{"count":39502,"next":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=15300","previous":"https://eartharxiv.org/api/articles/?format=json&limit=100&offset=15100","results":[{"pk":44741,"title":"A Pediatric Patient with Cri du Chat Syndrome and Its Anesthetic Considerations","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/0kx9z5pj","frozenauthors":[{"first_name":"Christina","middle_name":"","last_name":"Ma","name_suffix":"MS4","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Fei","middle_name":"","last_name":"Zheng-Ward","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Elizabeth","middle_name":"","last_name":"Tsai","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T15:06:50-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44741/galley/33534/download/"}]},{"pk":44740,"title":"Lemierre Syndrome: A Rare, Potentially Fatal Complication of Acute Pharyngitis","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/00b517mf","frozenauthors":[{"first_name":"Sarah","middle_name":"","last_name":"Goldgar","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T15:04:00-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44740/galley/33533/download/"}]},{"pk":44739,"title":"Acute Bilateral Pyelonephritis","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/584128z0","frozenauthors":[{"first_name":"Megana","middle_name":"","last_name":"Ballal","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Linda","middle_name":"","last_name":"Czypinkski","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T15:01:34-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44739/galley/33532/download/"}]},{"pk":44738,"title":"Postural Orthostatic Tachycardia Syndrome in a Young Female","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/410784k7","frozenauthors":[{"first_name":"Noah","middle_name":"","last_name":"Kojima","name_suffix":"","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Daniel","middle_name":"G.","last_name":"Kahn","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T14:58:02-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44738/galley/33531/download/"}]},{"pk":44737,"title":"PFAPA (Periodic Fever, Aphthous Ulcer, Pharyngitis and Adenopathies) Syndrome: A Case of Periodic Fever","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/0w50v3kk","frozenauthors":[{"first_name":"Sarah","middle_name":"","last_name":"Alsarray","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Mustafa","middle_name":"","last_name":"Albustani","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Ahmed","middle_name":"","last_name":"Alsarray","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T14:55:22-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44737/galley/33530/download/"}]},{"pk":44736,"title":"New-Onset Diabetes in a 90-Year-Old Male: A Diagnostic Dilemma","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/2vp98703","frozenauthors":[{"first_name":"Deepashree","middle_name":"","last_name":"Gupta","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Gabriela","middle_name":"","last_name":"Sauder","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T14:53:20-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44736/galley/33529/download/"}]},{"pk":44735,"title":"A Small Sterile Vegetation Noted in a Recovering Critically Ill Patient with Hypercoagulability","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/43j7671p","frozenauthors":[{"first_name":"Adam","middle_name":"","last_name":"Solis-Cohen","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Patrick","middle_name":"","last_name":"Bui","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Amir","middle_name":"","last_name":"Rabbani","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2019-08-09T14:51:13-03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/44735/galley/33528/download/"}]},{"pk":12427,"title":"Three Airway Management Techniques for Airway Decontamination in Massive Emesis: A Manikin Study","subtitle":null,"abstract":"Introduction:\n Emesis occurs during airway management and results in pulmonary aspiration at rates of 0.01% – 0.11% in fasted patients undergoing general anesthesia and 0% - 22% in non-fasted emergency department patients. Suction-assisted laryngoscopy and airway decontamination (SALAD) involves maneuvering a suction catheter into the hypopharynx, while performing laryngoscopy and endotracheal intubation. Intentional esophageal intubation (IEI) involves blindly intubating the esophagus to control emesis before endotracheal intubation.  Both are previously described techniques for endotracheal intubation in the setting of massive emesis. This study compares the SALAD and IEI techniques with the traditional approach of ad hoc, rigid suction catheter airway decontamination and endotracheal intubation in the setting of massive simulated emesis.\nMethods:\n Senior anesthesiology and emergency medicine (EM) residents were randomized into three trial arms: the traditional, IEI, or SALAD. Each resident watched an instructional video on the assigned technique, performed the technique on a manikin, and completed the trial simulation with the SALAD simulation manikin. The primary trial outcome was aspirate volume collected in the manikin’s lower airway.  Secondary outcomes included successful intubation, intubation attempts, and time to successful intubation. We also collected pre- and post-simulation demographics and confidence questionnaire data.\nResults:\n Thirty-one residents (21 anesthesiology and 10 EM residents) were randomized. Baseline group characteristics were similar. The mean aspirate volumes collected in the lower airway (standard deviation [SD]) in the traditional, IEI, and SALAD arms were 72 (45) milliliters per liter (mL), 100 (45) mL, and 83 (42) mL, respectively (p = 0.392). Intubation success was 100% in all groups. Times (SD) to successful intubation in the traditional, IEI, and SALAD groups were 1.69 (1.31) minutes, 1.74 (1.09) minutes, and 1.74 (0.93) minutes, respectively (p = 0.805).  Overall, residents reported increased confidence (1.0 [0.0-1.0]; P = 0.002) and skill (1.0 [0.0-1.0]; P < 0.001) in airway management after completion of the study.\nConclusion: \nThe intubation techniques provided similar performance results in our study, suggesting any one of the three can be employed in the setting of massive emesis; although this conclusion deserves further study. Residents reported increased confidence and skill in airway management following the experience, suggesting use of the manikin provides a learning impact.","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":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5qf2g8nm","frozenauthors":[{"first_name":"Michael","middle_name":"P.","last_name":"Fiore","name_suffix":"","institution":"Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois","department":"None"},{"first_name":"Steven","middle_name":"L.","last_name":"Marmer","name_suffix":"","institution":"Des Moines University, College of Osteopathic Medicine, Des Moines, Iowa","department":"None"},{"first_name":"Michael","middle_name":"T.","last_name":"Steuerwald","name_suffix":"","institution":"University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin","department":"None"},{"first_name":"Ryan","middle_name":"J.","last_name":"Thompson","name_suffix":"","institution":"University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin","department":"None"},{"first_name":"Richard","middle_name":"E.","last_name":"Galgon","name_suffix":"","institution":"University of Wisconsin School of Medicine and Public Health, Department of Anesthesiology, Madison, Wisconsin","department":"None"}],"date_submitted":"2019-01-08T20:49:11-02:00","date_accepted":"2019-01-08T20:49:11-02:00","date_published":"2019-08-06T17:29:34-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12427/galley/6603/download/"}]},{"pk":12543,"title":"Clinical Features and Outcomes Associated with Angioedema in the Emergency Department","subtitle":null,"abstract":"Introduction:\n Angioedema represents self-limited, localized swelling of submucosal or subcutaneous tissues. While the underlying etiology may be undeterminable in the emergent setting, nonhistaminergic and histaminergic angioedema respond differently to therapeutic interventions, with implications for empiric treatment. Clinical features and outcome differences among nonhistaminergic vs histaminergic angioedema patients in the emergency department (ED) are poorly characterized. We aim to describe the clinical characteristics and outcomes among ED patients with angioedema by suspected etiology.\nMethods:\n This was a 10-year retrospective study of adult ED patients with angioedema, using data abstracted from the electronic health record. We evaluated univariable associations of select clinical features with etiology and used them to develop a multivariable logistic regression model for nonhistaminergic vs histaminergic angioedema.\nResults:\n Among 450 adult angioedema patients, the mean +/- standard deviation age was 57 +/- 18 years, and 264 (59%) were female. Among patients, 30% had suspected nonhistaminergic angioedema, 30% had suspected histaminergic angioedema, and 40% were of unknown etiology. As compared to histaminergic angioedema, nonhistaminergic angioedema was associated with angiotensin-converting enzyme inhibitors (ACEI) or use of angiotensin II receptor blockers (ARB) (odds ratio [OR] [60.9]; 95% confidence interval [CI], 23.16-160.14) and time of onset one hour or more prior to ED arrival (OR [5.91]; 95% CI,1.87-18.70) and was inversely associated with urticaria (OR [0.05]; 95% CI, 0.02-0.15), dyspnea (OR [0.23]; 95% CI, 0.08-0.67), and periorbital or lip edema (OR [0.25]; 95% CI, 0.08-0.79 and OR [0.32]; 95% CI, 0.13-0.79, respectively).\nConclusion:\n As compared to histaminergic angioedema, patients with nonhistaminergic angioedema were more likely to present one hour or more after symptom onset and take ACEI or ARB medications, and were less likely to have urticaria, dyspnea, or periorbital or lip angioedema. Identification of characteristics associated with the etiology of angioedema may assist providers in more rapidly initiating targeted therapies.","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":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3nq3h9s8","frozenauthors":[{"first_name":"Benjamin","middle_name":"J.","last_name":"Sandefur","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Lucas","middle_name":"","last_name":"Oliveira J. e Silva","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota\n\nFederal University of Rio Grande do Sul, Department of Medicine, Rio Grande do Sul","department":"None"},{"first_name":"Christine","middle_name":"M.","last_name":"Lohse","name_suffix":"","institution":"Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota","department":"None"},{"first_name":"Kiran","middle_name":"A.","last_name":"Goyal","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"David","middle_name":"W.","last_name":"Barbara","name_suffix":"","institution":"Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Ana","middle_name":"","last_name":"Castaneda-Guarderas","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Xiao-wei","middle_name":"","last_name":"Liu","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota\n\nThe First Affiliated Hospital of China Medical University, Department of Emergency Medicine, Liaoning, Shenyang","department":"None"},{"first_name":"Ronna","middle_name":"L.","last_name":"Campbell","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"}],"date_submitted":"2019-02-25T12:41:27-03:00","date_accepted":"2019-02-25T12:41:27-03:00","date_published":"2019-08-06T17:19:13-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12543/galley/6651/download/"}]},{"pk":12382,"title":"Examining the Effect of the Affordable Care Act on Two Illinois Emergency Departments","subtitle":null,"abstract":"Introduction:\n The emergency department (ED) has long served as a safety net for the uninsured and those with limited access to routine healthcare. This study aimed to compare the characteristics and severity of ED visits in an Illinois academic medical center (AMC) and community hospital (CH) of a single health system before and after the implementation of the Affordable Care Act (ACA).\nMethods:\n This was a retrospective record review of 357,764 ED visits from January 1, 2011– December 31, 2016, of which 74% were at the AMC and 26% at the CH. We assessed the severity of ED visits by applying the previously validated Ballard algorithm, which classifies ED visits as non-emergent, intermediate, or emergent. Descriptive analyses were conducted to compare the characteristics of ED visits before and after the implementation of the ACA. We conducted multilevel logistic regression analysis to examine the odds of non-emergent compared to intermediate/emergent ED visits by the ACA implementation status controlling for patient demographic characteristics, insurance status, and multiple visits per patient.\nResults:\n ED visits for patients with Medicaid or other governmental coverages increased in the post-ACA compared to pre-ACA period (Pre: 33.2 % vs Post: 38.3% at the AMC, and Pre: 29.7% vs Post: 35.1% at the CH). A statistically significant decrease in ED visits for uninsured patients was observed at the AMC and CH in the post-ACA period compared to the pre-ACA period (Pre: 12.1% vs Post: 6.4%, and Pre: 13.9% vs Post: 9.8%, respectively). Results from the regression analysis showed a significant decreased odds of non-emergent vs intermediate/emergent ED visits during the post-ACA period compared to the pre-ACA period at the AMC (odds ratio [OR] 0.68; confidence interval [CI], 0.66-0.70). However, an increased odds of non-emergent vs. intermediate/emergent ED visits was observed at the CH (OR 1.09; CI, 1.04-1.14).\nConclusion:\n Similar to other Medicaid expansion states, ED utilization for uninsured patients decreased at both the AMC and the CH in the post-ACA period. While Medicaid visits for children < 18 years declined in the post-ACA period, it increased for ages 21 to 65 years of age. Contrary to our hypothesis, the severity of emergent ED visits increased in the post-ACA period but not at the CH.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Emergency Department Access","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2zx8r693","frozenauthors":[{"first_name":"Beatrice","middle_name":"D.","last_name":"Probst","name_suffix":"","institution":"Loyola University Chicago, Stritch School of Medicine, Department of Emergency Medicine, Maywood, Illinois","department":"None"},{"first_name":"Luther","middle_name":"","last_name":"Walls","name_suffix":"","institution":"Loyola University Chicago, Stritch School of Medicine, Department of Emergency Medicine, Maywood, Illinois","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Cirone","name_suffix":"","institution":"University of Illinois at Chicago, Advocate Christ Medical Center, Department of Emergency Medicine, Oak Lawn, Illinois","department":"None"},{"first_name":"Talar","middle_name":"","last_name":"Markossian","name_suffix":"","institution":"Public Health Sciences at Loyola University Chicago, Maywood, Illinois","department":"None"}],"date_submitted":"2018-12-10T19:22:26-02:00","date_accepted":"2018-12-10T19:22:26-02:00","date_published":"2019-08-06T17:15:08-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12382/galley/6589/download/"}]},{"pk":12373,"title":"Potential of Mobile Health Technology to Reduce Health Disparities in Underserved Communities","subtitle":null,"abstract":"Introduction:\n Mobile health (mHealth) has the potential to change how patients make healthcare decisions. We sought to determine the readiness to use mHealth technology in underserved communities.\nMethods:\n We conducted a cross-sectional survey of patients presenting with low-acuity complaints to an urban emergency department (ED) with an underserved population. Patients over the age of two who presented with low-acuity complaints were included. We conducted  structured interview with each patient or parent (for minors) about willingness to use mHealth tools for guidance. Analysis included descriptive statistics and univariate analysis based on age and gender.\nResults:\n Of 560 patients included in the survey, 80% were adults, 64% female, and 90% Black. The mean age was 28 ± 9 years for adults and 9 ± 5 years for children. One-third of patients reported no primary care physician, and 55% reported no access to a nurse or clinician for medical advice. Adults were less likely to have access to phone consultation than parents of children (odds ratio [OR] 0.49, 95% confidence interval [CI], 0.32 – 0.74), as were males compared to females (OR 0.52, 95% CI, 0.37– 0.74). Most patients (96%) reported cellular internet access. Two-thirds of patients reported using online references. When asked how they would behave if an mHealth tool advised them that their current health problem was low risk, 69% of patients responded that they would seek care in an outpatient clinic instead of the ED (30%), stay home and not seek urgent medical care (28%), or use telehealth (11%).\nConclusion:\n In this urban community we found a large capacity and willingness to use mHealth technology in medical triage.","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":"mobile health"},{"word":"underserved"},{"word":"Telehealth"}],"section":"Population Health Research Design","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8vk7f65q","frozenauthors":[{"first_name":"Tara","middle_name":"","last_name":"Van Veen","name_suffix":"","institution":"Henry Ford Hospital, Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan","department":"None"},{"first_name":"Sophia","middle_name":"","last_name":"Binz","name_suffix":"","institution":"Henry Ford Hospital, Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan;\n\nWayne State University School of Medicine, Detroit, Michigan","department":"None"},{"first_name":"Meri","middle_name":"","last_name":"Muminovic","name_suffix":"","institution":"Wayne State University School of Medicine, Detroit, Michigan","department":"None"},{"first_name":"Kaleem","middle_name":"","last_name":"Chaudhry","name_suffix":"","institution":"Henry Ford Hospital, Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan","department":"None"},{"first_name":"Katie","middle_name":"","last_name":"Rose","name_suffix":"","institution":"Central Michigan University School of Medicine, Mount Pleasant, Michigan","department":"None"},{"first_name":"Sean","middle_name":"","last_name":"Calo","name_suffix":"","institution":"Central Michigan University School of Medicine, Mount Pleasant, Michigan","department":"None"},{"first_name":"Jo-Ann","middle_name":"","last_name":"Rammal","name_suffix":"","institution":"Henry Ford Hospital, Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan","department":"None"},{"first_name":"John","middle_name":"","last_name":"France","name_suffix":"","institution":"Wayne State University School of Medicine, Detroit, Michigan","department":"None"},{"first_name":"Joseph","middle_name":"B.","last_name":"Miller","name_suffix":"","institution":"Henry Ford Hospital, Wayne State University, Detroit, MI","department":"None"}],"date_submitted":"2018-12-05T12:44:42-02:00","date_accepted":"2018-12-05T12:44:42-02:00","date_published":"2019-08-06T17:10:43-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12373/galley/6586/download/"}]},{"pk":12667,"title":"Single Versus Double Tourniquet Technique for  Ultrasound-Guided Venous Catheter Placement","subtitle":null,"abstract":"Introduction:\n Peripheral, ultrasound-guided intravenous (IV) access occurs frequently in the emergency department, but certain populations present unique challenges for successfully completing this procedure. Prior research has demonstrated decreased compressibility under double tourniquet technique (DT) compared with single tourniquet (ST). We hypothesized that catheters inserted under DT method would have a higher first-stick success rate compared with those inserted under ST method.\nMethods:\n We randomized 100 patients with a history of difficult IV access, as defined by past ultrasound IV, prior emergency visit with two or more attempts required for vascular access, history of IV drug abuse, history of end stage renal disease on hemodialysis or obesity, to ultrasound-guided IV placement under either DT or ST method. We measured the vein characteristics measured under ultrasound, and recorded the number of attempts and location of attempts at vascular access.\nResults:\n Of an initial 100 patients enrolled, we analyzed a total of 99 with 48 placed under ST and 51 placed under DT. Attending physicians inserted 41.7% of ST and 41.2% of DT, with non-attending inserters (including residents, nurses, and technicians) inserted the remainder. First-stick success rate was observed at 64.3% in ST and 66.7% in DT (p=0.93). Attendings had an overall higher first-stick success rate (95.1%) compared to non-attending inserters (65.5%) (p=<0.001). The average vein depth measured in ST was 0.73 centimeters (cm) compared with 0.87 cm in DT (p=0.02).\nConclusion: \nDT technique did not produce a measureable increase in first-stick success rate compared to ST, including after adjusting for level of training of inserter. However, a significant difference in average vein depth between the study arms may have limited the reliability of our overall results. Future studies controlling for this variable may be required to more accurately compare these two techniques.","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 Tourniquet IV"}],"section":"Technology in Emergency Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3m77s0z4","frozenauthors":[{"first_name":"Jacob","middle_name":"","last_name":"Price","name_suffix":"","institution":"St. Mary Mercy Hospital, Department of Emergency Medicine, Livonia, Michigan","department":"None"},{"first_name":"Jane","middle_name":"","last_name":"Xiao","name_suffix":"","institution":"Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon","department":"None"},{"first_name":"Katie","middle_name":"","last_name":"Tausch","name_suffix":"","institution":"Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"},{"first_name":"Bophal","middle_name":"","last_name":"Hang","name_suffix":"","institution":"Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"},{"first_name":"Amit","middle_name":"","last_name":"Bahl","name_suffix":"","institution":"Oakland University William Beaumont School of Medicine, Department of Emergency Medicine, Royal Oak, Michigan","department":"None"}],"date_submitted":"2019-04-08T13:51:07-03:00","date_accepted":"2019-04-08T13:51:07-03:00","date_published":"2019-08-06T17:06:42-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12667/galley/6699/download/"}]},{"pk":709,"title":"Monocular Vision Loss: A Rare Cause","subtitle":null,"abstract":"A 62-year-old woman with a history of metastatic breast cancer and known meningioma presented with unilateral vision loss associated with anisocoria and an afferent pupillary defect. On magnetic resonance imaging we found the cause to be optic nerve compression by a right frontal meningioma. Monocular vision-loss etiologies are anatomically localized to structures anterior to the optic chiasm. This case serves as a reminder that cerebral structures in this location must not be forgotten in the 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":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5tn6v2z0","frozenauthors":[{"first_name":"David","middle_name":"","last_name":"Lane","name_suffix":"","institution":"University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Kaila","middle_name":"","last_name":"Pomeranz","name_suffix":"","institution":"University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Shannon","middle_name":"","last_name":"Findlay","name_suffix":"","institution":"University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Miller","name_suffix":"","institution":"University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa","department":"None"}],"date_submitted":"2019-08-05T16:46:34-03:00","date_accepted":"2019-08-05T16:46:34-03:00","date_published":"2019-08-06T17:03:29-03:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/709/galley/466/download/"}]},{"pk":12669,"title":"Sepsis in Pregnancy: Recognition and Resuscitation","subtitle":null,"abstract":"The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.","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":"sepsis"},{"word":"pregnancy"},{"word":"SIRS"},{"word":"qSOFA"},{"word":"pneumonia"},{"word":"pyelonephritis"},{"word":"endometritis"},{"word":"appendicitis"},{"word":"Pelvic Inflammatory Disease"}],"section":"Injury Prevention and Population Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7q0569wz","frozenauthors":[{"first_name":"Rachel","middle_name":"E.","last_name":"Bridwell","name_suffix":"","institution":"Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas","department":"None"},{"first_name":"Brandon","middle_name":"M.","last_name":"Carius","name_suffix":"","institution":"Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas","department":"None"},{"first_name":"Brit","middle_name":"J.","last_name":"Long","name_suffix":"","institution":"Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas","department":"None"},{"first_name":"Joshua","middle_name":"J.","last_name":"Oliver","name_suffix":"","institution":"Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas","department":"None"},{"first_name":"Gillian","middle_name":"","last_name":"Schmitz","name_suffix":"","institution":"Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas","department":"None"}],"date_submitted":"2019-04-09T07:40:52-03:00","date_accepted":"2019-04-09T07:40:52-03:00","date_published":"2019-08-06T17:01:06-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12669/galley/6700/download/"}]},{"pk":12329,"title":"Evaluating a Novel Simulation Course for Prehospital Provider Resuscitation Training in Botswana","subtitle":null,"abstract":"Introduction: \nIn 2012, Botswana embarked on an organized public approach to prehospital medicine. One goal of the Ministry of Health (MOH) was to improve provider education regarding patient stabilization and resuscitation. Simulation-based instruction is an effective educational strategy particularly for high-risk, low-frequency events. In collaboration with partners in the United States, the team created a short, simulation-based course to teach and update prehospital providers on common field responses in this resource-limited setting. The objective of this study was to evaluate an educational program for Botswanan prehospital providers via written and simulation-based examinations.\nMethods:\n We developed a two-day course based on a formal needs assessment and MOH leadership input. The subject matter of the simulation scenarios represented common calls to the prehospital system in Botswana. Didactic lectures and facilitated skills training were conducted by U.S. practitioners who also served as instructors for a rapid-cycle, deliberate practice simulation education model and simulation-based testing scenarios. Three courses, held in three cities in Botswana, were offered to off-duty MOH prehospital providers, and the participants were evaluated using written multiple-choice tests, videotaped traditional simulation scenarios, and self-efficacy surveys.\nResults:\n Collectively, 31 prehospital providers participated in the three courses. The mean scores on the written pretest were 67% (standard deviation [SD], 10) and 85% (SD, 7) on the post-test (p < 0.001). The mean scores for the simulation were 42% (SD, 14.2) on the pretest and 75% (SD, 11.3) on the post-test (p < 0.001). Moreover, the intraclass correlation coefficient scores between reviewers were highly correlated at 0.64 for single measures and 0.78 for average measures (p < 0.001 for both). Twenty-one participants (68%) considered the course “extremely useful.”\nConclusion:\n Botswanan prehospital providers who participated in this course significantly improved in both written and simulation-based performance testing. General feedback from the participants indicated that the simulation scenarios were the most useful and enjoyable aspects of the course. These results suggest that this curriculum can be a useful educational tool for teaching and reinforcing prehospital care concepts in Botswana and may be adapted for use in other resource-limited settings. [West J Emerg Med. 2019;20(5)XX-XX.]","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":"Simulation"},{"word":"emergency medical services"},{"word":"prehospital"},{"word":"education"},{"word":"Botswana"},{"word":"collaboration"},{"word":"resource limited"},{"word":"resuscitation"}],"section":"International Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1hw9j7r1","frozenauthors":[{"first_name":"Adeola","middle_name":"A.","last_name":"Kosoko","name_suffix":"","institution":"McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, Texas","department":"None"},{"first_name":"Nicolaus","middle_name":"W.","last_name":"Glomb","name_suffix":"","institution":"University of California, San Francisco School of Medicine, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Bushe","middle_name":"","last_name":"Laba","name_suffix":"","institution":"Ministry of Health & Wellness, Emergency Medical Services System, Gaborone, Botswana","department":"None"},{"first_name":"Cafen","middle_name":"","last_name":"Galape","name_suffix":"","institution":"Ministry of Health & Wellness, Emergency Medical Services System, Gaborone, Botswana","department":"None"},{"first_name":"Manish","middle_name":"","last_name":"Shah","name_suffix":"","institution":"Baylor College of Medicine/Texas Children’s Hospital, Department of Pediatrics, Houston, Texas","department":"None"},{"first_name":"Marideth","middle_name":"","last_name":"Rus","name_suffix":"","institution":"Baylor College of Medicine/Texas Children’s Hospital, Department of Pediatrics, Houston, Texas","department":"None"},{"first_name":"Cara","middle_name":"","last_name":"Doughty","name_suffix":"","institution":"Baylor College of Medicine/Texas Children’s Hospital, Department of Pediatrics, Houston, Texas","department":"None"}],"date_submitted":"2018-11-15T09:40:37-02:00","date_accepted":"2018-11-15T09:40:37-02:00","date_published":"2019-08-06T16:57:23-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12329/galley/6567/download/"}]},{"pk":11675,"title":"Emergency Reversal of Anticoagulation","subtitle":null,"abstract":"Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Patients may also be using antiplatelet agents. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient.","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":"anticoagulation"},{"word":"Reversal"},{"word":"Bleeding"},{"word":"Warfarin"},{"word":"DOAC"},{"word":"rivaroxaban"},{"word":"Dabigatran"},{"word":"Heparin"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3b99r7px","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Yee","name_suffix":"","institution":"Wexner Medical Center, The Ohio State University, Department of Emergency Medicine, Columbus, Ohio","department":"None"},{"first_name":"Colin","middle_name":"G.","last_name":"Kaide","name_suffix":"","institution":"Wexner Medical Center, The Ohio State University, Department of Emergency Medicine, Columbus, Ohio","department":"None"}],"date_submitted":"2018-03-11T19:05:25-03:00","date_accepted":"2018-03-11T19:05:25-03:00","date_published":"2019-08-06T16:16:37-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/11675/galley/6279/download/"}]},{"pk":711,"title":"Cardiac Arrhythmia Following an Epileptic Seizure","subtitle":null,"abstract":"Sudden unexplained death in epilepsy (SUDEP) refers to a death in a patient with epilepsy that is not due to trauma, drowning, status epilepticus, or another apparent cause. Although the pathophysiology of SUDEP is incompletely understood, growing evidence supports the role of seizure-associated arrhythmias as a potential etiology. We present a unique case of a patient presenting with ventricular tachycardia shortly following a seizure, along with corresponding laboratory data. Awareness of high risk arrhythmias in seizure patients could lead to advances in understanding pathophysiology and treatment of this complication of seizure disorder and ultimately prevention of SUDEP.","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/7kj240jb","frozenauthors":[{"first_name":"Hani","middle_name":"I.","last_name":"Kuttab","name_suffix":"","institution":"University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Elizabeth","middle_name":"A.","last_name":"Harris","name_suffix":"","institution":"University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Katie","middle_name":"L.","last_name":"Tataris","name_suffix":"","institution":"University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"James","middle_name":"","last_name":"Tao","name_suffix":"","institution":"University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"David","middle_name":"G.","last_name":"Beiser","name_suffix":"","institution":"University of Chicago Medical Center, Section of Emergency Medicine, Chicago, Illinois","department":"None"}],"date_submitted":"2019-08-05T16:54:59-03:00","date_accepted":"2019-08-05T16:54:59-03:00","date_published":"2019-08-05T17:51:39-03:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/711/galley/468/download/"}]},{"pk":710,"title":"Importance of Multiple-window Assessment for the Diagnosis of Ascending Aortic Dissection Using Point-of-care Ultrasound: Report of Three Cases","subtitle":null,"abstract":"Acute ascending aortic dissection has a high mortality rate and requires rapid diagnosis and treatment. Point-of-care ultrasound (POCUS) can aid in the diagnosis. The aortic root is usually evaluated in the parasternal long-axis view; however, a dissection flap is not always visible in this projection. We present three cases of acute, type A aortic dissection in which the dissection flap was only evident in the apical five-chamber and subxyphoid views. These cases suggest that POCUS may play a pivotal role in the initial diagnosis of acute ascending aortic dissection and highlight the importance of viewing multiple windows to fully evaluate this possibility.","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 Series","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6qn4h59f","frozenauthors":[{"first_name":"Virginia","middle_name":"","last_name":"Zarama","name_suffix":"","institution":"Fundación Valle del Lili, ICESI University, Department of Emergency Medicine, Cali, Colombia","department":"None"},{"first_name":"María","middle_name":"C.","last_name":"Arango-Granados","name_suffix":"","institution":"Fundación Valle del Lili, ICESI University, Department of Emergency Medicine, Cali, Colombia","department":"None"},{"first_name":"Luis","middle_name":"A.","last_name":"Bustamante Cristancho","name_suffix":"","institution":"Fundación Valle del Lili, ICESI University, Department of Emergency Medicine, Cali, Colombia","department":"None"}],"date_submitted":"2019-08-05T16:51:08-03:00","date_accepted":"2019-08-05T16:51:08-03:00","date_published":"2019-08-05T17:50:08-03:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/710/galley/467/download/"}]},{"pk":708,"title":"A Case of Central Venous Sinus Thrombosis in a Young Woman","subtitle":null,"abstract":"Altered mental status is a common symptom in emergency department evaluations and may be present in as many as four to ten percent of patients. The etiology can be difficult to determine without significant evidence from laboratory, radiographic and physical examination. The diagnostic approach is largely driven by the provider’s clinical judgment based on the available history. Consequently, less-common diagnoses can be easily missed or delayed if a reasonable suspicion does not exist when considering possible causes. Cerebral venous sinus thrombosis (CVST) is one such uncommon, seldom-considered disease that carries a significant morbidity and mortality. Its clinical presentations vary and it disproportionally affects young to middle-aged individuals. Knowledge of the disease, particularly the risk factors, is key to making the diagnosis. We will discuss the case of a patient who presented with CVST and intraparenchymal hemorrhage in a resource-limited environment.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5949w0r2","frozenauthors":[{"first_name":"Liam","middle_name":"F.","last_name":"Delahanty","name_suffix":"","institution":"Naval Hospital Okinawa, Department of Emergency Medicine, Okinawa, Japan","department":"None"},{"first_name":"Timothy","middle_name":"G.","last_name":"Parker","name_suffix":"","institution":"Flight Surgeon, HMH-466 “Wolfpack,” Camp Pendleton, California","department":"None"}],"date_submitted":"2019-08-05T16:43:21-03:00","date_accepted":"2019-08-05T16:43:21-03:00","date_published":"2019-08-05T17:47:43-03:00","render_galley":null,"galleys":[{"label":"","type":"","path":"https://journalpub.escholarship.org/uciem_cpcem/article/708/galley/465/download/"}]},{"pk":39763,"title":"An updated list of chironomid species from Italy with biogeographic considerations (Diptera, Chironomidae)","subtitle":null,"abstract":"In a first list of chironomid species from Italy from 1988, 359 species were recognized. The subfamilies represented were Tanypodinae, Diamesinae, Prodiamesinae, Orthocladiinae and Chironominae. Most of the species were cited as widely distributed in the Palearctic region with few Mediterranean (6), Afrotropical (19) or Panpaleotropical (3) species. The list also included five species previously considered Nearctic. An updated list was thereafter prepared and the number of species raised to 391. Species new to science were added in the following years further raising the number of known species. The list of species known to occur in Italy is now updated to 580, and supported by voucher specimens. Most species have a Palearctic distribution, but many species are distributed in other biogeographical regions; 366 species are in common with the East Palaearctic region, 281 with the Near East, 248 with North Africa, 213 with the Nearctic, 104 with the Oriental, 23 species with the Neotropical, 23 with the Afrotropical, 16 with the Australian region, and 46 species at present are known to occur only in Italy. On the basis of new findings in Italy and in nearby areas it is stated that the knowledge of chironomid fauna is still incomplete.","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":"Italy"},{"word":"Chironomidae"},{"word":"species list"},{"word":"biodiversity"},{"word":"faunistics"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4vc5w4r7","frozenauthors":[{"first_name":"Bruno","middle_name":"","last_name":"Rossaro","name_suffix":"","institution":"Dipartimento di Scienze Agrarie e Ambientali (DiSAA), University of Milano, Via Celoria 2, 20133 Milano (Italy)","department":"None"},{"first_name":"Niccolò","middle_name":"","last_name":"Pirola","name_suffix":"","institution":"Dipartimento di Scienze Agrarie e Ambientali (DiSAA), University of Milano, Via Celoria 2, 20133 Milano (Italy)","department":"None"},{"first_name":"Laura","middle_name":"","last_name":"Marziali","name_suffix":"","institution":"Water Research Institute - National Research Council (IRSA-CNR), Via del Mulino 19, 20861 Brugherio (MB) (Italy)","department":"None"},{"first_name":"Giulia","middle_name":"","last_name":"Magoga","name_suffix":"","institution":"Dipartimento di Scienze Agrarie e Ambientali (DiSAA), University of Milano, Via Celoria 2, 20133 Milano (Italy)","department":"None"},{"first_name":"Angela","middle_name":"","last_name":"Boggero","name_suffix":"","institution":"Water Research Institute - National Research Council (IRSA-CNR), Corso Tonolli 50, 28922 Verbania Pallanza (Italy)","department":"None"},{"first_name":"Matteo","middle_name":"","last_name":"Montagna","name_suffix":"","institution":"Dipartimento di Scienze Agrarie e Ambientali (DiSAA), University of Milano, Via Celoria 2, 20133 Milano (Italy)","department":"None"}],"date_submitted":"2019-03-11T14:56:08-03:00","date_accepted":"2019-03-11T14:56:08-03:00","date_published":"2019-08-02T08:48:27-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/biogeographia/article/39763/galley/29947/download/"}]},{"pk":13131,"title":"Using a Novel, Online Relational Database Tool to Track Attendance and Increase Didactic Evaluations in Graduate Medical Education","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Abstracts","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8k50k0tv","frozenauthors":[{"first_name":"WG","middle_name":"","last_name":"Sungar","name_suffix":"","institution":"","department":"None"},{"first_name":"R","middle_name":"","last_name":"Byyny","name_suffix":"","institution":"","department":"None"},{"first_name":"M","middle_name":"","last_name":"Moreira","name_suffix":"","institution":"","department":"None"},{"first_name":"T","middle_name":"","last_name":"McCormick","name_suffix":"","institution":"","department":"None"},{"first_name":"B","middle_name":"","last_name":"Kaplan","name_suffix":"","institution":"","department":"None"},{"first_name":"J","middle_name":"","last_name":"Buchanan","name_suffix":"","institution":"","department":"None"},{"first_name":"B","middle_name":"","last_name":"Blok","name_suffix":"","institution":"","department":"None"},{"first_name":"C","middle_name":"","last_name":"Angerhofer","name_suffix":"","institution":"","department":"None"},{"first_name":"B","middle_name":"","last_name":"Baker","name_suffix":"","institution":"","department":"None"},{"first_name":"C","middle_name":"","last_name":"Lawson","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-07-31T15:52:25-03:00","date_accepted":"2019-07-31T15:52:25-03:00","date_published":"2019-07-31T17:49:34-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13131/galley/6912/download/"}]},{"pk":13095,"title":"Advancing Diversity In Emergency Medicine: The NYU EM Summer Fellowship for Underrepresented Minority Medical Students","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Abstracts","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6fv917mc","frozenauthors":[{"first_name":"AB","middle_name":"","last_name":"Tse","name_suffix":"","institution":"","department":"None"},{"first_name":"M","middle_name":"","last_name":"Berger","name_suffix":"","institution":"","department":"None"},{"first_name":"L","middle_name":"","last_name":"Nesheiwat","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2019-07-31T14:32:46-03:00","date_accepted":"2019-07-31T14:32:46-03:00","date_published":"2019-07-31T17:44:13-03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13095/galley/6877/download/"}]},{"pk":13134,"title":"CORD Abstracts 2019 Issue","subtitle":null,"abstract":"n/a","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. 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