{"count":39500,"next":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=13600","previous":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=13400","results":[{"pk":44863,"title":"Bicuspid Aortic Valve Infective Endocarditis: Is There a Need to Widen the Indications for Antibiotic Prophylaxis","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/89h0k1mv","frozenauthors":[{"first_name":"Ramtin","middle_name":"","last_name":"Anousheh","name_suffix":"MD, MPH","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Ramona","middle_name":"","last_name":"Mehrinfar-Zadeh","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2020-03-13T17:26:11Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44863/galley/33656/download/"}]},{"pk":44862,"title":"Evolution of Multiple Myeloma to B-cell Acute Lymphoblastic Leukemia","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/13t1p0q4","frozenauthors":[{"first_name":"Ryan","middle_name":"","last_name":"Aronin","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Christos","middle_name":"","last_name":"Haveles","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2020-03-13T17:23:12Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44862/galley/33655/download/"}]},{"pk":44642,"title":"Blastic Plasmacytoid Dendritic Cell Neoplasm","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5dm702zk","frozenauthors":[{"first_name":"Chaivat","middle_name":"","last_name":"Phuvadakorn","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Angela","middle_name":"","last_name":"Lai","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2020-03-13T17:20:36Z","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44642/galley/33435/download/"}]},{"pk":62808,"title":"Climate and Land-Use Controls on Surface Water Diversions in the Central Valley, California","subtitle":null,"abstract":"California’s Central Valley (CV) is one of the most productive agricultural regions in the world, enabled by the conjunctive use of surface water and groundwater. We investigated variations in the CV’s managed surface water diversions relative to climate variability. Using a historical record (1979−2010) of diversions from 531 sites, we found diversions are largest in the wetter Sacramento basin to the north, but most variable in the drier Tulare basin to the south. A rotated empirical orthogonal function (REOF) analysis finds 72% of the variance of diversions is captured by the first three REOFs. The leading REOF (35% of variance) exhibited strong positive loadings in the Tulare basin, and the corresponding principal component time-series (RPC1) was strongly correlated (ρ > 0.9) with contemporaneous hydrologic variability. This pattern indicates larger than average diversions in the south, with neutral or slightly less than average diversions to the north during wet years, with the opposite true for dry years. The second and third REOFs (20% and 17% of variance, respectively), were strongest in the Sacramento basin and San Francisco Bay−Delta. RPC2 and RPC3 were associated with variations in agricultural- and municipal-bound diversions, respectively. RPC2 and RPC3 were also moderately correlated with 7-year cumulative precipitation based on lagged correlation analysis, indicating that diversions in the north and central portions of the CV respond to longer-term hydrologic variations. The results illustrate a dichotomy of regimes wherein diversions in the more arid Tulare are governed by year-to-year hydrologic variability, while those in wetter northern basins reflect land-use patterns and low-frequency hydrologic variations.","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":"Climate, land use, hydrology, Central Valley, diversions"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3408m651","frozenauthors":[{"first_name":"Jordan","middle_name":"P.","last_name":"Goodrich","name_suffix":"","institution":"Scripps Institution of Oceanography, University of California, San Diego","department":""},{"first_name":"Daniel","middle_name":"R.","last_name":"Cayan","name_suffix":"","institution":"Scripps Institution of Oceanography, University of California, San Diego","department":""},{"first_name":"David","middle_name":"W.","last_name":"Pierce","name_suffix":"","institution":"Scripps Institution of Oceanography, University of California, San Diego","department":""}],"date_submitted":"2020-03-04T17:16:53Z","date_accepted":"2020-03-04T17:16:53Z","date_published":"2020-03-12T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62808/galley/48489/download/"}]},{"pk":62809,"title":"Combining Models of the Critical Streakline and the Cross-Sectional Distribution of Juvenile Salmon to Predict Fish Routing at River Junctions","subtitle":null,"abstract":"Because fish that enter the interior Delta have poorer survival than those emigrating via the Sacramento River, understanding the mechanisms that drive entrainment rates at side channel junctions is critically important for the management of imperiled juvenile salmon. Here, we implement a previously proposed process-based conceptual model to study entrainment rates based on three linked elements: the entrainment zone, critical streakline, and cross-sectional distribution of fish. The critical streakline is the location along a channel cross-section immediately upstream of a junction that forms the spatial divide between parcels of water that enter a side channel or remain in the main channel. The critical streakline therefore divides the main channel into entrainment zones within which fish would likely enter each channel. Combined with information about the cross-sectional distribution of fish upstream of a junction, this conceptual model provides a means to predict fish entrainment into each channel. To apply this conceptual model, we combined statistical models of the critical streakline, the cross-sectional distribution of acoustic tagged juvenile Chinook salmon, and their probability of entrainment into Georgiana Slough. We fit joint beta regression and logistic regression models to acoustic telemetry data gathered in 2011 and 2012 to estimate the cross-sectional distribution of fish upstream of the junction, and to estimate the probability of entrainment for fish on either side of the critical streakline. We show that entrainment rates can be predicted by understanding how the combination of critical streakline position and cross-sectional distribution of fish co-vary as a function of environmental covariates. By integrating over individual positions and entrainment fates to arrive at population-level entrain probability in relation to environmental covariates, our model offers managers a simple but powerful tool to evaluate how alternative actions affect migrating fish.","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":"Chinook Salmon, entrainment rates, Georgiana Slough, critical streakline, telemetry, Bayesian data analysis"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1wr2f87f","frozenauthors":[{"first_name":"Dalton","middle_name":"J.","last_name":"Hance","name_suffix":"","institution":"Western Fisheries Research Center, US Geological Survey","department":""},{"first_name":"Russell","middle_name":"W.","last_name":"Perry","name_suffix":"","institution":"Western Fisheries Research Center, US Geological Survey","department":""},{"first_name":"Jon","middle_name":"R.","last_name":"Burau","name_suffix":"","institution":"California Water Science Center, US Geological Survey","department":""},{"first_name":"Aaron","middle_name":"","last_name":"Blake","name_suffix":"","institution":"California Water Science Center, US Geological Survey","department":""},{"first_name":"Paul","middle_name":"","last_name":"Stumpner","name_suffix":"","institution":"California Water Science Center, US Geological Survey","department":""},{"first_name":"Xiaochung","middle_name":"","last_name":"Wang","name_suffix":"","institution":"Bay–Delta Office, California Department of Water Resources","department":""},{"first_name":"Adam","middle_name":"","last_name":"Pope","name_suffix":"","institution":"Western Fisheries Research Center, US Geological Survey","department":""}],"date_submitted":"2020-03-04T17:24:53Z","date_accepted":"2020-03-04T17:24:53Z","date_published":"2020-03-12T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62809/galley/48490/download/"}]},{"pk":62807,"title":"Did a Shifting Ecological Baseline Mask the Predatory Effect of Striped Bass on Delta Smelt?","subtitle":null,"abstract":"Striped Bass, \nMorone saxatilis\n, has been an established member of the San Francisco Estuary’s (estuary’s) aquatic community for nearly a century and a half. As a predator, it has the potential to shape community composition through top-down control of lower trophic species, including the endangered Delta Smelt, \nHypomesus transpacificus\n. Invasive predators can be particularly disruptive to native communities because they present novel dangers to naïve populations, but, as a long-established member of the aquatic community, Striped Bass has not previously been considered to limit the Delta Smelt population. Here, we develop an argument that Striped Bass are important to controlling Delta Smelt. We support this argument by reviewing historical data which suggests that declines in Delta Smelt before the current-day monitoring program were driven by the invasion of Striped Bass into the estuary. We describe this phenomenon as the ‘phantom predator’ hypothesis in the context of an analog to the shifting baseline syndrome previously described for marine fisheries. A deeper understanding of how well studied (and rapidly changing) bottom-up drivers of the estuary food web interact with poorly understood (but also rapidly changing) controls at the top of the food web could prove very important to the conservation of other declining native fishes and possible future attempts to re-introduce captive-reared Delta Smelt to the estuary.","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":"Striped Bass, Delta Smelt, shifting baseline, phantom predator, ephemeral predatory impact, density-dependent prey consumption"}],"section":"Essay","is_remote":true,"remote_url":"https://escholarship.org/uc/item/46f3j55m","frozenauthors":[{"first_name":"Matthew","middle_name":"L.","last_name":"Nobriga","name_suffix":"","institution":"San Francisco Bay−Delta Fish and Wildlife Office, US Fish and Wildlife Service","department":""},{"first_name":"Wiliam","middle_name":"E.","last_name":"Smith","name_suffix":"","institution":"San Francisco Bay−Delta Fish and Wildlife Office, US Fish and Wildlife Service","department":""}],"date_submitted":"2020-02-25T22:34:29Z","date_accepted":"2020-02-25T22:34:29Z","date_published":"2020-03-12T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62807/galley/48488/download/"}]},{"pk":62810,"title":"Sacramento River Predator Diet Analysis:  A Comparative Study","subtitle":null,"abstract":"This study examined diets of two predatory fish species, the native Sacramento Pikeminnow (\nPtychocheilus grandis\n) and the introduced Striped Bass (\nMorone saxatilis\n), in the Sacramento River, California, USA. Both species have been implicated in native species declines through predation, eliciting our investigation of their diets in the Sacramento River. Sampling occurred between March and November 2017, and was conducted via hook and line on a 35-km reach near Chico, California. Habitat types sampled include engineered structures (water diversions and beam bridges), rip-rapped channel edges, and natural riverbank. Stomach contents were collected via gastric lavage and later processed using visual, gravimetric, and genetic techniques. Diets of Sacramento Pikeminnow and Striped Bass were highly similar as determined through index of relative importance and PERMANOVA modeling. Water temperature was the only variable that significantly affected diet composition. Results reflect similar dietary niches for both species in the Sacramento River.","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":"Sacramento Pikeminnow, predation, Striped Bass, introduced species, California, fisheries, water diversion, Chinook Salmon"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3sb5g6w4","frozenauthors":[{"first_name":"Dylan","middle_name":"K.","last_name":"Stompe","name_suffix":"","institution":"Department of Biological Sciences, California State University, Chico\nand\nNorthern Region, California Department of Fish and Wildlife","department":""},{"first_name":"Jason","middle_name":"D.","last_name":"Roberts","name_suffix":"","institution":"Northern Region, California Department of Fish and Wildlife","department":""},{"first_name":"Carlos","middle_name":"A.","last_name":"Estrada","name_suffix":"","institution":"Department of Biological Sciences, California State University, Chico","department":""},{"first_name":"David","middle_name":"M.","last_name":"Keller","name_suffix":"","institution":"Department of Biological Sciences, California State University, Chico","department":""},{"first_name":"Nicholas","middle_name":"M.","last_name":"Balfour","name_suffix":"","institution":"Department of Biological Sciences, California State University, Chico","department":""},{"first_name":"Amanda","middle_name":"I.","last_name":"Banet","name_suffix":"","institution":"Department of Biological Sciences, California State University, Chico","department":""}],"date_submitted":"2020-03-04T17:31:36Z","date_accepted":"2020-03-04T17:31:36Z","date_published":"2020-03-12T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62810/galley/48491/download/"}]},{"pk":2256,"title":"So That All May Speak: Inviting All to Describe Themselves in the L2 French Classroom","subtitle":null,"abstract":"In this article, I examine two focal students of L2 French whose curiosity and embodied learning inspired me to rethink my teaching about personal gender expression and grammatical gender and to develop curricular innovations that would open up pathways for self-expression in the L2 French classroom.","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.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nc-nd/4.0"},"keywords":[{"word":"L2 French, SLA, language pedagogy, queer linguistics"}],"section":"Teachers' Forum","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6x04n96c","frozenauthors":[{"first_name":"William","middle_name":"Allen","last_name":"Heidenfeldt","name_suffix":"","institution":"Salesian College Preparatory","department":"None"}],"date_submitted":"2019-08-06T21:09:29+01:00","date_accepted":"2019-08-06T21:09:29+01:00","date_published":"2020-03-10T23:33:14Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/l2/article/2256/galley/1425/download/"}]},{"pk":5552,"title":"Discrimination of person odor by owned domestic dogs","subtitle":null,"abstract":"In the field of dog cognition research, many studies assume that their subjects have multimodal recognition of their owner: Experiments using the face or voice of the person have proliferated. An outstanding question is whether owned domestic dogs represent the people with whom they live via smell. Olfaction is a principle sensory modality for dogs, and there is evidence that it is integral to recognition of conspecifics. In the current study, we investigated whether owned dogs spontaneously (without training) distinguished their owner's odor from a stranger's odor. Using natural body odor captured on a t-shirt, we found that dogs habituated to a familiar odor and dishabituated to an unfamiliar odor. This finding begins to answer the question of how dogs recognize and represent humans, including their owners.","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":"Domestic dog"},{"word":"Olfaction"},{"word":"discrimination"},{"word":"Odor"}],"section":"Special Issue: Canine Research","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9m86s396","frozenauthors":[{"first_name":"Alexandra","middle_name":"","last_name":"Horowitz","name_suffix":"","institution":"Barnard College","department":"None"}],"date_submitted":"2019-11-21T16:50:14Z","date_accepted":"2019-11-21T16:50:14Z","date_published":"2020-03-09T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5552/galley/3361/download/"}]},{"pk":800,"title":"Serotonin Syndrome versus Cannabis Toxicity in the Emergency Department","subtitle":null,"abstract":"As more states legalize marijuana, the potential of marijuana abuse could lead to an increase in the number of emergency department (ED) visits. We describe two patients who presented to the ED with dilated pupils, rigidity in both lower extremities, and clonus in both feet after inhaling the vapor of a highly potent form of marijuana. Serotonin syndrome diagnosis was initially considered in the differential diagnosis. Ultimately, high-potency marijuana abuse was the final diagnosis. Therefore, marijuana toxicity should be considered in ED patients who present with signs and symptoms similar to that of serotonin 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":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2kj531sc","frozenauthors":[{"first_name":"Jacob","middle_name":"W.","last_name":"Baltz","name_suffix":"","institution":"CoxHealth System, Department of Emergency Medicine, Springfield, Missouri","department":"None"},{"first_name":"Lamanh","middle_name":"T.","last_name":"Le","name_suffix":"","institution":"CoxHealth System, Department of Pharmacy, Springfield, Missouri","department":"None"}],"date_submitted":"2020-03-03T02:56:27Z","date_accepted":"2020-03-03T02:56:27Z","date_published":"2020-03-03T02:57:03Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/800/galley/553/download/"}]},{"pk":797,"title":"Intracranial Hemorrhage Due to Secondary Hypertension from Intracranial Large Vessel Occlusion","subtitle":null,"abstract":"Simultaneous hemorrhagic and ischemic strokes have been previously reported in the literature. Typically, these occur in patients secondary to dialysis, cerebral amyloid angiopathy, or thrombotic thrombocytopenic purpura.1,2,3 However, this is the unique case of a 62-year-old Asian female who presented with a hemorrhagic stroke suspected to be secondary to refractory hypertension from intracranial large vessel atherosclerotic flow limiting stenosis, with rapid subsequent large vessel occlusion and ischemic stroke. Questions arise such as ideal blood pressure parameters for dual management, timeliness of computed tomography angiography imaging in the emergency department for detection of large vessel occlusion during intracranial hemorrhage, and subsequent selection of treatment plan in the dual-lesion patient population.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2j48n4hb","frozenauthors":[{"first_name":"Amit","middle_name":"","last_name":"Rawal","name_suffix":"","institution":"North Florida Regional Medical Center, Department of Emergency Medicine, Gainesville, Florida","department":"None"},{"first_name":"Alex","middle_name":"","last_name":"Waldman","name_suffix":"","institution":"North Florida Regional Medical Center, Department of Emergency Medicine, Gainesville, Florida","department":"None"},{"first_name":"Omar","middle_name":"","last_name":"Saeed","name_suffix":"","institution":"University of Tennessee Health Science Center, Department of Neurology, Memphis, Tennessee; Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota","department":"None"},{"first_name":"Asif","middle_name":"A.","last_name":"Khan","name_suffix":"","institution":"North Florida Regional Medical Center, Department of Vascular and Interventional Neurology, Gainesville, Florida","department":"None"}],"date_submitted":"2020-03-03T02:08:39Z","date_accepted":"2020-03-03T02:08:39Z","date_published":"2020-03-03T02:09:26Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/797/galley/551/download/"}]},{"pk":795,"title":"Rare External Jugular Vein Pseudoaneurysm","subtitle":null,"abstract":"External jugular vein pseudoaneurysm is a very rare cause of a neck mass due to the low pressure venous system. This case demonstrates a 27-year-old female who presented to the emergency department with a non-tender, compressible, left-sided neck mass that enlarged with valsalva and talking, and intermittent paresthesias. Upon workup, she was diagnosed with an external jugular vein pseudoaneurysm. Complications of this diagnosis are mentioned in the literature; however, most patients with an external jugular vein pseudoaneurysm or aneurysm can be safely discharged with close follow-up with a vascular surgeon.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8z02x1nw","frozenauthors":[{"first_name":"Patrick","middle_name":"J.","last_name":"Wallace","name_suffix":"","institution":"University of Nevada Las Vegas, Department of Emergency Medicine, Las Vegas, Nevada","department":"None"},{"first_name":"Jordana","middle_name":"","last_name":"Haber","name_suffix":"","institution":"University of Nevada Las Vegas, Department of Emergency Medicine, Las Vegas, Nevada","department":"None"}],"date_submitted":"2020-03-03T00:00:37Z","date_accepted":"2020-03-03T00:00:37Z","date_published":"2020-03-03T00:09:30Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/795/galley/549/download/"}]},{"pk":13560,"title":"Volume 21, Issue 2 - March","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"WestJEM Full-Text Issue","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1mc339n2","frozenauthors":[{"first_name":"Dana","middle_name":"H.","last_name":"Le","name_suffix":"","institution":"","department":"None"},{"first_name":"Christine","middle_name":"A.","last_name":"Louis","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-02-10T19:41:06Z","date_accepted":"2020-02-10T19:41:06Z","date_published":"2020-03-02T20:17:31Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13560/galley/7093/download/"}]},{"pk":799,"title":"An Early Holiday Surprise: Cholecystitis Wrapped in Takotsubo Cardiomyopathy","subtitle":null,"abstract":"This is a novel case report of a 44-year-old woman who presented to the emergency department with epigastric pain wrapping around to her back. She had no risk factors for cardiac disease, but her initial electrocardiogram (ECG) showed a Wellens syndrome pattern and she was taken urgently to the catheterization lab. After a negative catheterization, she underwent cardiac magnetic resonance imaging, which was positive for Takotsubo cardiomyopathy (TC). Ultimately, abdominal computed tomography revealed that she had cholecystitis, which likely was the cause of her TC and ECG changes.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/81s0p1k7","frozenauthors":[{"first_name":"Kevin","middle_name":"","last_name":"Gould","name_suffix":"","institution":"Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Stephen","middle_name":"","last_name":"Miller","name_suffix":"","institution":"Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia","department":"None"},{"first_name":"Joel","middle_name":"","last_name":"Moll","name_suffix":"","institution":"Virginia Commonwealth University, Department of Emergency Medicine, Richmond, Virginia","department":"None"}],"date_submitted":"2020-03-03T02:18:16Z","date_accepted":"2020-03-03T02:18:16Z","date_published":"2020-03-02T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/799/galley/552/download/"}]},{"pk":60804,"title":"A Perfect Storm: Environmental Justice and Air Quality Impacts of Offshore Oil and Gas Development in the Arctic Outer Continental Shelf","subtitle":null,"abstract":"The Arctic Outer Continental Shelf is the next great legal battleground over oil and gas resources, environmental protection, and environmental justice.  The Arctic is home to an array of sensitive ecological resources and a large Native Alaskan population that relies heavily on the natural environment for food and supplies.  The Arctic Ocean also holds a vast amount of untapped oil and gas resources that had previously been largely inaccessible because of harsh climatic conditions and withdrawals of large swaths of the Shelf by Congress and multiple presidents.  However, climate change is melting Arctic sea ice and opening up previously inaccessible areas.  In addition, President Trump is pushing to expand oil and gas development everywhere, including the Arctic.  If President Trump’s plans prevail against the many legal challenges seeking to protect the Arctic, Native Alaskans will face a multitude of threats to their health, safety, and way of life.\nScholars, journalists, and environmental groups have already illuminated the threats of oil spills and climate change.  This Comment focuses on a less discussed impact of offshore oil and gas development: air pollution and its effects on Native Alaskans.  Onshore oil and gas development has already been polluting the air of Alaskan communities, causing increases in respiratory illnesses and other health problems, and leading to climate change, which is disrupting the natural environment upon which Native Alaskans depend for food and supplies.  A new era of offshore development would amplify these problems and create new and unique challenges that disproportionately burden Native Alaskan communities.\nThis Comment makes two novel contributions.  First, it illuminates the erratic history and disjointed nature of air quality regulation on the Outer Continental Shelf.  Second, this Comment highlights how the federal government’s current regulatory structure for offshore air emissions uniquely fails Native Alaskans who are seeking to protect their health and way of life.  In addition, this Comment makes some recommendations for statutory and regulatory changes to better address the environmental justice impacts of air pollution from offshore oil and gas development in the Arctic.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Arctic Outer Continental Shelf"},{"word":"environmental justice"},{"word":"Environmental Protection"},{"word":"oil and gas"},{"word":"air quality"}],"section":"Comments","is_remote":true,"remote_url":"https://escholarship.org/uc/item/80j4z9n9","frozenauthors":[{"first_name":"Kayla","middle_name":"","last_name":"Race","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:54:02Z","date_accepted":"2020-02-28T23:54:02Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60804/galley/46766/download/"}]},{"pk":60802,"title":"California Carbon Offsets and Working Forest Conservation Easements","subtitle":null,"abstract":"California’s cap-and-trade system is a vital laboratory for testing the effectiveness of this market-driven approach in meeting greenhouse gas emission reduction goals and the use of forestry-based carbon offsets within these systems generally. Based on this experience, this Article explores one of the primary challenges, layering offsets with working forest conservation easements, which currently limits opportunities to effectively use these tools in concert. Ultimately, this market may need to foster and rely on natural linkages with working forest conservation easements to develop these offsets and to better ensure that the critical societal objectives of these projects are being met.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"california"},{"word":"Cap-and-Trade"},{"word":"conservation easement"},{"word":"greenhouse gas"},{"word":"Emission reduction"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9k0499g8","frozenauthors":[{"first_name":"Jess","middle_name":"R.","last_name":"Phelps","name_suffix":"","institution":"","department":""},{"first_name":"David","middle_name":"P.","last_name":"Hoffer","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:49:00Z","date_accepted":"2020-02-28T23:49:00Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60802/galley/46764/download/"}]},{"pk":60803,"title":"Downsizing National Monuments: The Current Debate and Lessons From History","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"national monument"},{"word":"national monument designation"},{"word":"property clause"}],"section":"Comments","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9258s4dm","frozenauthors":[{"first_name":"Grant","middle_name":"","last_name":"Horton","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:51:31Z","date_accepted":"2020-02-28T23:51:31Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60803/galley/46765/download/"}]},{"pk":60800,"title":"From Attleboro to EPSA: The Pace of Change and Evolving Jurisdictional Frameworks in the Electricity Sector","subtitle":null,"abstract":"This Article compares the pattern of fundamental change, legal and regulatory response, and judicial adaptation underlying the electricity sector’s twentieth century beginnings to its current and ongoing rapid transition.  This comparison is then used as a basis to examine and contextualize the collaborative federalism jurisdictional framework that the Supreme Court employs when adjudicating modern-day jurisdictional disputes in the sector.\nThe early 1900s saw a period of rapid industry expansion, with the electricity sector progressing from small intrastate utilities to a sprawling interstate grid.  The expanding grid rapidly outgrew the state-led regulatory framework that had organically developed.  In turn, Congress responded by passing the Federal Power Act to fill what is now known as the Attleboro gap.  Courts in turn needed to resolve consequent jurisdictional tensions that arose under the new federal and state balance of authority.  The courts employed a bright-line jurisdictional framework that divided authority on the basis of location, adjudicating disputes by determining where the contested action took place.  This line-drawing split federal authority on one side of the juridical line—such as wholesale sales and interstate activities—and state authority on the other, such as retail sales and intrastate activities.\nJust as the interstate expansion of the grid disrupted industry and regulatory structure in the 1900s, modern rapid change is once again creating new benefits and interests through foundational sector disruption.  This disruption has similarly placed pressure upon the electricity sector and its regulation.  This Article analyzes three foundational changes to the electricity sector that are spurring energy transition and grid modernization: opening the industry to competitive market forces; technological advances making a multidirectional grid possible; and evolving state policy preferences and priorities that seek to combat climate change.\nThe foundational change underway in the electricity sector has spurred a legal and regulatory response in order to create new connections between longstanding statutory mandate and sector change.  Congress, the Federal Energy Regulatory Commission (FERC), and states have responded with laws and regulations that acknowledge a sector that now resists simple, bright-line jurisdictional division.  These responses have invited increasingly frequent court review.  In adjudicating disputes in the electricity sector, the courts have turned to and fully embraced a functionalist, ‘collaborative federalism’ jurisdictional framework.  This jurisdictional framework considers an issue’s intent, target, and effect rather than an issue’s location.  It best enables courts to adjudicate disputes in the context of changes occurring within the modern electricity sector.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"FERC"},{"word":"electricity sector"},{"word":"EPSA"},{"word":"federal jurisdiction"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7k9512pg","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Panfil","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:40:31Z","date_accepted":"2020-02-28T23:40:31Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60800/galley/46762/download/"}]},{"pk":60798,"title":"Front Matter","subtitle":null,"abstract":"","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Front Matter","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5vx8j72h","frozenauthors":[{"first_name":"Editors","middle_name":"","last_name":"Editors","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:33:18Z","date_accepted":"2020-02-28T23:33:18Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60798/galley/46760/download/"}]},{"pk":60801,"title":"Integrating Green Infrastructure Into Stormwater Policy: Reliability, Watershed Management, and Environmental Psychology as Holistic Tools for Success","subtitle":null,"abstract":"As cities continue to expand, the issues of flood control and urban water quality have become major modern sustainability challenges. Green infrastructure—the use of nature-based solutions to target, treat, and store stormwater at its source—has emerged as a possible solution. While green infrastructure does offer multiple benefits for urban users, its performance is also highly variable. This Article addresses a key gap in existing literature by explicitly addressing how uncertainty in environmental and anthropogenic factors affects green infrastructure performance and integration within the Clean Water Act’s municipal separate storm sewer (MS4) regulatory program.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clean Water Act"},{"word":"Green Infrastructure"},{"word":"sustainability"},{"word":"stormwater"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/074396qn","frozenauthors":[{"first_name":"Reshmina","middle_name":"","last_name":"William","name_suffix":"","institution":"","department":""},{"first_name":"A.","middle_name":"Bryan","last_name":"Endres","name_suffix":"","institution":"","department":""},{"first_name":"Ashlynn","middle_name":"S.","last_name":"Stillwell","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:44:44Z","date_accepted":"2020-02-28T23:44:44Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60801/galley/46763/download/"}]},{"pk":60799,"title":"Table of Contents","subtitle":null,"abstract":"","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Table of Contents","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4661m2g3","frozenauthors":[{"first_name":"Editors","middle_name":"","last_name":"Editors","name_suffix":"","institution":"","department":""}],"date_submitted":"2020-02-28T23:34:22Z","date_accepted":"2020-02-28T23:34:22Z","date_published":"2020-02-28T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/uclalaw_jelp/article/60799/galley/46761/download/"}]},{"pk":12375,"title":"Abscess Size and Depth on Ultrasound and Association with Treatment Failure without Drainage","subtitle":null,"abstract":"Introduction:\n Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary.\nMethods:\n We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure.\nResults:\n A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44-0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74-93).\nConclusion:\n This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure.","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, ultrasound, size, depth, outome, management"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9c65q0vp","frozenauthors":[{"first_name":"Frances","middle_name":"M.","last_name":"Russell","name_suffix":"","institution":"Indiana University, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Matt","middle_name":"","last_name":"Rutz","name_suffix":"","institution":"Indiana University, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"L. Ken","middle_name":"","last_name":"Rood","name_suffix":"","institution":"Indiana University, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Justin","middle_name":"","last_name":"McGee","name_suffix":"","institution":"Indiana University, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"},{"first_name":"Elisa","middle_name":"J.","last_name":"Sarmiento","name_suffix":"","institution":"Indiana University, Department of Emergency Medicine, Indianapolis, Indiana","department":"None"}],"date_submitted":"2018-12-06T21:00:26Z","date_accepted":"2018-12-06T21:00:26Z","date_published":"2020-02-26T23:34:18Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12375/galley/6587/download/"}]},{"pk":13009,"title":"Comparison of Ultrasound-Guided Vs Traditional Arterial Cannulation by Emergency Medicine Residents","subtitle":null,"abstract":"Introduction:\n We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.\nMethods:\n We identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training.\nResults: \nThe USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; p<0.001); 29 out of 30 (96%) successful radial arterial lines were placed using USGAC, whereas 14 out of 30 (47%) successful lines were placed using traditional AC (p<0.001). There was no significant difference in length of procedure or complication rate between the two groups. There was no difference in provider experience with respect to USGAC vs traditional AC.\nConclusion: \nEM residents were more successful and had fewer cannulation attempts with USGAC when compared to traditional AC after standard, intern-level ultrasound 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":"ultrasound guided, radial artery cannulation, traditional arterial cannulation, emergency medicine, residents"}],"section":"Technology in Emergency Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7358t6nm","frozenauthors":[{"first_name":"Casey","middle_name":"","last_name":"Wilson","name_suffix":"","institution":"Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"David","middle_name":"","last_name":"Rose","name_suffix":"","institution":"Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Gabor","middle_name":"D.","last_name":"Kelen","name_suffix":"","institution":"Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Veena","middle_name":"","last_name":"Billioux","name_suffix":"","institution":"Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Leah","middle_name":"","last_name":"Bright","name_suffix":"","institution":"Johns Hopkins Hospital, Department of Emergency Medicine, Baltimore, Maryland","department":"None"}],"date_submitted":"2019-07-18T22:11:56+01:00","date_accepted":"2019-07-18T22:11:56+01:00","date_published":"2020-02-26T20:16:11Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13009/galley/6816/download/"}]},{"pk":13028,"title":"Does the Removal of Textbook Reading from Emergency Medicine Resident Education Negatively Affect In-Service Scores?","subtitle":null,"abstract":"Introduction:\n In-service exam scores are used by residency programs as a marker for progress and success on board exams. Conference curriculum helps residents prepare for these exams. At our institution, due to resident feedback a change in curriculum was initiated. Our objective was to determine whether assigned Evidence-Based Medicine (EBM) articles and Rosh Review questions were non-inferior to Tintinalli textbook readings. We further hypothesized that the non-textbook assigned curriculum would lead to higher resident satisfaction, greater utilization, and a preference over the old curriculum.\nMethods:\n We collected scores from both the allopathic In-training Examination (ITE) and osteopathic Emergency Medicine Residency In-service Exam (RISE) scores taken by our program’s residents from both the 2015-2016 and 2016-2017 residency years. We compared scores pre-curriculum change (pre-CC) to scores post-curriculum change (post-CC). A five-question survey was sent to the residents regarding their satisfaction, preference, and utilization of the two curricula.\nResults: \nResident scores post-CC were shown to be non-inferior to their scores pre-CC for both exams. There was also no significant difference when we compared scores from each class post-CC to their respective class year pre-CC for both exams. Our survey showed significantly more satisfaction, utilization, and preference for this new curriculum among residents.\nConclusion:\n We found question-based learning and Evidence-Based Medicine articles non-inferior to textbook readings. This study provides evidence to support a move away from textbook readings without sacrificing scores on examinations.","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":"in-service, exams, education, rosh review, tintinalli,"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/93c0t4gp","frozenauthors":[{"first_name":"Christine","middle_name":"","last_name":"Ju","name_suffix":"","institution":"Saint Joseph’s University Medical Center, Department of Emergency Medicine, Paterson, New Jersey","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"Bove","name_suffix":"","institution":"Saint Joseph’s University Medical Center, Department of Emergency Medicine, Paterson, New Jersey","department":"None"},{"first_name":"Steven","middle_name":"","last_name":"Hochman","name_suffix":"","institution":"Saint Joseph’s University Medical Center, Department of Emergency Medicine, Paterson, New Jersey","department":"None"}],"date_submitted":"2019-07-27T19:02:59+01:00","date_accepted":"2019-07-27T19:02:59+01:00","date_published":"2020-02-25T22:04:07Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13028/galley/6823/download/"}]},{"pk":13164,"title":"How to Stop the Bleed: First Care Provider Model for Developing Public Trauma Response Beyond Basic Hemorrhage Control","subtitle":null,"abstract":"Introduction:\n Since 2013, the First Care Provider (FCP) model has successfully educated the non-medical population on how to recognize life-threatening injuries and perform interventions recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) and the Hartford Consensus in the disaster setting. Recent programs, such as the federal “Stop The Bleed” campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality. To date, no training programs have produced a validated study with regard to training a community population in these necessary principles of disaster response.\nMethods:\n In our study, we created a reproducible community training model for implementation into prehospital systems. Two matched demographic groups were chosen and divided into “trained” and “untrained” groups. The trained group was taught the FCP curriculum, which the Department of Homeland Security recognizes as a Stop the Bleed program, while the untrained group received no instruction. Both groups then participated in a simulated mass casualty event, which required evaluation of multiple victims with varying degree of injury, particularly a patient with an arterial bleed and a patient with an airway obstruction.\nResults:\n The objective measures in comparing the two groups were the time elapse until their first action was taken (T1A) and time to their solution of the simulation (TtS). We compared their times using one-sided t-test to demonstrate their responses were not due to chance alone. At the arterial bleed simulation, the T1A for the trained and untrained groups, respectively, were 34.75 seconds and 111 seconds (p-value = .1064), while the TtS were 3 minutes and 33 seconds in the trained group and eight minutes in the untrained groups (physiologic cutoff) (p-value = .0014). At the airway obstruction simulation, the T1A for the trained and untrained groups, respectively, were 20.5 seconds and 43 seconds (p-value = .1064), while the TtS were 32.6 seconds in the trained group and 7 minutes and 3 seconds in the untrained group (p-value = .0087). Simulation values for recently graduated nursing students and a local fire department engine company (emergency medical services [EMS]) were also given for reference. The trained group’s results mirrored times of EMS.\nConclusion:\n This study demonstrates an effective training model to civilian trauma response, while adhering to established recommendations. We offer our model as a potential solution for accomplishing the Stop The Bleed mission while advancing the potential of public disaster response.","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":"Disaster Medicine/ Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0sp8p3gd","frozenauthors":[{"first_name":"Joshua","middle_name":"P.","last_name":"Bobko","name_suffix":"","institution":"Loma Linda University, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Dylan","middle_name":"J.","last_name":"Badin","name_suffix":"","institution":"Dartmouth Geisel School of Medicine, Hanover, New Hampshire","department":"None"},{"first_name":"Leila","middle_name":"","last_name":"Danishgar","name_suffix":"","institution":"University of California, Irvine, Department of Emergency Medicine, Orange, California\nFirst Care Provider Foundation, Corona del Mar, California","department":"None"},{"first_name":"Kate","middle_name":"","last_name":"Bayhan","name_suffix":"","institution":"First Care Provider Foundation, Corona del Mar, California\nCalifornia State University, Fullerton, Department of Health and Human Development, School of Nursing, Fullerton, California","department":"None"},{"first_name":"Kevin","middle_name":"J.","last_name":"Thompson","name_suffix":"","institution":"First Care Provider Foundation, Corona del Mar, California","department":"None"},{"first_name":"William","middle_name":"J.","last_name":"Harris","name_suffix":"","institution":"First Care Provider Foundation, Corona del Mar, California","department":"None"},{"first_name":"R.","middle_name":"Todd","last_name":"Baldridge","name_suffix":"","institution":"Citrus College, Department of Health Science, Glendora, California","department":"None"},{"first_name":"Gerald","middle_name":"R.","last_name":"Fortuna","name_suffix":"","institution":"Washington University in St. Louis, Department of Surgery, St. Louis, Missouri","department":"None"}],"date_submitted":"2019-08-13T23:36:34+01:00","date_accepted":"2019-08-13T23:36:34+01:00","date_published":"2020-02-25T21:58:29Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13164/galley/6924/download/"}]},{"pk":12733,"title":"Role of Point-of-Care Testing in Reducing Time to Treatment Decision-Making in Urgency Patients: A Randomized Controlled Trial","subtitle":null,"abstract":"Introduction:\n Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS.\nMethods:\n We conducted a randomized control trial at the Urgency Room of Siriraj Hospital in Bangkok, Thailand. Patients triaged as level 3 or 4 were randomized to either the POCT or central laboratory testing (CLT) group. Primary outcomes were time to decision-making and ED LOS, which we compared using Mann-Whitney-Wilcoxon test.\nResults:\n We enrolled a total of 248 patients: 124 in the POCT and 124 in the CLT group. The median time from arrival to decision was significantly shorter in the POCT group (106.5 minutes (interquartile [IQR] 78.3-140) vs 204.5 minutes (IQR 165-244), p <0.001). The median ED LOS of the POCT group was also shorter (240 minutes (IQR 161.3-410) vs 395.5 minutes (IQR 278.5-641.3), p <0.001).\nConclusion:\n Using a point-of-care testing system could decrease time to decision-making and ED LOS, which could in turn reduce ED crowding.","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, decision making, emergency department, cost-effectiveness"}],"section":"Emergency Department Administration","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9fd8t75d","frozenauthors":[{"first_name":"Wansiri","middle_name":"","last_name":"Chaisirin","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Preechaya","middle_name":"","last_name":"Wongkrajang","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Clinical Pathology, Bangkok, Thailand","department":"None"},{"first_name":"Tenzin","middle_name":"","last_name":"Thoesam","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Nattakarn","middle_name":"","last_name":"Praphruetkit","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Tanyaporn","middle_name":"","last_name":"Nakornchai","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Sattha","middle_name":"","last_name":"Riyapan","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Onlak","middle_name":"","last_name":"Ruangsomboon","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"},{"first_name":"Sathima","middle_name":"","last_name":"Laiwejpithaya","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Clinical Pathology, Bangkok, Thailand","department":"None"},{"first_name":"Kavisara","middle_name":"","last_name":"Rattanathummawat","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Clinical Pathology, Bangkok, Thailand","department":"None"},{"first_name":"Rungrudee","middle_name":"","last_name":"Pavichai","name_suffix":"","institution":"Siriraj Hospital, Outpatient unit, Bangkok, Thailand","department":"None"},{"first_name":"Tipa","middle_name":"","last_name":"Chakorn","name_suffix":"","institution":"Siriraj Hospital, Mahidol University, Department of Emergency Medicine, Bangkok, Thailand","department":"None"}],"date_submitted":"2019-05-05T17:37:49+01:00","date_accepted":"2019-05-05T17:37:49+01:00","date_published":"2020-02-25T21:51:58Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12733/galley/6722/download/"}]},{"pk":794,"title":"A Rare Case of Hip Pain Secondary to Pigmented Villonodular Synovitis","subtitle":null,"abstract":"A 19-year-old Asian male presented to our emergency department with atraumatic right hip pain radiating to the right groin associated with pain on ambulation. Magnetic resonance imaging of the right hip with and without contrast revealed the diagnosis. Pigmented villonodular synovitis is a rare, monoarticular benign tumor originating from the synovium of the joint. The treatment is synovectomy of the pathological joint to prevent further disease progression.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4hv8147t","frozenauthors":[{"first_name":"Gary","middle_name":"","last_name":"Lai","name_suffix":"","institution":"Broward Health, Department of Emergency Medicine, Coral Springs, Florida","department":"None"},{"first_name":"Brett","middle_name":"","last_name":"Staller","name_suffix":"","institution":"Broward Health, Department of Diagnostic Radiology, Coral Springs, Florida","department":"None"},{"first_name":"Bhaskar","middle_name":"","last_name":"Ganguly","name_suffix":"","institution":"Broward Health, Department of Internal Medicine, Coral Springs, Florida","department":"None"},{"first_name":"Quan","middle_name":"","last_name":"Ta","name_suffix":"","institution":"Florida Atlantic University, Boca Raton, Florida","department":"None"},{"first_name":"Alexander","middle_name":"J.","last_name":"Scumpia","name_suffix":"","institution":"Broward Health, Department of Emergency Medicine, Coral Springs, Florida","department":"None"}],"date_submitted":"2020-02-25T01:08:32Z","date_accepted":"2020-02-25T01:08:32Z","date_published":"2020-02-25T01:09:09Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/794/galley/548/download/"}]},{"pk":793,"title":"An Atypical Presentation of Cystic Echinococcosis","subtitle":null,"abstract":"Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient’s serum was positive for echinococcus antibodies.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3zv1s1kc","frozenauthors":[{"first_name":"Bhavana","middle_name":"","last_name":"Tetali","name_suffix":"","institution":"Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan; Wayne State University School of Medicine, Detroit, Michigan","department":"None"},{"first_name":"Daniel","middle_name":"C.","last_name":"Grahf","name_suffix":"","institution":"Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan; Henry Ford Health System, Department of Emergency Medicine, Detroit Michigan","department":"None"},{"first_name":"Elian","middle_name":"D.","last_name":"Abou Asala","name_suffix":"","institution":"Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Axelson","name_suffix":"","institution":"Henry Ford Health System, Department of Emergency Medicine, Detroit Michigan","department":"None"}],"date_submitted":"2020-02-25T01:03:31Z","date_accepted":"2020-02-25T01:03:31Z","date_published":"2020-02-25T01:04:08Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/793/galley/547/download/"}]},{"pk":792,"title":"Acute Jaundice in a Six-year-old:  An Unusual Presentation of Atypical Kawasaki Disease","subtitle":null,"abstract":"Kawasaki disease (KD) is a rare vasculitis of childhood that is critical to recognize and treat due to associated morbidity and mortality. A six-year-old male presented to our emergency department (ED) afebrile but with reported recent fevers. Exam revealed jaundice and erythematous tongue with papules, and laboratory studies indicated a direct hyperbilirubinemia. Admitted for evaluation, he developed continuous fever, increasing maculopapular rash, and subsequent desquamation of hands and feet. He ultimately met criteria for incomplete KD, was treated with intravenous immunoglobulin, and avoided cardiac complications. This presentation of incomplete KD with hyperbilirubinemia is rare because the patient was afebrile at ED presentation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7jt127p7","frozenauthors":[{"first_name":"LCDR William","middle_name":"","last_name":"Bylund","name_suffix":"","institution":"Naval Hospital Okinawa, Department of Emergency Medicine, Okinawa, Japan","department":"None"},{"first_name":"Gregory","middle_name":"J.","last_name":"Zarow","name_suffix":"","institution":"Combat Trauma Research Group, Naval Medical Center Portsmouth, Portsmouth, Virginia; The Emergency Statistician, Idyllwild, California","department":"None"},{"first_name":"LCDR Daphne","middle_name":"","last_name":"Morrison Ponce","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2020-02-25T00:58:43Z","date_accepted":"2020-02-25T00:58:43Z","date_published":"2020-02-25T00:59:15Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/792/galley/546/download/"}]},{"pk":791,"title":"False Elevation of Volume Determined by Bladder Scanner Secondary to Bowel Obstruction","subtitle":null,"abstract":"Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a falsely elevated BV. We believe this is the first case report of a SBO causing an elevated BV by bladder scanner. Emergency physicians should be aware of the pitfalls of using bladder scanners, and use their point-of-care ultrasound skills when possible to expand their differential.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/03g7h5tz","frozenauthors":[{"first_name":"Sean","middle_name":"","last_name":"Schowalter","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Internal Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Zaid","middle_name":"","last_name":"Altawil","name_suffix":"","institution":"Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Elissa","middle_name":"M.","last_name":"Schechter-Perkins","name_suffix":"","institution":"Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Joseph","middle_name":"R.","last_name":"Pare","name_suffix":"","institution":"Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2020-02-25T00:54:00Z","date_accepted":"2020-02-25T00:54:00Z","date_published":"2020-02-25T00:54:33Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/791/galley/545/download/"}]},{"pk":790,"title":"Image to Fit the Clinical Picture: Point-of-care Ultrasound Assessment of Ebstein’s Anomaly in Peru","subtitle":null,"abstract":"Ebstein’s anomaly is a congenital heart defect that when left untreated can lead to unique physical exam and ultrasound findings. This case describes a patient who presented with dyspnea and was found to have cyanosis, clubbing, and dilation of right-sided chambers on point-of-care ultrasound. The series of images highlights findings in late-stage Ebstein’s anomaly and serves as a springboard for the discussion of the pathophysiology, diagnosis, and treatment of this rare congenital heart 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":[],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8qm9w8jg","frozenauthors":[{"first_name":"Ashley","middle_name":"C.","last_name":"Rider","name_suffix":"","institution":"Highland Hospital, Alameda Health System, Oakland, California","department":"None"},{"first_name":"Andrea","middle_name":"","last_name":"Dreyfuss","name_suffix":"","institution":"Highland Hospital, Alameda Health System, Oakland, California","department":"None"},{"first_name":"Roberto","middle_name":"","last_name":"Inga","name_suffix":"","institution":"Hospital Nacional Dos de Mayo, Department of Emergency Medicine, Lima, Peru","department":"None"}],"date_submitted":"2020-02-25T00:48:42Z","date_accepted":"2020-02-25T00:48:42Z","date_published":"2020-02-25T00:50:15Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/790/galley/544/download/"}]},{"pk":788,"title":"Urethral Calculi","subtitle":null,"abstract":"Urolithiasis is a condition with calculi commonly found within the kidney, ureter, or bladder. The urethra is an uncommon location of urolithiasis, with limited case reports and literature reviews of its presentation and management. Here we discuss a 24-year-old female who presented with urinary urgency, flank pain, and urinary retention for 12 hours. Physical exam showed a calculus at the urethral meatus. This case discusses the manual removal of a urethral calculus in a female patient with use of forceps, resulting in complete resolution of symptoms and urinary retention.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6r05q0w6","frozenauthors":[{"first_name":"Perry","middle_name":"","last_name":"Lee","name_suffix":"","institution":"University of Las Vegas, Department Emergency Medicine, Las Vegas, Nevada","department":"None"},{"first_name":"Jordana","middle_name":"","last_name":"Haber","name_suffix":"","institution":"University of Las Vegas, Department Emergency Medicine, Las Vegas, Nevada","department":"None"}],"date_submitted":"2020-02-25T00:37:15Z","date_accepted":"2020-02-25T00:37:15Z","date_published":"2020-02-25T00:38:05Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/788/galley/542/download/"}]},{"pk":12830,"title":"Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov","subtitle":null,"abstract":"Introduction: \nPromoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.\nMethods:\n We abstracted data from ClinicalTrials.gov (February 2000 - September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 - September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.\nResults: \nWe found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.\nConclusion:\n Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research.","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":"Population Health Research Design","is_remote":true,"remote_url":"https://escholarship.org/uc/item/07t4d7xv","frozenauthors":[{"first_name":"Lisa","middle_name":"","last_name":"Calvocoressi","name_suffix":"","institution":"Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut","department":"None"},{"first_name":"Jesse","middle_name":"","last_name":"Reynolds","name_suffix":"","institution":"Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut","department":"None"},{"first_name":"Benjamin","middle_name":"","last_name":"Johnson","name_suffix":"","institution":"Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut.","department":"None"},{"first_name":"Meghan","middle_name":"M.","last_name":"Warzoha","name_suffix":"","institution":"Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut","department":"None"},{"first_name":"Megan","middle_name":"","last_name":"Carroll","name_suffix":"","institution":"Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"},{"first_name":"Federico","middle_name":"E.","last_name":"Vaca","name_suffix":"","institution":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland","department":"None"},{"first_name":"Lori","middle_name":"","last_name":"Post","name_suffix":"","institution":"Northwestern University, Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"James","middle_name":"","last_name":"Dziura","name_suffix":"","institution":"Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut\n\nYale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut","department":"None"}],"date_submitted":"2019-06-13T20:53:25+01:00","date_accepted":"2019-06-13T20:53:25+01:00","date_published":"2020-02-24T21:43:27Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12830/galley/6759/download/"}]},{"pk":12356,"title":"Public Performance Metrics: Driving Physician  Motivation and Performance","subtitle":null,"abstract":"Introduction:\n As providers transition from “fee-for-service” to “pay-for-performance” models, focus has shifted to improving performance. This trend extends to the emergency department (ED) where visits continue to increase across the United States. Our objective was to determine whether displaying public performance metrics of physician triage data could drive intangible motivators and improve triage performance in the ED.\nMethods: \nThis is a single institution, time-series performance study on a physician-in-triage system. Individual physician baseline metrics—number of patients triaged and dispositioned per shift—were obtained and prominently displayed with identifiable labels during each quarterly physician group meeting. Physicians were informed that metrics would be collected and displayed quarterly and that there would be no bonuses, punishments, or required training; physicians were essentially free to do as they wished. It was made explicit that the goal was to increase the number triaged, and while the number dispositioned would also be displayed, it would not be a focus, thereby acting as this study’s control. At the end of one year, we analyzed metrics.\nResults:\n The group’s average number of patients triaged per shift were as follows: Q1-29.2; Q2-31.9; Q3-34.4; Q4-36.5 (Q1 vs Q4, p < 0.00001). The average numbers of patients dispositioned per shift were Q1-16.4; Q2-17.8; Q3-16.9; Q4-15.3 (Q1 vs Q4, p = 0.14). The top 25% of Q1 performers increased their average numbers triaged from Q1-36.5 to Q4-40.3 (ie, a statistically insignificant increase of 3.8 patients per shift [p = 0.07]). The bottom 25% of Q1 performers, on the other hand, increased their averages from Q1-22.4 to Q4-34.5 (ie, a statistically significant increase of 12.2 patients per shift [p = 0.0013]).\nConclusion:\n Public performance metrics can drive intangible motivators (eg, purpose, mastery, and peer pressure), which can be an effective, low-cost strategy to improve individual performance, achieve institutional goals, and thrive in the pay-for-performance era.","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":"Provider Workforce","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8k70408s","frozenauthors":[{"first_name":"Maxwell","middle_name":"","last_name":"Jen","name_suffix":"","institution":"University of California Irvine","department":"None"},{"first_name":"Vy","middle_name":"","last_name":"Han","name_suffix":"","institution":"University of California Irvine, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Kathryn","middle_name":"","last_name":"Bennett","name_suffix":"","institution":"University of California Irvine, School of Medicine, Irvine, California","department":"None"},{"first_name":"Scott","middle_name":"E.","last_name":"Rudkin","name_suffix":"","institution":"University of California Irvine, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Andrew","middle_name":"C.","last_name":"Wong","name_suffix":"","institution":"University of California Irvine, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Erik","middle_name":"D.","last_name":"Barton","name_suffix":"","institution":"University of California Irvine, Department of Emergency Medicine, Orange, California","department":"None"},{"first_name":"Ronald","middle_name":"","last_name":"Gaubert","name_suffix":"","institution":"University of California Irvine, School of Medicine, Irvine, California","department":"None"}],"date_submitted":"2018-11-29T04:25:21Z","date_accepted":"2018-11-29T04:25:21Z","date_published":"2020-02-24T21:37:41Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12356/galley/6580/download/"}]},{"pk":12782,"title":"Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System","subtitle":null,"abstract":"Introduction:\n Emergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).\nMethods:\n The analysis included data from 2007–2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system.\nResults:\n We found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%).\nConclusion: \nIt is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, sepsis, and trauma diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population.","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":"EMS, triage, ALS, release to BLS"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6vv7h2gj","frozenauthors":[{"first_name":"Joshua","middle_name":"","last_name":"Bucher","name_suffix":"","institution":"Rutgers - Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey;\n\nRWJ Barnabas Mobile Health Services, New Brunswick, New Jersey","department":"None"},{"first_name":"David","middle_name":"","last_name":"Feldman","name_suffix":"","institution":"Morristown Medical Center, Department of Emergency Medicine, Morristown, New Jersey","department":"None"},{"first_name":"Joselyn","middle_name":"","last_name":"Joseph","name_suffix":"","institution":"Newark Beth Israel Medical Center, Department of Emergency Medicine, Newark, New Jersey","department":"None"}],"date_submitted":"2019-05-28T18:53:58+01:00","date_accepted":"2019-05-28T18:53:58+01:00","date_published":"2020-02-24T21:31:21Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12782/galley/6738/download/"}]},{"pk":13293,"title":"Prediction Model for 30-day Outcomes Among Emergency Department Patients with Lower Gastrointestinal Bleeding","subtitle":null,"abstract":"Introduction: \nThere are currently no robust tools available for risk stratification of emergency department (ED) patients with lower gastrointestinal bleed (LGIB). Our aim was to identify risk factors and develop a preliminary model to predict 30-day serious adverse events among ED LGIB patients.\nMethods: \nWe conducted a health records review including adult ED patients with acute LGIB. We used a composite outcome of 30-day all-cause death, recurrent LGIB, need for intervention to control the bleeding, and severe adverse events resulting in intensive care unit admission. One researcher collected data for variables and a second researcher independently collected 10% of the variables for inter-observer reliability. We used backward multivariable logistic regression analysis and SELECTION=SCORE option to create a preliminary risk-stratification tool. We assessed the diagnostic accuracy of the final model.\nResults:\n Of 372 patients, 48 experienced an adverse outcome. We found that age ≥75 years, hemoglobin ≤100 g/L, international normalized ratio ≥2.0, ongoing bleed in the ED, and a medical history of colorectal polyps were statistically significant predictors in the multivariable regression analysis. The area under the curve (AUC) for the model was 0.83 (95% confidence interval, 0.77-0.89). We developed a scoring system based on the logistic regression model and found a sensitivity 0.96 (0.90-1.00) and specificity 0.53 (0.48-0.59) for a cut-off score of 1.\nConclusion:\n This model showed good ability to differentiate patients with and without serious outcomes as evidenced by the high AUC and sensitivity. The results of this study could be used in the prospective derivation of a clinical decision tool.","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":"gastrointestinal bleeding"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9140p9gv","frozenauthors":[{"first_name":"Rosa","middle_name":"","last_name":"Ramaekers","name_suffix":"","institution":"Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario\nUniversity of Ottawa, School of Epidemiology, Epidemiology and Public Health, Ottawa, Ontario\nUniversity of Ottawa, Department of Emergency Medicine, Ottawa, Ontario","department":"None"},{"first_name":"Jeffrey","middle_name":"","last_name":"Perry","name_suffix":"","institution":"Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario\nUniversity of Ottawa, School of Epidemiology, Epidemiology and Public Health, Ottawa, Ontario\nUniversity of Ottawa, Department of Emergency Medicine, Ottawa, Ontario","department":"None"},{"first_name":"Cameron","middle_name":"","last_name":"Leafloor","name_suffix":"","institution":"University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario","department":"None"},{"first_name":"Venkatesh","middle_name":"","last_name":"Thiruganasambandamoorthy","name_suffix":"","institution":"Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario\nUniversity of Ottawa, School of Epidemiology, Epidemiology and Public Health, Ottawa, Ontario\nUniversity of Ottawa, Department of Emergency Medicine, Ottawa, Ontario","department":"None"}],"date_submitted":"2019-10-03T18:22:05+01:00","date_accepted":"2019-10-03T18:22:05+01:00","date_published":"2020-02-24T21:29:17Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13293/galley/6995/download/"}]},{"pk":13268,"title":"Using Tenecteplase for Acute Ischemic Stroke:  What Is the Hold Up?","subtitle":null,"abstract":"Alteplase is the only Food and Drug Administration-approved intravenous (IV) thrombolytic medication for acute ischemic stroke. However, multiple recent studies comparing tenecteplase and alteplase suggest that tenecteplase is at least as efficacious as alteplase with regards to neurologic improvement. When given at 0.25 milligrams per kilogram (mg/kg), tenecteplase may have less bleeding complications than alteplase as well. This narrative review evaluates the literature and addresses the practical issues with regards to the use of tenecteplase versus alteplase for acute ischemic stroke, and it recommends that physicians consider tenecteplase rather than alteplase for thrombolysis of acute ischemic stroke.","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":"thrombolytics, tenecteplase vs alteplase, tpa."}],"section":"Commentary (Limit 2000 words)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4pz126bq","frozenauthors":[{"first_name":"Tony","middle_name":"","last_name":"Zitek","name_suffix":"","institution":"Kendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida\nNova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Department of Emergency Medicine, Fort Lauderdale, Florida","department":"None"},{"first_name":"Ramsey","middle_name":"","last_name":"Ataya","name_suffix":"","institution":"Kendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida","department":"None"},{"first_name":"Isabel","middle_name":"","last_name":"Brea","name_suffix":"","institution":"Kendall Regional Medical Center, Department of Emergency Medicine, Miami, Florida\nNova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Department of Emergency Medicine, Fort Lauderdale, Florida","department":"None"}],"date_submitted":"2019-09-19T18:48:54+01:00","date_accepted":"2019-09-19T18:48:54+01:00","date_published":"2020-02-24T21:24:57Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13268/galley/6987/download/"}]},{"pk":13429,"title":"Applicability of Winthrop Score for the Diagnosis of Influenza A in the Emergency Department of Hospital Pablo Arturo Suárez, January to March of 2018","subtitle":null,"abstract":"Introduction:\n In 2010, the Department of Infectious Diseases at Winthrop University Hospital designed a score system for the diagnosis of Legionella pneumonia. In this study, we applied the score to patients with acute respiratory symptoms suspected of having type A influenza. The identification of patients at medium to high risk of Influenza A allows for early initiation of treatment.\nObjective:\n To study the applicability of the Winthrop score for the diagnosis of Influenza A.\nMethodology:\n A prospective cohort study was performed in 2018 at Hospital Pablo Arturo Suárez, in Quito, Ecuador. Patients 0 to 100 years old presenting to the emergency department with influenza-like illness in January-March of 2018 were included in the study. Winthrop score results were then compared with the result of the reverse transcription polymerase chain reaction (RT-PCR) for influenza A, the gold standard for diagnosis. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were used to establish the diagnostic performance of this point system for influenza A within the sample at large and in subgroup analyses by age (<5 years, 5-65 years, and >65 years) and comorbidities.\nResults:\n 149 patients were enrolled in the study period. The study population included 81 males (54.4%) and the majority of patients were less than 5 years of age (N=85, 57.0%). Furthermore, almost one-third of the patients were less than one year old (N=38, 25.5%). According to the Winthrop point system, 68.5% of the cases had a low probability of having influenza (n = 102), 8.7% of cases had a medium probability (n = 13) and 22.8 % of cases had a high probability (n = 34). The RT-PCR test for influenza was positive for 26.2% of patients (n = 39). The Winthrop point system had a sensitivity of 97.4%, specificity of 91.8%, positive predictive value of 80.8%, negative predictive value of 99.0%, positive likelihood ratio of 11.9, and negative likelihood ratio of 35.8 in the total study population. For children under 5 years, a sensitivity of 100%, specificity of 96.3%, positive predictive value of 77.7%, negative predictive value of 100%, positive likelihood ratio of 27, and negative likelihood ratio of 0. In patients older than 6 years, a sensitivity of 96.9%, specificity of 89%, positive predictive value of 84.21%, negative predictive value of 98%, positive likelihood ratio of 8.8, and negative likelihood ratio of 29.4. Testing in patients over 65 years had a sensitivity of 100%, specificity of 90%, positive predictive value of 87.5%, negative predictive value of 100%, positive likelihood ratio of 10 and negative likelihood ratio of 0. Finally, patients with comorbidities had a sensitivity of 90%, specificity of 88.24%, positive predictive value of 81.82%, negative predictive value of 93.75%, positive likelihood ratio of 7.65, and negative likelihood ratio of 8.82.\nConclusions:\n The Winthrop score performed well in predicting Influenza A in patients with acute respiratory symptoms. This score may be useful in settings were Influenza A PCR testing is unavailable.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Abstracts","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4qz0d1xj","frozenauthors":[{"first_name":"Rafael","middle_name":"S.","last_name":"Montesdeoca","name_suffix":"","institution":"","department":"None"},{"first_name":"Leonardo","middle_name":"Y.","last_name":"Ortiz","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-12-16T23:14:22Z","date_accepted":"2019-12-16T23:14:22Z","date_published":"2020-02-24T21:20:04Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13429/galley/7047/download/"}]},{"pk":13428,"title":"Management of Stroke with Pharmacological Fibrinolysis in an Emergency Department at a Level 2 Hospital in Central Ecuador","subtitle":null,"abstract":"Introduction: \nA timely and organized response in the emergency department is crucial for the treatment of stroke with pharmacological fibrinolysis. Currently, few stroke patients have access to fibrinolytic treatment in Ecuador, as most hospitals lack a well-coordinated stroke response. This remains true at even the highest acuity (level 3) hospitals. In this study we report the initial results of the first code stroke and fibrinolysis pathway established in a level 2 public hospital in a small city (pop 300,000) in Ecuador.\nObjective:\n To develop an organized and coordinated pathway within the hospital for the correct diagnosis and treatment of patients with clinical presentation of stroke, starting with early identification of signs/symptoms and the activation of a specific pathway, which in turn improves the prognosis and the quality of life of acute ischemic stroke patients.\nMethods:\n This was a prospective, longitudinal, descriptive study of patients presenting with stroke symptoms, for whom a code stroke and red triage priority was applied in the emergency department of Hospital General Docente Ambato in the first three months of 2019. To be eligible for thrombolysis, patients had to arrive within 4.5 hours of symptom onset and not have any contraindications to thrombolysis.\nResults:\n 30 patients arrived at the emergency department with stroke symptoms, and in each case a code stroke was activated upon arrival to the emergency department. The mean age of patients was 66.63 years, and 15 patients were male (50%). 19 patients (63%) arrived within 4.5 hours of symptom onset, of which 8 patients (42%) had no contraindication and received thrombolysis. The mean door-to-needle time was 66 minutes.\nConclusions:\n This study demonstrates that it is feasible to establish a code stroke and fibrinolysis treatment pathway in level 2 hospitals in Ecuador. Many other hospitals in the country could establish similar treatment protocols and improve their management of ischemic stroke patients.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Abstracts","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1rw6h1fj","frozenauthors":[{"first_name":"Paulina","middle_name":"L.","last_name":"Teran","name_suffix":"","institution":"Hospital General Docente Ambato, Department of Emergency Medicine, Ambato, Ecuador","department":"None"},{"first_name":"Manuel","middle_name":"J.","last_name":"Vintimilla","name_suffix":"","institution":"Hospital General Docente Ambato, Department of Emergency Medicine, Ambato, Ecuador","department":"None"}],"date_submitted":"2019-12-16T23:03:35Z","date_accepted":"2019-12-16T23:03:35Z","date_published":"2020-02-24T21:14:59Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13428/galley/7046/download/"}]},{"pk":13259,"title":"Federal Funding in Emergency Medicine: Demographics and Perspectives of Awardees","subtitle":null,"abstract":"Introduction:\n Emergency physicians face multiple challenges to obtaining federal funding. The objective of this investigation was to describe the demographics of federally-funded emergency physicians and identify key challenges in obtaining funding.\nMethods:\n We conducted a retrospective database search of the National Institutes of Health (NIH) Research Portfolio Online Reporting Tool (NIH RePORTER) to collect data regarding the distribution and characteristics of federally-funded grants awarded to emergency medicine (EM) principal investigators between 2010-2017.  An electronic survey was then administered to the identified investigators to obtain additional demographic data, and information regarding their career paths, research environment, and perceived barriers to obtaining federal funding.\nResults:\n We identified 219, corresponding to 51 unique, mentored career development awardees and 105 independent investigators. Sixty-two percent of investigators responded to the electronic survey. Awardees were predominantly White males, although a larger portion of the mentored awardee group was female. Greater than half of respondents reported their mentor to be outside of the field of EM. The most common awarding institution was the National Heart Lung and Blood Institute. Respondents identified barriers in finding adequate mentorship, time to gather preliminary data, and the quality of administrative support.\nConclusion:\n The last five years have showed a trend toward increasing grants awarded to EM investigators; however, we identified several barriers to funding. Initiatives geared toward support and mentorship of junior faculty, particularly to females, minorities, and those in less heavily funded areas of the country are warranted.","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":"Mentoring"},{"word":"research"},{"word":"Emergency Medicine"},{"word":"academics"},{"word":"gender"}],"section":"Population Health Research Design","is_remote":true,"remote_url":"https://escholarship.org/uc/item/03g6w86x","frozenauthors":[{"first_name":"Peter","middle_name":"R.","last_name":"Chai","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts\nThe Fenway Institute, Boston, Massachusetts\nMassachusetts Institute of Technology, The Koch Institute for Integrated Cancer Research, Cambridge, Massachusetts","department":"None"},{"first_name":"Stephanie","middle_name":"","last_name":"Carreiro","name_suffix":"","institution":"University of Massachusetts Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, Massachusetts","department":"None"},{"first_name":"Brittany","middle_name":"P.","last_name":"Chapman","name_suffix":"","institution":"University of Massachusetts Medical Center, Department of Emergency Medicine, Division of Medical Toxicology, Worcester, Massachusetts","department":"None"},{"first_name":"Edward","middle_name":"W.","last_name":"Boyer","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts\nHarvard Medical School, Department of Emergency Medicine, Boston, Massachusetts\nThe Fenway Institute, Boston, Massachusetts","department":"None"},{"first_name":"Kelli","middle_name":"N.","last_name":"O'Laughlin","name_suffix":"","institution":"University of Washington, Department of Emergency Medicine, Seattle, Washington\nUniversity of Washington, Department of Global Health, Seattle, Washington","department":"None"}],"date_submitted":"2019-09-20T12:36:53+01:00","date_accepted":"2019-09-20T12:36:53+01:00","date_published":"2020-02-24T21:01:18Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13259/galley/6983/download/"}]},{"pk":12937,"title":"Human Papillomavirus Awareness, Vaccine Status, and Risk Factors in Female Emergency Patients","subtitle":null,"abstract":"Introduction:\n A vaccine targeting high-risk human papillomavirus (HPV) strains can effectively prevent HPV-associated cervical cancer risk. However, many girls and women do not receive the vaccine, more often those impacted by health disparities associated with race and/or socioeconomic status. This same disparate population has also been shown to be at higher risk for cervical cancer. Many of these women also rely on the emergency department (ED) as a safety net for their healthcare. This study sought to gather information pertaining to HPV and cervical cancer risk factors, awareness of HPV and the vaccine, as well as HPV vaccine uptake in female patients presenting to an ED.\nMethods:\n We obtained 81 surveys completed by female ED patients. Demographics included age, race, income, insurance status, primary care provider status, and known cervical-cancer risk factors. Subsequent survey questions explored respondents’ knowledge, familiarity, and attitudes regarding HPV, cervical cancer, and the HPV vaccine, including vaccination uptake rates. We analyzed data using descriptive statistics and Fisher’s exact test.\nResults:\n Approximately one in seven respondents (14.8%) had never previously heard of HPV and 32.1% were unaware of the existence of a HPV vaccine. Minority patients, including those who were Black and Hispanic patients, low income patients, and uninsured and publicly insured patients were less likely to be aware of HPV and the vaccine and likewise were less likely to be offered and receive the vaccine. More than 60% of all respondents (61.3%) had never previously been offered the vaccine, and only 24.7% of all respondents had completed the vaccine series.\nConclusion:\n Female ED patients may represent an at-risk cohort with relatively low HPV awareness and low HPV vaccine uptake. The ED could represent a novel opportunity to access and engage high-risk HPV 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":"human papilloma virus, sexually transmitted infection, emergency medicine"}],"section":"Women's Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1wx6f5th","frozenauthors":[{"first_name":"Lauren","middle_name":"A.","last_name":"Walter","name_suffix":"","institution":"University of Alabama at Birmingham, Department of Emergency Medicine, \nBirmingham, Alabama","department":"None"},{"first_name":"Elizabeth","middle_name":"","last_name":"Leader","name_suffix":"","institution":"University of Alabama at Birmingham, Department of Emergency Medicine, \nBirmingham, Alabama","department":"None"},{"first_name":"James","middle_name":"W.","last_name":"Galbraith","name_suffix":"","institution":"University of Mississippi Medical Center, Department of Emergency Medicine, \nJackson, Mississippi","department":"None"}],"date_submitted":"2019-07-11T16:22:33+01:00","date_accepted":"2019-07-11T16:22:33+01:00","date_published":"2020-02-24T20:54:10Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12937/galley/6793/download/"}]},{"pk":12688,"title":"UNIFIED: Understanding New Information from Emergency Departments Involved in the San Bernardino Terrorist Attack","subtitle":null,"abstract":"Introduction: \nEmergency departments (ED) are on the front line for treating victims of multi-casualty incidents. The primary objective of this study was to gather and detail the common experiences from those hospital-based health professionals directly involved in the response to the San Bernardino terrorism attack on December 2, 2015. Secondary objectives included gathering information on experiences participants found were best practices.\nMethods:\n We undertook a qualitative study using Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines by performing semi-structured interviews with physicians, nurses, and incident management staff from multiple institutions responding to the San Bernardino terrorist attack. We coded transcripts using qualitative analysis techniques and we delineated and agreed upon a refined list with code definitions using a negotiated group process. Final themes were developed and analyzed.\nResults:\n A total of 26 interviews were completed; 1172 excerpts were coded and categorized into 66 initial themes. Six final categories of communication, training, unexpected help, process bypassed, personal impact/emotions, and practical advice resulted.\nConclusion:\n Our study provides context regarding the response of healthcare personnel from multiple institutions to a singular terrorist attack in the United States. It elucidates several themes to help other institutions prepare for similar events. Understanding these common experiences provides opportunity to prepare for future incidents and develop questions to study in future events.","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":"terrorist"},{"word":"Shooting"},{"word":"emergency department"},{"word":"Mass casualty"},{"word":"Gunshot"}],"section":"Disaster Medicine/ Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5rs389gn","frozenauthors":[{"first_name":"Dustin","middle_name":"","last_name":"Smith","name_suffix":"","institution":"Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Elizabeth","middle_name":"L.","last_name":"Walters","name_suffix":"","institution":"Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Ellen","middle_name":"","last_name":"Reibling","name_suffix":"","institution":"Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Darren","middle_name":"","last_name":"Brockie","name_suffix":"","institution":"Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California","department":"None"},{"first_name":"Carol","middle_name":"","last_name":"Lee","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Neeki","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Humberto","middle_name":"","last_name":"Ochoa","name_suffix":"","institution":"Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California","department":"None"},{"first_name":"Travis","middle_name":"","last_name":"Henson","name_suffix":"","institution":"St. Bernardine’s Medical Center, Department of Emergency Medicine, San Bernardino, California","department":"None"},{"first_name":"James","middle_name":"","last_name":"Fisgus","name_suffix":"","institution":"San Antonio Regional Hospital, Department of Emergency Medicine, Upland, California","department":"None"},{"first_name":"Tammi","middle_name":"","last_name":"Thomas","name_suffix":"","institution":"Loma Linda University Health, Department of Emergency Medicine, Loma Linda, California","department":"None"}],"date_submitted":"2019-04-16T21:44:53+01:00","date_accepted":"2019-04-16T21:44:53+01:00","date_published":"2020-02-24T19:52:02Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12688/galley/6705/download/"}]},{"pk":42984,"title":"‘Pando/Pando’ Across the Americas: Transnational Settler Territorialities and Decolonial Pluralities","subtitle":null,"abstract":"In Allison Hedge Coke’s 2015 poem “Pando/Pando,” Pando is, in one instance, the site of a 2008 massacre in Bolivia, in which thirteen Evo Morales supporters, many Indigenous, were killed by a militia backed by a US-supported right-wing opposition. While this support clearly illustrates the longstanding exertion of US influence over Latin American countries, it also moves across related sites of settler territorialities to reaffirm in Bolivia the structures of racialized hierarchization and Indigenous elimination as the very grounds of sociopolitical legitimacy and normativity through which the US controls its own “domestic” political space. This essay wants to show how Hedge Coke’s poem engages with this transnational production of settler territorialities while redefining the linkage between the two sites as a decolonial crossing. For, secondly, “Pando” refers to a giant clonal colony in present-day Utah: a forest-sized tree and the “largest living organism on earth.” The poem links this form of Indigenous growth at a site of colonial violence via “Pando” to Morales and the Indigenous political movement he signifies. As it connects these different forms of Indigenous (political) life through their rootedness within their specific lands, the poem works to disrupt the normativity of any territorial settler claim. Beyond the limited settler state conceptions of politics as a centralized project of hierarchization, “Pando/Pando” envisions instead a multiscalar structure of relationships as the normative principle of sociopolitical formation, in which transnational settler colonial connections are redrawn as decolonial pluralities of Indigenous territorialities and dimensions of political life.","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":"Settler colonialism"},{"word":"Indigenous territoriality in Bolivia"},{"word":"Allison Hedge Coke"},{"word":"Pando/Pando poem"},{"word":"Transnational American Studies"},{"word":"JTAS"}],"section":"SPECIAL FORUM: (Im)Mobilities","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6g60x78r","frozenauthors":[{"first_name":"René","middle_name":"","last_name":"Dietrich","name_suffix":"","institution":"Mainz University","department":"None"}],"date_submitted":"2020-02-17T20:35:48Z","date_accepted":"2020-02-17T20:35:48Z","date_published":"2020-02-24T09:09:27Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jtas/article/42984/galley/32035/download/"}]},{"pk":789,"title":"Ruptured Coronary Sinus of Valsalva in the Setting of a Supracristal Ventricular Septal Defect","subtitle":null,"abstract":"A sinus of Valsalva aneurysm (SOVA) is usually a silent entity until one of its complications arises, such as heart failure. SOVA itself is uncommon, but it is more frequently associated with a supracristal ventricular septal defect (SVSD). We present a 67-year-old man with a history of an asymptomatic SVSD who presented to the emergency department with signs and symptoms of heart failure. He was subsequently found to have a ruptured SOVA and underwent urgent surgical 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":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/84r9p158","frozenauthors":[{"first_name":"Abilio","middle_name":"","last_name":"Arrascaeta-Llanes","name_suffix":"","institution":"Long Island Community Hospital, Department of Emergency Medicine, Patchogue, New York","department":"None"},{"first_name":"Akanksha","middle_name":"","last_name":"Kashyap","name_suffix":"","institution":"Long Island Community Hospital, Department of Emergency Medicine, Patchogue, New York","department":"None"},{"first_name":"Diana","middle_name":"","last_name":"Meyler","name_suffix":"","institution":"Long Island Community Hospital, Department of Emergency Medicine, Patchogue, New York","department":"None"},{"first_name":"Ravi","middle_name":"","last_name":"Gupta","name_suffix":"","institution":"Long Island Community Hospital, Department of Emergency Medicine, Patchogue, New York","department":"None"},{"first_name":"Zubin","middle_name":"","last_name":"Tharayil","name_suffix":"","institution":"Long Island Community Hospital, Department of Emergency Medicine, Patchogue, New York","department":"None"},{"first_name":"Waqas","middle_name":"","last_name":"Khan","name_suffix":"","institution":"Long Island Community Hospital, Department of Cardiology, Patchogue, New York","department":"None"}],"date_submitted":"2020-02-25T00:43:42Z","date_accepted":"2020-02-25T00:43:42Z","date_published":"2020-02-24T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/789/galley/543/download/"}]},{"pk":12569,"title":"Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors","subtitle":null,"abstract":"Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.","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":"Wellness"},{"word":"burnout"},{"word":"physician wellness"},{"word":"Resident Education"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5vc7f6c6","frozenauthors":[{"first_name":"Melissa","middle_name":"","last_name":"Parsons","name_suffix":"","institution":"University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida","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":"Arlene","middle_name":"S.","last_name":"Chung","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Alexandra","middle_name":"","last_name":"Mannix","name_suffix":"","institution":"University of Florida College of Medicine, Department of Emergency Medicine, Jacksonville, Florida","department":"None"},{"first_name":"Nicole","middle_name":"","last_name":"Battaglioli","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Michelle","middle_name":"","last_name":"Clinton","name_suffix":"","institution":"Carilion Clinic, Department of Emergency Medicine, Roanoke, Virginia","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":"2019-03-04T18:34:49Z","date_accepted":"2019-03-04T18:34:49Z","date_published":"2020-02-21T22:38:17Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12569/galley/6662/download/"}]},{"pk":12927,"title":"Emergency Department Clinicians’ Attitudes Toward Opioid Use Disorder and Emergency Department-initiated Buprenorphine Treatment: A Mixed-Methods Study","subtitle":null,"abstract":"Introduction: \nEmergency department (ED) visits related to opioid use disorder (OUD) have increased nearly twofold over the last decade. Treatment with buprenorphine has been demonstrated to decrease opioid-related overdose deaths. In this study, we aimed to better understand ED clinicians’ attitudes toward the initiation of buprenorphine treatment in the ED.\nMethods:\n We performed a mixed-methods study consisting of a survey of 174 ED clinicians (attending physicians, residents, and physician assistants) and semi-structured interviews with 17 attending emergency physicians at a tertiary-care academic hospital.\nResults:\n A total of 93 ED clinicians (53% of those contacted) completed the survey. While 80% of respondents agreed that buprenorphine should be administered in the ED for patients requesting treatment, only 44% felt that they were prepared to discuss medication for addiction treatment. Compared to clinicians with fewer than five years of practice, those with greater experience were less likely to approve of ED-initiated buprenorphine. In our qualitative analysis, physicians had differing perspectives on the role that the ED should play in treating OUD. Most physicians felt that a buprenorphine-based intervention in the ED would be feasible with institutional support, including training opportunities, protocol support within the electronic health record, counseling and support staff, and a robust referral system for outpatient follow-up.\nConclusion: \nED clinicians’ perception of buprenorphine varied by years of practice and training level. Most ED clinicians did not feel prepared to initiate buprenorphine in the ED. Qualitative interviews identified several addressable barriers to ED-initiated buprenorphine.","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":"Opioid use disorder, buprenorphine, medication for addiction treatment, suboxone"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2ww85533","frozenauthors":[{"first_name":"Dana","middle_name":"D.","last_name":"Im","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Anita","middle_name":"","last_name":"Chary","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \n\nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Anna","middle_name":"L.","last_name":"Condella","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \n\nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Hurnan","middle_name":"","last_name":"Vongsachang","name_suffix":"","institution":"University of Southern California, Keck School of Medicine, Department of Emergency Medicine, Los Angeles, California","department":"None"},{"first_name":"Lucas","middle_name":"C.","last_name":"Carlson","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \n\nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Lara","middle_name":"","last_name":"Vogel","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Alister","middle_name":"","last_name":"Martin","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \n\nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Nathan","middle_name":"","last_name":"Kunzler","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts;\nBrigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts \n\nDepartment of Emergency Medicine\nBrigham and Women’s Hospital\n75 Francis Street, NH-2\nBoston, MA 02115, USA","department":"None"},{"first_name":"Scott","middle_name":"G.","last_name":"Weiner","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Margaret","middle_name":"","last_name":"Samuels-Kalow","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2019-07-08T23:43:03+01:00","date_accepted":"2019-07-08T23:43:03+01:00","date_published":"2020-02-21T22:33:45Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12927/galley/6790/download/"}]},{"pk":12709,"title":"Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians","subtitle":null,"abstract":"Introduction: \nWe conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.\nMethods:\n Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4-6 hours.\nResults: \nWe approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.\nConclusion:\n Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints.","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":"intensive care unit"},{"word":"Critical illness"},{"word":"Critical care"},{"word":"physicians"},{"word":"Emergency Medicine"},{"word":"triage"},{"word":"decision making"}],"section":"Health Outcomes","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8072336n","frozenauthors":[{"first_name":"Kusum","middle_name":"S.","last_name":"Mathews","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, New York;\nIcahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Sandra","middle_name":"M.","last_name":"Rodriguez","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Judith","middle_name":"E.","last_name":"Nelson","name_suffix":"","institution":"Memorial Sloan Kettering Cancer Center, Weill Cornell College of Medicine, Departments of Medicine and Anesthesiology and Critical Care, New York, New York","department":"None"},{"first_name":"Lynne","middle_name":"D.","last_name":"Richardson","name_suffix":"","institution":"Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York;\nIcahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York, New York","department":"None"}],"date_submitted":"2019-04-26T19:59:36+01:00","date_accepted":"2019-04-26T19:59:36+01:00","date_published":"2020-02-21T22:14:55Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12709/galley/6713/download/"}]},{"pk":13013,"title":"#MeToo in EM: A Multicenter Survey of Academic Emergency Medicine Faculty on Their Experiences with Gender Discrimination and Sexual Harassment","subtitle":null,"abstract":"Introduction: \nGender-based discrimination and sexual harassment of female physicians are well documented. The #MeToo movement has brought renewed attention to these problems. This study examined academic emergency physicians’ experiences with workplace gender discrimination and sexual harassment.\nMethods:\n We conducted a cross-sectional survey of a convenience sample of emergency medicine (EM) faculty across six programs. Survey items included the following: the Overt Gender Discrimination at Work (OGDW) Scale; the frequency and source of experienced and observed discrimination; and whether subjects had encountered unwanted sexual behaviors by a work superior or colleague in their careers. For the latter question, we asked subjects to characterize the behaviors and whether those experiences had a negative effect on their self-confidence and career advancement. We made group comparisons using t-tests or chi-square analyses, and evaluated relationships between gender and physicians’ experiences using correlation analyses.\nResults:\n A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Women reported higher mean OGDW scores than men (15.4 vs 10.2; 95% confidence interval [CI], 3.6–6.8). Female faculty were also more likely to report having experienced gender-based discriminatory treatment than male faculty (62.7% vs 12.5%; 95% CI, 35.1%-65.4%), although male and female faculty were equally likely to report having observed gender-based discriminatory treatment of another physician (64.7% vs 56.3%; 95% CI, 8.6%-25.5%). The three most frequent sources of experienced or observed gender-based discriminatory treatment were patients, consulting or admitting physicians, and nursing staff. The majority of women reported having encountered unwanted sexual behaviors in their careers, with a significantly greater proportion of women reporting them compared to men (52.9% vs 26.2%, 95% CI, 9.9%-43.4%). The majority of unwanted behaviors were sexist remarks and sexual advances. Of those respondents who encountered these unwanted behaviors, 22.9% and 12.5% reported at least somewhat negative effects on their self-confidence and career advancement.\nConclusion:\n Female EM faculty perceived more gender-based discrimination in their workplaces than their male counterparts. The majority of female and approximately a quarter of male EM faculty encountered unwanted sexual behaviors in their careers.","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":"Sexual Harassment"},{"word":"physicians, women"},{"word":"workplace"}],"section":"Provider Workforce","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3112f0k0","frozenauthors":[{"first_name":"Dave","middle_name":"W.","last_name":"Lu","name_suffix":"","institution":"Tufts University School of Medicine – Maine Medical Center, Department of Emergency Medicine, Portland, Maine;\nUniversity of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Michelle","middle_name":"D.","last_name":"Lall","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Mitzman","name_suffix":"","institution":"The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Sheryl","middle_name":"","last_name":"Heron","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Ava","middle_name":"","last_name":"Pierce","name_suffix":"","institution":"University of Texas Southwestern Medical School, Department of Emergency Medicine, Dallas, Texas","department":"None"},{"first_name":"Nicholas","middle_name":"D.","last_name":"Hartman","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Danielle","middle_name":"M.","last_name":"McCarthy","name_suffix":"","institution":"Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Joshua","middle_name":"","last_name":"Jauregui","name_suffix":"","institution":"University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Tania","middle_name":"D.","last_name":"Strout","name_suffix":"","institution":"Tufts University School of Medicine – Maine Medical Center, Department of Emergency Medicine, Portland, Maine","department":"None"}],"date_submitted":"2019-07-19T18:24:18+01:00","date_accepted":"2019-07-19T18:24:18+01:00","date_published":"2020-02-21T22:09:42Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13013/galley/6818/download/"}]},{"pk":13014,"title":"Prehospital Trauma Scene and Transport Times for Pediatric and Adult Patients","subtitle":null,"abstract":"Introduction:\n Increased out-of-hospital time is associated with worse outcomes in trauma. Sparse literature exists comparing prehospital scene and transport time management intervals between adult and pediatric trauma patients. National Emergency Medical Services guidelines recommend that trauma scene time be less than 10 minutes. The objective of this study was to examine prehospital time intervals in adult and pediatric trauma patients.\nMethods:\n We performed a retrospective cohort study of blunt and penetrating trauma patients in a five-county region in North Carolina using prehospital records. We included patients who were transported emergency traffic directly from the scene by ground ambulance to a Level I or Level II trauma center between 2013-2018. We defined pediatric patients as those less than 16 years old. Urbanicity was controlled for using the Centers for Medicare and Medicaid’s Ambulance Fee Schedule. We performed descriptive statistics and linear mixed-effects regression modeling.\nResults: \nA total of 2179 records met the study criteria, of which 2077 were used in the analysis. Mean scene time was 14.2 minutes (95% confidence interval [CI], 13.9-14.5) and 35.3% (n = 733) of encounters had a scene time of 10 minutes or less. Mean transport time was 17.5 minutes (95% CI, 17.0-17.9). Linear mixed-effects regression revealed that scene times were shorter for pediatric patients (p<0.0001), males (p=0.0016), penetrating injury (p<0.0001), and patients with blunt trauma in rural settings (p=0.005), and that transport times were shorter for males (p = 0.02), non-White patients (p<0.0001), and patients in urban areas (p<0.0001).\nConclusion:\n This study population largely missed the 10-minute scene time goal. Demographic and patient factors were associated with scene and transport times. Shorter scene times occurred with pediatric patients, males, and among those with penetrating trauma. Additionally, suffering blunt trauma while in a rural environment was associated with shorter scene time. Males, non-White patients, and patients in urban environments tended to have shorter transport times. Future studies with outcomes data are needed to identify factors that prolong out-of-hospital time and to assess the impact of out-of-hospital time on patient outcomes.","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":"Prehospital time"},{"word":"emergency medical services (EMS)"},{"word":"Trauma"},{"word":"scene times"},{"word":"transport time"},{"word":"pediatric"},{"word":"Golden Hour"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0161w6sz","frozenauthors":[{"first_name":"Nicklaus","middle_name":"P.","last_name":"Ashburn","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Nella","middle_name":"W.","last_name":"Hendley","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Ryan","middle_name":"M.","last_name":"Angi","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Andrew","middle_name":"B.","last_name":"Starnes","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"R. Darrell","middle_name":"","last_name":"Nelson","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Henderson","middle_name":"D.","last_name":"McGinnis","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"James \"Tripp\"","middle_name":"E.","last_name":"Winslow","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency 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":"Brian","middle_name":"C.","last_name":"Hiestand","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"},{"first_name":"Jason","middle_name":"P.","last_name":"Stopyra","name_suffix":"","institution":"Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina","department":"None"}],"date_submitted":"2019-07-22T06:59:52+01:00","date_accepted":"2019-07-22T06:59:52+01:00","date_published":"2020-02-21T22:04:58Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13014/galley/6819/download/"}]},{"pk":12697,"title":"Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey","subtitle":null,"abstract":"Introduction: \nEmergency departments (ED) in the United States (US) have increasingly taken the central role for the expedited diagnosis and treatment of acute episodic illnesses and exacerbations of chronic diseases, allowing outpatient management to be possible for many conditions that traditionally required hospitalization and inpatient care. The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided.\nMethods: \nWe analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007-2016. Incorporating survey design and weight, we calculated the changes in ED patient characteristics and ED care provided between 2007 and 2016. We also calculated changes in the proportion of visits with low-severity illnesses that may be safely managed at alternative settings. Lastly, we compared ED care received and final ED dispositions by calculating adjusted relative risk (aRR) comparing ED visits in 2007 to 2016, using survey weighted multivariable logistic regression.\nResults:\n NHAMCS included 35,490 visits in 2007 and 19,467 visits in 2016, representing 117 million and 146 million ED visits, respectively. Between 2007 and 2016, there was an increase in the proportion of ED patients aged 45-64 (21.0% to 23.6%) and 65-74 (5.9% to 7.5%), while visits with low-severity illnesses decreased from 37.3% to 30.4%. There was a substantial increase in the proportion of Medicaid patients (22.2% to 34.0%) with corresponding decline in the privately insured (36.2% to 28.3%) and the uninsured (15.4% to 8.6%) patients. After adjusting for patient and visit characteristics, there was an increase in the utilization of advanced imaging (aRR 1.29; 95% confidence interval [CI], 1.17-1.41), blood tests (aRR 1.16; 95% CI, 1.10-1.22), urinalysis (aRR 1.22; 95% CI, 1.13-1.31), and visits where the patient received four or more medications (aRR 2.17; 95% CI, 1.88-2.46). Lastly, adjusted hospitalization rates declined (aRR 0.74; 95% CI, 0.64-0.84) while adjusted discharge rates increased (aRR 1.06; 95%CI 1.03-1.08). \nConclusion:\n From 2007 to 2016, ED care intensity appears to have increased modestly, including aging of patient population, increased illness severity, and increased resources utilization. The role of increased care intensity in the decline of ED hospitalization rate requires further 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":"Emergency Care, Value of Care, Hospitalization"}],"section":"Healthcare Utilization","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7s39425d","frozenauthors":[{"first_name":"Shih-Chuan","middle_name":"","last_name":"Chou","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Olesya","middle_name":"","last_name":"Baker","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Jeremiah","middle_name":"D.","last_name":"Schuur","name_suffix":"","institution":"The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island","department":"None"}],"date_submitted":"2019-04-21T04:10:08+01:00","date_accepted":"2019-04-21T04:10:08+01:00","date_published":"2020-02-21T21:51:05Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12697/galley/6709/download/"}]},{"pk":12834,"title":"Does Orally-Administered Radiocontrast Impair Ultrasound Image Quality in Pediatric Patients?","subtitle":null,"abstract":"Introduction: \nIt is commonly assumed that orally-administered radiocontrast material (ORC) preceding abdominal ultrasound (US) performance can obscure image quality and potentially impair diagnostic accuracy when assessing patients with abdominal pain. Due to this concern, ORC administration per protocol for computed tomography (CT) is often delayed until after US performance, potentially contributing to prolonged length of stay in the emergency department (ED) in patients with concern for abdominal pathology. The objective of this study was to evaluate whether early administration of ORC in children with abdominal pain receiving abdominal CT for possible appendicitis obscures subsequent abdominal US image quality.\nMethods:\n We designed a prospective observational study of children <18 years of age presenting to a pediatric ED with abdominal pain who were set to receive ORC prior to obtaining an abdominal CT. These patients received a point-of-care ultrasound (POCUS) of the abdomen to assess the abdominal aorta and right lower quadrant (RLQ) structures (psoas muscle and iliac vessels) pre- and post- ORC administration. Images were compared independently by two blinded emergency US-certified physician-assessors for quality, specifically to determine whether ORC obscured the anatomical structures in question.\nResults:\n A total of 17 subjects were enrolled, and each subject had two POCUS studies of the abdomen, one pre- and one post-ORC administration looking to visualize the anatomy of the RLQ and abdominal aorta in both studies. Statistical analysis showed no significant differences in mean values of POCUS image quality scoring by two blinded US-trained physician-assessors for either RLQ structures or abdominal aorta when performed pre- and post-administration of ORC.\nConclusion:\n Early ORC administration in children with abdominal pain does not adversely affect image quality of a subsequently performed abdominal US. Patients who may require abdominal CT to determine the etiology of abdominal pain can receive early administration of ORC prior to US performance to help minimize ED length of stay without impairing US diagnostic accuracy.","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":"ultrasound"},{"word":"pediatrics"},{"word":"Contrast Media"}],"section":"Technology in Emergency Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9dz5b95k","frozenauthors":[{"first_name":"Amit","middle_name":"","last_name":"Patel","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Marla","middle_name":"","last_name":"Levine","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Eitan","middle_name":"","last_name":"Dickman","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Lawrence","middle_name":"","last_name":"Haines","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Peter","middle_name":"","last_name":"Homel","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Antonios","middle_name":"","last_name":"Likourezos","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Illya","middle_name":"","last_name":"Pushkar","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Jefferson","middle_name":"","last_name":"Drapkin","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"},{"first_name":"Alexander","middle_name":"","last_name":"Arroyo","name_suffix":"","institution":"Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York","department":"None"}],"date_submitted":"2019-06-14T16:38:51+01:00","date_accepted":"2019-06-14T16:38:51+01:00","date_published":"2020-02-21T21:46:09Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12834/galley/6761/download/"}]},{"pk":12597,"title":"Safety and Efficacy of Hospital Utilization of Tranexamic Acid in Civilian Adult Trauma Resuscitation","subtitle":null,"abstract":"Introduction:\n Patients with trauma-induced coagulopathies may benefit from the use of antifibrinolytic agents, such as tranexamic acid (TXA). This study evaluated the safety and efficacy of TXA in civilian adults hospitalized with traumatic hemorrhagic shock.\nMethods:\n Patients who sustained blunt or penetrating trauma with signs of hemorrhagic shock from June 2014 through July 2018 were considered for TXA treatment. A retrospective control group was formed from patients seen in the same past five years who were not administered TXA and matched based on age, gender, Injury Severity Score (ISS), and mechanism of injury (blunt vs penetrating trauma). The primary outcome of this study was mortality measured at 24 hours, 48 hours, and 28 days. Secondary outcomes included total blood products transfused, hospital length of stay (LOS), intensive care unit LOS, and adverse events. We conducted three pre-specified subgroup analyses to assess outcomes of patients, including (1) those who were severely injured (ISS >15), (2) those who sustained significant blood loss (≥10 units of total blood products transfused), and (3) those who sustained blunt vs penetrating trauma.\nResults:\n Propensity matching yielded two cohorts: the hospital TXA group (n = 280) and a control group (n = 280). The hospital TXA group had statistically lower mortality at 28 days (1.1% vs 5%, odds ratio [OR] [0.21], (95% confidence interval [CI], 0.06, 0.72)) and used fewer units of blood products (median = 4 units, interquartile range (IQR) = [1, 10] vs median=7 units, IQR = [2, 12.5] for the hospital TXA and control groups, respectively, (95% CI for the difference in median, -3 to -1). There were no statistically significant differences between groups with regard to 24-hour mortality (1.1% vs 1.1%, OR = 1, 95% CI, 0.20, 5.00), 48-hour mortality (1.1% vs 1.4%, OR [0.74], 95% CI, 0.17, 3.37), hospital LOS (median= 9 days, IQR = (5, 16) vs median =12 days IQR = (6, 22.5) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-5 to 0)), and incidence of thromboembolic events (eg, deep vein thrombosis, pulmonary embolism) during hospital stay (0.7% vs 0.7% for the hospital TXA and control group, respectively, OR [1], 95% CI, 0.14 to 7.15). We conducted subgroup analyses on patients with ISS>15, patients transfused with ≥10 units of blood products, and blunt vs penetrating trauma. The results indicated lower 28-day mortality for ISS>15 (1.8% vs 7.1%, OR [0.23], 95% CI, 0.06 to 0.81) and blunt trauma  (0.6% vs 6.3%, OR [0.09], 95% CI, 0.01 to 0.75); fewer units of blood products for penetrating trauma (median = 2 units, IQR = (1, 8) vs median = 8 units, IQR = (5, 15) for the hospital TXA and control groups, respectively, 95% CI for the difference in median = (-6 to -3)), and ISS>15 (median = 7 units, IQR = (2, 14) vs median = 8.5 units, IQR = (4, 16) for the hospital TXA and control groups, respectively, 95% CI for the difference in median, -3 to 0).\nConclusion:\n The current study demonstrates a statistically significant reduction in mortality after TXA administration at 28 days, but not at 24 and 48 hours, in patients with traumatic hemorrhagic shock.","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, civilian, adult, hospital"}],"section":"Trauma","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7nd9r2rt","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Neeki","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California;\nCalifornia University of Science and Medicine, Colton, California","department":"None"},{"first_name":"Fanglong","middle_name":"","last_name":"Dong","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Jake","middle_name":"","last_name":"Toy","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Joseph","middle_name":"","last_name":"Salameh","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Massoud","middle_name":"","last_name":"Rabiei","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"Kenji","middle_name":"","last_name":"Inaba","name_suffix":"","institution":"Univeristy of Southern California, Department of Surgery, Los Angeles, California","department":"None"},{"first_name":"Joe","middle_name":"","last_name":"Powell","name_suffix":"","institution":"City of Rialto Fire Department, Rialto, California","department":"None"},{"first_name":"Richard","middle_name":"","last_name":"Vara","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California","department":"None"},{"first_name":"David","middle_name":"","last_name":"Wong","name_suffix":"","institution":"California University of Science and Medicine, Colton, California;\nArrowhead Regional Medical Center, Department of Surgery, Colton, California","department":"None"},{"first_name":"Mark","middle_name":"E.","last_name":"Comunale","name_suffix":"","institution":"California University of Science and Medicine, Colton, California;\n\nArrowhead Regional Medical Center, Department of Anesthesia, Colton, California","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Lowe","name_suffix":"","institution":"California University of Science and Medicine, Colton, California;\n\nArrowhead Regional Medical Center, Department of Pharmacy, Colton, California","department":"None"},{"first_name":"Deepak","middle_name":"","last_name":"Chandwani","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California;\n\nCalifornia University of Science and Medicine, Colton, California","department":"None"},{"first_name":"Juan","middle_name":"","last_name":"Quispe","name_suffix":"","institution":"Loma Linda University Medical Center, Department of General Surgery, Loma Linda, California","department":"None"},{"first_name":"Rodney","middle_name":"","last_name":"Borger","name_suffix":"","institution":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California;\nCalifornia University of Science and Medicine, Colton, California","department":"None"}],"date_submitted":"2019-03-11T21:26:51Z","date_accepted":"2019-03-11T21:26:51Z","date_published":"2020-02-21T21:42:22Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12597/galley/6676/download/"}]},{"pk":12189,"title":"Penalties for Emergency Medical Treatment and Labor Act Violations Involving Obstetrical Emergencies","subtitle":null,"abstract":"Introduction: \nThe Emergency Medical Treatment and Labor Act (EMTALA) was intended to prevent inadequate, delayed, or denied treatment of emergent conditions by emergency departments (ED). While controversies exist regarding the scope of the law, there is no question that EMTALA applies to active labor, a key tenet of the statute and the only medical condition – labor – specifically included in the title of the law. In light of rising maternal mortality rates in the United States, further exploration into the state of emergency obstetrical (OB) care is warranted. Understanding civil monetary penalty settlements levied by the Office of the Inspector General (OIG) related to EMTALA violations involving labor and other OB emergencies will help to inform the current state of access to and quality of OB emergency care.\nMethods:\n We reviewed descriptions of all EMTALA-related OIG civil monetary penalty settlements from 2002-2018. OB-related cases were identified using keywords in settlement descriptions. We described characteristics of settlements including the nature of the allegation and compared them with non-OB settlements.\nResults:\n Of 232 EMTALA-related OIG settlements during the study period, 39 (17%) involved active labor and other OB emergencies. Between 2002 and 2018 the proportion of settlements involving OB emergencies increased from 17% to 40%. Seven (18%) of these settlements involved a pregnant minor. Most OB cases involved failure to provide screening exam (82%) and/or stabilizing treatment (51%). Failure to arrange appropriate transfer was more common for OB  (36%) compared with non-OB settlements (21%) (p = 0.041). Fifteen (38%) involved a provider specifically directing a pregnant woman to proceed to another hospital, typically by private vehicle.\nConclusion:\n Despite inclusion of the term “labor” in the law’s title, one in six settlements related to EMTALA violations involved OB emergencies. One in five settlements involved a pregnant minor, indicating that providers may benefit from education regarding obligations to evaluate and stabilize minors absent parental consent. Failure to arrange appropriate transfer was more common among OB settlements. Findings suggesting need for providers to understand EMTALA-specific requirements for appropriate transfer and for EDs at hospitals without dedicated OB services to implement policies for evaluation of active labor and protocols for transfer when indicated.","language":"English","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":"EMTALA"},{"word":"obstetrical emergency"},{"word":"civil monetary penatly"},{"word":"Patient dumping"}],"section":"Legal Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9rn213dp","frozenauthors":[{"first_name":"Sophie","middle_name":"","last_name":"Terp","name_suffix":"","institution":"Keck School of Medicine, University of Southern California, Los Angeles, California","department":"None"},{"first_name":"Brandon","middle_name":"","last_name":"Wang","name_suffix":"","institution":"New York University School of Medicine, New York, New York","department":"None"},{"first_name":"Elizabeth","middle_name":"","last_name":"Burner","name_suffix":"","institution":"Keck School of Medicine, University of Southern California, Los Angeles, California","department":"None"},{"first_name":"Sanjay","middle_name":"","last_name":"Arora","name_suffix":"","institution":"Keck School of Medicine, University of Southern California, Los Angeles, California","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Menchine","name_suffix":"","institution":"Keck School of Medicine, University of Southern California, Los Angeles, California","department":"None"}],"date_submitted":"2019-05-04T05:57:43+01:00","date_accepted":"2019-05-04T05:57:43+01:00","date_published":"2020-02-21T21:32:02Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12189/galley/6512/download/"}]},{"pk":12679,"title":"A Playroom Internal Waiting Area Improves Productivity in the Pediatric Emergency Department","subtitle":null,"abstract":"Introduction: \nPediatric emergency department (PED) volume is often constrained by the number of available treatment rooms. In many PEDs patients occupy treatment rooms while awaiting test results or imaging, thereby delaying care for patients who arrive after them.\nMethods: \nWe opened a PED where selected patients were moved to a playroom when they did not actively require a treatment room. The treatment room was then available for the next patient. We measured the effect of using the playroom on time from arrival to rooming and length of stay (LOS) using proportional hazards regression and the odds of being roomed within 30 minutes of arrival using logistic regression. We adjusted for the number  of the previous eight patients who were “playroom eligible”; age; triage category; provider; the number of patients who arrived within the preceding hour; prior census; and testing ordered in the preceding eight patients.\nResults:\n We analyzed 43,634 patient encounters, of which 10,134 (23%) were playroom eligible. The adjusted hazards ratio for the next patient being roomed was 1.14 (95% confidence interval [CI], 1.10-1.18) per prior playroom eligible patient. The adjusted odds ratio of the next patient being roomed within 30 minutes was 1.46 (95% CI, 1.33-1.56) per prior playroom eligible patient. The playroom typically decreased median rooming time by four to 42 minutes and LOS by two to 40 minutes depending on patient volumes and acuity. The benefit of the playroom was maximal at busier times.\nConclusion:\n Implementing a playroom in the PED for selected patients generally decreased time to rooming of the next patient and LOS.","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":"Patient flow, Pediatric emergency department"},{"word":"Playroom"},{"word":"Length of Stay"},{"word":"Revenue"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8vj884m3","frozenauthors":[{"first_name":"Paul","middle_name":"","last_name":"Walsh","name_suffix":"","institution":"Sutter Medical Center, Department of Pediatric Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Denno","name_suffix":"","institution":"Sutter Medical Center, Department of Pediatric Emergency Medicine, Sacramento, California","department":"None"}],"date_submitted":"2019-04-14T09:12:33+01:00","date_accepted":"2019-04-14T09:12:33+01:00","date_published":"2020-02-21T20:44:22Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12679/galley/6702/download/"}]},{"pk":13010,"title":"“Breaking” the Emergency Department: Does the Culture of Emergency Medicine Present a Barrier to Self-Care?","subtitle":null,"abstract":"Introduction: \nOur goal was to critically examine emergency physician’s (EP) beliefs about taking breaks for self-care on shift. Our operational definition of a break for self-care included time not engaging in direct patient care, eating, drinking, using the bathroom, or leaving a clinical area for a mental break. Using focus groups, the study aimed to accomplish the following: 1) identify barriers to why residents and faculty at our academic center may not take breaks in the emergency department; 2) generate hypotheses for empirical testing; and 3) generate solutions to include in a departmental breaks initiative.\nMethods:\n We convened eight focus groups comprised separately of resident and faculty physicians. Group discussion was guided by eight questions representing a priori themes. The groups were recorded for transcription and subjected to a “cut-and-sort” process. Six themes were identified by consensus after independent review by three of the co-authors, which were confirmed by participant validation.\nResults:\n We identified six themes that represented the pooled outcomes of both resident and faculty focus groups: 1) Physiological needs affect clinical performance, 2) EPs share beliefs around taking breaks that center on productivity, patient safety and the dichotomy of strength/weakness, 3) when taking breaks EPs fear worst-case scenarios, 4) breaking is a learned skill, 5) culture change is needed to allow EPs to engage in self-care; and 6) a flexible, individualized approach to breaking is necessary. Our central finding was that productivity and patient safety are of key importance to EPs when considering whether to take a break for self-care. We identified a dichotomy with the concept of strength related to productivity/patient safety, and the concept of weakness related to self-care.\nConclusion:\n The current practice culture of emergency medicine and the organization of our unique work environment may present barriers to physicians attempting to engage in self-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":"Self-care in working Emergency Medicine Physicians"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3kp2c57x","frozenauthors":[{"first_name":"James","middle_name":"","last_name":"O'Shea","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Salwar","middle_name":"","last_name":"Vu","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Jeffrey","middle_name":"","last_name":"Siegelman","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Sheryl","middle_name":"","last_name":"Heron","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Michelle","middle_name":"","last_name":"Lall","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"}],"date_submitted":"2019-07-18T22:25:20+01:00","date_accepted":"2019-07-18T22:25:20+01:00","date_published":"2020-02-21T20:38:58Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13010/galley/6817/download/"}]},{"pk":12764,"title":"Innovative Approaches to Emergency Medical Services Fellowship Challenges","subtitle":null,"abstract":"Introduction:\n Since the development of an Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medical services (EMS) fellowship, there has been little published literature on effective methods of content delivery or training modalities. Here we explore a variety of innovative approaches to the development and revision of the EMS fellowship curriculum.\nMethods: \nThree academic, university-based ACGME-accredited EMS fellowship programs each implemented an innovative change to their existing training curricula. These changes included the following: a novel didactic curriculum delivery modality and evaluation; implementation of a distance education program to improve EMS fellows’ rural EMS experiences; and modification of an existing EMS fellowship curriculum to train a non-emergency medicine physician.\nResults: \nChanges made to each of the above EMS fellowship programs addressed unique challenges, demonstrating areas of success and promise for more generalized implementation of these curricula. Obstacles remain in tailoring the described curricula to the needs of each unique institution and system.\nConclusion: \nThree separate curricula and program changes were implemented to overcome specific challenges and achieve educational goals. It is our hope that our shared experiences will enable others in addressing common barriers to teaching the EMS fellowship core content and share similar innovative approaches to educational challenges.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"education, fellowships and scholarships, curriculum, emergency medicine, emergency medical services, disaster medicine, pediatrics"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/29j3r528","frozenauthors":[{"first_name":"Benjamin","middle_name":"W.","last_name":"Weston","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":"None"},{"first_name":"Joshua","middle_name":"","last_name":"Gaither","name_suffix":"","institution":"University of Arizona, College of Medicine, Department of Emergency Medicine, Tucson, Arizona;\nArizona Emergency Medicine Research Center, Tucson, Arizona","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Schulz","name_suffix":"","institution":"Houston Fire Department, Houston, Texas;\nMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, Texas","department":"None"},{"first_name":"Saranya","middle_name":"","last_name":"Srinivasen","name_suffix":"","institution":"Houston Fire Department, Houston, Texas;\nMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, Texas","department":"None"},{"first_name":"Jennifer","middle_name":"J.","last_name":"Smith","name_suffix":"","institution":"University of Arizona, College of Medicine, Department of Emergency Medicine, Tucson, Arizona;\n\nArizona Emergency Medicine Research Center, Tucson, Arizona","department":"None"},{"first_name":"M.","middle_name":"Riccardo","last_name":"Colella","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":"None"}],"date_submitted":"2019-05-21T16:56:10+01:00","date_accepted":"2019-05-21T16:56:10+01:00","date_published":"2020-02-21T20:34:12Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12764/galley/6733/download/"}]},{"pk":12789,"title":"Qualitative Research of Violent Incidents Toward Young Paramedics in the Czech Republic","subtitle":null,"abstract":"Introduction:\n Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual’s urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine.\nMethods:\n We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23–33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences.\nResults: \nOf the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases.\nConclusion:\n We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict.","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":"violence, paramedics, EMS personnel, qualitative research"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8wb6v563","frozenauthors":[{"first_name":"Jiri","middle_name":"","last_name":"Knor","name_suffix":"","institution":"Emergency Medical Services of the Central Bohemian Region, Czech Republic \nMedical College in Prague, Prague, Czech Republic\nPrague Emergency Medical Services, Czech Republic\nCharles University, 3rd Medical Faculty, Prague, Czech Republic","department":"None"},{"first_name":"Jaroslav","middle_name":"","last_name":"Pekara","name_suffix":"","institution":"Medical College in Prague, Prague, Czech Republic\nPrague Emergency Medical Services, Czech Republic","department":"None"},{"first_name":"Jana","middle_name":"","last_name":"Seblova","name_suffix":"","institution":"Emergency Medical Services of the Central Bohemian Region, Czech Republic \nMedical College in Prague, Prague, Czech Republic","department":"None"},{"first_name":"David","middle_name":"","last_name":"Peran","name_suffix":"","institution":"Medical College in Prague, Prague, Czech Republic\nPrague Emergency Medical Services, Czech Republic\nCharles University, 3rd Medical Faculty, Prague, Czech Republic","department":"None"},{"first_name":"Patrik","middle_name":"","last_name":"Cmorej","name_suffix":"","institution":"Emergency Medical Services of the Ústí nad Labem Region, Czech Republic\nJan Evangelista Purkyně University, Division of Health Studies, Ústí nad Labem, Czech Republic","department":"None"},{"first_name":"Jitka","middle_name":"","last_name":"Nemcova","name_suffix":"","institution":"Medical College in Prague, Prague, Czech Republic\nPrague Emergency Medical Services, Czech Republic","department":"None"}],"date_submitted":"2019-05-31T18:10:48+01:00","date_accepted":"2019-05-31T18:10:48+01:00","date_published":"2020-02-21T20:27:46Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12789/galley/6741/download/"}]},{"pk":12868,"title":"Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department","subtitle":null,"abstract":"Introduction:\n Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.\nMethods:\n Research assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0–7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner’s score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate.\nResults:\n About 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47-6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44-20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00-38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39-7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04-14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52-23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11-46.64; p<001).\nConclusion:\n Among patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.","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":"Violence Assessment and Prevention","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4mp4j716","frozenauthors":[{"first_name":"Raul","middle_name":"","last_name":"Caetano","name_suffix":"","institution":"Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, California","department":"None"},{"first_name":"Carol","middle_name":"","last_name":"Cunradi","name_suffix":"","institution":"Pacific Institute for Research and Evaluation, Prevention Research Center, Berkeley, California","department":"None"},{"first_name":"Harrison","middle_name":"","last_name":"Alter","name_suffix":"","institution":"Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California","department":"None"},{"first_name":"Christina","middle_name":"","last_name":"Mair","name_suffix":"","institution":"University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania","department":"None"}],"date_submitted":"2019-06-20T22:48:44+01:00","date_accepted":"2019-06-20T22:48:44+01:00","date_published":"2020-02-21T20:18:29Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12868/galley/6767/download/"}]},{"pk":13412,"title":"Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management","subtitle":null,"abstract":"Scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. There have been outbreaks not only in the developing world, but also in the developed world among refugees and asylum seekers. Once infested with scabies mites, symptomatic patients, as well as asymptomatic carriers, quickly spread the disease through direct skin-to-skin contact. Typically, symptoms of scabies are characterized by an erythematous, papular, pruritic rash associated with burrows. Treatment of scabies involves using topical or systemic scabicides and treating secondary bacterial infections, if present. Given the prevalence and contagiousness of scabies, measures to prevent its spread are essential. Through application of the novel Identify-Isolate-Inform (3I) Tool, emergency medical providers can readily identify risk factors for exposure and important symptoms of the disease, thus limiting its spread through prompt scabicide therapy; isolate the patient until after treatment; and inform local public health authorities and hospital infection prevention, when appropriate. Ultimately, these three actions can aid public health in controlling the transmission of scabies cases, thus ensuring the protection of the general public from this highly contagious skin infestation.","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":"Scabies"},{"word":"Public health"},{"word":"emergency department"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5d5411c1","frozenauthors":[{"first_name":"Tabitha","middle_name":"","last_name":"Cheng","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, La Jolla, California","department":"None"},{"first_name":"Bandr","middle_name":"","last_name":"Mzahim","name_suffix":"","institution":"King Fahad Medical City, Saudi Arabia","department":"None"},{"first_name":"Kristi","middle_name":"L.","last_name":"Koenig","name_suffix":"","institution":"University of California, Irvine, Department of Emergency Medicine, Orange, California;\n\nCounty of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, California","department":"None"},{"first_name":"Abdulrahman","middle_name":"","last_name":"Alsugair","name_suffix":"","institution":"King Fahad Medical City, Saudi Arabia","department":"None"},{"first_name":"Abdussalam","middle_name":"","last_name":"Al-Wabel","name_suffix":"","institution":"King Fahad Medical City, Saudi Arabia","department":"None"},{"first_name":"Bandar","middle_name":"Saad","last_name":"Almutairi","name_suffix":"","institution":"Presidency of State Security, Emergency Consultant, Saudi Arabia","department":"None"},{"first_name":"Eshmawi","middle_name":"","last_name":"Maysa","name_suffix":"","institution":"King Fahad Medical City, Saudi Arabia","department":"None"},{"first_name":"Christopher","middle_name":"A.","last_name":"Kahn","name_suffix":"","institution":"University of California, San Diego, Department of Emergency Medicine, La Jolla, California","department":"None"}],"date_submitted":"2019-12-09T18:01:13Z","date_accepted":"2019-12-09T18:01:13Z","date_published":"2020-02-21T20:11:11Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13412/galley/7043/download/"}]},{"pk":12112,"title":"Screening for QT Prolongation in the Emergency Department: Is There a Better “Rule of Thumb?”","subtitle":null,"abstract":"Introduction:\n Identification of QT prolongation in the emergency department (ED) is critical for appropriate monitoring, disposition, and treatment of patients at risk for torsades de pointes (TdP). Unfortunately, identifying prolonged QT is not straightforward. Computer algorithms are unreliable in identifying prolonged QT. Manual QT-interval assessment methods, including QT correction formulas and the QT nomogram, are time-consuming and are not ideal screening tools in the ED. Many emergency clinicians rely on the “rule of thumb” or “Half the RR” rule (Half-RR) as an initial screening method, but prior studies have shown that the Half-RR rule performs poorly as compared to other QT assessment methods. We sought to characterize the problems associated with the Half-RR rule and find a modified screening tool to more safely assess the QT interval of ED patients for prolonged QT.\nMethods:\n We created graphs comparing the prediction of the Half-RR rule to other common QT assessment methods for a spectrum of QT and heart rate pairs. We then proposed various modifications to the Half-RR rule and assessed these modifications to find an improved “rule of thumb.”\nResults:\n When compared to other methods of QT correction, the Half-RR rule appears to be more conservative at normal and elevated heart rates, making it a safe initial screening tool. However, in bradycardia, the Half-RR rule is not sufficiently sensitive in identifying prolonged QT. Adding a fixed QT cutoff of 485 milliseconds (ms) increases the sensitivity of the rule in bradycardia, creating a safer initial screening tool.\nConclusion: \nFor a rapid and more sensitive screening evaluation of the QT interval on electrocardiograms in the ED, we propose combining use of the Half-RR rule at normal and elevated heart rates with a fixed uncorrected QT cutoff of 485 ms in bradycardia.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"ECG Interpretation"},{"word":"QT interval"},{"word":"QT prolongation"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9kf4j4wv","frozenauthors":[{"first_name":"Megan","middle_name":"L.","last_name":"Rischall","name_suffix":"","institution":"Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Stephen","middle_name":"W.","last_name":"Smith","name_suffix":"","institution":"Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota","department":"None"},{"first_name":"Ari","middle_name":"B.","last_name":"Friedman","name_suffix":"","institution":"University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"}],"date_submitted":"2018-08-22T22:43:49+01:00","date_accepted":"2018-08-22T22:43:49+01:00","date_published":"2020-02-21T20:07:42Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12112/galley/6488/download/"}]},{"pk":12540,"title":"Tree of Life Synagogue Shooting in Pittsburgh: Preparedness, Prehospital Care, and Lessons Learned","subtitle":null,"abstract":"On Saturday, October 27, 2018, a man with anti-Semitic motivations entered Tree of Life synagogue in the Squirrel Hill section of Pittsburgh, Pennsylvania; he had an AR-15 semi-automatic rifle and three handguns, opening fire upon worshippers. Eventually 11 civilians died at the scene and eight people sustained non-fatal injuries, including five police officers. Each person injured but alive at the scene received care at one of three local level-one trauma centers.  The injured had wounds often seen in war-settings, with the signature of high velocity weaponry.  We describe the scene response, specific elements of our hospital plans, the overall out-of-hospital preparedness in Pittsburgh, and the lessons learned.","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":"Tree of Life, Mass Shooting"}],"section":"Disaster Medicine/ Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4j57536g","frozenauthors":[{"first_name":"Adam","middle_name":"Z.","last_name":"Tobias","name_suffix":"","institution":"University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":"None"},{"first_name":"Ronald","middle_name":"N.","last_name":"Roth","name_suffix":"","institution":"University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":"None"},{"first_name":"Leonard","middle_name":"S.","last_name":"Weiss","name_suffix":"","institution":"University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":"None"},{"first_name":"Keith","middle_name":"","last_name":"Murray","name_suffix":"","institution":"Allegheny Health Network, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":"None"},{"first_name":"Donald","middle_name":"M.","last_name":"Yealy","name_suffix":"","institution":"University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":"None"}],"date_submitted":"2019-02-21T18:35:29Z","date_accepted":"2019-02-21T18:35:29Z","date_published":"2020-02-21T19:51:55Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12540/galley/6650/download/"}]},{"pk":2228,"title":"Creating Books for Use in Language Revitalization Classrooms: Considerations and Outcomes","subtitle":null,"abstract":"In this paper, I examine the development, implementation, and results of utilizing three types of storybooks in a language revitalization classroom for students ages 5-12 learning Teotitlán del Valle Zapotec, an indigenous language of southern Mexico. Although each method used for creating books in Zapotec generated a positive reaction from students and parents, I consider the ways in which each method facilitates student learning while also problematizing the cultural authenticity of the classroom. Based on classroom observations, a parent focus group, and student interviews, I conclude that the most effective method for storybook creation involved students creating their own book modeled on a pre-existing book written in the non-indigenous language. This student-created book generated sustained interest in the language and allowed for students to shape the materials into something that was culturally relevant for them personally.","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.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\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-nc-nd/4.0"},"keywords":[{"word":"Language Revitalization"},{"word":"Indigenous Languages"},{"word":"second language teaching"},{"word":"Heritage Language Teaching"},{"word":"language ideology"},{"word":"Language Attitudes"}],"section":"Teachers' Forum","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4hx2s59c","frozenauthors":[{"first_name":"Julia","middle_name":"","last_name":"Nee","name_suffix":"","institution":"UC Berkeley","department":"None"}],"date_submitted":"2019-02-24T03:09:47Z","date_accepted":"2019-02-24T03:09:47Z","date_published":"2020-02-20T21:26:15Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/l2/article/2228/galley/1423/download/"}]},{"pk":39525,"title":"Review: Solar Power innovation, sustainability, and environmental justice","subtitle":null,"abstract":"review","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":"Solar power, policy, photovoltaics, review"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6t005058","frozenauthors":[{"first_name":"Dawn","middle_name":"","last_name":"Lowe-Wincentsen","name_suffix":"","institution":"Oregon Institute of Technology","department":"None"}],"date_submitted":"2019-07-18T20:18:45+01:00","date_accepted":"2019-07-18T20:18:45+01:00","date_published":"2020-02-18T04:19:58Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39525/galley/29835/download/"}]},{"pk":39524,"title":"Review:  Climate Justice: Hope, Resilience, and the Fight for a Sustainable Future","subtitle":null,"abstract":"Book review for Climate Justice: Hope, Resilience, and the Fight for a Sustainable Future","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6jn8n9gb","frozenauthors":[{"first_name":"Blair","middle_name":"","last_name":"Vallie","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-07-05T21:17:31+01:00","date_accepted":"2019-07-05T21:17:31+01:00","date_published":"2020-02-18T04:10:06Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39524/galley/29834/download/"}]},{"pk":39530,"title":"Review: Critical Care : Architecture and Urbanism for a Broken Planet","subtitle":null,"abstract":"Today, architecture and urbanism are capital-centric, speculation-driven, and investment-dominated. Many cannot afford housing. Austerity measures have taken a disastrous toll on public infrastructures. The climate crisis has rendered the planet vulnerable, even uninhabitable. This book offers an alternative vision in architecture and urbanism that focuses on caring for a broken planet. Rooted in a radical care perspective that always starts from the given, in the midst of things, this edited collection of essays and illustrated case studies documents ideas and practices from an extraordinarily diverse group of contributors.Focusing on the three crisis areas of economy, ecology, and labor, the book describes projects including village reconstruction in China; irrigation in Spain; community land trust in Puerto Rico; revitalization of modernist public housing in France; new alliances in informal settlements in Nairobi; and the redevelopment of traditional building methods in flood areas in Pakistan. Essays consider such topics as ethical architecture, land policy, creative ecologies, diverse economies, caring communities, and the exploitation of labor. Taken together, these case studies and essays provide evidence that architecture and urbanism have the capacity to make the planet livable, again.","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7s77w00r","frozenauthors":[{"first_name":"Kenneth","middle_name":"","last_name":"Rankins","name_suffix":"","institution":"Other","department":"None"}],"date_submitted":"2019-09-21T04:33:54+01:00","date_accepted":"2019-09-21T04:33:54+01:00","date_published":"2020-02-18T04:05:33Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39530/galley/29839/download/"}]},{"pk":39539,"title":"Review: Le Saint-Laurent d'île en île. Rencontres et paysages (The St. Lawrence from Island to Island: Meetings and Landscapes)","subtitle":null,"abstract":"Book review of \nLe Saint-Laurent d'île en île. Rencontres et paysages","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5s68k935","frozenauthors":[{"first_name":"Yves","middle_name":"","last_name":"Laberge","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-01-13T21:03:50Z","date_accepted":"2020-01-13T21:03:50Z","date_published":"2020-02-18T01:16:22Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39539/galley/29846/download/"}]},{"pk":39540,"title":"Review: Plastic Soup: An Atlas of Ocean Pollution","subtitle":null,"abstract":"Book review for \nPlastic Soup: An Atlas of Ocean Pollution.","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2nh6d678","frozenauthors":[{"first_name":"Yves","middle_name":"","last_name":"Laberge","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-01-15T19:28:24Z","date_accepted":"2020-01-15T19:28:24Z","date_published":"2020-02-18T00:53:12Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39540/galley/29847/download/"}]},{"pk":39541,"title":"Review: Food Loss and Food Waste: Causes and Solutions","subtitle":null,"abstract":"Book review for \nFood Loss and Food Waste: Causes and Solutions.","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1q64631q","frozenauthors":[{"first_name":"Yves","middle_name":"","last_name":"Laberge","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-01-20T21:31:35Z","date_accepted":"2020-01-20T21:31:35Z","date_published":"2020-02-18T00:40:25Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39541/galley/29848/download/"}]},{"pk":39542,"title":"Review: Éduquer par la Philosophie et le Conte au Développement Durable: 12 Ateliers Pédagogiques (Education through philosophy and tale for Sustainability development: 12 pedagogical workshops)","subtitle":null,"abstract":"Book review of \nÉduquer par la Philosophie et le Conte au Développement Durable: 12 Ateliers Pédagogiques.","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6wm7f42m","frozenauthors":[{"first_name":"Yves","middle_name":"","last_name":"Laberge","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2020-01-21T19:10:38Z","date_accepted":"2020-01-21T19:10:38Z","date_published":"2020-02-18T00:35:53Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39542/galley/29849/download/"}]},{"pk":39528,"title":"Review: Wilted: Pathogens, Chemicals, and the Fragile Future of the Strawberry Industry.","subtitle":null,"abstract":"Book review","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":"Strawberry"},{"word":"Wilted"},{"word":"Fumigation, California"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/79b843ts","frozenauthors":[{"first_name":"Jan","middle_name":"","last_name":"Kunnas","name_suffix":"","institution":"Independent researcher/consultant Jyväskylä, Finland","department":"None"}],"date_submitted":"2019-09-12T10:22:05+01:00","date_accepted":"2019-09-12T10:22:05+01:00","date_published":"2020-02-17T20:16:40Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39528/galley/29838/download/"}]},{"pk":39521,"title":"A Qualitative Case Study of Green Environment: Practices, Attitudes and Future Strategies of Pakistani University Librarians","subtitle":null,"abstract":"Scope:\n This paper attempts to explicate sustainable practices’ status in university libraries with specific reference to Pakistan. This idea enunciates the potential of university libraries to address the environmental issues through work operations as a social responsibility.\n \nDesign/methodology/approach: \nThis case study utilized multiple methods for mapping data from different sources, such as face-to-face in-person 27 interviews, observation (participants and the sites), pictures, document review and field notes to explore the existing status of sustainable practices of librarians. Furthermore, a cross case analysis was done to validate the findings.\n \nFindings:\n Status of green work practices is unsatisfactory. Majority of librarians are not familiar, have a limited or different understanding of going green. Consequently, green work practices are highly uneven in absence of framed guidelines.\n \nPractical Implications:\n Overall, there is a dearth of LIS literature in the domain of going green. The current research based on the belief that every small individual green action counts on protecting planet earth across nation and across globe.\n \nOriginality/Value:\n This case study is to stimulate a conversation on environmental education and promotion among library professionals. Additionally, the study will also place local librarianship into the latest perspective of “green literature” and increase the value and significance of local librarians’ green efforts in the global context.","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":"sustainable practices"},{"word":"Green work practices"},{"word":"Green Library Movement"},{"word":"climate change"},{"word":"Reduce, Reuse, Recycle"},{"word":"University libraries"},{"word":"pakistan"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9gc3s8h6","frozenauthors":[{"first_name":"Ayesha","middle_name":"","last_name":"Khalid","name_suffix":"","institution":"University of the Punjab,Lahore","department":"None"},{"first_name":"Syeda","middle_name":"Hina","last_name":"Batool","name_suffix":"","institution":"Dr Syeda Hina Batool\nAssistant Professor, Dept, of Information Management, University of the Punjab, Lahore","department":"None"}],"date_submitted":"2019-05-11T09:18:05+01:00","date_accepted":"2019-05-11T09:18:05+01:00","date_published":"2020-02-17T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39521/galley/29831/download/"}]},{"pk":39535,"title":"Review: Sea Level Rise: A Slow Tsunami on America’s Shores","subtitle":null,"abstract":"Book Review","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":"climate change"},{"word":"Sea level rise--impacts"}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8zn830v8","frozenauthors":[{"first_name":"Theresa","middle_name":"M","last_name":"Calcagno","name_suffix":"","institution":"George Mason University","department":"None"}],"date_submitted":"2019-10-31T00:39:17Z","date_accepted":"2019-10-31T00:39:17Z","date_published":"2020-02-14T18:53:30Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39535/galley/29843/download/"}]},{"pk":39532,"title":"Review: Flint Fights Back: Environmental Justice and Democracy in the Flint Water Crisis","subtitle":null,"abstract":"Book Review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1263t4cq","frozenauthors":[{"first_name":"Ellen","middle_name":"","last_name":"Ahlness","name_suffix":"","institution":"University of Washington","department":"None"}],"date_submitted":"2019-10-11T17:28:56+01:00","date_accepted":"2019-10-11T17:28:56+01:00","date_published":"2020-02-14T18:36:53Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39532/galley/29840/download/"}]},{"pk":39526,"title":"Review: Water Rites: Reimagining Water in the West","subtitle":null,"abstract":"Review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8xx3q217","frozenauthors":[{"first_name":"Ellen","middle_name":"","last_name":"Ahlness","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-08-16T19:25:09+01:00","date_accepted":"2019-08-16T19:25:09+01:00","date_published":"2020-02-14T18:24:27Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39526/galley/29836/download/"}]},{"pk":39523,"title":"Review:  Living with Oil & Coal: Resource Politics & Militarization in Northeast India","subtitle":null,"abstract":"Book review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0bm5z61g","frozenauthors":[{"first_name":"CJ","middle_name":"","last_name":"Appleton","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-07-05T20:03:31+01:00","date_accepted":"2019-07-05T20:03:31+01:00","date_published":"2020-02-14T18:10:41Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39523/galley/29833/download/"}]},{"pk":39527,"title":"Review: Ocean Recovery: A Sustainable Future for Global Fisheries?","subtitle":null,"abstract":"Review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0xp2h7sg","frozenauthors":[{"first_name":"Byron","middle_name":"P.","last_name":"Anderson","name_suffix":"","institution":"Retired/Northern Illinois University","department":"None"}],"date_submitted":"2019-09-11T19:26:56+01:00","date_accepted":"2019-09-11T19:26:56+01:00","date_published":"2020-02-14T00:23:28Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39527/galley/29837/download/"}]},{"pk":39538,"title":"Review:  Green Growth That Works: Natural Capital Policy and Finance Mechanisms Around the World","subtitle":null,"abstract":"Book Review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/85j400cg","frozenauthors":[{"first_name":"Byron","middle_name":"P.","last_name":"Anderson","name_suffix":"","institution":"Retired/Northern Illinois University","department":"None"}],"date_submitted":"2019-12-22T17:37:50Z","date_accepted":"2019-12-22T17:37:50Z","date_published":"2020-02-14T00:10:28Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39538/galley/29845/download/"}]},{"pk":39522,"title":"Review: Renewable Energy; A Primer for the Twenty-First Century","subtitle":null,"abstract":"Book review","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":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4pp170d3","frozenauthors":[{"first_name":"Byron","middle_name":"P.","last_name":"Anderson","name_suffix":"","institution":"Retired/Northern Illinois University","department":"None"}],"date_submitted":"2019-06-23T22:38:31+01:00","date_accepted":"2019-06-23T22:38:31+01:00","date_published":"2020-02-14T00:06:09Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39522/galley/29832/download/"}]},{"pk":39520,"title":"Development and validation of the Just Community Gardening Survey: A measure of the social and dietary outcomes of community garden participation","subtitle":null,"abstract":"Our aim was to develop and validate a survey measuring outcomes of community gardening related to food system equity. Face validity was assessed by six community gardening experts and resulted in minor changes to the survey. Weighted kappa and Cronbach’s alpha were used to determine test-retest reliability and internal consistency using a sample of community gardeners in New York City (n=38). Weighted kappa analyses revealed almost perfect agreement (mean = 0.981, range 0.498-1, p≤.001). Cronbach’s alpha was calculated for eight scales, most of which had excellent agreement. The resulting 25-item Just Community Gardening Survey consisted of demographic, garden participation, garden activities, social participation, social cohesion, collective efficacy, perceived impact on dietary intake, food access and security, horticultural and environmental knowledge and diet-related health questions. This validated survey not only measures the social and dietary outcomes of community gardening, it incorporates important aspects of food justice not assessed in previous research.","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":"community gardening"},{"word":"food justice"},{"word":"food access"},{"word":"social cohesion"},{"word":"dietary health"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8v54p6r3","frozenauthors":[{"first_name":"Kate","middle_name":"G.","last_name":"Burt","name_suffix":"","institution":"Lehman College, City University of New York","department":"None"},{"first_name":"Kathleen","middle_name":"","last_name":"Delgado","name_suffix":"","institution":"Hostos Community College, City University of New York","department":"None"}],"date_submitted":"2019-05-09T19:21:41+01:00","date_accepted":"2019-05-09T19:21:41+01:00","date_published":"2020-02-13T22:08:39Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/egj/article/39520/galley/29830/download/"}]},{"pk":5534,"title":"Personality and Affiliation in a Cooperative Task for Bottlenose Dolphin (Tursiops truncatus) Dyads","subtitle":null,"abstract":"Social species can depend on each other for survival, helping in rearing of young, predator defense, and foraging. Personality dynamics between individuals may influence cooperative behaviors. Bottlenose dolphins (\nTursiops truncatus\n) live in social communities and cooperate with other conspecifics to achieve goals both in the wild and in human care. We investigated the role that personality plays in the willingness of dolphins to work together. We tested five bottlenose dolphin pairs at the Roatan Institute for Marine Sciences, Honduras, with an apparatus previously used to experimentally test dolphin cooperation. Personality profiles of each dolphin were created using surveys completed by the caretakers, in particular noting two different categories of interactions: dolphin to dolphin and dolphin to world. We hypothesized that dyadic success in the cooperative task would differ based on specific personality traits of individuals. We also hypothesized that the most successful dyads would show similar types of conspecific sociality and different means of interacting with objects. Although none of the dolphin pairs cooperated to open the apparatus, individual personalities were analyzed in relation to the dolphins’ individual and mutual interactions with the apparatus as well as the pairs’ social behaviors. Playfulness, curiosity, and affiliation as well as agreeableness, and extraversion were positively related to affiliation with the apparatus and each other. These findings suggest that certain aspects of personality are indicative of affiliation or interaction by an individual dolphin. These results could guide future animal research on the relationship between personality, social interactions, and problem-solving.","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":"Dolphins, Tursiops truncatus, cooperation, problem-solving, personality, affiliative behavior"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5n43p6d7","frozenauthors":[{"first_name":"Kimberly","middle_name":"Corinne","last_name":"Bagley","name_suffix":"","institution":"The University of Tennessee at Chattanooga","department":"None"},{"first_name":"Kelley","middle_name":"","last_name":"Winship","name_suffix":"","institution":"Dolphins Plus Marine Mammal Responder\nThe University of Miami","department":"None"},{"first_name":"Teri","middle_name":"","last_name":"Bolton","name_suffix":"","institution":"The Roatan Institute for Marine Sciences","department":"None"},{"first_name":"Preston","middle_name":"","last_name":"Foerder","name_suffix":"","institution":"The University of Tennessee at Chattanooga","department":"None"}],"date_submitted":"2019-04-29T16:31:30+01:00","date_accepted":"2019-04-29T16:31:30+01:00","date_published":"2020-02-11T21:55:34Z","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5534/galley/3350/download/"}]},{"pk":5538,"title":"Comparisons of Animal “Smarts” Using the First Four Stages of the Model of Hierarchical Complexity","subtitle":null,"abstract":"The Model of Hierarchical Complexity is a behavioral model of development and evolution of the complexity of behavior. It is based on task analysis. Tasks are ordered in terms of their hierarchical complexity, which is an ordinal scale that measures difficulty. The hierarchical difficulty of tasks is categorized as the \norder of hierarchical complexity\n. Successful performance on a task is called the \nbehavioral stage\n. This model can be applied to non-human animals, and humans. Using data from some of the simplest animals and also somewhat more complex ones, this analysis describes the four lowest behavioral stages and illustrate them using the behaviors of a range of simple organisms. For example, \nStage 1\n tasks, and performance on them, are addressed with automatic unconditioned responses. Behavior at this Stage includes sensing, tropisms, habituation and, other automatic behaviors. Single cell organisms operate at this Stage. \nStage 2\n tasks include these earlier behaviors, but also include respondent conditioning but not operant conditioning. Animals such as some simple invertebrates have shown respondent conditioning, but not operant conditioning. \nStage 3\n tasks coordinate three instances of these earlier tasks to make possible operant conditioning. These stage 3 performances are similar to those of some invertebrates and also insects. \nStage 4\n tasks organisms coordinate 2 or more circular sensory-motor task actions into a superordinate “concept”. This explanation of the early stages of the Model of Hierarchical Complexity may help future research in animal behavior, and comparative psychology.","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":"Model of Hierarchical Complexity, Animal Stages, Classical Conditioning, Respondent Conditioning, Operant Conditioning, Behavior Psychology, Evolutionary Psychology, Development Psychology, Comparat.."}],"section":"SI: ISCP bienniel meeting (2018)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7mm2m1nn","frozenauthors":[{"first_name":"Mansi","middle_name":"J","last_name":"Shah","name_suffix":"","institution":"Dare Institute","department":"None"},{"first_name":"Michael","middle_name":"L","last_name":"Commons","name_suffix":"","institution":"Harvard Medical 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