Implementation of the Modified Brain Injury Guidelines Might Be Feasible and Cost-Effective Even in a Nontrauma Hospital.

Introduction: The modified Brain Injury Guidelines (mBIG) provide a framework to stratify traumatic brain injury (TBI) patients based on clinical and radiographic factors in level 1 and 2 trauma centers. Approximately 75% of all U.S.

Residents' Perceptions of Effective Features of Educational Podcasts.

Introduction: Educational podcasts are used by emergency medicine (EM) trainees to supplement clinical learning and to foster a sense of connection to broader physician communities. Yet residents report difficulties remembering what they learned from listening, and the features of podcasts that residents find most effective for learning remain poorly understood. Therefore, we sought to explore residents' perceptions of the design features of educational podcasts that they felt most effectively promoted learning.

What's All the Chatter? A Mixed-Methods Analysis of Emergency Physicians' Tweets.

Introduction: Twitter is growing in popularity and influence among emergency physicians (EP), with over 2200 self-identified EP users. As Twitter's popularity has increased among EPs so too has its influence. While there has been debate about the value of Twitter as an effective educational delivery tool, little attention has been paid to the nature of the conversation occurring on Twitter.

Does the Medium Matter? Evaluating the Depth of Reflective Writing by Medical Students on Social Media Compared to the Traditional Private Essay Using the REFLECT Rubric.

Introduction: Social media is a novel medium to host reflective writing (RW) essays, yet its impact on depth of students' reflection is unknown. Shifting reflection on to social platforms offers opportunities for students to engage with their community, yet may leave them feeling vulnerable and less willing to reflect deeply. Using sociomateriality as a conceptual framework, we aimed to compare the depth of reflection in RW samples submitted by medical students in a traditional private essay format to those posted on a secure social media platform.

Navigating Cognitive Dissonance: A Qualitative Content Analysis Exploring Medical Students' Experiences of Moral Distress in the Emergency Department.

Background: As undergraduate medical students are acculturated into clinical practice, they develop a set of refined professional values that impact their decision making. We aimed to use students' reflective narratives on ethical dilemmas to identify how students experience moral distress while working in the emergency department (ED) to better understand how to support them in the development of their own agency to act ethically.

Methods: Students rotating in our emergency medicine clerkship are required to submit an essay describing an ethical dilemma they encountered.

Independent and Interwoven: A Qualitative Exploration of Residents' Experiences With Educational Podcasts.

Purpose: Educational podcasts are an increasingly popular platform for teaching and learning in health professions education. Yet it remains unclear why residents are drawn to podcasts for educational purposes, how they integrate podcasts into their broader learning experiences, and what challenges they face when using podcasts to learn.

Method: The authors used a constructivist grounded theory approach to explore residents' motivations and listening behaviors.

Head of the Bed Down: Paradoxical Management for Paradoxical Herniation.

Emergency physicians are well versed in cerebral herniation, pathology that typically results from increased intracranial pressure; however, paradoxical herniation is less common and requires opposing treatments. We describe a case of paradoxical herniation following lumbar puncture in a patient with previous hemicraniectomy. The symptomatology was similar to cerebral herniation from intracranial hypertension and included lethargy, bradycardia, headache, and compression of brain structures on non-contrast head computed tomography.

Endophthalmitis and Mycotic Aneurysm: The Only Clues to Underlying Endocarditis.

Infective endocarditis is a deadly disease that can present as a myriad of symptoms and thus its diagnosis can be missed. We present a case of infective endocarditis presenting as endogenous endophthalmitis and a ruptured mycotic aneurysm. This case illustrates both the complexity of infective endocarditis as a disease process and the more subtle diagnostic criteria as outlined by the Modified Duke Criteria.

Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment.

Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct.

Communicating Value in Simulation: Cost-Benefit Analysis and Return on Investment.

Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and the economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct.

Who Are the Most Influential Emergency Physicians on Twitter?

Introduction: Twitter has recently gained popularity in emergency medicine (EM). Opinion leaders on Twitter have significant influence on the conversation and content, yet little is known about these opinion leaders. We aimed to describe a methodology to identify the most influential emergency physicians (EP) on Twitter and present a current list.

The Effect of Written Posted Instructions on Collection of Clean-Catch Urine Specimens in the Emergency Department.

Background: Urinalysis testing is frequently ordered in the emergency department (ED), but contamination of urine specimens limits the interpretation of results. The mid-stream, clean-catch (MSCC) procedure for urine specimen collection is recommended to decrease contamination rates, but without instructions this procedure has poor compliance.

Objective: To evaluate the effectiveness of written instructions alone, we analyzed the rate of specimen contamination, defined by presence of squamous epithelial cells (SECs) and culture results, in the ED after posting information on the MSCC procedure.

Hemorrhagic Encephalopathy From Acute Baking Soda Ingestion.

Baking soda is a readily available household product composed of sodium bicarbonate. It can be used as a home remedy to treat dyspepsia. If used in excessive amounts, baking soda has the potential to cause a variety of serious metabolic abnormalities.

Cumulative response of ecosystem carbon and nitrogen stocks to chronic CO₂ exposure in a subtropical oak woodland.

Rising atmospheric carbon dioxide (CO₂) could alter the carbon (C) and nitrogen (N) content of ecosystems, yet the magnitude of these effects are not well known. We examined C and N budgets of a subtropical woodland after 11 yr of exposure to elevated CO₂. We used open-top chambers to manipulate CO₂ during regrowth after fire, and measured C, N and tracer (15) N in ecosystem components throughout the experiment.

The effects of 11 yr of CO₂ enrichment on roots in a Florida scrub-oak ecosystem.

Uncertainty surrounds belowground plant responses to rising atmospheric CO₂ because roots are difficult to measure, requiring frequent monitoring as a result of fine root dynamics and long-term monitoring as a result of sensitivity to resource availability. We report belowground plant responses of a scrub-oak ecosystem in Florida exposed to 11 yr of elevated atmospheric CO₂ using open-top chambers. We measured fine root production, turnover and biomass using minirhizotrons, coarse root biomass using ground-penetrating radar and total root biomass using soil cores.

Physiological profiling of soil microbial communities in a Florida scrub-oak ecosystem: spatial distribution and nutrient limitations.

Rapid physiological profiling of heterotrophic microbial communities enables intensive analysis of the factors affecting activity in aerobic habitats, such as soil. Previous methods for performing such profiling were severely limited due to enrichment bias and inflexibility in incubation conditions. We tested a new physiological profiling approach based on a microtiter plate oxygen sensor system (Becton Dickinson Oxygen Biosensor System (BDOBS)), which allows for testing of lower substrate addition (i.

Growing in circles: rearing environment alters spatial navigation in fish.

Animals of many species use the geometric shape of an enclosed rectangular environment to reorient, even in the presence of a more informative featural cue. Manipulating the rearing environment affects performance on spatial tasks, but its effect on the use of geometric versus featural navigational cues is unknown. Our study varied the geometric information available in the rearing environment (circular vs.