Purpose: During the third-year emergency medicine (EM) clerkship, medical students are immersed in traumatic incidents with their patients and clinical teams. Trauma-informed medical education (TIME) applies trauma-informed care (TIC) principles to help students manage trauma. We aimed to qualitatively describe the extent to which students perceived the six TIME domains as they navigated critical incidents during their EM clerkship.
\nMethods: We employed a constructivist, modified grounded theory approach to explore medical students’ experiences. We used the critical incident technique to elicit narratives to better understand the six TIME domains as they naturally appear in the clerkship. Participants were asked to describe a traumatic incident they experienced during the clerkship, followed by the clerkship’s role in helping them manage the incident. Using the framework method, transcripts were analyzed 1) deductively by matching transcript excerpts to relevant TIME domains and 2) inductively by generating de novo themes to capture factors that affected students’ handling of trauma during critical incidents.
\nResults: Twelve participants were enrolled and interviewed in July 2022. “Safety” was the most frequently described TIME domain, whereas “Gender, Cultural, and Historical issues” and “Peer Support” were discussed least. Inductive analysis revealed themes that hindered or supported their ability to manage traumatic experiences, which were grouped into three categories: 1) student interactions with the learning environment: complex social determinants of health, inequalities in care, and overt discrimination; 2) student interactions with patients: ethically ambiguous care, witnessing acute patient presentations, and reactivation of past trauma; and 3) student interactions with supervisors: power dynamics, invalidation of contributions, role-modeling, and student empowerment.
\nConclusion: The six TIME domains are represented in students’ perceptions of immediate, stressful critical incidents during their EM clerkship, with “Safety” being the most commonly described; however, the degree to which these domains are supported in students’ experiences of the EM clerkship differ, and instances of inadequately experienced domains may contribute to student distress. Understanding the EM clerkship through the specific lens of students’ experiences of trauma may be an effective strategy to guide curricular changes that promote a supportive learning environment for students in the emergency department.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"trauma-informed medical education"},{"word":"Emergency Medicine clerkship"},{"word":"medical student"},{"word":"emergency department"},{"word":"Clinical rotation"}],"section":"Medical Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4kk0v7qb","frozenauthors":[{"first_name":"Giselle","middle_name":"","last_name":"Appel","name_suffix":"","institution":"Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Ahmed","middle_name":"T.","last_name":"Shahzad","name_suffix":"","institution":"Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Kestrel","middle_name":"","last_name":"Reopelle","name_suffix":"","institution":"Icahn School of Medicine, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Stephen","middle_name":"","last_name":"DiDonato","name_suffix":"","institution":"Thomas Jefferson University, College of Nursing, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Frances","middle_name":"","last_name":"Rusnack","name_suffix":"","institution":"New York University Grossman Long Island School of Medicine, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Dimitrios","middle_name":"","last_name":"Papanagnou","name_suffix":"","institution":"Thomas Jefferson University, Sidney Kimmel Medical College, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":""}],"date_submitted":"2023-10-06T19:49:38+03:00","date_accepted":"2024-03-18T02:04:49.008000+03:00","date_published":"2024-06-28T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18498/galley/14645/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18498/galley/10891/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18498/galley/14645/download/"}]},{"pk":18439,"title":"Impact of Prehospital Ultrasound Training on Simulated Paramedic Clinical Decision-Making","subtitle":null,"abstract":"Introduction: When used appropriately, focused limited-scope ultrasound exams could potentially provide paramedics with accurate and actionable diagnostic information to guide prehospital decision-making. In this study we aimed to investigate the impact of a 13-hour prehospital ultrasound training course on the simulated clinical decision-making of paramedics as well as their ultrasound skills, knowledge, and self-confidence.
\nMethods: We evaluated the ultrasound competence of 31 participants using post-course written and practical assessments. Written clinical decision scenarios were administered pre- and post-training. Post-training scenarios included an uninterpreted ultrasound clip to aid decision-making. Scenarios included extended focused assessment with sonography in trauma, pulmonary exam, and focused echocardiography combined with carotid pulse check exams. Correct answers to scenarios were defined as those selected by a veteran emergency physician. Participants also indicated their confidence in each of their decisions using a Likert scale.
\nResults: Training yielded a statistically significant increase in both mean scenario score (35.5%absolute increase) and mean participant self-confidence (15.8% relative increase), across all exam/decision types assessed (P ≤ 0.001). The focused pulmonary exam yielded the largest increase in both mean score improvement (59.7% absolute increase) and paramedic confidence in their decisions (28.6% increase).
\nConclusion: Trained paramedics can perform focused ultrasound exams and accurately interpret and apply actionable exam findings in the context of written scenarios. Analysis through our model characterized the theoretical clinical yield of each prehospital ultrasound exam and demonstrated how each exam may provide improved decision accuracy in several specific simulated clinical contexts. These results provide support for growing evidence that focused limited-scope ultrasound may be an effective prehospital diagnostic tool in the hands of trained paramedics.
","language":null,"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 ultrasound"},{"word":"Paramedicine"},{"word":"paramedic clinical decisions"},{"word":"prehospital ultrasound training"}],"section":"Emergency Medical Services","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0zj5g1p8","frozenauthors":[{"first_name":"Andrea","middle_name":"","last_name":"Roche","name_suffix":"","institution":"New England College of Osteopathic Medicine, Biddeford, Maine","department":"None"},{"first_name":"Evan","middle_name":"","last_name":"Watkins","name_suffix":"","institution":"Dartmouth College, Geisel School of Medicine, Department of Medical Education, Hanover, New Hampshire","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Pettit","name_suffix":"","institution":"Dartmouth College, Geisel School of Medicine, Department of Medical Education, Hanover, New Hampshire","department":"None"},{"first_name":"Jacob","middle_name":"","last_name":"Slagle","name_suffix":"","institution":"Dartmouth College, Geisel School of Medicine, Department of Medical Education, Hanover, New Hampshire","department":"None"},{"first_name":"Isain","middle_name":"","last_name":"Zapata","name_suffix":"","institution":"Rocky Vista University, College of Osteopathic Medicine, Englewood, Colorado","department":"None"},{"first_name":"Andrew","middle_name":"","last_name":"Seefeld","name_suffix":"","institution":"Speare Memorial Hospital, Department of Emergency Medicine, Plymouth, New Hampshire","department":"None"},{"first_name":"Nena","middle_name":"","last_name":"Lundgreen Mason","name_suffix":"","institution":"Dartmouth College, Geisel School of Medicine, Department of Medical Education, Hanover, New Hampshire","department":""}],"date_submitted":"2023-08-21T21:14:11+03:00","date_accepted":"2024-03-05T23:48:21.021000+03:00","date_published":"2024-06-28T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18439/galley/14646/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18439/galley/10892/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18439/galley/14646/download/"}]},{"pk":18466,"title":"Neutrophil-to-Lymphocyte Ratio Predicts Sepsis in Adult Patients Meeting Two or More Systemic Inflammatory Response Syndrome Criteria","subtitle":null,"abstract":"Introduction: Determining which patients who meet systemic inflammatory response syndrome (SIRS) criteria have bacterial sepsis is a difficult challenge for emergency physicians. We sought to determine whether the neutrophil-to-lymphocyte ratio (NLR) could be used to exclude bacterial sepsis in adult patients who meet ≥2 SIRS criteria and are being evaluated for sepsis.
\nMethods: Consenting adult patients meeting ≥2 SIRS criteria and undergoing evaluation for sepsis were enrolled. We recorded patient age, gender, vital signs, and laboratory results. We then later reviewed health records for culture results, end organ dysfunction, survival to discharge, and final diagnoses.
Patients were classified as having sepsis if they met ≥2 SIRS criteria and were ultimately diagnosed with a bacterial source. We analyzed data using descriptive statistics and sensitivity and specificity analyses. A receiver operating characteristic curve (ROC) was created to determine test characteristics.
Results: A total of 231 patients had complete datasets. Patients’ median age was 69 (interquartile range [IQR] 54–81), and 49.6% were male. There were 154 patients (66.7%) ultimately diagnosed with sepsis with an identified bacterial source, while 77 patients with ≥2 SIRS criteria had non-infectious reasons for their presentations (33.3%). Septic patients had a median NLR 12.36 (IQR [interquartile range] 7.29–21.69), compared to those without sepsis (median NLR 5.62, IQR 3.89–9.11, P < 0.001). The NLR value of 3 applied as a cutoff for sepsis had a sensitivity of 96.8 (95% confidence interval [CI] 92.2–98.8), and a specificity of 18.2 (95% CI 10.6–29.0). The ROC for NLR had an area under the curve of 0.74.
\nConclusion: The neutrophil-to-lymphocyte ratio is a sensitive tool to help determine which patients with abnormal SIRS screens have bacterial sepsis.
","language":null,"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":"NLR"},{"word":"SIRS"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/85h8d6pt","frozenauthors":[{"first_name":"Vamsi","middle_name":"","last_name":"Balakrishnan","name_suffix":"","institution":"St. Luke’s University Health Network, Bethlehem, Pennsylvania","department":"None"},{"first_name":"Anna","middle_name":"","last_name":"Yang","name_suffix":"","institution":"Regional One Health, Memphis, Tennessee","department":"None"},{"first_name":"Donald","middle_name":"","last_name":"Jeanmonod","name_suffix":"","institution":"St. Luke’s University Health Network, Bethlehem, Pennsylvania","department":""},{"first_name":"Harrison","middle_name":"","last_name":"Courie","name_suffix":"","institution":"St. Luke’s University Health Network, Bethlehem, Pennsylvania","department":"None"},{"first_name":"Spencer","middle_name":"","last_name":"Thompson","name_suffix":"","institution":"Linn County Emergency Medicine PC, Cedar Rapids, Iowa","department":"None"},{"first_name":"Valerian","middle_name":"","last_name":"Peterson","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Grand Rapids, Michigan","department":"None"},{"first_name":"Rebecca","middle_name":"K.","last_name":"Jeanmonod","name_suffix":"","institution":"St. Luke’s University Health Network, Bethlehem, Pennsylvania","department":""}],"date_submitted":"2023-09-14T17:47:01+03:00","date_accepted":"2024-03-25T19:22:33.601000+03:00","date_published":"2024-06-28T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18466/galley/14647/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18466/galley/14242/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18466/galley/14647/download/"}]},{"pk":46130,"title":"CHEK2 Variant in a Patient with Multi-Malignancies","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/2vs2t8hm","frozenauthors":[{"first_name":"Jason","middle_name":"","last_name":"Lee","name_suffix":"BS","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Jennifer","middle_name":"E.L.","last_name":"Diaz","name_suffix":"MD, PhD","institution":"","department":""},{"first_name":"Daniel","middle_name":"Sanghoon","last_name":"Shin","name_suffix":"MD, PhD","institution":"","department":""},{"first_name":"Michael","middle_name":"","last_name":"Lewis","name_suffix":"MD","institution":"","department":""},{"first_name":"Mehran","middle_name":"J.","last_name":"Kashefi","name_suffix":"DO","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-27T23:05:05+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46130/galley/34861/download/"}]},{"pk":18033,"title":"Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions","subtitle":null,"abstract":"Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with first responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, field-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for first responder programs.
\nMethods: Our team completed semi-structured, qualitative interviews with 32 first responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February–May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached.
\nResults: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for first responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identified as a barrier. Many believed field-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were significant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for first responders to conduct but recommended that this service be provided by mobile integrated health staff.
\nConclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.
","language":null,"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"},{"word":"opioid overdose"},{"word":"naloxone"},{"word":"buprenorphine"},{"word":"HIV testing"},{"word":"HCV testing"},{"word":"emergency medical services"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4rq0g3d0","frozenauthors":[{"first_name":"Callan","middle_name":"Elswick","last_name":"Fockele","name_suffix":"","institution":"University of Washington, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"Tessa","middle_name":"","last_name":"Frohe","name_suffix":"","institution":"University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, Washington","department":"None"},{"first_name":"Owen","middle_name":"","last_name":"McBride","name_suffix":"","institution":"University of Washington, Department of Emergency Medicine, Seattle, Washington","department":"None"},{"first_name":"David","middle_name":"L.","last_name":"Perlmutter","name_suffix":"","institution":"University of Washington, Department of Health Systems and Population Health, Seattle, Washington","department":"None"},{"first_name":"Brenda","middle_name":"","last_name":"Goh","name_suffix":"","institution":"University of Washington, Department of Health Systems and Population Health, Seattle, Washington","department":"None"},{"first_name":"Grover","middle_name":"","last_name":"Williams","name_suffix":"","institution":"Research with Expert Advisors on Drug Use, Seattle, Washington","department":"None"},{"first_name":"Courteney","middle_name":"","last_name":"Wettemann","name_suffix":"","institution":"Research with Expert Advisors on Drug Use, Seattle, Washington","department":"None"},{"first_name":"Nathan","middle_name":"","last_name":"Holland","name_suffix":"","institution":"Research with Expert Advisors on Drug Use, Seattle, Washington","department":"None"},{"first_name":"Brad","middle_name":"","last_name":"Finegood","name_suffix":"","institution":"Public Health – Seattle & King County, Seattle, Washington","department":"None"},{"first_name":"Thea","middle_name":"","last_name":"Oliphant-Wells","name_suffix":"","institution":"Public Health – Seattle & King County, Seattle, Washington","department":"None"},{"first_name":"Emily","middle_name":"C.","last_name":"Williams","name_suffix":"","institution":"University of Washington, Department of Health Systems and Population Health, Seattle, Washington; Health Services Research & Development Center of Innovation for Veteran- Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington","department":"None"},{"first_name":"Jenna","middle_name":"","last_name":"van Draanen","name_suffix":"","institution":"University of Washington, Department of Health Systems and Population Health, Seattle, Washington; University of Washington, Department of Child, Family, and Population Health Nursing, Seattle, Washington","department":"None"}],"date_submitted":"2023-04-01T04:07:03+03:00","date_accepted":"2023-04-01T04:07:03+03:00","date_published":"2024-06-27T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18033/galley/14590/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18033/galley/10129/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18033/galley/14590/download/"}]},{"pk":18029,"title":"Initiation of Buprenorphine in the Emergency Department: A Survey of Emergency Clinicians","subtitle":null,"abstract":"Introduction: Initiation of buprenorphine for opioid use disorder (OUD) in the emergency department (ED) is supported by the American College of Emergency Physicians and is shown to be beneficial. This practice, however, is largely underutilized.
\nMethods: To assess emergency clinicians’ attitudes and readiness to initiate buprenorphine in the ED we conducted a cross-sectional, electronic survey of clinicians (attendings, residents, and non-physician clinicians) in a single, academic ED of a tertiary-care hospital, which serves a rural population. Our survey aimed to assess emergency clinicians’ attitudes toward and readiness to initiate buprenorphine in the ED and identify clinician-perceived facilitators and barriers. Our survey took place after the initiation of the IMPACT (Initiation of Medication, Peer Access, and Connection to Treatment) project.
\nResults: Our results demonstrated the level of agreement that buprenorphine prescribing is within the emergency clinician’s scope of practice was inversely correlated to average years in practice (R2 = 0.93). X-waivered clinicians indicated feeling more prepared to administer buprenorphine in the ED R2 = 0.93. However, they were not more likely to report ordering buprenorphine or naloxone in the ED within the prior three months. Those who reported having a family member or close friend with substance use disorder (SUD) were not more likely to agree buprenorphine initiation is within the clinician’s scope of practice (P = 0.91), nor were they more likely to obtain an X-waiver (P = 0.58) or report ordering buprenorphine or naloxone for patients in the ED within the prior three months (P = 0.65, P = 0.77). Clinicians identified availability of pharmacists, inpatient/outpatient referral resources, and support staff (peer recovery support specialists and care managers) as primary facilitators to buprenorphine initiation. Inability to ensure follow-up, lack of knowledge of available resources, and insufficient education/preparedness were primary barriers to ED buprenorphine initiation. Eighty-three percent of clinicians indicated they would be interested in additional education regarding OUD treatment.
\nConclusion: Our data suggests that newer generations of emergency clinicians may have less hesitancy initiating buprenorphine in the ED. In time, this could mean increased access to treatment for patients with OUD. Understanding clinician-perceived facilitators and barriers to buprenorphine initiation allows for better resource allocation. Clinicians would likely further benefit from additional education regarding medications for opioid use disorder (MOUD), available resources, and follow-up statistics.
","language":null,"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":"buprenorphine"},{"word":"opioid use disorder"},{"word":"emergency department"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8kn031wt","frozenauthors":[{"first_name":"Ariana","middle_name":"","last_name":"Barkley","name_suffix":"","institution":"West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Laura","middle_name":"","last_name":"Lander","name_suffix":"","institution":"West Virginia University, Department of Behavioral Medicine and Psychiatry, Morgantown, West Virginia","department":"None"},{"first_name":"Brian","middle_name":"","last_name":"Dilcher","name_suffix":"","institution":"West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia","department":"None"},{"first_name":"Meghan","middle_name":"","last_name":"Tuscano","name_suffix":"","institution":"West Virginia University, Department of Behavioral Medicine and Psychiatry, Morgantown, West Virginia","department":"None"}],"date_submitted":"2023-03-31T22:25:11+03:00","date_accepted":"2023-03-31T22:25:11+03:00","date_published":"2024-06-27T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18029/galley/14589/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18029/galley/10530/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18029/galley/14589/download/"}]},{"pk":19476,"title":"Atraumatic Infected Septal Hematoma in a Pediatric Patient","subtitle":null,"abstract":"Case Presentation: We present a case of a 10-year-old male who developed an atraumatic, nasal septal hematoma with abscess following several days of rhinorrhea and cough. His chief complaint to the emergency department was a two-day history of nasal swelling and discomfort, associated with difficulty breathing through his nose. The patient was well-appearing with swelling and tenderness along the external nasal ridge and nasal septal swelling that occluded both nares. Contrast-enhanced maxillofacial computed tomography revealed a rim-enhancing, fluid-filled collection to the anterior nasal septum. The patient underwent successful incision and drainage by otolaryngology.
\n
Discussion: Infected septal hematomas are rare but important to recognize as they can result in septal deformity and potentially life-threatening sequelae, such as intracranial infections. Most are secondary to nasal trauma in adult patients. This case highlights a unique presentation of atraumatic septal hematoma with abscess formation in an immunocompetent pediatric patient.
Lamma 2 Front Matter
","language":null,"license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[],"section":"Front Matter","is_remote":true,"remote_url":"https://escholarship.org/uc/item/48h8q1zw","frozenauthors":[{"first_name":"Adam","middle_name":"","last_name":"Benkato","name_suffix":"","institution":"UC Berkeley","department":""}],"date_submitted":"2024-06-12T01:26:23+03:00","date_accepted":"2024-06-13T00:32:47+03:00","date_published":"2024-06-25T20:31:40.520000+03:00","render_galley":null,"galleys":[{"label":"Lamma 2 Front Matter","type":"pdf","path":"https://journalpub.escholarship.org/lamma/article/24849/galley/14585/download/"}]},{"pk":1432,"title":"A decade of language processing research: Which place for linguistic diversity?","subtitle":null,"abstract":"This paper surveys the linguistic diversity in psycholinguistic and neurolinguistic research by examining the languages under investigation in major international conferences from 2012 to 2023. The results showed that these studies are highly skewed towards English in particular and Indo-European languages in general. However, the overall number of languages, as well as the number and proportion of Indo-European (other than English) and non-Indo-European languages increased over time, indicating that language processing research is becoming more and more diversified. This typological bias was also found in the inspection of specific linguistic phenomena: (a) morphosyntactic alignment, richness of case morphology, canonical word order, and (b) temporal concepts. The analyses of typological bias at the general and specific levels indicate that there are gaps in various topics, and these can be filled by including more non-Indo-European languages in the investigation process. In addition, a sociolinguistic bias in language processing research emerges as the languages investigated are more often ‘Western’ languages with more than one million speakers and a shared written form. These results reflect the numerous challenges encountered when conducting experiments on less familiar languages, such as the geographic difficulty finding participants speaking these languages, the need of institutional support, as well as the difficulties in setting up collaborations with native speakers, among others.
","language":"eng","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":"Regular Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1xc45121","frozenauthors":[{"first_name":"Aymeric","middle_name":"","last_name":"Collart","name_suffix":"","institution":"Academia Sinica","department":"Institute of Linguistics"}],"date_submitted":"2023-06-10T05:31:51.206000+03:00","date_accepted":"2024-04-05T22:18:43.837000+03:00","date_published":"2024-06-24T19:35:00+03:00","render_galley":{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1432/galley/14463/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1432/galley/14462/download/"},{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1432/galley/14463/download/"}]},{"pk":65625,"title":"11.2 Table of Contents and Editors' Note (June 24, 2024)","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3j2407x4","frozenauthors":[{"first_name":"AGS","middle_name":"","last_name":"Editors","name_suffix":"","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-24T12:01:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/analoggamestudies/article/65625/galley/50391/download/"}]},{"pk":65627,"title":"50 Years of Gen Con Events: A Dataset Analysis","subtitle":null,"abstract":"This article examines tabletop role-playing game (TTRPG) activities at Gen Con, the original, longest-running gaming convention in the world with 70,000+ annual attendees as of 2023 to document two key characteristics of Gen Con RPG events over 50 years: 1) a long-term and increasing transmedia presence, and 2) an overlooked educational function as a format to teach and learn about gaming. By examining TTRPG events at Gen Con between 1968-2017 against a backdrop of 160,000+ convention program offerings, this analysis demonstrates the \"knowledge work\" and transmedia nature of theoretical and ethnographic scholarship about fandom.","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Gen Con"},{"word":"TTRPG"},{"word":"transmedia"},{"word":"fandom"},{"word":"data analysis"},{"word":"education"},{"word":"ethnography"},{"word":"history"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4r74s3ck","frozenauthors":[{"first_name":"Neal","middle_name":"","last_name":"Baker","name_suffix":"","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-24T12:01:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/analoggamestudies/article/65627/galley/50393/download/"}]},{"pk":65626,"title":"An Elegant Little Instrument: The Japanese Standards Association and the Birth of the Modern d20","subtitle":null,"abstract":"This article traces the history of the twenty-sided die or d20. The story of how the d20 became synonymous with wargames and role-playing games is an unlikely one, full of bizarre twists and fortuitous encounters. It includes some familiar characters, such as game designers Gary Gygax and Lou Zocchi, but others less well known in gaming circles, including eminent science writer Martin Gardner, and Ishida Yasushi, a quality control engineer at Toshiba. It spans several decades and three continents, from the seaside town of Kamakura in the autumn of 1950, to the shores of Lake Geneva in the winter of 1973-4.","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"TTRPG"},{"word":"d20"},{"word":"dice"},{"word":"polyhedral"},{"word":"Dungeons & Dragons"},{"word":"D&D"},{"word":"industrial design"},{"word":"history"},{"word":"Japanese Standards Association"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/06t0v6h9","frozenauthors":[{"first_name":"Peter","middle_name":"D.","last_name":"Evan","name_suffix":"","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-24T12:01:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/analoggamestudies/article/65626/galley/50392/download/"}]},{"pk":65628,"title":"From Consumers to Creators: Bridging Game Play and Playful Game Design for Impactful Civic Education","subtitle":null,"abstract":"This paper explores game-based learning in youth work, as games offer immense variety in form and subject matter and can vary from simple to very complex, enabling different learning outcomes from cognitive skills and affective changes (feelings and emotions) to interpersonal social skills. Specifically, the paper presents the findings and experiences of running a project called \"Board Games Design as a Tool in Civic Education,\" which allowed young people take the role of creators and game designers to explore social topics they cared about. The project was a response to the theme of the Slovenian Presidency of the Council of the EU 2021, \"Europe for YOUth – YOUth for Europe: Space for Democracy and Participation,\" which hoped to strengthen young people's democratic participation.","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"board games"},{"word":"game-based learning"},{"word":"game design"},{"word":"youth work"},{"word":"civic education"},{"word":"Paolo Pedercini"},{"word":"democracy"},{"word":"European Union"},{"word":"Slovenia"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0hj3z32j","frozenauthors":[{"first_name":"Sabina","middle_name":"","last_name":"Belc","name_suffix":"","institution":"","department":""},{"first_name":"Joseph","middle_name":"","last_name":"Dumit","name_suffix":"","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-24T12:01:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/analoggamestudies/article/65628/galley/50394/download/"}]},{"pk":55178,"title":"About the Cover","subtitle":null,"abstract":"The cover of volume IV, The Space Between Oceans, was illustrated by our chief designer SeoLee. The woman is outlined with minimal lines, accentuating the negative space, to give thefigure an inclusive silhouette that any reader can project themselves onto. In order to emphasizethe theme of this year’s topic of fluctuating heritage and the fluidity of cross-cultural identity, thecover features motifs of waves. The tea poured by the woman from the traditional pot serves asthe medium through which the white stripes of the American flag bleed into the Japanese-stylewave art to capture the exchange of tradition and communities overseas. The American flagmotif continues on the back cover with the blue moon speckled with white stars. The red, white,and blue color palette encompasses both the famously “American” colors and the lucky shade ofred that many Asian cultures recognize. The woman, or anyone part of the Asian Americandiaspora, is claiming agency over the flow of her cultural heritage as she contributes her story tothe ocean of cross-cultural experiences.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1px5710b","frozenauthors":[{"first_name":"Seo","middle_name":"","last_name":"Lee","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:10:21+03:00","date_accepted":"2024-06-24T11:10:21+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55178/galley/41549/download/"}]},{"pk":55181,"title":"A Recipe for Disaster? Challenging Los Angeles’ Motion to Ban Gas Stoves on Equal Protection Grounds","subtitle":null,"abstract":"This paper explores whether an equal protection challenge to Los Angeles’ motion banninggas stoves in all new residential and commercial buildings is legally viable. Although themotion makes no specific mention of race (making it facially-neutral), Asian Americans haveraised concerns about the potential disproportionate impacts on their communities, due to thecultural significance of gas stoves in Asian cuisine. Stimulating the two-step process forevaluating whether unconstitutional discrimination has occurred from a facially neutral law, Idemonstrate that such litigation would not be legally viable at this time for three reasons.First, the unique circumstances surrounding the affected population make establishingdisparate impact, the first element, much more challenging than similarly situated cases.Second, political processes protecting the pseudo-right of government employees todiscriminate increase the burden of the challenger to prove discriminatory intent, the secondelement. Third, the Los Angeles’ motion would likely survive the “narrowly tailored andcompelling interest” requirement of strict scrutiny review—the final step in an equalprotection challenge. The courts’ rigorous standards for proving unseen forms ofdiscrimination reflect a failure to recognize legacies of systemic inequities appearing underthe guise of neutrality. This is certainly the case for Asian Americans, whose longtimereliance on gas stoves is influenced by Western colonization, exploitation, and theindustrialization of their home nations. Any environmental legislation—howeverwell-meaning—must consider the economic realities of climate policy on the livelihoods ofAsian Americans, which are inextricably intertwined with the climate crisis. In this regard,legislatures can play a powerful role in balancing the state’s decarbonization goals whilesafeguarding marginalized communities from policy’s unintended consequences.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5wg71391","frozenauthors":[{"first_name":"Stephanie","middle_name":"Wing Yin","last_name":"Wong","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:20:58+03:00","date_accepted":"2024-06-24T11:20:58+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55181/galley/41552/download/"}]},{"pk":55180,"title":"Balancing Tongues: ESL Programs in Combating Asian American Stereotypes","subtitle":null,"abstract":"To many immigrant students and students who speak a language other than English athome, ESL (English as a second language) programs are all too familiar. There is muchconversation surrounding the benefits and drawbacks of ESL programs but, historically, theestablishment of programs aiming to provide supplemental English resources to public schoolstudents has overturned students’ equal opportunity for education. Specifically, the 1974 Lau v.Nichols case reinforced the ruling of the Brown v. Board of Education and placed AsianAmericans at the forefront of education. This case occurred during a complex time: theChinatown community was struggling to balance cultural and language preservation with thedesegregation of schools and integration of Chinese students into majority-white schools. Thispaper examines the historical significance of the Lau v. Nichols case and its effects on Englishlanguage programs and Asian American stereotypes.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0v47h2r7","frozenauthors":[{"first_name":"Vickie","middle_name":"","last_name":"Cai","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:19:30+03:00","date_accepted":"2024-06-24T11:19:30+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55180/galley/41551/download/"}]},{"pk":55184,"title":"Breaking the Generational Silence: Collective Healing from Historical Trauma","subtitle":null,"abstract":"Trauma is primarily understood as a personal experience in which an event occurs andleaves long-term psychological distress. However, historical trauma exposes that trauma does notexist in isolation. Historical trauma is defined as “distressing or life-threatening events whichmembers of a group with a shared social identity experience together and pass on to theirdescendants”. This shift from direct survivor to descendant is very nuanced because it can 1manifest in genetic and psychological ways. Historical trauma has been studied in Holocaust 2survivors and Indigenous communities in North America, yet research is lacking AsianAmerican experiences. In this paper, I study historical and intergenerational trauma from the 3Japanese Incarceration Camps and the Khmer Rouge Genocide. This paper does not aim toequate or compare these two dissimilar experiences, but rather, learn from their differingcircumstances. In particular, I focus on the interactions between survivors of these traumaticperiods and their descendants in the United States, using these two perspectives to explorepathways to intergenerational healing.\nTo contextualize these experiences, I synthesized several sources regarding the Japanese American and Cambodian American experiences. For the Japanese American experience, Iinterviewed Evelyn Tanaka (real name omitted for confidentiality), who is a Yonsei(fourth-generation) Japanese American woman and social worker in the Bay Area. To capturethe Cambodian American experience, I utilized Afterparties by Anthony Veasna So, a collection.\nBy exploring these two ethnicities’ nuanced experiences, I seek to investigate howdifferent generations can build compassionate relationships through emotional understanding. Iask, How can the development of emotional literacy between survivors and descendants helpcommunities rediscover their identities and relationships with one another, within and beyond thecontext of their trauma? How can Asian Americans heal in community with one another?","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/56b8d4hv","frozenauthors":[{"first_name":"Zora","middle_name":"","last_name":"Uyeda-Hale","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:29:23+03:00","date_accepted":"2024-06-24T11:29:23+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55184/galley/41555/download/"}]},{"pk":55176,"title":"Chief Editors' Note","subtitle":null,"abstract":"To the community,\nThe Asian American Research Journal (AARJ) is honored and excited to share our fourth issuewith you, “The Space Between Oceans.” Our journal was founded in 2020 as the first AsianAmerican research journal at the University of California, Berkeley. Through our publication,AARJ hopes to further the pursuits of the student activists of the Third World Liberation Front(WTLF) by providing an accessible platform for students to produce and engage with academia. .Thanks to the incredible support of our faculty, peers, and authors, we have grown from our rootsand maintained our goal to provide Asian American and Asian voices with a place to share theirstories.The theme of our fourth edition “The Space Between Oceans” seeks to explore the changinglandscape of Asian American identity and heritage through the scope of immigration, livedexperiences, and historical representation of cross-cultural identity. This volume is a testament tothe fluctuating state of Asian American identity throughout history and today.The Asian American Research Journal would not be possible without the incredible work of ourauthors, editors, designers, faculty, and community members. This volume is the culmination ofthe invaluable work of our board; we’d like to thank our executive editor and chief designer SeoLee, our executive editor Cynthia Rahman, and our communications and finance and operationschair Amy Lee. We’d also like to express a special thanks to the eScholarship team and ourfaculty sponsors Professor Khatharya Um and Professor Vernadette Vicuña Gonzalez. Finally,we’d like to thank our outstanding authors and editors for their contributions toward furtheringAsian American academia and for their dedication to AARJ.“The Space Between Oceans” has been an incredible and rewarding experience. We hope youenjoy reading as much as we have.\nIn Solidarity,\nJulianne Han and Grace Huang\nChief Editors 2023-2024","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/41w9c9dc","frozenauthors":[{"first_name":"Julianne","middle_name":"","last_name":"Han","name_suffix":"","institution":"","department":""},{"first_name":"Grace","middle_name":"","last_name":"Huang","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T10:59:45+03:00","date_accepted":"2024-06-24T10:59:45+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55176/galley/41547/download/"}]},{"pk":55185,"title":"Contributors","subtitle":null,"abstract":"Names and biographies of everyone who made this journal possible.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9dn12359","frozenauthors":[{"first_name":"Julianne","middle_name":"","last_name":"Han","name_suffix":"","institution":"","department":""},{"first_name":"Grace","middle_name":"","last_name":"Huang","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:31:01+03:00","date_accepted":"2024-06-24T11:31:01+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55185/galley/41556/download/"}]},{"pk":55183,"title":"How the COVID-19 Pandemic Reshaped Community Health Needs in San Francisco’s Chinatown: Examining The Historical, Social and Global Upstream Influencers","subtitle":null,"abstract":"A comparison of the San Francisco Chinese Hospital’s Community Health NeedsAssessment (CHNA) from the year 2019 to 2022 reveals striking transformations in top-reportedcommunity health concerns in San Francisco Chinatown during the COVID-19 Pandemic.Thesurvey reports skyrocketing mentions of mental health, community safety, and linguisticallyappropriate health information. These concerns emerged as pressing unmet needs during thepandemic. The spread of the COVID-19 virus alone is not enough to explain these shifts, rather,the sudden change in community health needs highlights the interrelationship between the healthof the individual and their environment. Major changes in social stigma, politics, andcommunication had a direct impact on health during the pandemic. This literature reviewsynthesizes recent literature to uncover how the influence of historical, social, and global factorsduring COVID-19 catalyzed these shifts in health priorities among a vulnerable population. Iargue that historical scapegoating, exclusionary policies, anti-Asian ethnic violence, and novelhealth communication framed and contributed to the greater concerns in safety, mental health,and in-language education, reiterating the embeddedness of health in the social sphere.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2sf1f7s3","frozenauthors":[{"first_name":"Vivian","middle_name":"","last_name":"Lee","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:27:05+03:00","date_accepted":"2024-06-24T11:27:05+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55183/galley/41554/download/"}]},{"pk":55177,"title":"Narrating the ‘Hippie’: Bengali Perceptions of the Trail","subtitle":null,"abstract":"With this paper, I will attempt to shift the focus of the Counterculture of the 1960s and1970s from the Global North and examine how it affected cultural norms and perceptions in theGlobal South. My presentation will look at the ‘Hippie Trail’, a colloquial way to refer to a travelroute taken by many European and North-American youths to the East at the height of thecounterculture movement. The East served as an allegory of varying meanings but travelers oftencame by land from a European center like London and Amsterdam to anywhere relatively east,often ending in South and Southeast Asia. In this presentation, I try to understand the perceptionsof the trail in the Bengali cultural milieu through the literary representation in Satyajit Ray’sdetective Novel, Gangtok-e-Gondogol.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/55v5z26q","frozenauthors":[{"first_name":"Pratiti","middle_name":"","last_name":"Ketoki","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:05:11+03:00","date_accepted":"2024-06-24T11:05:11+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55177/galley/41548/download/"}]},{"pk":55179,"title":"Quality of Elderly Vietnamese Immigrant Healthcare In the Bay Area","subtitle":null,"abstract":"Elderly Vietnamese immigrants experience unique stressors and healthcareincompatibilities that demand an examination of the quality of their physician-patientinteractions. Previous studies on Vietnamese American health disparities demonstrate concernsover stroke rates, heart disease, and reluctance to communicate with health providers. Particularstructural, political, cultural, and behavioral effects resulting from forcible immigration from theVietnam War and communism have exacerbated healthcare complications. To study the depth ofthese effects, I surveyed and interviewed Vietnamese individuals sixty years of age or older whoimmigrated to America. These surveys and interviews allowed participants to rate their primarycare physicians on different metrics to demonstrate their level of satisfaction with theirpatient-physician interactions holistically and to connect these ratings to their personal levels ofintegration within American society and ability to navigate American healthcare systems. Theresults surprisingly demonstrate an overwhelmingly positive response towards Americanhealthcare,highlighting not the challenges that Vietnamese elderly face in regards to achievingsatisfactory levels of healthcare, but rather the means through which they have overcome thedifficulties of acculturation and gained access to quality healthcare. My findings indicate successstories in traversing the difficult realm of healthcare for these Vietnamese elderly individuals,whether through their education and information seeking or through caretakers who are capableof providing for them and provide insight into how we can extend this success to others stillstruggling to find quality healthcare. To expand upon these findings, I suggest conductingsimilar surveys and interviews, but with a larger sample of Vietnamese Americans, includingdiversity in education, income, class, employment, and family/home life, as this study was mostlimited by its small and non-diverse sample.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2kh5j95n","frozenauthors":[{"first_name":"Nicole","middle_name":"","last_name":"Lai","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:14:52+03:00","date_accepted":"2024-06-24T11:14:52+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55179/galley/41550/download/"}]},{"pk":55182,"title":"Resistance from Overseas: U.S. Diasporic and Transnational Activism in Response to the 2021 Myanmar Military Coup","subtitle":null,"abstract":"While homeland activism among the Burmese diaspora in the United States experienceda decline in momentum throughout Myanmar’s democratic transition period (2011-2021), therehas been a discernible shift since the 2021 Myanmar Military Coup. The junta’s attempts tothwart the formation of organized resistance proved unsuccessful against the rise of a newtransnational social movement—the Spring Revolution. With the 2021 Myanmar Military Coupcontinuing to unfold, this study seeks to discuss how modal and ideological shifts influence thediasporic and transnational dimensions of homeland activism among Burmese Americans.Existing literature on Burmese diasporic and transnational activism has largely focused on socialmovements responding to the 8888 Uprising (1988) and Saffron Revolution (2007). WhileBurmese Americans have traditionally played an active role in delivering political and economicremittances to Myanmar’s pro-democracy forces, the U.S. Burmese diaspora has not beenoperating on the same modality of precursive social movements. This study explores the U.S.Burmese diaspora’s responses to the 2021 Myanmar Military Coup, closely examining the goals,visions, tactics, and strategies that U.S. Burmese activist organizations operated under. Usingsemi-structured and in-depth interviews, the findings of this research suggest three key sites ofadvocacy within the U.S. Burmese diaspora: 1) networking and coalition-building across ethnic,religious, and political boundaries, 2) political lobbying to shape U.S. foreign policy onMyanmar, and 3) cross-border assistance through economic remittances and on-the-groundcoordination.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4836x48v","frozenauthors":[{"first_name":"Diane","middle_name":"","last_name":"Chao","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T11:25:43+03:00","date_accepted":"2024-06-24T11:25:43+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55182/galley/41553/download/"}]},{"pk":55175,"title":"Table of Contents","subtitle":null,"abstract":"List of all works.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivatives 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/91b2r1dz","frozenauthors":[{"first_name":"Julianne","middle_name":"","last_name":"Han","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-24T10:56:49+03:00","date_accepted":"2024-06-24T10:56:49+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/aarj/article/55175/galley/41546/download/"}]},{"pk":41469,"title":"Whole genome analysis of spontaneous antimicrobial resistance in Liberibacter crescens suggests long-term efficacy for antimicrobial treatment of citrus greening disease","subtitle":null,"abstract":"Currently, oxytetracycline and streptomycin are being applied to citrus groves in Florida for the control of citrus greening disease caused by the unculturable bacterium Candidatus Liberibacter asiaticus. Here, the closest cultured relative, L. crescens , was used to estimate the frequency of spontaneous antimicrobial resistance of Liberibacter spp. Results yielded thirteen streptomycin and zero oxytetracycline mutants after exposing 13 billion cells to the antimicrobials. These low rates, alongside the restrictive habitats of the vector and pathogen, suggest resistance may develop very slowly, if at all. Thus, the treatments will likely remain useful long enough before pathogen-resistant or -tolerant genotypes are deployed.
","language":null,"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":"Candidatus Liberibacter asiaticus"},{"word":"Streptomycin"},{"word":"Oxytetracycline"},{"word":"AMR"},{"word":"HLB"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2s35d2fw","frozenauthors":[{"first_name":"Paula","middle_name":"","last_name":"Rios Glusberger","name_suffix":"","institution":"University of Florida","department":"None"},{"first_name":"Jordan","middle_name":"T.","last_name":"Russell","name_suffix":"","institution":"","department":"None"},{"first_name":"Alexa","middle_name":"R.","last_name":"Cohn","name_suffix":"","institution":"","department":"None"},{"first_name":"Joseph","middle_name":"R.","last_name":"Petrone","name_suffix":"","institution":"","department":"None"},{"first_name":"Kin-Kwan","middle_name":"","last_name":"Lai","name_suffix":"","institution":"","department":"None"},{"first_name":"Eric","middle_name":"W.","last_name":"Triplett","name_suffix":"","institution":"University of Florida","department":"None"}],"date_submitted":"2023-10-12T20:29:14+03:00","date_accepted":"2023-10-12T20:29:14+03:00","date_published":"2024-06-24T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/iocv_journalcitruspathology/article/41469/galley/31045/download/"}]},{"pk":24889,"title":"Privacy and Precedent: Exploring the Factors Influencing the U.S. Supreme Court’s Departures from Precedent","subtitle":null,"abstract":"This thesis explores the factors that influence the US Supreme Court’s decisions to overturn precedent. I argue that the Court is more likely to depart from precedent in cases relating to the right to privacy due to the dynamic nature of privacy rights and their inherent connection to rapidly evolving technology and societal values. As society grapples with digital surveillance, data collection, and personal freedoms, the question of how the Supreme Court navigates past precedents in the face of new realities becomes increasingly relevant. I find that privacy precedents are more likely to be altered than other subject matter. This research contributes to a deeper understanding of the common law system’s adaptability in the face of contemporary challenges by examining the Court’s decisions to overturn precedents based on subject matter.
","language":"eng","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":"Supreme Court"},{"word":"digital surveilance"},{"word":"data collection"},{"word":"personal freedoms"},{"word":"privacy precedent"},{"word":"stare decisis"},{"word":"overturning precedent"},{"word":"privacy rights"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2fn7s76d","frozenauthors":[{"first_name":"Luna","middle_name":"","last_name":"Gilson","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-18T02:21:13.570000+03:00","date_accepted":"2024-06-18T02:22:57.308000+03:00","date_published":"2024-06-22T19:27:12.303000+03:00","render_galley":null,"galleys":[{"label":"LunaTypeset","type":"pdf","path":"https://journalpub.escholarship.org/ucsdulr/article/24889/galley/14580/download/"}]},{"pk":41470,"title":"Applying volumetric electron microscopy to visualize xylem tissue impacted by citrus tristeza virus-induced stem pitting","subtitle":null,"abstract":"Citrus tristeza virus (CTV) causes several disease syndromes in different citrus hosts: quick decline, seedling yellows and stem pitting. CTV-induced stem pitting leads to substantial economic losses in sensitive citrus varieties, including grapefruit. The formation of stem pits has previously been linked to the ability of the virus to colonize xylem tissue outside of its typical phloem limitation, thereby disrupting normal xylem development. The nature of this compromised tissue has not been fully elucidated. In this study, stem pits were characterized at the molecular anatomical level using a combination of techniques to better understand the characteristics of the xylem and phloem tissues impacted by severe pitting. Biological staining was used to visualize CTV-induced stem pitting and was complemented with a novel technology that has not previously been used to study CTV-induced stem pitting, namely serial block-face scanning electron microscopy (SBF-SEM). This proof-of-concept study yielded new insights into the morphology of stem pitting-affected tissue. The utility of SBF-SEM for stem pitting characterization was also demonstrated and an optimized protocol for its application on hard, woody material is presented.
","language":null,"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":"CTV"},{"word":"3DEM"},{"word":"SBF-SEM"},{"word":"Software renderings"},{"word":"Biological staining"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5ks4156z","frozenauthors":[{"first_name":"Dirk","middle_name":"Jacobus","last_name":"Aldrich","name_suffix":"","institution":"Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa","department":"None"},{"first_name":"Jurgen","middle_name":"","last_name":"Kriel","name_suffix":"","institution":"Central Analytical Facilities, Microscopy Unit, Stellenbosch University, Cape Town, South Africa","department":"None"},{"first_name":"Rachelle","middle_name":"","last_name":"Bester","name_suffix":"","institution":"Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa\n\nCitrus Research International, PO Box 2201, Matieland, 7602, South Africa","department":"None"},{"first_name":"Johan","middle_name":"Theodorus","last_name":"Burger","name_suffix":"","institution":"Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa","department":"None"},{"first_name":"Hans","middle_name":"Jacob","last_name":"Maree","name_suffix":"","institution":"Department of Genetics, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa\n\nCitrus Research International, PO Box 2201, Matieland, 7602, South Africa","department":"None"}],"date_submitted":"2023-11-14T16:12:07+03:00","date_accepted":"2023-11-14T16:12:07+03:00","date_published":"2024-06-21T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/iocv_journalcitruspathology/article/41470/galley/31046/download/"}]},{"pk":18082,"title":"A Measure of the Impact on Real-Time Patient Care of Evidence-based Medicine Logs","subtitle":null,"abstract":"Introduction: Evidence-based medicine (EBM) is a critical skill for physicians, and EBM competency has been shown to increase implementation of best medical practices, reduce medical errors, and increase patient-centered care. Like any skill, EBM must be practiced, receiving iterative feedback to improve learners’ comprehension. Having residents document patient interactions in logbooks to allow for residency program review, feedback, and documentation of competency has been previously described as a best practice within emergency medicine (EM) to document practice-based learning (PBL) competency. Quantifying how residents use the information they query, locate, evaluate, and apply while providing direct patient care can measure the efficacy of EBM education and provide insight into more efficient ways of providing medical care.
\nMethods: Practice-based learning logs were surveys created to record resident EBM activity on-shift and were placed into our residency management software program. Residents were required to submit 3–5 surveys of EBM activity performed during a 28-day rotation during which additional information was sought. This study included all PBL logs completed by EM residents from June 1, 2013–May 11, 2020. Using qualitative methodology, a codebook was created to analyze residents’ free-text responses to the prompt: “Based on your research, would you have done anything differently?” The codebook was designed to generate a three-digit code conveying the effect of the researched information on the patient about whom the log was written, as well as whether the information would affect future patient care and whether these decisions were based on scientific evidence.
\nResults: A total of 10,574 logs were included for primary analysis. In total, 1,977 (18.7%) logs indicated that the evidence acquired through research would affect future patient care. Of these, 392 (3.7%) explicitly stated that the EBM activity conducted as part of our project led to real-time changes in patient care in the ED and would change future management of patients as well.
\nConclusion: We present a proof of concept that PBL log activity can lead to integration of evidence-based medicine into real-time patient care. While a convenience sample, our cohort recorded evidence of both lifelong learning and application to patient care.
","language":null,"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":"Residents"},{"word":"Graduate Medical Education"},{"word":"Evidence-based medicine"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5dq882xq","frozenauthors":[{"first_name":"Jeffrey","middle_name":"B.","last_name":"Brown","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Ajay","middle_name":"K.","last_name":"Varadhan","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Jacob","middle_name":"R.","last_name":"Albers","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Shreyas","middle_name":"","last_name":"Kudrimoti","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Estelle","middle_name":"","last_name":"Cervantes","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Phillip","middle_name":"","last_name":"Sgobba","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Dawn","middle_name":"M.","last_name":"Yenser","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"},{"first_name":"Bryan","middle_name":"G.","last_name":"Kane","name_suffix":"","institution":"Lehigh Valley Health Network, University of South Florida Morsani College of Medicine, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania","department":"None"}],"date_submitted":"2023-04-20T22:08:31+03:00","date_accepted":"2023-04-20T22:08:31+03:00","date_published":"2024-06-20T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18082/galley/14515/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18082/galley/10653/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18082/galley/14515/download/"}]},{"pk":18400,"title":"Perceived Versus Actual Time of Prehospital Intubation by Paramedics","subtitle":null,"abstract":"Introduction: Situational awareness is essential during emergent procedures such as endotracheal intubation. Previous studies suggest that time distortion can occur during intubation. However, only in-hospital intubations performed by physicians have been studied. We aimed to determine whether time distortion affected paramedics performing intubation by examining the perceived vs actual total laryngoscopy time, defined as time elapsed from the laryngoscope blade entering the mouth until the endotracheal tube balloon passes the vocal cords.
\nMethods: For this retrospective study we collected prehospital intubation data from a suburban, fire department-based emergency medical services (EMS) system from January 5, 2021–May 21, 2022. The perceived total laryngoscopy time was queried as a part of the electronic health record. Video laryngoscopy recordings were reviewed by a panel of experts to determine the actual time. Patients >18 years old who underwent intubation by paramedics with video laryngoscopy were included for analysis. The primary outcome was the difference between actual and perceived total laryngoscopy time. Secondary analysis examined the relationship between high time distortion, defined as the highest quartile of the primary outcome, and patient age, paramedic years of experience, perceived presence of difficult anatomy, excess secretions, use of rapid sequence intubation, and multiple intubation attempts. We conducted descriptive analysis followed by logistic regression analysis, chi-square tests, and Fisher exact tests when appropriate.
\nResults: A total of 122 intubations were collected for analysis, and 10 were excluded due to lack of video recording. Final analysis included 112 intubations. Mean actual laryngoscopy time was 50.0 seconds (s)(95% confidence interval [CI] 43.7–56.3). Mean perceived laryngoscopy time was 27.8 s (95% CI 24.7–31.0). The median difference between actual and perceived time was 18 s (interquartile range 6–30). We calculated high time distortion as having a difference greater than 30 s between actual and perceived laryngoscopy time. None of the secondary variables had statistically significant associations with high time distortion. Overall, we show that the paramedic’s perception of total laryngoscopy time is significantly underestimated even when accounting for paramedic experience and perceived airway difficulty.
\nConclusion: This study suggests that time distortion may lead to an unrecognized prolonged procedure time. Limitations include use of a convenience sample, small sample size, and potential uncollected confounding variables.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"intubation"},{"word":"paramedic"},{"word":"procedure"},{"word":"Laryngoscopy"},{"word":"situational awareness"}],"section":"Prehospital Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3tp314qj","frozenauthors":[{"first_name":"Daniel","middle_name":"","last_name":"Shou","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Matthew","middle_name":"","last_name":"Levy","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; Howard County Department of Fire and Rescue Services, Office of the Chief Medical Officer, Marriottsville, Maryland","department":"None"},{"first_name":"Ruben","middle_name":"","last_name":"Troncoso","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; Howard County Department of Fire and Rescue Services, Office of the Chief Medical Officer, Marriottsville, Maryland","department":"None"},{"first_name":"Becca","middle_name":"","last_name":"Scharf","name_suffix":"","institution":"Howard County Department of Fire and Rescue Services, Office of the Chief Medical Officer, Marriottsville, Maryland","department":"None"},{"first_name":"Asa","middle_name":"","last_name":"Margolis","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; Howard County Department of Fire and Rescue Services, Office of the Chief Medical Officer, Marriottsville, Maryland","department":"None"},{"first_name":"Eric","middle_name":"","last_name":"Garfinkel","name_suffix":"","institution":"Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; Howard County Department of Fire and Rescue Services, Office of the Chief Medical Officer, Marriottsville, Maryland","department":""}],"date_submitted":"2023-07-13T04:30:57+03:00","date_accepted":"2024-02-29T22:32:37.258000+03:00","date_published":"2024-06-20T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18400/galley/14512/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18400/galley/10805/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18400/galley/14512/download/"}]},{"pk":18335,"title":"Role of the Critical Care Resuscitation Unit in a Comprehensive Stroke Center: Operations for Mechanical Thrombectomy During the Pandemic","subtitle":null,"abstract":"Introduction: Standard of care for patients with acute ischemic stroke from large vessel occlusion (AISLVO) includes prompt evaluation for urgent mechanical thrombectomy (MT) at a comprehensive stroke center (CSC). During the start of the coronavirus 2019 pandemic (COVID-19), there were reports about disruption to emergency department (ED) operations and delays in management of patients with AIS-LVO. In this study we investigate the outcome and operations for patients who were transferred from different EDs to an academic CSC’s critical care resuscitation unit (CCRU), which specializes in expeditious transfer of time-sensitive disease.
\nMethods: This was a pre-post retrospective study using prospectively collected clinical data from our CSC’s stroke registry. Adult patientswho were transferred fromany ED to the CCRUand underwent MT were eligible. We compared time intervals in the pre-pandemic (PP) period between January 2018– February 2020, such as ED in-out and CCRU arrival-angiography, to those during the pandemic (DP) between March 2020–May 31, 2021. We used classification and regression tree (CART) analysis to identify which time intervals, besides clinical factors, were associated with good neurological outcome (90-day modified Rankin scale 0–2).
\nResults: We analyzed 203 patients: 135 (66.5%) in the PP group and 68 (33.5%) in the DP group. Time from ED triage to computed tomography (difference 7 minutes, 95% confidence interval [CI] −12 to −1, P < 0.01) for the DP group was statistically longer, but ED in-out was similar for both groups. Time from CCRU arrival to angiography (difference 9 minutes, 95% CI 4–13, P < 0.01) for the DP group was shorter. Forty-nine percent of the DP group achieved mRS ≤ 2 vs 32% for the PP group (difference −17%, 95% CI −0.32 to −0.03, P < 0.01). The CART identified initial National Institutes of Health Stroke Scale, age, ED in-and-out time, and CCRU arrival-to-angiography time as important predictors of good outcome.
\nConclusion: Overall, the care process in EDs and at this single CSC for patients requiring MT were not heavily affected by the pandemic, as certain time metrics during the pandemic were statistically shorter than pre-pandemic intervals. Time intervals such as ED in-and-out and CCRU arrival-to-angiography were important factors in achieving good neurologic outcomes. Further study is necessary to confirm our observation and improve operational efficiency in the future.
","language":null,"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":"Critical care"},{"word":"CCRU"},{"word":"mechanical thrombectomy"},{"word":"stroke"},{"word":"large vessel occlusion"},{"word":"operation"},{"word":"Pandemic"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8j59j059","frozenauthors":[{"first_name":"Quincy","middle_name":"K.","last_name":"Tran","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland","department":""},{"first_name":"Robinson","middle_name":"","last_name":"Okolo","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"William","middle_name":"","last_name":"Gum","name_suffix":"","institution":"University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland","department":"None"},{"first_name":"Manal","middle_name":"","last_name":"Faisal","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Vainavi","middle_name":"","last_name":"Gambhir","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Aditi","middle_name":"","last_name":"Singh","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland","department":"None"},{"first_name":"Zoe","middle_name":"","last_name":"Gasparotti","name_suffix":"","institution":"University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland","department":"None"},{"first_name":"Chad","middle_name":"","last_name":"Schrier","name_suffix":"","institution":"University of Maryland Medical Center, Department of Neurology, Baltimore,Maryland","department":"None"},{"first_name":"Gaurav","middle_name":"","last_name":"Jindal","name_suffix":"","institution":"University of Maryland Medical Center, Department of Neurology, Baltimore,Maryland; University of Maryland School of Medicine, Department of Neuroradiology, Baltimore, Maryland","department":"None"},{"first_name":"William","middle_name":"","last_name":"Teeter","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland","department":""},{"first_name":"Jessica","middle_name":"","last_name":"Downing","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program in Emergency & Critical Care, Baltimore, Maryland; University of Maryland Medical Center, Critical Care Resuscitation Unit, Baltimore, Maryland","department":""},{"first_name":"Daniel","middle_name":"J.","last_name":"Haase","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Program in Trauma, Baltimore, Maryland","department":""}],"date_submitted":"2023-05-31T13:33:55+03:00","date_accepted":"2024-03-05T03:24:51.110000+03:00","date_published":"2024-06-20T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18335/galley/14514/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18335/galley/10893/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18335/galley/14514/download/"}]},{"pk":18462,"title":"What the Fika? Implementation of Swedish Coffee Breaks During Emergency Medicine Conference","subtitle":null,"abstract":"Introduction: In this study we aimed to investigate the effects of incorporating Swedish-style fika (coffee) breaks into the didactic schedule of emergency medicine residents on their sleepiness levels during didactic sessions. Fika is a Swedish tradition that involves a deliberate decision to take a break during the workday and usually involves pastries and coffee. We used the Karolinska Sleepiness Scale to assess changes in sleepiness levels before and after the implementation of fika breaks.
\nMethods: The study design involved a randomized crossover trial approach, with data collected from emergency medicine residents over a specific period. This approach was done to minimize confounding and to be statistically efficient.
\nResults: Results revealed the average sleepiness scale was 4.6 and 5.5 on fika and control days, respectively (P = 0.004).
\nConclusion: Integration of fika breaks positively influenced sleepiness levels, thus potentially enhancing the educational experience during residency didactics.
","language":null,"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":"didactics"},{"word":"Residency"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7f42038g","frozenauthors":[{"first_name":"Jesse","middle_name":"Zane","last_name":"Kellar","name_suffix":"","institution":"Saint Agnes Medical Center, Department of Emergency Medicine, Fresno, California","department":""},{"first_name":"Hanna","middle_name":"","last_name":"Barrett","name_suffix":"","institution":"Saint Agnes Medical Center, Department of Emergency Medicine, Fresno, California","department":""},{"first_name":"Jaclyn","middle_name":"","last_name":"Floyd","name_suffix":"","institution":"Eisenhower Health, Emergency Medicine Residency, Rancho Mirage, California","department":""},{"first_name":"Michelle","middle_name":"","last_name":"Kim","name_suffix":"","institution":"Riverside Community Hospital, Department of Emergency Medicine, Riverside, California","department":""},{"first_name":"Matthias","middle_name":"","last_name":"Barden","name_suffix":"","institution":"Eisenhower Health, Emergency Medicine Residency, Rancho Mirage, California","department":""},{"first_name":"Jason","middle_name":"","last_name":"An","name_suffix":"","institution":"Riverside Community Hospital, Department of Emergency Medicine, Riverside, California","department":""},{"first_name":"Ashley","middle_name":"","last_name":"Garispe","name_suffix":"","institution":"Saint Agnes Medical Center, Department of Emergency Medicine, Fresno, California","department":""},{"first_name":"Matthew","middle_name":"","last_name":"Hysell","name_suffix":"","institution":"Emergency Medicine Residency Corewell Health South, Graduate Medical Education Department, St. Joseph, Michigan","department":""}],"date_submitted":"2023-09-13T04:17:18+03:00","date_accepted":"2024-02-29T18:58:58.006000+03:00","date_published":"2024-06-20T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18462/galley/14513/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18462/galley/10798/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18462/galley/14513/download/"}]},{"pk":3932,"title":"Gebel Moya (Site 100)","subtitle":null,"abstract":"Gebel Moya, officially known as Site 100, is a large agricultural-pastoral site located below the Nile’s Sixth Cataract in Sudan. It lies between the Blue Nile and White Nile in what is now a semi-desert environment. It was first excavated by Henry Wellcome in the early twentieth century and was known as a cemetery until 2017, when fieldwork was renewed by a joint international mission. Current excavations show that, in addition to being a major cemetery, the site bears traces of Mesolithic habitation. Over a period of 5,000 years the area witnessed rapid climate change, and ongoing work is focused on reconstructing the ancient flora and fauna. It is now clear that Site 100, long considered insignificant by scholars, was home to dynamic communities across the millennia.
","language":"eng","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":"Upper Nile Region","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8125t582","frozenauthors":[{"first_name":"Isabelle","middle_name":"","last_name":"Vella Gregory","name_suffix":"","institution":"","department":""}],"date_submitted":"2022-05-10T19:40:26+03:00","date_accepted":"2024-06-17T11:48:36.502000+03:00","date_published":"2024-06-17T11:50:00+03:00","render_galley":{"label":"Galley 3932v1_Gebel Moya","type":"pdf","path":"https://journalpub.escholarship.org/nelc_uee/article/3932/galley/14457/download/"},"galleys":[{"label":"Galley 3932v1_Gebel Moya","type":"pdf","path":"https://journalpub.escholarship.org/nelc_uee/article/3932/galley/14457/download/"}]},{"pk":42164,"title":"Bringing Real Life into the Classroom: Learning in Nearness & Distance","subtitle":null,"abstract":"This article details and reflects on how student learning was elevated to a new level through inviting real life into the classroom of a course in cultural understanding, aimed at engineering students at the Norwegian University of Science and Technology. In preceding years, the learning was organized as two group assignments where students authored a make-believe narrative, wherein a technical project was accomplished in collaboration with a foreign party. This year, the students’ second project was a collaboration with social science students from the West University in Timișoara. The students not only learned facts about Romanian culture, but, more importantly, they became immersed in culture as an experience and a process, observing a turn from culture understood as a reified scientific entity, to culture as an environment or lifeworld. Rather than trying to approach culture at a distance, distance itself became the students’ environment. Only as the students came to accept a state of unknowing, with associated feelings of frustration and anxiety, were they able to dwell in a nearness to Romanian culture quite unlike that in which a “native” dwells. The students’ project solutions evocate this nearness. In previous projects, cultural challenges were hurdles for the technical product that needed solving much like any technical hurdle. This relationship was flipped upside down in the real collaboration, putting technical products in the service of culture rather than the other way around. We show and discuss how our open-ended pedagogical philosophy was critical in unlocking this new level of learning.","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNonCommercial — You may not use the material for commercial purposes.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"Culture"},{"word":"active learning"},{"word":"Remote Collaboration"},{"word":"Communication"},{"word":"Problem-based learning"},{"word":"pedagogy"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6sb3r8pc","frozenauthors":[{"first_name":"Alexander","middle_name":"","last_name":"Berntsen","name_suffix":"","institution":"Studio Apertura, NTNU Social Research, and Department of Social Anthropology, NTNU","department":"None"},{"first_name":"Håkon","middle_name":"","last_name":"Fyhn","name_suffix":"","institution":"NTNU","department":"None"},{"first_name":"Hans Martin","middle_name":"","last_name":"Thomassen","name_suffix":"","institution":"NTNU","department":"None"},{"first_name":"Trond","middle_name":"","last_name":"Berge","name_suffix":"","institution":"NTNU","department":"None"},{"first_name":"Melinda","middle_name":"","last_name":"Dinca","name_suffix":"","institution":"WUT","department":"None"}],"date_submitted":"2022-02-04T11:38:20+03:00","date_accepted":"2022-02-04T11:38:20+03:00","date_published":"2024-06-16T01:38:33+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42164/galley/31483/download/"}]},{"pk":6667,"title":"Antecedents of Procrastination-Examining the Role of Academic Identity, and Self-Esteem","subtitle":null,"abstract":"Procrastination is a widespread problem among students, yet feasible solutions have remained elusive. Recognizing the detrimental impact of procrastination on students’ potential, this study aims to investigate the underlying factors contributing to this problem. Specifically, this study explores the associations between academic identity, self-esteem, and procrastination in both male and female participants. Previous research suggests a negative relationship between self-esteem and procrastination. There has been substantially less research examining the relationship between academic identity types (i.e., achieved, foreclosed, moratorium, and diffused academic identity) and procrastination. The current study surveyed 244 college students about their personality habits, academic identity, and self-esteem. It was hypothesized that self-esteem would moderate the relationship between achieved academic identity and procrastination. Regression analyses support this hypothesis, indicating that college students who have a well-developed sense of achieved academic identity are less likely to procrastinate in academic settings, especially for students high in self-esteem. Additionally, results suggest students who have not made a commitment to academic goals and values, are more likely to procrastinate. Theoretical implications for studying academic identity and procrastination will be discussed, along with intervention recommendations for college students.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"Academic identity"},{"word":"Self-Esteem"},{"word":"Procrastination"},{"word":"Academic identity self-esteem"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4hg5j8k9","frozenauthors":[{"first_name":"Yohannes","middle_name":"N","last_name":"Tsigab","name_suffix":"","institution":"University of California, Riverside","department":"Psychology"}],"date_submitted":"2024-01-09T01:36:48.174000+03:00","date_accepted":"2024-04-08T18:17:03.662000+03:00","date_published":"2024-06-15T22:00:00+03:00","render_galley":{"label":"Yohannes N. Tsigab","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/6667/galley/28627/download/"},"galleys":[{"label":"Yohannes N. Tsigab","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/6667/galley/28627/download/"}]},{"pk":7213,"title":"A 77-Year-Old Male with a Rapid Change in Mental Status","subtitle":null,"abstract":"A 77-year-old male who presented to the emergency department with generalized weakness and worsening chronic dysphagia was diagnosed with pneumonia. Shortly after receiving vascular access for his treatment, he had a rapid change in his mental status and neurological examination.
","language":"eng","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":"Air embolism"},{"word":"stroke"},{"word":"CPC"}],"section":"Clinicopathological Cases from the University of Maryland","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2qv5t80j","frozenauthors":[{"first_name":"Andrew","middle_name":"","last_name":"Piner","name_suffix":"","institution":"University of Maryland Medical Center, Baltimore, Maryland","department":""},{"first_name":"Spencer","middle_name":"S.","last_name":"Lovegrove","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"Laura","middle_name":"J.","last_name":"Bontempo","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""},{"first_name":"T.","middle_name":"Andrew","last_name":"Windsor","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland","department":""}],"date_submitted":"2024-01-18T04:35:13.899000+03:00","date_accepted":"2024-03-18T23:48:11.911000+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7213/galley/14451/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7213/galley/10835/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7213/galley/14451/download/"}]},{"pk":18401,"title":"Compartment Syndrome Following Snake Envenomation in the United States: A Scoping Review of the Clinical Literature","subtitle":null,"abstract":"Introduction: Local tissue destruction following envenomation from North American snakes, particularly those within the Crotalinae subfamily, has the potential to progress to compartment syndrome. The pathophysiology of venom-induced compartment syndrome (VICS) is a debated topic and is distinct from trauma/reperfusion-induced compartment syndrome. Heterogeneity exists in the treatment practices of VICS, particularly regarding the decision to progress to fasciotomy. Associations with functional outcomes and evolution in clinical practice since the introduction of Crotalidae polyvalent immune Fab (FabAV) have not been well defined. Our goal was to identify the potential gaps in the literature regarding this phenomenon, as well as illuminate salient themes in the clinical characteristics and treatment practices of VICS.
\nMethods: We conducted this systematic scoping-style review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were included if they contained data surrounding the envenomation and hospital course of one or more patients who were envenomated by a snake species native to North America and were diagnosed with compartment syndrome
from 1980–2020.
Results: We included 19 papers: 10 single- or two-patient case reports encompassing 12 patients, and nine chart reviews providing summary statistics of the included patients. In case reports, the median compartment pressure when reported was 60 millimeters of mercury (interquartile range 55–68), 66% underwent fasciotomy, and functional outcomes varied. Use of antivenom appeared to be more liberal with FabAV than the earlier antivenin Crotalidae polyvalent. Rapid progression of swelling was the most commonly reported symptom. Among the included retrospective chart reviews, important data such as compartment pressures, consistent laboratory values, and snake species was inconsistently reported.
\nConclusions: Venom-induced compartment syndrome is relatively rare. Existing papers generally describe good outcomes even in the absence of surgical management. Significant gaps in the literature regarding antivenom dosing practices, serial compartment pressure measurements, and functional outcomes highlight the need for prospective studies and consistent standardized reporting.
","language":null,"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":"antivenom"},{"word":"Snakes"},{"word":"Crotalinae"},{"word":"Compartment Syndromes"}],"section":"Toxicology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5c93k6d6","frozenauthors":[{"first_name":"John","middle_name":"","last_name":"Newman","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia; Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology, Nashville, Tennessee","department":"None"},{"first_name":"Colin","middle_name":"","last_name":"Therriault","name_suffix":"","institution":"University of Illinois College of Medicine, Department of Emergency Medicine, Peoria, Illinois","department":"None"},{"first_name":"Mia","middle_name":"S.","last_name":"White","name_suffix":"","institution":"Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Nogee","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia; Georgia Poison Center, Atlanta, Georgia","department":"None"},{"first_name":"Joseph","middle_name":"E.","last_name":"Carpenter","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia; Georgia Poison Center, Atlanta, Georgia","department":""}],"date_submitted":"2023-07-13T20:54:24+03:00","date_accepted":"2023-07-13T20:54:24+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18401/galley/14446/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18401/galley/10126/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18401/galley/14446/download/"}]},{"pk":18413,"title":"Impact of Bystander Cardiopulmonary Resuscitation on Out-of- Hospital Cardiac Arrest Outcome in Vietnam","subtitle":null,"abstract":"Introduction: Patients experiencing an out-of-hospital cardiac arrest (OHCA) frequently do not receive bystander cardiopulmonary resuscitation (CPR), especially in low- and middle-income countries (LMIC). In this study we sought to determine the prevalence of OHCA patients in Vietnam who received bystander CPR and its effects on survival outcomes.
\nMethods: We performed a multicenter, retrospective observational study of patients (≥18 years) presenting with OHCA at three major hospitals in an LMIC from February 2014–December 2018. We collected data on the hospital and patient characteristics, the cardiac arrest events, the emergency medical services (EMS) system, the therapy methods, and the outcomes and compared these data, before and after pairwise 1:1 propensity score matching, between patients who received bystander CPR and those who did not. Upon admission, we assessed factors associated with good neurological survival at hospital discharge in univariable and multivariable logistic models.
\nResults: Of 521 patients, 388 (74.5%) were men, and the mean age was 56.7 years (SD 17.3). Although most cardiac arrests (68.7%, 358/521) occurred at home and 78.8% (410/520) were witnessed, a low proportion (22.1%, 115/521) of these patients received bystander CPR. Only half of the patients were brought by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521), 50.8% (133/262) of whom had resuscitation attempts. Before matching, there was a significant difference in good neurological survival between patients who received bystander CPR (12.2%, 14/115) and patients who did not (4.7%, 19/406; P < .001). After matching, good neurological survival was absent in all OHCA patients who did not receive CPR from a bystander. The multivariable analysis showed that bystander CPR (adjusted odds ratio: 3.624; 95% confidence interval 1.629–8.063) was an independent predictor of good neurological survival.
\nConclusion: In our study, only 22.1% of total OHCA patients received bystander CPR, which contributed significantly to a low rate of good neurological survival in Vietnam. To improve the chances of survival with good neurological functions of OHCA patients, more people should be trained to perform bystander CPR and teach others as well. A standard program for emergency first-aid training is necessary for this purpose.
","language":null,"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":"Bystander Cardiopulmonary Resuscitation"},{"word":"emergency medical services"},{"word":"low- and middle-income countries"},{"word":"Out-of-hospital Cardiac Arrest"},{"word":"Pan-Asian Resuscitation Outcomes Study"},{"word":"return of spontaneous circulation"},{"word":"Vietnam"}],"section":"Cardiology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/663530m7","frozenauthors":[{"first_name":"Co","middle_name":"Xuan","last_name":"Dao","name_suffix":"","institution":"*Bach Mai Hospital, Center for Critical Care Medicine, Hanoi, Vietnam; Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam","department":"None"},{"first_name":"Chinh","middle_name":"Quoc","last_name":"Luong","name_suffix":"","institution":"Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam","department":"Center for Emergency Medicine"},{"first_name":"Toshie","middle_name":"","last_name":"Manabe","name_suffix":"","institution":"Nagoya City University Graduate School of Medicine, Department of Medical Innovation, Nagoya, Aichi, Japan; Nagoya City University West Medical Center, Center for Clinical Research, Nagoya, Aichi, Japan","department":"None"},{"first_name":"My","middle_name":"Ha","last_name":"Nguyen","name_suffix":"","institution":"Thai Binh University of Medicine and Pharmacy, Department of Health Organization and Management, Thai Binh, Vietnam","department":""},{"first_name":"Dung","middle_name":"Thi","last_name":"Pham","name_suffix":"","institution":"Thai Binh University of Medicine and Pharmacy, Department of Nutrition and Food Safety, Thai Binh, Vietnam","department":"None"},{"first_name":"Tra","middle_name":"Thanh","last_name":"Ton","name_suffix":"","institution":"Cho Ray Hospital, Emergency Department, Ho Chi Minh City, Vietnam","department":"None"},{"first_name":"Quoc","middle_name":"Trong Ai","last_name":"Hoang","name_suffix":"","institution":"Hue Central General Hospital, Emergency Department, Hue City, Thua Thien Hue, Vietnam","department":"None"},{"first_name":"Tuan","middle_name":"Anh","last_name":"Nguyen","name_suffix":"","institution":"Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam","department":"None"},{"first_name":"Anh","middle_name":"Dat","last_name":"Nguyen","name_suffix":"","institution":"Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam","department":"None"},{"first_name":"Bryan","middle_name":"Francis","last_name":"McNally","name_suffix":"","institution":"Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia; Emory University Rollins School of Public Health, Atlanta, Georgia","department":""},{"first_name":"Marcus","middle_name":"Eng Hock","last_name":"Ong","name_suffix":"","institution":"Singapore General Hospital, Department of Emergency Medicine, Singapore, Singapore; Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore","department":"None"},{"first_name":"Son","middle_name":"Ngoc","last_name":"Do","name_suffix":"","institution":"Bach Mai Hospital, Center for Critical Care Medicine, Hanoi, Vietnam; Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam; Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam","department":""},{"first_name":"The Local PAROS Investigators","middle_name":"","last_name":"Group","name_suffix":"","institution":"Names and affiliations listed in supplemental file","department":"None"}],"date_submitted":"2023-09-09T05:57:05+03:00","date_accepted":"2024-03-05T01:22:23.914000+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18413/galley/14456/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18413/galley/10802/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18413/galley/14456/download/"}]},{"pk":18434,"title":"Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study","subtitle":null,"abstract":"Introduction: Prognosis and management of patients with intermediate-risk pulmonary embolism (PE) is challenging. We investigated whether stroke volume may be used to identify the subset of this population at increased risk of clinical deterioration or PE-related death. Our secondary objective was to compare echocardiographic measurements of patients who received escalated interventions vs anticoagulation monotherapy.
\nMethods: We selected patients with intermediate-risk PE, who had comprehensive echocardiography within 18 hours of PE diagnosis and before any escalated interventions, from a PE registry populated by 11 emergency departments. Echocardiographers measured right ventricle (RV) size, tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) using velocity time integral (VTI) by left ventricular (LV) outflow tract Doppler or two-dimensional method of discs (MOD). The primary outcome was a composite of PE-related death, cardiac arrest, catecholamine administration for sustained hypotension, or emergency respiratory intervention during the index hospitalization. Secondary outcome was escalated intervention with reperfusion or extracorporeal membrane oxygenation therapy.
\nResults: Of 370 intermediate-risk PE patients (mean age 64.0 ± 15.5 years, 38.1% male), 39 (10.5%) had the primary outcome. These 39 patients had lower mean SV regardless of measurement method than those without the primary outcome: SV MOD 36.2 vs 49.9 milliliters (mL), P < 0.001; SV Doppler 41.7 vs 57.2 mL, P = 0.003; VTI 13.6 vs 17.9 centimeters [cm], P = 0.003. Patients with primary outcome also had lower mean TAPSE than those without (1.54 vs 1.81 cm, P = 0.003). Multivariable models, selecting SV as predictor, had area under the receiver operating curve of 0.8 and Brier score 0.08. The best echocardiographic predictor of our primary outcome was SV MOD (odds ratio 0.72 [0.53, 0.94], P = 0.02). Patients who received escalated interventions had significantly lower SV or surrogate measurements, greater RV dilatation, and lower RV systolic function than patients who received anticoagulation monotherapy.
\nConclusion: Low stroke volume was a predictor of clinical deterioration and PE-related death. Low SV may be used to identify a subset of intermediate-risk PE patients, who are higher risk (intermediate-high risk), and for whom escalated interventions should be considered.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"pulmonary embolism"},{"word":"Risk"},{"word":"Outcome"},{"word":"Prognosis"},{"word":"Stroke Volume"},{"word":"Echocardiography"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/64h6d23q","frozenauthors":[{"first_name":"Anthony","middle_name":"J.","last_name":"Weekes","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":""},{"first_name":"Parker","middle_name":"","last_name":"Hambright","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Ariana","middle_name":"","last_name":"Trautmann","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Shane","middle_name":"","last_name":"Ali","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Angela","middle_name":"","last_name":"Pikus","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Nicole","middle_name":"","last_name":"Wellinsky","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Sanjeev","middle_name":"","last_name":"Shah","name_suffix":"","institution":"Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina","department":"None"},{"first_name":"Nathaniel","middle_name":"","last_name":"O'Connell","name_suffix":"","institution":"Wake Forest University School of Medicine, Department of Biostatistics and Data Science, Winston-Salem, North Carolina","department":"None"}],"date_submitted":"2023-08-19T03:20:04+03:00","date_accepted":"2024-02-29T22:00:09.398000+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18434/galley/14453/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18434/galley/10800/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18434/galley/14453/download/"}]},{"pk":17984,"title":"Pediatric Burns – Who Requires Follow-up? A Study of Urban Pediatric Emergency Department Patients","subtitle":null,"abstract":"Introduction: Hundreds of children suffer burn injuries each day, yet care guidelines regarding the need for acute inpatient treatment vs outpatient follow-up vs no required follow-up remain nebulous. This gap in the literature is particularly salient for the emergency clinician, who must be able to rapidly determine appropriate disposition.
\nMethods: This was a retrospective review of patients presenting to a Level II pediatric trauma center, January 1, 2017–December 31, 2019, and discharged with an International Classification of Diseases, Rev 10, burn diagnosis. We obtained and analyzed demographics, burn characteristics, and follow-up data using univariate and bivariate analysis as well as logistic regression modeling. Patients were stratified into three outcome groups: group 1—patients who underwent emergent evaluation at a burn center or were admitted at their first follow-up appointment; group 2—patients who followed up at a burn center (as an outpatient) or at the emergency department (and were discharged home); and group 3—patients with no known follow-up.
\nResults: A total of 572 patients were included in this study; 58.9% of patients were 1–5 years of age. Sixty-five patients met group 1 criteria, 189 patients met group 2 criteria, and 318 patients met group 3 criteria. Sixty-five percent of patients met at least one American Burn Association criteria, and 79% of all burns were second-degree burns. Flame and scald burns were associated with increased odds (odds ratio [OR] 1.21,O1.12) of group 1 vs group 2 + group 3 (P = 0.02, P < 0.001). Second/third-degree burns and concern for non-accidental trauma were also associated with increased odds of group 1 vs 2 or 3 (OR = 1.11, 1.35, P ≤ 0.001, 0.001, respectively). Scald burns were associated with increased odds of group 2 compared to group 3 (OR 1.11, P = 0.04). Second/third degree burns were also associated with increased odds of group 2 vs 3 (OR 1.19, P ≤ 0.001).
\nConclusion: There were few statistically significant variables strongly associated with group 1 (emergent treatment/admission) vs group 2 (follow-up/outpatient treatment) vs group 3 (no follow- up). However, one notable finding in this study was the association of scald burns with treatment (admission or follow-up) suggesting that the presence of a scald burn in a child may signify to clinicians that a burn center consult is warranted.
","language":null,"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":"burn"},{"word":"Emergency Medicine"},{"word":"pediatrics"}],"section":"Pediatrics","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2d70d6c2","frozenauthors":[{"first_name":"Theodore","middle_name":"","last_name":"Heyming","name_suffix":"","institution":"Children’s Hospital of Orange County, Orange, California; University of California Irvine, Department of Emergency Medicine, Irvine, California","department":"None"},{"first_name":"Andrea","middle_name":"","last_name":"Dunkelman","name_suffix":"","institution":"Orange County Global Medical Center, Department of General and Plastic Surgery, Santa Ana, California","department":"None"},{"first_name":"David","middle_name":"","last_name":"Gibbs","name_suffix":"","institution":"Children’s Hospital of Orange County, Orange, California","department":"None"},{"first_name":"Chloe","middle_name":"","last_name":"Knudsen-Robbins","name_suffix":"","institution":"University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, Ohio","department":"None"},{"first_name":"John","middle_name":"","last_name":"Schomberg","name_suffix":"","institution":"Children’s Hospital of Orange County, Orange, California","department":"None"},{"first_name":"Armin","middle_name":"","last_name":"Takallou","name_suffix":"","institution":"University of California, Irvine, California; Oregon Health Science University, School of Medicine, Portland, Oregon","department":"None"},{"first_name":"Bryan","middle_name":"","last_name":"Lara","name_suffix":"","institution":"Children’s Hospital of Orange County, Orange, California","department":"None"},{"first_name":"Brooke","middle_name":"","last_name":"Valdez","name_suffix":"","institution":"Children’s Hospital of Orange County, Orange, California","department":"None"},{"first_name":"Victor","middle_name":"","last_name":"Joe","name_suffix":"","institution":"University of California Irvine, Department of General Surgery, Irvine, California","department":"None"}],"date_submitted":"2023-03-20T23:24:46+03:00","date_accepted":"2023-03-20T23:24:46+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17984/galley/14447/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17984/galley/10649/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17984/galley/14447/download/"}]},{"pk":6658,"title":"Point-of-Care Ultrasound Findings in Occlusive Iliac Vein Thrombus During Pregnancy: A Case Report","subtitle":null,"abstract":"Introduction: Diagnosing deep venous thromboses and venous thromboemboli (DVT/VTE) in pregnant patients presents a unique challenge for emergency physicians. The risk of DVT/VTE increases during pregnancy, and the potential consequences of misdiagnoses are severe. Point-of-care ultrasonography (POCUS) is frequently a first-line diagnostic imaging modality. However, recent studies have shown a high incidence of thromboses proximal to the common femoral vein during pregnancy, and these would not be visualized using compressive ultrasonography, which traditionally can only visualize thromboses distal to the femoral vein.
\n
Case Report: A 38-year-old female, 25-weeks primiparous, presented to the emergency department with a three-day history of left lower extremity swelling. Point-of-care three-point compression testing was used to evaluate for a DVT; however, no thrombus was visualized. Given high clinical suspicion, color and spectral Doppler testing were performed and demonstrated turbulent flow and reduced respiratory variation in the common femoral vein. This prompted further additional testing for a proximal DVT using magnetic resonance venography, which revealed an occlusive left external iliac thrombus. The patient was subsequently started on daily subcutaneous enoxaparin and discharged home with close follow-up.
Conclusion: Emergency physicians play a critical role in evaluations for the presence of DVT/VTE, particularly in pregnant patients. We endorse the use of POCUS with three-point compression testing, as well as color and spectral Doppler imaging, to help identify proximal DVTs in this patient population. This case report can aid physicians in the diagnosis of this pathological condition that if left untreated can have severe consequences.
Introduction: ST-elevation myocardial infarction (STEMI) can be caused by underlying coronary artery vasospasm (CAV) with or without associated atherosclerotic disease. Coronary artery vasospasm is a rare but potentially devastating manifestation of eosinophilic granulomatosis with polyangiitis (EGPA).
\n
Case Report: We describe a 54-year-old male with a known history of EGPA and coronary artery disease presenting to the emergency department with chest pain and an inferior STEMI on electrocardiogram. He was ultimately taken for coronary angiography and found to have a discrete vasospastic lesion in the right coronary artery that was treated with intra-coronary nitroglycerin and calcium channel blockers. He was continued on immunosuppressant agents (prednisone and mepolizumab) for management of EGPA and followed up with outpatient cardiology and rheumatology for vasospastic angina.
Conclusion: This case highlights a rare cause of STEMI, discusses the nuances in treatment of STEMI due to CAV, and provides background on pathophysiology and treatment of EGPA.
Background: It is an unfortunate truth that Emergency Medicine (EM) physicians will, at some point, have contact with the medicolegal system. However, most EM residency training programs lack education on the legal system in their curriculum, leaving EM physicians unprepared for litigation. To fill this gap, we designed a high-yield and succinct medical legal workshop highlighting legal issues commonly encountered by EM physicians. We aimed to determine the effectiveness of this curriculum by measuring pre and post knowledge questions.
\nMethods: A two-hour session included a case-based discussion of common misconceptions held by physicians about the legal system, proper steps when interacting with the legal system and review of legal documents. This session was developed with the involvement of our hospital legal counsel and discussed real encounters. The effectiveness of the session was determined using pre- and post-session surveys assessing participant knowledge and comfort approaching the scenarios.
\nResults: A total of 34 EM residents had the opportunity to complete this workshop as a part of their conference curriculum. A total of 26 participants completed the pre-survey and 19 participants completed the post-survey. No participants had previous training in the legal aspects of medicine, including handling a subpoena, serving as a witness, or giving a deposition.
The pre-survey demonstrated that there was significant uncertainty surrounding the processes, definitions, and the legal system interaction. Many participants stated they would not know what to do if they received a subpoena (85.71%), were called as a witness in a trial (96.43%) or receive correspondence from a lawyer (96.43%).
The post survey revealed an increased knowledge base and confidence following the session. 100% of residents reported knowing what to do after receiving a subpoena, being called as a witness and understanding the process involved in giving a deposition. All residents reported that the session was beneficial and provided crucial information.
Conclusion: EM residents have limited baseline understanding of how to approach common legal scenarios. Educational materials available for this curriculum topic are limited. Based on the rapid knowledge increase observed in our residents, we believe our workshop could be adapted for use at other residency programs.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Medical Education"},{"word":"Law"}],"section":"Legal Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/49d5x5n8","frozenauthors":[{"first_name":"Kathleen","middle_name":"S.","last_name":"Williams","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":""},{"first_name":"Tatiana","middle_name":"","last_name":"Griffith","name_suffix":"","institution":"Healthpartners Regions Hospital Emergency Medicine, St. Paul, Minnesota","department":"None"},{"first_name":"Sean","middle_name":"","last_name":"Gaynor","name_suffix":"","institution":"Leib Knott Gaynor LLC, Milwaukee, Wisconsin","department":"None"},{"first_name":"Thomas","middle_name":"","last_name":"Johnson","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":"None"},{"first_name":"Alisa","middle_name":"","last_name":"Hayes","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":"None"}],"date_submitted":"2023-03-21T02:18:42+03:00","date_accepted":"2024-02-13T02:18:25.426000+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17809/galley/14444/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17809/galley/10650/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17809/galley/14444/download/"}]},{"pk":18541,"title":"The Evolution of Board-Certified Emergency Physicians and Staffing of Emergency Departments in Israel","subtitle":null,"abstract":"Introduction: Emergency medicine (EM) was recognized as a specialty in Israel in 1999. Fifty-nine of the 234 (25%) attending physicians working in emergency departments (ED) nationwide in 2002 were board-certified emergency physicians (EP). A 2012 study revealed that 123/270 (45%) of ED attendings were EPs, and that there were 71 EM residents. The EPs primarily worked midweek morning shifts, leaving the EDs mostly staffed by other specialties. Our objective in this study was to re-evaluate the EP workforce in Israeli EDs and their employment status and satisfaction 10 years after the last study, which was conducted in 2012.
\nMethods: We performed a three-part, prospective cross-sectional study: 1) a survey, sent to all EDs in Israel, to assess the numbers, level of training, and specialties of physicians working in EDs; 2) an anonymous questionnaire, sent to EPs in Israel, to assess their demographics, training, employment, and work satisfaction; and 3) interviews of a convenience sample of EPs analyzed by a thematic approach.
\nResults: There were 266 board-certified EPs, 141 (53%) of whom were employed in EDs full-time or part-time. Sixty-two non-EPs also worked in EDs. The EPs were present in the EDs primarily during weekday morning shifts. There were 273 EM residents nationwide. A total of 101 questionnaires were completed and revealed that EPs working part-time in the ED worked fewer hours, received higher salaries, and had more years of experience compared to EPs working full time or not working in the ED. Satisfaction correlated only with working part time. Meaningful work, diversity, and rewarding relationships with patients and colleagues were major positive reasons for working in the ED. Feeling undervalued, carrying a heavy caseload, and having complicated relationships with other hospital departments were reasons against working in the ED.
\nConclusion: Our study findings showed an increase in the number of trained and in-training EPs, and a decrease in the percentage of board-certified EPs who persevere in the EDs. Emergency medicine in Israel is at a crossroads: more physicians are choosing EM than a decade ago, but retention of board-certified EPs is a major concern, as it is worldwide. We recommend taking measures to maintain trained and experienced EPs working in the ED by allowing part-time ED positions, introducing dedicated academic time, and diversifying EP roles, functioning, and work routine.
","language":null,"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 Departments"},{"word":"Emergency Medicine"},{"word":"attending physician"},{"word":"hospital"},{"word":"healthcare workers"},{"word":"burnout"},{"word":"survey"}],"section":"Global Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1m5476t8","frozenauthors":[{"first_name":"Noaa","middle_name":"","last_name":"Shopen","name_suffix":"","institution":"Tel Aviv Medical Center, Department of Emergency Medicine, Tel Aviv, Israel","department":""},{"first_name":"Raphael","middle_name":"","last_name":"Tshuva","name_suffix":"","institution":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""},{"first_name":"Michael","middle_name":"J.","last_name":"Drescher","name_suffix":"","institution":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""},{"first_name":"Miguel","middle_name":"","last_name":"Glatstein","name_suffix":"","institution":"Tel Aviv Medical Center, Department of Emergency Medicine, Tel Aviv, Israel; Tel Aviv Medical Center, Department of Pediatric Emergency Medicine, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""},{"first_name":"Neta","middle_name":"","last_name":"Cohen","name_suffix":"","institution":"Tel Aviv Medical Center, Department of Emergency Medicine, Tel Aviv, Israel; Tel Aviv Medical Center, Department of Pediatric Emergency Medicine, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""},{"first_name":"Rony","middle_name":"","last_name":"Coral","name_suffix":"","institution":"Psychiatry Unit, Sheba Medical Center, Ramat Gan, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""},{"first_name":"Itay","middle_name":"","last_name":"Ressler","name_suffix":"","institution":"Tel Aviv Medical Center, Oncology Division, Psycho-Oncological Service, Tel Aviv, Israel","department":""},{"first_name":"Pinchas","middle_name":"(Pinny)","last_name":"Halpern","name_suffix":"","institution":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel","department":""}],"date_submitted":"2023-11-01T12:39:05+03:00","date_accepted":"2024-02-22T19:39:41.853000+03:00","date_published":"2024-06-14T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18541/galley/14450/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18541/galley/10652/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18541/galley/14450/download/"}]},{"pk":6600,"title":"Ultrasound-guided Supraclavicular Brachial Plexus Block for Therapeutic Management of Postoperative Compressive Brachial Plexus Neuropathy: A Case Report","subtitle":null,"abstract":"Introduction: Compressive neuropathy of the brachial plexus is a common issue following laparoscopic and robotic surgeries.
\n
Case Report: A 71-year-old male, post-lumbar spinal surgery, presented with excruciating right upper extremity pain and paresthesias. A supraclavicular brachial plexus (SBP) block with bupivacaine provided significant pain relief, lasting 36 hours. Subsequent physical therapy led to gradual pain and weakness improvement in compressive neuropathy.
Discussion: The SBP block, facilitated by ultrasound guidance, is a safe procedure with few serious complications. It proves beneficial for managing postoperative compressive neuropathy, allowing patients to break pain cycles and participate in rehabilitation.
Conclusion: The SBP block is an effective addition to the management of postoperative compressive neuropathy, given its ease, safety, and potency. Although regional anesthesia provides only temporary relief, patients can experience a break in debilitating pain cycles associated with compressive neuropathy.
Old Nubian is the modern designation for a literary language attested in texts from the Nubian kingdoms of Nobadia and Makuria in the Middle Nile Valley between the late eighth and fifteenth centuries ce. It belongs to the Nilo-Saharan linguistic phylum and is written in an alphabetic script based on Coptic, with the addition of several characters from the Meroitic alphasyllabary. Old Nubian was written in a multiliterate context, alongside Greek, Coptic, and Arabic, and its materials encompass documents and inscriptions of both a religious and secular nature.
","language":"eng","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":"Nubia"},{"word":"Middle Nile"}],"section":"Upper Nile Region","is_remote":true,"remote_url":"https://escholarship.org/uc/item/03x6d68h","frozenauthors":[{"first_name":"Vincent","middle_name":"W. J.","last_name":"van Gerven Oei","name_suffix":"","institution":"UC Santa Barbara","department":""}],"date_submitted":"2021-03-01T15:33:07+03:00","date_accepted":"2024-06-02T18:27:57.697000+03:00","date_published":"2024-06-14T15:15:00+03:00","render_galley":null,"galleys":[{"label":"3919v1_van Gerven Oei_ Old Nubian","type":"pdf","path":"https://journalpub.escholarship.org/nelc_uee/article/3919/galley/14443/download/"}]},{"pk":24862,"title":"Review of Essays on Astronomical History and Heritage. A Tribute to Wayne Orchiston on his 80th Birthday. S. Gullberg, P. Robertson (eds.). Springer. 719 pgs.","subtitle":null,"abstract":"","language":"eng","license":{"name":"Creative Commons Attribution 4.0 International (CC BY 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":"S. Gullberg"},{"word":"P. Robertson (eds.). Springer. 719 pgs."}],"section":"Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1c11s37j","frozenauthors":[{"first_name":"A.","middle_name":"César","last_name":"González-García","name_suffix":"","institution":"","department":"Instituto de Ciencias del Patrimonio, INCIPIT, CSIC"}],"date_submitted":"2024-06-14T00:15:29.577000+03:00","date_accepted":"2024-06-14T00:17:18.625000+03:00","date_published":"2024-06-13T10:30:00+03:00","render_galley":{"label":"Rvw EAHH","type":"pdf","path":"https://journalpub.escholarship.org/jac/article/24862/galley/14455/download/"},"galleys":[{"label":"Rvw EAHH","type":"pdf","path":"https://journalpub.escholarship.org/jac/article/24862/galley/14455/download/"}]},{"pk":46125,"title":"Severe Hypothyroid-Induced Cardiomyopathy","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/1qw5d4k7","frozenauthors":[{"first_name":"Megha","middle_name":"","last_name":"Agarwal","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Christine","middle_name":"","last_name":"Bishop","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T20:49:49+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46125/galley/34856/download/"}]},{"pk":46124,"title":"Substitution of GLP-1 Medications in Ambulatory Care","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/1c70v0n8","frozenauthors":[{"first_name":"Anusha","middle_name":"","last_name":"Fatehpuria","name_suffix":"","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Tannaz","middle_name":"","last_name":"Moin","name_suffix":"MD, MBA, MSHS","institution":"","department":""},{"first_name":"Mehran","middle_name":"J.","last_name":"Kashefi","name_suffix":"DO","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T20:40:42+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46124/galley/34855/download/"}]},{"pk":46123,"title":"Legionnaires’ Disease Presenting as Encephalopathy in a Returning Traveler: 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/5qj3d5q0","frozenauthors":[{"first_name":"Grace","middle_name":"","last_name":"Huang","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"John","middle_name":"","last_name":"Ebrahim","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T20:17:32+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46123/galley/34854/download/"}]},{"pk":46122,"title":"Therapeutic Drug Monitoring in Inflammatory Bowel Disease","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"clinical-review"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0wn4x07s","frozenauthors":[{"first_name":"Tina","middle_name":"","last_name":"Storage","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Vikas","middle_name":"","last_name":"Pabby","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T20:03:30+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46122/galley/34853/download/"}]},{"pk":46121,"title":"Progressive Kidney Dysfunction due to Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID)","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/79h8h5d6","frozenauthors":[{"first_name":"Rahul","middle_name":"","last_name":"Vasavada","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Nathan","middle_name":"","last_name":"Cox","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T19:44:38+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46121/galley/34852/download/"}]},{"pk":46120,"title":"Synchronous MSI-H Colon Cancer and Follicular Lymphoma in a 54-Year-Old Male","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/6216m082","frozenauthors":[{"first_name":"Samuel","middle_name":"J.","last_name":"Slomowitz","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Julie","middle_name":"","last_name":"Huynh","name_suffix":"MD, MSHS","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-06-12T19:28:47+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46120/galley/34851/download/"}]},{"pk":3924,"title":"Conceptualizations of the Moon","subtitle":null,"abstract":"Our understanding of the moon as it was regarded in ancient Egypt from the Old Kingdom to the Ptolemaic and Roman Periods is based mostly on texts and images from temples, but also on stelae, coffins, and papyri. Just as Conceptual Metaphor Theory provides a theoretical background for research on the moon in ancient Egypt, a basic knowledge of astronomical facts is essential for our understanding of the sources and of how the moon was conceptualized anciently. The conceptualizations can be categorized into those concerning astronomical properties of the celestial body (its shape, luminosity, motion, constellations), those in which the moon takes on anthropomorphic (man, child, eye, leg, arm) and zoomorphic (bull, ibis, baboon) forms, and those that have a socio-political background, concerning the reign of the pharaoh, the measuring and conception of time, and the maintenance of the cosmos (maat) as a whole.
","language":"eng","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":"Domains of Knowledge","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3g7673v5","frozenauthors":[{"first_name":"Victoria","middle_name":"","last_name":"Altmann-Wendling","name_suffix":"","institution":"","department":"None","country":"Germany"}],"date_submitted":"2021-04-15T17:27:00+03:00","date_accepted":"2024-06-12T17:00:24.710000+03:00","date_published":"2024-06-12T17:15:00+03:00","render_galley":{"label":"3924v1_Altmann-Wendling_Conceptions of the Moon","type":"pdf","path":"https://journalpub.escholarship.org/nelc_uee/article/3924/galley/13261/download/"},"galleys":[{"label":"3924v1_Altmann-Wendling_Conceptions of the Moon","type":"pdf","path":"https://journalpub.escholarship.org/nelc_uee/article/3924/galley/13261/download/"}]},{"pk":18030,"title":"A Novel Use of the “3-Day Rule”: Post-discharge Methadone Dosing in the Emergency Department","subtitle":null,"abstract":"Introduction: Methadone is a medically necessary and lifesaving medication for many patients with opioid use disorder. To adequately address these patients’ needs, methadone should be offered in the hospital, but barriers exist that limit its continuation upon discharge. The code of federal regulations allows for methadone dosing as an inpatient as well as outpatient dispensing for
up to three days to facilitate linkage to treatment. As a quality initiative, we created a new workflow for discharging patients on methadone to return to the emergency department (ED) for uninterrupted dosing.
Methods: Our addiction medicine team changed hospital methadone policy to better allow hospitalization as a window of opportunity to start methadone. This necessitated the creation of a warm-handoff process to link patients to methadone clinics if that linkage could not happen immediately on discharge. Thus, our team created the “ED Bridge” process, which uses the “3-day rule” to dispense methadone from the ED post hospital discharge. We then followed every patient we directed through this workflow as an observational cohort for outcomes and trends.
\nResults: Of the patients for whom ED bridge dosing was planned, 40.4% completed all bridge dosing and an additional 17.3% received at least one but not all bridge doses. Established methadone patients made up 38.1% of successful linkages, and 61.9% were patients who were newly started on methadone in the hospital.
\nConclusion: Improving methadone as a treatment option remains an ongoing issue for policymakers and advocates. Our ED bridge workflow allows us to expand access and continuation of methadone now using existing laws and regulations, and to better use hospitals as a point of entry into methadone treatment.
","language":null,"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":"Methadone"},{"word":"addiction"},{"word":"opioid use disorder"},{"word":"emergency department"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6hq9k398","frozenauthors":[{"first_name":"Jenna","middle_name":"K.","last_name":"Nikolaides","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois; Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois","department":"None"},{"first_name":"Tran","middle_name":"H.","last_name":"Tran","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois; Chicago College of Pharmacy, Midwestern University, Downers Grove, Illinois","department":"None"},{"first_name":"Elisabeth","middle_name":"","last_name":"Ramsey","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois","department":"None"},{"first_name":"Sophia","middle_name":"","last_name":"Salib","name_suffix":"","institution":"Rush University Medical Center, Substance Use Intervention Team, Department of Psychiatry and Behavioral Sciences, Chicago, Illinois","department":"None"},{"first_name":"Henry","middle_name":"","last_name":"Swoboda","name_suffix":"","institution":"Queen’s University, Department of Emergency Medicine and Addictions Medicine, Kingston, Canada","department":"None"}],"date_submitted":"2023-04-01T00:28:59+03:00","date_accepted":"2023-04-01T00:28:59+03:00","date_published":"2024-06-11T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/14439/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/10544/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18030/galley/14439/download/"}]},{"pk":18012,"title":"Assessing Team Performance: A Mixed-Methods Analysis Using Interprofessional in situ Simulation","subtitle":null,"abstract":"Introduction: Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams.
\nMethods: This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2–4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis.
\nResults: Eighteen team-based simulations took place between January–April 2021. Raters’ scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance.
\nConclusion: Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual’s contribution to a team’s performance.
","language":null,"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":"team performance"},{"word":"leadership"},{"word":"Simulation"},{"word":"Interprofessional"},{"word":"interdependence"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8j52388r","frozenauthors":[{"first_name":"Ashley","middle_name":"C.","last_name":"Rider","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Sarah","middle_name":"R.","last_name":"Williams","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":""},{"first_name":"Vivien","middle_name":"","last_name":"Jones","name_suffix":"","institution":"Royal College of Surgeons, Dublin, Ireland","department":"None"},{"first_name":"Daniel","middle_name":"","last_name":"Rebagliati","name_suffix":"","institution":"Albany Medical College, Albany, New York","department":"None"},{"first_name":"Kimberly","middle_name":"","last_name":"Schertzer","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":""},{"first_name":"Michael","middle_name":"A.","last_name":"Gisondi","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"},{"first_name":"Stefanie","middle_name":"S.","last_name":"Sebok-Syer","name_suffix":"","institution":"Stanford University, Department of Emergency Medicine, Palo Alto, California","department":"None"}],"date_submitted":"2023-04-01T01:52:19+03:00","date_accepted":"2024-02-07T00:14:35+03:00","date_published":"2024-06-11T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18012/galley/14442/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18012/galley/10651/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18012/galley/14442/download/"}]},{"pk":18403,"title":"End-tidal Carbon Dioxide Trajectory-based Prognostication of Out-of-hospital Cardiac Arrest","subtitle":null,"abstract":"Background: During cardiopulmonary resuscitation (CPR), end-tidal carbon dioxide (EtCO2) is primarily determined by pulmonary blood flow, thereby reflecting the blood flow generated by CPR. We aimed to develop an EtCO2 trajectory-based prediction model for prognostication at specific time points during CPR in patients with out-of-hospital cardiac arrest (OHCA).
\nMethods: We screened patients receiving CPR between 2015–2021 from a prospectively collected database of a tertiary-care medical center. The primary outcome was survival to hospital discharge. We used group-based trajectory modeling to identify the EtCO2 trajectories. Multivariable logistic regression analysis was used for model development and internally validated using bootstrapping. We assessed performance of the model using the area under the receiver operating characteristic curve (AUC).
\nResults: The primary analysis included 542 patients with a median age of 68.0 years. Three distinct EtCO2 trajectories were identified in patients resuscitated for 20 minutes (min): low (average EtCO2 10.0 millimeters of mercury [mm Hg]; intermediate (average EtCO2 26.5 mm Hg); and high (average EtCO2: 51.5 mm Hg). Twenty-min EtCO2 trajectory was fitted as an ordinal variable (low, intermediate, and high) and positively associated with survival (odds ratio 2.25, 95% confidence interval [CI] 1.07–4.74). When the 20-min EtCO2 trajectory was combined with other variables, including arrest location and arrest rhythms, the AUC of the 20-min prediction model for survival was 0.89 (95% CI 0.86–0.92). All predictors in the 20-min model remained statistically significant after bootstrapping.
\nConclusion: Time-specific EtCO2 trajectory was a significant predictor of OHCA outcomes, which could be combined with other baseline variables for intra-arrest prognostication. For this purpose, the 20-min survival model achieved excellent discriminative performance in predicting survival to hospital discharge.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"cardiopulmonary resuscitation"},{"word":"End-tidal Carbon Dioxide"},{"word":"Group-based trajectory modelling"},{"word":"Out-of-hospital Cardiac Arrest"},{"word":"survival"},{"word":"trajectory"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/55m7h987","frozenauthors":[{"first_name":"Chih-Hung","middle_name":"","last_name":"Wang","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Tsung-Chien","middle_name":"","last_name":"Lu","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Joyce","middle_name":"","last_name":"Tay","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Cheng-Yi","middle_name":"","last_name":"Wu","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Meng-Che","middle_name":"","last_name":"Wu","name_suffix":"","institution":"National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chun-Yen","middle_name":"","last_name":"Huang","name_suffix":"","institution":"Far Eastern Memorial Hospital, Department of Emergency Medicine, New Taipei City, Taiwan","department":"None"},{"first_name":"Chu-Lin","middle_name":"","last_name":"Tsai","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Chien-Hua","middle_name":"","last_name":"Huang","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"},{"first_name":"Matthew","middle_name":"Huei-Ming","last_name":"Ma","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital Yunlin Branch, Department of Emergency Medicine, Yunlin County, Taiwan","department":"None"},{"first_name":"Wen-Jone","middle_name":"","last_name":"Chen","name_suffix":"","institution":"National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan; National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan","department":"None"}],"date_submitted":"2023-07-18T23:03:43+03:00","date_accepted":"2023-07-18T23:03:43+03:00","date_published":"2024-06-11T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18403/galley/14438/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18403/galley/10105/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18403/galley/14438/download/"}]},{"pk":18103,"title":"RISE-EM: Resident Instruction in Social Emergency Medicine, a Cohort Study of a Novel Curriculum","subtitle":null,"abstract":"There is recognition in the field of emergency medicine (EM) that social determinants of health (SDoH) are key drivers of patient care outcomes. Leaders in EM are calling for curricula integrating SDoH assessment and intervention, public health, and multidisciplinary approaches to EM care throughout medical school and residency. This intersection of SDoH and the emergency care system is known as social emergency medicine (SEM). Currently, there are few resources available for EM training programs to integrate this content; as a result, few EM trainees receive adequate education in SEM. To address this gap, we developed a four-part training in SEM tailored to EM residency programs and medical schools.
\nThis curriculum, known as RISE-EM (Resident Instruction in Social Emergency Medicine), uses video lectures, case examples, and group discussions to engage trainees and develop competency in providing sound care that is grounded in evidence-based principles of SEM. In the current study, we tested RISE-EM by delivering the video lectures to residents and medical students in two training programs. We administered pre- and post-course knowledge tests and a post-course participant attitudes survey to assess the acceptability and potential efficacy of the program for improving SEM knowledge and attitudes among EM learners.
\nWe found it to be both feasible and acceptable to introduce SEM content in residency conferences, with preliminary data showing statistically significant improvement in knowledge of the content and self-efficacy to apply it to their clinical practice. In summary, RISE-EM has been highly valued by EM learners and viewed as a strong supplement to their existing training, and it has been shown to successfully improve SEM knowledge and attitudes.
","language":null,"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":"social emergency medicine"},{"word":"Social Medicine"},{"word":"social determinants of health"},{"word":"Medical Education"},{"word":"Emergency Medicine"}],"section":"Health Equity","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9jj7z771","frozenauthors":[{"first_name":"Heidi","middle_name":"","last_name":"Roche","name_suffix":"","institution":"Department of Emergency Medicine, Maine Medical Center, Portland, Maine; Tufts University School of Medicine, Portland, Maine","department":""},{"first_name":"Brandon","middle_name":"A.","last_name":"Knettel","name_suffix":"","institution":"Duke University School of Nursing, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina","department":"None"},{"first_name":"Christine","middle_name":"","last_name":"Knettel","name_suffix":"","institution":"Department of Emergency Medicine, University of North Carolina School of Medicine, Rex Hospital, Chapel Hill, North Carolina","department":"None"},{"first_name":"Timothy","middle_name":"","last_name":"Fallon","name_suffix":"","institution":"Department of Emergency Medicine, Maine Medical Center, Portland, Maine; Tufts University School of Medicine, Portland, Maine","department":"None"},{"first_name":"Jessica","middle_name":"","last_name":"Dunn","name_suffix":"","institution":"Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia","department":"None"}],"date_submitted":"2023-04-29T18:45:37+03:00","date_accepted":"2024-02-09T10:20:37.682000+03:00","date_published":"2024-06-11T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18103/galley/14440/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18103/galley/10546/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18103/galley/14440/download/"}]},{"pk":18019,"title":"Variability in Practice of Buprenorphine Treatment by Emergency Department Operational Characteristics","subtitle":null,"abstract":"Introduction: We sought to describe emergency department (ED) buprenorphine treatment variability among EDs with varying operational characteristics.
\nMethods: We performed a retrospective cohort study of adult patients with opioid use disorder discharged from 12 hospital-based EDs within a large healthcare system as a secondary data analysis of a quality improvement study. Primary outcome of interest was buprenorphine treatment rate. We described treatment rates between EDs, categorized by tertile of operational characteristics including annual census, hospital and intensive care unit (ICU) admission rates, ED length of stay (LOS), and boarding time. Secondary outcomes were ED LOS and 30-day return rates.
\nResults: There were 7,469 unique ED encounters for patients with opioid use disorder between January 2020–May 2021, of whom 759 (10.2%) were treated with buprenorphine. Buprenorphine treatment rates were higher in larger EDs and those with higher hospital and ICU admission rates. Emergency department LOS and 30-day ED return rate did not have consistent associations with buprenorphine treatment.
\nConclusion: Rates of treatment with ED buprenorphine vary according to the operational characteristics of department. We did not observe a consistent negative relationship between buprenorphine treatment and operational metrics, as many feared. Additional funding and targeted resource allocation should be prioritized by departmental leaders to improve access to this evidence-based and life-saving intervention.
","language":null,"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"},{"word":"buprenorphine"},{"word":"Addiction Medicine"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4214m881","frozenauthors":[{"first_name":"Grant","middle_name":"","last_name":"Comstock","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Division of Medical Toxicology, Milwaukee, Wisconsin","department":"None"},{"first_name":"Natalia","middle_name":"","last_name":"Truszczynski","name_suffix":"","institution":"University of Colorado School of Medicine, Aurora, Colorado","department":"None"},{"first_name":"Sean","middle_name":"S.","last_name":"Michael","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado","department":"None"},{"first_name":"Jason","middle_name":"","last_name":"Hoppe","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Emergency Medicine, Division of Medical Toxicology and Pharmacology, Aurora, Colorado","department":"None"}],"date_submitted":"2023-03-30T14:56:45+03:00","date_accepted":"2023-03-30T14:56:45+03:00","date_published":"2024-06-11T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18019/galley/14441/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18019/galley/10548/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18019/galley/14441/download/"}]},{"pk":62897,"title":"Climate Change Scenarios for Air and Water Temperatures in the Upper San Francisco Estuary: Implications for Thermal Regimes and Delta Smelt","subtitle":null,"abstract":"Climate projections and their effects in the San Francisco Estuary have been evaluated as part of the US Geological Survey’s CASCaDE2 project. Understanding the ecological effects of climate change can help manage and maintain the ecological health and productivity of the San Francisco Estuary. In this study, we assessed downscaled air temperature data from 10 global climate models (GCMs) under two representative concentration pathway (RCP) trajectories for greenhouse gas concentrations for three regions of the San Francisco Estuary: Sacramento–San Joaquin Delta, Suisun and Grizzly bays, and Suisun Marsh. We also used previously derived regression models to estimate future water temperatures at 16 locations in the upper San Francisco Estuary. We used a thermal regime approach to summarize water temperature projections to investigate changes to the thermal regime of the upper San Francisco Estuary, and used the Delta Smelt (Hypomesus transpacificus) to demonstrate the effects that a warming climate may have on the habitat needs of this fish species. Our results suggested there were no major differences in the extent of air-temperature warming among the three regions. Annual average air temperatures were projected to increase approximately 2.0 °C and 4.7 °C by the end of the century for the low and high RCP scenarios, respectively. We found timing, frequency, and magnitude metrics varied by period and RCP scenario, while duration and variability metrics varied by space for water-temperature thermal regimes. For example, the spawning window for Delta Smelt (thermal-regime duration metric) is projected to expand in the future, with spawning starting earlier for both RCP scenarios for most sites. Although our thermal-regime analysis focused on the life history of Delta Smelt, similar approaches could be used to assess climate-change threats to a wide array of native and invasive terrestrial and aquatic species found in San Francisco 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":"Sacramento River, San Joaquin River, Delta Smelt, CASCaDE2"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7q8714d0","frozenauthors":[{"first_name":"Brock","middle_name":"","last_name":"Huntsman","name_suffix":"","institution":"California Water Science Center\nUS Geological Survey\nSacramento, CA 95819 USA","department":""},{"first_name":"Larry","middle_name":"R.","last_name":"Brown","name_suffix":"","institution":"California Water Science Center\nUS Geological Survey\nSacramento, CA 95819 USA","department":""},{"first_name":"Marissa","middle_name":"","last_name":"Wulff","name_suffix":"","institution":"California Water Science Center\nUS Geological Survey\nSacramento, CA 95819 USA","department":""},{"first_name":"Noah","middle_name":"","last_name":"Knowles","name_suffix":"","institution":"US Geological Survey\nMenlo Park, CA 94025 USA","department":""},{"first_name":"R.","middle_name":"Wayne","last_name":"Wagner","name_suffix":"","institution":"University of New Orleans\nNew Orleans, LA 70184 USA","department":""},{"first_name":"Frederick","middle_name":"","last_name":"Feyrer","name_suffix":"","institution":"California Water Science Center\nUS Geological Survey\nSacramento, CA 95819 USA","department":""}],"date_submitted":"2024-06-04T14:51:25+03:00","date_accepted":"2024-06-04T14:51:25+03:00","date_published":"2024-06-11T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62897/galley/48583/download/"}]},{"pk":62895,"title":"Managed Wetlands for Climate Action: Potential Greenhouse Gas and Subsidence Mitigation in the Sacramento–San Joaquin Delta","subtitle":null,"abstract":"In the Sacramento–San Joaquin Delta (Delta), widespread drainage of historical wetlands has led to extensive subsidence and peat carbon losses, as well as high ongoing greenhouse gas (GHG) emissions. Large-scale wetland restoration and conversion to rice fields has the potential to mitigate these effects while conferring flood protection and creating habitat for wetland species. To explore the scale of these potential benefits, this study evaluated the effects of seven Delta-wide land-use scenarios on carbon stocks, land-surface elevation, GHG emissions, and habitat. Peat mapping and data from peat cores indicate that soil carbon stocks have decreased between the early 1800s and 2010s from 288 ± 15 to 145 ± 14 million metric tons (Mt) of carbon (C). If existing land uses continue, the Delta could lose an additional 8.3 Mt C during the coming 40 years, equal to average GHG emissions of 1.2 Mt CO2 equivalents (CO2e) yr-1. Future restoration and rice-farming scenarios indicate that wetland restoration could theoretically halt GHG emissions, converting the Delta from a large GHG source to a weak net source or sink. Across three future scenarios based on existing restoration targets, wetland creation and conversion to rice fields reduced GHG emissions by 0.39 to 0.67 Mt CO2e yr-1, with per-area benefits of 16 to 28 t CO2e per hectare (ha) yr-1. Differences among scenarios in extents of wetland types influenced their relative benefits for different management goals. Tidal restoration and conversion to rice fields enhanced habitat benefits and offered a source of agricultural income, but with reduced GHG mitigation compared with conversion to peat-building wetlands. This highlights the importance of clear objectives when developing land-use plans. A strategic land-management portfolio that includes rice fields and both impounded and tidal wetlands could be designed to provide GHG and subsidence mitigation while offering a diverse suite of benefits for ecosystems and people.","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":"subsidence, soil carbon, climate change mitigation, greenhouse gas (GHG) emissions, greenhouse gas (GHG) emissions reductions, carbon dioxide removal, wetland, peat loss, restoration, multi-benefit .."}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/79q102xm","frozenauthors":[{"first_name":"Lydia","middle_name":"J. S.","last_name":"Vaughn","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA","department":""},{"first_name":"Steven","middle_name":"J.","last_name":"Deverel","name_suffix":"","institution":"Hydrofocus, Inc.\nDavis, CA 95618 USA","department":""},{"first_name":"Stephanie","middle_name":"","last_name":"Panlasigui","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA","department":""},{"first_name":"Judith","middle_name":"Z.","last_name":"Drexler","name_suffix":"","institution":"US Geological Survey\nCalifornia Water Science Center\nSacramento, CA 95819 USA","department":""},{"first_name":"Marc","middle_name":"A.","last_name":"Olds","name_suffix":"","institution":"Hydrofocus, Inc.\nDavis, CA 95618 USA","department":""},{"first_name":"José","middle_name":"T.","last_name":"Díaz","name_suffix":"","institution":"Hydrofocus, Inc.\nDavis, CA 95618 USA","department":""},{"first_name":"Kendall","middle_name":"F.","last_name":"Harris","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA","department":""},{"first_name":"James","middle_name":"","last_name":"Morris","name_suffix":"","institution":"University of South Carolina\nColumbia, SC 29208 USA","department":""},{"first_name":"J.","middle_name":"Letitia","last_name":"Grenier","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA\n\nCurrent: Public Policy Institute of California \nSan Francisco, CA 94111 USA","department":""},{"first_name":"April","middle_name":"H.","last_name":"Robinson","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA","department":""},{"first_name":"Donna","middle_name":"A.","last_name":"Ball","name_suffix":"","institution":"San Francisco Estuary Institute–Aquatic Science Center\nRichmond, CA 94804 USA","department":""}],"date_submitted":"2024-06-04T14:43:48+03:00","date_accepted":"2024-06-04T14:43:48+03:00","date_published":"2024-06-11T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62895/galley/48581/download/"}]},{"pk":62896,"title":"Regional Diversity Trends of Nearshore Fish Assemblages of the Upper San Francisco Estuary","subtitle":null,"abstract":"The loss of biodiversity and biotic homogenization are on the rise in ecosystems around the world as a result of species invasions, habitat degradation, and the effects of climate change. In the Sacramento–San Joaquin Delta, non-native species make up the majority of the fish community, and declines in native species have been well documented; however, little is known about whether these trends have resulted in biotic homogenization. In this study, we used data from a long-term beach seine survey to analyze regional beta diversity trends of nearshore fish assemblages in the Delta from 1995 to 2019. Overall, we found no evidence of regional biotic homogenization occurring over the study period. Regional beta diversity increased moderately over time and was significantly influenced by the high interannual variability of freshwater inflow. These beta diversity patterns were driven by the non-native Mississippi Silverside that has proliferated in the system in recent years, but also by a handful of native fish species such as the Sacramento Sucker, Tule Perch, and Splittail. Overall, our results offer a contrast to other highly invaded ecosystems around the world and suggest that despite the near extinction of some native fish species, there remain pockets of suitable habitat in the Delta that may play a key role in the conservation of remnant native fish diversity.","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":"beta diversity, biotic homogenization, diversification, fish communities, long-term monitoring, California, Sacramento–San Joaquin Delta, Sacramento River, climate change"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4507774x","frozenauthors":[{"first_name":"Ryan","middle_name":"","last_name":"McKenzie","name_suffix":"","institution":"US Fish and Wildlife Service\nLodi, CA 95240 USA","department":""},{"first_name":"Christian","middle_name":"","last_name":"Gredzens","name_suffix":"","institution":"US Fish and Wildlife Service\nLodi, CA 95240 USA","department":""},{"first_name":"Brian","middle_name":"","last_name":"Mahardja","name_suffix":"","institution":"US Bureau of Reclamation\nSacramento, CA 95825 USA","department":""}],"date_submitted":"2024-06-04T14:48:05+03:00","date_accepted":"2024-06-04T14:48:05+03:00","date_published":"2024-06-11T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62896/galley/48582/download/"}]},{"pk":62898,"title":"Spatial Patterns of Water Supply and Use in California","subtitle":null,"abstract":"Spatial and temporal patterns of water supply and consumptive water use were analyzed from 475 Detailed Analysis Units by County (DAUCOs) spatial units across California during 2002 through 2016 to evaluate spatial and temporal variability and how it might associate with precipitation variability and other factors. Many, but not all, DAUCOs have relatively low total water supply variability compared to that of state-wide precipitation. Such low variability, in DAUCOs having sufficient diversity of water supply sources, is the result of switching between sources as needed to maintain a reliable total water supply. We used multiple approaches to explore these variations which involved four categories of water supply (local, groundwater, imported, and other) and two categories of water use (agricultural and urban). First, a cluster analysis of the volumetric water balance data identified a small set of clusters having similar magnitudes and proportions of water supply sources and water use—some of them composed of only a few DAUCOs but accounting for a disproportionate amount of the state’s water use. Second, a principal components analysis identified leading modes of anomalous water supply and water use among the 475 DAUCOs, capturing most of the time variation during 2002 to 2016. The most prominent mode exhibits a multi-year trend, most strongly involving increasing groundwater supply and agricultural water use, and decreasing urban water use and imported water supply. Over the study period, trends in both supply and use were pronounced, but differed considerably across California DAUCOs. One predominant subset of DAUCOs grew their agricultural water use with increased groundwater supply; in contrast to a widespread group of DAUCOs which reduced their urban water use. An important result for planners is our finding that variation in precipitation—itself important—is amplified by the human response to water supply availability and regulatory policy.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\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":"California, water supply, water use, infrastructure, data, cluster analysis, principal components analysis, hydrology, sustainability"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5v04j0xc","frozenauthors":[{"first_name":"John","middle_name":"","last_name":"Helly","name_suffix":"","institution":"Climate, Atmospheric Science and Physical Oceanography \nScripps Institution of Oceanography \nUniversity of California San Diego \nLa Jolla, CA, USA\n\nSan Diego Supercomputer Center \nUniversity of California San Diego \nLa Jolla, CA, USA","department":""},{"first_name":"Daniel","middle_name":"","last_name":"Cayan","name_suffix":"","institution":"Climate, Atmospheric Science and Physical Oceanography \nScripps Institution of Oceanography \nUniversity of California San Diego \nLa Jolla, CA, USA","department":""},{"first_name":"Jennifer","middle_name":"","last_name":"Stricklin","name_suffix":"","institution":"California Department of Water Resources Sacramento, CA USA","department":""},{"first_name":"Laurel","middle_name":"","last_name":"Dehaan","name_suffix":"","institution":"Climate, Atmospheric Science and Physical Oceanography \nScripps Institution of Oceanography \nUniversity of California San Diego \nLa Jolla, CA, USA","department":""}],"date_submitted":"2024-06-04T18:10:24+03:00","date_accepted":"2024-06-04T18:10:24+03:00","date_published":"2024-06-11T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62898/galley/48584/download/"}]},{"pk":62894,"title":"Sub-Lethal Responses of Delta Smelt to Contaminants Under Different Flow Conditions","subtitle":null,"abstract":"The Delta Smelt is a largely zooplanktivorous, endangered fish endemic to the San Francisco Estuary (the estuary). High flows increase the availability of fresh and brackish water habitat for Delta Smelt, but also may mobilize contaminants, potentially increasing toxicological stress. Here, we examine the association between contaminants and Delta Smelt health across contrasting water year types and flow-related management actions. Our study spanned the fall season of three years: 1 dry year (2018) bracketed by 2 wet years (2017 and 2019) and coincided with several management actions meant to benefit Delta Smelt. We collected field water from six sites in the estuary that encompass the freshwater and low-salinity habitat of Delta Smelt and analyzed the water for contaminant concentrations. After a 96-hour exposure to the field water, we assessed cultured Delta Smelt survival and the histopathological condition of the gill and liver. Insecticides, particularly fipronil metabolites, were the most prevalent contaminants detected in 2017 and 2018, and a variety of contaminants associated with the rice harvest were detected in 2019. No acute toxicity was observed during any exposure, but we observed negative effects in the livers of Delta Smelt exposed to agricultural water from the Toe Drain and Cache Slough during a 2019 pulse flow action, which coincided with elevated detections and concentrations of organic pesticides. Other noteworthy sub-lethal effects, likely occurring in response to contaminant mixtures, included severe gill lesions in Delta Smelt exposed to Decker Island water in 2019. In the drier year of 2018, lesions were generally mild or absent. Thus, the trade-offs between increased habitat availability and contaminant loading may provide one explanation for why Delta Smelt abundance does not consistently respond positively to outflow.","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":"Delta Smelt, toxicology, contaminants, histopathology, Delta, SFE, analytical chemistry"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6589s8wg","frozenauthors":[{"first_name":"Marie","middle_name":"E.","last_name":"Stillway","name_suffix":"","institution":"School of Veterinary Medicine\nDepartment of Anatomy, Physiology, and Cell Biology\nAquatic Health Program Laboratory\nUniversity of California, Davis, CA 95616 USA","department":""},{"first_name":"Bruce","middle_name":"G.","last_name":"Hammock","name_suffix":"","institution":"School of Veterinary Medicine\nDepartment of Anatomy, Physiology, and Cell Biology\nAquatic Health Program Laboratory\nUniversity of California, Davis, CA 95616 USA","department":""},{"first_name":"Shawn","middle_name":"","last_name":"Acuña","name_suffix":"","institution":"Metropolitan Water District of Southern California\nSacramento, CA 95814 USA","department":""},{"first_name":"Amanda","middle_name":"R.","last_name":"McCormick","name_suffix":"","institution":"School of Veterinary Medicine\nDepartment of Anatomy, Physiology, and Cell Biology\nAquatic Health Program Laboratory\nUniversity of California, Davis, CA 95616 USA","department":""},{"first_name":"Tien-Chieh","middle_name":"","last_name":"Hung","name_suffix":"","institution":"Department of Biological and Agricultural Engineering\nUniversity of California, Davis, CA 95616 USA","department":""},{"first_name":"Andrew","middle_name":"","last_name":"Schultz","name_suffix":"","institution":"Science Division, Bay–Delta Office\nUS Bureau of Reclamation\nSacramento, CA 95814 USA\n\nCurrently: US Geological Survey\nSouthwest Biological Science Center\nGrand Canyon Monitoring and Research Center\nFlagstaff, AZ 86001 USA","department":""},{"first_name":"Thomas","middle_name":"M.","last_name":"Young","name_suffix":"","institution":"Department of Civil and Environmental Engineering\nUniversity of California, Davis, CA 95616 USA","department":""},{"first_name":"Swee","middle_name":"J.","last_name":"Teh","name_suffix":"","institution":"School of Veterinary Medicine\nDepartment of Anatomy, Physiology, and Cell Biology\nAquatic Health Program Laboratory\nUniversity of California, Davis, CA 95616 USA","department":""}],"date_submitted":"2024-06-04T14:40:35+03:00","date_accepted":"2024-06-04T14:40:35+03:00","date_published":"2024-06-11T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/jmie_sfews/article/62894/galley/48580/download/"}]},{"pk":53784,"title":"La possessió en el txitximec de Jonaz i llengües emparentades","subtitle":null,"abstract":"Aquest article explora la possessió en el txitximec de Jonaz, el qual, amb una base de 800 parlants el 2004, és emprat a la Misión de Chichimecas, a l’est de la localitat de San Luis de la Paz (estat mexicà de Guanajuato). Es tracta d’una de les llengües més septentrionals de la família otopamé, adscrita al seu torn al tronc comú de l’otomang. No són gaires els estudis que s’han dut a terme a l’entorn d’aquesta varietat, la qual proveeix dades certament interessants per a estudis tipològics i relatius als universals lingüístics. Després d’un recorregut breu per les característiques principals del sistema lingüístic (a escala fonològica/fonètica, morfològica i sintàctica), abordarem el tractament que fa el txitximec de Jonaz de la possessió, tot emfasitzant la variació formal que es desprèn de la distinció establerta entre substantius alienables i inalienables. Amb aquest objectiu, es revisa i s’amplia l’anàlisi detallada de Lastra (2004), alhora que es compara la possessió en txitximec amb el tractament homòleg que en fan llengües emparentades, com ara el mixtec de Yosundúa (Farris 2004) o el txinantec de San Pedro Tlatepuzco (Merrifield i Anderson 2007). Al capdavall, es constata la vasta presència de substantius inalienables en el txitximec de Jonaz en comparació d’altres llengües de la mateixa família i, a grans trets, les llengües del món.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1kj9t732","frozenauthors":[{"first_name":"Marc","middle_name":"","last_name":"Gandarillas","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-07T02:34:56+03:00","date_accepted":"2024-06-07T02:34:56+03:00","date_published":"2024-06-08T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53784/galley/40687/download/"}]},{"pk":20771,"title":" A computational model for individual epithelial cells captures how shape dynamics depend on cell size ","subtitle":null,"abstract":"The dynamics of epithelial cells during wound healing exhibit significant complexity, notably in their size-dependent behavior. This work aims to depict a fundamental mechanism underlying this size dependence in cellular dynamics by developing a computational model. Our research question investigates how the physical size of epithelial cells influences their motility and behavior patterns, specifically during the epithelial-to-mesenchymal transition critical for wound healing. Thus, we propose a model where the key mechanism involves a field of spatially coupled forces acting on the cell membrane, driven by the dynamics of actin monomers. These monomers, randomly distributed within the cell, become focal points for membrane protrusions, thus influencing cell behavior. Our model succinctly captures the essence of size-dependent cellular dynamics without resorting to changes in gene expression patterns, offering new insights into the variations in cell behavior. Through this computational framework, we demonstrate that the diversity in cellular responses during wound healing can be fundamentally attributed to differences in cell size. This insight contributes to a deeper understanding of the behavioral plasticity of epithelial cells in critical physiological processes like wound closure.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"Epithelial-to-Mesenchymal Transition"},{"word":"Size-Dependent Dynamics"},{"word":"Computational Model"},{"word":"Protrusions"},{"word":"Computational Software"},{"word":"Wound-closure"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7gf8s5m6","frozenauthors":[{"first_name":"Rayan","middle_name":"","last_name":"Awais","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-04-06T00:24:59.394000+03:00","date_accepted":"2024-04-30T22:52:00.480000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Rayan Awais","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20771/galley/28632/download/"},{"label":"Rayan Awais","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20771/galley/28633/download/"}]},{"pk":20549,"title":"A Genome-wide Search for Essential SUMOylation E3 ligase for Influenza A Virus through qFRET Technology","subtitle":null,"abstract":"Influenza is one of the most prevalent viruses that has plagued millions worldwide. Every year health organizations encourage the public to get their flu vaccines to combat the flu season. Although the flu vaccines and medicines are widely available, it is estimated that flu viruses still cause 20,000-50,000 deaths every year. The two most common influenza virus strains are influenza A and B viruses, or IAV and IBV, respectively. It has been discovered that drug resistance develops very soon after a new drug is launched. It is highly demanded that anti-flu virus drugs with novel mechanisms be developed. Our lab has discovered that SUMOylation, a post-translational modification, is essential to the viral IAV and IBV life cycle. In this study, we have screened all the E3 ligases in the human genome to discover the SUMO E3 ligase responsible for the essential SUMOylation of IAV M1 protein using our Quantitative Fluorescence Energy Transfer(qFRET). We first determined the FRET spectrum of all E3 ligases with M1 protein and then quantified the FRET signals to provide a first-line examination of interactions. We then determined the E3-M1 interaction affinities, KD, to ensure the real interactions. We found the E3 ligase PIAS1 has the highest affinity to M1 among other E3s. By understanding the interaction affinity between IAV M1 protein with SUMOylation E3 ligase, we hope to block the interaction between the PIAS1-M1 for novel anti-flu medicine development.
\n","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"SUMOylation"},{"word":"influenza"},{"word":"Quantitative Förster Resonance Energy Transfer"},{"word":"viral proteins"},{"word":"protein interaction"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0c74n4mb","frozenauthors":[{"first_name":"Nikki","middle_name":"","last_name":"Wong","name_suffix":"","institution":"University of California Riverside","department":"Bioengineering"},{"first_name":"Shifa","middle_name":"","last_name":"Mirza","name_suffix":"","institution":"University of California, Riverside","department":""}],"date_submitted":"2024-04-03T23:20:37.350000+03:00","date_accepted":"2024-04-30T01:42:49.905000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Nikki Wong, Shifa Mirza","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20549/galley/28628/download/"}]},{"pk":20765,"title":"Exploring the World by Touch: Guidance in Bimanual Haptic Search","subtitle":null,"abstract":"
Haptic attention is an integral facet of everyday life, often arising in everyday activities like feeling for a pencil in a backpack or searching for keys in one’s pockets. We sought to understand how proprioception and features in objects contribute to the efficiency of bimanual haptic search in an unrestrained environment. The haptic task required participants to search for a target item among a set of distractor items without the use of vision, either in a single container, using hands together, or in separate containers with hands apart. We investigated whether the use of two hands enhanced or impeded search efficiency. The items to be felt were cylinders of varying length and volume. We found that bimanual search in one container was not appreciably different from bimanual search in two containers. We also found that there was an additive effect of diameter discrimination and length discrimination on search efficiency.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"haptic search"},{"word":"bimanual search"},{"word":"frames of reference"},{"word":"proprioception"},{"word":"attention"},{"word":"features"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4qt5z5h7","frozenauthors":[{"first_name":"Alina","middle_name":"","last_name":"Ahmed","name_suffix":"","institution":"University of California Riverside","department":"Psychology"},{"first_name":"Adam","middle_name":"","last_name":"Babeshkov","name_suffix":"","institution":"University of California, Riverside","department":"Psychology"}],"date_submitted":"2024-04-04T23:54:30.427000+03:00","date_accepted":"2024-05-14T03:10:31.717000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Alina Ahmed, Adam Babeshkov","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20765/galley/28629/download/"}]},{"pk":40044,"title":"Front Matter 2024","subtitle":null,"abstract":"NA
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"NA"}],"section":"Front Matter","is_remote":true,"remote_url":"https://escholarship.org/uc/item/40n1p0kt","frozenauthors":[{"first_name":"Sreenidhi","middle_name":"","last_name":"Surineni","name_suffix":"","institution":"UC Riverside","department":"Research Journal"}],"date_submitted":"2024-11-28T00:50:47.698000+03:00","date_accepted":"2024-11-28T01:03:16.964000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Front Matter","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/40044/galley/31108/download/"}]},{"pk":20768,"title":"Interpreting Crowding Effects on FRET Signals for Protein Kinetics Analysis","subtitle":null,"abstract":"In biological studies in vitro and in vivo, techniques involving Förster resonance energy transfer (FRET) and FRET quantification use the interaction of CyPet-SUMO1 and its E2 ligase, YPet-Ubc9, to determine the dissociation constant (KD). Dipole-dipole resonance interactions, where energy transfers from an excited donor to an acceptor chromophore, allow the detection of molecular interactions to elucidate protein interactions in many regulatory cascades spanning signal transduction, medical diagnostics, and optical imaging. This study was aimed to explore how protein-protein interactions are affected by the crowded environment typically found within cells using FRET signals. An in vitro assay using a 96-well plate was conducted using varying concentrations of bovine serum albumin (BSA) to simulate crowded conditions and determine their effect on KD values. FRET measurements were conducted in a solution phase to mimic the protein interaction affinity in living cells. In contrast, other KD measurement methods such as radio-labeled ligand binding assay, surface plasmon resonance (SPR), or isothermal titration calorimetry (ITC) require extensive preparation or orientation on solid surfaces, making them less representative for such assessments. Emission wavelengths from CyPet-SUMO1 (414 nm to 475 nm) and YPet-Ubc9 (475 nm to 530 nm) were obtained to determine fluorescence signals along with KD. A comparison between protein interactions in crowded and uncrowded settings was made with varying KD value results. This investigation provides insights into protein interactions and cellular crowding, with potential implications for pharmaceuticals, bioseparations processes, and drug discovery targeting protein-protein interactions.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"Protein-Protein Interactions"},{"word":"Kd"},{"word":"qFRET"},{"word":"FRET signals"},{"word":"bovine serum albumin (BSA)"},{"word":"crowded proteins"},{"word":"SUMOylation"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8nf1z17f","frozenauthors":[{"first_name":"Mandy","middle_name":"","last_name":"Hsieh","name_suffix":"","institution":"University of California Riverside (UCR)","department":"Bioengineering"}],"date_submitted":"2024-04-06T02:14:11.787000+03:00","date_accepted":"2024-05-21T01:26:58.318000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Mandy Hsieh","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20768/galley/28630/download/"}]},{"pk":38050,"title":"Isometric Hamstrings:Quadriceps Strength Ratio, Flexibility, and Gait Pattern as Predictors of Knee Health","subtitle":null,"abstract":"The knee joint faces daily stresses that cause its overall health to degrade and pathologies to develop. I hypothesized that increased stress on the knee joint and imbalance in thigh musculature would positively correlate with increased acoustic emissions from the knee joint, a biomarker of inflammation in the joint. We tested this hypothesis by selecting a cohort of healthy, moderately active individuals aged 18-32 across a range of BMIs. We collected baseline knee acoustic measurements and measured quadricep and hamstring flexibility, hamstring and quadricep maximum voluntary isometric contraction, and heel strike angle during self-selected walking gait. Heel strike angle does not correlate with increased acoustic emissions from the knee, but BMI negatively correlates with the hamstrings:quadriceps strength ratio. Furthermore, left hamstring flexibility positively correlates with left heel strike angle. Finally, we found that right quadricep flexibility had a positive correlation with right heel strike angle. Since the hamstrings:quadriceps strength ratio is an important biomarker for knee health, this finding may indicate evidence of progressing knee pathology in individuals with higher BMI. Changes in gait associated with muscle rigidity indicate that differential levels of upper leg muscle flexibility may translate to changes in the mechanics of everyday movements, such as walking.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"knee health"},{"word":"BMI"},{"word":"Strength"},{"word":"Stability"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7gr3r68k","frozenauthors":[{"first_name":"Lorenzo","middle_name":"","last_name":"Bazzani","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-10-12T01:53:45.340000+03:00","date_accepted":"2024-10-12T01:56:35.884000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Lorenzo Bazzani","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/38050/galley/28637/download/"}]},{"pk":20770,"title":"Pacing - Slowing Phenomenon in Varying Length Tasks","subtitle":null,"abstract":"Pacing is a critical mechanism for sustaining performance. When making decisions, people must consider the demands of a task to pace themselves accordingly. Compared to sports literature, this project looks at pacing and how it manifests in an everyday work environment - an area of research that is surprisingly little studied. The team sought to study pacing, by comparing performance over successively longer distances, like sprints compared to marathons. In two preliminary experiments, undergraduate students pressed the enter key some varying number of times, N = [8 16 32 64]. Additionally, students were told to exceed N just as runners run through the finish line of a race. The main question was if participants would tap slower when N was large compared to when N was small, just like runners. Surprisingly, participants did not change their performance based on N and participants slowed dramatically as they approached N, despite being instructed not to. Our main method of measurement was the mean interresponse interval (IRI) which is the average elapsed time between consecutive taps. We changed the count feedback between separate experiments and no change has extinguished the slowing effect. Results from two experiments show premature slowing suggesting that as people approach the end of a task, they slow their performance. This new phenomenon has implications for everyone who does multiple tasks in a day. Future work will explore whether changing the tap rate or removing the IRI feedback will affect the premature slowing phenomenon.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"Meta-Cognition"},{"word":" Learning Process"},{"word":" Slowing Effect"},{"word":"Pacing"},{"word":"Learning Process"},{"word":"Slowing Effect"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/86v9x2h2","frozenauthors":[{"first_name":"Uditi","middle_name":"","last_name":"Desai","name_suffix":"","institution":"","department":""},{"first_name":"Elliot","middle_name":"","last_name":"Randolph","name_suffix":"","institution":"University of California, Riverside","department":"Undergraduate Research Journal Student Editorial Board"}],"date_submitted":"2024-04-06T00:04:34.655000+03:00","date_accepted":"2024-05-14T20:24:30.424000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Uditi Desai, Elliot Randolph","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20770/galley/28631/download/"}]},{"pk":20773,"title":"The impact of a QTPOC-serving student organization in combating food insecurity and mental health disparities","subtitle":null,"abstract":"Despite increased institutional awareness toward diversity, equity, and inclusion on college campuses, LGBTQ+ students–and especially LGBTQ+ students of color–continue to experience disproportionate mental and behavioral health burdens and food insecurity compared to their cisgender and heterosexual peers. To address this issue, QTPOC (Queer and Trans People of Color) is a student organization that supports students at the intersection of oppression based on race, gender, and/or sexuality on campus. This study aims to evaluate how well our organization serves QTPoC students and how student organizations can better serve QTPoC students in general. Specifically, we study the impact our programming model–which integrates educational elements with incentives to attend events including food and crafts–has on QTPoC's well-being and knowledge of mental health resources on campus in order to both understand the factors contributing to mental health disparities and to evaluate strategies aimed to remedy those disparities. We recruited QTPoC students to complete pre- and post-event surveys to assess attendance, motivation, well-being, and awareness of campus resources regarding both food insecurity and sexual and gender health. We find increases in knowledge and well-being among QTPoC students who attended QTPOC events. We also found that offering hot food significantly contributed to positive experiences, fostered community building, and alleviated concerns regarding food insecurity. We conclude that our programming model effectively combats mental health disparities and food insecurity among QTPoC students. Student-serving organizations looking to address disparities among marginalized students should consider adopting our programming model.
\n","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial 4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\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/4.0"},"keywords":[{"word":"LGBTQ+"},{"word":"QTPOC"},{"word":"Food Insecurity"},{"word":"Mental Health"},{"word":"college campus"}],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4zq5p4p1","frozenauthors":[{"first_name":"Uditi","middle_name":"","last_name":"Desai","name_suffix":"","institution":"","department":""},{"first_name":"Abtin","middle_name":"","last_name":"Shafie","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-04-06T01:54:03.415000+03:00","date_accepted":"2024-05-14T03:26:20.464000+03:00","date_published":"2024-06-07T10:00:00+03:00","render_galley":null,"galleys":[{"label":"Uditi Desai, Abtin Shafie","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20773/galley/28634/download/"},{"label":"Uditi Desai, Abtin Shafie","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20773/galley/28635/download/"},{"label":"Uditi Desai, Abtin Shafie","type":"pdf","path":"https://journalpub.escholarship.org/ucr_undergrad_research_j/article/20773/galley/28636/download/"}]},{"pk":53786,"title":"Team","subtitle":null,"abstract":"","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"End Matter","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9fk9x0wq","frozenauthors":[{"first_name":"Editors","middle_name":"","last_name":"LUCERO","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-07T02:42:49+03:00","date_accepted":"2024-06-07T02:42:49+03:00","date_published":"2024-06-07T02:43:15+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53786/galley/40689/download/"}]},{"pk":53785,"title":"Peter Neil Carroll. Sketches of Spain: Homage to the Abraham Lincoln Brigade. ALBA Special Edition. Charlotte, NC: Main Street Rag Publishing Company, 2024.","subtitle":null,"abstract":"In this poetry book, Peter Neil Carroll compiles the voices and lived experiences of United States volunteers who fought in the Spanish Civil War.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Book Reviews","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2hp0z79x","frozenauthors":[{"first_name":"Claude","middle_name":"","last_name":"Potts","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-07T02:38:06+03:00","date_accepted":"2024-06-07T02:38:06+03:00","date_published":"2024-06-07T02:38:39+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53785/galley/40688/download/"}]},{"pk":53783,"title":"Manifestations of Spinoza’s Potentia: “Un violador en tu camino” at Santa Martha Acatitla Women’s Prison","subtitle":null,"abstract":"“Un violador en tu camino” is a protest-performance that combines language and movement to indict the state and expose its role in the perpetuation of violence against women. Created by the Chilean feminist collective Las Tesis, it was first performed in Santiago in November 2019. In the months following, it quickly spread beyond the borders of Chile, having been performed in cities from London to Istanbul to New Delhi to Mexico City to Montreal, and beyond the Spanish-speaking world, translated into over a dozen languages. This paper considers an attempt by incarcerated women at Santa Martha Acatitla Women’s Penitentiary in Mexico City to perform their own version of the protest within the prison walls. Through “Un violador en tu camino” the women at Santa Martha resist carceral discipline and produce an affectual connection with the outside that unsettles carceral space. This power of the protest lies in the coordination of voices and bodies in a combined affect, rendering it, as this paper argues, a manifestation of Spinozan \npotentia\n. Through the lens of Latin American feminist theory and drawing on recent work in performance, embodiment, and new materialisms, this paper aims to celebrate the power (\npotentia\n) of the women at Santa Marta by considering the theoretical stakes of their collective reclamation of body and voice. The reticence, fear, and ultimate refusal by prison authorities to authorize the performance of “Un violador en tu camino” within the prison walls speak to the power of their combined affect.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9b315196","frozenauthors":[{"first_name":"Cameron","middle_name":"","last_name":"Flynn","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-07T02:32:33+03:00","date_accepted":"2024-06-07T02:32:33+03:00","date_published":"2024-06-07T02:33:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53783/galley/40686/download/"}]},{"pk":53782,"title":"“Daguerreotypes in the South at New York Prices:” A Paper Archaeology of John Armstrong Bennet","subtitle":null,"abstract":"The study of nineteenth century photography has focused for the most part on paper photography, acknowledging the years of the daguerreotype as a period of curiosity and experimentation while disregarding the impact of this era today. Available scholarship has sought to study these early images through archival and material approaches, navigating recurring historiographic voids and image losses, often in the form of national histories of the medium. This essay builds on the overlap of some of these histories to reconsider the production of photography in the Americas, namely through daguerreotype portraits and their fashioning as commodities by print cultures aimed at creating and seeking new customers. To do so, the article follows John Armstrong Bennet, a multifaceted tradesman and occasionally a daguerreotypist, on his continental journeys between 1840 and 1877. Bennet’s written traces allow for an archaeological study of the relations between early photography and print, evidencing the complexities behind mechanical but not exactly multiple reproduction. Through Lisa Gitelman’s concept of \npaper knowledge \n(2014), the article considers the manifold manifestations of a hybrid form of authorship put forward by Bennet in the written form, be it in his advertisements, bureaucratic paperwork, or in his own \noeuvre\n. Through the analysis of the written sources, it may be possible to grasp a fleeting likeness of the author behind these marketable ‘works of art’, and more importantly, link through his presence the expansion of a photographic frontier to that of liberalism, manifest in the ever-growing presence of multiple reproduction in the printed form.","language":"en","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[],"section":"Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9m10x8v6","frozenauthors":[{"first_name":"María","middle_name":"Fernanda","last_name":"Domínguez Londoño","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-07T02:27:10+03:00","date_accepted":"2024-06-07T02:27:10+03:00","date_published":"2024-06-07T02:28:41+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53782/galley/40685/download/"}]},{"pk":53781,"title":"Letter from the Editors","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/3q87d91j","frozenauthors":[{"first_name":"Editors","middle_name":"","last_name":"LUCERO","name_suffix":"","institution":"UC Berkeley","department":""}],"date_submitted":"2024-06-07T02:19:52+03:00","date_accepted":"2024-06-07T02:19:52+03:00","date_published":"2024-06-07T02:22:45+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/lucero/article/53781/galley/40684/download/"}]},{"pk":21313,"title":"Bezold Abscess in a Case of Eosinophilic Otitis Media","subtitle":null,"abstract":"
Case Presentation: A 57-year-old man with a history of bronchial asthma and eosinophilic sinusitis presented to the emergency department with an exacerbation of otitis media. His primary complaints were otopyorrhea, headache, and neck pain with redness. Contrast-enhanced computed tomography revealed a posterior neck abscess contiguous with the mastoid process. The patient underwent mastoidectomy and received antimicrobial therapy. Eosinophilic granulation tissue in the middle ear obstructed the middle ear aditus and directed the inflammatory process toward the mastoid tip.
\nDiscussion: Bezold abscess is a rare extracranial complication of acute mastoiditis. Therefore, clinicians should consider neck pain with redness as an important physical sign that suggests Bezold abscess in patients with otitis media.
","language":null,"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":"Mastoiditis"},{"word":"Otitis media"},{"word":"abscess"},{"word":"Eosinophilic otitis media"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5f7087vb","frozenauthors":[{"first_name":"Satoshi","middle_name":"","last_name":"Tsuruta","name_suffix":"","institution":"Kurashiki Central Hospital, Department of Otolaryngology, Kurashiki city, Okayama, Japan","department":""},{"first_name":"Takashi","middle_name":"","last_name":"Fujiwara","name_suffix":"","institution":"Kurashiki Central Hospital, Department of Otolaryngology, Kurashiki city, Okayama, Japan","department":""}],"date_submitted":"2024-06-06T20:06:11.534000+03:00","date_accepted":"2024-06-06T20:10:06.480000+03:00","date_published":"2024-06-06T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/21313/galley/10912/download/"},"galleys":[{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/21313/galley/10912/download/"}]},{"pk":21307,"title":"WestJEM Full-Text Issue","subtitle":null,"abstract":"","language":null,"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/3r0000qh","frozenauthors":[{"first_name":"Cassandra","middle_name":"","last_name":"Saucedo","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-06-05T09:22:00.759000+03:00","date_accepted":"2024-06-05T09:32:48.245000+03:00","date_published":"2024-06-05T09:43:23.500000+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/21307/galley/10910/download/"}]},{"pk":18366,"title":"Rural and Ethnic Disparities in Out-of-hospital Care and Transport Pathways After Road Traffic Trauma in New Zealand","subtitle":null,"abstract":"Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.
\nMethods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients <85 years in age who were injured in a road traffic crash (RTC). In this study we examined the combined relationship between ethnicity and geographical location of injury in EMS out-of-hospital care and transport pathways following RTCs in Aotearoa-NZ. Analyses were stratified by geographical location of injury (rural and urban) and combined ethnicity-geographical location (rural Māori, rural non-Māori, urban Māori, and urban non-Māori).
\nResults: In a two-year period, there were 746 eligible patients; of these, 692 were transported to hospital. Indigenous Māori comprised 28% (196) of vehicle occupants attended by EMS, while 47% (324) of patients’ injuries occurred in a rural location. The EMS transport pathways to hospital for rural patients
were slower to reach first hospital (total in slowest tertile of time 44% vs 7%, P ≥ 0.001) and longer to reach definitive care (direct transport, 77% vs 87%, P = 0.001) compared to urban patients. Māori patients injured in a rural location were comparatively less likely than rural non-Māori to be triaged to priority transport pathways (fastest dispatch triage, 92% vs 97%, respectively, P = 0.05); slower to reach first hospital (total in slowest tertile of time, 55% vs 41%, P = 0.02); and had less access to specialist trauma care (reached tertiary trauma hospital, 51% vs 73%, P = 0.02).
Conclusion: Among RTC patients attended and transported by EMS in NZ, there was variability in out-of-hospital EMS transport pathways through to specialist trauma care, strongly patterned by location of incident and ethnicity. These findings, mirroring other health disparities for Māori, provide an equity-focused evidence base to guide clinical and policy decision makers to optimize the delivery of EMS care and reduce disparities associated with out-of-hospital EMS care.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency medical services"},{"word":"out-of-hospital"},{"word":"transport"},{"word":"ambulance"},{"word":"Trauma"},{"word":"disparities"},{"word":"Rural"},{"word":"Indigenous."}],"section":"Health Equity","is_remote":true,"remote_url":"https://escholarship.org/uc/item/61t0c674","frozenauthors":[{"first_name":"Rebbecca","middle_name":"","last_name":"Lilley","name_suffix":"","institution":"University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand","department":"None"},{"first_name":"Gabrielle","middle_name":"","last_name":"Davie","name_suffix":"","institution":"University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand","department":"None"},{"first_name":"Bridget","middle_name":"","last_name":"Dicker","name_suffix":"","institution":"Auckland University of Technology, Department of Paramedicine, Faculty of Health and Environmental Sciences, Auckland, New Zealand; Hato Hone St John, Mt Wellington, Auckland, New Zealand","department":"None"},{"first_name":"Papaarangi","middle_name":"","last_name":"Reid","name_suffix":"","institution":"Waipapa Taumata Rau-University of Auckland, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, Auckland, New Zealand","department":"None"},{"first_name":"Shanthi","middle_name":"","last_name":"Ameratunga","name_suffix":"","institution":"University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand; Te Whatu Ora (Health New Zealand) Counties Manukau, Population Health Directorate, Auckland, New Zealand; Monash University, Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia","department":"None"},{"first_name":"Charles","middle_name":"","last_name":"Branas","name_suffix":"","institution":"Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York","department":"None"},{"first_name":"Nicola","middle_name":"","last_name":"Campbell","name_suffix":"","institution":"University of Otago, Dunedin School of Medicine, Department of Preventive and Social Medicine, Injury Prevention Research Unit, Dunedin, New Zealand","department":"None"},{"first_name":"Ian","middle_name":"","last_name":"Civil","name_suffix":"","institution":"Auckland District Health Board, Trauma Services, Auckland, New Zealand","department":"None"},{"first_name":"Bridget","middle_name":"","last_name":"Kool","name_suffix":"","institution":"University of Auckland, School of Population Health, Section of Epidemiology and Biostatistics, Auckland, New Zealand","department":"None"}],"date_submitted":"2023-06-12T02:36:44+03:00","date_accepted":"2023-06-12T02:36:44+03:00","date_published":"2024-06-04T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18366/galley/10904/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18366/galley/10089/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18366/galley/10904/download/"}]},{"pk":6592,"title":"A Case Study of Spontaneous Category Formation and Behavioral Expression in a Language-Trained Steller Sea Lion Eumetopias jubatus","subtitle":null,"abstract":"The purpose of this study was to examine the responses of a Steller sea lion to two consecutive commands. We conducted this study on one same subject, Hama, as a continuation of Sasaki et al. (2022), which examined whether the Steller sea lion can discriminate human vocal commands. In Sasaki et al. (2022), commands were presented individually to examine the accuracy rate for each command. In the present study, we observed how Hama responded to the rapid presentation of two consecutive commands. The commands were presented in 20 different orders and combinations as 20 command combination patterns using five different commands. The results showed that Hama responded to 12 command combination patterns by performing behaviors corresponding to two consecutive commands. Hama performed the two behaviors in sequence in 8 of the 12 command combination patterns. The responses to the other four command combination patterns were combined single behaviors that combined the behaviors indicated by the two consecutive commands and that were already connected to different single commands. Although the combined single behaviors were not simple combinations of behaviors induced by the two consecutive commands, the combined single behaviors included the common body parts (e.g., fore flippers) or common action types (e.g., rotation) of behaviors induced by each command in the two consecutive commands. These results not only indicate that Hama could understand multiple linguistic information, but also suggest the possibility that Hama spontaneously formed categories based on the learned commands.
","language":"eng","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":"pinniped"},{"word":"word learning"},{"word":"Categorization"},{"word":"training"},{"word":"acoustic signal"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3pt275rx","frozenauthors":[{"first_name":"Masahiro","middle_name":"","last_name":"Sasaki","name_suffix":"","institution":"UC Berkeley","department":""},{"first_name":"Toshimune","middle_name":"","last_name":"Kambara","name_suffix":"","institution":"","department":""}],"date_submitted":"2023-11-29T00:57:14.885000+03:00","date_accepted":"2024-02-16T23:08:20.708000+03:00","date_published":"2024-06-04T08:00:00+03:00","render_galley":{"label":"Sasaki_final","type":"pdf","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/6592/galley/10903/download/"},"galleys":[{"label":"Sasaki_final","type":"pdf","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/6592/galley/10903/download/"}]},{"pk":6591,"title":"A Case Report of Hematogenous Osteomyelitis of the Manubrium Caused by Seeding from a Colovesicular Fistula","subtitle":null,"abstract":"Introduction: Osteomyelitis can occur at various osseous locations and commonly presents in the emergency department (ED). The incidence of osteomyelitis is 21.8 cases per 100,000 persons annually.1 Hematogenous osteomyelitis typically occurs in the vertebrae; however, it may seldomly occur in the manubrium. Hematogenous osteomyelitis can be seen in patients with complicated thoracic surgery, radiation, fracture, diabetes, immunosuppression, steroid therapy, and malnutrition.2 Because signs and symptoms of osteomyelitis may be nonspecific, clinicians must have high suspicion based on history and physical. Workup should include identifying the source, imaging, and surgical cultures.
\nCase Report: A 60-year-old male with hypertension and diabetes presented with atraumatic right shoulder and chest pain. The patient presented twice to the ED for clavicle pain five days prior. Computed tomography (CT) of the chest detected osseous infection of the manubrium and upper sternum, right clavicle, and mediastinal phlegmon. A CT of the abdomen and pelvis revealed osteomyelitis and discitis of the 12th thoracic and first lumbar vertebral body with gas at the psoas muscle, as well as sigmoid diverticulitis with colovesicular fistula. The patient was started on broad spectrum antibiotics and 1,500 milliliters of lactated Ringer’s in the ED. After evaluation by cardiothoracic surgery, the patient was taken to the operating room for neck exploration, incision/drainage, manubriectomy, and right sternoclavicular joint resection. Surgical, blood, urine, and respiratory cultures grew Klebsiella pneumoniae. After a 34-day hospital course, the patient was discharged on two weeks of oral levofloxacin and follow-up appointments with cardiothoracic surgery and infectious disease. The patient had good prognosis and recovery.
\nConclusion: Hematogenous osteomyelitis to the manubrium is rare and may present with only chest pain. It is important to consider other sources that seed in the manubrium and imaging to evaluate multisite infection. Treatment should include intravenous antibiotics and/or surgical intervention for debridement with washout or manubriectomy.
","language":"eng","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":"Hematogenous osteomyelitis"},{"word":"Sternal osteomyelitis"},{"word":"discitis"},{"word":"Colovesicular fistula"},{"word":"Klebsiella pneumoniae"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8r9563pw","frozenauthors":[{"first_name":"Celina","middle_name":"","last_name":"Wong","name_suffix":"","institution":"Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California","department":""},{"first_name":"Tammy","middle_name":"","last_name":"Phan","name_suffix":"","institution":"Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California","department":"Emergency Medicine"},{"first_name":"Emmelyn","middle_name":"","last_name":"Samones","name_suffix":"","institution":"Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California","department":"Emergency Medicine"},{"first_name":"Sharmin","middle_name":"","last_name":"Kalam","name_suffix":"","institution":"Loma Linda University Medical Center, Department of Emergency Medicine, Loma Linda, California","department":""}],"date_submitted":"2023-11-28T23:50:15.979000+03:00","date_accepted":"2024-02-24T23:11:07.794000+03:00","date_published":"2024-06-03T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6591/galley/10898/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6591/galley/10806/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6591/galley/10898/download/"}]},{"pk":7200,"title":"A Woman with Right Shoulder Pain","subtitle":null,"abstract":"Case Presentation: We report a case of an 89-year-old female who presented with pain in her right shoulder following a fall onto her outstretched hand. Upon presentation, her right hand was held behind her head and elbow held above her head in flexion. There was obvious deformity seen and felt in her axilla. Radiograph of the shoulder showed an inferior shoulder dislocation and impacted humeral neck fracture. Given her age and comorbid osteoporosis, a bedside reduction was performed by orthopedics where the humeral head was intentionally dislocated from the humeral shaft. Thirteen days after the initial shoulder dislocation, the patient’s shoulder was successfully repaired by open reduction.
\n
Discussion: Luxatio erecta, which means “erect dislocation” in Latin, refers to an inferior shoulder dislocation. It accounts for less than 1% of shoulder dislocations. Our case report highlights an inferior shoulder dislocation with a rare, concomitant humeral neck fracture, managed via staged reduction by orthopedics with intentional dislocation of the humeral head given concern over patient’s age and osteoporosis. The patient was eventually successfully repaired via arthroplasty within two weeks.
Keywords: inferior shoulder dislocation; luxatio erecta; shoulder pain.
Introduction: Neurogenic pulmonary edema is a rare and potentially life-threatening condition that can present as severe pulmonary edema after significant neurologic insults. This is the first documented instance that shows a plausible causal link between cannabis consumption, psychogenic polydipsia, and the subsequent development of neurogenic pulmonary edema associated with status epilepticus secondary to acute hyponatremia.
\nCase Report: We report a case of a 34-year-old female who presented to the emergency department altered and postictal after a witnessed new-onset seizure. She developed significant respiratory distress that required intubation. Her sodium was 121 millimoles per liter (mmol/L), from 137 mmol/L 36 hours prior on routine outpatient labs. Further history revealed excessive water ingestion after eating a cannabis edible prior to the seizure.
\nConclusion: This case highlights the importance of recognizing neurogenic pulmonary edema in connection with psychogenic polydipsia, severe hyponatremia, and status epilepticus subsequent to cannabis consumption.
","language":"eng","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":"Neurogenic pulmonary edema"},{"word":"hyponatremia"},{"word":"primary polydipsia"},{"word":"cannabis intoxication"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/165329d0","frozenauthors":[{"first_name":"Christian","middle_name":"","last_name":"Treat","name_suffix":"","institution":"Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":""},{"first_name":"Nicholas","middle_name":"","last_name":"Ulloa","name_suffix":"","institution":"Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":""},{"first_name":"Alyssa","middle_name":"","last_name":"Kettler","name_suffix":"","institution":"Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":""},{"first_name":"David","middle_name":"","last_name":"Lawrence","name_suffix":"","institution":"Stony Brook University, Department of Emergency Medicine, Stony Brook, New York","department":"Emergency Medicine"}],"date_submitted":"2023-11-13T23:13:00.996000+03:00","date_accepted":"2024-02-28T02:04:47.124000+03:00","date_published":"2024-06-03T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6562/galley/10899/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6562/galley/10808/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6562/galley/10899/download/"}]},{"pk":1296,"title":"Pneumothorax Identified by a Remote Physician Using Paramedic-obtained Tele-ultrasound: Case Report","subtitle":null,"abstract":"Introduction: The use of telemedicine and ultrasound is emerging and novel in the field of community paramedicine. However, there is a paucity of data supporting its use and even less evidence that shows a morbidity and mortality benefit. This case highlights a unique way to diagnose a common medical emergency, which can lead to a good outcome.
\nCase Report: We describe the use of lung point-of-care ultrasound by a trained community paramedic that led to the identification of a pneumothorax in an 86-year-old male at a scheduled home visit. The images were interpreted over telehealth in real-time by an emergency physician, and the patient was transported to the emergency department where the diagnosis was confirmed by chest radiography. He underwent chest tube placement and was discharged five days later after returning to his baseline.
\nConclusion: Despite minimal data to support or refute the use of paramedic tele-ultrasound, this case highlights a unique opportunity to expand the use of telemedicine and ultrasound in community paramedicine to improve patient outcomes.
","language":"eng","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":"Telehealth"},{"word":"community paramedicine"},{"word":"Pneumothorax"},{"word":"point-of-care-ultrasound"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0062d06z","frozenauthors":[{"first_name":"Shriman","middle_name":"","last_name":"Balasubramanian","name_suffix":"","institution":"New York Presbyterian Hospital Cornell and Columbia, Department of Emergency Medicine, New York","department":"Emergency Medicine"},{"first_name":"Michael","middle_name":"","last_name":"Defilippo","name_suffix":"","institution":"New York Presbyterian Hospital Cornell and Columbia, Department of Emergency Medicine, New York","department":""},{"first_name":"Michael","middle_name":"","last_name":"Stone","name_suffix":"","institution":"New York Presbyterian Hospital Cornell and Columbia, Department of Emergency Medicine, New York","department":""},{"first_name":"Gabriela","middle_name":"","last_name":"Galli","name_suffix":"","institution":"New York Presbyterian Hospital Cornell and Columbia, Department of Emergency Medicine, New York","department":""},{"first_name":"Matthew","middle_name":"","last_name":"McCarty","name_suffix":"","institution":"Weill Cornell Medicine, Department of Emergency Medicine, New York","department":"Emergency Medicine"},{"first_name":"Brock","middle_name":"","last_name":"Daniels","name_suffix":"","institution":"Weill Cornell Medicine, Department of Emergency Medicine, New York","department":""}],"date_submitted":"2023-04-23T18:20:40.185000+03:00","date_accepted":"2023-09-20T21:00:04.619000+03:00","date_published":"2024-06-03T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1296/galley/10895/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1296/galley/2708/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1296/galley/10895/download/"}]},{"pk":7189,"title":"Spinal Arachnoid Web","subtitle":null,"abstract":"Case Presentation: We describe a case of a 57-year-old male with multiple medical comorbidities who presented to the emergency department with a two-week history of upper back pain with associated numbness. Physical exam demonstrated sensory loss in a bilateral third and fourth thoracic dermatome distribution. The diagnosis of spinal arachnoid web was made based on neurological exam and imaging findings.
\nDiscussion: Spinal arachnoid web is a rare diagnosis, but consideration is important, as early recognition and surgical intervention can resolve symptoms and prevent worsening neurological sequelae.
","language":"eng","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":"Neurology"},{"word":"spinal arachnoid web"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2h94936v","frozenauthors":[{"first_name":"Maiya","middle_name":"","last_name":"Smith","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""},{"first_name":"Morgan","middle_name":"","last_name":"Ketterling","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""},{"first_name":"Alexander","middle_name":"","last_name":"Gallaer","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""},{"first_name":"Rowan","middle_name":"","last_name":"Kelner","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""},{"first_name":"Christine","middle_name":"","last_name":"Raps","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""},{"first_name":"Allison","middle_name":"M.","last_name":"Beaulieu","name_suffix":"","institution":"University of Utah, Department of Emergency Medicine, Salt Lake City, Utah","department":""}],"date_submitted":"2024-01-11T04:19:50.265000+03:00","date_accepted":"2024-03-08T23:48:09.831000+03:00","date_published":"2024-06-03T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7189/galley/10896/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7189/galley/10810/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/7189/galley/10896/download/"}]},{"pk":6568,"title":"Spontaneous Osteomyelitis and Intraosseous Abscess: A Case Report","subtitle":null,"abstract":"Introduction: Acute hematogenous osteomyelitis may have significant morbidity and mortality if undiagnosed. Because it is uncommon in developed countries and has variable presentations, the patient may undergo several healthcare visits prior to diagnosis.
\nCase Report: We report the case of a 9-year-old male who presented with hip and knee pain with associated fevers and was found to have osteomyelitis and intraosseous abscess in the diaphysis of the right femur. He had multiple emergency department and outpatient visits before the ultimate diagnosis was made. He was treated with irrigation and debridement in addition to intravenous antibiotics.
\nConclusion: Pediatric acute hematogenous osteomyelitis can have subtle presentations, and this case illustrates some of the difficulties in making the diagnosis. This condition should be considered in the workup of a child with undifferentiated fever, pain, or decrease in mobility.
","language":"eng","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":"osteomyelitis"},{"word":"intraosseous abscess"},{"word":"pediatric"},{"word":"case report"},{"word":"Infectious disease"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9vs871p1","frozenauthors":[{"first_name":"Meghan","middle_name":"","last_name":"Chamberlain","name_suffix":"","institution":"Cooper University Hospital, Department of Emergency Medicine, Camden, New Jersey","department":"Emergency Department"},{"first_name":"Simon","middle_name":"","last_name":"Sarkisian","name_suffix":"","institution":"Cooper University Hospital, Department of Emergency Medicine, Camden, New Jersey","department":""}],"date_submitted":"2023-11-17T23:10:36.982000+03:00","date_accepted":"2024-01-22T21:07:29.976000+03:00","date_published":"2024-06-03T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6568/galley/10897/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6568/galley/10109/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/6568/galley/10897/download/"}]}]}