in areas inhospitable to traditional livestock production, and it would reduce animal cruelty. Currently, however, the federal statutory and regulatory framework governing livestock production is not prepared to address cultured meat. After introducing cultured meat and the technology behind it, this essay explores how current federal regulations fail to adequately address this development. The essay concludes by recommending the adoption of new regulations to clarify the growth, inspection, certification, and sale of cultured meat in the United States.", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "livestock production" }, { "word": "lab-grown meat" }, { "word": "cultured meat" }, { "word": "greenhouse gas" }, { "word": "climate change" } ], "section": "Comments", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3k48n1gr", "frozenauthors": [ { "first_name": "Jennifer", "middle_name": "", "last_name": "Penn", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:21:25+02:00", "date_accepted": "2018-07-18T18:21:25+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60777/galley/46739/download/" } ] }, { "pk": 60772, "title": "Front Matter", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [], "section": "Front Matter", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1zz7299r", "frozenauthors": [ { "first_name": "Editors", "middle_name": "", "last_name": "Editors", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:09:15+02:00", "date_accepted": "2018-07-18T18:09:15+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60772/galley/46734/download/" } ] }, { "pk": 60774, "title": "Masthead", "subtitle": null, "abstract": "", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [], "section": "Masthead", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3wj102st", "frozenauthors": [ { "first_name": "Editors", "middle_name": "", "last_name": "Editors", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:12:39+02:00", "date_accepted": "2018-07-18T18:12:39+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60774/galley/46736/download/" } ] }, { "pk": 60775, "title": "Sequestering Carbon Dioxide Undersea in the Atlantic: Legal Problems and Solutions", "subtitle": null, "abstract": "Reducing the amount of carbon dioxide in the atmosphere is vital to mitigate climate change. To date, reduction efforts have primarily focused on minimizing the production of carbon dioxide during electricity generation, transport, and other activities. Going forward, to the extent that carbon dioxide continues to be produced, it will need to be captured before release. The captured carbon dioxide can then be utilized in some fashion or injected into underground geological formations (e.g., depleted oil and gas reserves, deep saline aquifers, or basalt rock reservoirs) where it will hopefully remain permanently sequestered. This injection process is referred to as “carbon capture and storage” (CCS).\n \nSignificant research has been undertaken to identify possible carbon dioxide injection sites in the continental United States. There is also growing interest in the possibility of injecting carbon dioxide offshore into geological formations underlying the seabed. However, little is currently known about the legal regime for sub-seabed injection. This article outlines the key legal requirements for injecting carbon dioxide into the seabed off the northeast coast of the U.S.\n \nThe legal requirements for offshore carbon dioxide injection differ depending on the location of the injection operation. Injection operations undertaken in the Northeastern U.S., within three nautical miles of the coast (i.e., in “state waters”), are regulated under the Environmental Protection Agency’s (EPA) Underground Injection Control Program. That Program does not, however, apply to operations in “federal waters,” 3 to 200 nautical miles from shore, or on the “high seas” beyond those waters.\n \nThere is currently no regulatory regime specific to carbon dioxide injection in federal waters or on the high seas. However, injection operations in those areas may be regulated under general programs, such as the ocean dumping regime established in the Marine Protection, Research, and Sanctuaries Act (MPRSA). The MPRSA was enacted to fulfill the U.S.’s obligations under the London Convention, which aims to prevent pollution of the seas by waste and/or other materials. Consistent with the terms of the Convention, the MPRSA regulates the disposal of material at sea. The EPA has suggested that the MPRSA may apply to the injection of carbon dioxide into the seabed.\n \nAssuming it applies to seabed injection, the MPRSA may operate as a barrier to offshore CCS. Under the MPRSA, any person transporting material from the U.S. for the purpose of dumping it at sea, whether in state waters, federal waters, or on the high seas, must obtain a permit from the EPA. Notably, the EPA cannot grant a permit when the material consists of industrial waste, which is defined as “solid, semi-solid, or liquid waste generated by a manufacturing or processing plant.” The dumping of such waste is therefore effectively prohibited by the MPRSA.\n \nDepending on whether carbon dioxide is considered an industrial waste, the MPRSA may operate either to ban its offshore injection or allow its injection with a permit from the EPA. Various other permits and authorizations may also be required depending on where and how injection occurs. The key requirements are outlined in this article.", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "regulation" }, { "word": "climate change" }, { "word": "carbon dioxide" }, { "word": "EPA" }, { "word": "Environmental Protection Agency" } ], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/8wz8f131", "frozenauthors": [ { "first_name": "Romany", "middle_name": "", "last_name": "Webb", "name_suffix": "", "institution": "", "department": "" }, { "first_name": "Michael", "middle_name": "B.", "last_name": "Gerrard", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:16:58+02:00", "date_accepted": "2018-07-18T18:16:58+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60775/galley/46737/download/" } ] }, { "pk": 60773, "title": "Table of Contents", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [], "section": "Table of Contents", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0sd8h91j", "frozenauthors": [ { "first_name": "Editors", "middle_name": "", "last_name": "Editors", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:09:57+02:00", "date_accepted": "2018-07-18T18:09:57+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60773/galley/46735/download/" } ] }, { "pk": 60778, "title": "The Law and Policy of Rainwater harvesting: A Comparative Analysis of Australia, India, and the United States", "subtitle": null, "abstract": "Rainwater harvesting is increasingly being turned to as a viable water conservation measure in the face of increasing water shortages. Legislatures at local, state, and national levels have begun implementing legislation that regulates rainwater harvesting; in some cases, governments choose to make the practice mandatory. This article examines four mandatory rainwater harvesting policies implemented in Australia, India, and the United States. The article summarizes the relative success of each policy’s adoption, and then moves on to discuss the impact of the policy on overall water conservation. In comparing the relative success of the policies, one finds that while financial investment plays an important role in determining the impact of the programs, other factors, such as the leniency of the mandate, cost to consumer, and support from non-governmental organizations play an important role in determining whether the policies are adopted. Furthermore, policymakers can encourage greater water conservation by incentivizing behavioral change and creating more robust financial incentives.", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "rainwater harvesting" }, { "word": "water conservation" }, { "word": "water shortages" }, { "word": "regulation" }, { "word": "Comparative Law" } ], "section": "Comments", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/19121940", "frozenauthors": [ { "first_name": "Brianne", "middle_name": "", "last_name": "Holland-Stergar", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:23:50+02:00", "date_accepted": "2018-07-18T18:23:50+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60778/galley/46740/download/" } ] }, { "pk": 60776, "title": "Vulnerability and the Climate Change Regime", "subtitle": null, "abstract": "Climate change is precipitating social issues that are not traceable to a discreet, culpable actor. This is because greenhouse gas accumulation in the stratosphere is a global problem transcending the socio-political boundaries that law uses to assign responsibility. The diffuse nature of climate change calls for new legal approaches that can provide greater juridical responsiveness[1] to social problems and universal human vulnerability that is emerging in the wake of one of the most pressing environmental challenges facing the international community today.[2] Those social problems include displacement and dispossession of indigenous communities whose livelihoods depend directly on their environment, such as Arctic communities in Alaska, rural dwellers in the Himalayas, livestock farmers in the Kalahari, and forest-dwellers in the Amazon.[3] Farming communities reliant upon rain-fed agriculture also face food insecurity due to changing, unpredictable rainfall patterns.[4] While social impacts may be most keenly felt at the local level, the global nature of climate change means that jurisprudential bases of law at all levels—local, national, regional, and international[5]—need to promote coherent legal responses that recognize the global genesis of what may be seen as localized problems.\n \nThis essay will draw on human vulnerability theory to discuss law’s role in promoting social justice in the wake of climate change. Vulnerability is the “characteristic that positions us in relation to each other as human beings and also suggests a relationship of responsibility between the state and its institutions and the individual.”[6] Vulnerability theory critiques the contemporary understanding of “the legal subject,” which is built on an ideology that values liberty over equality and manipulates contractual concepts such as choice and consent to justify exploitation and structural inequality.[7] That inequality has distorted and constrained the conception of the legal subject into a narrow and limited autonomous subject that is at the center of the analysis that law uses to organize society.[8] Human vulnerability theory calls for enriching the legal subject by placing it in social context, and engaging with its complex and dynamic characteristics.\n The paper is divided into five Parts. Part I provides an overview of human vulnerability theory. Part II presents a vulnerability perspective on liberalism and neoliberalism, two theories that underlie the current global climate regime. Part III examines the concept of vulnerability in the climate discourse, while Part IV applies human vulnerability theory to the global climate regime. The final part states the conclusions. \n[1] Anna Grear, \nVulnerability, Advanced Global Capitalism and co-Symptomatic Injustice: Locating the Vulnerable Subject, in\n Vulnerability: Reflections on a New Ethical Paradigm for Law and Politics 41, 41 (Martha Alberston Fineman & Anna Grear eds., 2013).\n \n[2] David Hunter, James Salzman & Durwood Zaelke, International Environmental Law & Policy 3rd ed. 631. Foundation Press, NY (2007). \n \n[3] \nClimate Change and Indigenous Peoples\n,\n \nUnited Nations Permanent Forum on Indigenous Issues,\n \nhttp://www.un.org/en/events/indigenousday/pdf/Backgrounder_ClimateChange_FINAL.pdf [http://perma.cc/7G3H-M9MP].\n \n[4] Berhanu F. Alemaw & Timothy Simalenga, \nClimate Change Impacts and \nAdaptation in Rainfed Farming Systems: A Modeling Framework for Scaling-\nOut Climate Smart Agriculture in Sub-Saharan Africa\n, 4 Am. J. of Climate Change 313 (2015).\n \n[5] \nSee\n Klaus Bosselmann, The Rule of Law Grounded in Earth (2013), p.5.\n \n[6] \nVulnerability and the Human Condition\n,\n \nEmory University, http://web.gs.emory.edu/vulnerability/index.html [http://perma.cc/D363-SFCR] [hereinafter Vulnerability Index].\n \n[7] \nDefinitions of Vulnerability and the Human Condition Initiative\n, Emory University, http://web.gs.emory.edu/vulnerability/about/definitions.html [http://perma.cc/D363-SFCR].\n \n[8] \nSee\n Martha Albertson Fineman, The Autonomy Myth, The New Press (2004). In this book, Fineman argues that popular ideology in the United States (and adopted in other common law based legal systems) has become fixated on the myth that citizens are and should be autonomous. However, the fact is that dependency is unavoidable in any society and human beings are more or less dependent on others at all stages in the human life-cycle. I extend the notion of dependency to our dependence on the environment and the resources it provides for our subsistence on Earth throughout our lives.", "language": "en", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "human vulnerability theory" }, { "word": "Social Justice" }, { "word": "climate change" } ], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5zx443v9", "frozenauthors": [ { "first_name": "Atieno", "middle_name": "", "last_name": "Mboya", "name_suffix": "", "institution": "", "department": "" } ], "date_submitted": "2018-07-18T18:19:30+02:00", "date_accepted": "2018-07-18T18:19:30+02:00", "date_published": "2018-03-13T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/uclalaw_jelp/article/60776/galley/46738/download/" } ] }, { "pk": 44463, "title": "Lambert-Eaton Myasthenic Syndrome and Small Cell Lung Cancer Associated with Voltage-Gated Calcium Channel Antibody – Case Report and Review of Literature", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/62z1k5vx", "frozenauthors": [ { "first_name": "Yi-Kong", "middle_name": "", "last_name": "Keung", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Eddie", "middle_name": "", "last_name": "Hong-Lung Hu", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-12T10:13:38+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44463/galley/33256/download/" } ] }, { "pk": 44462, "title": "Should G-CSFs be used with Antibiotics to Treat Established Neutropenic Fever?", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Brief Clinical Update" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/35s0s648", "frozenauthors": [ { "first_name": "Grace", "middle_name": "", "last_name": "Huang", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-12T10:11:36+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44462/galley/33255/download/" } ] }, { "pk": 44450, "title": "Drug-Induced Thrombotic Microangiopathy and Use of Eculizumab", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9s1196p3", "frozenauthors": [ { "first_name": "Hamid", "middle_name": "", "last_name": "Hajmomenian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-10T17:31:19+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44450/galley/33243/download/" } ] }, { "pk": 44461, "title": "Acthar Gel in Treatment of Idiopathic Membranous Nephropathy-Associated Nephrotic Syndrome", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3vm7s8px", "frozenauthors": [ { "first_name": "Hamid", "middle_name": "", "last_name": "Hajmomenian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-10T10:09:30+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44461/galley/33254/download/" } ] }, { "pk": 44460, "title": "Anti-Neutrophil Cytoplasmic Associated Vasculitis in Systemic Sclerosis", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/8nd767t6", "frozenauthors": [ { "first_name": "Hamid", "middle_name": "", "last_name": "Hajmomenian", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-10T10:07:35+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44460/galley/33253/download/" } ] }, { "pk": 44499, "title": "A Depressed Patient with Underlying Comorbidities Demonstrates that Counseling Alone is Not Enough", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/140880rp", "frozenauthors": [ { "first_name": "Timothy", "middle_name": "", "last_name": "Chen", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-09T19:40:30+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44499/galley/33292/download/" } ] }, { "pk": 44449, "title": "Chronic Beryllium Disease", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0ss0w1wp", "frozenauthors": [ { "first_name": "Sharon", "middle_name": "", "last_name": "De Cruz", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-09T17:27:07+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44449/galley/33242/download/" } ] }, { "pk": 11397, "title": "Scholarly Tracks in Emergency Medicine Residency Programs Are Associated with Increased Choice of Academic Career", "subtitle": null, "abstract": "Introduction:\n Career preparation in residency training is not standardized. Scholarly tracks have emerged in emergency medicine (EM) residencies to allow specialized training in an area of focus. The characteristics of these tracks and their value and impact on resident career choice are unknown. We aim to describe the current state of scholarly tracks in residency training programs and their association with pursuit of an academic career.\nMethods:\n Program leaders at EM training programs completed an online survey consisting of multiple-choice items with free-text option. Additionally, participants completed a matrix of dropdown items identifying the immediately chosen post-residency position and applicable track of each member of their graduating class. Descriptive statistics were calculated and reported for multiple-choice items. We performed comparative statistics using chi-squared and Wilcoxon rank-sum tests. Free-text responses were analyzed using a thematic approach. \nResults: \n113/157(72%) programs participated, 51 with and 62 without tracks. Tracks were more common in four-year programs (odds ratio [OR]=4.8;[2.0-11.9]) and larger programs (chi-sq, p=0.001). Perceived benefits of tracks from programs with them included advanced training (46/50; 92%), career guidance (44/50; 88%), mentorship (44/50; 88%), and preparation for an academic career (40/50; 80%). Residents often participated in a single track (37/50; 74%) usually during their later residency years. Programs with tracks were more likely to graduate residents to an academic career, OR 1.8;[1.3-2.4].\nConclusion:\n This study describes the current characteristics and perceptions of scholarly tracks in EM residencies. Scholarly tracks are associated with an academic position immediately following residency. The results of this study may inform the development and use of scholarly tracks in residency training programs.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "scholarly track, graduate medial education, resident, career choice" } ], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/07h7281k", "frozenauthors": [ { "first_name": "Jaime", "middle_name": "", "last_name": "Jordan", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California\nDavid Geffen School of Medicine at University of California Los Angeles, Los Angeles, California\nLos Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California", "department": "None" }, { "first_name": "Michael", "middle_name": "", "last_name": "Hwang", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California", "department": "None" }, { "first_name": "Amy", "middle_name": "H.", "last_name": "Kaji", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California\nDavid Geffen School of Medicine at University of California Los Angeles, Los Angeles, California\nLos Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California", "department": "None" }, { "first_name": "Wendy", "middle_name": "C.", "last_name": "Coates", "name_suffix": "", "institution": "Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California\nDavid Geffen School of Medicine at University of California Los Angeles, Los Angeles, California\nLos Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California", "department": "None" } ], "date_submitted": "2017-10-13T23:35:38+02:00", "date_accepted": "2017-10-13T23:35:38+02:00", "date_published": "2018-03-08T19:04:57+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11397/galley/6173/download/" } ] }, { "pk": 11116, "title": "Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial", "subtitle": null, "abstract": "Introduction:\n Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as “scripting” has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction.\nMethods:\n Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient’s care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. \nResults:\n We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student’s overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction.\nConclusion:\n We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Communication" }, { "word": "Scripting" }, { "word": "patient satisfaction" } ], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2t99c7xc", "frozenauthors": [ { "first_name": "Katie", "middle_name": "E.", "last_name": "Pettit", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Joseph", "middle_name": "S.", "last_name": "Turner", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Katherine", "middle_name": "A.", "last_name": "Pollard", "name_suffix": "", "institution": "Washington University School of Medicine, Department of Medicine, St. Louis, Missouri", "department": "None" }, { "first_name": "Bryce", "middle_name": "B.", "last_name": "Buente", "name_suffix": "", "institution": "Marion University College of Osteopathic Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Aloysius", "middle_name": "J.", "last_name": "Humbert", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Anthony", "middle_name": "J.", "last_name": "Perkins", "name_suffix": "", "institution": "Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana", "department": "None" }, { "first_name": "Cherri", "middle_name": "D.", "last_name": "Hobgood", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" }, { "first_name": "Jeffrey", "middle_name": "A.", "last_name": "Kline", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana", "department": "None" } ], "date_submitted": "2017-08-22T16:59:20+02:00", "date_accepted": "2017-08-22T16:59:20+02:00", "date_published": "2018-03-08T19:00:58+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11116/galley/5978/download/" } ] }, { "pk": 11373, "title": "Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?", "subtitle": null, "abstract": "Introduction: \nEmergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed “Code Help.” Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed.\nMethods:\n This was a retrospective analysis of data collected from electronic, patient-care, timestamp events and from a prospective Code Help registry for consecutive adult patients admitted from the ED at a single academic center during a 15-month period. For each patient, we determined whether the concurrent hospital status complied with the Code Help policy or violated it at the time of admission decision. We then compared ED boarding time and overall ED LOS for patients cared for during periods of Code Help policy compliance and during periods of Code Help policy violation, both with reference to patients cared for during normal operations.\nResults: \nOf 89,587 adult patients who presented to the ED during the study period, 24,017 (26.8%) were admitted to an acute care or critical care bed. Boarding time ranged from zero to 67 hours 30 minutes (median 4 hours 31 minutes). Total ED LOS for admitted patients ranged from 11 minutes to 85 hours 25 minutes (median nine hours). Patients admitted during periods of Code Help policy violation experienced significantly longer boarding times (median 20 minutes longer) and total ED LOS (median 46 minutes longer), compared to patients admitted under normal operations. However, patients admitted during Code Help policy compliance did not experience a significant increase in either metric, compared to normal operations.\nConclusion:\n In this single-center experience, implementation of the Massachusetts Code Help regulation was associated with reduced ED boarding time and ED LOS when the policy was consistently followed, but there were adverse effects on both metrics during violations of the policy.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "ED operations" }, { "word": "Health Policy" }, { "word": "overcrowding" }, { "word": "Flow" }, { "word": "boarding" }, { "word": "Efficiency" } ], "section": "Emergency Department Administration", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5mt1s22q", "frozenauthors": [ { "first_name": "Sean", "middle_name": "S.", "last_name": "Michael", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts\nUniversity of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado", "department": "None" }, { "first_name": "John", "middle_name": "P.", "last_name": "Broach", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "None" }, { "first_name": "Kevin", "middle_name": "A.", "last_name": "Kotkowski", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "None" }, { "first_name": "D.", "middle_name": "Eric", "last_name": "Brush", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "None" }, { "first_name": "Gregory", "middle_name": "A.", "last_name": "Volturo", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "None" }, { "first_name": "Martin", "middle_name": "A.", "last_name": "Reznek", "name_suffix": "", "institution": "University of Massachusetts Medical School, Department of Emergency Medicine, Worcester, Massachusetts", "department": "None" } ], "date_submitted": "2017-10-03T20:14:49+02:00", "date_accepted": "2017-10-03T20:14:49+02:00", "date_published": "2018-03-08T18:56:31+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11373/galley/6164/download/" } ] }, { "pk": 11436, "title": "Retrospective Chart Review of Synthetic Cannabinoid Intoxication with Toxicologic Analysis", "subtitle": null, "abstract": "Introduction:\n Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation.Our goal was to describe these novel presentations and characterize the compounds.\n \nMethods:\n We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015. A retrospective chart review recorded initial vital signs, chief complaint and clinical course. Urine, blood and xenobiotic samples were analyzed using either liquid chromatography/mass spectrometry or gas chromatography/mass spectrometry. We compared resulting spectra against databases containing numerous SCs or metabolites and scored based on a reference comparison. \nResults:\n Between 2/11/2015 and 6/23/2015, we identified 141 visits. Males comprised 139 visits (age range 21-68 years; median 35, interquartile range 20). Sixty-eight percent presented with lethargy or loss of consciousness. Hypotension (SBP <90 mmHg) and bradycardia (HR<60 bpm) were seen in 10% and 24% of visits, respectively. While most patients were discharged after observation, three were admitted to the intensive care unit and seven to telemetry. Admissions were for vital sign instability, bradycardia requiring pacing, prolonged sedation and respiratory failure requiring mechanical ventilation.Laboratory analysis revealed SC in the XLR-11 family in 18/36 drug, 9/12 blood, and 23/31 urine samples. Carboxamide indazole derivative (CID) family compounds were detected in 13/36 drug samples, 21/31 urine samples, but no blood samples; 11/31 drug samples contained both XLR-11 and CID. Other compounds detected included PB-22 and nicotine. No JWH compounds, opiates, imidazoline receptor agonists, benzodiazepines or other sedative-hypnotics were detected.\nConclusion:\n Unlike their predecessors, novel SC may be associated with significant central nervous system depression and bradycardia. While prior reports indicated that SC mostly contained JWH compounds, none were detected in these samples. The most commonly identified compounds in this series were CID and alkyl SC derivatives, such as INACA compounds and XLR-11. These tend to be full agonists at the cannabinoid receptor and are presumably more potent. The lack of other depressants suggests that the clinical findings are due to the combination of these compounds and not coingestants or adulterants. SC intoxication should be considered for patients with undifferentiated psychomotor depression and bradycardia.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "K2, Synthetic Cannabinoids, Toxicology, Intoxication" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7tk154t0", "frozenauthors": [ { "first_name": "Payal", "middle_name": "", "last_name": "Sud", "name_suffix": "", "institution": "Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, New Hyde Park, New York\nGlen Cove Hospital, Northwell Health, Department of Emergency Medicine, Glen Cove, New York", "department": "None" }, { "first_name": "Miles", "middle_name": "", "last_name": "Gordon", "name_suffix": "", "institution": "Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, New Hyde Park, New York\nNorth Shore University Hospital Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, Manhasset, New York", "department": "None" }, { "first_name": "Laura", "middle_name": "", "last_name": "Tortora", "name_suffix": "", "institution": "Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, New Hyde Park, New York\nBanner-University Medical Center, Department of Emergency Medicine, Department of Toxicology, Phoenix, Arizona", "department": "None" }, { "first_name": "Matthew", "middle_name": "", "last_name": "Stripp", "name_suffix": "", "institution": "Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, New Hyde Park, New York\nCarolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina", "department": "None" }, { "first_name": "Damon", "middle_name": "", "last_name": "Borg", "name_suffix": "", "institution": "Cordant Health Solutions, Huntington, New York", "department": "None" }, { "first_name": "Adam", "middle_name": "", "last_name": "Berman", "name_suffix": "", "institution": "Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, New Hyde Park, New York\nNorth Shore University Hospital Medical Center, Northwell Health, Department of Emergency Medicine, Division of Toxicology, Manhasset, New York", "department": "None" } ], "date_submitted": "2017-11-07T17:04:42+01:00", "date_accepted": "2017-11-07T17:04:42+01:00", "date_published": "2018-03-08T18:53:42+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11436/galley/6187/download/" } ] }, { "pk": 11291, "title": "Emergency Physicians at War", "subtitle": null, "abstract": "Operation Enduring Freedom (OEF-A) in Afghanistan and Operation Iraqi Freedom (OIF) represent the first major, sustained wars in which emergency physicians (EPs) fully participated as an integrated part of the military’s health system. EPs proved invaluable in the deployments, and they frequently used the full spectrum of trauma and medical care skills. The roles EPs served expanded over the years of the conflicts and demonstrated the unique skill set of emergency medicine (EM) training. EPs supported elite special operations units, served in medical command positions, and developed and staffed flying intensive care units. EPs have brought their combat experience home to civilian practice. This narrative review summarizes the history, contributions, and lessons learned by EPs during OEF-A/OIF and describes changes to daily clinical practice of EM derived from the combat environment.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Trauma" }, { "word": "Resuscitation medicine" }, { "word": "Critical care" }, { "word": "Military medicine" } ], "section": "Disaster Medicine/ Emergency Medical Services", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6ct1b8gr", "frozenauthors": [ { "first_name": "Andrew", "middle_name": "E.", "last_name": "Muck", "name_suffix": "", "institution": "University of Texas Health at San Antonio, Department of Emergency Medicine, San Antonio, Texas", "department": "None" }, { "first_name": "Melissa", "middle_name": "", "last_name": "Givens", "name_suffix": "", "institution": "Uniformed Services University, Department of Military and Emergency Medicine, Bethesda, Maryland", "department": "None" }, { "first_name": "Vikhyat", "middle_name": "S.", "last_name": "Bebarta", "name_suffix": "", "institution": "University of Colorado Denver, Department of Pharmacology, Denver, Colorado", "department": "None" }, { "first_name": "Phillip", "middle_name": "E.", "last_name": "Mason", "name_suffix": "", "institution": "San Antonio Military Medical Center, Department of Emergency Medicine, San Antonio, Texas", "department": "None" }, { "first_name": "Craig", "middle_name": "", "last_name": "Goolsby", "name_suffix": "", "institution": "Uniformed Services University, Department of Military and Emergency Medicine, Bethesda, Maryland", "department": "None" } ], "date_submitted": "2017-08-29T00:03:25+02:00", "date_accepted": "2017-08-29T00:03:25+02:00", "date_published": "2018-03-08T18:49:11+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11291/galley/6135/download/" } ] }, { "pk": 11341, "title": "3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop", "subtitle": null, "abstract": "Introduction:\n Chest pain is a common chief complaint among patients presenting to health systems and often leads to complex and intensive evaluations. While these patients are often cared for by a multidisciplinary team (primary care, emergency medicine, and cardiology), medical students usually learn about the care of these patients in a fragmented, single-specialty paradigm. The present and future care of patients with chest pain is multidisciplinary, and the education of medical students on the subject should be as well. Our objective was to evaluate the effectiveness of a multidisciplinary, problem-based learning workshop to teach third-year medical students about risk assessment for patients presenting with chest pain, specifically focusing on acute coronary syndromes.\nMethods:\n To create an educational experience consistent with multidisciplinary team-based care, we designed a multidisciplinary, problem-based learning workshop to provide medical students with an understanding of how patients with chest pain are cared for in a systems-based manner to improve outcomes. Participants included third-year medical students (n=219) at a single, tertiary care, academic medical center. Knowledge acquisition was tested in a pre-/post-retention test study design.\nResults:\n Following the workshop, students achieved a 19.7% (95% confidence interval [CI] [17.3-22.2%]) absolute increase in scores on post-testing as compared to pre-testing. In addition, students maintained an 11.1% (95% CI [7.2-15.0%]) increase on a retention test vs. the pre-test. \nConclusion: \nA multidisciplinary, problem-based learning workshop is an effective method of producing lasting gains in student knowledge about chest pain risk stratification.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Chest Pain Risk Stratification, Multidisciplinary, Problem Based Learning" } ], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7rj6p5p2", "frozenauthors": [ { "first_name": "William", "middle_name": "D.", "last_name": "Alley", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Cynthia", "middle_name": "", "last_name": "Burns", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Internal Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Nicholas", "middle_name": "D.", "last_name": "Hartman", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Kim", "middle_name": "", "last_name": "Askew", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Simon", "middle_name": "A.", "last_name": "Mahler", "name_suffix": "", "institution": "Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" } ], "date_submitted": "2017-09-19T04:39:53+02:00", "date_accepted": "2017-09-19T04:39:53+02:00", "date_published": "2018-03-08T17:08:50+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11341/galley/6155/download/" } ] }, { "pk": 11363, "title": "Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care", "subtitle": null, "abstract": "Introduction: \nIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.\nMethods:\n We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. \nResults:\n Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. \nConclusion:\n Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "altered mental status" }, { "word": "Altered Level of Consciousness" }, { "word": "Glasgow Coma Scale" }, { "word": "emergency medical services" }, { "word": "Clinical Protocols" }, { "word": "Evidence-based" }, { "word": "prehospital care" } ], "section": "Disaster Medicine/ Emergency Medical Services", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/6315b2wb", "frozenauthors": [ { "first_name": "Ashley", "middle_name": "", "last_name": "Sanello", "name_suffix": "", "institution": "Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California\nHarbor UCLA, Department of Emergency Medicine, Torrance, California", "department": "None" }, { "first_name": "Marianne", "middle_name": "", "last_name": "Gausche-Hill", "name_suffix": "", "institution": "Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California\nHarbor UCLA, Department of Emergency Medicine, Torrance, California\nDavid Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "William", "middle_name": "", "last_name": "Mulkerin", "name_suffix": "", "institution": "Stanford University, Department of Emergency Medicine, Stanford, California", "department": "None" }, { "first_name": "Karl", "middle_name": "A.", "last_name": "Sporer", "name_suffix": "", "institution": "University of California, San Francisco, Department of Emergency Medicine, San Francisco, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "John", "middle_name": "F.", "last_name": "Brown", "name_suffix": "", "institution": "University of California, San Francisco, Department of Emergency Medicine, San Francisco, California\nEMS Medical Directors Association of California", "department": "None" }, { "first_name": "Kristi", "middle_name": "L.", "last_name": "Koenig", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nCounty of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, California\nUniversity of California, Irvine, Department of Emergency Medicine, Orange, California", "department": "None" }, { "first_name": "Eric", "middle_name": "M.", "last_name": "Rudnick", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nNorCal EMS Agency, Redding, California", "department": "None" }, { "first_name": "Angelo", "middle_name": "A.", "last_name": "Salvucci", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nVentura County EMS Agency, Oxnard, California", "department": "None" }, { "first_name": "Gregory", "middle_name": "H.", "last_name": "Gilbert", "name_suffix": "", "institution": "EMS Medical Directors Association of California\nStanford University, Department of Emergency Medicine, Stanford, California", "department": "None" } ], "date_submitted": "2017-09-28T08:00:16+02:00", "date_accepted": "2017-09-28T08:00:16+02:00", "date_published": "2018-03-08T17:03:35+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11363/galley/6162/download/" } ] }, { "pk": 11249, "title": "Continuous Intravenous Sub-Dissociative Dose Ketamine Infusion for Managing Pain in the Emergency Department", "subtitle": null, "abstract": "Introduction:\n Our objective was to describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). \nMethods:\n We conducted a retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over six years (2010-2016). Primary data analyses included dosing and duration of infusion, rates of pre- and post-infusion analgesic administration, and final diagnoses. Secondary data included pre- and post-infusion pain scores and rates of side effects.\nResults:\n A total of 104 patients were enrolled in the study. Average dosing of SDK infusion was 11.26 mg/hr, and the mean duration of infusion was 135.87 minutes. There was a 38% increase in patients not requiring post-infusion analgesia. The average decrease in pain score was 5.04. There were 12 reported adverse effects, with nausea being the most prevalent.\nConclusion:\n Continuous intravenous SDK infusion has a role in controlling pain of various etiologies in the ED with a potential to reduce the need for co-analgesics or rescue analgesic administration. There is a need for more robust, prospective, randomized trials that will further evaluate the analgesic efficacy and safety of this modality across a wide range of pain syndromes and different age groups in the ED.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Ketamine, Analgesia, Emergency Department, Infusion" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/78d9r96c", "frozenauthors": [ { "first_name": "Sergey", "middle_name": "", "last_name": "Motov", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "Jefferson", "middle_name": "", "last_name": "Drapkin", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "Antonios", "middle_name": "", "last_name": "Likourezos", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "Tyler", "middle_name": "", "last_name": "Beals", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "Ralph", "middle_name": "", "last_name": "Monfort", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "Christian", "middle_name": "", "last_name": "Fromm", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" }, { "first_name": "John", "middle_name": "", "last_name": "Marshall", "name_suffix": "", "institution": "Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York", "department": "None" } ], "date_submitted": "2017-08-24T21:09:36+02:00", "date_accepted": "2017-08-24T21:09:36+02:00", "date_published": "2018-03-08T16:58:28+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11249/galley/6102/download/" } ] }, { "pk": 11389, "title": "Implementation of an Emergency Medicine Research Associates Program: Sharing 20 Years of Experience", "subtitle": null, "abstract": "Introduction:\n The use of research associates (RA) programs to facilitate study enrollment in the emergency department was initiated during the mid-1990s. The University of Rochester Medical Center (URMC) was an early adopting site for this model, which has experienced considerable growth and development over the past 20 years. \nMethods:\n Our goal was to detail the Emergency Department Research Associates (EDRA) program processes developed at the URMC that has led to our program’s sustainability and productivity. These processes, and the lessons learned during their development, can assist institutions seeking to establish an RA program or refine an existing program. \nResults: \nDefined procedures for selecting, training, and monitoring EDRAs have been created and refined with the goal of maximizing study enrollment and minimizing protocol deviations. Our EDRA program functions as a paid service center for investigators, and our EDRAs engage in a variety of study-related activities including screening and enrolling patients, administering surveys, collecting bio-specimens, and making follow-up calls. Over the past two years, our program has averaged 222 enrollments/month (standard deviation = 79.93), gathering roughly 25 participants per study per month. \nConclusion:\n Our EDRA model has consistently resulted in some of the highest number of enrollments across a variety of recently funded, multi-center studies. Maintaining a high-quality EDRA program requires continual investment on the part of the leadership team, though the benefits to investigators within and outside the department outweigh these costs.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "emergency department" }, { "word": "Research Associates" }, { "word": "enrollment" } ], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9hm3s6bs", "frozenauthors": [ { "first_name": "Beau", "middle_name": "", "last_name": "Abar", "name_suffix": "", "institution": "University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York", "department": "None" }, { "first_name": "Vincent", "middle_name": "", "last_name": "DeRienzo", "name_suffix": "", "institution": "University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York", "department": "None" }, { "first_name": "Joseph", "middle_name": "", "last_name": "Glick", "name_suffix": "", "institution": "University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York", "department": "None" }, { "first_name": "Nancy", "middle_name": "", "last_name": "Wood", "name_suffix": "", "institution": "University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York", "department": "None" }, { "first_name": "Manish", "middle_name": "N.", "last_name": "Shah", "name_suffix": "", "institution": "University of Wisconsin-Madison, School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin", "department": "None" }, { "first_name": "Sandra", "middle_name": "", "last_name": "Schneider", "name_suffix": "", "institution": "Hofstra University, Hofstra Northwell School of Medicine, Department of Emergency Medicine, Hempstead, New York\nAmerican College of Emergency Physicians, Irving Texas", "department": "None" }, { "first_name": "David", "middle_name": "", "last_name": "Adler", "name_suffix": "", "institution": "University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York", "department": "None" } ], "date_submitted": "2017-10-10T19:22:13+02:00", "date_accepted": "2017-10-10T19:22:13+02:00", "date_published": "2018-03-08T16:54:56+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11389/galley/6169/download/" } ] }, { "pk": 11284, "title": "Ruling out Pulmonary Embolism in Patients with High Pretest Probability", "subtitle": null, "abstract": "Introduction: \nThe American College of Emergency Physicians guidelines recommend more aggressive workup beyond imaging alone in patients with a high pretest probability (PTP) of pulmonary embolism (PE). However, the ability of multiple tests to safely rule out PE in high PTP patients is not known. We sought to measure the ability of negative computed tomography pulmonary angiography (CTPA) along with negative D-dimer to rule out PE in these high-risk patients.\nMethods:\n We analyzed data from a previous prospective observational study conducted in 12 emergency departments (ED). Wells score criteria were entered by providers before final PE testing. PE was diagnosed by imaging on the index ED visit, or within 45 days, demonstrating either PE ordeep vein thrombosis (DVT), or if the patient died of PE during the 45-day, follow-up period. Testing threshold was set at 1.8%.\nResults:\n A total of 7,940 patients were enrolled and tested for PE, and 257 had high PTP (Wells >6). Sixteen of these high-risk patients had negative CTPA and negative D-dimer, of whom two were positive for PE (12.5% [95% confidence interval 2.2%-40.0%]). One of these patients had a DVT on CT venogram and the other was diagnosed at follow-up.\nConclusion:\n Our analysis suggests that in patients with high PTP of PE, neither negative CTPA by itself nor a negative CTPA plus a negative D-dimer are sufficient to rule out PE. More aggressive workup strategies may be required for these patients.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Treatment Protocol Assessment", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/74h4h8qb", "frozenauthors": [ { "first_name": "Murtaza", "middle_name": "", "last_name": "Akhter", "name_suffix": "", "institution": "University of Arizona College of Medicine-Phoenix, Maricopa Integrated Health System, Department of Emergency Medicine, Phoenix, Arizona", "department": "None" }, { "first_name": "Jeffrey", "middle_name": "", "last_name": "Kline", "name_suffix": "", "institution": "Indiana University School of Medicine, Department of Emergency Medicine and\nDepartment of Cellular and Integrative Physiology, Indianapolis, Indiana", "department": "None" }, { "first_name": "Bikash", "middle_name": "", "last_name": "Bhattarai", "name_suffix": "", "institution": "University of Arizona College of Medicine-\nPhoenix, Maricopa Integrated Health System,Department of Medicine Administration, Phoenix, Arizona", "department": "None" }, { "first_name": "Mark", "middle_name": "", "last_name": "Courtney", "name_suffix": "", "institution": "Northwestern University’s Feinberg School of\nMedicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Christopher", "middle_name": "", "last_name": "Kabrhel", "name_suffix": "", "institution": "Massachusetts General Hospital, Department of Emergency Medicine, Center for\nVascular Emergencies, Boston, Massachusetts.\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" } ], "date_submitted": "2017-08-27T02:36:25+02:00", "date_accepted": "2017-08-27T02:36:25+02:00", "date_published": "2018-03-08T16:51:35+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11284/galley/6134/download/" } ] }, { "pk": 11639, "title": "This Article Corrects: “GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes”", "subtitle": null, "abstract": "Introduction: \nThere are established and validated clinical decision tools for cervical spine clearance. Almost all the rules include spinal tenderness on exam as an indication for imaging. Our goal was to apply GLASS, a previously derived clinical decision tool for cervical spine clearance, to thoracolumbar injuries. GLass intact Assures Safe Spine (GLASS) is a simple, objective method to evaluate those patients involved in motor vehicle collisions and determine which are at low risk for thoracolumbar injuries.\nMethods:\n We performed a retrospective cohort study using the National Accident Sampling System-Crashworthiness Data System (NASS-CDS) over an 11-year period (1998-2008). Sampled occupant cases selected in this study included patients age 16-60 who were belt-restrained, front- seat occupants involved in a crash with no airbag deployment, and no glass damage prior to the crash.\nResults:\n We evaluated 14,191 occupants involved in motor vehicle collisions in this analysis. GLASS had a sensitivity of 94.4% (95% CI [86.3-98.4%]), specificity of 54.1% (95% CI [53.2-54.9%]), and negative predictive value of 99.9% (95% CI [99.8-99.9%]) for thoracic injuries, and a sensitivity of 90.3% (95% CI [82.8-95.2%]), specificity of 54.2% (95% CI [53.3-54.9%]), and negative predictive value of 99.9% (95% CI [99.7-99.9%]) for lumbar injuries.\nConclusion:\n The GLASS rule represents the possibility of a novel, more-objective thoracolumbar spine clearance tool. Prospective evaluation would be required to further evaluate the validity of this clinical decision rule. [West J Emerg Med. 2017;18(6)1108-1113.]", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Erratum", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/080492rs", "frozenauthors": [ { "first_name": "Seth", "middle_name": "", "last_name": "Althoff", "name_suffix": "", "institution": "Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" }, { "first_name": "Ryan", "middle_name": "", "last_name": "Overberger", "name_suffix": "", "institution": "Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" }, { "first_name": "Mark", "middle_name": "", "last_name": "Sochor", "name_suffix": "", "institution": "University of Virginia, Department of Emergency Medicine, Charlottesville, Virginia", "department": "None" }, { "first_name": "Dipan", "middle_name": "", "last_name": "Bose", "name_suffix": "", "institution": "World Bank, Transport Specialist, Washington, DC", "department": "None" }, { "first_name": "Joshua", "middle_name": "", "last_name": "Werner", "name_suffix": "", "institution": "Einstein Medical Center, Department of Emergency Medicine, Philadelphia, Pennsylvania", "department": "None" } ], "date_submitted": "2018-02-19T18:53:10+01:00", "date_accepted": "2018-02-19T18:53:10+01:00", "date_published": "2018-03-05T23:11:40+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11639/galley/6263/download/" } ] }, { "pk": 11658, "title": "WestJEM Full-Text Issue", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "WestJEM Full-Text Issue", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0r76n1qv", "frozenauthors": [ { "first_name": "Nancy", "middle_name": "G.", "last_name": "Hernandez", "name_suffix": "", "institution": "UC Irvine", "department": "None" } ], "date_submitted": "2018-03-05T22:13:13+01:00", "date_accepted": "2018-03-05T22:13:13+01:00", "date_published": "2018-03-05T22:13:43+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11658/galley/6270/download/" } ] }, { "pk": 44448, "title": "A Subcarinal Mass", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7p7493zw", "frozenauthors": [ { "first_name": "Sharon", "middle_name": "", "last_name": "De Cruz", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Eric", "middle_name": "", "last_name": "Kleerip", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-05T17:24:43+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44448/galley/33241/download/" } ] }, { "pk": 44459, "title": "Nutritional Deficiencies and Metabolic Bone Disease in Primary Biliary Cholangitis", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2br1g6ck", "frozenauthors": [ { "first_name": "Rauz", "middle_name": "A", "last_name": "Eshraghi", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Sonya", "middle_name": "", "last_name": "Heitmann", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-03-05T10:05:34+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44459/galley/33252/download/" } ] }, { "pk": 1827, "title": "The fivethirtyeight R Package: \"Tame Data\" Principles for Introductory Statistics and Data Science Courses", "subtitle": null, "abstract": "As statistics and data science instructors, we often seek to use data in our courses that are rich, real, realistic, and relevant. To this end we created the fivethirtyeight R package of data and code behind the stories and interactives at the data journalism website FiveThirtyEight.com. After a discussion on the conflicting pedagogical goals of \"minimizing prerequisites to research\" (Cobb 2015) while at the same time presenting students with a realistic view of data as it exists \"in the wild,\" we articulate how a desired balance between these two goals informed the design of the package. The details behind this balance are articulated as our proposed \"Tame data principles for introductory statistics and data science courses.\" Details of the package's construction and example uses are included as well.", "language": "en", "license": null, "keywords": [], "section": "Technology Innovations", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0rx1231m", "frozenauthors": [ { "first_name": "Albert", "middle_name": "Y.", "last_name": "Kim", "name_suffix": "", "institution": "Department of Mathematics and Statistics\nAmherst College", "department": "None" }, { "first_name": "Chester", "middle_name": "", "last_name": "Ismay", "name_suffix": "", "institution": "DataCamp", "department": "None" }, { "first_name": "Jennifer", "middle_name": "", "last_name": "Chunn", "name_suffix": "", "institution": "Nordstrom", "department": "None" } ], "date_submitted": "2017-08-08T21:41:00+02:00", "date_accepted": "2017-08-08T21:41:00+02:00", "date_published": "2018-03-02T09:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "", "path": "https://journalpub.escholarship.org/tise/article/1827/galley/1248/download/" } ] }, { "pk": 39744, "title": "Cosmopolitism and endemism in free-living nematodes", "subtitle": null, "abstract": "Most free-living nematodes should have a global distribution if they would follow general tendencies of microbial organisms. Information on free-living nematodes presented in this review demonstrates that this cosmopolitanism is less common than assumed by theory. While very large distribution ranges are observed in a number of nematode species, various examples of endemism are described for isolated units like islands, extreme environments and ancient pre-Quaternary lakes. Endemism is generally rare among microorganisms, but a typical observation for larger organisms. The biogeography of nematodes thus reflects their intermediate position between macro- and microorganisms and future studies on this interesting group may help identifying why the positive relationship between body size and range size observed in large animals shifts to a negative relationship in microbial organisms.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1dt9c15r", "frozenauthors": [ { "first_name": "Aldo", "middle_name": "", "last_name": "Zullini", "name_suffix": "", "institution": "Università di Milano-Bicocca, Piazza della Scienza 2, 20126 Milan", "department": "None" } ], "date_submitted": "2017-04-21T08:13:06+02:00", "date_accepted": "2017-04-21T08:13:06+02:00", "date_published": "2018-03-01T09:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/biogeographia/article/39744/galley/29936/download/" } ] }, { "pk": 44447, "title": "Multiple Myeloma Presenting with Sub-acute Kidney Injury and No Proteinuria", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/9hn1448h", "frozenauthors": [ { "first_name": "Ramya", "middle_name": "", "last_name": "Malchira", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Michael", "middle_name": "", "last_name": "Shye", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-02-28T17:19:21+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44447/galley/33240/download/" } ] }, { "pk": 39746, "title": "Mammal endemism In Italy: A review", "subtitle": null, "abstract": "Although there are various checklists of Italian mammals, there is not yet a synthesis of those mammals that are endemic to Italy. Therefore, we provide for the first time a detailed review on Italian mammal endemic species including endemic taxa deserving additional studies. This review is based on the most recent taxonomic revisions obtained using Scopus and Google Scholar databases. We also considered the age of endemic species. Some aspects of mammalian conservation are also provided and discussed.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Endemism, Mammals, Italy, Conservation, Taxonomy, Regional biodiversity" } ], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1jq6b383", "frozenauthors": [ { "first_name": "Giovanni", "middle_name": "", "last_name": "Amori", "name_suffix": "", "institution": "CNR", "department": "None" }, { "first_name": "Riccardo", "middle_name": "", "last_name": "Castiglia", "name_suffix": "", "institution": "Dipartimento di Biologia e Biotecnologie \"Charles Darwin\", Roma", "department": "None" } ], "date_submitted": "2017-06-16T11:17:50+02:00", "date_accepted": "2017-06-16T11:17:50+02:00", "date_published": "2018-02-28T15:25:47+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/biogeographia/article/39746/galley/29937/download/" } ] }, { "pk": 39749, "title": "Epikarstic crustaceans from some Italian caves: endemisms and spatial scales.", "subtitle": null, "abstract": "The epikarst crustacean fauna from four Sicilian caves (Conza, Entella, Molara, and Zubbia del Cavallo caves) and four caves in the Lessinian Massif in the Venetian Prealps (Covolo della Croce, Ponte di Veja, Roverè Mille, Buso della Rana caves) was recently investigated. The two groups of caves differ in their environmental conditions: the Sicilian caves are fossil except one which has an active branch; they are all fed by strongly intermittent and scarce rainfall peaking in the fall. The Lessinian caves are fed by more abundant rainfall, with two yearly peaks (May-June and October-November); two of them are active, one has a temporary stream, one is fossil. The crustacean fauna found in the epikarst drip of each of the studied caves is characterized by interesting endemic harpacticoid and cyclopoid copepods, and one bathynellacean syncarid, often collected in only one cave. Higher diversity of stygobiotic taxa was recorded for the Lessinian caves (9 species of copepods in the Lessinian, and 6 species of copepods and one bathynellacean in Sicily); most of the taxa collected in Sicily are endemic to one cave. Spatial analysis showed very different distributions over short spatial scales (tens of kilometers) and, within each cave, the distribution also varied over distances of a few meters. Our data correspond with other studies where many epikarst crustaceans showed a distribution with a linear extent of only a few hundred meters: the epikarst fauna is not uniformly distributed but rather divided in “blocks” probably characterized by different environmental conditions and, as a consequence, by different taxocoenoses. The data highlight the epikarst as a source of “hidden” biodiversity, and the importance of management protection plans which include not only the caves, but also the epikarst overlying layer and the water sources that feed it.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "epikarstic drip, Copepoda, Sicily, Venetia, Italy." } ], "section": "Articles", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5918g1mx", "frozenauthors": [ { "first_name": "Maria Cristina", "middle_name": "", "last_name": "Bruno", "name_suffix": "", "institution": "Edmund Mach Foundation, Research and Innovation Centre, S. Michele all’Adige (TN), Italy;", "department": "None" }, { "first_name": "Vezio", "middle_name": "", "last_name": "Cottarelli", "name_suffix": "", "institution": "Department for Innovation in Biological, Agro-food and Forest systems, Tuscia University, Viterbo, Italy;", "department": "None" }, { "first_name": "Rosario", "middle_name": "", "last_name": "Grasso", "name_suffix": "", "institution": "Department of Biological, Geological and Environmental Sciences, Catania University, Catania, Italy;", "department": "None" }, { "first_name": "Leonardo", "middle_name": "", "last_name": "Latella", "name_suffix": "", "institution": "Department of Zoology, Museo Civico di Storia Naturale, Verona, Italy;", "department": "None" }, { "first_name": "Silvia", "middle_name": "", "last_name": "Zaupa", "name_suffix": "", "institution": "Department of Earth and Environmental Sciences, Bicocca University, Milan, Italy.", "department": "None" }, { "first_name": "Maria Teresa", "middle_name": "", "last_name": "Spena", "name_suffix": "", "institution": "Department of Biological, Geological and Environmental Sciences, Catania University, Catania, Italy;", "department": "None" } ], "date_submitted": "2017-07-28T11:49:04+02:00", "date_accepted": "2017-07-28T11:49:04+02:00", "date_published": "2018-02-28T15:22:36+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/biogeographia/article/39749/galley/29939/download/" } ] }, { "pk": 44458, "title": "Life-Threatening Venous Thrombosis and Bowel Ischemia Associated with Prothrombin G20210A and MTHFR Mutations – Report of Four Cases and Review of Literature", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3r63w04c", "frozenauthors": [ { "first_name": "Yi-Kong", "middle_name": "", "last_name": "Keung", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Tina", "middle_name": "", "last_name": "Wang", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Eddie", "middle_name": "", "last_name": "Hong-Lung Hu", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-02-27T18:33:00+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44458/galley/33251/download/" } ] }, { "pk": 10929, "title": "Emergency Department Experience with Novel Electronic Medical Record Order for Referral to Food Resources", "subtitle": null, "abstract": "Introduction: \nFood insecurity is a significant issue in the United States and is prevalent in emergency department (ED) patients. The purpose of this study was to report the novel use of an integrated electronic medical record (EMR) order for food resources, and to describe our initial institutional referral patterns after focused education and implementation of the order.\nMethods:\n This was a retrospective, observational study, describing food-bank referral patterns before and after the implementation of dedicated ED education on the novel EMR order for food resources. \nResults:\n In 2015, prior to formal education a total of 1,003 referrals were made to the regional food bank, Second Harvest Heartland. Five referrals were made from the ED. In 2016, after the educational interventions regarding the referral, there were 1,519 referrals hospital-wide, and 55 referrals were made from the ED. Of the 1,519 referrals 1,129 (74%) were successfully contacted by Second Harvest Heartland, and 954 (63%) accepted and received assistance. \nConclusion:\n Use of the EMR as a tool to refer patients to partner organizations for food resources is plausible and may result in an increase in ED referrals for food resources. Appropriate education is crucial for application of this novel ED process.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Food Insecurity" }, { "word": "Electronic medical record" }, { "word": "emergency department" }, { "word": "Food Bank" } ], "section": "Societal Influence on Emergency Department Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5gg6b2x4", "frozenauthors": [ { "first_name": "Marc", "middle_name": "L.", "last_name": "Martel", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Lauren", "middle_name": "R.", "last_name": "Klein", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Kurt", "middle_name": "A.", "last_name": "Hager", "name_suffix": "", "institution": "Tufts University School of Medicine and Friedman School of Nutrition Science and Policy, Boston, Massachusetts", "department": "None" }, { "first_name": "Diana", "middle_name": "B.", "last_name": "Cutts", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Pediatrics, Minneapolis, Minnesota", "department": "None" } ], "date_submitted": "2017-06-14T00:53:26+02:00", "date_accepted": "2017-06-14T00:53:26+02:00", "date_published": "2018-02-26T21:49:09+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10929/galley/5917/download/" } ] }, { "pk": 11535, "title": "Comparison of the NEXUS II and Canadian Head CT Decision Instruments", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Abstracts", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7x65c0m2", "frozenauthors": [ { "first_name": "W", "middle_name": "R", "last_name": "Mower", "name_suffix": "", "institution": "Department of Emergency Medicine, UCLA Geffen School of Medicine", "department": "None" }, { "first_name": "M.", "middle_name": "", "last_name": "Gupta", "name_suffix": "", "institution": "UCLA Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California", "department": "None" }, { "first_name": "R.", "middle_name": "", "last_name": "Rodriguez", "name_suffix": "", "institution": "UCLA Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California", "department": "None" }, { "first_name": "G.", "middle_name": "W.", "last_name": "Hendey", "name_suffix": "", "institution": "UCLA Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California", "department": "None" } ], "date_submitted": "2018-01-03T18:16:08+01:00", "date_accepted": "2018-01-03T18:16:08+01:00", "date_published": "2018-02-26T19:10:17+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11535/galley/6222/download/" } ] }, { "pk": 11534, "title": "Triage Accuracy and Variability Using the Emergency Severity Index: A Multinational Study", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Abstracts", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/65k4w63t", "frozenauthors": [ { "first_name": "Binoy", "middle_name": "", "last_name": "Mistry", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland, USA", "department": "None" }, { "first_name": "S.", "middle_name": "", "last_name": "Stewart de Ramirez", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "K.", "middle_name": "", "last_name": "Balhara", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "S.", "middle_name": "", "last_name": "Levin", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "G.", "middle_name": "", "last_name": "Kelen", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "P.", "middle_name": "", "last_name": "Schmitz", "name_suffix": "", "institution": "Hospital Moinhos de Vento, Department of Emergency Medicine, Porto Alegre, Brazil", "department": "None" }, { "first_name": "X.", "middle_name": "", "last_name": "Anton", "name_suffix": "", "institution": "Al Rahba Hospital, Department of Emergency Medicine, Abu Dhabi, United Arab Emirates", "department": "None" }, { "first_name": "D.", "middle_name": "", "last_name": "Martinez", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "K.", "middle_name": "", "last_name": "Psoter", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland", "department": "None" }, { "first_name": "D.", "middle_name": "", "last_name": "Radu", "name_suffix": "", "institution": "Hospital Moinhos de Vento, Department of Emergency Medicine, Porto Alegre, Brazil", "department": "None" }, { "first_name": "I.", "middle_name": "", "last_name": "Yassin Othman", "name_suffix": "", "institution": "Al Rahba Hospital, Department of Emergency Medicine, Abu Dhabi, United Arab Emirates", "department": "None" }, { "first_name": "M.", "middle_name": "", "last_name": "Abdel Latif E’nouz", "name_suffix": "", "institution": "Al Rahba Hospital, Department of Emergency Medicine, Abu Dhabi, United Arab Emirates", "department": "None" }, { "first_name": "J.", "middle_name": "S.", "last_name": "Hinson", "name_suffix": "", "institution": "Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" } ], "date_submitted": "2018-01-03T18:14:22+01:00", "date_accepted": "2018-01-03T18:14:22+01:00", "date_published": "2018-02-26T19:07:54+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11534/galley/6221/download/" } ] }, { "pk": 11533, "title": "Paediatric Traumatic Cardiac Arrest in England and Wales: A 10-Year Epidemiological Study", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Abstracts", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5xn686gs", "frozenauthors": [ { "first_name": "J", "middle_name": "", "last_name": "Vassallo", "name_suffix": "", "institution": "University of Cape Town", "department": "None" }, { "first_name": "M.", "middle_name": "", "last_name": "Webster", "name_suffix": "", "institution": "Bristol Royal Hospital for Children, Emergency Department, Bristol, United Kingdom", "department": "None" }, { "first_name": "E.", "middle_name": "D.", "last_name": "Barnard", "name_suffix": "", "institution": "Institute of Naval Medicine,\nGosport, United Kingdom\nRoyal Centre for Defence Medicine, Academic Department of Military Emergency Medicine, Birmingham, United Kingdom", "department": "None" }, { "first_name": "M.", "middle_name": "", "last_name": "Fragoso-Iniguez", "name_suffix": "", "institution": "University of Manchester, Trauma Audit and Research Network, Manchester, United Kingdom", "department": "None" }, { "first_name": "M.", "middle_name": "D.", "last_name": "Lyttle", "name_suffix": "", "institution": "Bristol Royal Hospital for Children, Emergency Department, Bristol, United Kingdom\nUniversity of the West of England, Health and Life Sciences, Bristol, United Kingdom", "department": "None" }, { "first_name": "J.", "middle_name": "E.", "last_name": "Smith", "name_suffix": "", "institution": "Derriford Hospital, Emergency Department, Plymouth, United Kingdom\nRoyal Centre for Defence Medicine, Academic Department of Military Emergency Medicine, Birmingham, United Kingdom", "department": "None" } ], "date_submitted": "2018-01-03T18:11:39+01:00", "date_accepted": "2018-01-03T18:11:39+01:00", "date_published": "2018-02-26T19:00:06+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11533/galley/6220/download/" } ] }, { "pk": 11102, "title": "Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia", "subtitle": null, "abstract": "Introduction:\n Procedural sedation and analgesia (PSA) is used by non-anesthesiologists (NAs) outside of the operating room for several types of procedures. Adverse events during pediatric PSA that pose the most risk to patient safety involve airway compromise. Higher Mallampati scores may indirectly indicate children at risk for airway compromise. Medical governing bodies have proposed guidelines for PSA performed by NAs, but these recommendations rarely suggest using Mallampati scores in pre-PSA evaluations. Our objective was to compare rates of adverse events during pediatric PSA in children with Mallampati scores of III/IV vs. scores of Mallampati I/II. \nMethods:\n This was a prospective, observational study. Children 18 years of age and under who presented to the pediatric emergency department (PED) and required PSA were enrolled. We obtained Mallampati scores as part of pre-PSA assessments. We defined adverse events as oxygen desaturation < 90%, apnea, laryngospasm, bag-valve-mask ventilation performed, repositioning of patient, emesis, and “other.” We used chi-square analysis to compare rates of adverse events between groups. \nResults: \nWe enrolled 575 patients. The median age of the patients was 6.0 years (interquartile range = 3.1,9.9). The primary reasons for PSA was fracture reduction (n=265, 46.1%). Most sedations involved the use of ketamine (n= 568, 98.8%). Patients with Mallampati scores of III/IV were more likely to need repositioning compared to those with Mallampati scores of I/II (p=0.049). Overall, patients with Mallampati III/IV scores did not experience a higher proportion of adverse events compared to those with Mallampati scores of I/II. The relative risk of any adverse event in patients with Mallampati scores of III/IV (40 [23.8%]) compared to patients with Mallampati scores of I/II (53 [18.3%]) was 1.3 (95% confidence interval [0.91-1.87]).\nConclusion:\n Patients with Mallampati scores of III/IV vs. Mallampati scores of I/II are not at an increased risk of adverse events during pediatric PSA. However, patients with Mallampati III/IV scores showed an increased need for repositioning, suggesting that the sedating physician should be vigilant when performing PSA in children with higher Mallampati scores.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "pediatric procedural sedation and analgesia, Mallampati, adverse events" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5qk5b7k2", "frozenauthors": [ { "first_name": "Maya", "middle_name": "S.", "last_name": "Iyer", "name_suffix": "", "institution": "The Ohio State University College of Medicine/Nationwide Children’s Hospital, Department of Pediatrics, Section of Emergency Medicine, Columbus, Ohio", "department": "None" }, { "first_name": "Raymond", "middle_name": "D.", "last_name": "Pitteti", "name_suffix": "", "institution": "Children’s Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania", "department": "None" }, { "first_name": "Melissa", "middle_name": "", "last_name": "Vitale", "name_suffix": "", "institution": "Children’s Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania", "department": "None" } ], "date_submitted": "2017-08-10T13:29:21+02:00", "date_accepted": "2017-08-10T13:29:21+02:00", "date_published": "2018-02-26T18:40:38+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11102/galley/5971/download/" } ] }, { "pk": 10692, "title": "Addition of Audiovisual Feedback During Standard Compressions Is Associated with Improved Ability", "subtitle": null, "abstract": "Introduction: \nA benefit of in-hospital cardiac arrest is the opportunity for rapid initiation of “high-quality” chest compressions as defined by current American Heart Association (AHA) adult guidelines as a depth 2-2.4 inches, full chest recoil, rate 100 -120 per minute, and minimal interruptions with a chest compression fraction (CCF) ≥ 60%. The goal of this study was to assess the effect of audiovisual feedback on the ability to maintain high-quality chest compressions as per 2015 updated guidelines.\nMethods:\n Ninety-eight participants were randomized into four groups. Participants were randomly assigned to perform chest compressions with or without use of audiovisual feedback (+/- AVF). Participants were further assigned to perform either standard compressions with a ventilation ratio of 30:2 to simulate cardiopulmonary resuscitation (CPR) without an advanced airway or continuous chest compressions to simulate CPR with an advanced airway. The primary outcome measured was ability to maintain high-quality chest compressions as defined by current 2015 AHA guidelines.\nResults: \nOverall comparisons between continuous and standard chest compressions (n=98) were without significant differences in chest compression dynamics (p’s >0.05). Overall comparisons between +/- AVF (n = 98) were significant for differences in average rate of compressions per minute (p= 0.0241) and proportion of chest compressions within guideline rate recommendations (p = 0.0084). There was a significant difference in the proportion of high quality-chest compressions favoring AVF (p = 0.0399). Comparisons between chest compression strategy groups +/- AVF were significant for differences in compression dynamics favoring AVF (p’s < 0.05). \nConclusion:\n Overall, AVF is associated with greater ability to maintain high-quality chest compressions per most-recent AHA guidelines. Specifically, AVF was associated with a greater proportion of compressions within ideal rate with standard chest compressions while demonstrating a greater proportion of compressions with simultaneous ideal rate and depth with a continuous compression strategy.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Cardiopulmonary Arrest" }, { "word": "chest compressions" }, { "word": "Simulation" }, { "word": "Quality Improvement" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/8kk6q5bn", "frozenauthors": [ { "first_name": "Steve", "middle_name": "A.", "last_name": "Aguilar", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" }, { "first_name": "Nicholas", "middle_name": "", "last_name": "Asakawa", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" }, { "first_name": "Cameron", "middle_name": "", "last_name": "Saffer", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" }, { "first_name": "Christine", "middle_name": "", "last_name": "Williams", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" }, { "first_name": "Steven", "middle_name": "", "last_name": "Chuh", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" }, { "first_name": "Lewei", "middle_name": "", "last_name": "Duan", "name_suffix": "", "institution": "Kaiser Permanente Medical Center, San Diego, Emergency Medicine, San Diego, California", "department": "None" } ], "date_submitted": "2017-03-24T21:59:38+01:00", "date_accepted": "2017-03-24T21:59:38+01:00", "date_published": "2018-02-26T18:40:07+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10692/galley/5841/download/" } ] }, { "pk": 9949, "title": "A Tactical Medicine After-action Report of the San Bernardino Terrorist Incident", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Active Shooter" }, { "word": "San Bernardino" }, { "word": "Tactical" }, { "word": "TECC" }, { "word": "Disaster Medicine" }, { "word": "Mass Casualty Incident" } ], "section": "Disaster Preparedness", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/7zf9j4w1", "frozenauthors": [ { "first_name": "Joshua", "middle_name": "P.", "last_name": "Bobko", "name_suffix": "", "institution": "Loma Linda University, Department of Emergency Medicine, Loma Linda, California \nWest County Special Weapons and Tactical Team, Orange County, California", "department": "None" }, { "first_name": "Mrinal", "middle_name": "", "last_name": "Sinha", "name_suffix": "", "institution": "First Care Provider Foundation, Research Associate", "department": "None" }, { "first_name": "David", "middle_name": "", "last_name": "Chen", "name_suffix": "", "institution": "Huntington Beach Special Weapons and Tactical Team, Huntington Beach, California", "department": "None" }, { "first_name": "Stephen", "middle_name": "", "last_name": "Patterson", "name_suffix": "", "institution": "San Bernardino Sheriff Aviation Department, Division of Aviation, San Bernardino, California", "department": "None" }, { "first_name": "Michael", "middle_name": "", "last_name": "Eby", "name_suffix": "", "institution": "Adjunct Professor, Citrus College", "department": "None" }, { "first_name": "William", "middle_name": "", "last_name": "Harris", "name_suffix": "", "institution": "First Care Provider Foundation, Director", "department": "None" }, { "first_name": "Ryan", "middle_name": "", "last_name": "Starling", "name_suffix": "", "institution": "San Bernardino Police Department, San Bernardino, California", "department": "None" }, { "first_name": "Ofer", "middle_name": "", "last_name": "Lichtman", "name_suffix": "", "institution": "Rancho Cucamonga Fire District, Rancho Cucamonga, California", "department": "None" } ], "date_submitted": "2016-06-24T00:50:29+02:00", "date_accepted": "2016-06-24T00:50:29+02:00", "date_published": "2018-02-26T18:38:19+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/9949/galley/5454/download/" } ] }, { "pk": 10864, "title": "Emergency Department Frequent Users for Acute Alcohol Intoxication", "subtitle": null, "abstract": "Introduction:\n A subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described.\n \nMethods:\n This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters.\nResults:\n We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. \nConclusion:\n In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Frequent Users, Alcohol intoxication" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3km108tw", "frozenauthors": [ { "first_name": "Lauren", "middle_name": "R.", "last_name": "Klein", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Marc", "middle_name": "L.", "last_name": "Martel", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Brian", "middle_name": "E.", "last_name": "Driver", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Mackenzie", "middle_name": "", "last_name": "Reing", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" }, { "first_name": "Jon", "middle_name": "B.", "last_name": "Cole", "name_suffix": "", "institution": "Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota", "department": "None" } ], "date_submitted": "2017-06-02T21:34:25+02:00", "date_accepted": "2017-06-02T21:34:25+02:00", "date_published": "2018-02-26T18:37:38+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10864/galley/5899/download/" } ] }, { "pk": 11295, "title": "An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit", "subtitle": null, "abstract": "Introduction:\n Physicians are at much higher risk for burnout, depression, and suicide than their non-medical peers. One of the working groups from the May 2017 Resident Wellness Consensus Summit (RWCS) addressed this issue through the development of a longitudinal residency curriculum to address resident wellness and burnout.\nMethods:\n A 30-person (27 residents, three attending physicians) Wellness Curriculum Development workgroup developed the curriculum in two phases. In the first phase, the workgroup worked asynchronously in the Wellness Think Tank – an online resident community – conducting a literature review to identify 10 core topics. In the second phase, the workgroup expanded to include residents outside the Wellness Think Tank at the live RWCS event to identify gaps in the curriculum. This resulted in an additional seven core topics. \nResults:\n Seventeen foundational topics served as the framework for the longitudinal resident wellness curriculum. The curriculum includes a two-module introduction to wellness; a seven-module “Self-Care Series” focusing on the appropriate structure of wellness activities and everyday necessities that promote physician wellness; a two-module section on physician suicide and self-help; a four-module “Clinical Care Series” focusing on delivering bad news, navigating difficult patient encounters, dealing with difficult consultants and staff members, and debriefing traumatic events in the emergency department; wellness in the workplace; and dealing with medical errors and shame. \nConclusion:\n The resident wellness curriculum, derived from an evidence-based approach and input of residents from the Wellness Think Tank and the RWCS event, provides a guiding framework for residency programs in emergency medicine and potentially other specialties to improve physician wellness and promote a culture of wellness.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0k44t25v", "frozenauthors": [ { "first_name": "Jacob", "middle_name": "", "last_name": "Arnold", "name_suffix": "", "institution": "Carl R. Darnall Army Medical Center, Department of Emergency Medicine, Fort Hood, Texas", "department": "None" }, { "first_name": "Jennifer", "middle_name": "", "last_name": "Tango", "name_suffix": "", "institution": "Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California", "department": "None" }, { "first_name": "Ian", "middle_name": "", "last_name": "Walker", "name_suffix": "", "institution": "Sinai-Grace Hospital, Department of Emergency Medicine, Detroit, Michigan", "department": "None" }, { "first_name": "Chris", "middle_name": "", "last_name": "Waranch", "name_suffix": "", "institution": "University of Missouri Hospital, Department of Emergency Medicine, Columbia, Missouri", "department": "None" }, { "first_name": "Joshua", "middle_name": "", "last_name": "McKamie", "name_suffix": "", "institution": "Detroit Receiving Hospital, Department of Emergency Medicine, Detroit, Michigan", "department": "None" }, { "first_name": "Zafrina", "middle_name": "", "last_name": "Poonja", "name_suffix": "", "institution": "University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada", "department": "None" }, { "first_name": "Anne", "middle_name": "", "last_name": "Messman", "name_suffix": "", "institution": "Sinai-Grace Hospital, Department of Emergency Medicine, Detroit, Michigan", "department": "None" } ], "date_submitted": "2017-08-29T21:48:50+02:00", "date_accepted": "2017-08-29T21:48:50+02:00", "date_published": "2018-02-26T18:36:55+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11295/galley/6138/download/" } ] }, { "pk": 11303, "title": "Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial", "subtitle": null, "abstract": "Introduction: Oleoresin capsicum (OC) or pepper spray, and tear gas (CS) are used by police and the military and produce severe discomfort. Some have proposed that washing with baby shampoo helps reduce this discomfort. Methods: We conducted a prospective, randomized, controlled study to determine if baby shampoo is effective in reducing the severity and duration of these effects. Study subjects included volunteers undergoing OC or CS exposure as part of their police or military training. After standardized exposure to OC or CS all subjects were allowed to irrigate their eyes and skin ad lib with water. Those randomized to the intervention group were provided with baby shampoo for application to their head, neck, and face. Participants rated their subjective discomfort in two domains on a scale of 0-10 at 0, 3, 5, 10, and 15 minutes. We performed statistical analysis using a two-tailed Mann-Whitney Test.Results: There were 58 participants. Of 40 subjects in the OC arm of the study, there were no significant differences in the ocular or respiratory discomfort at any of the time points between control (n=19) and intervention (n=21) groups. Of 18 subjects in the CS arm, there were no significant differences in the ocular or skin discomfort at any of the time points between control (n=8) and intervention (n=10) groups.Conclusion: Irrigation with water and baby shampoo provides no better relief from OC- or CS-induced discomfort than irrigation with water alone.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Tear Gas, Pepper Spray, decontamination, police" } ], "section": "Disaster Preparedness", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5dw246nw", "frozenauthors": [ { "first_name": "Jason", "middle_name": "P.", "last_name": "Stopyra", "name_suffix": "", "institution": "Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "James", "middle_name": "E.", "last_name": "Winslow", "name_suffix": "", "institution": "Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "James", "middle_name": "C.", "last_name": "Johnson", "name_suffix": "", "institution": "Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "Keith", "middle_name": "D.", "last_name": "Hill", "name_suffix": "", "institution": "Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" }, { "first_name": "William", "middle_name": "P.", "last_name": "Bozeman", "name_suffix": "", "institution": "Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina", "department": "None" } ], "date_submitted": "2017-09-02T21:30:22+02:00", "date_accepted": "2017-09-02T21:30:22+02:00", "date_published": "2018-02-26T18:36:16+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11303/galley/6140/download/" } ] }, { "pk": 11056, "title": "High Prevalence of Sterile Pyuria in the Setting of Sexually Transmitted Infection in Women Presenting to an Emergency Department", "subtitle": null, "abstract": "Introduction:\n The clinical presentations for sexually transmitted infections (STI) and urinary tract infections (UTI) often overlap, and symptoms of dysuria and urinary frequency/urgency occur with both STIs and UTIs. Abnormal urinalysis (UA) findings and pyuria are common in both UTIs and STIs, and confirmatory urine cultures are not available to emergency clinicians to aid in decision-making regarding prescribing antibiotics for UTIs. The objective of this study was to determine the frequency of sterile pyuria in women with confirmed STIs, as well as whether the absolute number of leukocytes on microscopy or nitrite on urine dipstick correlated with positive urine cultures in patients with confirmed STIs. We also sought to determine how many patients with STIs were inappropriately prescribed a UTI antibiotic. \nMethods:\n We performed a retrospective chart review of patients aged 18-50 who had a urinalysis and pelvic examination in the emergency department (including cervical cultures), and tested positive for Neisseria gonorrhoeae, Chlamydia trachomatis, and/or Trichomonas vaginalis. Descriptive statistics were obtained for all variables, and associations between various findings were sought using the Fisher’s exact test for categorical variables. We calculated comparison of proportions using the N-1 chi-squared analysis. \nResults: \nA total of 1,052 female patients tested positive for Neisseria gonorrhoeae, Chlamydia trachomatis, and/or Trichomonas vaginalis and were entered into the database. The prevalence of pyuria in all cases was 394/1,052, 37% (95% confidence interval [CI] [0.34-0.40]). Of the cases with pyuria, 293/394, 74% (95% CI [0.70-0.78]) had sterile pyuria with negative urine cultures. The prevalence of positive urine cultures in our study population was 101/1,052, 9.6% (95% CI [0.08-0.11]). Culture positive urines had a mean of 34 leukocytes per high-power field, and culture negative urines had a mean of 24 leukocytes per high-power field, with a difference of 10, (95% CI [3.46-16.15]), which was statistically significant (p=0.003). Only 123 cases tested positive for nitrite on the urinalysis dipstick; 50/123, 41% (95% CI [0.32-0.49]) had positive urine cultures, and 73/123, 59% (95% CI [0.51-0.68]) had negative urine cultures. Nitrite-positive urines were actually 18% more likely to be associated with negative urine cultures in the setting of positive STI cases, (95% CI [4.95-30.42], p=0.0048). Antibiotics were prescribed for 295 patients with suspected UTI. Of these, 195/295, 66% (95% CI [0.61-0.71]) had negative urine cultures, and 100/295, 34% (0.33, 95% CI [0.28-0.39]) had positive urine cultures. Chi-square analysis yielded a difference of these proportions of 32% (95% CI [23.92-39.62], p<0.0001).\nConclusion:\n This study demonstrated that in female patients with STIs who have pyuria, there is a high prevalence of sterile pyuria. Our results suggest that reliance on pyuria or positive nitrite for the decision to add antimicrobial therapy empirically for a presumed urinary tract infection in cases in which an STI is confirmed or highly suspected is likely to result in substantial over-treatment.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Sterile Pyuria Sexually Transmitted Infection" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3d42q3cg", "frozenauthors": [ { "first_name": "Stacia", "middle_name": "B.", "last_name": "Shipman", "name_suffix": "", "institution": "Integris Southwest Medical Center, Department of Emergency Medicine, Oklahoma City, Oklahoma", "department": "None" }, { "first_name": "Chelsea", "middle_name": "R.", "last_name": "Risinger", "name_suffix": "", "institution": "Norman Regional Health System, Department of Emergency Medicine, Norman, Oklahoma", "department": "None" }, { "first_name": "Crystalle", "middle_name": "M.", "last_name": "Evans", "name_suffix": "", "institution": "Chickasaw Nation Medical Center, Department of Emergency Medicine, Ada, Oklahoma", "department": "None" }, { "first_name": "Chelsey", "middle_name": "D.", "last_name": "Gilbertson", "name_suffix": "", "institution": "Integris Southwest Medical Center, Department of Emergency Medicine, Oklahoma City, Oklahoma", "department": "None" }, { "first_name": "David", "middle_name": "E.", "last_name": "Hogan", "name_suffix": "", "institution": "Integris Southwest Medical Center, Department of Emergency Medicine, Oklahoma City, Oklahoma", "department": "None" } ], "date_submitted": "2017-07-06T23:03:43+02:00", "date_accepted": "2017-07-06T23:03:43+02:00", "date_published": "2018-02-26T18:35:39+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11056/galley/5954/download/" } ] }, { "pk": 10820, "title": "Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis", "subtitle": null, "abstract": "Introduction:\n This study investigated whether a 9.6% decrease in the use of head computed tomography (HCT) for patients presenting to the emergency department (ED) with a chief complaint of headache was followed by an increase in proportions of death or missed intracranial diagnosis during the 22.5-month period following each index ED visit.\nMethods:\n We reviewed the electronic medical records of all patients sampled during a quality improvement effort in which the aforementioned decrease in HCT use had been observed. We reviewed notes from the ED, neurology, neurosurgery, and primary care services, as well as all brain imaging results to determine if death occurred or if an intracranial condition was discovered in the 22.5 months after each index ED visit. An independent, blinded reviewer reviewed each case where an intracranial condition was diagnosed after ED discharge to determine whether the condition was reasonably likely to have been related to the index ED visit’s presentation, thereby representing a missed diagnosis.\nResults:\n Of the 582 separate index ED visits sampled, we observed a total of nine deaths and 10 missed intracranial diagnoses. There was no difference in the proportion of death (p = 0.337) or missed intracranial diagnosis (p = 0.312) observed after a 9.6% reduction in HCT use. Among patients who subsequently had visits for headache or brain imaging, we found that these patients were significantly more likely to have not had a HCT done during the index ED visit (59.2% vs. 49.6% (p = 0.031) and 37.1% vs. 26% (p = 0.006), respectively).\nConclusion:\n Our study adds to the compelling evidence that there is opportunity to safely decrease CT imaging for ED patients. To determine the cost effectiveness of such reductions further research is needed to measure what patients and their healthcare providers do after discharge from the ED when unnecessary testing is withheld.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Medical Imaging, Headache, Education, Clinical Guidelines, Administration/CQI" } ], "section": "Health Outcomes", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/59w5q18r", "frozenauthors": [ { "first_name": "Daniel", "middle_name": "G.", "last_name": "Miller", "name_suffix": "", "institution": "University of Iowa, College of Medicine, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Priyanka", "middle_name": "", "last_name": "Vakkalanka", "name_suffix": "", "institution": "University of Iowa, College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\nUniversity of Iowa, College of Public Health, Department of Epidemiology, Iowa City, Iowa", "department": "None" }, { "first_name": "Mark", "middle_name": "L.", "last_name": "Moubarek", "name_suffix": "", "institution": "University of Iowa, College of Medicine, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Sangil", "middle_name": "", "last_name": "Lee", "name_suffix": "", "institution": "University of Iowa, College of Medicine, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Nicholas", "middle_name": "M.", "last_name": "Mohr", "name_suffix": "", "institution": "University of Iowa, College of Medicine, Department of Emergency Medicine, Iowa City, Iowa\nUniversity of Iowa, College of Medicine, Iowa City, Iowa", "department": "None" } ], "date_submitted": "2017-05-18T21:32:55+02:00", "date_accepted": "2017-05-18T21:32:55+02:00", "date_published": "2018-02-26T18:35:08+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10820/galley/5890/download/" } ] }, { "pk": 11517, "title": "Just Missing the Mark: Discharging High-risk Atrial Fibrillation / Flutter without Thromboprophylaxis", "subtitle": null, "abstract": "n/a", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Patient Safety", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/76j267ts", "frozenauthors": [ { "first_name": "Linda", "middle_name": "B.", "last_name": "Thompson", "name_suffix": "", "institution": "University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama", "department": "None" }, { "first_name": "Michael", "middle_name": "C.", "last_name": "Kurz", "name_suffix": "", "institution": "University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama", "department": "None" } ], "date_submitted": "2017-12-19T21:09:45+01:00", "date_accepted": "2017-12-19T21:09:45+01:00", "date_published": "2018-02-26T18:34:15+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11517/galley/6213/download/" } ] }, { "pk": 44457, "title": "A Case of Bilateral Peripheral Facial Nerve Palsy", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/5jz139p7", "frozenauthors": [ { "first_name": "Deborah", "middle_name": "", "last_name": "Soong", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Sural", "middle_name": "", "last_name": "Shah", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-02-24T18:31:15+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44457/galley/33250/download/" } ] }, { "pk": 44456, "title": "Discordant Metastatic Breast Cancer Markers", "subtitle": null, "abstract": "", "language": "eng", "license": { "name": "", "short_name": "", "text": null, "url": "" }, "keywords": [ { "word": "Clinical Vignette" } ], "section": "Article", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2d34c8sq", "frozenauthors": [ { "first_name": "Maurice", "middle_name": "J", "last_name": "Berkowitz", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" }, { "first_name": "Karo", "middle_name": "", "last_name": "Arzoo", "name_suffix": "MD", "institution": "University of California, Los Angeles", "department": "Medicine" } ], "date_submitted": null, "date_accepted": null, "date_published": "2018-02-23T18:28:33+01:00", "render_galley": null, "galleys": [ { "label": "PDF", "type": "pdf", "path": "https://journalpub.escholarship.org/ucladom_proceedings/article/44456/galley/33249/download/" } ] }, { "pk": 11385, "title": "Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation", "subtitle": null, "abstract": "Introduction:\n In the emergency department setting, it is essential to rapidly and accurately confirm correct endotracheal tube (ETT) placement. Ultrasound is an increasingly studied modality for identifying ETT location. However, there has been significant variation in techniques between studies, with some using the dynamic technique, while others use a static approach. This study compared the static and dynamic techniques to determine which was more accurate for ETT identification. \n \nMethods: \nWe performed this study in a cadaver lab using three different cadavers to represent variations in neck circumference. Cadavers were randomized to either tracheal or esophageal intubation in equal proportions. Blinded sonographers then assessed the location of the ETT using either static or dynamic sonography. We assessed accuracy of sonographer identification of ETT location, time to identification, and operator confidence.\nResults: \nA total of 120 intubations were performed: 62 tracheal intubations and 58 esophageal intubations. The static technique was 93.6% (95% confidence interval [CI] [84.3% to 98.2%]) sensitive and 98.3% specific (95% CI [90.8% to 99.9%]). The dynamic technique was 92.1% (95% CI [82.4% to 97.4%]) sensitive and 91.2% specific (95% CI [80.7% to 97.1%]). The mean time to identification was 6.72 seconds (95% CI [5.53 to 7.9] seconds) in the static technique and 6.4 seconds (95% CI [5.65 to 7.16] seconds) in the dynamic technique. Operator confidence was 4.9/5.0 (95% CI [4.83 to 4.97]) in the static technique and 4.86/5.0 (95% CI [4.78 to 4.94]) in the dynamic technique. There was no statistically significant difference between groups for any of the outcomes.\nConclusion:\n This study demonstrated that both the static and dynamic sonography approaches were rapid and accurate for confirming ETT location with no statistically significant difference between modalities. Further studies are recommended to compare these techniques in ED patients and with more novice sonographers.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "intubation" }, { "word": "ultrasound" }, { "word": "dynamic" }, { "word": "static" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/07s9h3qf", "frozenauthors": [ { "first_name": "Michael", "middle_name": "", "last_name": "Gottlieb", "name_suffix": "", "institution": "Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Damali", "middle_name": "", "last_name": "Nakitende", "name_suffix": "", "institution": "Advocate Christ Medical Center, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Tina", "middle_name": "", "last_name": "Sundaram", "name_suffix": "", "institution": "Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Anthony", "middle_name": "", "last_name": "Serici", "name_suffix": "", "institution": "Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Shital", "middle_name": "", "last_name": "Shah", "name_suffix": "", "institution": "Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois\nRush University Medical Center, Department of Health Systems Management, Chicago, Illinois", "department": "None" }, { "first_name": "John", "middle_name": "", "last_name": "Bailitz", "name_suffix": "", "institution": "Northwestern Memorial Hospital, Department of Emergency Medicine, Chicago, Illinois", "department": "None" } ], "date_submitted": "2017-10-09T23:05:22+02:00", "date_accepted": "2017-10-09T23:05:22+02:00", "date_published": "2018-02-22T18:21:43+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11385/galley/6167/download/" } ] }, { "pk": 10771, "title": "Nasal Cannula Apneic Oxygenation Prevents Desaturation During Endotracheal Intubation: An Integrative Literature Review", "subtitle": null, "abstract": "Patients requiring emergency airway management may be at greater risk of acute hypoxemic events because of underlying lung pathology, high metabolic demands, insufficient respiratory drive, obesity, or the inability to protect their airway against aspiration. Emergency tracheal intubation is often required before complete information needed to assess the risk of procedural hypoxia is acquired (i.e., arterial blood gas level, hemoglobin value, or chest radiograph). During pre-oxygenation, administering high-flow nasal oxygen in addition to a non-rebreather face mask can significantly boost the effective inspired oxygen. Similarly, with the apnea created by rapid sequence intubation (RSI) procedures, the same high-flow nasal cannula can help maintain or increase oxygen saturation during efforts to secure the tube (oral intubation). Thus, the use of nasal oxygen during pre-oxygenation and continued during apnea can prevent hypoxia before and during intubation, extending safe apnea time, and improve first-pass success attempts. We conducted a literature review of nasal-cannula apneic oxygenation during intubation, focusing on two components: oxygen saturation during intubation, and oxygen desaturation time. We performed an electronic literature search from 1980 to November 2017, using PubMed, Elsevier, ScienceDirect, and EBSCO. We identified 14 studies that pointed toward the benefits of using nasal cannula during emergency intubation.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "nasal cannula, intubation, oxygenation, hypoxia, hypoxemia, tracheal, pharyngeal, apnea, apneic, preoxygenation, insufflation" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/47r141dq", "frozenauthors": [ { "first_name": "Joshua", "middle_name": "M.", "last_name": "Gleason", "name_suffix": "", "institution": "Ross University School of Medicine, Miramar, Florida", "department": "None" }, { "first_name": "Bill", "middle_name": "R.", "last_name": "Christian", "name_suffix": "", "institution": "Ross University School of Medicine, Miramar, Florida", "department": "None" }, { "first_name": "Erik", "middle_name": "D.", "last_name": "Barton", "name_suffix": "", "institution": "University of California Irvine Health, Department of Emergency Medicine, Orange, California", "department": "None" } ], "date_submitted": "2017-04-27T06:12:50+02:00", "date_accepted": "2017-04-27T06:12:50+02:00", "date_published": "2018-02-22T18:18:48+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10771/galley/5869/download/" } ] }, { "pk": 11110, "title": "Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department", "subtitle": null, "abstract": "The opioid epidemic is the most significant modern-day, public health crisis. Physicians and lawmakers have developed methods and practices to curb opioid use. This article describes one method, prescription drug monitoring programs (PDMP), through the lens of how to optimize use for emergency departments (ED). EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. These improvements may help improve clinical decision-making for emergency physicians through better data, data presentation, and accessibility.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "prescription drug monitoring program" }, { "word": "Opioid" }, { "word": "Public health" }, { "word": "Electronic Health Records" } ], "section": "Behavioral Health", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/8695s0p8", "frozenauthors": [ { "first_name": "Joshua", "middle_name": "W.", "last_name": "Elder", "name_suffix": "", "institution": "University of California Davis School of Medicine, Department of Emergency Medicine, Sacramento, California", "department": "None" }, { "first_name": "Garrett", "middle_name": "", "last_name": "DePalma", "name_suffix": "", "institution": "None", "department": "None" }, { "first_name": "Jesse", "middle_name": "M.", "last_name": "Pines", "name_suffix": "", "institution": "The George Washington University School of Medicine and Health Sciences, Departments of Emergency Medicine and Health Policy & Management, Washington, District of Columbia", "department": "None" } ], "date_submitted": "2017-08-15T06:52:04+02:00", "date_accepted": "2017-08-15T06:52:04+02:00", "date_published": "2018-02-22T18:18:14+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11110/galley/5975/download/" } ] }, { "pk": 10602, "title": "Intravenous Continuous Infusion vs. Oral Immediate-release Diltiazem for Acute Heart Rate Control", "subtitle": null, "abstract": "Introduction: \nAtrial fibrillation (AF) is a common diagnosis of patients presenting to the emergency department (ED). Intravenous (IV) diltiazem bolus is often the initial drug of choice for acute management of AF with rapid ventricular response (RVR). The route of diltiazem after the initial IV loading dose may influence the disposition of the patient from the ED. However, no studies exist comparing oral (PO) immediate release and IV continuous infusion diltiazem in the emergency setting. The objective of this study was to compare the incidence of treatment failure, defined as a heart rate (HR) of >110 beats/min at four hours or conversion to another agent, between PO immediate release and IV continuous infusion diltiazem after an initial IV diltiazem loading dose in patients in AF with RVR.\nMethods: \nThis was a single-center, observational, retrospective study conducted at a tertiary academic medical center. The study population included patients ≥18 years old who presented to the ED in AF with a HR > 110 beats/min and received an initial IV diltiazem loading dose. We used multivariate logistic regression to assess the association between routes of administration and treatment failure.\nResults:\n A total of 111 patients were included in this study. Twenty-seven percent (11/41) of the patients in the PO immediate-release group had treatment failure compared to 46% (32/70) in the IV continuous-infusion group. The unadjusted odds ratio (OR) of treatment failure with PO was less than IV at 0.4 (95% confidence interval [CI] [0.18, 0.99], p = 0.046). When we performed a multivariate analysis adjusted for race and initial HR, PO was still less likely to be associated with treatment failure than IV with an OR of 0.4 (95% CI [0.15, 0.94], p = 0.041). The median dose of PO diltiazem and IV continuous infusion diltiazem at four hours was 30 mg and 10 mg/h, respectively.\nConclusion:\n After a loading dose of IV diltiazem, PO immediate-release diltiazem was associated with a lower rate of treatment failure at four hours than IV continuous infusion in patients with AF with RVR.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "atrial fibrillation" }, { "word": "diltiazem" }, { "word": "Emergency Medicine" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/37b9f1hq", "frozenauthors": [ { "first_name": "Kimberly", "middle_name": "N.", "last_name": "Means", "name_suffix": "", "institution": "Virginia Commonwealth University Medical Center, Department of Pharmacy, Richmond, Virginia", "department": "None" }, { "first_name": "Amanda", "middle_name": "E.", "last_name": "Gentry", "name_suffix": "", "institution": "Virginia Commonwealth University, Department of Biostatistics, Richmond, Virginia", "department": "None" }, { "first_name": "Tammy", "middle_name": "T.", "last_name": "Nguyen", "name_suffix": "", "institution": "Virginia Commonwealth University Medical Center, Department of Pharmacy, Richmond, Virginia\nVirginia Commonwealth University Medical Center, Department of Emergency Medicine, Richmond, Virginia", "department": "None" } ], "date_submitted": "2017-02-07T17:59:07+01:00", "date_accepted": "2017-02-07T17:59:07+01:00", "date_published": "2018-02-22T16:24:40+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10602/galley/5813/download/" } ] }, { "pk": 40792, "title": "An Endless End", "subtitle": null, "abstract": "", "language": "en", "license": { "name": "Creative Commons Attribution-NonCommercial 4.0", "short_name": "CC BY-NC 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by-nc/4.0" }, "keywords": [ { "word": "Contemporary Italian Poetry" }, { "word": "Italian poetry" } ], "section": "FORTY ITALIAN POETS ON THEIR ENDS", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/3027111w", "frozenauthors": [ { "first_name": "Gian Maria", "middle_name": "", "last_name": "Annovi", "name_suffix": "", "institution": "", "department": "None" } ], "date_submitted": "2019-02-21T04:15:14+01:00", "date_accepted": "2019-02-21T04:15:14+01:00", "date_published": "2018-02-22T09:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/cisj/article/40792/galley/30568/download/" } ] }, { "pk": 10783, "title": "Radial Arterial Lines Have a Higher Failure Rate than Femoral", "subtitle": null, "abstract": "Introduction:\n Arterial lines are important for monitoring critically ill patients. They are placed most commonly in either femoral or radial sites, though there is little evidence to guide site preference.\nMethods:\n This is an ambispective, observational, cohort study to determine variance in failure rates between femoral and radial arterial lines. This study took place from 2012 to 2016 and included all arterial lines placed in adult patients at a single institution. Causes of line failure were defined as inaccuracy, blockage, site issue, or accidental removal. The primary outcome was line failure by location. Secondary outcomes included time to failure and cause of failure.\nResults:\n We evaluated 272 arterial lines over both arms of the study. Fifty-eight lines eventually failed (21.32%). Femoral lines failed less often in both retrospective (5.36% vs 30.71%) and prospective (5.41% vs. 25.64%) arms. The absolute risk reduction of line failure in the femoral site was 20.2% (95% confidence interval [3.7 - 36.2%]). Failures occurred sooner in radial sites compared to femoral. Infection was not a significant cause of removal in our femoral cohort.\nConclusion:\n Femoral arterial lines fail much less often then radial arterial lines. If placed preferentially in the femoral artery, one line failure would be prevented for every fourth line.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Arterial line, Line failure" } ], "section": "Patient Safety", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1sc971dk", "frozenauthors": [ { "first_name": "Matthew", "middle_name": "R.", "last_name": "Greer", "name_suffix": "", "institution": "Kern Medical, Bakersfield, Department of Emergency Medicine, Bakersfield, California", "department": "None" }, { "first_name": "Scott", "middle_name": "", "last_name": "Carney", "name_suffix": "", "institution": "Kern Medical, Bakersfield, Department of Emergency Medicine, Bakersfield, California", "department": "None" }, { "first_name": "Rick", "middle_name": "A.", "last_name": "McPheeters", "name_suffix": "", "institution": "Kern Medical, Bakersfield, Department of Emergency Medicine, Bakersfield, California", "department": "None" }, { "first_name": "Phillip", "middle_name": "", "last_name": "Aguiniga", "name_suffix": "", "institution": "Kern Medical, Emergency Medicine Assistant Program, Bakersfield, California", "department": "None" }, { "first_name": "Stephanie", "middle_name": "", "last_name": "Rubio", "name_suffix": "", "institution": "Kern Medical, Emergency Medicine Assistant Program, Bakersfield, California", "department": "None" }, { "first_name": "Jason", "middle_name": "", "last_name": "Lee", "name_suffix": "", "institution": "Kern Medical, Emergency Medicine Assistant Program, Bakersfield, California", "department": "None" } ], "date_submitted": "2017-05-01T15:44:43+02:00", "date_accepted": "2017-05-01T15:44:43+02:00", "date_published": "2018-02-20T19:56:56+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10783/galley/5873/download/" } ] }, { "pk": 10911, "title": "Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays", "subtitle": null, "abstract": "Introduction:\n Thailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.\nMethods:\n We conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008–2015 and Songkran holidays in 2008–2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity.\nResults: \nOverall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%–39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, p < 0.001). Moreover, EMSuse was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, p < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88–2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95–2.73]).\nConclusion:\n In this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Emergency Medical Service, EMS Utilization, Road Traffic Injury" } ], "section": "Emergency Medical Services", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4sk726vm", "frozenauthors": [ { "first_name": "Sattha", "middle_name": "", "last_name": "Riyapan", "name_suffix": "", "institution": "Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand", "department": "None" }, { "first_name": "Phanthanee", "middle_name": "", "last_name": "Thitichai", "name_suffix": "", "institution": "Bureau of Epidemiology, Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand", "department": "None" }, { "first_name": "Wansiri", "middle_name": "", "last_name": "Chaisirin", "name_suffix": "", "institution": "Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand", "department": "None" }, { "first_name": "Tanyaporn", "middle_name": "", "last_name": "Nakornchai", "name_suffix": "", "institution": "Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand", "department": "None" }, { "first_name": "Tipa", "middle_name": "", "last_name": "Chakorn", "name_suffix": "", "institution": "Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand", "department": "None" } ], "date_submitted": "2017-06-12T06:58:51+02:00", "date_accepted": "2017-06-12T06:58:51+02:00", "date_published": "2018-02-20T19:55:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10911/galley/5914/download/" } ] }, { "pk": 10877, "title": "Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods", "subtitle": null, "abstract": "Introduction: \nThe implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. \nMethods:\n We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. \nResults:\n Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001).\nConclusion:\n A high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "disparities, cardiac arrest, bystander CPR, AED" } ], "section": "Critical Care", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2pn6b039", "frozenauthors": [ { "first_name": "Marina", "middle_name": "", "last_name": "Del Rios", "name_suffix": "", "institution": "University of Illinois at Chicago – College of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Josiah", "middle_name": "", "last_name": "Han", "name_suffix": "", "institution": "University of Illinois at Chicago – College of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Alejandro", "middle_name": "", "last_name": "Cano", "name_suffix": "", "institution": "University of Illinois at Chicago – College of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Victor", "middle_name": "", "last_name": "Ramirez", "name_suffix": "", "institution": "University of Illinois at Chicago – College of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" }, { "first_name": "Gabriel", "middle_name": "", "last_name": "Morales", "name_suffix": "", "institution": "University of Washington, Department of Emergency Medicine, Seattle, Washington", "department": "None" }, { "first_name": "Teri", "middle_name": "L.", "last_name": "Campbell", "name_suffix": "", "institution": "University of Chicago Aeromedical Network, Chicago, Illinois", "department": "None" }, { "first_name": "Terry", "middle_name": "Vanden", "last_name": "Hoek", "name_suffix": "", "institution": "University of Illinois at Chicago – College of Medicine, Department of Emergency Medicine, Chicago, Illinois", "department": "None" } ], "date_submitted": "2017-06-06T07:54:51+02:00", "date_accepted": "2017-06-06T07:54:51+02:00", "date_published": "2018-02-20T19:52:50+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/10877/galley/5902/download/" } ] }, { "pk": 11294, "title": "Identifying Gaps and Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit", "subtitle": null, "abstract": "Introduction:\n Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs. \nMethods:\n Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online, resident community consisting of 142 residents from 100 EM residencies in North America. A 15-person subgroup (13 residents, two faculty facilitators) met at the RWCS to develop a public, central repository of initiatives for programs, as well as tools to assist programs in identifying gaps in their overarching wellness programs. \nResults:\n An online submission form and central database of wellness initiatives were created and accessible to the public. Wellness Think Tank members collected an initial 36 submissions for the database by the time of the RWCS event. Based on general workplace, needs-assessment tools on employee wellbeing and Kern’s model for curriculum development, a resident-based needs-assessment survey and an implementation worksheet were created to assist residency programs in wellness program development. \nConclusion:\n The Programmatic Initiatives workgroup from the resident-driven RWCS event created tools to assist EM residency programs in identifying existing initiatives and gaps in their wellness programs to meet the ACGME’s expanded focus on resident wellbeing.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [], "section": "Education", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/0tz7s9hm", "frozenauthors": [ { "first_name": "Fareen", "middle_name": "", "last_name": "Zaver", "name_suffix": "", "institution": "University of Calgary, Department of Emergency Medicine, Alberta, Canada", "department": "None" }, { "first_name": "Nicole", "middle_name": "", "last_name": "Battaglioli", "name_suffix": "", "institution": "Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota", "department": "None" }, { "first_name": "William", "middle_name": "", "last_name": "Denq", "name_suffix": "", "institution": "George Washington University, Department of Emergency Medicine, Washington, District of Columbia", "department": "None" }, { "first_name": "Anne", "middle_name": "", "last_name": "Messman", "name_suffix": "", "institution": "Sinai-Grace Hospital, Detroit Medical Center, Department of Emergency Medicine, Detroit, Michigan", "department": "None" }, { "first_name": "Arlene", "middle_name": "", "last_name": "Chung", "name_suffix": "", "institution": "Mount Sinai Hospital, Department of Emergency Medicine, New York, New York", "department": "None" }, { "first_name": "Michelle", "middle_name": "", "last_name": "Lin", "name_suffix": "", "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California", "department": "None" }, { "first_name": "Emberlynn", "middle_name": "L.", "last_name": "Liu", "name_suffix": "", "institution": "University of Texas Southwestern, Department of Emergency Medicine, Dallas, Texas", "department": "None" } ], "date_submitted": "2017-08-29T07:48:55+02:00", "date_accepted": "2017-08-29T07:48:55+02:00", "date_published": "2018-02-19T19:12:25+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11294/galley/6137/download/" } ] } ] }