Background: Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO2/FiO2) ratio is a non-invasive assessment of respiratory dysfunction substituted for the PaO2:FiO2 ratio in Sequential Organ Failure Assessment scoring. We hypothesized that emergency department (ED) SpO2/FiO2 ratios correlate with requirement for mechanical ventilation in COVID-19 patients. Our objective was to identify COVID-19 patients at greatest risk of requiring mechanical ventilation, using SpO2/FiO2 ratios.
\nMethods: We performed a retrospective review of patients admitted with COVID-19 at two hospitals. Highest and lowest SpO2/FiO2 ratios (percent saturation/fraction of inspired O2) were calculated on admission. We performed chi-square, univariate, and multiple regression analysis to evaluate the relationship of admission SpO2/FiO2 ratios with requirement for mechanical ventilation and intensive care unit (ICU) care.
\nResults: A total of 539 patients (46% female; 84% White), with a mean age 67.6 ± 18.6 years, met inclusion criteria. Patients who required mechanical ventilation during their hospital stay were statistically younger in age (P = 0.001), had a higher body mass index (P < .001), and there was a higher percentage of patients who were obese (P = 0.03) and morbidly obese (P < .001). Shortness of breath, cough, and fever were the most common presenting symptoms with a median temperature of 99°F. Average white blood count was higher in patients who required ventilation (P =<0.001). A highest obtained ED SpO2/FiO2 ratio of ≤300 was associated with a requirement for mechanical ventilation. A lowest obtained ED SpO2/FiO2 ratio of ≤300 was associated with a requirement for intensive care unit care. There was no statistically significant correlation between ED SpO2/FiO2 ratios >300 and mechanical ventilation or intensive care unit (ICU) requirement.
\nConclusion: The ED SpO2/FiO2 ratios correlated with mechanical ventilation and ICU requirements during hospitalization for COVID-19. These results support ED SpO2/FiO2 as a possible triage tool and predictor of hospital resource requirements for patients admitted with COVID-19. Further investigation 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":"COVID-19"},{"word":"SpO2/FiO2 ratio"},{"word":"Emergency Medicine"},{"word":"intensive care unit"},{"word":"mechincal ventilation"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2qj4h8s4","frozenauthors":[{"first_name":"Gary","middle_name":"","last_name":"Zhang","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":"None"},{"first_name":"Michael","middle_name":"J.","last_name":"Burla","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine; Southern Maine Healthcare, Department of Emergency Medicine, Biddeford, Maine; Tufts School of Medicine, Boston, Massachusetts","department":""},{"first_name":"Benjamin","middle_name":"B.","last_name":"Caesar","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":""},{"first_name":"Carolyne","middle_name":"R.","last_name":"Falank","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":"None"},{"first_name":"Peter","middle_name":"","last_name":"Kyros","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":""},{"first_name":"Victoria","middle_name":"C.","last_name":"Zucco","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":"None"},{"first_name":"Aneta","middle_name":"","last_name":"Strumilowska","name_suffix":"","institution":"University of New England College of Osteopathic Medicine, Biddeford, Maine","department":""},{"first_name":"Daniel","middle_name":"C.","last_name":"Cullinane","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":""},{"first_name":"Forest","middle_name":"","last_name":"Sheppard","name_suffix":"","institution":"Maine Medical Center, Department of Surgery, Portland, Maine","department":""}],"date_submitted":"2023-03-31T18:34:40+03:00","date_accepted":"2023-03-31T18:34:40+03:00","date_published":"2024-04-18T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17975/galley/10644/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17975/galley/9620/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17975/galley/10644/download/"}]},{"pk":46065,"title":"Neuropalliative Care Education for Adult Neurology Residents: Priorities to Improve Training","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Original Research"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3nz524nn","frozenauthors":[{"first_name":"Katherine","middle_name":"E.","last_name":"Makaroff","name_suffix":"MD, MHDS","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Nathan","middle_name":"","last_name":"Chu","name_suffix":"","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Cara","middle_name":"","last_name":"Siegel","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-17T22:49:59+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46065/galley/34797/download/"}]},{"pk":20907,"title":"A Critical Combination of Esophageal Rupture and Upside-down Stomach: A Case Report","subtitle":null,"abstract":"Introduction: Spontaneous esophageal rupture, or Boerhaave syndrome, and upside-down stomach are rare pathologies associated with grave sequelae. Boerhaave syndrome can have a mortality rate as high as 44%. Upside-down stomach accounts for less than 5% of hiatal hernias and can lead to incarceration and volvulus.
\nCase Report: An 80-year-old woman presented to the emergency department with sudden onset, severe epigastric pain. Physical examination revealed normal vital signs with mild epigastric tenderness. Imaging obtained revealed a large hiatal hernia and findings concerning for esophageal perforation. The patient was started on 3.375 grams of intravenous piperacillin/tazobactam, and transfer to a tertiary care facility was initiated. After transfer, esophagography confirmed a perforation near the gastroesophageal junction and findings consistent with an upside-down stomach. The patient underwent successful repair of the esophageal perforation and gastropexy followed by intensive care unit admission and ultimately discharge.
\nConclusion: Boerhaave syndrome and upside-down stomach are two conditions with high associated morbidity and mortality requiring prompt intervention. Information obtained in the history and physical examination including acute onset of chest pain after vomiting, tachypnea, subcutaneous emphysema, and hypoxia can assist in the diagnosis of the described pathologies. These signs and symptoms can be subtle on examination but are important in raising clinical suspicion for an otherwise rare etiology for acute onset chest pain.
","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":"Esophageal Rupture"},{"word":"Boerhaave Syndrome"},{"word":"upside-down stomach"},{"word":"Hiatal Hernia"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0vn5t2tg","frozenauthors":[{"first_name":"Kay","middle_name":"Nicole","last_name":"Tipton","name_suffix":"","institution":"UNC Health Southeastern, Department of Emergency Medicine, Lumberton, North Carolina; Campbell University, School of Medicine, Emergency Medicine Residency, Lumberton, North Carolina","department":""},{"first_name":"Daniel","middle_name":"","last_name":"Schroder","name_suffix":"","institution":"UNC Health Southeastern, Department of Emergency Medicine, Lumberton, North Carolina; Campbell University, School of Medicine, Emergency Medicine Residency, Lumberton, North Carolina","department":""}],"date_submitted":"2024-04-17T22:46:49.376000+03:00","date_accepted":"2024-04-17T22:49:21.144000+03:00","date_published":"2024-04-17T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/20907/galley/10643/download/"},"galleys":[{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/20907/galley/10643/download/"}]},{"pk":1650,"title":"Cardiac Arrest During a Ferric Derisomaltose Infusion Followed by Complete Heart Block: A Case Report","subtitle":null,"abstract":"Introduction: Ferric derisomaltose is the newest available parenteral iron formulation. Studies have demonstrated a good safety profile with improved tolerability compared to alternative parenteral iron formulations. To date there have been no reported acute, life-threatening cardiac events associated with ferric derisomaltose.
\nCase Report: An 86-year-old male who had previously tolerated routine iron infusions received a first dose of ferric derisomaltose at an outpatient infusion clinic. Six minutes into the infusion the patient became unresponsive with no palpable pulse. Return of spontaneous circulation was achieved after two minutes of chest compressions. Electrocardiogram showed complete heart block requiring transcutaneous pacing and vasopressor administration. The patient was transferred to the emergency department for stabilization and then admitted to the cardiac intensive care unit. During admission, the patient received a dual-chamber, permanent pacemaker without complication and was ultimately discharged.
\nConclusion: It may be reasonable to consider parenteral iron as a toxicological etiology for patients presenting with complete heart block temporally associated with parenteral iron administration, particularly in patients with underlying conduction abnormalities.
","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":"Ferric compounds"},{"word":"iron"},{"word":"heart block"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6vv7r0h2","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"Scott","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Natalie","middle_name":"","last_name":"Jansen","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""},{"first_name":"Leslie","middle_name":"A.","last_name":"Bilello","name_suffix":"","institution":"Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":""}],"date_submitted":"2023-09-05T21:44:59.666000+03:00","date_accepted":"2023-12-31T00:00:41.831000+03:00","date_published":"2024-04-17T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1650/galley/10639/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1650/galley/4315/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1650/galley/10639/download/"}]},{"pk":4814,"title":"Child with Closed Head Injury and Persistent Vomiting","subtitle":null,"abstract":"
Case Presentation: We present the case of a six-year-old child with autism who presented with persistent vomiting in the setting of a closed head injury (CHI). Computed tomography of the head was normal, but due to persistent vomiting a radiograph of the abdomen was done, which showed multiple, rare-earth magnets in the abdomen. There was no history of witnessed ingestion. These magnets had caused enteroenteric fistula formation leading to persistent vomiting.
\nDiscussion: In the setting of CHI, vomiting can be a sign of concussion or intracranial hemorrhage. In cases of CHI where intracranial pathology is ruled out and vomiting still persists, it is important to explore intra-abdominal causes of vomiting, especially in developmentally challenged children as they have higher incidence of unwitnessed foreign body ingestions.
","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":"Rare Earth Magnets"},{"word":"Closed Head Injury"},{"word":"vomiting"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8sj094vw","frozenauthors":[{"first_name":"Abdullah","middle_name":"","last_name":"Khan","name_suffix":"","institution":"Sidra Medical and Research Centre, Department of Emergency Medicine, Doha, Qatar","department":""}],"date_submitted":"2023-10-28T11:17:30.005000+03:00","date_accepted":"2024-01-17T21:20:14.250000+03:00","date_published":"2024-04-17T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/4814/galley/10642/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/4814/galley/9624/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/4814/galley/10642/download/"}]},{"pk":2582,"title":"One in a Million: A Woman Presenting with Unilateral Painful Ophthalmoplegia","subtitle":null,"abstract":"Case Presentation: A 52-year-old female presented to the emergency department with four days of right periorbital pain, ipsilateral temporal headache, diplopia, and photophobia. Physical examination of the right eye revealed painful ophthalmoplegia, cranial nerves III and VI paresis, increased intraocular pressure, and mild proptosis. Magnetic resonance venogram and magnetic resonance imaging orbits with contrast demonstrated an abnormal signal surrounding the right cavernous sinus/petrous apex. Tolosa-Hunt syndrome (THS) was diagnosed. Per neurology recommendations, the patient was placed on a steroid regimen over the course of three weeks. She was discharged on hospital day nine following resolution of symptoms. She had no recurrence of symptoms or residual deficits noted at her two-week follow-up appointment.
\nDiscussion: With an estimated annual incidence of one case per million, THS is a sinister etiology of unilateral headache, painful ophthalmoplegia, and oculomotor palsy. Tolosa-Hunt syndrome is caused by granulomatous inflammation in the cavernous sinus and is highly responsive to corticosteroids. Magnetic resonance imaging studies of the cavernous sinus and orbital apex are highly sensitive for THS and characteristically show enlargement and focal-enhancing masses within the affected cavernous sinus.
Introduction: Phlegmasia cerulea dolens (PCD) is an uncommon, potentially life-threatening complication of acute deep venous thromboses that requires a timely diagnosis. The name of the condition, the visual diagnostic criteria, and the preponderance of cases in the literature referencing findings exclusively in patients with lighter skin complexions means that PCD may not be on the differential diagnosis for the patient with more melanated skin who is experiencing this time-sensitive vascular emergency.
\nCase Report: We describe one case of PCD in a patient with darker skin complexion and the importance of identifying clinical findings, regardless of skin color, given the paucity of reference images for PCD in darker complected patients. Our literature review yielded 60 case reports for PCD. Only two papers included images referencing patients of color.
\nConclusion: Accurate diagnosis requires recognition of diagnostic findings, which may vary significantly between phenotypically distinct populations. Many pathognomonic physical exam findings rely on descriptors based on presentation in phenotypically white patients.
","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":"case report"},{"word":"health disparities"},{"word":"deep venous thrombosis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2m3397tx","frozenauthors":[{"first_name":"Kasha","middle_name":"","last_name":"Bornstein","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Internal and Emergency Medicine, New Orleans, Louisiana","department":""},{"first_name":"Elizabeth","middle_name":"","last_name":"LaRosa","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana","department":""},{"first_name":"Kelsey","middle_name":"","last_name":"Byrd","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana","department":""},{"first_name":"Daniel","middle_name":"","last_name":"Laney","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Interventional Radiology, New Orleans, Louisiana","department":""},{"first_name":"Hector","middle_name":"","last_name":"Ferral","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Interventional Radiology, New Orleans, Louisiana","department":""},{"first_name":"Heather","middle_name":"","last_name":"Murphy-Lavoie","name_suffix":"","institution":"Louisiana State University Health Sciences Center, Department of Emergency Medicine, New Orleans, Louisiana","department":""}],"date_submitted":"2023-10-04T20:31:41.702000+03:00","date_accepted":"2023-11-25T03:05:44.494000+03:00","date_published":"2024-04-17T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1905/galley/10640/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1905/galley/4316/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1905/galley/10640/download/"}]},{"pk":35108,"title":"Beyond evidentiality, the case of Ladakhi inok & siblings [HL Archive 13]","subtitle":null,"abstract":"The crosslinguistic concept of evidentiality, discriminating between direct and indirect knowledge, does not account for the Tibetic system, where the domain of direct is split up between \nexternal\n direct knowledge, based on immediate sense perception, and \ninternal\n direct knowledge, based on acquaintance, control/ volition, responsibility, and/ or authority or engagement. With the so-called ‘factual’ auxiliary \nred\n, several Tibetic languages also differentiate assertions, which are said to be neutral with respect to evidentiality. Ladakhi does not seem to have a corresponding counterpart. However, many instances of red can be directly translated by the compound auxiliary \ninok\n of the Central Ladakhi dialects and its siblings \nɦinak\n, \nɦindak\n, \nɦinɖak\n, and \nintsuk\n elsewhere. The opposite, however, is not true. inok & Cie. do not present events neutrally, but express a speaker’s attitude towards the content \nand\n the addressee and, logivally, express the expected attitude of the addressee in questions. This attitude may vary considerably according to the context and socio-pragmatic contstraints. The Ladakhi auxiliaries \ninok\n & Cie. may thus shed light on the perhaps not so neutral character of the auxiliary red and, more generally, on how ‘evidential’ the ‘evidential’ systems in Tibetic languages and those influenced by them actually are.","language":"en","license":null,"keywords":[{"word":"Tibetic languages, Ladakhi, evidentiality, speaker attitude, ‘factual’ marker red, inferential, irrealis, social conventions"}],"section":"Archives","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0tm2v2sr","frozenauthors":[{"first_name":"Bettina","middle_name":"","last_name":"Zeisler","name_suffix":"","institution":"Eberhard Karls Universität Tübingen","department":"None"}],"date_submitted":"2020-12-21T22:40:32+03:00","date_accepted":"2020-12-21T22:40:32+03:00","date_published":"2024-04-17T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/himalayanlinguistics/article/35108/galley/26149/download/"}]},{"pk":40211,"title":"A Hybrid Avant-Garde: Kati Horna’s Balance between Artist Autonomy and Political Engagement","subtitle":null,"abstract":"During the Spanish Civil War (1936–1939), Mexican-Hungarian photographer Kati Horna (1912–2000) produced visual materials for the anarcho-syndicalist union, the CNT-FAI (Confederación Nacional del Trabajo-Federación Anarquista Ibérica/National Labor Confederation-Iberian Anarchist Federation). From 1937 to 1938, she created photographs, photomontages, and collages that contain anarchist intonations. However, Horna’s own humanitarian-feminist voice can still be heard and recognized beyond the immediate goals of the organization. She was able to achieve this by combining Constructivist and Surrealist formal elements with a theory espoused by Lajos Kassák (1887–1967), the founder of Hungarian Activism, to create a heterogeneous artistic practice which extended beyond the traditional borders of a singular avant-garde movement. Horna inherited the belief from Kassák that artistic autonomy and politically engaged art can coexist, without allowing one to engulf the other. Her hybrid avant-garde presented a solution to the dominant interwar debate on how to create art that transformed life praxis (and by extension, politics) without sacrificing artistic autonomy. Horna’s participation in this discourse, profession as a photojournalist, and presence on the front lines during the Spanish Civil War challenged spaces traditionally reserved for men. Her creative voice uniquely resonates in these spaces due to her constant compassion towards her subjects and her creation of a hybrid avant-garde.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8bn3x7z6","frozenauthors":[{"first_name":"Lizi","middle_name":"","last_name":"Anderson-Cleary","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:49:55+03:00","date_accepted":"2024-04-15T23:49:55+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40211/galley/30261/download/"}]},{"pk":40210,"title":"Dreaming Out Loud: Aphantasia and the Contingencies of Artistic Imagination","subtitle":null,"abstract":"Cole Graham’s article “Inefficient, Unsustainable, and Fragmentary: The Rauschenberg Combines as Disabled Bodies” prompts us to consider disability as one of the precarious, suspended, and contradictive subversion zones that this volume explores. Framed through the lens of a cultural-critical disability model he calls sitpoint theory, Graham demonstrates how Robert Rauschenberg's Combines disrupt spatial, bodily, and sociocultural hegemonies, thus challenging existing ableist power structures and introducing the potential for new ways of living that do not center around conventional notions of ability. What if we were to apply Graham’s sitpoint theory to other modalities of disability or neurodivergence?","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/55h741bk","frozenauthors":[{"first_name":"Sophia","middle_name":"","last_name":"Gimenez","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:46:54+03:00","date_accepted":"2024-04-15T23:46:54+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40210/galley/30260/download/"}]},{"pk":40214,"title":"For Play and Pleasure","subtitle":null,"abstract":"A review of Kris Lemsalu's sculpture 'Chará,' exhibited in Vienna's Graben from August to November 2023. This public sculpture, made of steel and pigmented synthetic resin, explores the themes of feminine pleasure and joy. It was commissioned by KÖR to enhance Vienna's public spaces and serves as an art installation that engages the public in a dialogue of mythological and contemporary feminist narratives. The review highlights the sculpture's material attributes, its connection to ancient myths like vagina dentata and Baubo, and its societal impact.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2833367t","frozenauthors":[{"first_name":"Leander","middle_name":"","last_name":"Gussmann","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:55:04+03:00","date_accepted":"2024-04-15T23:55:04+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40214/galley/30264/download/"}]},{"pk":40203,"title":"Front Matter","subtitle":null,"abstract":"volume 4 | subversion zones","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/68d3v4t2","frozenauthors":[{"first_name":"Board","middle_name":"","last_name":"Editorial","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:31:27+03:00","date_accepted":"2024-04-15T23:31:27+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40203/galley/30253/download/"}]},{"pk":40209,"title":"Inefficient, Unsustainable, and Fragmentary: The Rauschenberg Combines as Disabled Bodies","subtitle":null,"abstract":"In a 1960 article entitled “Younger American Painters,” William Rubin accused Rauschenberg’s Combines of rendering the “inherently biographical style of Abstract Expressionism… even more personal, more particular, and sometimes almost embarrassingly private.” Rubin’s choice of the word “embarrassingly” was telling; the problem the Combines presented was that they were not private when good sense said they should be. This spilling over of the private into the embarrassingly deviant public has been read as an insistence on the work of art as both in its environment and in communication with it, as a valorization of the femininity associated with the interior/personal and relatedly, as a refusal of heteronormative subjectivity as dictated in the Cold War era. This article, however, suggest a supplementary reading of Rauschenberg’s Combines through the lens of disability theory. If Rauschenberg’s Combines are debased, and if one’s experience of them is bodily, then their association with the abject body demands inquiry. Made up of disparate parts that insist upon their discrete, adjunctive identities and former lives, the Combines might be best understood as disabled bodies that refuse to comply and in so doing inscribe new ways of being (corporeally) in the world.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4744m5dr","frozenauthors":[{"first_name":"Cole","middle_name":"J.","last_name":"Graham","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:45:20+03:00","date_accepted":"2024-04-15T23:45:20+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40209/galley/30259/download/"}]},{"pk":40213,"title":"Insights from Ecology for Health: Design Guide for Fostering Human Health and Biodiversity in Cities","subtitle":null,"abstract":"As cities globally aim for healthier environments and confront biodiversity threats, integrating nature into urban settings becomes crucial for various ecosystem services and ecological functions. Urban green spaces, with features like trees, water elements, and green roofs, play a vital role in supporting biodiversity and human health. However, designing such spaces involves navigating tradeoffs, such as balancing recreational needs with wildlife habitat preservation. To address this challenge, the San Francisco Estuary Institute (SFEI) developed Ecology for Health, a science-based urban design guide. This guide, accessible on SFEI's Making Nature's City Toolkit website, merges biodiversity research with the health benefits of green spaces, aiming to enhance urban community well-being.The guide offers strategies across three scales: urban planning, site design, and detailed design and management. It synthesizes three decades of global research on urban greening, human health, and biodiversity, with a focus on supporting native wildlife. Highlighted strategies from the guide include enhancing greenspace connectivity, optimizing park and waterfront designs, and balancing planning and site design considerations. These insights, coupled with feedback received during an outreach event with practitioners following publication of the guide, offer valuable direction for planners and designers aiming to create biodiverse urban environments that promote both human health and wildlife conservation.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2701c3hr","frozenauthors":[{"first_name":"Vanessa","middle_name":"","last_name":"Lee","name_suffix":"","institution":"","department":"None"},{"first_name":"Karen","middle_name":"","last_name":"Verpeet","name_suffix":"","institution":"","department":"None"},{"first_name":"Jennifer","middle_name":"","last_name":"Symonds","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:53:35+03:00","date_accepted":"2024-04-15T23:53:35+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40213/galley/30263/download/"}]},{"pk":40204,"title":"Introduction: Inhabiting the Uninhabitable at Oakland’s Wood Street Encampment","subtitle":null,"abstract":"From 2013 to 2023, the unhoused residents of West Oakland’s Wood Street encampment constructed a sprawling informal neighborhood from the city’s vast material and spatial excess. They built and furnished myriad shanties, tiny homes, and shacks from items cast off by Oakland’s middle and upper classes and by the industries surrounding the city’s massive port. It was common to see tarps and banners used as shading materials, fastened to utility poles and chain link fences. Forklift pallets became picket fences demarcating yards. Structures made from plywood and discarded furniture populated the shade beneath freeway.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3gh0g1f0","frozenauthors":[{"first_name":"Ben","middle_name":"","last_name":"Jameson-Ellsmore","name_suffix":"","institution":"","department":"None"},{"first_name":"Taylor","middle_name":"","last_name":"Van Doorne","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:37:20+03:00","date_accepted":"2024-04-15T23:37:20+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40204/galley/30254/download/"}]},{"pk":40205,"title":"Pineal/Perineal: The Anthropological Divide at Monkey Hill","subtitle":null,"abstract":"This paper examines Monkey Hill, a hamadryas baboon enclosure built in the 1920s at the London Zoo. Georges Bataille’s experience staring across at the baboons during a visit in 1927 inspired writings in which the upper parts of the primate body—the mouth, the face, the pineal gland—represented humanity, and the lower parts—the ano-genital or perineal regions—symbolized a base and contemptible animality associated with the baboons. This human-animal binary is reflected in the architecture of Monkey Hill. Its large, waterless moat divided the baboons from the zoo’s human visitors, operating as a management device to maintain distance between humans and other animals. Despite efforts to distance humanity, encounters like Bataille’s reveal the fragility of the human-animal divide. The paper thus explores notions of civilization and animality and how this dichotomy is constructed and maintained.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9hk2n4qb","frozenauthors":[{"first_name":"Corey","middle_name":"","last_name":"Ratch","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:38:44+03:00","date_accepted":"2024-04-15T23:38:44+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40205/galley/30255/download/"}]},{"pk":40202,"title":"react/review vol. 4, subversion zones: bodies and spaces at the threshold","subtitle":null,"abstract":"Full issue","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1d7530zh","frozenauthors":[{"first_name":"Board","middle_name":"","last_name":"Editorial","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:29:42+03:00","date_accepted":"2024-04-15T23:29:42+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40202/galley/30252/download/"}]},{"pk":40206,"title":"Red Tide and the Anthropological Divide at Lake Merritt in Oakland, California","subtitle":null,"abstract":"In this issue, Corey Ratch explores the less permeable divides at Monkey Hill, the London Zoo’s early twentieth-century baboon exhibit. Surrounded by unjumpable ditches, it forcefully articulated human/non-human distinctions. Just as Monkey Hill put human interventions in the natural world on display, so did a mass fish die-off in Lake Merritt. The August 2022 red tide algal bloom siphoned enough oxygen from the water to litter Lake Merritt’s edges with the asphyxiated bodies of fish, crustaceans, and mollusks. In the Anthropocene and the era of human induced climate change, clear anthropological divides are unsustainable.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8t63k6bz","frozenauthors":[{"first_name":"Ben","middle_name":"","last_name":"Jameson-Ellsmore","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:39:58+03:00","date_accepted":"2024-04-15T23:39:58+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40206/galley/30256/download/"}]},{"pk":40207,"title":"Skating the Surrounds: Chemi Rosado-Seijo’s \nEl Bowl\n in La Perla, Puerto Rico","subtitle":null,"abstract":"In 2006 artist Chemi Rosado Siejo completed construction of \nEl Bowl\n, a public structure with a dual function of a swimming pool and skate ramp in the La Perla neighborhood of San Juan, Puerto Rico. This article draws upon histories of urbanism and site specific art to examine the history of the structure and its site, located outside the colonial walls of the city. Looking to the development and visibility of the neighborhood since the site’s construction, Jekabson argues that \nEl Bowl\n is a structure that simultaneously disrupts and supports the growing pervasiveness of media tourism in Puerto Rico.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8mv5w21w","frozenauthors":[{"first_name":"Alida","middle_name":"R.","last_name":"Jekabson","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:41:59+03:00","date_accepted":"2024-04-15T23:41:59+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40207/galley/30257/download/"}]},{"pk":40212,"title":"The Body and the City: Walking Barcelona with las Milicianas and Eileen O’Shaughnessy","subtitle":null,"abstract":"In her recent book on Eileen O’Shaughnessy, a British logistics worker with the Partit Obrer d'Unificació Marxista (POUM) during the Spanish Civil War, Anna Funder examines a passage from George Orwell’s \nHomage to Catalonia\n in which Eileen sits alone in the Hotel Continental's lobby at night. Located on the major promenade of Las Ramblas in Barcelona, the hotel occupies a central location in a zone scarred by conflict and was a site of skirmishes during the war (1936-1939), acting at various moments as an avenue for collective movement, a no-man’s-land in street battles, and a space to be defended. Thinking about Eileen moving through the city, I respond to Anderson-Cleary’s discussion of representations of women by the Spanish left to consider how we might imagine \nmilicianas \nand other women active in the war as being present on the frontlines and the city streets \ntogether\n.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Feature Articles","is_remote":true,"remote_url":"https://escholarship.org/uc/item/95s7r33q","frozenauthors":[{"first_name":"Megan","middle_name":"J.","last_name":"Sheard","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-04-15T23:51:01+03:00","date_accepted":"2024-04-15T23:51:01+03:00","date_published":"2024-04-15T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/reactreview/article/40212/galley/30262/download/"}]},{"pk":63045,"title":"Factors Associated with Pediatric Emergency Department Avoidance During COVID-19 Pandemic: A Cross-sectional, Telephone-based Survey in Beirut, Lebanon ","subtitle":null,"abstract":"Introduction: We aimed to explore avoidant behavior of parents of frequent pediatric Emergency Department (ED) users, reasons behind avoidance and healthcare seeking behaviors in avoiders during COVID-19 pandemic.
\nMethods: We conducted a cross-sectional telephone-based survey on parents of frequent pediatric ED users at a tertiary care center in Beirut between March and August 2021.
\nResults: A total of 240 frequent pediatric ED users were included. Female comprised 39.6% of the sample. Of the surveyed patients, 117 reported ED avoidance. ED avoidance was common among parents of patients with concern for their child contracting COVID-19 during an ED visit (aOR=1.28, p<0.001,95%CI[1.13, 1.45]). However, parents of patients with an underlying malignancy/hematologic disease were less likely to refrain from ED visits (aOR=0.29, p<0.001, 95%CI[0.14, 0.60]). Moreover, 97.9% of parents of patients with acute symptoms who avoided the ED reported the fear of contracting COVID-19 as the main reason behind their avoidance. Of those who had acute symptoms and avoided the ED, the majority messaged or called a doctor as an alternative for their acute complaint. Furthermore, 28.9 sought yielded worse quality of care than what they would have experienced from the ED.
\nConclusion: In patients with high ED utilization rates, ED avoidance was common among parents of patients with concern for their child contracting COVID-19 during an ED visit. However, parents of patients with an underlying malignancy/hematologic disease were less likely to report avoidance. Developing alternative strategies to reduce emergency department (ED) avoidance during pandemics is crucial to ensuring that children continue to have access to acute care without a reduction in quality during public health crises.
","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.\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":"emergency department"},{"word":"ED avoidance"},{"word":"pediatric population"},{"word":"frequent ED users"}],"section":"Original Research","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8gc9v88n","frozenauthors":[{"first_name":"Dina","middle_name":"","last_name":"Mahmassani","name_suffix":"MD","institution":"American University of Beirut Medical Center","department":"Department of Emergency Medicine","country":"Lebanon"},{"first_name":"Abdo","middle_name":"Joseph","last_name":"Mghames","name_suffix":"MD","institution":"American University of Beirut Medical Center","department":"Department of Emergency Medicine","country":"Lebanon"},{"first_name":"Hani","middle_name":"","last_name":"Tamim","name_suffix":"PhD","institution":"American University of Beirut Medical Center","department":"Clinical Research Institute","country":"Lebanon"},{"first_name":"Walaa","middle_name":"","last_name":"El Sheikh","name_suffix":"","institution":"American University of Beirut Medical Center","department":"Clinical Research Institute"},{"first_name":"Eveline","middle_name":"","last_name":"Hitti","name_suffix":"MD, MBA","institution":"American University of Beirut Medical Center","department":"Department of Emergency Medicine","country":"Lebanon"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-15T00:00:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_medjem/article/63045/galley/48692/download/"}]},{"pk":63044,"title":"My Journey from ER to Palliative Care ","subtitle":null,"abstract":"","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.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Other","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1jx7v3ft","frozenauthors":[{"first_name":"Alexa","middle_name":"","last_name":"Gale","name_suffix":"MD FAAEM","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-15T00:00:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_medjem/article/63044/galley/48690/download/"}]},{"pk":63043,"title":"Why I No Longer Teach ATLS ","subtitle":null,"abstract":"","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.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Other","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4w6478kn","frozenauthors":[{"first_name":"Michael","middle_name":"","last_name":"LeWitt","name_suffix":"MD MPH","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-15T00:00:00+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/uciem_medjem/article/63043/galley/48689/download/"}]},{"pk":1517,"title":"Evidence for a constituent order boost in structural priming","subtitle":null,"abstract":"The study investigates the role of constituent order in structural priming. We report the results from a PO/DO priming experiment in German, in which we experimentally manipulated verb position in primes and targets. Significant structural priming effects occurred irrespective of whether verb position was the same in prime and target or not. However, additional similarity in constituent order was able to boost structural priming effects, with significantly stronger priming when the verb occurred in the same position in prime and target. We argue that existing one-stage and two-stage accounts of formulation struggle to account for the entire data pattern and propose an alternative account of formulation which can explain our results.","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/5p75z6br","frozenauthors":[{"first_name":"Gunnar","middle_name":"","last_name":"Jacob","name_suffix":"","institution":"Universität Mannheim","department":"Anglistisches Seminar"},{"first_name":"Kalliopi","middle_name":"","last_name":"Katsika","name_suffix":"","institution":"University of Kaiserslautern","department":""},{"first_name":"Neiloufar","middle_name":"","last_name":"Family","name_suffix":"","institution":"RPTU Kaiserslautern-Landau","department":"Psycholinguistics and Language Development"},{"first_name":"Alina","middle_name":"","last_name":"Kholodova","name_suffix":"","institution":"RPTU Kaiserslautern-Landau","department":"Psycholinguistics and Language Development"},{"first_name":"Shanley","middle_name":"E.M.","last_name":"Allen","name_suffix":"","institution":"Technische Universität Kaiserslautern","department":""}],"date_submitted":"2023-07-12T21:36:15.918000+03:00","date_accepted":"2024-01-19T22:34:15.998000+03:00","date_published":"2024-04-14T23:05:00+03:00","render_galley":{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1517/galley/10121/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1517/galley/10120/download/"},{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1517/galley/10121/download/"}]},{"pk":1306,"title":"Gender Competition in the Production of Nonbinary ‘They’","subtitle":null,"abstract":"Two experiments test how college students use nonbinary they to refer to a single and specific person whose pronouns are they/them, e.g., “Alex played basketball on the neighborhood court. At one point they made a basket,” compared to matched stories about characters with binary (she/her or he/him) pronouns. Experiment 1 shows that for both types of pronouns, people use pronouns more in a one-person than a two-person context. In both experiments, people produce nonbinary they at least as frequently as binary pronouns, suggesting that any difficulty does not result in pronoun avoidance in spoken language, even though it does in written language (Arnold et al., 2022). Nevertheless, there is evidence that nonbinary they is somewhat difficult, in that people made gender errors on about 9% of trials, and they used a more acoustically prominent and disfluent-sounding pronunciation for nonbinary pronouns than binary pronouns. However, exposure to they in the context of the experiment had no effect on frequency, accuracy, or pronunciation of pronouns. This provides the first evidence of how nonbinary they is used in a naturalistic storytelling context and shows that while it poses some minor difficulties, it can be used successfully in a supportive context.
","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/0pp284w3","frozenauthors":[{"first_name":"Jennifer","middle_name":"E","last_name":"Arnold","name_suffix":"","institution":"jarnold@email.unc.edu","department":"Psychology and Neuroscience"},{"first_name":"Ranjani","middle_name":"","last_name":"Venkatesh","name_suffix":"","institution":"UNC Chapel Hill","department":"Dept. of Psychology and Neuroscience"},{"first_name":"Zachary","middle_name":"","last_name":"Vig","name_suffix":"","institution":"UNC Chapel Hill","department":"Dept. of Psychology and Neuroscience"}],"date_submitted":"2023-04-12T20:36:38.275000+03:00","date_accepted":"2024-01-21T19:49:09.158000+03:00","date_published":"2024-04-14T23:00:00+03:00","render_galley":{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1306/galley/10119/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1306/galley/10118/download/"},{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/1306/galley/10119/download/"}]},{"pk":197,"title":"Dutch speakers take referent predictability into account, irrespective of addressee presence","subtitle":null,"abstract":"Language comprehension involves continuously making predictions about what will be mentioned next. If speakers take these predictions into account, one would expect that they try to be extra clear (e.g., by saying “the girl with the big earrings”) when they are going to say something less predictable. Conversely, speakers do not need to be as clear when the listener already expects the thing that they are about to mention, and can therefore suffice with a pronoun such as she. Previous research testing this hypothesis has found mixed results, with some studies finding that the referent’s predictability in discourse affects pronoun use and others finding that it does not. One explanation might be that speakers are more likely to take predictability into account when there is a co-present addressee who is predicting the next referent. To test this possibility, I conducted a language production experiment in which participants produced spoken continuations of narrative fragments. The fragments were accompanied by pictures that made clear how the story continued. Half of the participants performed the task without anyone else being present, while the other half told the stories to another person, who had to pick out the correct picture. Referent predictability was varied by manipulating the coherence relation in the narrative context. In addition, I calculated a surprisal score for each character in each narrative, as a more direct measure of its predictability. The results showed that with higher predictability, speakers were indeed more likely to use a pronoun than a definite NP to refer to the target character in their continuations. However, it did not matter whether the speaker was telling the stories to a co-present addressee or not. The results are discussed in light of accounts that distinguish between taking the perspective of a specific and that of a hypothetical listener.","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/9xr6w0z4","frozenauthors":[{"first_name":"Jorrig","middle_name":"","last_name":"Vogels","name_suffix":"","institution":"","department":""}],"date_submitted":"2022-09-22T10:26:45.494000+03:00","date_accepted":"2023-12-27T18:19:37.482000+03:00","date_published":"2024-04-14T22:30:00+03:00","render_galley":{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/197/galley/10099/download/"},"galleys":[{"label":"XML","type":"xml","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/197/galley/10099/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/glossapsycholinguistics/article/197/galley/10100/download/"}]},{"pk":42188,"title":"The Impacts of Ongoing Higher Education Legislation on University Instruction: Perspectives from an Anthropology Graduate Student in the State of Florida","subtitle":null,"abstract":"In this essay, I reflect on my own experiences as a graduate student in applied anthropology working in the context of ongoing higher education legislation implemented under the DeSantis administration in the state of Florida. In particular, I focus on the ways Florida’s House Bill 7 and Senate Bill 266 have impacted my experiences as a graduate student teaching general education courses in anthropology. This commentary argues that these laws have promoted a culture of uncertainty and precarity by disrupting the academic freedoms of people in teaching positions, while potentially undermining critical and creative thinking in the classroom.","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":"Legislation"},{"word":"graduate student"},{"word":"Higher education"},{"word":"Teaching"},{"word":"Florida"}],"section":"Commentaries","is_remote":true,"remote_url":"https://escholarship.org/uc/item/4n64k088","frozenauthors":[{"first_name":"Emma","middle_name":"","last_name":"Abell-Selby","name_suffix":"","institution":"University of South Florida","department":"None"}],"date_submitted":"2023-08-15T21:15:51+03:00","date_accepted":"2023-08-15T21:15:51+03:00","date_published":"2024-04-14T10:02:12+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/teachinglearninganthro/article/42188/galley/31499/download/"}]},{"pk":18320,"title":"Addressing System and Clinician Barriers to Emergency Department-initiated Buprenorphine: An Evaluation of Post-intervention Physician Outcomes","subtitle":null,"abstract":"Introduction: Emergency departments (ED) are in the unique position to initiate buprenorphine, an evidence-based treatment for opioid use disorder (OUD). However, barriers at the system and clinician level limit its use. We describe a series of interventions that address these barriers to ED-initiated buprenorphine in one urban ED. We compare post-intervention physician outcomes between the study site and two affiliated sites without the interventions.
\nMethods: This was a cross-sectional study conducted at three affiliated urban EDs where the intervention site implemented OUD-related electronic note templates, clinical protocols, a peer navigation program, education, and reminders. Post-intervention, we administered an anonymous, online survey to physicians at all three sites. Survey domains included demographics, buprenorphine experience and knowledge, comfort with addressing OUD, and attitudes toward OUD treatment. Physician outcomes were compared between the intervention site and the control sites with bivariate tests. We used logistic regression controlling for significant demographic differences to compare physicians’ buprenorphine experience.
\nResults: Of 113 (51%) eligible physicians, 58 completed the survey: 27 from the intervention site, and 31 from the control sites. Physicians at the intervention site were more likely to spend <75% of their work week in clinical practice and to be in medical practice for <7 years. Buprenorphine knowledge (including status of buprenorphine prescribing waiver), comfort with addressing OUD, and attitudes toward OUD treatment did not differ significantly between the sites. Physicians were 4.5 times more likely to have administered buprenorphine at the intervention site (odds ratio [OR] 4.5, 95% confidence interval 1.4–14.4, P = 0.01), which remained significant after adjusting for clinical time and years in practice, (OR 3.5 and 4.6, respectively).
\nConclusion: Physicians exposed to interventions addressing system- and clinician-level implementation barriers were at least three times as likely to have administered buprenorphine in the ED. Physicians’ buprenorphine knowledge, comfort with addressing and attitudes toward OUD treatment did not differ significantly between sites. Our findings suggest that ED-initiated buprenorphine can be facilitated by addressing implementation barriers, while physician knowledge, comfort, and attitudes may be harder to improve.
","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":"Emergency Medicine"},{"word":"buprenorphine"},{"word":"opioid use disorder"},{"word":"Substance Use Disorder"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0qr9s5pz","frozenauthors":[{"first_name":"Jacqueline","middle_name":"J.","last_name":"Mahal","name_suffix":"","institution":"Jacobi Medical Center, Department of Emergency Medicine, Bronx, New York; Albert Einstein College of Medicine, Department of Emergency Medicine, Bronx, New York","department":"None"},{"first_name":"Polly","middle_name":"","last_name":"Bijur","name_suffix":"","institution":"Albert Einstein College of Medicine, Department of Emergency Medicine, Bronx, New York","department":"None"},{"first_name":"Audrey","middle_name":"","last_name":"Sloma","name_suffix":"","institution":"Jacobi Medical Center, Department of Emergency Medicine, Bronx, New York","department":"None"},{"first_name":"Joanna","middle_name":"","last_name":"Starrels","name_suffix":"","institution":"Albert Einstein College of Medicine/Montefiore Medical Center, Department of Medicine, Bronx, New York","department":"None"},{"first_name":"TIffany","middle_name":"","last_name":"Lu","name_suffix":"","institution":"Jacobi Medical Center, Department of Psychiatry & Behavioral Sciences, Bronx, New York","department":"None"}],"date_submitted":"2023-05-22T16:56:45+03:00","date_accepted":"2023-05-22T16:56:45+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18320/galley/10539/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18320/galley/9596/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18320/galley/10539/download/"}]},{"pk":17882,"title":"Changing Incidence and Characteristics of Photokeratoconjunctivitis During the COVID-19 Pandemic","subtitle":null,"abstract":"Introduction: Photokeratoconjunctivitis (PKC) is primarily caused by welding. However, inappropriate use of germicidal lamps, which have been widely used following the COVID-19 outbreak, can also cause PKC. Our goal in this study was to investigate the incidence of and changes in the causes of PKC during the coronavirus 2019 (COVID-19) pandemic.
\nMethods: We conducted a single-center, retrospective observational study. The health records of patients who visited the emergency department in a tertiary care hospital from January 1, 2018–December 31, 2021 and were diagnosed with PKC, were reviewed. We then conducted an analysis to compare the characteristics of PKC before and after COVID-19 began and the features of PKC caused by welding and germicidal lamps.
\nResults: There were 160 PKC cases with a clear etiology before the COVID-19 pandemic and 147 cases during the COVID-19 pandemic. No significant differences in age and gender were detected between the two groups. The incidence of PKC induced by the use of germicidal lamps during the COVID-19 pandemic was significantly higher (10.2%) than the incidence before the pandemic (3.1%). The ratio of females to males in the germicidal lamp subgroup was significantly higher than the ratio in the welding subgroup. Limitations included incomplete information due to the retrospective nature of the study, underestimation of incidence, and possible recall bias.
\nConclusion: In the era of COVID-19, clinicians should be aware of the hazards of germicidal lamps. Although the COVID-19 pandemic seems to show signs of easing, new infectious diseases that require protective measures could still emerge in the future. Therefore, injuries related to germicidal lamps deserve more public health attention.
","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":"COVID-19"},{"word":"SARS-CoV-2"},{"word":"ultraviolet light"},{"word":"photokeratoconjunctivitis"},{"word":"germicidal lamp"},{"word":"welding"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0570r4tx","frozenauthors":[{"first_name":"Yu-Shiuan","middle_name":"","last_name":"Lin","name_suffix":"","institution":"Chi Mei Medical Center, Department of Ophthalmology, Tainan, Taiwan","department":"None"},{"first_name":"Chih-Cheng","middle_name":"","last_name":"Lai","name_suffix":"","institution":"Chi Mei Medical Center, Division of Hospital Medicine, Department of Internal Medicine, Tainan, Taiwan","department":"None"},{"first_name":"Yu-Chang","middle_name":"","last_name":"Liu","name_suffix":"","institution":"Chi Mei Medical Center, Department of Emergency Medicine, Tainan, Taiwan; National Cheng Kung University, College of Medicine, Department of Environmental and Occupational Health, Tainan, Taiwan","department":"None"},{"first_name":"Shu-Chun","middle_name":"","last_name":"Kuo","name_suffix":"","institution":"Chi Mei Medical Center, Department of Ophthalmology, Tainan, Taiwan; Chung Hwa University of Medical Technology, Department of Optometry, Jen-Teh, Tainan, Taiwan","department":"None"},{"first_name":"Shih-Bin","middle_name":"","last_name":"Su","name_suffix":"","institution":"Chi Mei Medical Center, Department of Occupational Medicine, Tainan, Taiwan; Chi Mei Medical Center, Department of Family Medicine, Tainan, Taiwan","department":"None"}],"date_submitted":"2023-02-13T05:30:01+03:00","date_accepted":"2023-02-13T05:30:01+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17882/galley/10542/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17882/galley/10090/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17882/galley/10542/download/"}]},{"pk":20780,"title":"Clinical Images in Emergency Medicine: Cushing’s Disease","subtitle":null,"abstract":"Case Presentation: A 22-year-old female presented to the emergency department with a two-month history of worsening fatigue, unintentional weight gain, and progressive facial swelling. Physical examination findings included hirsutism, moon facies, and abdominal striae. Subsequent brain magnetic resonance imaging revealed the presence of a 2.4-centimeter pituitary macroadenoma, confirming the diagnosis of Cushing’s disease. The patient was then admitted for neurosurgical tumor resection.
\nDiscussion: Cushing’s disease is exceedingly rare and often presents with symptoms resembling more prevalent disorders, contributing to delays in diagnosis. Therefore, maintaining a high index of suspicion for this disease is crucial for emergency physicians.
","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":"Cushing’s disease"},{"word":"Cushing syndrome"},{"word":"pituitary adenoma"},{"word":"case report"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/16g630jx","frozenauthors":[{"first_name":"Jason","middle_name":"D.","last_name":"Vadhan","name_suffix":"","institution":"UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas","department":""},{"first_name":"Nathaniel","middle_name":"","last_name":"Hansen","name_suffix":"","institution":"UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas","department":""},{"first_name":"Fernando","middle_name":"L.","last_name":"Benitez","name_suffix":"","institution":"UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas","department":""},{"first_name":"Larissa","middle_name":"I.","last_name":"Velez","name_suffix":"","institution":"UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas","department":""}],"date_submitted":"2024-04-09T19:54:05.287000+03:00","date_accepted":"2024-04-09T19:58:07.242000+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/20780/galley/10543/download/"},"galleys":[{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/20780/galley/10543/download/"}]},{"pk":17996,"title":"Factors Associated with Acute Telemental Health Consultations in Older Veterans","subtitle":null,"abstract":"Introduction: The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65 years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process.
\nMethods: This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55 years who received a mental health consultation in the ED or UCC from April 1, 2020–September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression.
\nResults: Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24–0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04–11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00–0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH.
\nConclusion: High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care. [West J Emerg Med. 2024;25(2)1–8.]
","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":"Geriatrics"},{"word":"Mental Health"},{"word":"Emergency Psychiatry"},{"word":"Telehealth"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6ks537sh","frozenauthors":[{"first_name":"Erica","middle_name":"C.","last_name":"Koch","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee; Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennesse; Veterans Affairs Quality Scholars Program, Nashville, Tennesseee","department":"None"},{"first_name":"Michael","middle_name":"J.","last_name":"Ward","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee; Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee; Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee","department":"None"},{"first_name":"Alvin","middle_name":"D.","last_name":"Jeffery","name_suffix":"","institution":"Vanderbilt University School of Nursing, Nashville, Tennessee; Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee; Tennessee Valley Healthcare System, Nursing Services, Nashville, Tennessee","department":"None"},{"first_name":"Thomas","middle_name":"J.","last_name":"Reese","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee","department":"None"},{"first_name":"Chad","middle_name":"","last_name":"Dorn","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee","department":"None"},{"first_name":"Shannon","middle_name":"","last_name":"Pugh","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Melissa","middle_name":"","last_name":"Rubenstein","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee","department":"None"},{"first_name":"Jo Ellen","middle_name":"","last_name":"Wilson","name_suffix":"","institution":"Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee; Vanderbilt University Medical Center, Department of Psychiatry, Nashville, Tennessee","department":"None"},{"first_name":"Corey","middle_name":"","last_name":"Campbell","name_suffix":"","institution":"Tennessee Valley Healthcare System, Psychiatric Services, Nashville, Tennessee","department":"None"},{"first_name":"Jin","middle_name":"H.","last_name":"Han","name_suffix":"","institution":"Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee; Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee","department":"None"}],"date_submitted":"2023-03-23T23:50:20+03:00","date_accepted":"2023-03-23T23:50:20+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17996/galley/10540/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17996/galley/9621/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17996/galley/10540/download/"}]},{"pk":17966,"title":"Implementation and Evaluation of a Bystander Naloxone Training Course","subtitle":null,"abstract":"Introduction: Bystander provision of naloxone is a key modality to reduce opioid overdose-related death. Naloxone training courses are available, but no standardized program exists. As part of a bystander empowerment course, we created and evaluated a brief naloxone training module.
\nMethods: This was a retrospective evaluation of a naloxone training course, which was paired with Stop the Bleed training for hemorrhage control and was offered to administrative staff in an office building. Participants worked in an organization related to healthcare, but none were clinicians. The curriculum included the following topics: 1) background about the opioid epidemic; 2) how to recognize the signs of an opioid overdose; 3) actions not to take when encountering an overdose victim; 4) the correct steps to take when encountering an overdose victim; 5) an overview of naloxone products; and 6) Good Samaritan protection laws. The 20-minute didactic section was followed by a hands-on session with nasal naloxone kits and a simulation mannequin. The course was evaluated with the Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales for take-home naloxone training evaluation. We used the paired Wilcoxon signed-rank test to compare scores pre- and post-course.
\nResults: Twenty-eight participants completed the course. The OOKS, measuring objective knowledge about opioid overdose and naloxone, had improved scores from a median of 73.2% (interquartile range [IQR] 68.3%–79.9%) to 91.5% (IQR 85.4%–95.1%), P < 0.001. The three domains on the OOAS score also showed statistically significant results. Competency to manage an overdose improved on a five-point scale from a median of 2.5 (IQR 2.4–2.9) to a median of 3.7 (IQR 3.5–4.1), P < 0.001. Concerns about managing an overdose decreased (improved) from a median of 2.3 (IQR 1.9–2.6) to median 1.8 (IQR 1.5–2.1), P < 0.001. Readiness to intervene in an opioid overdose improved from a median of 4 (IQR 3.8–4.2) to a median of 4.2 (IQR 4–4.2), P < 0.001.
\nConclusion: A brief course designed to teach bystanders about opioid overdose and naloxone was feasible and effective. We encourage hospitals and other organizations to use and promulgate this model. Furthermore, we suggest the convening of a national consortium to achieve consensus on program content and delivery.
","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":"Opioids"},{"word":"opioid overdose"},{"word":"naloxone"}],"section":"Behavioral Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5kb2199k","frozenauthors":[{"first_name":"Scott","middle_name":"G.","last_name":"Weiner","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Scott","middle_name":"A.","last_name":"Goldberg","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Cheryl","middle_name":"","last_name":"Lang","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Surgery, Boston, Massachusetts","department":"None"},{"first_name":"Molly","middle_name":"","last_name":"Jarman","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Surgery, Boston, Massachusetts","department":"None"},{"first_name":"Cory","middle_name":"J.","last_name":"Miller","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Sarah","middle_name":"","last_name":"Li","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Ewelina","middle_name":"W.","last_name":"Stanek","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Eric","middle_name":"","last_name":"Goralnick","name_suffix":"","institution":"Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"}],"date_submitted":"2023-03-14T01:05:18+03:00","date_accepted":"2023-03-14T01:05:18+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17966/galley/10541/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17966/galley/9622/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17966/galley/10541/download/"}]},{"pk":18399,"title":"Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study","subtitle":null,"abstract":"Background/Objective: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma.
\nMethods: We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2–17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers.
\nResults: A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7–15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2–5 years, OR 2.0, 95% confidence interval [CI] 1.4–2.9), male gender (OR 1.4, 95% CI 1.1–1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2–2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1–0.4).
\nConclusion: Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.
","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":"asthma"},{"word":"pediatric"},{"word":"interfacility transfer"},{"word":"healthcare systems"},{"word":"emergency medical services"}],"section":"Pediatrics","is_remote":true,"remote_url":"https://escholarship.org/uc/item/21n2c9g9","frozenauthors":[{"first_name":"Gregory","middle_name":"A.","last_name":"Peters","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts; Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Rebecca","middle_name":"E.","last_name":"Cash","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Scott","middle_name":"A.","last_name":"Goldberg","name_suffix":"","institution":"Harvard Medical School, Boston, Massachusetts; Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Jingya","middle_name":"","last_name":"Gao","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Lily","middle_name":"M.","last_name":"Kolb","name_suffix":"","institution":"The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York","department":"None"},{"first_name":"Carlos","middle_name":"A.","last_name":"Camargo","name_suffix":"Jr.","institution":"Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusett; Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusettss","department":"None"}],"date_submitted":"2023-07-12T16:40:48+03:00","date_accepted":"2023-07-12T16:40:48+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18399/galley/10538/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18399/galley/9594/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18399/galley/10538/download/"}]},{"pk":18404,"title":"Sexually Transmitted Infection Co-testing in a Large Urban Emergency Department","subtitle":null,"abstract":"Introduction: The incidence of sexually transmitted infections (STI) increased in the United States between 2017–2021. There is limited data describing STI co-testing practices and the prevalence of STI co-infections in emergency departments (ED). In this study, we aimed to describe the prevalence of co-testing and co-infection of HIV, hepatitis C virus (HCV), syphilis, gonorrhea, and chlamydia, in a large, academic ED.
\nMethods: This was a single-center, retrospective cross-sectional study of ED patients tested for HIV, HCV, syphilis, gonorrhea or chlamydia between November 27, 2018–May 26, 2019. In 2018, the study institution implemented an ED-based infectious diseases screening program in which any patient being tested for gonorrhea/chlamydia was eligible for opt-out syphilis screening, and any patient 18–64 years who was having blood drawn for any clinical purpose was eligible for opt-out HIV and HCV screening. We
analyzed data from all ED patients ≥13 years who had undergone STI testing. The outcomes of interest included prevalence of STI testing/co-testing and the prevalence of STI infection/co-infection. We describe data with simple descriptive statistics.
Results: During the study period there were 30,767 ED encounters for patients ≥13 years (mean age: 43 ± 14 years, 52% female), and 7,866 (26%) were tested for at least one of HIV, HCV, syphilis, gonorrhea, or chlamydia. We observed the following testing frequencies (and prevalence of infection): HCV, 7,539 (5.0%); HIV, 7,359 (0.9%); gonorrhea, 574 (6.1%); chlamydia, 574 (9.8%); and syphilis, 420 (10.5%). Infectious etiologies with universal testing protocols (HIV and HCV) made up the majority of STI testing. In patients with syphilis, co-infection with chlamydia (21%, 9/44) and HIV (9%, 4/44) was high. In patients with gonorrhea, co-infection with chlamydia (23%, 8/35) and syphilis (9%, 3/35) was high, and in patients with chlamydia, co-infection with syphilis (16%, 9/56) and gonorrhea (14%, 8/56) was high. Patients with HCV had low co-infection proportions (<2%).
\nConclusion: Prevalence of STI co-testing was low among patients with clinical suspicion for STIs; however, co-infection prevalence was high in several co-infection pairings. Future efforts are needed to improve STI co-testing rates among high-risk individuals.
","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":"emergency department"},{"word":"sexually transmitted infection"},{"word":"Sexually Transmitted Disease"},{"word":"Public health"},{"word":"Human immunodeficiency virus"},{"word":"hepatitis C virus"},{"word":"Syphilis"},{"word":"gonorrhea"},{"word":"chlamydia"}],"section":"Endemic Infections","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9tc121t5","frozenauthors":[{"first_name":"James","middle_name":"S.","last_name":"Ford","name_suffix":"","institution":"University of California San Francisco, Department of Emergency Medicine, San Francisco, California","department":"None"},{"first_name":"Joseph","middle_name":"C.","last_name":"Morrison","name_suffix":"","institution":"University of California Davis, Davis, California","department":"None"},{"first_name":"Jenny","middle_name":"L.","last_name":"Wagner","name_suffix":"","institution":"California State University, Department of Public Health, Sacramento, California","department":"None"},{"first_name":"Disha","middle_name":"","last_name":"Nangia","name_suffix":"","institution":"University of California Davis, School of Medicine, Sacramento, California","department":"None"},{"first_name":"Stephanie","middle_name":"","last_name":"Voong","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Cynthia","middle_name":"G.","last_name":"Matsumoto","name_suffix":"","institution":"University of California Davis Health, Learning Health System, Department of Population Health and Accountable Care, Sacramento, California","department":"None"},{"first_name":"Tasleem","middle_name":"","last_name":"Chechi","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"},{"first_name":"Nam","middle_name":"","last_name":"Tran","name_suffix":"","institution":"University of California Davis Health, Department of Pathology and Laboratory Medicine, Sacramento, California","department":"None"},{"first_name":"Larissa","middle_name":"","last_name":"May","name_suffix":"","institution":"University of California Davis Health, Department of Emergency Medicine, Sacramento, California","department":"None"}],"date_submitted":"2023-07-19T16:10:35+03:00","date_accepted":"2023-07-19T16:10:35+03:00","date_published":"2024-04-09T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/10537/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/9593/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18404/galley/10537/download/"}]},{"pk":18063,"title":"Support for Thrombolytic Therapy for Acute Stroke Patients on Direct Oral Anticoagulants: Mortality and Bleeding Complications","subtitle":null,"abstract":"Background: Alteplase (tPA) is the initial treatment for acute ischemic stroke. Current tPA guidelines exclude patients who took direct oral anticoagulants (DOAC) within the prior 48 hours. In this propensity-matched retrospective study we compared acute ischemic stroke patients treated with tPA who had received DOACs within 48 hours of thrombolysis to those not previously treated with DOACs, regarding three outcomes: mortality; intracranial hemorrhage (ICH); and need for acute blood transfusions (as a marker of significant blood loss).
\nMethods: Using the United States cohort of 54 healthcare organizations in the TriNetx database, we identified 8,582 stroke patients treated with tPA on DOACs within 48 hours of thrombolysis and 46,703 stroke patients treated with tPA not on DOACs since January 1, 2012. We performed propensity score matching on demographic information and seven prior clinical diagnostic groups, resulting in a total of 17,164 acute stroke patients evenly matched between groups. We recorded mortality rates, frequency of ICH, and need for blood transfusions for each group over the ensuing 7- and 30-day periods.
\nResults: Patients treated with tPA on DOACs had reduced mortality (3.3% vs 7.3%; risk ratio [RR] 0.456; P < 0.001), fewer ICHs (6.8% vs 10.1%; RR 0.678; P < 0.001), and less risk of major bleeding as measured by frequency of blood transfusions (0.5% vs 1.5%; RR 0.317; p < 0.001) at 7 days post thrombolytic, than the tPA patients not on DOACS. Findings for 30 days post-thrombolytics were similar/statistically significant with lower mortality rate (7.2% vs 13.1%; RR 0.550; P < 0.001), fewer ICHs (7.6%vs 10.8%; RR 0.705; P < 0.001), and fewer blood transfusions (0.9% vs 2.0%; RR 0.448; P < 0.001).
\nConclusion: Acute ischemic stroke patients treated with tPA who received DOACs within 48 hours of thrombolysis had lower mortality rates, reduced incidence of ICH, and less blood loss than those not on DOACs. Our study suggests that prior use of DOACs should not be a contraindication to thrombolysis for ischemic stroke.
","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":"Ischemic stroke"},{"word":"thrombolysis"},{"word":"anticoagulation"},{"word":"hemorrhage"}],"section":"Neurology","is_remote":true,"remote_url":"https://escholarship.org/uc/item/72b1d6nt","frozenauthors":[{"first_name":"Paul","middle_name":"","last_name":"Koscumb","name_suffix":"","institution":"University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas","department":"None"},{"first_name":"Luke","middle_name":"","last_name":"Murphy","name_suffix":"","institution":"University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas","department":""},{"first_name":"Matthew","middle_name":"","last_name":"Talbott","name_suffix":"","institution":"University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas","department":""},{"first_name":"Shiva","middle_name":"","last_name":"Nuti","name_suffix":"","institution":"University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas","department":""},{"first_name":"George","middle_name":"","last_name":"Golovko","name_suffix":"","institution":"University of Texas Medical Branch, Department of Pharmacology and Toxicology, Galveston, Texas","department":""},{"first_name":"Hashem","middle_name":"","last_name":"Shaltoni","name_suffix":"","institution":"University of Texas Medical Branch, Department of Neurology, Galveston, Texas","department":""},{"first_name":"Dietrich","middle_name":"","last_name":"Jehle","name_suffix":"","institution":"University of Texas Medical Branch, Department of Emergency Medicine, Galveston, Texas","department":""}],"date_submitted":"2023-04-10T17:33:52+03:00","date_accepted":"2023-04-10T17:33:52+03:00","date_published":"2024-04-08T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18063/galley/10535/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18063/galley/9581/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18063/galley/10535/download/"}]},{"pk":18394,"title":"Trauma-informed Care Training in Trauma and Emergency Medicine: A Review of the Existing Curricula","subtitle":null,"abstract":"Background and Objectives: Greater lifetime exposure to psychological trauma correlates with a higher number of health comorbidities and negative health outcomes. However, physicians often are not specifically trained in how to care for patients with trauma, especially in acute care settings. Our objective was to identify implemented trauma-informed care (TIC) training protocols for emergency and/or trauma service physicians that have both sufficient detail that they can be adapted and outcome data indicating positive impact.
\nMethods: We conducted a comprehensive literature search in MEDLINE (Ovid), Scopus, PsycInfo, Web of Science, Cochrane Library, Ebsco’s Academic Search Premier, and MedEdPORTAL. Inclusion criteria were EM and trauma service clinicians (medical doctors, physician assistants and nurse practitioners, residents), adult and/or pediatric patients, and training evaluation. Evaluation was based on the Kirkpatrick Model.
\nResults: We screened 2,280 unique articles and identified two different training protocols. Results demonstrated the training included patient-centered communication and interprofessional collaboration. One curriculum demonstrated that targeted outcomes were due to the training (Level 4). Both curricula received overall positive reactions (Level 1) and illustrated behavioral change (Level 3). Neither were found to specifically illustrate learning due to the training (Level 2).
\nConclusion: Study findings from our review show a paucity of published TIC training protocols that demonstrate positive impact and are described sufficiently to be adopted broadly. Current training protocols demonstrated an increasing comfort level with the TIC approach, integration into current practices, and referrals to trauma intervention specialists.
","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"},{"word":"Trauma-Informed Care"},{"word":"Emergency Medicine"},{"word":"training"},{"word":"evaluation"}],"section":"Trauma","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5w47h4gz","frozenauthors":[{"first_name":"Cecelia","middle_name":"","last_name":"Morra","name_suffix":"","institution":"Medical College of Wisconsin, Milwaukee, Wisconsin","department":"None"},{"first_name":"Kevin","middle_name":"","last_name":"Nguyen","name_suffix":"","institution":"Medical College of Wisconsin, Milwaukee, Wisconsin","department":"None"},{"first_name":"Rita","middle_name":"","last_name":"Sieracki","name_suffix":"","institution":"Medical College of Wisconsin, Milwaukee, Wisconsin","department":"None"},{"first_name":"Ashley","middle_name":"","last_name":"Pavlic","name_suffix":"","institution":"Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin","department":"None"},{"first_name":"Courtney","middle_name":"","last_name":"Barry","name_suffix":"","institution":"Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, Wisconsin","department":"None"}],"date_submitted":"2023-07-07T19:28:35+03:00","date_accepted":"2023-07-07T19:28:35+03:00","date_published":"2024-04-08T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18394/galley/10536/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18394/galley/9595/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18394/galley/10536/download/"}]},{"pk":46082,"title":"Li-Fraumeni Syndrome and Multiple Primary Malignancies, including Systemic Mastocytosis","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/3nr7g41w","frozenauthors":[{"first_name":"David","middle_name":"D.","last_name":"Kim","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Sheldon","middle_name":"","last_name":"Davidson","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T23:31:50+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46082/galley/34813/download/"}]},{"pk":46081,"title":"Diagnostic Considerations in the Evaluation of Cavitary Lung Lesions","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/61s0r62s","frozenauthors":[{"first_name":"Jody","middle_name":"","last_name":"Tai","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Matthew","middle_name":"","last_name":"McCullough","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T21:08:44+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46081/galley/34812/download/"}]},{"pk":46080,"title":"Immune Checkpoint-Inhibitor Induced Cholangiopathy","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/0sc3m6x6","frozenauthors":[{"first_name":"Juan","middle_name":"M.","last_name":"Alcantar","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Fukai","middle_name":"","last_name":"Chuang","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T20:33:47+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46080/galley/34811/download/"}]},{"pk":46079,"title":"Abnormal Breathing after Vagal Nerve Stimulator Implantation (VNS)","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/4802s63q","frozenauthors":[{"first_name":"Melisa","middle_name":"","last_name":"Chang","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Alfonso","middle_name":"","last_name":"Padilla","name_suffix":"MD","institution":"","department":""},{"first_name":"Oragun","middle_name":"","last_name":"Rojanapairat","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T20:20:40+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46079/galley/34810/download/"}]},{"pk":46078,"title":"Resolution of Idiopathic Intracranial Hypertension after Bariatric Surgery in a12-Year-Old Girl","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/6wh5s0hv","frozenauthors":[{"first_name":"Nazanin","middle_name":"Izadpanah","last_name":"Gunn","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Yijun","middle_name":"","last_name":"Chen","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T20:05:48+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46078/galley/34809/download/"}]},{"pk":46064,"title":"Monoclonal Immunoglobulin Deposition Disease due to Chronic Lymphocytic Leukemia causing Nephrotic Syndrome","subtitle":null,"abstract":"","language":"eng","license":{"name":"","short_name":"","text":null,"url":""},"keywords":[{"word":"Clinical Vignette"}],"section":"Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/0dg082kw","frozenauthors":[{"first_name":"Ramya","middle_name":"","last_name":"Malchira","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Michael","middle_name":"","last_name":"Shye","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-04T19:36:58+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46064/galley/34796/download/"}]},{"pk":5639,"title":"Inhibitory S-R Associations Influence the Partial Reinforcement Extinction Effect","subtitle":null,"abstract":"The Partial Reinforcement Extinction Effect (PREE) is the finding of more rapid extinction to a continuously reinforced cue than to a partially reinforced cue. Despite its well-documented existence, it has challenged many theoretical accounts of learning that assume the likelihood of responding is correlated with the strength of the learned Stimulus (S) – Response (R) association. While a number of explanations (notably by Amsel and Capaldi) of the PREE have been proposed, Rescorla (1999) reported a PREE using an entirely within-subjects design—a finding that runs counter to these proposed explanations. We describe how the PREE might be explained by the formation of inhibitory S-R associations that develop during the acquisition of partial reinforcement, but not continuous reinforcement. To test this proposal, we trained pigeons to peck a response key in the presence of one partially reinforced stimulus but also omitted the response key during the training of an alternative partially reinforced stimulus—thus preventing the development of inhibitory S-Rs to that latter stimulus. We found evidence for the PREE only for the partially reinforced stimulus where inhibitory S-Rs were capable of being formed, thus supporting our proposal. Alternative explanations of our procedure and its relevance to broader computational rules of learning is discussed.","language":"en","license":null,"keywords":[{"word":"instrumental conditioning"},{"word":"Law of Effect"},{"word":"habit"},{"word":"Pigeon"},{"word":"learning"}],"section":"Research Article","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3h34z46z","frozenauthors":[{"first_name":"Benjamin","middle_name":"M","last_name":"Seitz","name_suffix":"","institution":"UCLA","department":"None"},{"first_name":"Aaron","middle_name":"P","last_name":"Blaisdell","name_suffix":"","institution":"UCLA","department":"None"}],"date_submitted":"2023-03-06T04:28:05+03:00","date_accepted":"2023-03-06T04:28:05+03:00","date_published":"2024-04-03T19:00:00+03:00","render_galley":{"label":"Seitz_Final_pdf","type":"pdf","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5639/galley/10313/download/"},"galleys":[{"label":"Seitz_Final_pdf","type":"pdf","path":"https://journalpub.escholarship.org/uclapsych_ijcp/article/5639/galley/10313/download/"}]},{"pk":46077,"title":"A 75-Year-Old Woman with Left Wrist Pain and Swelling","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/3g86367d","frozenauthors":[{"first_name":"Olga","middle_name":"N.","last_name":"Popel","name_suffix":"MD, MBA","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"William","middle_name":"","last_name":"Martin","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T22:49:20+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46077/galley/34808/download/"}]},{"pk":46076,"title":"A 50-Year-Old Woman with B Insulin Resistance","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/6q25c7d2","frozenauthors":[{"first_name":"Amit","middle_name":"K.S.","last_name":"Sumal","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Dorothy","middle_name":"","last_name":"Martinez","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T22:39:25+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46076/galley/34807/download/"}]},{"pk":46075,"title":"Pulmonary Adenocarcinoma Presenting as Adrenal Hematoma","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/2pp6k6wq","frozenauthors":[{"first_name":"Salim","middle_name":"","last_name":"Ahmed","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Alanna","middle_name":"","last_name":"Chau","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T22:23:25+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46075/galley/34806/download/"}]},{"pk":46074,"title":"Thyrotoxicosis from Long-term Use of Redotex, a Fixed-dose Combination Weight-loss Medication","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/7zb7x599","frozenauthors":[{"first_name":"Jennifer","middle_name":"","last_name":"Siani","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Yaroslav","middle_name":"","last_name":"Gofnung","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T22:14:09+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46074/galley/34805/download/"}]},{"pk":46073,"title":"Single-session Laser with Concomitant Photodynamic Therapy and Adjuvant Topical Imiquimod for Basal Cell Skin Cancer","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/87z2b4dj","frozenauthors":[{"first_name":"Ekra","middle_name":"","last_name":"Rai","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Deeti","middle_name":"J.","last_name":"Pithadia","name_suffix":"MD","institution":"","department":""},{"first_name":"Teo","middle_name":"","last_name":"Soleymani","name_suffix":"MD","institution":"","department":""},{"first_name":"Carol","middle_name":"","last_name":"Cheng","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T22:04:34+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46073/galley/34804/download/"}]},{"pk":46072,"title":"PTEN Gene Mutation in a Young Woman with Multiple Cancers","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/7mz6x1mn","frozenauthors":[{"first_name":"Stephen","middle_name":"C.","last_name":"Ross","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T21:49:56+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46072/galley/34803/download/"}]},{"pk":46071,"title":"MAC versus Conscious Sedation for Gastrointestinal Endoscopy: Quality and Throughput","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/89m453xq","frozenauthors":[{"first_name":"Bijan","middle_name":"","last_name":"Navidi","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Kianusch","middle_name":"","last_name":"Kiai","name_suffix":"MD","institution":"","department":""},{"first_name":"Michael","middle_name":"","last_name":"Rofail","name_suffix":"","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T21:41:50+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46071/galley/34802/download/"}]},{"pk":46070,"title":"A Young Woman with Hypertension","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/6sx3x52f","frozenauthors":[{"first_name":"Daniel","middle_name":"J.","last_name":"Philipson","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Dustin","middle_name":"T.","last_name":"Lee","name_suffix":"MD","institution":"","department":""}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T21:26:01+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46070/galley/34801/download/"}]},{"pk":46069,"title":"Paxlovid-induced Tacrolimus Toxicity in a Renal Transplant Recipient","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/7338h9b8","frozenauthors":[{"first_name":"Reece","middle_name":"","last_name":"Doughty","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T20:23:42+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46069/galley/34800/download/"}]},{"pk":46063,"title":"Clinical Diagnosis Renal Artery Stenosis in a 65-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/9nb787w3","frozenauthors":[{"first_name":"Raghu","middle_name":"K.","last_name":"Venkataram","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Ramya","middle_name":"","last_name":"Malchira","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T19:54:47+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46063/galley/34795/download/"}]},{"pk":46062,"title":"Herpes Zoster Infection Following a Cosmetic Facial Procedure","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/27p2p6hs","frozenauthors":[{"first_name":"David","middle_name":"X.","last_name":"Li","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Nasser","middle_name":"","last_name":"El-Okdi","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T19:53:38+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46062/galley/34794/download/"}]},{"pk":46026,"title":"A Giant, Mobile, Mural Thrombus of the Aortic Arch","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/0z08g7sb","frozenauthors":[{"first_name":"Ramona","middle_name":"","last_name":"Mehrinfar-Zadeh","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Sahar","middle_name":"","last_name":"Sohrabian","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"},{"first_name":"Jina","middle_name":"","last_name":"Chung","name_suffix":"MD","institution":"University of California, Los Angeles","department":"Medicine"}],"date_submitted":null,"date_accepted":null,"date_published":"2024-04-02T19:52:15+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/ucladom_proceedings/article/46026/galley/34758/download/"}]},{"pk":17982,"title":"Prevalence and Characteristics of Emergency Department Visits by Pregnant People: An Analysis of a National Emergency Department Sample (2010–2020)","subtitle":null,"abstract":"Introduction: The number and characteristics of pregnant patients presenting to the emergency department (ED) has not been well described. Our objective in this study was to determine the prevalence and characteristics of pregnant patients presenting to EDs in the US between 2010–2020.
\n\n
Methods: We completed a retrospective, cross-sectional study of patient encounters at hospital-based EDs in the US from 2010–2020. Using the ED subsample of the National Hospital Ambulatory Medical Care Survey (NHAMCS) we identified ED visits for female patients aged 15–44 years. We defined a subsample of these as visits for pregnant patients using discharge diagnosis codes specificto pregnancy. We compared this population of pregnant patient visits to those for non-pregnant patients and computed point estimates for nationally weighted values. Multivariable linear regression was used to determine factors independently associated with pregnant patient visits.
\n\n
Results: The 2010–2020 NHAMCS dataset included 255,963 ED visits. Of these visits 59,080 were for female patients 15–44 years old, and 6,068 of those visits were for pregnant patients. Pregnant patients accounted for 3% (95% confidence interval [CI] 2.7–3.2) of all ED visits and 8.6% (95% CI 8–9.3) of all visits among female patients 15–44 years. Weighting to a national sample, this equates to 2.77 million pregnant patients presenting for ED visits annually. Pregnant patients were more likely to be Black, Hispanic, or to use public insurance.
\n\n
Conclusion: Pregnant patients make up a significant number of ED visits annually and are more likely to be people of color or publicly insured. Interventions to address the effects of changing abortion legislation on emergency medicine practice may benefit from consideration that certain populations of pregnant people are more likely to present to the ED for 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 Medicine"},{"word":"pregnancy"},{"word":"abortion"},{"word":"Reproductive Healthcare"}],"section":"Women's Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/48x0d7dn","frozenauthors":[{"first_name":"Carl","middle_name":"","last_name":"Preiksaitis","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California","department":"None"},{"first_name":"Monica","middle_name":"","last_name":"Saxena","name_suffix":"","institution":"Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California","department":"None"},{"first_name":"Jiaqi","middle_name":"","last_name":"Zhang","name_suffix":"","institution":"Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, California","department":"None"},{"first_name":"Andrea","middle_name":"","last_name":"Henkel","name_suffix":"","institution":"Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, California","department":"None"}],"date_submitted":"2023-03-19T07:24:42+03:00","date_accepted":"2023-03-19T07:24:42+03:00","date_published":"2024-04-02T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17982/galley/10317/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17982/galley/9597/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17982/galley/10317/download/"}]},{"pk":18352,"title":"The Utility of Dot Phrases and SmartPhrases in Improving Physician Documentation of Interpreter Use","subtitle":null,"abstract":"Background: Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use.
\n\n
Methods: We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreter-services use in ED charts at three time points: 1) pre-intervention baseline; 2) post-implementation of a clinician-driven dot phrase shortcut; and 3) post-implementation of a SmartPhrase.
\n\n
Results: Most emergency clinicians reported using an interpreter “almost always” or “often.” Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients’ preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients’ preferred languages.
\n\n
Conclusion: There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients.
","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":"interpreter use"},{"word":"Documentation"},{"word":"provider survey"},{"word":"dotphrase"},{"word":"smartphrase"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/5j56r7tm","frozenauthors":[{"first_name":"Katrin","middle_name":"","last_name":"Jaradeh","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Elaine","middle_name":"","last_name":"Hsiang","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Malini","middle_name":"K.","last_name":"Singh","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Christopher","middle_name":"R.","last_name":"Peabody","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"},{"first_name":"Steven","middle_name":"","last_name":"Straube","name_suffix":"","institution":"Department of Emergency Medicine, University of California, San Francisco, California; San Francisco General Hospital, San Francisco, California","department":"None"}],"date_submitted":"2023-06-06T12:56:54+03:00","date_accepted":"2023-06-06T12:56:54+03:00","date_published":"2024-04-02T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/10318/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/9582/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18352/galley/10318/download/"}]},{"pk":18436,"title":"Geographic Location and Corporate Ownership of Hospitals in Relation to Unfilled Positions in the 2023 Emergency Medicine Match","subtitle":null,"abstract":"Introduction: In the 2023 National Resident Matching Program (NRMP) match, there were 554 unfilled emergency medicine (EM) positions before the Supplemental Offer and Acceptance Program (SOAP). We sought to describe features of EM programs that participated in the match and the association between select program characteristics and unfilled positions.
\n\n
Methods: The primary outcome measures included the proportion of positions filled in relation to state and population density, hospital ownership type, and physician employment model. Secondary outcome measures included comparing program-specific attributes between filled and unfilled programs, including original accreditation type, year of original accreditation, the total number of approved training positions, length of training, urban-rural designation, hospital size by number of beds, resident-to-bed ratio, and the percentage of disproportionate share patients seen.
\n\n
Results: The NRMP Match had 276 unique participating EM programs with 554 unfilled positions. Six states offered 52% of the total NRMP positions available. Five states were associated with two-thirds of the unfilled positions. Public hospitals had a statistically significant higher match rate (88%) when compared to non-profit and for-profit hospitals, which had match rates of 80% and 75%, respectively (P < 0.001). Programs with faculty employed by a health system had the highest match rate of 87%, followed by clinician partnerships at 79% and private equity groups at 68% (P < 0.001 overall and between all subgroups).
\n\n
Conclusion: The 2023 match in EM saw increased rates in the number of residency positions and programs that did not fill before the SOAP. Public hospitals had higher match rates than for-profit or non-profit hospitals. Residency programs that employed academic faculty through the hospital or health system were associated with higher match rates.
","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":"residency match"},{"word":"match"},{"word":"corporate medicine"},{"word":"Private Equity"}],"section":"Education","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7xm8r3wg","frozenauthors":[{"first_name":"Zachary","middle_name":"J.","last_name":"Jarou","name_suffix":"","institution":"Ascension Providence Hospital, Department of Emergency Medicine, Southfield, Michigan; Michigan State University, East Lansing, Michigan","department":"None"},{"first_name":"Angela","middle_name":"G.","last_name":"Cai","name_suffix":"","institution":"University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania","department":"None"},{"first_name":"Leon","middle_name":"","last_name":"Adelman","name_suffix":"","institution":"Ivy Clinicians, Raleigh, North Carolina","department":"None"},{"first_name":"David","middle_name":"J.","last_name":"Carlberg","name_suffix":"","institution":"Georgetown University, Department of Emergency Medicine, Washington DC","department":"None"},{"first_name":"Sara","middle_name":"P.","last_name":"Dimeo","name_suffix":"","institution":"Dignity Health East Valley Rehabilitation Hospital, Chandler Regional Medical Center, Chandler, Arizona","department":"None"},{"first_name":"Jonathan","middle_name":"","last_name":"Fisher","name_suffix":"","institution":"Texas Christian University, Burnett School of Medicine, Fort Worth, Texas","department":"None"},{"first_name":"Todd","middle_name":"","last_name":"Guth","name_suffix":"","institution":"University of Colorado School of Medicine, Department of Emergency Medicine, Denver, Colorado","department":"None"},{"first_name":"Bruce","middle_name":"M.","last_name":"Lo","name_suffix":"","institution":"Sentara Norfolk General Hospital, Virginia; Eastern Virginia Medical School, Virginia","department":"None"},{"first_name":"Laura","middle_name":"","last_name":"Oh","name_suffix":"","institution":"Emory University, Department of Emergency Medicine, Atlanta, Georgia","department":"None"},{"first_name":"Rahul","middle_name":"","last_name":"Puttagunta","name_suffix":"","institution":"Ascension Providence Hospital, Department of Emergency Medicine, Southfield, Michigan; Michigan State University, East Lansing, Michigan","department":"None"},{"first_name":"Gillian","middle_name":"R.","last_name":"Schmitz","name_suffix":"","institution":"Uniformed Services University of Health Sciences, Department of Military and Emergency Medicine, Bethesda, Maryland","department":"None"}],"date_submitted":"2023-08-19T05:51:50+03:00","date_accepted":"2023-08-19T05:51:50+03:00","date_published":"2024-03-29T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18436/galley/10316/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18436/galley/9583/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18436/galley/10316/download/"}]},{"pk":18515,"title":"Imaging in a Pandemic: How Lack of Intravenous Contrast for Computed Tomography Affects Emergency Department Throughput","subtitle":null,"abstract":"Introduction: During the coronavirus 2019 pandemic, hospitals in the United States experienced a shortage of contrast agent, much of which is manufactured in China. As a result, there was a significantly decreased amount of intravenous (IV) contrast available. We sought to determine the effect of restricting the use of IV contrast on emergency department (ED) length of stay (LOS).
\n\n
Methods: We conducted a single-institution, retrospective cohort study on adult patients presenting with abdominal pain to the ED from March 7–July 5, 2022. Of 26,122 patient encounters reviewed, 3,028 (11.6%) included abdominopelvic CT with a complaint including “abdominal pain.” We excluded patients with outside imaging and non-ED scans. Routine IV contrast agent was administered to approximately 74.6% of patients between March 7–May 6, 2022, when we altered usage guidelines due to a nationwide shortage. Between May 6–July 5, 2022, 32.8% of patients received IV contrast after institutional recommendations were made to limit contrast use. We compared patient demographics and clinical characteristics between groups with chi-square test for frequency data. We analyzed ED LOS with nonparametric Wilcoxon rank-sum test for continuous measures with focus before and after new ED protocols. We also used statistical process control charts and plotted the 1, 2 and 3 sigma control limits to visualize the variation in ED LOS over time. The charts include the average (mean) of the data and upper and lower control limits, corresponding to the number of standard deviations away from the mean.
\n\n
Results: After use of routine IV contrast was discontinued, ED LOS (229.0 vs 212.5 minutes,
\nP =<0.001) declined by 16.5 minutes (95% confidence interval −10, −22).
\n\n
Conclusion: Intravenous contrast adds significantly to ED LOS. Decreased use of routine IV contrast in the ED accelerates time to CT completion. A policy change to limit IV contrast during a national shortage significantly decreased ED LOS.
","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 department"},{"word":"Length of Stay"},{"word":"IV Contrast"},{"word":"computed tomography"},{"word":"Advanced Imaging"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/97w414rb","frozenauthors":[{"first_name":"Wayne","middle_name":"A.","last_name":"Martini","name_suffix":"","institution":"Mayo Clinic Arizona, Department of Emergency Medicine, Phoenix, Arizona","department":"None"},{"first_name":"Clinton","middle_name":"E.","last_name":"Jokerst","name_suffix":"","institution":"Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona","department":"None"},{"first_name":"Nicole","middle_name":"","last_name":"Hodgson","name_suffix":"","institution":"Mayo Clinic Arizona, Department of Emergency Medicine, Phoenix, Arizona","department":"None"},{"first_name":"Andrej","middle_name":"","last_name":"Urumov","name_suffix":"","institution":"Mayo Clinic Arizona, Department of Emergency Medicine, Phoenix, Arizona","department":"None"}],"date_submitted":"2023-10-20T19:42:22+03:00","date_accepted":"2023-10-20T19:42:22+03:00","date_published":"2024-03-29T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18515/galley/10314/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18515/galley/9585/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18515/galley/10314/download/"}]},{"pk":18316,"title":"Public Health Interventions in the Emergency Department: A Framework for Evaluation","subtitle":null,"abstract":"Emergency departments (ED) in the United States serve a dual role in public health: a portal of entry to the health system and a safety net for the community at large. Public health officials often target the ED for public health interventions due to the perception that it is uniquely able to reach underserved populations. However, under time and resource constraints, emergency physicians and public health officials must make calculated decisions in choosing which interventions in their local context could provide maximal impact to achieve public health benefit. We identify how decisions regarding public health interventions are affected by considerations of cost, time, and available personnel, and further consider the role of local community needs, health department goals, and political environment. We describe a sample of ED-based public health interventions and demonstrate how to use a proposed framework to assess interventions. We posit a series of questions and variables to consider: local disease prevalence; ability of the ED to perform the intervention; relative efficacy of the ED vs community partnerships as the primary intervention location; and expected outcomes. In using this framework, clinicians should be empowered to improve the public health in their communities.
","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":"Public health"},{"word":"interventions"}],"section":"Public Health","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3g4795zj","frozenauthors":[{"first_name":"Elisabeth","middle_name":"","last_name":"Fassas","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Kyle","middle_name":"","last_name":"Fischer","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Steven","middle_name":"","last_name":"Schenkel","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"John","middle_name":"David","last_name":"Gatz","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"},{"first_name":"Daniel","middle_name":"B.","last_name":"Gingold","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":"None"}],"date_submitted":"2023-05-21T10:29:05+03:00","date_accepted":"2023-05-21T10:29:05+03:00","date_published":"2024-03-29T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18316/galley/10315/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18316/galley/9584/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18316/galley/10315/download/"}]},{"pk":41473,"title":"Abstracts 2024 IRCHLB VII","subtitle":null,"abstract":"","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"International Research Conference on Huanglongbing (IRCHLB)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/33r648r0","frozenauthors":[{"first_name":"Committee","middle_name":"","last_name":"IRCHLB","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-05-16T03:03:53+03:00","date_accepted":"2024-05-16T03:03:53+03:00","date_published":"2024-03-29T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/iocv_journalcitruspathology/article/41473/galley/31049/download/"}]},{"pk":41472,"title":"Program of the 2024 IRCHLB VII","subtitle":null,"abstract":"","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\n\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"International Research Conference on Huanglongbing (IRCHLB)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/6hc7361d","frozenauthors":[{"first_name":"Committee","middle_name":"","last_name":"IRCHLB","name_suffix":"","institution":"","department":"None"}],"date_submitted":"2024-05-16T02:49:55+03:00","date_accepted":"2024-05-16T02:49:55+03:00","date_published":"2024-03-29T10:00:00+03:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/iocv_journalcitruspathology/article/41472/galley/31048/download/"}]},{"pk":20364,"title":"Editor’s Introduction: Special Issue on Student Self Placement (SSP)","subtitle":null,"abstract":"","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7mp54031","frozenauthors":[{"first_name":"Carl","middle_name":"","last_name":"Whithaus","name_suffix":"","institution":"UC Davis","department":"University Writing Program"}],"date_submitted":"2024-03-20T07:21:22.749000+03:00","date_accepted":"2024-03-20T16:13:27.519000+03:00","date_published":"2024-03-27T22:54:20.623000+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/20364/galley/10281/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/20364/galley/10306/download/"}]},{"pk":20360,"title":"Placement is Everyone’s Business: A Love Letter to Our SSP Coalition","subtitle":null,"abstract":"In this introduction to the special issue, the co-editors offer the umbrella term \"methods of student self-placement\" (SSP) to refer to any placement mechanism that includes student choice so that we can further build theoretical apparatus, gather much-needed empirical data, and subsequently flesh out meaningful differences in approaches. They argue that just as SSP asks us to rethink the mission of first-year writing, it also asks us to rethink some of the divisions in Writing Studies because placement work is meaningful across the university. Ultimately, they conclude that SSP isn't an easy fix for systemic problems in higher education, but it is powerful in fully acknowledging the complexity of placement and meeting students' diverse learning needs. ","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"Assessment"},{"word":"placement"},{"word":"directed self-placement"},{"word":"guided self-placement"},{"word":"research"},{"word":"collaboration"},{"word":"Equity"},{"word":"sustainability"},{"word":"writing program"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7v9830xh","frozenauthors":[{"first_name":"Kate","middle_name":"L","last_name":"Pantelides","name_suffix":"","institution":"Middle Tennessee State University","department":""},{"first_name":"Erin","middle_name":"","last_name":"Whittig","name_suffix":"","institution":"","department":""}],"date_submitted":"2024-03-19T02:50:00.971000+03:00","date_accepted":"2024-03-19T02:57:11.031000+03:00","date_published":"2024-03-27T22:53:48.855000+03:00","render_galley":null,"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/20360/galley/10305/download/"}]},{"pk":1637,"title":"Informing Self-Placement: A Polyvocal Narrative Case Study","subtitle":null,"abstract":"This article provides a polyvocal narrative of the development, initial assessment, and ongoing revision of an Informed Self-Placement (ISP) process initially implemented during the COVID pandemic. The authors intersperse collectively narrated description how the ISP unfolded in its first two years with individual reflections on those experiences from a variety of positions and identities. Data so far suggest that this ISP process has narrowed but not fully closed racial equity gaps in first-year writing placement while maintaining enrollments and academic performance in the first-year writing course sequence. Persistent equity issues reside not only in the ISP instrument itself but the systems by which students learn about the ISP and the opportunities they have to complete it.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"self-placement"},{"word":"Equity"},{"word":"first-year writing"},{"word":"Pandemic"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9fw125t3","frozenauthors":[{"first_name":"Christie","middle_name":"","last_name":"Toth","name_suffix":"","institution":"University of Utah","department":"Writing & Rhetoric Studies"},{"first_name":"Jennifer","middle_name":"","last_name":"Andrus","name_suffix":"","institution":"","department":""},{"first_name":"Nkenna","middle_name":"","last_name":"Onwuzuruoha","name_suffix":"","institution":"","department":""},{"first_name":"Nicole","middle_name":"","last_name":"Clawson","name_suffix":"","institution":"","department":""},{"first_name":"Pietera","middle_name":"","last_name":"Fraser","name_suffix":"","institution":"","department":""},{"first_name":"Aubrey","middle_name":"","last_name":"Fochs","name_suffix":"","institution":"","department":""},{"first_name":"Samuel","middle_name":"","last_name":"Rivera Aguilar","name_suffix":"","institution":"","department":""}],"date_submitted":"2023-08-24T01:26:38.074000+03:00","date_accepted":"2024-02-13T23:37:52.465000+03:00","date_published":"2024-03-27T22:53:35.561000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1637/galley/10304/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1637/galley/10113/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1637/galley/10304/download/"}]},{"pk":1627,"title":"Supporting Student Linguistic Identity and Autonomy in Directed Self Placement Through Linguistic Domains Using Qualtrics Scoring","subtitle":null,"abstract":"In this article, we review the current and dynamic state of multilingual writers, especially their experiences in Composition and with English self-placement methods. Then, we position our institution and department’s theoretical underpinnings for support of multilingual writers and their self-placement, and we describe how we utilized Cavazos and Karaman’s (2021) Translingual Disposition Questionnaire as a framework for our recent revision of our Directed Self-Placement survey and utilized Qualtrics scoring tools to provide students with feedback on a novel language domain. Our intent was to offer multilingual students transparency and choice in the English placement process so they could select the first year Composition course that best matched their needs. We hope that other WPAs gain insight on how to integrate asset-based philosophies and linguistic domains using Qualtrics scoring to offer their multilingual students more autonomy in their first year Composition experiences.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"directed self-placement"},{"word":"Generation 1.5"},{"word":"student autonomy"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2jw1298d","frozenauthors":[{"first_name":"Laura","middle_name":"","last_name":"Decker","name_suffix":"","institution":"Nevada State University","department":"English"},{"first_name":"Brianne","middle_name":"","last_name":"Taormina-Barrientos","name_suffix":"","institution":"Nevada State University","department":"English"}],"date_submitted":"2023-08-16T09:54:47.550000+03:00","date_accepted":"2024-01-23T00:09:28.244000+03:00","date_published":"2024-03-27T22:53:11.361000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1627/galley/10881/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1627/galley/10881/download/"}]},{"pk":1625,"title":"Self-Characterization in the Self-Placement Assessment Ecology: Complicating the Stories We Tell about DSP’s Effects and Effectiveness","subtitle":null,"abstract":"Scholarship on student self-placement (SSP) emphasizes the importance of understanding methods like directed self-placement (DSP) as dynamic assessment ecologies (e.g., Inoue, 2015; Nastal et al., 2022; Wang, 2020), with implications not only for placement but also for how students conceptualize writing and themselves (e.g., Johnson, 2022). What can be learned about SSP’s ecological impacts by more meaningfully attending not just to patterns in students’ placement decisions but also to the qualitative content of their (self-)reflections and (self-)characterizations? Leveraging a dataset of more than 5,000 SSP pathways, we examine a corpus of short-answer survey responses, totaling more than half a million words, in which students wrote about their strengths as writers and what writing tasks they find most challenging. Students’ words help us understand how they see themselves as writers and how they conceive of college writing expectations. Through data analysis, this study found implications for how corpus data can be used to better understand potential tensions between students’ and institutions’ understandings of academic writing in a self-placement ecology.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"assessment ecology"},{"word":"self-placement"},{"word":"qualitative analysis"},{"word":"corpus analysis."}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/07c5j8tp","frozenauthors":[{"first_name":"Theresa","middle_name":"","last_name":"Tinkle","name_suffix":"","institution":"","department":""},{"first_name":"Jason","middle_name":"","last_name":"Godfrey","name_suffix":"","institution":"","department":""},{"first_name":"J.","middle_name":"W.","last_name":"Hammond","name_suffix":"","institution":"Michigan Technological University","department":"Humanities"},{"first_name":"Andrew","middle_name":"","last_name":"Moos","name_suffix":"","institution":"Colby College","department":"Writing Department"}],"date_submitted":"2023-08-16T00:30:53.484000+03:00","date_accepted":"2024-02-03T02:52:55.162000+03:00","date_published":"2024-03-27T22:52:53.308000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1625/galley/10302/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1625/galley/10302/download/"}]},{"pk":1582,"title":"Localizing Directed Self-Placement: UX Stories and Methods","subtitle":null,"abstract":"This article seeks to address the need for research supporting localization efforts in placement assessment. We argue that as a highly technical communication endeavor, directed self-placement (DSP) and its developers can benefit from research in technical and professional communication (TPC). We synthesize the theoretical relations between DSP and TPC, especially regarding models of localization, and demonstrate how implementing user experience (UX) design can help address placement equity concerns by foregrounding accessibility and usability from the beginning. We follow this discussion of DSP and TPC scholarship with storied examples from our institution, providing a sample range of UX methods that (1) are flexible across contexts, (2) are relatively manageable to implement, and (3) are cognizant of WPA, staff, and students’ time, labor, and compensation concerns. We propose DSP as a form of advocacy, and we demonstrate how UX method/ologies are an excellent choice for DSP localization efforts toward equity and accessibility.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"directed self-placement"},{"word":" accessibility"},{"word":" technical and professional communication"},{"word":" UX design"},{"word":" localization"},{"word":"localization"},{"word":"user experience (UX)"},{"word":"accessibility"},{"word":"technical and professional communication"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9sm4851w","frozenauthors":[{"first_name":"Kathleen","middle_name":"","last_name":"Kryger","name_suffix":"","institution":"","department":""},{"first_name":"Catrina","middle_name":"","last_name":"Mitchum","name_suffix":"","institution":"","department":""},{"first_name":"Aly","middle_name":"","last_name":"Higgins","name_suffix":"","institution":"","department":""}],"date_submitted":"2023-08-02T08:22:59.794000+03:00","date_accepted":"2023-12-20T21:33:44.061000+03:00","date_published":"2024-03-27T22:52:28.664000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1582/galley/10301/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1582/galley/10074/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1582/galley/10301/download/"}]},{"pk":1578,"title":"(Re)Placing Personalis: A Study of Placement Reform and Self-Construction in Mission-Driven Contexts","subtitle":null,"abstract":"Recent movements in higher education have opened many opportunities for writing program administrators to reform first-year writing placement procedures, including continued development and adaptation of Directed Self Placement (DSP) models alongside ongoing research into their potential to foster student agency and advance linguistic, racial, and social justice in the academy. Our study traces and compares the efforts of two writing program administrators to reform flawed placement processes at their two mission-driven liberal arts institutions—one, a small Lasallian university and Hispanic-serving Institution in Northern California; the other, a private research Jesuit university located in New York City. Using inter-institutional, grounded theory research, this study examines students' reflections on their placement choices to understand “substantive validity,” inquiring intentionally into ways that students self-locate with regard to their self-placement assessments and connecting to the mission-based language of personalis, what belongs to the person. Findings indicate that students use four rhetorical moves to personalize their placement: proliferating, riffing, importing, and qualifying. Specifically, the study calls into question current understandings of under-placement in DSP models, complicating DSP’s fundamentals of choice, guidance, and justice.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"Directed self placement Directed self-placement"},{"word":" mission-driven university"},{"word":" self-efficacy"},{"word":" social justice"},{"word":" course choice rationale"},{"word":" substantive validity"},{"word":"directed self-placement"},{"word":"mission-driven university"},{"word":"Self-Efficacy"},{"word":"Social Justice"},{"word":"course choice rationale"},{"word":"substantive validity"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8bv4d2tb","frozenauthors":[{"first_name":"Meghan","middle_name":"","last_name":"Sweeney","name_suffix":"","institution":"Saint Mary's College of California","department":""},{"first_name":"Crystal","middle_name":"","last_name":"Colombini","name_suffix":"","institution":"Fordham University","department":""}],"date_submitted":"2023-08-01T19:26:10.447000+03:00","date_accepted":"2024-02-10T01:20:02.726000+03:00","date_published":"2024-03-27T22:52:19.732000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1578/galley/10300/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1578/galley/10115/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1578/galley/10300/download/"}]},{"pk":1576,"title":"It Takes a Campus: Agility in the Development of Directed Self-Placement","subtitle":null,"abstract":"Transitioning from a conventional placement model for first-year writing to a student self-placement (SSP) model requires many stakeholders to shift their perspectives on students, assessment, and the nature of the work of writing program administrators (WPAs). This article recounts the communicative and administrative agility involved in launching SSP while simultaneously researching its effects on student success. It also foregrounds the shifts in numerous roles--including those of instructors, students, and advisors, and even our own roles as WPA-researchers--that have been prompted by the transition to SSP. In particular, this article explores the connections between those roles and academic paternalism--an attitude that presumes to know what is best for students, that doubts students' abilities to make good placement decisions, and that treats conventional placement outcomes as the measure against which SSP should be judged. Adherence to academic paternalism and its investment in \"expert\" assessment of student writing ability emerges as an obstacle to realizing the full potential of SSP to support equitable placement practices.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"Student self-placement"},{"word":"writing program administration"},{"word":"Academic paternalism"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/7gg6v4gj","frozenauthors":[{"first_name":"Kelly","middle_name":"","last_name":"Whitney","name_suffix":"","institution":"Ohio State University","department":"English"},{"first_name":"Carolyn","middle_name":"","last_name":"Skinner","name_suffix":"","institution":"Ohio State University","department":"English"}],"date_submitted":"2023-08-01T20:23:07.311000+03:00","date_accepted":"2024-02-08T16:20:25.920000+03:00","date_published":"2024-03-27T22:50:40.583000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1576/galley/10299/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1576/galley/10116/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1576/galley/10299/download/"}]},{"pk":1571,"title":"After Implementation: Assessing Student Self-Placement in College Writing Programs","subtitle":null,"abstract":"
While a growing body of research provides instruction on how to implement student self-placement (SSP) for college writing courses, there is a gap in the literature about how to evaluate SSP after implementation. This article offers strategies and recommendations for assessing SSP processes, based on the authors’ experiences of developing a new SSP mechanism and evaluating its effectiveness over several years. This article presents statistical data from our analysis of our institution’s SSP, which informs a heuristic set o fquestions that others can use to evaluate the effectiveness of their own SSP after implementation. This analysis demonstrates the value of evaluating SSP processes for writing programs, as well as outlining issues that may emerge and should be considered when analyzing SSP.
","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[{"word":"student self placement"},{"word":"writing program administration"},{"word":"placement evaluation"}],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3pc0n4dz","frozenauthors":[{"first_name":"Lisa","middle_name":"R","last_name":"Arnold","name_suffix":"","institution":"North Dakota State University","department":"English"},{"first_name":"Lei","middle_name":"","last_name":"Jiang","name_suffix":"","institution":"","department":""},{"first_name":"Holly","middle_name":"","last_name":"Hassel","name_suffix":"","institution":"","department":""}],"date_submitted":"2023-07-31T20:44:15.177000+03:00","date_accepted":"2024-02-03T02:58:07.039000+03:00","date_published":"2024-03-27T22:49:55.690000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1571/galley/10298/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1571/galley/10117/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1571/galley/10298/download/"}]},{"pk":1550,"title":"Directed Self-Placement for Multilingual, Multicultural International Students","subtitle":null,"abstract":"Directed self-placement (DSP) methods remain relatively rare in multilingual writing programs because such methods present unique ethical and academic risks. Grounded in five years of institutional research, this article reports on a first-year writing program in which DSP is the sole means of placement for international students and in which the international student population is linguistically, educationally, and culturally diverse. We offer logistical and technical guidance for creating DSP programs for multilingual writers, and we argue that DSP can be a vehicle for more equitable, socially just writing placement for multilingual, multicultural writers.","language":"eng","license":{"name":"Creative Commons Attribution-NonCommercial-NoDerivs 4.0","short_name":"CC BY-NC-ND 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc-nd/4.0"},"keywords":[],"section":"Special Issue - Student Self Placement (SSP)","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3wz6s1qb","frozenauthors":[{"first_name":"Kristine","middle_name":"","last_name":"Johnson","name_suffix":"","institution":"Calvin University","department":"English"},{"first_name":"Sara","middle_name":"","last_name":"Vander Bie","name_suffix":"","institution":"Calvin University","department":""}],"date_submitted":"2023-07-20T21:34:13.360000+03:00","date_accepted":"2024-01-30T02:48:23.495000+03:00","date_published":"2024-03-27T22:48:58.629000+03:00","render_galley":{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1550/galley/10297/download/"},"galleys":[{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1550/galley/10075/download/"},{"label":"PDF","type":"pdf","path":"https://journalpub.escholarship.org/jwa/article/1550/galley/10297/download/"}]},{"pk":1666,"title":"54-year-old Woman with Chest Pain","subtitle":null,"abstract":"Chest pain is a common presentation to the emergency department (ED) that can be caused by a multitude of etiologies. It can be challenging to differentiate life-threatening conditions from more benign causes. A 54-year-old woman presented to the ED complaining of chest pain with dyspnea in the setting of recent blunt trauma. This case offers a thorough yet practical approach to the diagnostic workup of chest pain with dyspnea in the ED setting. The surprising final diagnosis and case outcome are then revealed.Discussion: Atraumatic orbital emphysema is a rare clinical condition more common in early middle-aged female patients with certain historical features such as chronic sinusitis, facial surgery or trauma, tobacco smoking, or current upper respiratory symptoms. While most cases will resolve spontaneously, rarely this condition can lead to vision-threatening orbital compartment syndrome, requiring lateral canthotomy or needle decompression.
","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":"Atraumatic orbital emphysema"},{"word":"point-of-care ultrasound"},{"word":"case report"}],"section":"Images in Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9dw9r43c","frozenauthors":[{"first_name":"Eladio","middle_name":"","last_name":"Albornoz","name_suffix":"","institution":"Arizona State University, Department of Medical Studies, Phoenix, Arizona","department":""},{"first_name":"Janet","middle_name":"","last_name":"Wildemuth","name_suffix":"","institution":"Valleywise Health, Departments of Emergency Medicine and Internal Medicine, Phoenix, Arizona","department":""},{"first_name":"Josephine","middle_name":"","last_name":"Valenzuela","name_suffix":"","institution":"Creighton University of Phoenix, Phoenix, Arizona; University of Arizona Phoenix, Phoenix, Arizona","department":""}],"date_submitted":"2023-09-29T05:41:45.389000+03:00","date_accepted":"2023-12-31T00:04:36.528000+03:00","date_published":"2024-03-26T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1897/galley/10295/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1897/galley/4314/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1897/galley/10295/download/"}]},{"pk":1520,"title":"Emergency Department Doppler Assessment of a Central Retinal Artery Occlusion: Case Report","subtitle":null,"abstract":"Introduction: Vision loss is a symptom found frequently in patients presenting to the emergency department (ED). Central retinal artery occlusion (CRAO) is an uncommon yet time-sensitive and critical cause of painless vision loss in which delayed diagnosis can lead to significant morbidity. Emergency medicine literature documents the ability to diagnose a CRAO using ultrasound by identifying the hyperechoic thrombus coined the retrobulbar spot sign.
Case Report: We present the case of a patient presenting with painless monocular vision loss for which CRAO was diagnosed in the ED using point-of-care ultrasound enhanced by the utilization of serial Doppler examinations as well as calculation of the central retinal artery resistive index.
Conclusion: Despite the pre-existing literature on point-of-care ultrasound investigation of central retinal artery occlusion, there are no emergency medicine case reports describing serial examination of the central retinal artery by spectral Doppler or calculation of arterial resistive index to improve this evaluation and monitor progression of the pathology. [2024;7(5)1–5.]
Case Report: Here we present the case of a 64-year-old male patient with previous history of alcohol use disorder leading to chronic pancreatitis and prior embolization of an inferior pancreaticoduodenal pseudoaneurysm, who presented to the emergency department (ED) with abdominal pain, nausea, and vomiting, and was found to have a large recurrent inferior pancreaticoduodenal pseudoaneurysm with associated obstructive cholangitis and pancreatitis via contrast-enhanced computed tomography (CT) of the abdomen and pelvis. The patient was managed emergently by interventional radiology angiography with embolic coiling and percutaneous biliary catheter placement, and he subsequently underwent biliary duct stenting with gastroenterology. The patient was successfully discharged after a brief hospitalization after resolution of his pancreatitis and associated hyperbilirubinemia.
Conclusion: Pancreaticoduodenal artery aneurysms and pseudoaneurysms are rare and dangerous visceral pathologies. Patients can be diagnosed rapidly in the ED with CT imaging and need
urgent endovascular management to prevent morbidity and mortality.Case Report: A 19-year-old male presented to the ED with complaints of severe sore throat and fever for the prior five days. A POCUS using an endocavitary probe with sterile cover demonstrated hypoechoic debris with a “swirl sign.” Ultrasound was used to successfully guide needle aspiration by using in-plane needle guidance. The patient had significant bleeding after needle aspiration, and repeat POCUS clearly identified a new pocket of blood that had formed and was contained in the soft tissue. We monitored the size of the hematoma in real time with ultrasound to ensure the hematoma had no rapid expansion and was stable.
Conclusion: Among the differential diagnoses for sore throat, the diagnosis of peritonsillar abscess is particularly concerning as it is both common and generally requires swift intervention. Presentations can range from a mild infection to a life-threatening emergency with potential airway compromise. The two primary avenues for treatment include either needle aspiration or incision and drainage. Ultrasound can successfully identify the abscess and other landmarks for safe and successful drainage, as well as early identification of complications.
Discussion: Dengue is one of many viral illnesses that should be considered in returning travelers presenting with fever and other nonspecific symptoms. Emergency physicians must keep a broad differential when evaluating fever in returned travelers and prioritize history and physical exam findings to help narrow the diagnosis and provide appropriate management and supportive care while awaiting further confirmatory testing.
Case Report: We present the case of a patient presenting to the emergency department (ED) with acute-onset severe left forearm pain with associated pruritic rash incurred while working in a retail store. Initial therapeutic management included administration of analgesics, antihistamines, and steroids. After obtaining a comprehensive history and consulting with the Poison Control Center, we suspected an asp caterpillar envenomation. Following extraction of the caterpillar spines with silk tape, the patient’s symptoms improved. After a period of observation in the ED, the patient was discharged home without any known sequelae.
Conclusion: Although asp caterpillars typically inhabit trees and foliage, human exposure to the caterpillar may occur in developed environments. Effective history-taking, prompt communication with toxicologic experts, and complete removal of intact spines are essential for early identification and effective clinical management of asp caterpillar envenomation.
Case Report: We describe a case in which a previously healthy, 28-year-old female presented with new-onset seizures and acute respiratory distress syndrome (ARDS) in the setting of a recent cosmetic procedure with silicone injections to the gluteal region. The patient’s hospital course was complicated by altered mental status, respiratory failure, rapid hemodynamic compromise, and eventual death.
Conclusion: In rare cases, one possible complication of cosmetic procedures is silicone embolism syndrome, which is characterized by pneumonitis, alveolar hemorrhage, and ARDS. The patient described in this report also experienced neurologic symptoms including seizure and altered mental status. This is a clinical diagnosis that relies upon thorough history-taking and detailed physical exam. Documentation on this phenomenon is limited, and medical management has not yet been standardized for this condition. Morbidity and mortality remain high.
Case Report: We report a rare case of rectus abdominis muscle tear in an amateur bodybuilder diagnosed by point-of-care ultrasound (POCUS) in the emergency department (ED). The patient had presented to the ED three separate times after strenuous exercise, received costly diagnostic workups, and ultimately was diagnosed on the third visit with grade 2 bilateral rectus abdominis tear. The patient was given appropriate education and sports medicine follow-up. He underwent rehabilitation focused on trunk and core stability. At eight-week follow-up, the patient had made a full recovery.
Conclusion: To our knowledge, a case of bilateral rectus abdominis tear diagnosed by ultrasound in the emergency setting has not been previously published. Our case report highlights the utility of POCUS in diagnosing musculoskeletal pathology and preventing costly bounce-back visits.
","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":"Key Words (3-5): Rectus Abdominis"},{"word":"ultrasound"},{"word":"Muscle Tear"},{"word":"emergency department"},{"word":"case report"},{"word":"Rectus Abdominis"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/9j10f9d4","frozenauthors":[{"first_name":"Alejandro","middle_name":"J.","last_name":"Sanoja","name_suffix":"","institution":"Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida","department":""},{"first_name":"Michael","middle_name":"","last_name":"Shalaby","name_suffix":"","institution":"Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida","department":""}],"date_submitted":"2023-09-14T22:51:04.382000+03:00","date_accepted":"2023-12-01T21:55:35.830000+03:00","date_published":"2024-03-26T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1670/galley/10292/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1670/galley/3867/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1670/galley/10292/download/"}]},{"pk":1466,"title":"Defibrillator Lead Perforation Leading to Concerning Electrocardiogram Findings: Case Report","subtitle":null,"abstract":"Introduction: Implantable cardioverter-defibrillator (ICD) lead perforation through the myocardium may result in chest pain and electrocardiogram (ECG) changes concerning for ST-segment elevation myocardial infarction. The clinical context of the ECG aids in appropriate management.Case Report: We report the case of a 71-year-old woman experiencing chest pain after an ICD placement two weeks earlier. On presentation, she exhibited ST-segment elevation on her ECG. Computed tomography confirmed ICD lead migration. The patient’s hemodynamics were normal, and she was discharged home after a five-day hospital stay following a lead revision.
Conclusion: Although rare, ICD lead perforation is a potential cause of chest pain and ischemic ECG changes. Emergency physicians should consider lead perforation as a potential differential diagnosis when evaluating chest pain in patients with ICDs, taking into account the potential complications of coronary angiography.
","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":"ICD"},{"word":"lead perforation"},{"word":"current of injury"},{"word":"STEMI"},{"word":"ECG"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8584c4xr","frozenauthors":[{"first_name":"Bryan","middle_name":"","last_name":"Rosenberg","name_suffix":"","institution":"Medstar Washington Hospital Center; Department of Emergency Medicine; Washington, District of Columbia","department":""},{"first_name":"Max","middle_name":"","last_name":"Hockstein","name_suffix":"","institution":"Medstar Washington Hospital Center; Department of Emergency Medicine; Washington, District of Columbia","department":""},{"first_name":"Cyrus","middle_name":"","last_name":"Hadadi","name_suffix":"","institution":"Medstar Washington Hospital Center; Department of Cardiology, Washington, District of Columbia","department":""}],"date_submitted":"2023-06-28T03:05:59.539000+03:00","date_accepted":"2023-10-02T18:13:28.555000+03:00","date_published":"2024-03-25T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1466/galley/10282/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1466/galley/3240/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1466/galley/10282/download/"}]},{"pk":18387,"title":"Foundations of Emergency Medicine: Impact of a Standardized, Open-access, Core Content Curriculum on In-Training Exam Scores","subtitle":null,"abstract":"Introduction: Learners frequently benefit from modalities such as small-group, case-based teaching and interactive didactic experiences rather than passive learning methods. These contemporary techniques are features of Foundations of Emergency Medicine (FoEM) curricula, and particularly the Foundations I (F1) course, which targets first-year resident (PGY-1) learners. The American Board of Emergency Medicine administers the in-training exam (ITE) that provides an annual assessment of EM-specific medical knowledge. We sought to assess the effect of F1 implementation on ITE scores.Methods: We retrospectively analyzed data from interns at four EM residency programs accredited by the Accreditation Council for Graduate Medical Education. We collected data in 2021. Participating sites were geographically diverse and included three- and four-year training formats. We collected data from interns two years before (control group) and two years after (intervention group) implementation of F1 at each site. Year of F1 implementation ranged from 2015–2018 at participating sites. We abstracted data using a standard form including program, ITE raw score, year of ITE administration, US Medical Licensing Exam Step 1 score, Step 2 Clinical Knowledge (CK) score, and gender. We performed univariable and multivariable linear regression to explore differences between intervention and control groups.
Results: We collected data for 180 PGY-1s. Step 1 and Step 2 CK scores were significant predictors of ITE in univariable analyses (both with P < 0.001). After accounting for Step 1 and Step 2 CK scores, we did not find F1 implementation to be a significant predictor of ITE score, P = 0.83.
Conclusion: Implementation of F1 curricula did not show significant changes in performance on the ITE after controlling for important variables.
Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members.
Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care).
Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice.
Case Report: We present a case of a postmenopausal female presenting to the emergency department with flank pain. Point-of-care ultrasound showed free fluid in the abdomen. She was diagnosed with an ovarian artery aneurysm on computed tomography angiography and treated successfully with embolization.
Conclusion: Ruptured ovarian artery aneurysm is an uncommon cause of intra-abdominal hemorrhage in women.
","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":"intra-abdominal hemorrhage"},{"word":"ovarian artery"},{"word":"aneurysm"},{"word":"case report"}],"section":"Case Reports","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3161x6j9","frozenauthors":[{"first_name":"Raj","middle_name":"","last_name":"Patel","name_suffix":"","institution":"Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California","department":""},{"first_name":"Amy","middle_name":"","last_name":"Russell","name_suffix":"","institution":"Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California","department":""},{"first_name":"Melanie","middle_name":"M.","last_name":"Randall","name_suffix":"","institution":"Riverside University Health System, Department of Emergency Medicine, Moreno Valley, California","department":""}],"date_submitted":"2023-08-28T22:41:13.392000+03:00","date_accepted":"2023-10-22T10:53:20.462000+03:00","date_published":"2024-03-25T16:00:00+03:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1643/galley/10283/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1643/galley/3830/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/uciem_cpcem/article/1643/galley/10283/download/"}]},{"pk":18596,"title":"The Effect of a Simulation-based Intervention on Emergency Medicine Resident Management of Early Pregnancy Loss","subtitle":null,"abstract":"Background: The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits. Unfortunately, these patients consistently report negative experiences with ED care. In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling. These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression. Poor satisfaction with care has been associated with worse mental health outcomes. These complaints represent an important opportunity for improvement in emergency medicine (EM) training. While no published literature to date describes the performance of EM residents in managing patients presenting with EPL, studies suggest that even obstetrics and gynecology (OB/GYN) residents find these interactions challenging. Simulation- and didactic-based training has been shown to be beneficial in improving OB/GYN resident EPL counseling and has been associated with improved patient outcomes. To our knowledge, this has yet to be replicated in EM residency training.