{"count":39139,"next":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=12800","previous":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=12600","results":[{"pk":42124,"title":"Border South / Frontera Sur","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":"transit migration"},{"word":"Central American migrants"},{"word":"borders"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8tn3z5nd","frozenauthors":[{"first_name":"Melissa","middle_name":"","last_name":"Gauthier","name_suffix":"","institution":"University of Victoria","department":"None"}],"date_submitted":"2020-06-09T22:41:56+02:00","date_accepted":"2020-06-09T22:41:56+02:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42124/galley/31452/download/"}]},{"pk":42123,"title":"Designing an Assignment on Undocumented Migration: It’s All About Framing","subtitle":null,"abstract":"Teaching about undocumented Mexican migration means teaching about an issue often seen as controversial. In many contexts, assumptions students bring with them can inhibit their ability to engage with nuance to more effectively understand the issue. It is therefore imperative that instructors deliver this information in a way that allows students to see such nuance. This article details an essay assignment I use to teach about undocumented Mexican migration in the context of the political and economic frameworks that help drive it. A key feature of this assignment is its use of “decoupling,” or separating the issue at hand from ideologies and associations surrounding it in order to facilitate understanding. Use of this strategy helps students understand this complex issue in a way, it is hoped, they can apply to complex issues beyond.","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":"migration"},{"word":"controversy"},{"word":"decoupling"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/06q2b2qh","frozenauthors":[{"first_name":"Evin","middle_name":"","last_name":"Rodkey","name_suffix":"","institution":"Muskegon Community College","department":"None"}],"date_submitted":"2020-02-25T22:49:01+01:00","date_accepted":"2020-02-25T22:49:01+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42123/galley/31451/download/"}]},{"pk":42125,"title":"Frontera Sur / Border South","subtitle":null,"abstract":"","language":"es","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":"transit migration"},{"word":"Central American migrants"},{"word":"borders"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9zv8p8zq","frozenauthors":[{"first_name":"Melissa","middle_name":"","last_name":"Gauthier","name_suffix":"","institution":"University of Victoria","department":"None"}],"date_submitted":"2020-06-11T00:19:51+02:00","date_accepted":"2020-06-11T00:19:51+02:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42125/galley/31453/download/"}]},{"pk":42115,"title":"“Judging Extreme Hardship”: An in-class activity for teaching critical interrogation of discursive frames in U.S. im/migration law","subtitle":null,"abstract":"A key element in teaching the anthropology of im/migration is fostering critical analysis of the discursive frames used in conversations about im/migrants. In this article I describe an in-class activity I use to foster critical thinking about discursive frames on im/migration—specifically those which are embedded into U.S. immigration law. Students are asked to play the role of an immigration judge deciding on a de-identified version of an actual “hardship waiver” case—a petition for relief from deportation. By putting themselves in the shoes of an immigration judge, students must work to disconnect from their own biases and assumptions in order to attempt to apply immigration law. In the process, students learn about the inner workings of the immigration system and interrogate how discursive frames shape the application of immigration law.","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":"immigration discourse"},{"word":"Immigration Law"},{"word":"immigration judge"},{"word":"hardship waiver"},{"word":"deportation"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0c60j8hc","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Cook","name_suffix":"","institution":"Southern Methodist University","department":"None"}],"date_submitted":"2020-02-15T22:32:23+01:00","date_accepted":"2020-02-15T22:32:23+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42115/galley/31447/download/"}]},{"pk":42122,"title":"Offering Informal Education in Public Libraries through Exhibit Design","subtitle":null,"abstract":"The American Anthropological Association’s forthcoming traveling exhibit on the subject of migration and mobility is designed to be hosted by public libraries. By recruiting libraries as host institutions, we make scholarship accessible to general audiences and provide a focal point for programming and community engagement. This essay outlines our approach to designing with libraries in mind, aiming to influence public discourse about a topical issue.","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":"migration"},{"word":"informal education"},{"word":"museum anthropology"},{"word":"youth outreach"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/44n939r2","frozenauthors":[{"first_name":"Daniel","middle_name":"","last_name":"Ginsberg","name_suffix":"","institution":"American Anthropological Association","department":"None"}],"date_submitted":"2020-02-25T18:12:07+01:00","date_accepted":"2020-02-25T18:12:07+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42122/galley/31450/download/"}]},{"pk":42114,"title":"Project- and Human-Centered Teaching and Learning: Diplomacy Lab and the Expanded Public Charge Rule for New Cabo Verdean Immigrants","subtitle":null,"abstract":"This commentary introduces the U.S. State Department-sponsored Diplomacy Lab. This program provides interdisciplinary teams of students an opportunity to learn how to directly inform government policy development and implementation. In the project discussed here, a team of student researchers considered how the new public charge final rule could impact Cabo Verdean immigrants in the United States. The program demonstrates how project- and human-centered pedagogy through social science research advances student learning by providing students an opportunity to directly observe the complex effects of policy decisions on people’s lives.","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":"experiential learning"},{"word":"Cabo Verde"},{"word":"Immigration"},{"word":"final public charge rule"},{"word":"Diplomacy Lab"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8999f57n","frozenauthors":[{"first_name":"Brandon","middle_name":"D","last_name":"Lundy","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Allison","middle_name":"C.","last_name":"Garefino","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Brenda","middle_name":"L","last_name":"Cleaver","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Danielle","middle_name":"","last_name":"Dumett","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Kaitlyn","middle_name":"","last_name":"Godwin","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Agazeet","middle_name":"","last_name":"Haile","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"William","middle_name":"P","last_name":"Hasse","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Alexandria","middle_name":"","last_name":"Seigler","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Kathleen","middle_name":"B","last_name":"Smith","name_suffix":"","institution":"Kennesaw State University","department":"None"},{"first_name":"Nicholas","middle_name":"A","last_name":"Zingleman","name_suffix":"","institution":"Kennesaw State University","department":"None"}],"date_submitted":"2020-02-15T19:17:06+01:00","date_accepted":"2020-02-15T19:17:06+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42114/galley/31446/download/"}]},{"pk":42093,"title":"Reading Alex E. Chávez's Sounds of Crossing: Music, Migration, and the Aural Poetics of Huapango Arribeño (Duke University Press, 2017), a Pedagogical Lesson","subtitle":null,"abstract":"In this article we argue for a slow, methodical, and collaborative approach to difficult texts. This article is the story of how, thanks to the efforts of the students and professor, a book that rewards diligent effort, and some creative pedagogical strategies borne of desperation, the experience of reading Alex E. Chávez’s Sounds of Crossing became a highlight of our college experience. In this article we explore the differing perspectives of students and faculty, including the reasons students came to view this as a meaningful experience. Some of our significant findings include the following: 1) the reading of the book was meaningful even though it was difficult; 2) the meaningfulness of the reading was not diminished by how difficult the theoretical and musical material remained, even with close exegesis; 3) the difficulty was eased by specific pedagogical methods, mainly based on collaborative learning, that were found by the students to be effective for increasing comprehension and navigation of the text; and 4) the connection between the book and the students’ lived experience enhanced the appeal of the text, their willingness to continue with it in spite of difficulty, their tolerance for confusion, and their overall satisfaction with the experience of reading it.","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":"ethnography"},{"word":"pedagogy"},{"word":"migration"},{"word":"teaching anthropology"},{"word":"Collaborative learning"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/76x4d7jv","frozenauthors":[{"first_name":"Alyshia","middle_name":"","last_name":"Gálvez","name_suffix":"","institution":"Lehman College","department":"None"},{"first_name":"Lizbeth","middle_name":"","last_name":"Bravo","name_suffix":"","institution":"Lehman College","department":"None"},{"first_name":"Edith","middle_name":"","last_name":"Carrasco","name_suffix":"","institution":"Lehman College","department":"None"},{"first_name":"Kathryn","middle_name":"","last_name":"Chuber","name_suffix":"","institution":"Lehman College","department":"None"},{"first_name":"Daisy","middle_name":"","last_name":"Flores","name_suffix":"","institution":"Lehman College","department":"None"}],"date_submitted":"2019-04-30T19:53:19+02:00","date_accepted":"2019-04-30T19:53:19+02:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42093/galley/31434/download/"}]},{"pk":42129,"title":"Special Issue: Teaching Migration","subtitle":null,"abstract":"Introduction to a special issue on teaching migration.","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":"migration"},{"word":"Immigration"},{"word":"public anthropology"},{"word":"pedagogy"}],"section":"Editorials","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8x98f8vf","frozenauthors":[{"first_name":"Angela","middle_name":"C.","last_name":"Jenks","name_suffix":"","institution":"University of California, Irvine","department":"None"}],"date_submitted":"2020-07-15T11:59:31+02:00","date_accepted":"2020-07-15T11:59:31+02:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42129/galley/31455/download/"}]},{"pk":42113,"title":"Teaching Im/migration through an Ethnographic Portrait Project","subtitle":null,"abstract":"The Im/migrant Ethnographic Portrait Project was designed for introductory cultural anthropology courses and has a threefold aim: 1) to familiarize students with research methods, 2) to facilitate students’ deeper understanding of migration by connecting course readings with a hands-on project, and 3) to humanize im/migrants by bringing students into one-on-one conversations where they will hear a person’s story in their own words. To support students’ success with this semester-long project and to ensure (as far as is possible) that no harm is done, we provide instruction and feedback through a series of progressive assignments. In this essay we explain each of these steps before concluding with remarks about the challenges and benefits of teaching this project.","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":"im/migration"},{"word":"ethnographic project"},{"word":"interview"},{"word":"assignment"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/39n937nt","frozenauthors":[{"first_name":"Jennifer","middle_name":"R","last_name":"Guzmán","name_suffix":"","institution":"State University of New York, Geneseo","department":"None"},{"first_name":"Melanie","middle_name":"A","last_name":"Medeiros","name_suffix":"","institution":"State University of New York, Geneseo","department":"None"},{"first_name":"Gwendolyn","middle_name":"","last_name":"Faulkner","name_suffix":"","institution":"State University of New York, Geneseo","department":"None"}],"date_submitted":"2020-02-15T04:51:05+01:00","date_accepted":"2020-02-15T04:51:05+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42113/galley/31445/download/"}]},{"pk":42106,"title":"Telling Migration Stories: Course Connections and Building Classroom Community","subtitle":null,"abstract":"This commentary shares an assignment on family migration stories from an upper-division undergraduate course on global migration. The assignment, which asks students to interview each other about their family migration histories and then analyze their partner’s story, requires students to apply course readings to the real-world context of their peers’ experiences. The commentary provides an overview of the assignment and challenges students encountered. I also highlight the lessons learned, both in terms of course content and classroom community. The large public teaching university where I work is a Hispanic-serving institution and is home to around 1,000 undocumented students. Many more students are immigrants or the children of immigrants. Bringing in students’ personal experiences with migration serves to build academic confidence and classroom community among these mostly first-generation students while building connections among students and setting the tone for the course as a whole. It positions students as experts and valuable members of our classroom learning community, while recognizing the importance of their experiences with issues of culture and identity, xenophobia, transnational family-life, immigration enforcement, and immigration status. The assignment also disrupts narrow assimilationist narratives of migration by highlighting the diversity of students’ migration histories.","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":": family migration"},{"word":"storytelling"},{"word":"class community"},{"word":"first-generation students"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0bv3d6c5","frozenauthors":[{"first_name":"Caitlin","middle_name":"E","last_name":"Fouratt","name_suffix":"","institution":"California State University, Long Beach","department":"None"}],"date_submitted":"2020-02-07T17:32:54+01:00","date_accepted":"2020-02-07T17:32:54+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42106/galley/31443/download/"}]},{"pk":42117,"title":"The Journey for the American Dream","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":"Immigration"},{"word":"American Dream"},{"word":"family stories"}],"section":"Student Showcase","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1cp107j8","frozenauthors":[{"first_name":"Idalia","middle_name":"","last_name":"Mora","name_suffix":"","institution":"Other","department":"None"}],"date_submitted":"2020-02-16T03:02:28+01:00","date_accepted":"2020-02-16T03:02:28+01:00","date_published":"2020-07-15T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42117/galley/31448/download/"}]},{"pk":877,"title":"Use of Point-of-care Ultrasound for the Seizing Infant: An Adjunct for Detection of Abusive Head Trauma","subtitle":null,"abstract":"Case Presentation:\n An eight-week-old infant presented to the emergency department in cardiac arrest. Return of spontaneous circulation was obtained and the patient subsequently began seizing. Point-of-care ultrasound of the anterior fontanelle revealed an extra-axial fluid collection consistent with subdural hematoma (SDH).\nDiscussion: \nAbusive head trauma is still frequently missed on initial presentation. In addition to validated screening clinical prediction rules, point-of-care cranial ultrasound can be used as a noninvasive adjunct for detection of SDH related to abusive head trauma in infants with an open fontanelle.","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":"ultrasound"},{"word":"abusive head trauma"},{"word":"subdural hematoma"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1xx632kp","frozenauthors":[{"first_name":"Jonathan","middle_name":"","last_name":"Rowland","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":"None"},{"first_name":"Dean","middle_name":"","last_name":"Fouchia","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":"None"},{"first_name":"Mark","middle_name":"","last_name":"Favot","name_suffix":"","institution":"Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan","department":"None"}],"date_submitted":"2020-07-14T21:27:58+02:00","date_accepted":"2020-07-14T21:27:58+02:00","date_published":"2020-07-14T21:29:06+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/877/galley/625/download/"}]},{"pk":876,"title":"Decompression of Subdural Hematomas Using an Intraosseous Needle in the Emergency Department: A Case Series","subtitle":null,"abstract":"Introduction: \nTraumatic subdural hematomas beget significant morbidity and mortality if not rapidly decompressed. This presents a unique challenge to the emergency physician without immediate neurosurgical support.\nCase Report:\n We report two cases of patients in Los Angeles County with traumatic subdural hematomas and clinical deterioration in the emergency department (ED) who were treated with decompression using an intraosseous needle drill.\nDiscussion:\n We believe these cases represent the first use of this technique to temporize a subdural hematoma 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":"Emergency Medicine"},{"word":"extra-axial hematoma"},{"word":"burr hole"}],"section":"Case Series","is_remote":true,"remote_url":"https://escholarship.org/uc/item/51d544js","frozenauthors":[{"first_name":"Brett","middle_name":"","last_name":"Barro","name_suffix":"","institution":"LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Scott","middle_name":"","last_name":"Kobner","name_suffix":"","institution":"Keck School of Medicine of USC, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Ashkon","middle_name":"","last_name":"Ansari","name_suffix":"","institution":"Keck School of Medicine of USC, Department of Emergency Medicine, Los Angeles, California; Antelope Valley Hospital, Department of Emergency Medicine, Lancaster, California","department":"None"}],"date_submitted":"2020-07-14T21:21:26+02:00","date_accepted":"2020-07-14T21:21:26+02:00","date_published":"2020-07-14T21:22:59+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/876/galley/624/download/"}]},{"pk":875,"title":"A Case Report of Nebulized Tranexamic Acid for Post-tonsillectomy Hemorrhage in an Adult","subtitle":null,"abstract":"Introduction:\n Post-tonsillectomy hemorrhage is a potentially life-threatening, postoperative complication that is commonly encountered in the emergency department (ED).\nCase Report:\n Herein, we describe the case of a 22-year-old male who presented to the ED with an active post-tonsillectomy hemorrhage. He rapidly became hypotensive and experienced an episode of syncope. Immediate interventions included intravenous fluids, emergency release blood and nebulized tranexamic acid (TXA). After completion of the nebulized TXA, the patient’s bleeding was controlled.\nConclusion:\n To our knowledge, this is the first case in the emergency medicine literature that describes the use of nebulized TXA in an adult to achieve hemostasis in post-tonsillectomy hemorrhage.","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":"tranexamic acid"},{"word":"TXA"},{"word":"post-tonsillectomy hemorrhage"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5fc0z5rx","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Poppe","name_suffix":"","institution":"Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California","department":"None"},{"first_name":"Felipe","middle_name":"","last_name":"Grimaldo","name_suffix":"","institution":"Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California","department":"None"}],"date_submitted":"2020-07-14T21:15:43+02:00","date_accepted":"2020-07-14T21:15:43+02:00","date_published":"2020-07-14T21:16:40+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/875/galley/623/download/"}]},{"pk":874,"title":"A Missed Celiac Artery Aneurysm Leading to Rupture: A Case Report","subtitle":null,"abstract":"Introduction: \nAbdominal pain is a common complaint seen in the emergency department (ED). We report a case of celiac artery aneurysm (CAA) in a male patient presenting with abdominal pain to the ED on two separate occasions, approximately 24 hours apart.\nCase Report:\n On the initial visit the patient was discharged with undifferentiated abdominal pain after computed tomography imaging and laboratory investigations. On the repeat visit he was found to have a rapidly expanding CAA with rupture. He became unstable requiring intubation, blood transfusions, and emergent transfer to a tertiary care center for surgical management where, unfortunately, he died hours after failed operative management.\nConclusion: \nAlthough rare, abdominal pain caused by CAAs can rapidly progress to rupture and have a high mortality.","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":"celiac artery aneurysm"},{"word":"abdominal pain"},{"word":"neurofibromatosis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/75k8c917","frozenauthors":[{"first_name":"Jason","middle_name":"","last_name":"Della Vecchia","name_suffix":"","institution":"Clovis Community Medical Center, Department of Emergency Medicine, Clovis, California","department":"None"},{"first_name":"Eric","middle_name":"","last_name":"Blazar","name_suffix":"","institution":"Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey","department":"None"}],"date_submitted":"2020-07-14T21:11:06+02:00","date_accepted":"2020-07-14T21:11:06+02:00","date_published":"2020-07-14T21:11:53+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/874/galley/622/download/"}]},{"pk":873,"title":"A Case Report on Paget-Schroetter Syndrome Presenting as Acute Localized Rhabdomyolysis","subtitle":null,"abstract":"Introduction:\n The life- or limb-threatening differential diagnosis for upper extremity swelling can include deep vein thrombosis (DVT), infectious processes, and compartment syndrome. Chronic anatomic abnormalities such as axillary vein stenosis are rarely a consideration in the emergency department.\nCase Report:\n We present a 26-year-old female with history of Chiari type 1 malformation who presented with acute left arm swelling. Initial workup, including point-of-care ultrasound, revealed the presence of significant soft tissue swelling without evidence of DVT.\nConclusion:\n Further workup revealed an early, localized rhabdomyolysis secondary to axillary vein stenosis or venous thoracic outlet syndrome, also known as Paget-Schroetter syndrome.","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":"Paget-Schroetter syndrome"},{"word":"point-of-care ultrasound"},{"word":"axillary vein stenosis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3nq099mt","frozenauthors":[{"first_name":"Jonathan","middle_name":"B.","last_name":"Lee","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Ami","middle_name":"","last_name":"Kurzweil","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Shadi","middle_name":"","last_name":"Lahham","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"}],"date_submitted":"2020-07-14T21:04:17+02:00","date_accepted":"2020-07-14T21:04:17+02:00","date_published":"2020-07-14T21:05:10+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/873/galley/621/download/"}]},{"pk":872,"title":"Rare Cause of Syncope in a Gravid Female","subtitle":null,"abstract":"Case Presentation:\n A 33-year-old gravid female was brought to the emergency department after she collapsed in the street. Point-of-care ultrasound showed free fluid in the abdomen and confirmed an intrauterine pregnancy. Surgical teams were consulted, and cross-sectional imaging revealed a spontaneously ruptured splenic artery aneurysm (SAA). The patient was taken expeditiously to the operating room for splenic artery ligation and subsequent splenectomy.\nDiscussion:\n Ruptured SAA in pregnant patients is associated with significant mortality for both mother and fetus. Maintaining a high index of suspicion in the correct population is crucial to avoid diagnostic errors and provide definitive care with operative repair.","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":"splenic artery aneurysm"},{"word":"aneurysm rupture"},{"word":"pregnancy"},{"word":"syncope"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1wv700zx","frozenauthors":[{"first_name":"Andrew","middle_name":"","last_name":"Bellino","name_suffix":"","institution":"Stanford University School of Medicine, Emergency Medicine Residency Program, Stanford, California","department":"None"},{"first_name":"Katherine","middle_name":"","last_name":"Staats","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Ngo","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California","department":"None"}],"date_submitted":"2020-07-14T20:23:04+02:00","date_accepted":"2020-07-14T20:23:04+02:00","date_published":"2020-07-14T20:23:54+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/872/galley/620/download/"}]},{"pk":871,"title":"Point-of-care Ultrasound Detection of Cataract in a Patient with Vision Loss: A Case Report","subtitle":null,"abstract":"Background:\n Point-of-care ocular ultrasound in the emergency department (ED) is an effective tool for promptly evaluating for several vision-threatening etiologies and can be used to identify more slowly progressing etiologies as well, such as cataract formation within the lens.\nCase Report:\n A 62-year-old female presented to the ED with a two-day history of painless vision loss of the left eye as well as reduced vision for the prior 30 days.\nConclusion:\n Point-of-care ultrasound was performed and showed calcification of the lens consistent with cataract.","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":"POCUS"},{"word":"ultrasonography"},{"word":"ocular"},{"word":"cataract"},{"word":"vision loss"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4pq6544f","frozenauthors":[{"first_name":"Kyle","middle_name":"","last_name":"Dornhofer","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Marawan","middle_name":"","last_name":"Alkhattabi","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Shadi","middle_name":"","last_name":"Lahham","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"}],"date_submitted":"2020-07-14T19:20:19+02:00","date_accepted":"2020-07-14T19:20:19+02:00","date_published":"2020-07-14T20:14:20+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/871/galley/619/download/"}]},{"pk":869,"title":"A Case Report: The Challenging Diagnosis of Spontaneous Cervical Epidural Hematoma","subtitle":null,"abstract":"Introduction:\n We present the case of a patient with a spontaneous cervical epidural hematoma that presented with neck pain and mild, left arm parasthesia.\nCase Report:\n A 59-year old man presented with sudden onset of severe neck pain, without history of injury or trauma. The patient also complained of associated left arm parasthesias that progressed to left arm and leg weakness while in the emergency department. Multiple diagnoses were considered and worked up; eventually the correct diagnosis was made with magnetic resonance imaging of the cervical spine.\nConclusion:\n Spontaneous cervical epidural hematoma typically presents with neck pain, and variable neurologic complaints. This case illustrates the challenge in making this uncommon but serious 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":[{"word":"Spontaneous cervical epidural hematoma"},{"word":"neck pain"},{"word":"epidural hematoma"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7r3204xc","frozenauthors":[{"first_name":"Francis","middle_name":"L.","last_name":"Counselman","name_suffix":"","institution":"Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Emergency Physicians of Tidewater, Norfolk, Virginia","department":"None"},{"first_name":"Julie","middle_name":"M.","last_name":"Tondt","name_suffix":"","institution":"Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia","department":"None"},{"first_name":"Harry","middle_name":"","last_name":"Lustig","name_suffix":"","institution":"Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Emergency Physicians of Tidewater, Norfolk, Virginia","department":"None"}],"date_submitted":"2020-07-13T22:12:44+02:00","date_accepted":"2020-07-13T22:12:44+02:00","date_published":"2020-07-13T22:26:58+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/869/galley/618/download/"}]},{"pk":13523,"title":"Visual Estimation of Tricuspid Annular Plane Systolic Excursion by Emergency Medicine Clinicians","subtitle":null,"abstract":"Introduction: \nTricuspid annular plane systolic excursion (TAPSE) is an established echocardiographic marker of right ventricular (RV) systolic function. The objective of this study was to evaluate whether emergency clinicians can visually estimate RV function using TAPSE in a set of video clips compared to a reference standard M-mode measurement.\nMethods:\n Emergency clinicians were shown a five-minute educational video on TAPSE. Participants then viewed 20 apical four-chamber point-of-care ultrasound (POCUS) echocardiography clips and recorded their estimate of TAPSE distance in centimeters (cm), as well as whether TAPSE was normal (>1.9 cm), borderline (1.5-1.9 cm), or abnormal (<1.5 cm). We calculated sensitivity, specificity, and overall accuracy of visual TAPSE categorization using M-mode measurement as the criterion standard. Participants also reported their comfort with assessing TAPSE on a five-point Likert scale before and after participation in the study.\nResults:\n Among 70 emergency clinicians, including 20 postgraduate year 1-4 residents, 22 attending physicians, and 28 physician assistants (PA), the pooled sensitivity and specificity for visual assessment of TAPSE was 88.6% (95% confidence interval, 85.4-91.7%) and 81.6% (95% CI, 78.2-84.4%), respectively. The sensitivity and specificity for the clips in which the measured TAPSE was <1.5 cm or >1.9 cm was 91.4% (95% CI, 88.4-94.3%) and 90.8% (95% CI, 87.7-93.9%), respectively. There was no significant difference in sensitivity (p = 0.27) or specificity (p = 0.55) between resident and attending physicians or between physicians and PAs (p = 0.17 and p = 0.81). Median self-reported comfort with TAPSE assessment increased from 1 (interquartile range [IQR] 1-2) to 3 (IQR 3-4) points after participation in the study.\nConclusion:\n A wide range of emergency clinicians demonstrated fair accuracy for visual estimation of TAPSE on previously recorded POCUS echocardiography video clips. These findings should be considered hypothesis generating and warrant validation in larger, prospective studies.","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":"Point-of-care Ultrasound, Echocardiography, Tricuspid Annular Plane Systolic Excursion, Right Ventricular Function"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5xq303b0","frozenauthors":[{"first_name":"Youyou","middle_name":"","last_name":"Duanmu","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Andrew","middle_name":"J.","last_name":"Goldsmith","name_suffix":"","institution":"Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Patricia","middle_name":"C.","last_name":"Henwood","name_suffix":"","institution":"Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Elke","middle_name":"","last_name":"Platz","name_suffix":"","institution":"Harvard Medical School, Brigham and Women’s Hospital, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts","department":"None"},{"first_name":"Janet","middle_name":"E.","last_name":"Hoyler","name_suffix":"","institution":"123Sonography, Cohasset, Massachusetts","department":"None"},{"first_name":"Heidi","middle_name":"H.","last_name":"Kimberly","name_suffix":"","institution":"Newton Wellesley Hospital, Department of Emergency Medicine, Newton, Massachusetts","department":"None"}],"date_submitted":"2020-01-27T06:25:43+01:00","date_accepted":"2020-01-27T06:25:43+01:00","date_published":"2020-07-10T21:55:06+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13523/galley/7081/download/"}]},{"pk":13362,"title":"Emergency Department-based Hepatitis A Vaccination Program in Response to an Outbreak","subtitle":null,"abstract":"Introduction:\n The Philadelphia Department of Public Health (PDPH) declared a public health emergency due to hepatitis A in August 2019.1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission. This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission.\nMethods:\n We conducted a retrospective review of all ED visits in the 12-week period centered around the implementation of the ED-based hepatitis A vaccination program. All adult patients presenting to the ED were offered vaccination, with vaccines supplied free of charge by the PDPH. We compared the incidence of diagnosis and of hospital admission for treatment of hepatitis A before and after implementation of the program.\nResults:\n There were 10,033 total ED visits during the study period, with 5009 of them prior to the implementation of the vaccination program and 5024 after implementation. During the study period, 669 vaccines were administered. Before the vaccination program began, 73 patients were diagnosed with hepatitis A, of whom 67 were admitted. After implementation of the program, 38 patients were diagnosed with hepatitis A, of whom 31 were admitted.\nConclusion:\n A partnership between an ED and the local public health department resulted in the vaccination of 669 patients in six weeks in the midst of an outbreak of a vaccine-preventable illness, with a corresponding drop in ED visits and hospital admission for acute hepatitis 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":"Hepatitis A, Emergency Department, Population Health"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8rd6j6f4","frozenauthors":[{"first_name":"Caroline","middle_name":"","last_name":"Kaigh","name_suffix":"","institution":"Cooper University Hospital, Department of Emergency Medicine, Camden, New Jersey","department":"None"},{"first_name":"Andrea","middle_name":"","last_name":"Blome","name_suffix":"","institution":"Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Kraftin","middle_name":"E.","last_name":"Schreyer","name_suffix":"","institution":"Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Megan","middle_name":"","last_name":"Healy","name_suffix":"","institution":"Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"}],"date_submitted":"2019-11-11T17:00:32+01:00","date_accepted":"2019-11-11T17:00:32+01:00","date_published":"2020-07-10T21:52:12+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13362/galley/7014/download/"}]},{"pk":13399,"title":"Necrotizing Fasciitis Within 72 hours After Presentation with Skin and Skin Structure Infection","subtitle":null,"abstract":"Introduction:\n A small percentage of patients with skin infections later develop necrotizing fasciitis (NF). Diagnostic testing is needed to identify patients with skin infections at low risk of NF who could be discharged from the emergency department (ED) after antibiotic initiation. Elevated lactate has been associated with NF; existing estimates of the frequency of NF are based on retrospective reviews, and cases often lack testing for lactate. We present the incidence of patients with skin infections who developed NF and their baseline lactates.\nMethods:\n In four phase-3 trials, 2883 adults with complicated or acute bacterial skin and skin structure infections were randomized to dalbavancin or comparator, with early and late follow-up visits through Day 28. We prospectively collected baseline plasma lactates in one trial to assess an association with NF.\nResults:\n NF was diagnosed in 3/2883 patients (0.1%); all three survived. In the study with prospectively collected baseline lactates (n = 622), 15/622 (2.4%) had a lactate ≥4 millimoles per liter (mmol/L), including 3/622 (0.5%) with a lactate ≥7 mmol/L. NF was not seen in patients with a lactate <4 mmol/L; NF was seen in 1/15 (6.7%) with a lactate ≥4 mmol/L, including 1/3 (33.3%) with lactate ≥7 mmol/L.\nConclusions:\n NF incidence within 72 hours of antibiotic initiation in patients with complicated or acute bacterial skin and skin structure infections was extremely low (0.1%) and occurred in 6.7% with a lactate ≥4 mmol/L. Lactate <4 mmol/L can be used to identify patients at low risk of NF who could be safely discharged from the ED after antibiotic initiation.","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":"necrotizing fasciitis"},{"word":"skin infection"},{"word":"lactate"},{"word":"Diagnosis"},{"word":"emergency department"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1v38f51n","frozenauthors":[{"first_name":"Urania","middle_name":"","last_name":"Rappo","name_suffix":"","institution":"Allergan PLC, Madison, New Jersey","department":"None"},{"first_name":"H.","middle_name":"Bryant","last_name":"Nguyen","name_suffix":"","institution":"Loma Linda University, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine Loma Linda, California","department":"None"},{"first_name":"Sailaja","middle_name":"","last_name":"Puttagunta","name_suffix":"","institution":"Allergan PLC, Madison, New Jersey\nBiomX Ltd, Ness Ziona, Israel","department":"None"},{"first_name":"Caroline","middle_name":"","last_name":"Ojaimi","name_suffix":"","institution":"Allergan PLC, Madison, New Jersey\nNovartis Pharmaceuticals Corp, East Hanover, New Jersey","department":"None"},{"first_name":"Karthik","middle_name":"","last_name":"Akinapelli","name_suffix":"","institution":"Independent consultant, Hamden, Connecticut\nIterum Therapeutics, Old Saybrook, Connecticut","department":"None"},{"first_name":"Michael","middle_name":"W.","last_name":"Dunne","name_suffix":"","institution":"Allergan PLC, Madison, New Jersey\nIterum Therapeutics, Old Saybrook, Connecticut","department":"None"}],"date_submitted":"2019-12-09T04:37:27+01:00","date_accepted":"2019-12-09T04:37:27+01:00","date_published":"2020-07-10T21:49:47+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13399/galley/7034/download/"}]},{"pk":12674,"title":"Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers","subtitle":null,"abstract":"Introduction:\n Falls are a frequent reason geriatric patients visit the emergency department (ED). To help providers, the Geriatric Emergency Department Guidelines were created to establish a standard of care for geriatric patients in the ED. We conducted a survey of emergency providers to assess 1) their knowledge of fall epidemiology and the geriatric ED guidelines; 2) their current ED practice for geriatric fall patients; and 3) their willingness to conduct fall-prevention interventions.\nMethods: \nWe conducted an anonymous survey of emergency providers including attending physicians, residents, and physician assistants at a single, urban, Level 1 trauma, tertiary referral hospital in the northeast United States.\nResults: \nWe had a response rate of 75% (102/136). The majority of providers felt that all geriatric patients should undergo screening for fall risk factors (84%, 86/102), and most (76%, 77/102) answered that all geriatric patients screened and at risk for falls should have an intervention performed. While most (80%, 82/102) answered that geriatric falls prevention was very important, providers were not willing to spend much time on screening or interventions. Less than half (44%, 45/102) were willing to spend 2-5 minutes on a fall risk assessment and prevention, while 46% (47/102) were willing to spend less than 2 minutes.\nConclusion:\n Emergency providers understand the importance of geriatric fall prevention but lack knowledge of which patients to screen and are not willing to spend more than a few minutes on screening for fall interventions.  Future studies must take into account provider knowledge and willingness to intervene.","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":"geriatric"}],"section":"Geriatrics","is_remote":true,"remote_url":"https://escholarship.org/uc/item/69m1p4fd","frozenauthors":[{"first_name":"Kathleen","middle_name":"","last_name":"Davenport","name_suffix":"","institution":"University of North Carolina Medical Center, Department of Emergency Medicine, Chapel Hill, North Carolina","department":"None"},{"first_name":"Amy","middle_name":"","last_name":"Cameron","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Margot","middle_name":"","last_name":"Samson","name_suffix":"","institution":"University of Central Florida, College of Medicine, Orlando, Florida","department":"None"},{"first_name":"Jiraporn","middle_name":"","last_name":"Lekand","name_suffix":"","institution":"Navamindradhiraj University, Geriatric Emergency Medicine Research Unit, Bangkok, Thailand","department":"None"},{"first_name":"Shan","middle_name":"Woo","last_name":"Liu","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-04-10T22:33:16+02:00","date_accepted":"2019-04-10T22:33:16+02:00","date_published":"2020-07-10T21:45:32+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12674/galley/6701/download/"}]},{"pk":13316,"title":"The Utility of Color Doppler to Confirm Endotracheal Tube Placement: A Pilot Study","subtitle":null,"abstract":"Introduction: \nGrayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years. The addition of color Doppler imaging (CDI) has been proposed to improve identification but has not been well studied. The aim of this study was to assess whether CDI improves correct localization of ETT placement.\nMethods:\n A convenience sample of emergency and critical care physicians at various levels of training and experience participated in an online assessment. Participants viewed US video clips of patients, which included either tracheal or esophageal intubations captured in grayscale or with CDI; there were five videos of each for a total of 20 videos. Participants were asked to watch each clip and then assess the location of the ETT.\nResults:\n Thirty-eight subjects participated in the online assessment. Levels of training included medical students (13%), emergency medicine (EM) residents (50%), EM attendings (32%), and critical care attendings (5%). The odds ratio of properly assessing tracheal placement using color relative to a grayscale imaging technique was 1.5 (p = 0.21). Regarding the correct assessment of esophageal placement, CDI had 1.4 times the odds of being correctly assessed relative to grayscale (p = 0.26). The relationship between training level and correct assessments was not significant for either tracheal or esophageal placements.\nConclusion:\n In this pilot study we found no significant improvement in correct identification of ETT placement using color Doppler compared to grayscale ultrasound; however, there was a trend toward improvement that might be better elucidated in a larger study.","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":"Intratracheal"},{"word":"ultrasound"},{"word":"Doppler, Color"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/30z890sc","frozenauthors":[{"first_name":"Thomas","middle_name":"H.","last_name":"Gildea","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Kenton","middle_name":"L.","last_name":"Anderson","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Kian","middle_name":"R.","last_name":"Niknam","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Laleh","middle_name":"","last_name":"Gharahbaghian","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Sarah","middle_name":"R.","last_name":"Williams","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Timothy","middle_name":"","last_name":"Angelotti","name_suffix":"","institution":"Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, California","department":"None"},{"first_name":"Paul","middle_name":"S.","last_name":"Auerbach","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Viveta","middle_name":"","last_name":"Lobo","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California","department":"None"}],"date_submitted":"2019-11-13T04:04:51+01:00","date_accepted":"2019-11-13T04:04:51+01:00","date_published":"2020-07-10T21:40:37+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13316/galley/7005/download/"}]},{"pk":868,"title":"A Case Report of a Migrated Pelvic Coil Causing Pulmonary Infarct in an Adult Female","subtitle":null,"abstract":"Introduction:\n It is possible but rare for a pelvic coil to migrate to the pulmonary vasculature, which can cause cardiac damage, arrhythmias, pulmonary infarct, and thrombophlebitis. The few cases reported typically do not describe removal of the coils, as patients were asymptomatic.\nCase report:\n A 39-year-old female with recent coil embolization of her left internal iliac and ovarian veins for pelvic congestion syndrome presented with one month of right-sided chest pain and dyspnea. Imaging revealed a migrated pelvic coil in the patient’s right main pulmonary artery with pulmonary infarcts and a pleural effusion.\nConclusion:\n Interventional radiology successfully removed the coil endovascularly, with significant symptom improvement. This prevented a more-invasive open surgical procedure and resolved symptoms without requiring long-term anticoagulation or monitoring.","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":"Migrated coil"},{"word":"pelvic congestion syndrome"},{"word":"pulmonary infarct"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2rr850qs","frozenauthors":[{"first_name":"Angel","middle_name":"","last_name":"Guerrero","name_suffix":"","institution":"Duke University Medical Center, Department of Surgery, Division of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"Rebecca","middle_name":"G.","last_name":"Theophanous","name_suffix":"","institution":"Duke University Medical Center, Department of Surgery, Division of Emergency Medicine, Durham, North Carolina","department":"None"}],"date_submitted":"2020-07-10T08:02:59+02:00","date_accepted":"2020-07-10T08:02:59+02:00","date_published":"2020-07-10T08:04:21+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/868/galley/617/download/"}]},{"pk":867,"title":"Symptomatic Aortic Endograft Occlusion in a 70-year-old Male","subtitle":null,"abstract":"Case Presentation:\n A 70-year-old male with prior aorta endovascular aneurysm repair presented with progressive lower extremity weakness over the course of several hours. There was noted loss of palpable bilateral femoral pulses in the emergency department. Computed tomography angiography revealed a kinked and occluded aortic endograft. He subsequently underwent successful axillobifemoral bypass revascularization.\nDiscussion:\n Kinking of endograft limbs and occlusion has been reported in a small percentage of patients. Bilateral leg ischemia due to aortic endograft occlusion is rare.","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 Medicine"},{"word":"aortic endograft occlusion"},{"word":"leg ischemia"},{"word":"EVAR"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/50w3g5rv","frozenauthors":[{"first_name":"Jose","middle_name":"","last_name":"Cardenas","name_suffix":"","institution":"Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California","department":"None"},{"first_name":"Babak","middle_name":"","last_name":"Khazaeni","name_suffix":"","institution":"Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California","department":"None"}],"date_submitted":"2020-07-10T07:54:00+02:00","date_accepted":"2020-07-10T07:54:00+02:00","date_published":"2020-07-10T07:55:45+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/867/galley/616/download/"}]},{"pk":866,"title":"Tranexamic Acid in a Case Report of Life-threatening Nontraumatic Hemorrhage in Immune Thrombocytopenic Purpura","subtitle":null,"abstract":"Introduction:\n Immune thrombocytopenic purpura (ITP) is an autoimmune-mediated disorder in which the body produces antibodies that destroy platelets, causing an increased risk of bleeding and bruising. Tranexamic acid (TXA) is a medication that prevents clot breakdown and is used to treat uncontrolled bleeding.\nCase Report:\n We present the case of an 11-year-old female with significant epistaxis and hypotension in the emergency department. Traditional therapies were initiated; however, the patient continued to have bleeding and remained hypotensive, so intravenous TXA was given. The patient’s bleeding then resolved.\nConclusion:\n TXA may be a safe and effective adjunct to traditional therapies for the treatment of life-threatening hemorrhage in ITP 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":[{"word":"immune thrombocytopenic purpura"},{"word":"tranexamic acid"},{"word":"epistaxis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3205x12m","frozenauthors":[{"first_name":"Melanie","middle_name":"M.","last_name":"Randall","name_suffix":"","institution":"Loma Linda University Medical Center and Children’s Hospital, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Nurse","name_suffix":"","institution":"San Gorgonio Memorial Hospital, Department of Emergency Medicine, Banning, California","department":"None"},{"first_name":"Karan","middle_name":"P.","last_name":"Singh","name_suffix":"","institution":"San Gorgonio Memorial Hospital, Department of Emergency Medicine, Banning, California","department":"None"}],"date_submitted":"2020-07-10T06:57:06+02:00","date_accepted":"2020-07-10T06:57:06+02:00","date_published":"2020-07-10T06:59:30+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/866/galley/615/download/"}]},{"pk":865,"title":"Ingestion of A Common Plant’s Leaves Leads to Acute Respiratory Arrest and Paralysis: A Case Report","subtitle":null,"abstract":"Background:\n Nicotiana glauca is a plant known to cause acute toxicity upon ingestion or dermal exposure due to the nicotinic alkaloid, anabasine. Nicotinic alkaloids cause toxicity by acting as agonists on nicotinic-type acetylcholine receptors (nAChRs). Initial stimulation of these receptors leads to symptoms such as tachycardia, miosis, and tremors. The effects of high doses of nicotinic alkaloids are biphasic, and eventual persistent depolarization of nAChRs at the neuromuscular junction occurs. This causes apnea, paralysis, and cardiovascular collapse.\nCase Report:\n In this report, we present a case of respiratory arrest due to nicotinic alkaloid poisoning from the ingestion of Nicotiana glauca. The diagnosis was suspected after the patient’s family gave a history of the patient ingesting a plant prior to arrival. They were able to also provide a physical sample of the plant.\nConclusion:\n The phone application, “Plant Snap”, determined the plant species and helped confirm the diagnosis. This case describes how modern technology and thorough history taking can combine to provide the best possible patient care.","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":"Nicotiana glauca"},{"word":"nicotinic alkaloids"},{"word":"respiratory arrest"},{"word":"toxicity"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1vm1t2vv","frozenauthors":[{"first_name":"Breelan","middle_name":"M.","last_name":"Kear","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Richard","middle_name":"W.","last_name":"Lee","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Internal Medicine, Orange, California","department":"None"},{"first_name":"Sanford","middle_name":"B.","last_name":"Church","name_suffix":"","institution":"University of California, Irvine Medical Center, Department of Internal Medicine, Orange, California","department":"None"},{"first_name":"Fady","middle_name":"A.","last_name":"Youssef","name_suffix":"","institution":"Memorial Care, Long Beach Medical Center, Department of Pulmonary and Critical Care Medicine, Long Beach, California; University of California, Irvine Medical Center, Department of Pulmonary and Critical Care Medicine, Orange, California","department":"None"},{"first_name":"Anthony","middle_name":"","last_name":"Arguija","name_suffix":"","institution":"Memorial Care, Long Beach Medical Center, Department of Emergency Medicine, Long Beach, California","department":"None"}],"date_submitted":"2020-07-10T06:42:16+02:00","date_accepted":"2020-07-10T06:42:16+02:00","date_published":"2020-07-10T06:46:06+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/865/galley/614/download/"}]},{"pk":864,"title":"Detection of Migrainous Infarction with Formal Visual Field Testing: A Case Report","subtitle":null,"abstract":"Introduction:\n Cerebrovascular accidents (CVA) of the posterior circulation are a rare complication of migraine, and present with atypical CVA symptomatology.\nCase Report:\n A 49-year-old-male presented with complaint of persistent visual aura and resolved mild cephalgia. His exam corroborated his reported incomplete left inferior quadrantanopia, and was confirmed by immediate formal optometry evaluation. Occipital CVA was confirmed on admission.\nConclusion:\n Migrainous strokes of posterior circulation should be considered as a potential diagnosis in any headache patient with persistent visual aura. This case suggests that incorporation of formal visual field testing in the emergent setting can shorten the time required for diagnosis in certain circumstances.","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":"cerebrovascular accident"},{"word":"homonymous hemianopsia"},{"word":"migraine"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0625v6dq","frozenauthors":[{"first_name":"William","middle_name":"","last_name":"Bylund","name_suffix":"","institution":"Naval Hospital Okinawa, Department of Emergency Medicine, Okinawa, Japan","department":"None"},{"first_name":"Ross","middle_name":"","last_name":"Patrick","name_suffix":"","institution":"Naval Hospital Okinawa, Department of Internal Medicine, Okinawa, Japan","department":"None"},{"first_name":"Ann","middle_name":"","last_name":"Macdonald","name_suffix":"","institution":"Naval Hospital Okinawa, Department of Optometry, Okinawa, Japan","department":"None"}],"date_submitted":"2020-07-10T04:02:11+02:00","date_accepted":"2020-07-10T04:02:11+02:00","date_published":"2020-07-10T04:03:37+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/864/galley/613/download/"}]},{"pk":39533,"title":"Global Quest for Zero Routine Flaring: An Appraisal of Nigeria’s Legal and Regulatory Abatement Frameworks","subtitle":null,"abstract":"This paper evaluates Nigeria’s commitment to ending gas flaring within the context of the global quest for zero routine flaring by 2030. The combination of strategies deployed by Nigeria has been generally ineffective in inducing compliance from IOCs. The ineffectiveness is linked to both Nigeria’s weak institutional framework and the unattractiveness of economic payoffs associated with investing in gas-gathering infrastructure by IOCs. Using data from secondary sources, the paper locates the non-realization of flare-out dates in the disconnect between legal enactments and economic permutations, especially in view of the huge capital outlay required to develop gas-gathering infrastructure and the uncertainty surrounding the gas market. The paper contends that achieving zero gas flaring in 2020 as planned by Nigeria or 2030 as projected by the international community will entail going beyond present operational arrangements by adopting a holistic implementation strategy that is capable of extracting unconditional compliance from IOCs.","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":"Gas flaring"},{"word":"gas gathering infrastructure"},{"word":"weak penalty regime"},{"word":"associated gas"},{"word":"nigeria"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1p59r0bw","frozenauthors":[{"first_name":"Agaptus","middle_name":"","last_name":"Nwozor","name_suffix":"","institution":"Landmark University","department":"None"},{"first_name":"John","middle_name":"Shola","last_name":"Olanrewaju","name_suffix":"","institution":"Landmark University","department":"None"},{"first_name":"Modupe","middle_name":"","last_name":"Ake","name_suffix":"","institution":"Landmark University","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Aleyomi","name_suffix":"","institution":"Landmark University","department":"None"}],"date_submitted":"2019-10-12T11:52:16+02:00","date_accepted":"2019-10-12T11:52:16+02:00","date_published":"2020-07-10T00:18:49+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39533/galley/29841/download/"}]},{"pk":13376,"title":"A Novel Multimodal Approach to Point-of-Care Ultrasound Education in Low-Resource Settings","subtitle":null,"abstract":"Point-of-care ultrasound (POCUS) enables physicians to make critical diagnosis and treatment decisions at the bedside. However, access to and expertise with this technology remain limited in Peru. Establishing longitudinal POCUS educational curriculums in remote, low-resource settings can be challenging due to geographical distances, encumbering the ability to provide ongoing hands-on support. Previously described educational interventions have focused on training individual users on clinical applications of POCUS, rather than training physicians how to teach POCUS, thereby limiting scalability and sustainable impact. We therefore describe our experiences establishing the first ultrasound fellowship curriculum in Peru, which incorporates tele-ultrasonography to circumvent traditional geographical barriers.","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":"Point-of-care-ultrasound (POCUS), global health education, telemedicine, tele-ultrasonography"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/81j0z7hq","frozenauthors":[{"first_name":"Andrea","middle_name":"","last_name":"Dreyfuss","name_suffix":"","institution":"Alameda Health System, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"David","middle_name":"A.","last_name":"Martin","name_suffix":"","institution":"Alameda Health System, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"Angel","middle_name":"","last_name":"Farro","name_suffix":"","institution":"Hospital Nacional Dos de Mayo, Department of Emergency Medicine, Cercado de Lima, Peru","department":"None"},{"first_name":"Robert","middle_name":"","last_name":"Inga","name_suffix":"","institution":"Hospital Nacional Dos de Mayo, Department of Emergency Medicine, Cercado de Lima, Peru","department":"None"},{"first_name":"Sayuri","middle_name":"","last_name":"Enríquez","name_suffix":"","institution":"Hospital Nacional Dos de Mayo, Department of Emergency Medicine, Cercado de Lima, Peru","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Mantuani","name_suffix":"","institution":"Alameda Health System, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"Arun","middle_name":"","last_name":"Nagdev","name_suffix":"","institution":"Alameda Health System, Department of Emergency Medicine, Oakland, California","department":"None"}],"date_submitted":"2019-11-19T09:54:09+01:00","date_accepted":"2019-11-19T09:54:09+01:00","date_published":"2020-07-09T23:29:25+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13376/galley/7021/download/"}]},{"pk":13401,"title":"Rural Interfacility Emergency Department Transfers: Framework and Qualitative Analysis","subtitle":null,"abstract":"Introduction:\n Interfacility transfers from rural emergency departments (EDs) are an important means of access to timely and specialized care.\nMethods:\n Our goal was to identify and explore facilitators and barriers in transfer processes and their implications for emergency rural care and access. Semi-structured interviews with ED staff at five rural and two urban Veterans Health Administration (VHA) hospitals were recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to identify themes and construct a conceptual framework.\nResults:\n From 81 interviews with clinical and administrative staff between March–June 2018, four themes in the interfacility transfer process emerged: 1) patient factors; 2) system resources; and 3) processes and communication for transfers, which culminate in 4) the location decision. Current and anticipated resource limitations were highly influential in transfer processes, which were described as burdensome and diverting resources from clinical care for emergency patients. Location decision was highly influenced by complexity of the transfer process, while perceived quality at the receiving location or patient preferences were not reported in interviews as being primary drivers of location decision. Transfers were described as burdensome for patients and their families. Finally, patients with mental health conditions epitomized challenges of emergency transfers.\nConclusion:\n Interfacility transfers from rural EDs are multifaceted, resource-driven processes that require complex coordination. Anticipated resource needs and the transfer process itself are important determinants in the location decision, while quality of care or patient preferences were not reported as key determinants by interviewees. These findings identify potential benefits from tracking transfer boarding as an operational measure, directed feedback regarding outcomes of transferred patients, and simplified transfer processes.","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":"Veterans"},{"word":"inter-facility transfers"},{"word":"Mental Health"},{"word":"access"},{"word":"Resources"},{"word":"qualitative analysis"},{"word":"Rural"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1z3840ts","frozenauthors":[{"first_name":"Candace","middle_name":"D.","last_name":"McNaughton","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee\nTenessee Valley Healthcare System, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Kemberlee","middle_name":"","last_name":"Bonnett","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"David","middle_name":"","last_name":"Schlundt","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Nicholas","middle_name":"M.","last_name":"Mohr","name_suffix":"","institution":"Evaluation (CADRE) Iowa City VA Healthcare System, Center for Access & Delivery Research and Evaluation, Iowa City, Iowa\nUniversity of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, Iowa \nUniversity of Iowa Carver College of Medicine, Department of Anesthesia, Iowa City, Iowa","department":"None"},{"first_name":"Suemin","middle_name":"","last_name":"Chung","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Peter","middle_name":"J.","last_name":"Kaboli","name_suffix":"","institution":"Evaluation (CADRE) Iowa City VA Healthcare System, Center for Access & Delivery Research and Evaluation, Iowa City, Iowa\nUniversity of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Michael","middle_name":"J.","last_name":"Ward","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee\nTenessee Valley Healthcare System, Department of Emergency Medicine, Nashville, Tennessee","department":"None"}],"date_submitted":"2019-12-04T00:53:06+01:00","date_accepted":"2019-12-04T00:53:06+01:00","date_published":"2020-07-09T23:23:26+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13401/galley/7036/download/"}]},{"pk":13476,"title":"Consensus Guidelines for Digital Scholarship in Academic Promotion","subtitle":null,"abstract":"Introduction:\n As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.\nMethods:\n We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.\nResults:\n We discussed consensus guidelines for evaluation and promotion of digital scholarship with the intent to develop specific, evidence-supported recommendations to P&T committees and applicants. These recommendations included the following: demonstrate scholarship criteria; provide external evidence of impact; and include digital peer-review roles. As traditional scholarship continues to evolve within the digital realm, academic medicine should adapt how that scholarship is evaluated. P&T committees in academic medicine are at the epicenter for supporting this changing paradigm in scholarship.\nConclusion:\n P&T committees can critically appraise the quality and impact of digital scholarship using specific, validated tools. Applicants for appointment and promotion should highlight and prepare their digital scholarship to specifically address quality, impact, breadth, and relevance. It is our goal to provide specific, timely guidance for both stakeholders to recognize the value of digital scholarship in advancing our field.","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":"Digital Scholarchip"},{"word":"Academic Medicine"},{"word":"Emergency Medicine"},{"word":"education theory"}],"section":"Research Publishing","is_remote":true,"remote_url":"https://escholarship.org/uc/item/44f3v8f1","frozenauthors":[{"first_name":"Abbas","middle_name":"","last_name":"Husain","name_suffix":"","institution":"Staten Island University Hospital - Northwell Health, Department of Emergency Medicine, Staten Island, New York","department":"None"},{"first_name":"Zachary","middle_name":"","last_name":"Repanshek","name_suffix":"","institution":"Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Manpreet","middle_name":"","last_name":"Singh","name_suffix":"","institution":"University of California, Los Angeles Medical School, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Felix","middle_name":"","last_name":"Ankel","name_suffix":"","institution":"University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Beck-Esmay","name_suffix":"","institution":"Mount Sinai St. Luke’s-West, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Cabrera","name_suffix":"","institution":"Mayo Clinic College of Medicine, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Teresa","middle_name":"M.","last_name":"Chan","name_suffix":"","institution":"McMaster University, Department of Medicine, Hamilton, Ontario","department":"None"},{"first_name":"Robert","middle_name":"","last_name":"Cooney","name_suffix":"","institution":"Geisinger Medical Center, Department of Emergency Medicine, Danville, Pennsylvania","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Gisondi","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California","department":"None"},{"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":"Jay","middle_name":"","last_name":"Khadpe","name_suffix":"","institution":"University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Repanshek","name_suffix":"","institution":"Lewis Katz School of Medicine at Temple University, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Mason","name_suffix":"","institution":"University of San Francisco-Fresno, Department of Emergency Medicine, Fresno, California","department":"None"},{"first_name":"Dimitri","middle_name":"","last_name":"Papanagnou","name_suffix":"","institution":"Sidney Kimmel Medical College at Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Jeff","middle_name":"","last_name":"Riddell","name_suffix":"","institution":"University of Southern California Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"N.","middle_name":"Seth","last_name":"Trueger","name_suffix":"","institution":"Northwestern University, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Fareen","middle_name":"","last_name":"Zaver","name_suffix":"","institution":"University of Calgary, Department of Emergency Medicine, Calgary, Alberta, Canada","department":"None"},{"first_name":"Emily","middle_name":"","last_name":"Brumfield","name_suffix":"","institution":"Oschner Clinic Foundation, Department of Emergency Medicine, New Orleans, Louisiana","department":"None"}],"date_submitted":"2020-01-06T13:20:52+01:00","date_accepted":"2020-01-06T13:20:52+01:00","date_published":"2020-07-08T21:52:48+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13476/galley/7061/download/"}]},{"pk":13857,"title":"Identifying Patients at Greatest Risk of Mortality due to COVID-19: A New England Perspective","subtitle":null,"abstract":"Introduction:\n Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly since December 2019, resulting in a pandemic that has, as of May 24, 2020, yielded over 5.3 million confirmed cases and over 340,000 deaths.1 As businesses move to safely reopen and frontline healthcare workers (HCW) continue to face this crisis, it is essential that health officials know who in the population is at the greatest risk of mortality if hospitalized and, therefore, has the greatest need to protect themselves from being infected. We examined the factors that increase the risk of mortality among hospitalized COVID-19 patients.\nMethods:\n This was a retrospective cohort study including confirmed COVID-19 patients admitted to the four Trinity Health of New England hospitals (THONE) in Connecticut and Massachusetts who either died or were discharged between March 1–April 22, 2020. Demographics, comorbidities, and outcomes of care were extracted from the electronic health record. A model of in-hospital mortality was made using a generalized linear model with binomial distribution and log link.\nResults: \nThe analysis included 346 patients: 229 discharged and 117 deceased. The likelihood of in-hospital mortality was increased for patients who were aged 60 or older (relative risk [RR] = 2.873; 95% confidence interval [CI], 1.733-4.764; p = <0.001), had diabetes (RR = 1.432; 95% CI,1.068-1.921; p = 0.016), or had chronic obstructive pulmonary disease (COPD) (RR = 1.410; 95% CI, 1.058-1.878; p = 0.019). Hyperlipidemia had a protective effect, reducing the likelihood of mortality (odds ratio = 0.745; 95% CI, 0.568-0.975; p = 0.032). Sensitivity and specificity of the model were 51.4% and 88.4%, respectively.\nConclusions:\n Being age 60 or older or having a history of diabetes or COPD are the most useful risk factors associated with mortality in hospitalized COVID-19 patients. As states ease stay-at-home orders, risk factors of severe disease can be used to identify those more likely to have worse outcomes if infected and hospitalized and, therefore, who in particular should continue to follow public health guidelines for avoiding infection: stay home if possible; practice physical distancing; and wear a facemask.","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 medicine, covid-19, sars-cov-2, risk factors, in-hospital mortality"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/88z3f7sd","frozenauthors":[{"first_name":"Aaron","middle_name":"A.","last_name":"Smith","name_suffix":"","institution":"Quinnipiac University, Frank H. Netter MD School of Medicine, North Haven, Connecticut","department":"None"},{"first_name":"Jeremy","middle_name":"","last_name":"Fridling","name_suffix":"","institution":"Quinnipiac University, Frank H. Netter MD School of Medicine, North Haven, Connecticut","department":"None"},{"first_name":"Danyal","middle_name":"","last_name":"Ibrahim","name_suffix":"","institution":"Trinity Health of New England, Saint Mary’s Hospital, Waterbury, Connecticut","department":"None"},{"first_name":"Paul","middle_name":"S.","last_name":"Porter Jr.","name_suffix":"","institution":"Trinity Health of New England, Saint Mary’s Hospital, Waterbury, Connecticut","department":"None"}],"date_submitted":"2020-04-30T21:41:44+02:00","date_accepted":"2020-04-30T21:41:44+02:00","date_published":"2020-07-08T21:26:19+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13857/galley/7213/download/"}]},{"pk":13841,"title":"Predictors of Mortality in Adult Population Admitted with COVID-19: A Retrospective Cohort Study from New York City","subtitle":null,"abstract":"Introduction: \nRapid spread of coronavirus disease 2019 (COVID-19) in the United States, especially in New York City (NYC), led to a tremendous increase in hospitalizations and mortality. There is very limited data available that associates outcomes during hospitalization in patients with COVID-19.\nMethods:\n In this retrospective cohort study, we reviewed the health records of patients with COVID-19 who were admitted from March 9–April 9, 2020, to a community hospital in NYC. Subjects with confirmed reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were included. We collected data related to demographics, laboratory results, and outcome of hospitalization. Outcome was measured based on whether the patient was discharged home or died during hospitalization.\nResults: \nThere were 888 consecutive admissions with COVID-19 during the study period, of which 513 were excluded with pending outcome or incomplete information. We included a total of 375 patients in the study, of whom 215 (57%) survived and 160 (43%) died during hospitalization. The majority of patients were male (63%) and of Hispanic origin (66%) followed by Blacks (25%), and others (9%). Hypertension (60%) stands out to be the most common comorbidity followed by diabetes mellitus (47%), cardiovascular disease (17%), chronic kidney disease (17%), and human immunodeficiency virus/acquired immunodeficiency syndrome (9%). On multiple regression analysis, increasing odds of mortality during hospitalization was associated with older age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.06 per year increase; p < 0.0001), admission D-dimer more than 1000 nanograms per milliliter (ng/mL) (OR 3.16; 95% CI, 1.75-5.73; p<0.0001), admission C-reactive protein (CRP) levels of more than 200 milligrams per liter  (mg/L) (OR 2.43; 95% CI, 1.36-4.34; p = 0.0028), and admission lymphopenia (OR 2.63; CI, 1.47-4.69; p 0.0010).\nConclusion: \nIn this retrospective cohort study originating in NYC, older age, admission levels of D-dimer of more than 1000 ng/mL, CRP of more than 200 mg/L and lymphopenia were associated with mortality in individuals hospitalized for COVID-19. We recommend using these risk factors on admission to triage patients to critical care units or surge units to maximize the use of surge capacity beds.","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":"COVID-19"},{"word":"SARS-CoV-2"},{"word":"Risk factors"},{"word":"New York"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/82x5x8g1","frozenauthors":[{"first_name":"Sridhar","middle_name":"","last_name":"Chilimuri","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Haozhe","middle_name":"","last_name":"Sun","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Ahmed","middle_name":"","last_name":"Alemam","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Nikhitha","middle_name":"","last_name":"Mantri","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Elona","middle_name":"","last_name":"Shehi","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Jairo","middle_name":"","last_name":"Tejada","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Alla","middle_name":"","last_name":"Yugay","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"},{"first_name":"Suresh","middle_name":"K.","last_name":"Nayudu","name_suffix":"","institution":"BronxCare Health System, Department of Medicine, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York","department":"None"}],"date_submitted":"2020-04-27T23:25:03+02:00","date_accepted":"2020-04-27T23:25:03+02:00","date_published":"2020-07-08T21:17:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13841/galley/7209/download/"}]},{"pk":13404,"title":"Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions","subtitle":null,"abstract":"Introduction:\n Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality.\nMethods:\n This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults.\nResults:\n We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%.\nConclusion: \nThe majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area.","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 services, inter-hospital transfers, goals of care, palliative care, emergency medicine"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/51q9m6md","frozenauthors":[{"first_name":"Justin","middle_name":"K.","last_name":"Brooten","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Alyssa","middle_name":"S.","last_name":"Buckenheimer","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on General Internal Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Joy","middle_name":"K.","last_name":"Hallmark","name_suffix":"","institution":"University of North Carolina, Department of Emergency Medicine, Chapel Hill, North Carolina","department":"None"},{"first_name":"Carl","middle_name":"R.","last_name":"Grey","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"David","middle_name":"M.","last_name":"Cline","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Candace","middle_name":"J.","last_name":"Breznau","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Tyler","middle_name":"S.","last_name":"McQueen","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Zvi","middle_name":"J.","last_name":"Harris","name_suffix":"","institution":"Wake Forest Graduate School of Arts and Science, Department of Biomedical Science, Winston-Salem, North Carolina","department":"None"},{"first_name":"David","middle_name":"","last_name":"Welsh","name_suffix":"","institution":"Wake Forest School of Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Jeff","middle_name":"D.","last_name":"Williamson","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Jennifer","middle_name":"L.","last_name":"Gabbard","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Winston-Salem, North Carolina\nWake Forest School of Medicine, Center for Health Care Innovation, Department of Internal Medicine, Winston-Salem, North Carolina","department":"None"}],"date_submitted":"2019-12-05T03:35:02+01:00","date_accepted":"2019-12-05T03:35:02+01:00","date_published":"2020-07-08T20:52:26+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13404/galley/7038/download/"}]},{"pk":13363,"title":"Impact of Emergency Department Crowding on Delays in Acute Stroke Care","subtitle":null,"abstract":"Introduction: \nDelays in identification and treatment of acute stroke contribute to significant morbidity and mortality. Multiple clinical factors have been associated with delays in acute stroke care. We aimed to determine the relationship between emergency department (ED) crowding and the delivery of timely emergency stroke care.\nMethods: \nWe used prospectively collected data from our institutional Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients presenting to our urban academic ED from July 2016–August 2018. We used capacity logs to determine the degree of ED crowding at the time of patients’ presentation and classified them as ordinal variables (normal, high, and severe capacity constraints). Outcomes of interest were door-to-imaging time (DIT) among patients potentially eligible for alteplase or endovascular therapy on presentation, door-to-needle time (DTN) for alteplase delivery, and door-to-groin puncture (DTP) times for endovascular therapy. Bivariate comparisons were made using t-tests, chi-square, and Wilcoxon rank-sum tests as appropriate. We used regression models to examine the relationship after accounting for patient demographics, transfer status, arrival mode, and initial stroke severity by the National Institutes of Health Stroke Scale.\nResults:\n Of the 1379 patients with ischemic stroke presenting during the study period, 1081 (78%) presented at times of normal capacity, 203 (15%) during high ED crowding, and 94 (7%) during severe crowding. Median DIT was 26 minutes (interquartile range [IQR] 17-52); DTN time was 43 minutes (IQR 31-59); and median DTP was 58.5 minutes (IQR 56.5-100). Treatment times were not significantly different during periods of higher ED utilization in bivariate or in multivariable testing.\nConclusion:\n In our single institution analysis, we found no significant delays in stroke care delivery associated with increased ED crowding. This finding suggests that robust processes of care may enable continued high-quality acute care delivery, even during times with an increased capacity burden.","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 crowding"},{"word":"stroke"},{"word":"Endovascular Therapy"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3494c2qc","frozenauthors":[{"first_name":"Todd","middle_name":"A.","last_name":"Jaffe","name_suffix":"","institution":"Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Joshua","middle_name":"N.","last_name":"Goldstein","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Brian","middle_name":"J.","last_name":"Yun","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Mark","middle_name":"","last_name":"Etherton","name_suffix":"","institution":"Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts","department":"None"},{"first_name":"Thabele","middle_name":"","last_name":"Leslie-Mazwi","name_suffix":"","institution":"Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts","department":"None"},{"first_name":"Lee","middle_name":"H.","last_name":"Schwamm","name_suffix":"","institution":"Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts","department":"None"},{"first_name":"Kori","middle_name":"S.","last_name":"Zachrison","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-12-19T19:32:00+01:00","date_accepted":"2019-12-19T19:32:00+01:00","date_published":"2020-07-08T20:43:31+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13363/galley/7015/download/"}]},{"pk":862,"title":"Atypical Cause of Sepsis from Bilateral Iliopsoas Abscesses Seeded from Self-mutilation: A Case Report","subtitle":null,"abstract":"Introduction:\n An iliopsoas abscess (IPA) is an abscess located adjacent to the iliopsoas and iliacus muscles. Although rare, their variable clinical presentations often lead to a delay in diagnosis.\nCase report:\n We present a case of sepsis secondary to multiple IPAs that was missed despite multiple healthcare encounters. The patient had no classical risk factors for an IPA, and the abscesses were found to be seeded via hematogenous spread from self-inflicted cutting.\nConclusion:\n This case illustrates the importance of obtaining a complete history, including psychiatric screen, and performing a thorough examination when evaluating patients with low back pain to rule out overlooked sources of bacteremia.","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":"abscess"},{"word":"sepsis"},{"word":"iliopsoas abscess"},{"word":"self-mutilation"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8fx441mk","frozenauthors":[{"first_name":"Sam","middle_name":"","last_name":"Langberg","name_suffix":"","institution":"University of Queensland School of Medicine, Ochsner Clinical School, Department of Emergency Medicine, New Orleans, Louisiana; Ochsner Health System, Department of Emergency Medicine, Division of Emergency Ultrasound, New Orleans, Louisiana","department":"None"},{"first_name":"Shayan","middle_name":"","last_name":"Azizi","name_suffix":"","institution":"University of Queensland School of Medicine, Ochsner Clinical School, Department of Emergency Medicine, New Orleans, Louisiana","department":"None"}],"date_submitted":"2020-07-07T21:34:40+02:00","date_accepted":"2020-07-07T21:34:40+02:00","date_published":"2020-07-07T21:35:30+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/862/galley/612/download/"}]},{"pk":13388,"title":"Emergency Department-based Intensive Care Unit Use Peaks Near Emergency Department Shift Turnover","subtitle":null,"abstract":"Introduction:\n The Emergency Critical Care Center (EC3) is an emergency department-based intensive care unit (ED-ICU) designed to improve timely access to critical care for ED patients. ED patients requiring intensive care are initially evaluated and managed in the main ED prior to transfer to a separate group of ED-ICU clinicians. The timing of patient transfers to the ED-ICU may decrease the number of handoffs between main ED teams and have an impact on both patient outcomes and optimal provider staffing models, but has not previously been studied. We aimed to analyze patterns of transfer to the ED-ICU and the relationship with shift turnover times in the main ED. We hypothesized that the number of transfers to the ED-ICU increases near main ED shift turnover times.\nMethods: \nAn electronic health record search identified all patients managed in the ED and ED-ICU in 2016 and 2017. We analyzed the number of ED arrivals per hour, the number of ED-ICU consults per hour, the time interval from ED arrival to ED-ICU consult, the distribution throughout the day, and the relationship with shift turnover times in the main ED.\nResults:\n A total of 160,198 ED visits were queried, of which 5308 (3.3%) were managed in the ED-ICU. ED shift turnover times were 7 am, 3 pm, and 11 pm. The mean number of ED-ICU consults placed per hour was 221 (85 standard deviation), with relative maximums occurring near ED turnover times: 10:31 pm -11:30 pm (372) and 2:31 pm -3:30 pm (365). The minimum was placed between 7:31 am – 8:30 am (88), shortly after the morning ED turnover time. The median interval from ED arrival time to ED-ICU consult order was 161 minutes (range 6-1,434; interquartile range 144-174). Relative minimums were observed for patients arriving shortly prior to ED turnover times: 4:31 am - 5:30 am (120 minutes [min]), 12:31 pm - 1:30 pm (145 min), and 9:31 pm - 10:30 pm (135 min). Relative maximums were observed for patients arriving shortly after ED turnover times: 7:31 am - 8:30 am (177 min), 4:31 pm - 5:30 pm (218 min), and 11:31 pm - 12:30 am (179 min).\nConclusion:\n ED-ICU utilization was highest near ED shift turnover times, and utilization was dissimilar to overall ED arrival patterns. Patients arriving immediately prior to ED shift turnover received earlier consults to the ED-ICU, suggesting these patients may have been preferentially transferred to the ED-ICU rather than signed out to the next team of emergency clinicians. These findings may guide operational planning, staffing models, and timing of shift turnover for other institutions implementing ED-ICUs. Future studies could investigate whether an ED-ICU model improves critically ill patients’ outcomes by minimizing ED provider handoffs.","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":"intensive care unit"},{"word":"Critical care"},{"word":"operations"},{"word":"staffing"},{"word":"turnover"},{"word":"Handoff"},{"word":"transitions of care"},{"word":"Sign-out"},{"word":"ED"},{"word":"ICU"},{"word":"ED-ICU"},{"word":"Emergency Critical Care"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7g4451f1","frozenauthors":[{"first_name":"Nathan","middle_name":"L.","last_name":"Haas","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Medicine, Division of Emergency Critical Care, Ann Arbor, Michigan","department":"None"},{"first_name":"Henrique","middle_name":"A.","last_name":"Puls","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Andrew","middle_name":"J.","last_name":"Adan","name_suffix":"","institution":"University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio","department":"None"},{"first_name":"Colman","middle_name":"","last_name":"Hatton","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"John","middle_name":"R.","last_name":"Joseph","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Hebert","name_suffix":"","institution":"University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington","department":"None"},{"first_name":"David","middle_name":"","last_name":"Hackenson","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Medicine, Division of Emergency Critical Care, Ann Arbor, Michigan","department":"None"},{"first_name":"Kyle","middle_name":"J.","last_name":"Gunnerson","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Medicine, Division of Emergency Critical Care, Ann Arbor, Michigan\nMichigan Medicine, Department of Internal Medicine, Ann Arbor, Michigan\nMichigan Medicine, Department of Anesthesiology/Critical Care, Ann Arbor, Michigan","department":"None"},{"first_name":"Benjamin","middle_name":"S.","last_name":"Bassin","name_suffix":"","institution":"Michigan Medicine, Department of Emergency Medicine, Ann Arbor, Michigan\nMichigan Medicine, Division of Emergency Critical Care, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2019-11-26T15:55:53+01:00","date_accepted":"2019-11-26T15:55:53+01:00","date_published":"2020-07-07T00:34:57+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13388/galley/7028/download/"}]},{"pk":13402,"title":"Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors","subtitle":null,"abstract":"Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include the Socratic method, the One-Minute Preceptor model, SNAPPS, ED STAT, teaching scripts, and bedside presentation rounds. Additionally, this article will suggest approaches to incorporating technology into clinical teaching, including just-in-time training, simulation, and telemedical teaching. This paper provides readers with strategies and techniques for improving clinical teaching effectiveness.","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":"Teaching"},{"word":"Clinical"},{"word":"Bedside"},{"word":"CORD"},{"word":"Best practices"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5h23k7d4","frozenauthors":[{"first_name":"Sreeja","middle_name":"","last_name":"Natesan","name_suffix":"","institution":"Duke University, Division of Emergency Medicine, Durham, North Carolina","department":"None"},{"first_name":"John","middle_name":"","last_name":"Bailitz","name_suffix":"","institution":"Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"King","name_suffix":"","institution":"The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Sara","middle_name":"M.","last_name":"Krzyzaniak","name_suffix":"","institution":"University of Illinois College of Medicine at Peoria/OSF Healthcare, Department of Emergency Medicine, Peoria, Illinois","department":"None"},{"first_name":"Sara","middle_name":"K.","last_name":"Kennedy","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Albert","middle_name":"J.","last_name":"Kim","name_suffix":"","institution":"Washington University in Saint Louis School of Medicine, Department of Emergency Medicine, St. Louis, Missouri","department":"None"},{"first_name":"Richard","middle_name":"","last_name":"Byyny","name_suffix":"","institution":"Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Gottlieb","name_suffix":"","institution":"Rush Medical Center, Department of Emergency medicine, Chicago, Illinois","department":"None"}],"date_submitted":"2019-12-04T04:11:19+01:00","date_accepted":"2019-12-04T04:11:19+01:00","date_published":"2020-07-04T00:31:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13402/galley/7037/download/"}]},{"pk":13373,"title":"Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department","subtitle":null,"abstract":"Introduction:\n The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter.\nMethods:\n This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing.\nResults:\n Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21-2.99], p<.01). Food insecure patients were younger than non-food insecure patients (50.4 vs 57.5 p<.02), and had significantly higher hemoglobin A1c (HgbA1c) levels (11.2% vs 9.9% p = 0.04). Of the 49 patients prescribed insulin, 17 (34.6%) stated they had used less insulin during the prior week than had been prescribed, and 21 (42.9%) stated they had used less insulin during the prior year than had been prescribed. Food insecure patients were more likely to have used less insulin than prescribed in the prior year (odds ratio = 3.60 [1.09-11.9], p = 0.04).\nConclusion: \nOur exploratory findings suggest almost half of clinically stable adults presenting to our inner-city ED with hyperglycemia experience food insecurity. More than one-third of those prescribed insulin used less than their prescribed amount in the prior year.","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":"Diabetes"},{"word":"Emergency Medicine"},{"word":"social determinants of health"}],"section":"Population Health and Social Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/823183bj","frozenauthors":[{"first_name":"Heng","middle_name":"Ky","last_name":"Nhoung","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Munish","middle_name":"","last_name":"Goyal","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Washington Hospital Center, Department of Emergency Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Maria","middle_name":"","last_name":"Cacciapuoti","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Hannah","middle_name":"","last_name":"Day","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Taymour","middle_name":"","last_name":"Hashemzadeh","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Michelle","middle_name":"","last_name":"Magee","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Health,\u2028MedStar Diabetes Institute, Columbia, Maryland","department":"None"},{"first_name":"Yumi","middle_name":"S.","last_name":"Jarris","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Georgetown University Hospital, Georgetown University School of Medicine, Department of Family Medicine, Washington, District of Columbia","department":"None"}],"date_submitted":"2019-11-18T23:58:34+01:00","date_accepted":"2019-11-18T23:58:34+01:00","date_published":"2020-07-04T00:19:18+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13373/galley/7020/download/"}]},{"pk":861,"title":"Spinal Arteriovenous Fistula, A Manifestation of Hereditary Hemorrhagic Telangiectasia: A Case Report","subtitle":null,"abstract":"Introduction:\n Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by arteriovenous malformations (AVM). HHT can have neurological manifestations.\nCase Report:\n A 32-year-old woman with a history of HHT presented to the emergency department with acute partial paralysis of the right leg, urinary retention, and right-sided back and hip pain. Magnetic resonance imaging of the spine demonstrated multiple, dilated blood vessels along the cervical spine, diffuse AVMs in the lumbar and thoracic spine, and a new arteriovenous fistula at the twelfth thoracic (T12) vertebral level. Her symptoms improved after endovascular embolization of the fistula.\nConclusion:\n Spinal AVMs are thought to be more prevalent in patients with HHT. Given the high morbidity of arteriovenous fistulas, early recognition and intervention are critical.","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":"pinal AVMs are thought to be more prevalent in patients with HHT. Given the high morbidity of arteriovenous fistulas, early recognition and intervention are critical"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2fw674wb","frozenauthors":[{"first_name":"Jodi","middle_name":"","last_name":"Spangler","name_suffix":"","institution":"University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Bjorn","middle_name":"","last_name":"Watsjold","name_suffix":"","institution":"University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Jonathan","middle_name":"S.","last_name":"Ilgen","name_suffix":"","institution":"University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington","department":"None"}],"date_submitted":"2020-07-03T22:23:04+02:00","date_accepted":"2020-07-03T22:23:04+02:00","date_published":"2020-07-03T22:25:44+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/861/galley/611/download/"}]},{"pk":860,"title":"Spontaneous Isolated Celiac Artery Dissection: A Case Report","subtitle":null,"abstract":"Introduction:\n Abdominal pain is a common chief complaint that can represent a wide breadth of diagnoses, ranging from benign to life-threatening. As our diagnostic tools become more sophisticated, we are able to better identify more causes of potentially life-threatening diseases. One such disease that is relatively unfamiliar to clinicians is spontaneous isolated celiac artery dissection (SICAD).\nCase Report:\n We describe a case of a 46-year-old man who presented to our emergency department with a chief complaint of abdominal pain and was found to have a SICAD and was successfully treated with anticoagulation, antihypertensives, and observation.\nConclusion:\n It is important for emergency physicians to keep this potentially life-threatening condition in mind and to know the appropriate first steps once identified.","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":"SICAD"},{"word":"spontaneous isolated celiac artery dissection"},{"word":"abdominal pain"},{"word":"imaging"},{"word":"computed tomography"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5sj1j8h4","frozenauthors":[{"first_name":"Clifford","middle_name":"L.","last_name":"Freeman","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Aaron","middle_name":"J.","last_name":"Lacy","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Aubrey","middle_name":"","last_name":"Miner","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Devin","middle_name":"M.","last_name":"Rogers","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Austin","middle_name":"T.","last_name":"Smith","name_suffix":"","institution":"Intermountain Healthcare, Park City Hospital, Department of Emergency Medicine, Park City, Utah","department":"None"},{"first_name":"Karan","middle_name":"S.","last_name":"Shah","name_suffix":"","institution":"Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"}],"date_submitted":"2020-07-03T22:18:27+02:00","date_accepted":"2020-07-03T22:18:27+02:00","date_published":"2020-07-03T22:19:21+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/860/galley/610/download/"}]},{"pk":13532,"title":"Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors","subtitle":null,"abstract":"Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.","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":"Best Practicies"},{"word":"Emergency Medicine"},{"word":"Residency"},{"word":"didactics"},{"word":"conferences"},{"word":"Medical Education"},{"word":"Post-Graduate Education"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3vm9q9vr","frozenauthors":[{"first_name":"D.","middle_name":"Brian","last_name":"Wood","name_suffix":"","institution":"St. Joseph’s Medical Center, Department of Emergency Medicine, Stockton, California","department":"None"},{"first_name":"Jaime","middle_name":"","last_name":"Jordan","name_suffix":"","institution":"Ronald Reagan UCLA Medical Center, David Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Rob","middle_name":"","last_name":"Cooney","name_suffix":"","institution":"Geisinger Commonwealth School of Medicine, Department of Emergency Medicine, Scranton, Pennsylvania","department":"None"},{"first_name":"Katja","middle_name":"","last_name":"Goldflam","name_suffix":"","institution":"Yale University, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Leah","middle_name":"","last_name":"Bright","name_suffix":"","institution":"Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Gottlieb","name_suffix":"","institution":"Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois","department":"None"}],"date_submitted":"2020-02-04T21:28:49+01:00","date_accepted":"2020-02-04T21:28:49+01:00","date_published":"2020-07-03T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13532/galley/7085/download/"}]},{"pk":45264,"title":"TRANSIT Vol. 13.1 Traveling Forms","subtitle":null,"abstract":"TRANSIT Vol. 13.1 Call for Papers: Traveling Forms","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives  4.0","short_name":"CC BY-NC-ND 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\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nd/4.0"},"keywords":[],"section":"Open Forum","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0qh7x7f7","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Sandberg","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-07-04T00:23:54+02:00","date_accepted":"2020-07-04T00:23:54+02:00","date_published":"2020-07-03T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/transit/article/45264/galley/34056/download/"}]},{"pk":13592,"title":"A Review of Journal Impact Metrics and Characteristics to Assist Emergency Medicine Investigators with Manuscript Submission Decisions","subtitle":null,"abstract":"Introduction:\n A crucial, yet subjective and non-evidence-based, decision for researchers is where to submit their original research manuscripts. The approach of submitting to journals in descending order of impact factor (IF) is a common but imperfect strategy. The validity of the IF as a measure of journal quality and significance is suspect, and a number of other journal impact scores have emerged, such that no one scale is universally accepted. Furthermore, practical considerations, such as likelihood of manuscript acceptance rates and times for decisions, may influence how authors prioritize journals. In this report, we sought to 1) review emergency medicine (EM) journal impact metrics, and 2) provide a comprehensive list of pertinent journal characteristics that may influence researchers’ choice of submission.\nMethods:\n We systematically reviewed five impact metrics (IF, H Index, CiteScore, Source-Normalized Impact per Paper, and SCImago Journal Rank) and other relevant characteristics of 20 EM journals.\nResults: \nWe found good to excellent agreement in ordinal rankings of four of the journal impact metrics, as measured by the Spearman rank correlation coefficient. The median acceptance rate for original research manuscripts in the EM category was 25% (interquartile range [IQR] 18, 31%), and the median initial decision time was 33 days (IQR 18, 56 days). Fourteen EM journals (70%) accepted brief reports, and 15 (75%) accepted case reports/images.\nConclusion:\n We recommend replication, expansion, and formalization of this repository of information for EM investigators in a continuously updated, open-access forum sponsored by an independent organization.","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":"Research Publishing","is_remote":true,"remote_url":"https://escholarship.org/uc/item/31n1z22z","frozenauthors":[{"first_name":"Robert","middle_name":"M.","last_name":"Rodriguez","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Virginia","middle_name":"","last_name":"Chan","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Angela","middle_name":"H.K.","last_name":"Wong","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Juan Carlos","middle_name":"C.","last_name":"Montoy","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"}],"date_submitted":"2020-02-20T20:51:08+01:00","date_accepted":"2020-02-20T20:51:08+01:00","date_published":"2020-07-03T06:05:16+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13592/galley/7110/download/"}]},{"pk":13596,"title":"The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban  Emergency Department","subtitle":null,"abstract":"Introduction: \nDroperidol carries a boxed warning from the United States Food and Drug Administration for QT prolongation and torsades des pointes (TdP). After a six-year hiatus, droperidol again became widely available in the US in early 2019. With its return, clinicians must again make decisions regarding the boxed warning. Thus, the objective of this study was to report the incidence of QT prolongation or TdP in patients receiving droperidol in the ED.\nMethods:\n Patients receiving droperidol at an urban Level I trauma center from 1997–2001 were identified via electronic health record query. All patients were reviewed for cardiac arrest. We reviewed electrocardiogram (ECG) data for both critically-ill and noncritical patients and recorded Bazett’s corrected QT intervals (QTc). ECGs from critically-ill patients undergoing resuscitation were further risk-stratified using the QT nomogram.\nResults:\n Of noncritical patients, 15,374 received 18,020 doses of droperidol; 2,431 had an ECG. In patients with ECGs before and after droperidol, the mean QTc was 424.3 milliseconds (ms) (95% confidence interval [CI], 419.7-428.9) before and 427.6 ms (95% CI, 424.3-430.9), after droperidol(n = 170). Regarding critically-ill patients, 1,172 received droperidol and 396 had an ECG. In the critically-ill group with ECGs before and after droperidol mean QTc was 435.7 ms (95% CI, 426.7–444.7) before and 435.8 ms (95% CI, 427.5–444.1) after droperidol (n = 114). Of 337 ECGs suitable for plotting on the QT nomogram, 13 (3.8%) were above the “at-risk” line; 3/136 (2.2%; 95% CI, 0.05-6.3%) in the before group, and 10/202 (4.9%; 95% CI, 2.4%-8.9%) in the after group. A single case of TdP occurred in a patient with multiple risk factors that did not reoccur after a droperidol rechallenge. Thus, the incidence of TdP was 1/16,546 (0.006%; 95% CI, 0.00015 - 0.03367%).\nConclusion:\n We found the incidence of QTc prolongation and TdP in ED patients receiving droperidol to be extremely rare. Our data suggest the FDA “black box warning” is overstated, and that close ECG monitoring is useful only in high-risk 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":[{"word":"droperidol, QT prolongation, QT nomogram, ventricular tachycardia, torsades des pointes"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2rc4p3bb","frozenauthors":[{"first_name":"Jon","middle_name":"B.","last_name":"Cole","name_suffix":"","institution":"University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota; Minnesota Poison Control System, Minneapolis, Minnesota; Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Samantha","middle_name":"C.","last_name":"Lee","name_suffix":"","institution":"Minnesota Poison Control System, Minneapolis, Minnesota","department":"None"},{"first_name":"Marc","middle_name":"L.","last_name":"Martel","name_suffix":"","institution":"University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota; Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Stephen","middle_name":"W.","last_name":"Smith","name_suffix":"","institution":"Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota; University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Michelle","middle_name":"H.","last_name":"Biros","name_suffix":"","institution":"University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"James","middle_name":"R.","last_name":"Miner","name_suffix":"","institution":"Hennepin Healthcare, Department of Emergency Medicine, Minneapolis, Minnesota; University of Minnesota Medical School, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"}],"date_submitted":"2020-02-22T04:51:57+01:00","date_accepted":"2020-02-22T04:51:57+01:00","date_published":"2020-07-03T01:27:39+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13596/galley/7113/download/"}]},{"pk":13368,"title":"Rabies Vaccination Compliance and Reasons for Incompletion","subtitle":null,"abstract":"Introduction:\n Rabies is a fatal disease with a 91% mortality rate in the United States. Current treatment of rabies consists of post-exposure prophylaxis treatment involving a complicated vaccination regimen. Studies conducted in other countries have found that patients do not complete their rabies vaccination treatment due to forgetting about their treatment, lack of time for visits, and the financial burden of treatment. However, little is known about why patients do not complete the rabies series in the US. The objective of this study was to determine the reasons why patients in the US do not complete rabies treatment.\nMethods:\n We performed a retrospective study to evaluate rabies post-exposure prophylaxis completion in the emergency department of an academic suburban hospital between June 2014–  July 2017. Further review was performed for patients who received inadequate vaccination to determine the cause of treatment incompletion. We conducted additional follow-up by phone survey for those patients who did not complete their rabies treatment but had no explanation for discontinuation available in the medical chart review.\nResults: \nResults indicated 198 patients received rabies post-exposure treatment during the inclusion period. Of these, 145 patients completed the rabies vaccination regimen. Reasons for treatment incompletion were found for 29 patients, and 24 patients were lost to follow-up. Of the 29 patients for which discontinuation was assessed, 23 patients (79.3%) stopped treatment due to appropriate reasons – either the animal involved tested negative for the rabies virus or the patient had prior rabies treatment and only required two booster shots. Reasons for not completing the series when medically indicated included the patient deciding to not return for treatment, lack of awareness of the full vaccination regimen, and the patient declining initiation of rabies vaccination.\nConclusion:\n Most patients in the US discontinue their rabies vaccination treatment for appropriate reasons; however, there is a proportion of patients who discontinue rabies vaccination when further treatment is medically indicated. This subset of patients is particularly at risk of rabies-related mortality, and additional measures need to be taken to ensure increased treatment compliance.","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":"Rabies Vaccination"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5x80w4z8","frozenauthors":[{"first_name":"Tony","middle_name":"","last_name":"Shi","name_suffix":"","institution":"The Pennsylvania State University College of Medicine, Hershey, Pennsylvania","department":"None"},{"first_name":"Eleanor","middle_name":"F.","last_name":"Dunham","name_suffix":"","institution":"Penn State Milton S. Hershey Medical Center, Department of Emergency Medicine, Hershey, Pennsylvania","department":"None"},{"first_name":"Jennifer","middle_name":"E.","last_name":"Nyland","name_suffix":"","institution":"The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, Pennsylvania","department":"None"}],"date_submitted":"2019-11-15T01:26:09+01:00","date_accepted":"2019-11-15T01:26:09+01:00","date_published":"2020-07-02T21:42:24+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13368/galley/7017/download/"}]},{"pk":13344,"title":"Current Understanding of the Neurobiology of Agitation","subtitle":null,"abstract":"Introduction\n: Managing agitation in the clinical setting is a challenge that many practitioners faceregularly. Our evolving understanding of the etiological factors involved in aggressive acts has betterinformed our interventions through pharmacologic and behavioral strategies. This paper reviews theliterature on the neurobiological underpinnings of aggressive behaviors, linking psychopathology withproposed mechanisms of action of psychiatric medications shown to be effective in mitigating agitation.\n \n Methods\n: We performed a review of the extant literature using PubMed as a primary database.Investigation focused on neurobiology of agitation and its relation to the current evidence base forparticular interventions.\n \n Results\n: There are well-established pathways that can lead to increased autonomic response andthe potential for violence. Psychopathology and substance-induced perceptual distortions may leadto magnification and overestimation of environmental threat, heightening the potential for aggression.Additional challenges have arisen with the advent of several novel drugs of abuse, many of whichlead to atypical clinical presentations and which can elude standard drug screens. Our interventionsstill lean on the evidence base found in Project BETA (Best Practices in Evaluation and Treatmentof Agitation). Although not a new drug and not included in the Project BETA guidelines, ketamineand its use are also discussed, given its unique pharmacology and potential benefits when otherprotocoled interventions have failed.\n \n Conclusion\n: Aggression can occur due to manifold reasons in the clinical setting. Having aninformed understanding of the possible determinants of agitation can help with more tailoredresponses to individual patients, limiting the unnecessary use of medications or of interventions thatcould be deemed forceful.","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":"Psychiatry"},{"word":"agitation"},{"word":"Psychopharmacology"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/85n1b3g2","frozenauthors":[{"first_name":"Christopher","middle_name":"W.T.","last_name":"Miller","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland","department":"None"},{"first_name":"Vedrana","middle_name":"","last_name":"Hodzic","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland","department":"None"},{"first_name":"Eric","middle_name":"","last_name":"Weintraub","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Psychiatry, Baltimore, Maryland","department":"None"}],"date_submitted":"2019-11-04T06:17:44+01:00","date_accepted":"2019-11-04T06:17:44+01:00","date_published":"2020-07-02T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13344/galley/7009/download/"}]},{"pk":13435,"title":"Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis","subtitle":null,"abstract":"Introduction: \n \nIleocolic intussusception is a common cause of pediatric bowel obstruction in youngchildren but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated,it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method ofassessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematicreview and meta-analysis was to determine the diagnostic accuracy of POCUS for children withsuspected ileocolic intussusception by emergency physicians (EP).\n \nMethods:\n \nWe conducted a systematic search on PubMed, Embase, CINAHL, LILACS, the Cochranedatabases, Google Scholar, as well as conference abstracts, and assessed bibliographies of selectedarticles for all studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children.We dual extracted data into a predefined worksheet and performed quality analysis with the QUADAS-2tool. Data were summarized and a meta-analysis was performed\n \nResults: \n \nSix studies (n = 1303 children) met our inclusion criteria. Overall, 11.9% of children hadintussusception. POCUS was 94.9% (95% confidence interval [CI], 89.9% to 97.5%) sensitive and 99.1%(95% CI, 94.7% to 99.8%) specific with a likelihood ratio (LR)+ of 105 (95% CI, 18 to 625) and a LR− of0.05 (95% CI, 0.03 to 0.10).\n \nConclusions:\n \nPOCUS by EPs is highly sensitive and specific for the identification of intussusception forchildren presenting to the emergency department.","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":"point-of-care ultrasound"},{"word":"pediatrics"},{"word":"Intussusception"},{"word":"emergency"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/31v3049k","frozenauthors":[{"first_name":"Margaret","middle_name":"","last_name":"Lin-Martore","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine and\nPediatrics, San Francisco, California","department":"None"},{"first_name":"Aaron","middle_name":"E","last_name":"Kornblith","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine and\nPediatrics, San Francisco, California","department":"None"},{"first_name":"Michael","middle_name":"A","last_name":"Kohn","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Stanford, California\nUniversity of California, San Francisco, Department of Epidemiology & Biostatistics, San\nFrancisco, California","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Gottlieb","name_suffix":"","institution":"Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois","department":"None"}],"date_submitted":"2019-12-18T22:15:33+01:00","date_accepted":"2019-12-18T22:15:33+01:00","date_published":"2020-07-02T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13435/galley/7048/download/"}]},{"pk":859,"title":"Infected Recurrent Thyroglossal Duct Cyst: A Case Report","subtitle":null,"abstract":"Introduction:\n A thyroglossal duct cyst (TGDC) is a congenital malformation in the neck. Surgical management is often recommended due to risk of recurrent infections and rare possibility of malignancy.\nCase Report:\n Herein, we describe the case of an adult presenting with tender neck mass and fever. She had a history of previous surgical excision of her TGDC as a child. On evaluation she was found to have a recurrent TGDC complicated by acute infection via computed tomography imaging.\nConclusion:\n In patients who have had previous surgical intervention to remove a TGDC, recurrence with infection should remain a diagnostic consideration.","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":"Thyroglossal duct cyst"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2zp6292x","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Foti","name_suffix":"","institution":"Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California","department":"None"},{"first_name":"Felipe","middle_name":"","last_name":"Grimaldo","name_suffix":"","institution":"Naval Medical Center San Diego, Department of Emergency Medicine, San Diego, California","department":"None"}],"date_submitted":"2020-07-03T00:54:48+02:00","date_accepted":"2020-07-03T00:54:48+02:00","date_published":"2020-07-02T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/859/galley/609/download/"}]},{"pk":858,"title":"A Case Report of Acute Motor and Sensory Polyneuropathy as the Presenting Symptom of SARS-CoV-2","subtitle":null,"abstract":"Introduction:\n Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) typically presents with respiratory illness and fever, however some rare neurologic symptoms have been described as presenting complaints. We report a case of an acute motor and sensory polyneuropathy consistent with Miller-Fisher Syndrome (MFS) variant of Guillain Barre Syndrome (GBS) as the initial symptom.\nCase Report:\n A 31-year old Spanish speaking male presents with two months of progressive weakness, numbness, and difficult walking. He had multiple cranial nerve abnormalities, dysmetria, ataxia, and absent lower extremity reflexes. An extensive workup including infectious, autoimmune, paraneoplastic, metabolic and neurologic testing was performed. Initially SARS-CoV-2 was not suspected based on a lack of respiratory symptoms. However, workup revealed a positive SARS-CoV-2 polymerase chain reaction test as well as presence of Anti-Ganglioside – GQ1b (Anti-GQ1b) immunoglobulin G antibodies.\nDiscussion:\n Miller Fisher syndrome (MFS) is a variant of Guillain-Barre syndrome (GBS) characterized by a triad of ophthalmoplegia, ataxia, and areflexia. The patient’s exam and workup including Anti-GQ1b is consistent with MFS.\nConclusion:\n SARS-CoV-2 infection in patients can have atypical presentations similar to this neurologic presentation. Prompt recognition and diagnosis can minimize the risk of transmission to hospital staff and facilitate initiation of 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":"SARS-CoV-2"},{"word":"COVID"},{"word":"COVID-19"},{"word":"Miller Fisher syndrome"},{"word":"Guillain-Barré syndrome"},{"word":"motor and sensory polyneuropathy"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/35j1f5zf","frozenauthors":[{"first_name":"Michael","middle_name":"R.","last_name":"Kopscik","name_suffix":"","institution":"Medical University of South Carolina, Department of Emergency Medicine, Charleston, South Carolina","department":"None"},{"first_name":"Barbra","middle_name":"K.","last_name":"Giourgas","name_suffix":"","institution":"Medical University of South Carolina, Department of Neurology, Charleston, South Carolina","department":"None"},{"first_name":"Bradley","middle_name":"C.","last_name":"Presley","name_suffix":"","institution":"Medical University of South Carolina, Department of Emergency Medicine, Charleston, South Carolina","department":"None"}],"date_submitted":"2020-07-02T01:46:05+02:00","date_accepted":"2020-07-02T01:46:05+02:00","date_published":"2020-07-02T01:47:19+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/858/galley/608/download/"}]},{"pk":857,"title":"Mixed Purpuric and Maculopapular Lesions in a Patient with COVID-19: A Case Report","subtitle":null,"abstract":"Introduction:\n The coronavirus disease of 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 is a global pandemic that expresses itself with a wide variety of presenting symptoms in patients. There is a paucity of literature describing the dermatologic manifestations of the virus, particularly in the United States.\nCase Report:\n Here we present a case of COVID-19 that manifested with a purpuric rash on the lower extremities and a maculopapular eruption on the abdomen in a patient in acute diabetic ketoacidosis and normal platelet count.\nDiscussion:\n The reported presenting symptoms of patients with COVID-19 vary greatly. This is the first documented case of COVID-19 presenting with mixed cutaneous manifestations of a purpuric as well as maculopapular rash.\nConclusion:\n The cutaneous lesions associated with the COVID-19 infection may mimic or appear similar to other well-known conditions. We illustrate a case of COVID-19 infection presenting with purpuric rash on the lower extremities and a maculopapular rash on the abdomen.","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":"COVID-19"},{"word":"coronavirus"},{"word":"rash"},{"word":"dermatologic"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5wd1f1cs","frozenauthors":[{"first_name":"Randall","middle_name":"","last_name":"Beaupre II","name_suffix":"","institution":"Creighton University Arizona Health Education Alliance, Department of Emergency Medicine, Phoenix, Arizona","department":"None"},{"first_name":"Cody","middle_name":"","last_name":"Petrie","name_suffix":"","institution":"Creighton University Arizona Health Education Alliance, Department of Emergency Medicine, Phoenix, Arizona","department":"None"},{"first_name":"Alexander","middle_name":"","last_name":"Toledo","name_suffix":"","institution":"Creighton University Arizona Health Education Alliance, Department of Emergency Medicine, Phoenix, Arizona","department":"None"}],"date_submitted":"2020-07-02T01:36:06+02:00","date_accepted":"2020-07-02T01:36:06+02:00","date_published":"2020-07-02T01:37:30+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/857/galley/607/download/"}]},{"pk":856,"title":"A Case Report: Co-presenting COVID-19 Infection and Acute Drug Intoxication","subtitle":null,"abstract":"Background:\n Coronavirus disease 2019 (COVID-19) has spread throughout the world since late 2019. Symptoms appear after a two-week incubation period and commonly include fever, cough, myalgia or fatigue, and shortness of breath.\nCase Report:\n A 32-year-old male with a history of opiate abuse presented to the emergency department with altered mental status. The patient was lethargic and hypoxic with improvement from naloxone. Official chest radiograph was read as normal; however, the treating clinicians noted bilateral interstitial opacities, raising concern for underlying infectious etiology. Opiates and cocaine were positive on drug screen, and an arterial blood gas on room air showed hypoxemia with respiratory acidosis. The patient was intubated during the treatment course due to persistent hypoxemia and for airway protection after resuscitation. The COVID-19 test was positive on admission, and later computed tomography showed ground-glass opacities. The patient was extubated and discharged after one week on the ventilator.\nConclusion:\n When screening patients at and during evaluation, physicans should consider a broad differential as patients with atypical presentations may be overlooked as candidates for COVID-19 testing. As screening and evaluation protocols evolve, we emphasize maintaining a high index of suspicion for COVID-19 in patients with atypical symptoms or presenting with other chief complaints in order to avoid spreading the disease","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":"COVID-19"},{"word":"Anchoring bias"},{"word":"Opiates"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3t3841qd","frozenauthors":[{"first_name":"Jeremy","middle_name":"","last_name":"Riekena","name_suffix":"","institution":"New York-Presbyterian Queens, Department of Emergency Medicine, Flushing, New York","department":"None"},{"first_name":"Irene","middle_name":"","last_name":"Lee","name_suffix":"","institution":"New York-Presbyterian Queens, Department of Emergency Medicine, Flushing, New York","department":"None"},{"first_name":"Anita","middle_name":"","last_name":"Lui","name_suffix":"","institution":"New York-Presbyterian Queens, Department of Emergency Medicine, Flushing, New York","department":"None"},{"first_name":"Marion-Vincent","middle_name":"","last_name":"Mempin","name_suffix":"","institution":"New York-Presbyterian Queens, Department of Emergency Medicine, Flushing, New York","department":"None"}],"date_submitted":"2020-07-02T01:29:36+02:00","date_accepted":"2020-07-02T01:29:36+02:00","date_published":"2020-07-02T01:30:14+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/856/galley/606/download/"}]},{"pk":61787,"title":"Can Ultrasound Aid in the Diagnosis of Gout and Septic Arthritis in the Setting of Monoarticular Joint Pain?","subtitle":null,"abstract":"Monoarticular joint pain is commonly encountered in the emergency department (ED) with a broad differential diagnosis. Septic arthritis represents a “can’t miss” diagnosis while gout represents a chronic, painful arthropathy. Traditionally these diagnoses are made with arthrocentesis in addition to history, physical exam, imaging and laboratory studies. Ultrasound (US) represents a novel modality that may aid in the diagnosis of gout without requiring arthrocentesis. Furthermore, the sonographic features of gout may exclude the diagnosis of septic arthritis. Additional research is required in the ED setting to better clarify the role of US in these two disease states.","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":"gout, ultrasound, joint pain"}],"section":"Review Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1nw9c836","frozenauthors":[{"first_name":"John","middle_name":"M","last_name":"Kiel","name_suffix":"","institution":"University of Florida College of Medicine Jacksonville","department":""},{"first_name":"Gurjit","middle_name":"","last_name":"Kaeley","name_suffix":"","institution":"Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, Jacksonville, United States","department":""}],"date_submitted":"2020-04-07T15:41:48+02:00","date_accepted":"2020-04-07T15:41:48+02:00","date_published":"2020-07-01T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uciem_medjem/article/61787/galley/47671/download/"}]},{"pk":38296,"title":"Anvil Age Economy: A Map of the Spread of Iron Metallurgy across Afro-Eurasia","subtitle":null,"abstract":"A large dataset is used to map the historical spread of iron use across Afro-Eurasia using a number of different methodologies. Traditional dates for the beginning of what archaeologists call the “Iron Age” in each region are unacceptable because they are imprecise and the dates themselves are reached on the basis of different methodologies. The author maps the spread of iron with a primary focus on its acceleration in use across many object classes. Three additional maps are also provided: the first critical use of iron for cutting tool or weapon, the spread of iron helmets and the spread of high-quality steel swords. While many of the maps are at the experimental stage, the results give a unique insight into technological change across history and can be used to test predictive models of historical change. As the mapping of the rise and spread of a technology has rarely or never been done before on this scale, the maps, the methodologies used, and the problems encountered provide a fork in the scholarship for more accurate and detailed successors.","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":"iron metallurgy"}],"section":"Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4t32q1mj","frozenauthors":[{"first_name":"Edward","middle_name":"A. L.","last_name":"Turner","name_suffix":"","institution":"Seshat Global History Databank","department":"None"}],"date_submitted":"2019-11-15T18:46:43+01:00","date_accepted":"2019-11-15T18:46:43+01:00","date_published":"2020-06-30T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/cliodynamics/article/38296/galley/28813/download/"}]},{"pk":38309,"title":"Complexities of Collapse: A Review of \"Understanding Collapse: Ancient History and Modern Myths\" by Guy D. Middleton (Cambridge University Press, 2017)","subtitle":null,"abstract":"A Review of \"Understanding Collapse: Ancient History and Modern Myths\" by Guy D. Middleton (Cambridge University Press, 2017)","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":"Book Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5bg8f4r1","frozenauthors":[{"first_name":"Eugene","middle_name":"N.","last_name":"Anderson","name_suffix":"","institution":"University of California, Riverside","department":"None"}],"date_submitted":"2020-05-11T18:58:22+02:00","date_accepted":"2020-05-11T18:58:22+02:00","date_published":"2020-06-30T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/cliodynamics/article/38309/galley/28816/download/"}]},{"pk":38308,"title":"New Technology, Same Culture: A Review of “Cultural Evolution in the Digital Age” by Alberto Acerbi (Oxford University Press, 2019)","subtitle":null,"abstract":"A Review of “Cultural Evolution in the Digital Age” by Alberto Acerbi (Oxford University Press, 2019)","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":"Cultural Evolution, Digital History"}],"section":"Book Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8hg2441f","frozenauthors":[{"first_name":"Joshua","middle_name":"Conrad","last_name":"Jackson","name_suffix":"","institution":"UNC","department":"None"}],"date_submitted":"2020-04-26T18:57:52+02:00","date_accepted":"2020-04-26T18:57:52+02:00","date_published":"2020-06-30T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/cliodynamics/article/38308/galley/28815/download/"}]},{"pk":38273,"title":"The Causes and Mechanisms of the Ukrainian Crisis of 2014: A Structural–Demographic Approach","subtitle":null,"abstract":"This article tests the hypothesis that Ukraine experienced a state breakdown in 2014. The methodology employed to test this statement is based on achievements of structural-demographic theory, created by Jack Goldstone and developed by Peter Turchin. The reasons for a fiscal crisis, intra-elite conflict and mass mobilization (the three criteria for a state breakdown) are discussed. It is demonstrated that budget management in Ukraine was ineffective, and, coupled with an unbalanced political system, led to the fiscal crisis. The intra-elite conflict was caused by Yanukovych’s politics and by lack of resources as a consequence of elite overproduction, which led to fewer opportunities among the traditional elites. To demonstrate the mass discontent that was the main factor for the protests and rallies, evidence is presented that the population of Ukraine experienced immiseration in 2010–13. The final factor determining the future of the Ukrainian system was the delegitimization of power. This could happen only under the conditions of intra-elite conflict. All of these factors arose because of the high degree of capital concentration in the hands of the economic elite. The article concludes that we have every reason to say that a state breakdown occurred in Ukraine.","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":"stuctural-demographic theory"},{"word":"revolution of Dignity"},{"word":"State collapse"},{"word":"Ukranian state breakdown"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/97f4c489","frozenauthors":[{"first_name":"Dmitry","middle_name":"","last_name":"Shevsky","name_suffix":"","institution":"National Research University Higher School of Economics","department":"None"}],"date_submitted":"2019-01-15T11:56:35+01:00","date_accepted":"2019-01-15T11:56:35+01:00","date_published":"2020-06-30T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/cliodynamics/article/38273/galley/28803/download/"}]},{"pk":38311,"title":"The Equinox2020 Seshat Data Release","subtitle":null,"abstract":"This report describes the current canonical time-series dataset named “Equinox2020,” a subset of Seshat: Global History Databank data for a well-curated list of polities and variables available on the Seshat Data Browser. The report provides an introduction to the methods and procedures of the Seshat project relating to the curation and release of the Equinox2020 dataset.","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":"Seshat, Databases, Databanks"}],"section":"Databases","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4wj1j1vb","frozenauthors":[{"first_name":"Peter","middle_name":"","last_name":"Turchin","name_suffix":"","institution":"","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Hoyer","name_suffix":"","institution":"","department":"None"},{"first_name":"James","middle_name":"","last_name":"Bennett","name_suffix":"","institution":"","department":"None"},{"first_name":"Kiran","middle_name":"","last_name":"Basava","name_suffix":"","institution":"","department":"None"},{"first_name":"Enrico","middle_name":"","last_name":"Cioni","name_suffix":"","institution":"","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Feeney","name_suffix":"","institution":"","department":"None"},{"first_name":"Pieter","middle_name":"","last_name":"Francois","name_suffix":"","institution":"","department":"None"},{"first_name":"Samantha","middle_name":"","last_name":"Holder","name_suffix":"","institution":"","department":"None"},{"first_name":"Jill","middle_name":"","last_name":"Levine","name_suffix":"","institution":"","department":"None"},{"first_name":"Selin","middle_name":"","last_name":"Nugent","name_suffix":"","institution":"","department":"None"},{"first_name":"Jenny","middle_name":"","last_name":"Reddish","name_suffix":"","institution":"","department":"None"},{"first_name":"Chelsea","middle_name":"","last_name":"Thorpe","name_suffix":"","institution":"","department":"None"},{"first_name":"Sal","middle_name":"","last_name":"Wiltshire","name_suffix":"","institution":"","department":"None"},{"first_name":"Harvey","middle_name":"","last_name":"Whitehouse","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-06-08T21:41:14+02:00","date_accepted":"2020-06-08T21:41:14+02:00","date_published":"2020-06-30T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/cliodynamics/article/38311/galley/28818/download/"}]},{"pk":13812,"title":"Novel Barrier Enclosure for Both Aerosol and Droplet Protection Model","subtitle":null,"abstract":"Emergency physicians are on the front lines of treating patients with highly infectious respiratory diseases. Personal protective equipment is one defense against contamination from droplet and aerosol secretions. Intubation is a procedure that greatly can increase provider’s risk of exposure. Utilization of an intubation box has been discussed and recommended on social media platforms. There has been scant literature demonstrating the effectiveness of such devices. This study aimed to determine degree of droplet contamination to the intubator utilizing a novel barrier enclosure with a fluorescent simulated respiratory contagion. This model confirmed both added protection to the providers preforming intubation, and reduction of spread of the droplets when such a device is applied to patient care.","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":"COVID19, Droplet, Aerosol, Simulation Model, Intbation, Intubation Box"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8db208ph","frozenauthors":[{"first_name":"Chad","middle_name":"E.","last_name":"Branecki","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Emergency Medicine, Omaha, Nebraska","department":"None"},{"first_name":"Nicholas","middle_name":"J.","last_name":"Jobeun","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Emergency Medicine, Omaha, Nebraska","department":"None"},{"first_name":"Tyler","middle_name":"J.","last_name":"Ronnfeldt","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Emergency Medicine, Omaha, Nebraska","department":"None"},{"first_name":"Michael","middle_name":"A.","last_name":"Ash","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Internal Medicine, Omaha, Nebraska","department":"None"},{"first_name":"Thomas","middle_name":"E.","last_name":"Schulte","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Anesthesia, Omaha, Nebraska","department":"None"},{"first_name":"Jason","middle_name":"G.","last_name":"Langenfeld","name_suffix":"","institution":"University of Nebraska College of Medicine, Department of Emergency Medicine, Omaha, Nebraska","department":"None"}],"date_submitted":"2020-04-23T23:23:49+02:00","date_accepted":"2020-04-23T23:23:49+02:00","date_published":"2020-06-30T03:24:49+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13812/galley/7194/download/"}]},{"pk":13241,"title":"Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge","subtitle":null,"abstract":"Introduction:\n Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.\nMethods:\n This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart reviewers abstracted data from patient problem lists and medical history in the electronic health record to assess stroke (CHA2DS2-VASc) and bleeding risk (HAS-BLED). The primary outcome was the provision of an OAC prescription at discharge in OAC-naive patients with high stroke risk. Descriptive statistics and multivariable logistic regression assessed associations between OAC prescription and patient characteristics.\nResults: \nWe included 138 patient visits in our analysis, of whom 39.9% (n = 55) were low stroke risk (CHA2DS2-VASc = 0 in males and 1 in females), 15.9% (n = 22) were intermediate risk (CHA2DS2-VASc = 1 in males), and 44.2% (n = 61) were high risk (CHA2DS2-VASc ≥ 2). Of patients with high stroke risk and low-to-intermediate bleeding risk (n = 57), 80.7% were not prescribed an OAC at discharge. Cardiology consultation and female gender, but not stroke risk (CHA2DS2-VASc score), were predictors of an ED provider prescribing an OAC to an OAC-naive AF patient at ED discharge.\nConclusion:\n The majority of OAC-eligible patients were discharged home without an OAC prescription. In OAC-naive patients discharged home from the ED, cardiology consultation and female gender were associated with OAC prescription. Our findings suggest that access to expert opinion may improve provider comfort with OAC prescribing and highlight the need for improved guidelines specific to ED-management of AF.","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, emergency department, cardiology consult, warfarin, anticoagulation"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/30n769qp","frozenauthors":[{"first_name":"Bory","middle_name":"","last_name":"Kea","name_suffix":"","institution":"Oregon Health & Science University, Center for Policy and Research—Emergency Medicine, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Bethany","middle_name":"T.","last_name":"Waites","name_suffix":"","institution":"Kaiser Permanente, Department of Obstetrics and Gynecology, San Francisco, California","department":"None"},{"first_name":"Amber","middle_name":"","last_name":"Lin","name_suffix":"","institution":"Oregon Health & Science University, Center for Policy and Research—Emergency Medicine, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Merritt","middle_name":"","last_name":"Raitt","name_suffix":"","institution":"Oregon Health & Science University, Knight Cardiovascular Institute, VA Portland Health Care System, Portland, Oregon","department":"None"},{"first_name":"David","middle_name":"R.","last_name":"Vinson","name_suffix":"","institution":"The Permanente Medical Group and Kaiser Permanente Division of Research, Oakland, California","department":"None"},{"first_name":"Niroj","middle_name":"","last_name":"Ari","name_suffix":"","institution":"Portland State University, School of Public Health, Portland, Oregon","department":"None"},{"first_name":"Luke","middle_name":"","last_name":"Welle","name_suffix":"","institution":"Oregon Health & Science University, School of Medicine, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Sill","name_suffix":"","institution":"Oregon Health & Science University, School of Medicine, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Dana","middle_name":"","last_name":"Button","name_suffix":"","institution":"Oregon Health & Science University, School of Medicine, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Benjamin","middle_name":"C.","last_name":"Sun","name_suffix":"","institution":"University of Pennsylvania, Department of Emergency Medicine, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania","department":"None"}],"date_submitted":"2019-09-12T07:05:17+02:00","date_accepted":"2019-09-12T07:05:17+02:00","date_published":"2020-06-29T21:24:30+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13241/galley/6971/download/"}]},{"pk":5550,"title":"Assessment of Canine Temperament: Predictive or Prescriptive?","subtitle":null,"abstract":"Canine temperament testing has historically been linked to the predictability of future behavior. A \npredictive\n model of canine temperament testing assumes that a dog’s behavior in one situation will likely be similar to its behavior in a variety of other situations. An alternative model is proposed for a canine temperament test that could identify areas in which a dog might fail to perform certain test items, but by using modern behavior analysis techniques, behaviors could be modified through a \nprescriptive\n approach. This article describes the AKC Temperament Test (ATT), which is the first prescriptive canine temperament test. The ATT is designed to provide pet dog owners with information about potential problem areas that can be modified through training.","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":"temperament, temperament tests, canine temperament tests, predictive validity"}],"section":"Special Issue: Canine Research","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4mw7n5tj","frozenauthors":[{"first_name":"Mary","middle_name":"Ruth","last_name":"Burch","name_suffix":"","institution":"American Kennel Club","department":"None"}],"date_submitted":"2019-10-10T04:10:07+02:00","date_accepted":"2019-10-10T04:10:07+02:00","date_published":"2020-06-29T20:18:26+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5550/galley/3360/download/"}]},{"pk":42991,"title":"North American Counterterritoriality: Nineteenth-Century Black Activism and Alternative Legal Spatiality","subtitle":null,"abstract":"This contribution uses the terms “territoriality” and “legal spatiality” to consider how they shape our understanding of the significance of the North American border between the US and Canada (British North America) in the nineteenth century. It looks, first, at the ways in which Black intellectual leaders constructed Upper Canada as a counterterritory to the United States in the context of debating Black emigration by combining politics and geography to challenge conflicting territorialities. Canada’s ambiguous position as a safe haven under the British lion’s paw that was formerly invested in slavery and the slave trade is reinforced, second, by the increasing numbers of black fugitives onto its territories. This perceived mass exodus provoked aggressive reactions from US slaveholders who relied on the fugitive slave laws to lay claims on their “property” in the form of fugitive slave extradition cases. The activism by Black communities along the border that emerged from the crises to save fugitives from being returned to bondage, this contribution shows, enacted a form of counterterritoriality that called on the British imperial center to challenge the legality of slavery, introducing alternative forms of “legal spatiality.”","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives  4.0","short_name":"CC BY-NC-ND 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\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nd/4.0"},"keywords":[{"word":"Upper Canada and fugitive slave laws"},{"word":"US-Canada borderland"},{"word":"Black fugitives in Canada"},{"word":"Black activism around fugitive slave laws"},{"word":"Transnational American Studies"},{"word":"JTAS"}],"section":"SPECIAL FORUM: (Im)Mobilities","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4cg540np","frozenauthors":[{"first_name":"Nele","middle_name":"","last_name":"Sawallisch","name_suffix":"","institution":"Mainz University","department":"None"}],"date_submitted":"2020-02-17T22:01:42+01:00","date_accepted":"2020-02-17T22:01:42+01:00","date_published":"2020-06-29T16:40:17+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jtas/article/42991/galley/32041/download/"}]},{"pk":42995,"title":"Borderwaters: Archipelagic Geometries between Indonesia and the United States","subtitle":null,"abstract":"Generally speaking, the border/borderlands complex has oriented itself around interactions between the border as a one-dimensional Euclidean line and the borderlands’ set of contestations growing out of cultural currents that exceed the state’s superimposed Euclidean geometry/geography. In complement and contradistinction, this essay advances a borderwaters framework as interlinked with governmentality’s engagement in and with modes of \nnon\n-Euclidean spatial perception, in which the state’s imagination of borders has not been the evocation of, in Gloria Anzaldúa’s term, an “unnatural boundary” but has rather been a partial function of the geological and hydrological materialities and processes to which governmentality has tended to affix water-based and water-dependent borders. These water-dependent and natural-cultural borders (with their attendant notions of human sovereignty) are intertwined with an arena of borderwaters where nonhuman actants (currents, waves, shorelines, and nonhuman animals) play roles in establishing how human borders will attain perception. In outlining some of the dynamics of the borderwaters, this essay turns toward the oceanic and archipelagic work of the Greater Mexican visual artist Miguel Covarrubias, whose midcentury representations of Indonesia and the United States’s Trust Territory of the Pacific Islands help contextualize and theorize state, Indigenous, and nonhuman cultures as they have converged and diverged across non-Euclidean modes of imagining boundaries, nonboundaries, and spatial area on a terraqueous planet.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives  4.0","short_name":"CC BY-NC-ND 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\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nd/4.0"},"keywords":[{"word":"borderwaters"},{"word":"nonhuman agency"},{"word":"non-Euclidean geometry"},{"word":"Miguel Covarrubias"},{"word":"Transnational American Studies"},{"word":"JTAS"}],"section":"SPECIAL FORUM: (Im)Mobilities","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7010021b","frozenauthors":[{"first_name":"Brian","middle_name":"Russell","last_name":"Roberts","name_suffix":"","institution":"Brigham Young University","department":"None"}],"date_submitted":"2020-02-21T10:24:15+01:00","date_accepted":"2020-02-21T10:24:15+01:00","date_published":"2020-06-29T06:25:11+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jtas/article/42995/galley/32045/download/"}]},{"pk":42986,"title":"The Banality of American Empire: The Curious Case of Guam, USA","subtitle":null,"abstract":"The title of a 2004 \nNew York Times \narticle sums up well the curious political existence of the island of Guam: “Looking for friendly base overseas, Pentagon finds it already has one.” Guam is known as the “tip of America’s spear” and has for more than a century played a crucial role in securing US strategic interests in the Asia-Pacific region. Guam is also one of seventeen remaining colonies in the world, as recognized by the United Nations, in need of decolonization. In media representations and critical discourse around US imperialism, Guam also occupies a curious space, where it is a US military colony that somehow does not represent colonialism or imperialism. This essay will use the concept of \nbanality \nto interrogate how this simultaneous fullness of Guam as a site for American military power, and its emptiness as a site for American critique, enable the US to project force largely unchallenged over a significant part of the globe.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives  4.0","short_name":"CC BY-NC-ND 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\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nd/4.0"},"keywords":[{"word":"Guam"},{"word":"US Imperialism"},{"word":"US military colony"},{"word":"unincorporated territory"},{"word":"banality"},{"word":"US overseas bases"},{"word":"Transnational American Studies"},{"word":"JTAS"}],"section":"SPECIAL FORUM: (Im)Mobilities","is_remote":true,"remote_url":"https://escholarship.org/uc/item/361824dg","frozenauthors":[{"first_name":"Michael","middle_name":"Lujan","last_name":"Bevacqua","name_suffix":"","institution":"University of Guam","department":"None"},{"first_name":"Manuel","middle_name":"Lujan","last_name":"Cruz","name_suffix":"","institution":"Auckland University of Technology","department":"None"}],"date_submitted":"2020-02-17T21:42:04+01:00","date_accepted":"2020-02-17T21:42:04+01:00","date_published":"2020-06-28T19:05:57+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jtas/article/42986/galley/32037/download/"}]},{"pk":39546,"title":"Cleaning up the U.S.-Mexico Border: NADBank’s Efforts to Close the Wastewater Infrastructure Gap","subtitle":null,"abstract":"The North American Development Bank (NADBank) was established in 1994 to “cleanup” the border region, which was characterized at the time as an open sewer. This research examines NADBank’s cleanup efforts to date by analyzing data from published reports, articles, and archival records using descriptive statistics and geospatial analysis. Overall, NADBank has provided almost $760 million in loans and grants to support the implementation of 133 wastewater infrastructure projects that have a total construction cost of $1.9 billion. Although a substantial investment, these projects have not fully addressed the wastewater infrastructure needs of the border, estimated in 1993 to be between $4.3 and $6 billion. However, these infrastructure projects have resulted in some tangible improvements in water quality in major transboundary rivers. Unfortunately, the border region continues to be plagued by discharges of raw sewage and additional investment in infrastructure and institutional capacity is needed to fully resolve the problems.","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":"NADBank, Mexico, Border, Wastewater Infrastructure, Water Quality"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0x13s2dk","frozenauthors":[{"first_name":"Linda","middle_name":"","last_name":"Allen","name_suffix":"","institution":"Other","department":"None"}],"date_submitted":"2020-05-15T23:26:58+02:00","date_accepted":"2020-05-15T23:26:58+02:00","date_published":"2020-06-26T22:05:29+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39546/galley/29852/download/"}]},{"pk":12785,"title":"Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care","subtitle":null,"abstract":"Introduction: \nWe developed evidence-based recommendations for prehospital evaluation and treatment of adult patients with respiratory distress. These recommendations are compared with current protocols used by the 33 local emergency medical services agencies (LEMSA) in California.\nMethods: \nWe performed a review of the evidence in the prehospital treatment of adult patients with respiratory distress. The quality of evidence was rated and used to form guidelines. We then compared the respiratory distress protocols of each of the 33 LEMSAs for consistency with these recommendations.\nResults: \nPICO (population/problem, intervention, control group, outcome) questions investigated were treatment with oxygen, albuterol, ipratropium, steroids, nitroglycerin, furosemide, and non-invasive ventilation. Literature review revealed that oxygen titration to no more than 94-96% for most acutely ill medical patients and to 88-92% in patients with acute chronic obstructive pulmonary disease (COPD) exacerbation is associated with decreased mortality. In patients with bronchospastic disease, the data shows improved symptoms and peak flow rates after the administration of albuterol. There is limited data regarding prehospital use of ipratropium, and the benefit is less clear. The literature supports the use of systemic steroids in those with asthma and COPD to improve symptoms and decrease hospital admissions. There is weak evidence to support the use of nitrates in critically ill, hypertensive patients with acute pulmonary edema (APE) and moderate evidence that furosemide may be harmful if administered prehospital to patients with suspected APE. Non-invasive positive pressure ventilation (NIPPV) is shown in the literature to be safe and effective in the treatment of respiratory distress due to acute pulmonary edema, bronchospasm, and other conditions. It decreases both mortality and the need for intubation. Albuterol, nitroglycerin, and NIPPV were found in the protocols of every LEMSA. Ipratropium, furosemide, and oxygen titration were found in a proportion of the protocols, and steroids were not prescribed in any LEMSA protocol.\nConclusion:\n Prehospital treatment of adult patients with respiratory distress varies widely across California. We present evidence-based recommendations for the prehospital treatment of undifferentiated adult patients with respiratory distress that will assist with standardizing management and may be useful for EMS medical directors when creating and revising 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":"ambulance"},{"word":"Dyspnea"},{"word":"emergency medical services"},{"word":"prehospital"},{"word":"Evidence-based"},{"word":"Guideline"},{"word":"clinical protocol"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9895j871","frozenauthors":[{"first_name":"Sammy","middle_name":"S.","last_name":"Hodroge","name_suffix":"","institution":"University of California, San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Melody","middle_name":"","last_name":"Glenn","name_suffix":"","institution":"University of Arizona, Department of Emergency Medicine, Tucson, Arizona","department":"None"},{"first_name":"Amelia","middle_name":"","last_name":"Breyre","name_suffix":"","institution":"Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"Bennett","middle_name":"","last_name":"Lee","name_suffix":"","institution":"Hawaii Emergency Physicians Associated, Kailua, Hawaii","department":"None"},{"first_name":"Nick","middle_name":"R.","last_name":"Aldridge","name_suffix":"","institution":"Kaiser Permanente San Diego, Department of Emergency Medicine, San Diego, 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","department":"None"},{"first_name":"Kristi","middle_name":"L.","last_name":"Koenig","name_suffix":"","institution":"County of San Diego Health & Human Services Agency, EMS, University of California, Irvine, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Marianne","middle_name":"","last_name":"Gausche-Hill","name_suffix":"","institution":"Harbor-UCLA Medical Center, Department of Emergency Medicine, Los Angeles County EMS Agency, Santa Fe Springs, California","department":"None"},{"first_name":"Angelo","middle_name":"A.","last_name":"Salvucci","name_suffix":"","institution":"Santa Barbara EMS agency, Santa Barbara, California","department":"None"},{"first_name":"Eric","middle_name":"M.","last_name":"Rudnick","name_suffix":"","institution":"Northern California EMS Agency, Redding, 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","department":"None"},{"first_name":"Gregory","middle_name":"H.","last_name":"Gilbert","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"}],"date_submitted":"2019-05-30T01:06:06+02:00","date_accepted":"2019-05-30T01:06:06+02:00","date_published":"2020-06-26T01:10:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12785/galley/6739/download/"}]},{"pk":13386,"title":"Social Determinants of Hallway Bed Use","subtitle":null,"abstract":"Introduction: \nHallway beds in the emergency department (ED) produce lower patient satisfaction and inferior care. We sought to determine whether socioeconomic factors influence which visits are assigned to hallway beds, independent of clinical characteristics at triage.\nMethods:\n We studied 332,919 visits, across 189,326 patients, to two academic EDs from 2013-2016. We estimated a logistic model of hallway bed assignment, conditioning on payor, demographics, triage acuity, chief complaint, patient visit frequency, and ED volume. Because payor is not generally known at the time of triage, we interpreted it as a proxy for other observable characteristics that may influence bed assignment. We estimated a Cox proportional hazards model of hallway bed assignment on length of stay.\nResults: \nMedian patient age was 53. 54.0% of visits were by women. 42.1% of visits were paid primarily by private payors, 37.1% by Medicare, and 20.7% by Medicaid. A total of 16.2% of visits were assigned to hallway beds. Hallway bed assignment was more likely for frequent ED visitors, for lower acuity presentations, and for psychiatric, substance use, and musculoskeletal chief complaints, which were more common among visits paid primarily by Medicaid. In a logistic model controlling for these factors, as well as for other patient demographics and for the volume of recent ED arrivals, Medicaid status was nevertheless associated with 22% greater odds of assignment to a hallway bed (odds ratio 1.22, [95% confidence interval, CI, 1.18-1.26]), compared to private insurance. Visits assigned to hallway beds had longer lengths of stay than roomed visits of comparable acuity (hazard ratio for departure 0.91 [95% CI, 0.90-0.92]).\nConclusion:\n We find evidence of social determinants of hallway bed use, likely involving epidemiologic, clinical, and operational factors. Even after accounting for different distributions of chief complaints and for more frequent ED use by the Medicaid population, as well as for other visit characteristics known at the time of triage, visits paid primarily by Medicaid retain a disproportionate association with hallway bed assignment. Further research is needed to eliminate potential bias in the use of hallway beds.","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 Medicine"},{"word":"health disparities"},{"word":"Health Economics"}],"section":"Population Health and Social Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4dp5p5pd","frozenauthors":[{"first_name":"David","middle_name":"A.","last_name":"Kim","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Leon","middle_name":"D.","last_name":"Sanchez","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"David","middle_name":"","last_name":"Chiu","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Ian","middle_name":"P.","last_name":"Brown","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"}],"date_submitted":"2019-11-26T01:16:44+01:00","date_accepted":"2019-11-26T01:16:44+01:00","date_published":"2020-06-24T20:22:32+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13386/galley/7026/download/"}]},{"pk":13364,"title":"Novice Physician Ultrasound Evaluation of Pediatric Tricuspid Regurgitant Jet Velocity","subtitle":null,"abstract":"Introduction: \nPulmonary hypertension, associated with high mortality in pediatric patients, is traditionally screened for by trained professionals by measuring a tricuspid regurgitant jet velocity (TRJV). Our objective was to test the feasibility of novice physician sonographers (NPS) to perform echocardiograms of adequate quality to exclude pathology (defined as TRJV > 2.5 meters per second).\nMethods:\n We conducted a cross-sectional study of NPS to assess TRJV by echocardiogram in an urban pediatric emergency department. NPS completed an educational course consisting of a didactic curriculum and hands-on workshop. NPS enrolled a convenience sample of patients aged 7-21 years. Our primary outcome was the proportion of echocardiograms with images of adequate quality to exclude pathology. Our secondary outcome was NPS performance on four image elements. We present descriptive statistics, binomial proportions, kappa coefficients, and logistic regression analysis.\nResults:\n Eight NPS completed 80 echocardiograms. We found 82.5% (95% confidence interval [CI], 74.2-90.8) of echocardiograms had images of adequate quality to exclude pathology. Among image elements, NPS obtained a satisfactory, apical 4-chamber view in 85% (95% CI, 77.1-92.9); positioned the color box accurately 65% (95% CI, 54.5-75.5); optimized TRJV color signal 78.7% (95% CI, 69.8-87.7); and optimized continuous-wave Doppler in 55% (95% CI, 44.1-66.0) of echocardiograms.\nConclusion:\n NPS obtained images of adequate quality to exclude pathology in a majority of studies; however, optimized acquisition of specific image elements varied. This work establishes the basis for future study of NPS assessment of TRJV pathology when elevated pulmonary pressures are of clinical concern.","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":"tricuspid regurgitant jet velocity, pediatric echocardiography, point-of-care ultrasound, novice echocardiography, pulmonary hypertension"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1nt70759","frozenauthors":[{"first_name":"Zachary","middle_name":"W.","last_name":"Binder","name_suffix":"","institution":"Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts","department":"None"},{"first_name":"Sharon","middle_name":"E.","last_name":"O'Brien","name_suffix":"","institution":"Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts","department":"None"},{"first_name":"Tehnaz","middle_name":"P.","last_name":"Boyle","name_suffix":"","institution":"Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts","department":"None"},{"first_name":"Howard","middle_name":"J.","last_name":"Cabral","name_suffix":"","institution":"Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts","department":"None"},{"first_name":"Sepehr","middle_name":"","last_name":"Sekhavat","name_suffix":"","institution":"Boston Medical Center, Boston University School of Medicine, Department of Pediatrics, Boston, Massachusetts","department":"None"},{"first_name":"Joseph","middle_name":"R.","last_name":"Pare","name_suffix":"","institution":"Boston Medical Center, Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-11-14T02:02:52+01:00","date_accepted":"2019-11-14T02:02:52+01:00","date_published":"2020-06-24T20:16:59+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13364/galley/7016/download/"}]},{"pk":13377,"title":"Patient and Community Organization Perspectives on  Accessing Social Resources from the Emergency Department: A Qualitative Study","subtitle":null,"abstract":"Introduction:\n Social risks adversely affect health and are associated with increased healthcare utilization and costs. Emergency department (ED) patients have high rates of social risk; however, little is known about best practices for ED-based screening or linkage to community resources. We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED.\nMethods:\n Qualitative interviews were conducted with a purposive sample of ED patients and local community organization staff. Participants completed a brief demographic survey, health literacy assessment, and qualitative interview focused on barriers/facilitators to social risk screening in the ED, and ideas for screening and linkage interventions in the ED. Interviews were conducted in English or Spanish, recorded, transcribed, and coded. Themes were identified by consensus.\nResults: \nWe conducted 22 interviews with 16 patients and six community organization staff. Three categories of themes emerged. The first related to the importance of social risk screening in the ED. The second category encompassed challenges regarding screening and linkage, including fear, mistrust, transmission of accurate information, and time/resource constraints. The third category included suggestions for improvement and program development. Patients had varied preferences for verbal vs electronic strategies for screening. Community organization staff emphasized resource scarcity and multimodal communication strategies.\nConclusion:\n The development of flexible, multimodal, social risk screening tools, and the creation and maintenance of an accurate database of local resources, are strategies that may facilitate improved identification of social risk and successful linkage to available community resources.","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 medicine, social determinants of health, qualitative"}],"section":"Population Health and Social Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7tk7m3hd","frozenauthors":[{"first_name":"Margaret","middle_name":"E.","last_name":"Samuels-Kalow","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Melanie","middle_name":"F.","last_name":"Molina","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Gia","middle_name":"E.","last_name":"Ciccolo","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Alexa","middle_name":"","last_name":"Curt","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Emily","middle_name":"C.","last_name":"Cleveland Manchanda","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Nicole","middle_name":"C.","last_name":"de Paz","name_suffix":"","institution":"Boston Children’s Hospital, Harvard Medical School, Division of General Pediatrics, Boston, Massachusetts","department":"None"},{"first_name":"Carlos","middle_name":"A.","last_name":"Camargo Jr.","name_suffix":"","institution":"Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-11-19T19:15:44+01:00","date_accepted":"2019-11-19T19:15:44+01:00","date_published":"2020-06-24T20:13:18+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13377/galley/7022/download/"}]},{"pk":13395,"title":"Assessment of Emergency Medicine Residents’ Clinical Reasoning: Validation of a Script Concordance Test","subtitle":null,"abstract":"Introduction: \nA primary aim of residency training is to develop competence in clinical reasoning. However, there are few instruments that can accurately, reliably, and efficiently assess residents’ clinical decision-making ability. This study aimed to externally validate the script concordance test in emergency medicine (SCT-EM), an assessment tool designed for this purpose.\nMethods:\n Using established methodology for the SCT-EM, we compared EM residents’ performance on the SCT-EM to an expert panel of emergency physicians at three urban academic centers. We performed adjusted pairwise t-tests to compare differences between all residents and attending physicians, as well as among resident postgraduate year (PGY) levels. We tested correlation between SCT-EM and Accreditation Council for Graduate Medical Education Milestone scores using Pearson’s correlation coefficients. Inter-item covariances for SCT items were calculated using Cronbach’s alpha statistic.\nResults:\n The SCT-EM was administered to 68 residents and 13 attendings. There was a significant difference in mean scores among all groups (mean + standard deviation: PGY-1 59 + 7; PGY-2 62 + 6; PGY-3 60 + 8; PGY-4 61 + 8; 73 + 8 for attendings, p < 0.01). Post hoc pairwise comparisons demonstrated that significant difference in mean scores only occurred between each PGY level and the attendings (p < 0.01 for PGY-1 to PGY-4 vs attending group). Performance on the SCT-EM and EM Milestones was not significantly correlated (r = 0.12, p = 0.35). Internal reliability of the exam was determined using Cronbach’s alpha, which was 0.67 for all examinees, and 0.89 in the expert-only group.\nConclusion:\n The SCT-EM has limited utility in reliably assessing clinical reasoning among EM residents. Although the SCT-EM was able to differentiate clinical reasoning ability between residents and expert faculty, it did not between PGY levels, or correlate with Milestones scores. Furthermore, several limitations threaten the validity of the SCT-EM, suggesting further study is needed in more diverse settings.","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 Education"},{"word":"Assessment"},{"word":"clinical reasoning"},{"word":"Emergency Medicine, Graduate Medical Education"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/92b825mf","frozenauthors":[{"first_name":"Eric","middle_name":"","last_name":"Steinberg","name_suffix":"","institution":"St. Joseph’s University Medical Center, Department of Emergency Medicine, Paterson, New Jersey","department":"None"},{"first_name":"Ethan","middle_name":"","last_name":"Cowan","name_suffix":"","institution":"Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Michelle","middle_name":"P.","last_name":"Lin","name_suffix":"","institution":"Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai","department":"None"},{"first_name":"Anthony","middle_name":"","last_name":"Sielicki","name_suffix":"","institution":"Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Steven","middle_name":"","last_name":"Warrington","name_suffix":"","institution":"Orange Park Medical Center, Department of Emergency Medicine, Orange Park, Florida","department":"None"}],"date_submitted":"2019-12-01T17:19:29+01:00","date_accepted":"2019-12-01T17:19:29+01:00","date_published":"2020-06-24T20:02:08+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13395/galley/7033/download/"}]},{"pk":13254,"title":"Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data","subtitle":null,"abstract":"Introduction:\n In this observational study, we evaluated time-of-day variation in the incidence of fever that is seen at triage. The observed incidence of fever could change greatly over the day because body temperatures generally rise and fall in a daily cycle, yet fever is identified using a temperature threshold that is unchanging, such as ≥38.0° Celsius (C) (≥100.4° Fahrenheit [F]).\nMethods:\n We analyzed 93,225 triage temperature measurements from a Boston emergency department (ED) (2009-2012) and 264,617 triage temperature measurements from the National Hospital Ambulatory Medical Care Survey (NHAMCS, 2002-2010), making this the largest study of body temperature since the mid-1800s. Boston data were investigated exploratorily, while NHAMCS was used to corroborate Boston findings and check whether they generalized. NHAMCS results are nationally representative of United States EDs. Analyses focused on adults.\nResults:\n In the Boston ED, the proportion of patients with triage temperatures in the fever range (≥38.0°C, ≥100.4°F) increased 2.5-fold from morning to evening (7:00-8:59 PM vs 7:00-8:59 AM: risk ratio [RR] 2.5, 95% confidence interval [CI], 2.0-3.3). Similar time-of-day changes were observed when investigating alternative definitions of fever: temperatures ≥39.0°C (≥102.2°F) and ≥40.0°C (≥104.0°F) increased 2.4- and 3.6-fold from morning to evening (7:00-8:59 PM vs 7:00-8:59 AM: RRs [95% CIs] 2.4 [1.5-4.3] and 3.6 [1.5-17.7], respectively). Analyses of adult NHAMCS patients provided confirmation, showing mostly similar increases for the same fever definitions and times of day (RRs [95% CIs] 1.8 [1.6-2.1], 1.9 [1.4-2.5], and 2.8 [0.8-9.3], respectively), including after adjusting for 12 potential confounders using multivariable regression (adjusted RRs [95% CIs] 1.8 [1.5-2.1], 1.8 [1.3-2.4], and 2.7 [0.8-9.2], respectively), in age-group analyses (18-64 vs 65+ years), and in several sensitivity analyses. The patterns observed for fever mirror the circadian rhythm of body temperature, which reaches its highest and lowest points at similar times.\nConclusion:\n Fever incidence is lower at morning triages than at evening triages. High fevers are especially rare at morning triage and may warrant special consideration for this reason. Studies should examine whether fever-causing diseases are missed or underappreciated during mornings, especially for sepsis cases and during screenings for infectious disease outbreaks. The daily cycling of fever incidence may result from the circadian rhythm.","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":"fever"},{"word":"Febrile"},{"word":"body temperature"},{"word":"Circadian"},{"word":"Emergency Departments"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/95w229gq","frozenauthors":[{"first_name":"Charles","middle_name":"","last_name":"Harding","name_suffix":"","institution":"Independent Statistical Analyst, Seattle, Washington","department":"None"},{"first_name":"Francesco","middle_name":"","last_name":"Pompei","name_suffix":"","institution":"Exergen Corporation, Watertown, Massachusetts","department":"None"},{"first_name":"Samantha","middle_name":"F.","last_name":"Bordonaro","name_suffix":"","institution":"Gates Vascular Institute, Professional Emergency Services, Buffalo, New York","department":"None"},{"first_name":"Daniel","middle_name":"C.","last_name":"McGillicuddy","name_suffix":"","institution":"Saint Joseph Mercy Hospital, Department of Emergency Medicine, Ann Arbor, Michigan\nUniversity of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Dmitriy","middle_name":"","last_name":"Burmistrov","name_suffix":"","institution":"Independent Statistical Analyst, Massachusetts","department":"None"},{"first_name":"Leon","middle_name":"D.","last_name":"Sanchez","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts\nHarvard Medical School, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-10-29T15:14:50+01:00","date_accepted":"2019-10-29T15:14:50+01:00","date_published":"2020-06-24T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13254/galley/6979/download/"}]},{"pk":13815,"title":"Mobilization of a Simulation Platform to Facilitate a System-wide Response to the COVID-19 Pandemic","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":"COVID-19"},{"word":"Simulation"},{"word":"resource utilization"},{"word":"Pandemic"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0v23k0sk","frozenauthors":[{"first_name":"David","middle_name":"J.","last_name":"Carlberg","name_suffix":"","institution":"Georgetown University School of Medicine, MedStar Georgetown University Hospital, Department of Emergency Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Tiffany","middle_name":"M.","last_name":"Chan","name_suffix":"","institution":"MedStar Harbor Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Diana","middle_name":"","last_name":"Ladkany","name_suffix":"","institution":"Georgetown University School of Medicine, MedStar Washington Hospital Center, Department of Emergency Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Palmer","name_suffix":"","institution":"Georgetown University School of Medicine, MedStar Southern Maryland Hospital Center, Department of Emergency Medicine, Prince George’s County, Maryland","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Bradshaw","name_suffix":"","institution":"MedStar Health Simulation Training and Education Lab, Washington, District of Columbia","department":"None"}],"date_submitted":"2020-04-23T18:25:08+02:00","date_accepted":"2020-04-23T18:25:08+02:00","date_published":"2020-06-24T03:32:30+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13815/galley/7197/download/"}]},{"pk":13932,"title":"Emergency Department Admissions During COVID-19: Implications from the 2002-2004 SARS Epidemic","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":"Severe Acute Respiratory Syndrome"},{"word":"Public health"},{"word":"Coronavirus disease 2019"},{"word":"Emergency Department Admissions"},{"word":"Pandemic"},{"word":"coronavirus"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2nc3k9v4","frozenauthors":[{"first_name":"Muhammad","middle_name":"M.","last_name":"Munir","name_suffix":"","institution":"Aga Khan University Hospital, Karachi City, Sindh, Pakistan","department":"None"},{"first_name":"Russell","middle_name":"S.","last_name":"Martins","name_suffix":"","institution":"Aga Khan University Hospital, Karachi City, Sindh, Pakistan","department":"None"},{"first_name":"Asad","middle_name":"I.","last_name":"Mian","name_suffix":"","institution":"Aga Khan University Hospital, Department of Emergency Medicine, Karachi City, Sindh, Pakistan","department":"None"}],"date_submitted":"2020-05-17T21:39:40+02:00","date_accepted":"2020-05-17T21:39:40+02:00","date_published":"2020-06-24T03:29:55+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13932/galley/7239/download/"}]},{"pk":13921,"title":"Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19","subtitle":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis that has quickly overwhelmed our healthcare system. It has led to significant shortages in personal protective equipment (PPE), ventilators, and intensive care unit beds across the nation. As the initial entry point for patients with suspected COVID illness, emergency departments (ED) have had to adapt quickly to prioritize the safety of patients and providers while still delivering optimal, timely patient care. COVID-19 has presented many challenges for the ED that also extend to all inpatient services. Some of these key challenges are the fundamental tasks of communicating with patients in respiratory isolation while minimizing PPE usage and enabling all patients who have been affected by hospitals’ visitor restrictions to connect with their families. We discuss the design principles behind implementing a robust in-hospital telehealth system for patient-provider and patient-family communication, provide a review of the strengths and weaknesses of potential videoconferencing options, and deliver concise, step-by-step guides for setting up a secure, low-cost, user-friendly solution that can be rapidly deployed.","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":"Telemedicine"},{"word":"Telehealth"},{"word":"palliative care"},{"word":"COVID-19"},{"word":"Pandemic"}],"section":"Technology in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0nb053tn","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Fang","name_suffix":"","institution":"Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California","department":"None"},{"first_name":"Yiju","middle_name":"T.","last_name":"Liu","name_suffix":"","institution":"Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California\nUniversity of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California\nThe Lundquist Institute for Biomedical Innovation, Torrance, California","department":"None"},{"first_name":"Ernest","middle_name":"Y.","last_name":"Lee","name_suffix":"","institution":"University of California, Los Angeles, Department of Bioengineering, Los Angeles, California\nUniversity of California, Los Angeles, Department of Medicine, Division of Dermatology, Los Angeles, California\nDavid Geffen School of Medicine at UCLA, UCLA-Caltech Medical Scientist Training Program, Los Angeles, California","department":"None"},{"first_name":"Kabir","middle_name":"","last_name":"Yadav","name_suffix":"","institution":"Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California\nUniversity of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California\nThe Lundquist Institute for Biomedical Innovation, Torrance, California","department":"None"}],"date_submitted":"2020-05-13T00:32:03+02:00","date_accepted":"2020-05-13T00:32:03+02:00","date_published":"2020-06-24T03:26:57+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13921/galley/7235/download/"}]},{"pk":853,"title":"Alternative Diagnostic Strategy for the Assessment and Treatment of Pulmonary Embolus: A Case Series","subtitle":null,"abstract":"Introduction:\n Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can be used as an alternate and safe method to diagnose patients with compromised renal function who present with acute pulmonary embolus in the emergency department (ED) setting.\nCase Report:\n A 62-year old man with a history of renal transplant and lymphoproliferative disease described new onset of breathlessness. His clinical symptoms were suggestive of pulmonary embolus. He underwent FeMRA in the ED to avoid exposure to intravenous iodinated contrast. FeMRA demonstrated a left main pulmonary artery embolus, which extended to the left interlobar pulmonary artery. Afterward, the patient initiated anticoagulation therapy. With preserved renal function he was able to continue his outpatient chemotherapy regimen.\nConclusion:\n This case highlights a safe imaging technique for emergency physicians to diagnose pulmonary embolus and subsequently guide anticoagulation therapy for patients in whom use of conventional contrast is contraindicated.","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":"FE-MRA"},{"word":"pulmonary embolus"},{"word":"renal transplant"},{"word":"lymphoproliferative"}],"section":"Case Series","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5sv71400","frozenauthors":[{"first_name":"Ayaz","middle_name":"","last_name":"Aghayev","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Radiology, Boston, Massachusetts","department":"None"},{"first_name":"Aliza","middle_name":"A.","last_name":"Memon","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Internal Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Paul","middle_name":"Gregg","last_name":"Greenough","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Lakshmi","middle_name":"","last_name":"Nayak","name_suffix":"","institution":"Dana Farber Cancer Institute, Boston, Massachusetts","department":"None"},{"first_name":"Sijie","middle_name":"","last_name":"Zheng","name_suffix":"","institution":"Kaiser Permanente, Oakland, California","department":"None"},{"first_name":"Andrew","middle_name":"M.","last_name":"Siedlecki","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Internal Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2020-06-23T02:30:25+02:00","date_accepted":"2020-06-23T02:30:25+02:00","date_published":"2020-06-23T02:31:03+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/853/galley/605/download/"}]},{"pk":852,"title":"Acute Transverse Myelitis Secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): A Case Report","subtitle":null,"abstract":"Introduction:\n Respiratory viral illnesses are associated with diverse neurological complications, including acute transverse myelitis (ATM). Among the respiratory viral pathogens, the Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts. Despite previous strains of coronaviruses exhibiting neurotropic and neuroinvasive capabilities, little is known about the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its involvement with the central nervous system (CNS). The current pandemic has highlighted the diverse clinical presentation of SARS-CoV-2 including a possible link to CNS manifestation with disease processes such as Guillain-Barré syndrome and cerebrovascular disease. It is critical to shed light on the varied neurological manifestation of SARS-CoV-2 to ensure clinicians do not overlook at-risk patient populations and are able to provide targeted therapies appropriately.\nCase Report:\n While there are currently no published reports on post-infectious ATM secondary to SARS-CoV-2, there is one report of parainfectious ATM attributed to SARS-CoV-2 in pre-print. Here, we present a case of infectious ATM attributed to SARS-CoV-2 in a 24-year-old male who presented with bilateral lower-extremity weakness and overflow urinary incontinence after confirmed SARS-CoV-2 infection. Magnetic resonance imaging revealed non-enhancing T2-weighted hyperintense signal abnormalities spanning from the seventh through the twelfth thoracic level consistent with acute myelitis.\nConclusion:\n The patient underwent further workup and treatment with intravenous corticosteroids with improvement of symptoms and a discharge diagnosis of ATM secondary to SARS-CoV-2.","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":"Acute Transverse Myelitis"},{"word":"Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)"},{"word":"Para-infectious Acute Transverse Myelitis"},{"word":"Post-infectious Acute Transverse Myelitis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2fs6w4c3","frozenauthors":[{"first_name":"Muhammad","middle_name":"","last_name":"Durrani","name_suffix":"","institution":"Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Kucharski","name_suffix":"","institution":"Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey","department":"None"},{"first_name":"Zachary","middle_name":"","last_name":"Smith","name_suffix":"","institution":"Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey","department":"None"},{"first_name":"Stephanie","middle_name":"","last_name":"Fien","name_suffix":"","institution":"Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey","department":"None"}],"date_submitted":"2020-06-22T22:49:12+02:00","date_accepted":"2020-06-22T22:49:12+02:00","date_published":"2020-06-22T22:49:46+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/852/galley/604/download/"}]},{"pk":851,"title":"Optimizing Non-invasive Oxygenation for COVID-19 Patients Presenting to the Emergency Department with Acute Respiratory Distress: A Case Report","subtitle":null,"abstract":"Introduction:\n The novel coronavirus (COVID-19) pandemic has led to an increase in the number of patients presenting to the emergency department (ED) with severe hypoxia and acute respiratory distress. With limited resources and ventilators available, emergency physicians working at a hospital within the epicenter of the United States outbreak developed a stepwise, non-invasive oxygenation strategy for treating COVID-19 patients presenting with severe hypoxia and acute respiratory distress.\nCase Report:\n A 72-year-old male suspected of having the COVID-19 virus presented to the ED with shortness of breath. He was found to be severely tachypneic, febrile, with rales in all lung fields. His initial oxygen saturation registered at SpO2 (blood oxygenation saturation) 55% on room air. Emergency physicians employed a novel non-invasive oxygenation strategy using a nasal cannula, non-rebreather, and self-proning. This approach led to a reversal of the patient’s respiratroy distress and hypoxia (SpO2 88-95%) for the following 24 hours.This non-invasive intervention allowed providers time to obtain and initiate high-flow nasal cannula and discuss end-of-life wishes with the patient and his family.\nConclusion:\n Our case highlights a stepwise, organized approach to providing non-invasive oxygenation for COVID-19 patients presenting with severe hypoxia and acute respiratory distress. This approach primarily employs resources and equipment that are readily available to healthcare providers around the world. The intent of this strategy is to provide conventional alternatives to aid in the initial airway management of confirmed or suspected COVID-19 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":[{"word":"COVID-19"},{"word":"hypoxia"},{"word":"non-invasive"},{"word":"Oxygenation"},{"word":"airway"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/47j5g4cw","frozenauthors":[{"first_name":"David","middle_name":"","last_name":"Zodda","name_suffix":"","institution":"Hackensack University Medical Center School of Medicine at Seton Hall, Nutley, New Jersey; Hackensack University Medical Center, Department of Emergency Medicine, Hackensack, New Jersey","department":"None"},{"first_name":"Allyson","middle_name":"","last_name":"Hanson","name_suffix":"","institution":"Hackensack University Medical Center, Department of Emergency Medicine, Hackensack, New Jersey","department":"None"},{"first_name":"Alyssa","middle_name":"","last_name":"Berns","name_suffix":"","institution":"Hackensack University Medical Center, Department of Emergency Medicine, Hackensack, New Jersey","department":"None"}],"date_submitted":"2020-06-22T22:43:23+02:00","date_accepted":"2020-06-22T22:43:23+02:00","date_published":"2020-06-22T22:43:59+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/851/galley/603/download/"}]},{"pk":850,"title":"Cardioembolic Stroke in a Patient with Coronavirus Disease of 2019 (COVID-19) Myocarditis: A Case Report","subtitle":null,"abstract":"Introduction:\n There is a growing body of literature detailing coronavirus 2019 (COVID-19) cardiovascular complications and hypercoagulability, although little has been published on venous or arterial thrombosis risk.\nCase Report:\n In this report, we present a single case of cardioembolic stroke in the setting of COVID-19 related myocarditis, diagnosed via cardiac magnetic resonance imaging and echocardiography. COVID-19 infection was confirmed via a ribonucleic acid polymerase chain reaction assay.\nConclusion:\n Further research is needed to evaluate the hypercoagulable state of patients with COVID-19 to determine whether prophylactic anticoagulation may be warranted to prevent intracardiac thrombi and cardioembolic disease in patients with COVID-19 related myocarditis.","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":"COVID-19"},{"word":"SARS-CoV-2"},{"word":"Myocarditis"},{"word":"thromboembolic stroke"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3bn795s3","frozenauthors":[{"first_name":"James","middle_name":"S.","last_name":"Ford","name_suffix":"","institution":"UC Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"James","middle_name":"F.","last_name":"Holmes","name_suffix":"","institution":"UC Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Russell","middle_name":"F.","last_name":"Jones","name_suffix":"","institution":"UC Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"}],"date_submitted":"2020-06-22T22:38:33+02:00","date_accepted":"2020-06-22T22:38:33+02:00","date_published":"2020-06-22T22:39:07+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/850/galley/602/download/"}]},{"pk":13778,"title":"Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19","subtitle":null,"abstract":"Introduction:\n Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.\nMethods: \nThis was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation. The primary objective was to estimate the test characteristics of both LUS B-lines and CXR for the associated diagnosis of COVID-19. Our secondary objective was to evaluate the proportion of patients with COVID-19 that have secondary LUS findings of pleural abnormalities and subpleural consolidations.\nResults:\n We identified 43 patients who underwent both LUS and CXR and were tested for COVID-19. Of these, 27/43 (63%) tested positive. LUS was more sensitive (88.9%, 95% confidence interval (CI), 71.1-97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% CI, 34.0-69.3; p = 0.013). LUS and CXR specificity were 56.3% (95% CI, 33.2-76.9) and 75.0% (95% CI, 50.0-90.3), respectively (p = 0.453). Secondary LUS findings of patients with COVID-19 demonstrated 21/27 (77.8%) had pleural abnormalities and 10/27 (37%) had subpleural consolidations.\nConclusion: \nAmong patients who underwent LUS and CXR, LUS was found to have a higher sensitivity than CXR for the evaluation of COVID-19. This data could have important implications as an aid in the diagnostic evaluation of COVID-19, particularly where viral testing is not available or restricted. If generalizable, future directions would include defining how to incorporate LUS into clinical management and its role in screening lower-risk populations.","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":"COVID-19, Coronavirus, Ultrasound, B-lines, Chest Radiograph"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1x83j2gv","frozenauthors":[{"first_name":"Joseph","middle_name":"R.","last_name":"Pare","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Ingrid","middle_name":"","last_name":"Camelo","name_suffix":"","institution":"Boston University School of Medicine, Department of Pediatric Infectious Diseases, Boston, Massachusetts","department":"None"},{"first_name":"Kelly","middle_name":"C.","last_name":"Mayo","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Megan","middle_name":"M.","last_name":"Leo","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Julianne","middle_name":"N.","last_name":"Dugas","name_suffix":"","institution":"Boston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Kerrie","middle_name":"P.","last_name":"Nelson","name_suffix":"","institution":"Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts","department":"None"},{"first_name":"William","middle_name":"E.","last_name":"Baker","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Faizah","middle_name":"","last_name":"Shareef","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Patrica","middle_name":"M.","last_name":"Mitchell R.N.","name_suffix":"","institution":"Boston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"},{"first_name":"Elissa","middle_name":"M.","last_name":"Schechter-Perkins","name_suffix":"","institution":"Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts","department":"None"}],"date_submitted":"2020-04-16T23:46:09+02:00","date_accepted":"2020-04-16T23:46:09+02:00","date_published":"2020-06-20T02:03:01+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13778/galley/7177/download/"}]},{"pk":849,"title":"Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report","subtitle":null,"abstract":"Introduction:\n Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises.\nCase Report:\n We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400-12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia.\nConclusion:\n This case highlights how pulmonary capillary hypoperfusion secondary to leukostasis, coupled with a ventilation/perfusion mismatch due to compression atelectasis by an enlarged thymus, resulted in this patient’s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial.","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":"Blast Cell Crisis"},{"word":"Hyperleukocytosis with Leukostasis"},{"word":"Thymus"},{"word":"Mediastinal Mass"},{"word":"Acute Lymphoblastic Leukemia"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7581435h","frozenauthors":[{"first_name":"Christian","middle_name":"I.","last_name":"Wade","name_suffix":"","institution":"Uniformed Services University of the Health Sciences, School of Medicine, Department of Emergency Medicine, Bethesda, Maryland","department":"None"},{"first_name":"Cody","middle_name":"J.","last_name":"Couperus-Mashewske","name_suffix":"","institution":"University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Mia","middle_name":"E.","last_name":"Geurts","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"},{"first_name":"Nicholas","middle_name":"","last_name":"Derfler","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"},{"first_name":"John","middle_name":"","last_name":"Ngo","name_suffix":"","institution":"Providence St. Peter Hospital Olympia, Department of Emergency Medicine, Olympia, Washington","department":"None"},{"first_name":"Kyle","middle_name":"S.","last_name":"Couperus","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"}],"date_submitted":"2020-06-19T23:51:11+02:00","date_accepted":"2020-06-19T23:51:11+02:00","date_published":"2020-06-19T23:51:52+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/849/galley/601/download/"}]},{"pk":13150,"title":"Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample","subtitle":null,"abstract":"Introduction:\n Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment.\nMethods:\n Participants (aged 25-60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use.\nResults: \nAmong participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55-9.17), daily opioid use (OR = 3.81, 95% CI, 1.64-8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07-2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses.\nConclusion:\n Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.","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":"opioids, emergency department, risky driving"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4606z9bb","frozenauthors":[{"first_name":"Aaron","middle_name":"D.","last_name":"Dora-Laskey","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan\nUniversity of Michigan, Department of Psychiatry, Ann Arbor, Michigan \nUniversity of Michigan Addiction Center, Ann Arbor, Michigan \nUniversity of Michigan Injury Prevention Center, Ann Arbor, Michigan\nHurley Medical Center, Department of Emergency Medicine, Flint, Michigan","department":"None"},{"first_name":"Jason","middle_name":"E.","last_name":"Goldstick","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan\nUniversity of Michigan Injury Prevention Center, Ann Arbor, Michigan","department":"None"},{"first_name":"Brooke","middle_name":"J.","last_name":"Arterberry","name_suffix":"","institution":"University of Michigan Addiction Center, Ann Arbor, Michigan \nIowa State University, Department of Psychology, Ames, Iowa","department":"None"},{"first_name":"Suni Jo","middle_name":"","last_name":"Roberts","name_suffix":"","institution":"University of Michigan, Department of Psychiatry, Ann Arbor, Michigan","department":"None"},{"first_name":"Rebecca","middle_name":"L.","last_name":"Haffajee","name_suffix":"","institution":"University of Michigan Injury Prevention Center, Ann Arbor, Michigan\nUniversity of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan and RAND Corporation, Boston, Massachusetts","department":"None"},{"first_name":"Amy","middle_name":"S.B.","last_name":"Bohnert","name_suffix":"","institution":"University of Michigan, Department of Psychiatry, Ann Arbor, Michigan \nUniversity of Michigan, Department of Anesthesiology, Ann Arbor, Michigan\nVA Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan","department":"None"},{"first_name":"Rebecca","middle_name":"M.","last_name":"Cunningham","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan\nUniversity of Michigan Injury Prevention Center, Ann Arbor, Michigan\nHurley Medical Center, Department of Emergency Medicine, Flint, Michigan","department":"None"},{"first_name":"Patrick","middle_name":"M/","last_name":"Carter","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan\nUniversity of Michigan Injury Prevention Center, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2019-08-06T07:03:49+02:00","date_accepted":"2019-08-06T07:03:49+02:00","date_published":"2020-06-19T21:27:55+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13150/galley/6918/download/"}]},{"pk":5555,"title":"Do honey bees (Apis mellifera) form cognitive representations of unconditioned stimuli?","subtitle":null,"abstract":"Previous research looking at expectancy in animals has used various experimental designs focusing on appetitive and avoidance behaviors. In this study, honey bees (\nApis mellifera\n) were tested ina series of three proboscis extension response (PER) experiments to determine to what degree honey bees’ form a cognitive-representation of an unconditioned stimulus (US). Tthe first experiment, bees were presented with either a 2 sec. sucrose US or 2 sec. honey US appetitive reward and the proboscis-extension duration was measured under each scenario. The PER duration was longer for the honey US even though each US was presented for just 2 sec.   Honey bees in the second experiment were tested during extinction trials on a conditioned stimulus (CS) of cinnamon or lavender that was paired with either the sucrose US or honey US in the acquisition trials.  The proportion of bees showing the PER response to the CS was recorded for each extinction trial for each US scenario, as was the duration of the proboscis extension for each bee.  Neither measure differed between the honey US and sucrose US scenarios,  In experiment three, bees were presented with a cinnamon or lavender CS paired with either honey US or sucrose US in a set of acquisition trials, but here the US was not given until after the proboscis was retracted. The PER duration after the CS, and again subsequent after the US, were recorded. While the PER duration after the US was longer for honey, the PER duration after the CS did not differ between honey US and sucrose US.","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":"Anticipation, Apis mellifera, expectancy learning"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1qj7w169","frozenauthors":[{"first_name":"KiriLi","middle_name":"N","last_name":"Stauch","name_suffix":"","institution":"Oklahoma State University","department":"None"},{"first_name":"Harrington","middle_name":"","last_name":"Wells","name_suffix":"","institution":"University of Tulsa","department":"None"},{"first_name":"Charles","middle_name":"Ira","last_name":"Abramson","name_suffix":"","institution":"Oklahoma State University","department":"None"}],"date_submitted":"2020-01-26T18:41:18+01:00","date_accepted":"2020-01-26T18:41:18+01:00","date_published":"2020-06-19T17:54:52+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5555/galley/3362/download/"}]},{"pk":63376,"title":"Early Childhood Education and Care and the Use of Digital Media in Informal Environments","subtitle":null,"abstract":"Early childhood is a time of rapid development when children are constantly influenced by experiences and relationships formed in informal environments. In a world that is increasingly reliant on digital media, parents and other caregivers play an important role in managing their children’s use of it. Parents’ choices regarding digital media use heavily depend on their understanding of how children learn from them and how they impact children’s development at different ages and developmental stages. The use of digital media has potential benefits in terms of improved cognitive and literacy skills, but it also has potential risks in terms of lower executive functioning and social-emotional skills due to a lack of social interactions. This article informs the role of parents and other caregivers who can help children benefit from the opportunities that digital media present, while making sure that children experience real-life interactions that are vital to children’s overall development.","language":"en","license":null,"keywords":[{"word":"Early childhood education and care"},{"word":"parents"},{"word":"digital media"},{"word":"screen devices"},{"word":"interactivity"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/64k433qs","frozenauthors":[{"first_name":"Zara","middle_name":"","last_name":"Qaiser","name_suffix":"","institution":"University of Cambridge","department":""}],"date_submitted":"2019-01-03T13:56:52+01:00","date_accepted":"2019-01-03T13:56:52+01:00","date_published":"2020-06-19T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/bre/article/63376/galley/48836/download/"}]},{"pk":2899,"title":"Collective Conclusion: Collective Reflections on Critical Storytelling for Racial and Social Justice","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[],"section":"Conclusion to Issue","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0mm8z490","frozenauthors":[{"first_name":"Brianna","middle_name":"","last_name":"Ramirez","name_suffix":"","institution":"","department":"None"},{"first_name":"Mayra","middle_name":"","last_name":"Puente","name_suffix":"","institution":"UC San Diego","department":"None"},{"first_name":"James","middle_name":"","last_name":"Crawford","name_suffix":"","institution":"","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Matschiner","name_suffix":"","institution":"","department":"None"},{"first_name":"Katherine","middle_name":"Arias","last_name":"Garcia","name_suffix":"","institution":"","department":"None"},{"first_name":"Zaynab","middle_name":"","last_name":"Gates","name_suffix":"","institution":"","department":"None"},{"first_name":"Kirk","middle_name":"","last_name":"Rogers Jr.","name_suffix":"","institution":"","department":"None"},{"first_name":"Ramon","middle_name":"","last_name":"Stephens","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-01-31T21:23:08+01:00","date_accepted":"2020-01-31T21:23:08+01:00","date_published":"2020-06-17T20:19:15+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2899/galley/1719/download/"}]},{"pk":2894,"title":"A Latina pursuing her medical dream (MD)","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"Counterstory, Latina, microaggressions"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6v03r1f7","frozenauthors":[{"first_name":"Katherine","middle_name":"Arias","last_name":"Garcia","name_suffix":"","institution":"UC San Diego, Education Studies Department","department":"None"}],"date_submitted":"2019-12-03T06:44:08+01:00","date_accepted":"2019-12-03T06:44:08+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2894/galley/1716/download/"}]},{"pk":2889,"title":"Introduction: When the Magic Happens. Critical Race Storytelling","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"critical race theory, counterstories, teaching"}],"section":"Introduction to Issue","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8v36956m","frozenauthors":[{"first_name":"Thandeka","middle_name":"K","last_name":"Chapman","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T02:16:46+01:00","date_accepted":"2019-12-03T02:16:46+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2889/galley/1712/download/"}]},{"pk":2885,"title":"Leaving La Puente: A Critical Race Counterstory of Rural Chicana/Latina College Choice","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"College choice, college proximity, spatial inequity, rural students, Chicanx/Latinx students, critical race theory, counterstorytelling methodology"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8w36c2km","frozenauthors":[{"first_name":"Mayra","middle_name":"","last_name":"Puente","name_suffix":"","institution":"University of California, San Diego","department":"None"}],"date_submitted":"2019-12-03T07:30:44+01:00","date_accepted":"2019-12-03T07:30:44+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2885/galley/1709/download/"}]},{"pk":2893,"title":"Liberation","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[],"section":"Cover Art","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8k10k1qf","frozenauthors":[{"first_name":"Mario","middle_name":"","last_name":"MillerJr","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-12-03T06:03:11+01:00","date_accepted":"2019-12-03T06:03:11+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2893/galley/1715/download/"}]},{"pk":2892,"title":"Pop: A Critical Race Story of Racialized Violence in America","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2zc0p8n1","frozenauthors":[{"first_name":"Kirk","middle_name":"D","last_name":"RogersJr","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T05:52:04+01:00","date_accepted":"2019-12-03T05:52:04+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2892/galley/1714/download/"}]},{"pk":2891,"title":"Seen Without (in)Sight","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"CRT"},{"word":"school discipline"},{"word":"restorative justice"},{"word":"anti-blackness"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/81g3d1d8","frozenauthors":[{"first_name":"James","middle_name":"","last_name":"Crawford","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T02:38:14+01:00","date_accepted":"2019-12-03T02:38:14+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2891/galley/1713/download/"}]},{"pk":2895,"title":"The Daily Dose: The End to Social Inequity","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3fs599mq","frozenauthors":[{"first_name":"Ramon","middle_name":"","last_name":"Stephens","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T07:00:34+01:00","date_accepted":"2019-12-03T07:00:34+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2895/galley/1717/download/"}]},{"pk":2875,"title":"The Hypervisibility and Disciplining of the Young Brown Mujer Body in School:  A Counternarrative of Mother-Daughter-Sister Pedagogies for Survival and Resistance","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"CRT, Chicana Feminism, Young Girls of Color"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/53d4m8m6","frozenauthors":[{"first_name":"Brianna","middle_name":"R","last_name":"Ramirez","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T06:43:24+01:00","date_accepted":"2019-12-03T06:43:24+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2875/galley/1705/download/"}]},{"pk":2888,"title":"The price we pay","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"Indigenous peoples, Argentina, Education"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9bv1552g","frozenauthors":[{"first_name":"Zaynab","middle_name":"Amelia","last_name":"Gates","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-03T04:49:12+01:00","date_accepted":"2019-12-03T04:49:12+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2888/galley/1711/download/"}]},{"pk":2886,"title":"What He Learned to Think He Earned","subtitle":null,"abstract":"","language":"en","license":null,"keywords":[{"word":"Critical Whiteness Studies"},{"word":"White Racial Socialization"},{"word":"White Youth"}],"section":"CounterStory","is_remote":true,"remote_url":"https://escholarship.org/uc/item/69b4c63b","frozenauthors":[{"first_name":"Andrew","middle_name":"","last_name":"Matschiner","name_suffix":"","institution":"UC San Diego","department":"None"}],"date_submitted":"2019-12-01T00:09:51+01:00","date_accepted":"2019-12-01T00:09:51+01:00","date_published":"2020-06-17T09:00:00+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/gseis_interactions/article/2886/galley/1710/download/"}]},{"pk":42985,"title":"Cartographies of the Self: Indigenous Territoriality and Literary Sovereignty in Contemporary Native American Life Writing","subtitle":null,"abstract":"This contribution sets out to show how contemporary Indigenous autobiographers critically counter hegemonic territorial inscriptions of “America” and American citizenship and explore alternatives that often connect to but are not identical with tribal–nationalist notions of territoriality in their insistence on sovereignty. In the context of Indigenous life writing, this contribution suggests, “territoriality“ can be broadly understood as a land-based and transgenerational relationality; the Indigenous authors whose autobiographical work is discussed in detail—N. Scott Momaday, Leslie Marmon Silko, and Louise Erdrich—engage with territoriality as a category of selfhood by way of a self-reflexive storytelling that draws its authority from reference to earlier storytelling and to storytelling conventions, but also from its orientation towards an individual and collective Indigenous future.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives  4.0","short_name":"CC BY-NC-ND 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\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nd/4.0"},"keywords":[{"word":"N. Scott Momaday"},{"word":"Leslie Marmon Silko"},{"word":"Louise Erdrich"},{"word":"Native American autobiography"},{"word":"Indigenous storytelling"},{"word":"land-based relationality"},{"word":"Indigenous sovereignty"},{"word":"transnational Indigenous studies"},{"word":"Transnational American Studies"},{"word":"JTAS"}],"section":"SPECIAL FORUM: (Im)Mobilities","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1hw3p4kx","frozenauthors":[{"first_name":"Katja","middle_name":"","last_name":"Sarkowsky","name_suffix":"","institution":"Augsburg University","department":"None"}],"date_submitted":"2020-02-17T21:38:18+01:00","date_accepted":"2020-02-17T21:38:18+01:00","date_published":"2020-06-16T15:38:36+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jtas/article/42985/galley/32036/download/"}]},{"pk":848,"title":"Acute Acalculous Cholecystitis from Infection with Epstein–Barr Virus in a Previously Healthy Child: A Case Report","subtitle":null,"abstract":"Background:\n Acute cholecystitis is the acute inflammation of the gallbladder. In adults it is most frequently caused by a gallstone(s) obstructing outflow from the cystic duct, leading to gallbladder distention and edema with eventual development of biliary stasis and bacterial overgrowth, often requiring operative management. However, in children acalculous cholecystitis is more common and is often the result of an infectious process.\nCase Report:\n Here we present a case of acute acalculous cholecystitis caused by infection with Epstein-Barr virus in an otherwise healthy three-year-old male.\nConclusion:\n Acalculous cholecystitis is an uncommon but potentially significant complication of Epstein-Barr virus infection in the pediatric population. Emergency providers should consider this diagnosis in any child being evaluated for EBV with the complaint of abdominal pain.","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":"Epstein-Barr"},{"word":"acalculous cholecystitis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3qj0687m","frozenauthors":[{"first_name":"Robert","middle_name":"","last_name":"Langenohl","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"},{"first_name":"Scott","middle_name":"","last_name":"Young","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"},{"first_name":"Kyle","middle_name":"","last_name":"Couperus","name_suffix":"","institution":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington","department":"None"}],"date_submitted":"2020-06-15T21:42:29+02:00","date_accepted":"2020-06-15T21:42:29+02:00","date_published":"2020-06-15T21:43:02+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/848/galley/600/download/"}]},{"pk":13392,"title":"Patient Safety Event Reporting and Opportunities for Emergency Medicine Resident Education","subtitle":null,"abstract":"Introduction:\n Healthcare systems often expose patients to significant, preventable harm causing an estimated 44,000 to 98,000 deaths or more annually. This has propelled patient safety to the forefront, with reporting systems allowing for the review of local events to determine their root causes. As residents engage in a substantial amount of patient care in academic emergency departments, it is critical to use these safety event reports for resident-focused interventions and educational initiatives. This study analyzes reports from the Virginia Commonwealth University Health System to understand how the reports are categorized and how it relates to opportunities for resident education.\nMethods: \nIdentifying categories from the literature, three subject matter experts (attending physician, nursing director, registered nurse) categorized an initial 20 reports to resolve category gaps and then 100 reports to determine inter-rater reliability. Given sufficient agreement, the remaining 400 reports were coded individually for type of event and education among other categories.\nResults:\n After reviewing 513 events, we found that the most common event types were issues related to staff and resident training (25%) and communication (18%), with 31% requiring no education, 46% requiring directed educational feedback to an individual or group, 20% requiring education through monthly safety updates or meetings, 3% requiring urgent communication by email or in-person, and <1% requiring simulation.\nConclusion:\n Twenty years after the publication of To Err is Human, gains have been made integrating quality assurance and patient safety within medical education and hospital systems, but there remains extensive work to be done. Through a review and analysis of our patient safety event reporting system, we were able to gain a better understanding of the events that are submitted, including the types of events and their severity, and how these relate to the types of educational interventions provided (eg, feedback, simulation). We also determined that these events can help inform resident education and learning using various types of education. Additionally, incorporating residents in the review process, such as through root cause analyses, can provide residents with high-quality, engaging learning opportunities and useful, lifelong skills, which is invaluable to our learners and future physicians.","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":"safety, resident, education"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0092g4rn","frozenauthors":[{"first_name":"V.","middle_name":"Ramana","last_name":"Feeser","name_suffix":"","institution":"Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Anne","middle_name":"","last_name":"Jackson","name_suffix":"","institution":"Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Regina","middle_name":"","last_name":"Senn","name_suffix":"","institution":"Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Timothy","middle_name":"","last_name":"Layng","name_suffix":"","institution":"Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Sally","middle_name":"A.","last_name":"Santen","name_suffix":"","institution":"Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Angela","middle_name":"B.","last_name":"Creditt","name_suffix":"","institution":"Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Harinder","middle_name":"S.","last_name":"Dhindsa","name_suffix":"","institution":"Virginia Commonwealth University Health System, Department of Emergency Medicine, Division of Emergency Medical Services, Richmond, Virginia","department":"None"},{"first_name":"Michael","middle_name":"J.","last_name":"Vitto","name_suffix":"","institution":"Virginia Commonwealth University School of Medicine, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Nastassia","middle_name":"M.","last_name":"Savage","name_suffix":"","institution":"Virginia Commonwealth University School of Medicine, Office of Assessment, Evaluation, and Scholarship, Richmond, Virginia","department":"None"},{"first_name":"Robin","middle_name":"R.","last_name":"Hemphill","name_suffix":"","institution":"Virginia Commonwealth University Health System, Department of Emergency Medicine, Richmond, Virginia","department":"None"}],"date_submitted":"2019-11-28T02:59:37+01:00","date_accepted":"2019-11-28T02:59:37+01:00","date_published":"2020-06-15T21:39:35+02:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13392/galley/7031/download/"}]},{"pk":847,"title":"A Case Report: Point-of-care Ultrasound in the Diagnosis of Post-Myocardial Infarction Ventricular Septal Rupture","subtitle":null,"abstract":"Introduction:\n Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization.\nCase report:\n We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management.\nConclusion:\n This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.","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":"Coronary artery disease"},{"word":"mechanical circulatory support"},{"word":"ST-elevation myocardial infarction"},{"word":"ventricular septal rupture"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6434249q","frozenauthors":[{"first_name":"Andrew","middle_name":"J.","last_name":"Portuguese","name_suffix":"","institution":"University of Rochester Medical Center, Department of Medicine, Rochester, New York","department":"None"},{"first_name":"Khaled","middle_name":"H.","last_name":"Abdulla","name_suffix":"","institution":"University of Rochester Medical Center, Department of Medicine, Rochester, New York","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Vornovitsky","name_suffix":"","institution":"University of Rochester Medical Center, Department of Cardiology, Rochester, New York","department":"None"},{"first_name":"John","middle_name":"","last_name":"DeAngelis","name_suffix":"","institution":"University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York","department":"None"}],"date_submitted":"2020-06-15T21:33:36+02:00","date_accepted":"2020-06-15T21:33:36+02:00","date_published":"2020-06-15T21:34:22+02:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/847/galley/599/download/"}]}]}