Association of Step Count with Cardiorespiratory Fitness: Results from the Virtual 2-Minute Step Test.

Objective: To test the hypothesis that step count based on a virtual 2-minute step test (2MST) predicts cardiorespiratory fitness (CRF).

Design: Cross-sectional study.

Setting: Veteran Affairs Medical Centers participating in a randomized trial of functional exercise training delivered by videoconferencing.

Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema.

Background: Angiotensin-converting enzyme inhibitors (ACEI) are the most common cause of drug-induced angioedema in the United States. Our primary objective was to provide descriptive evidence regarding emergency department (ED) disposition of ACEI-induced angioedema patients. Our secondary objective was to evaluate unique patterns in those with ACEI-induced angioedema at a tertiary referral center, including demographics, details of those requiring intubation, length of inpatient stay, and allergy documentation.

Snapshot of Examination Usage in Emergency Medicine Clerkships.

Objective Emergency Medicine (EM) clerkships often use a written exam to assess the knowledge gained over the course of an EM rotation in medical school. Clerkship Directors (CDs) may choose the National Board of Medical Examiners (NBME) EM Advanced Clinical Science Subject Exam (ACE), the Society for Academic Emergency Medicine (SAEM) M4 exam, which has two versions, the SAEM M3 exam, or departmental exams. There are currently no published guidelines or consensus regarding their utility.

Diagnosing aortic dissection: A review of this elusive, lethal diagnosis.

Aortic dissection (AD) remains a difficult diagnosis in the emergency setting. Despite its rare occurrence, it is a life-threatening pathology that, if missed, is typically fatal. Previous studies have documented minimal improvement in timely and accurate diagnoses despite the advancement of computed tomography.

Nutrient leaching potential along a time series of forest water reclamation facilities in northern Idaho.

Forest water reclamation is a decades-old practice of repurposing municipal reclaimed water using land application on forests to filter nutrients and increase wood production. However, long-term application may lead to nutrient saturation, leaching, and potential impairment of ground and surface water quality. We studied long-term effects of reclaimed water application on nutrient leaching potential in a four-decade time series of forest water reclamation facilities in northern Idaho.

A Prospective Clinical Study to EvaluAte the AbiliTy of the CloudCath System to Detect Peritonitis During In-Home Peritoneal Dialysis (CATCH).

Introduction: Peritonitis is the leading complication of peritoneal dialysis (PD). Patients are instructed to seek care promptly for signs (cloudy effluent) or symptoms (abdominal pain), and earlier treatment improves outcomes. The CloudCath Peritoneal Dialysis Drain Set Monitoring (CloudCath) system monitors turbidity in dialysis effluent and sends notifications of changes signaling possible peritonitis.

Association of chronotropic incompetence with reduced cardiorespiratory fitness in older adults with HIV.

Objective: Understanding the physiological drivers of reduced cardiorespiratory fitness in people with HIV (PWH) will inform strategies to optimize healthspan. Chronotropic incompetence is common in heart failure and associated with low cardiorespiratory fitness yet is understudied in PWH. The objective was to determine the prevalence of chronotropic incompetence and its relationship with cardiorespiratory fitness.

The burden of RSV, hMPV, and PIV amongst hospitalized adults in the United States from 2016 to 2019.

Background: Respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and parainfluenza virus (PIV) hospitalize many people yearly. Though severe lower respiratory tract disease has been described in children, the elderly, and the immunocompromised, there is a gap in our understanding of RSV, hMPV, and PIV in hospitalized adults. We sought to evaluate the association of RSV, hMPV, and PIV with severe respiratory disease requiring noninvasive or mechanical ventilation and death in hospitalized adults in the United States.

Microbial iron acquisition is influenced by spatial and temporal conditions in a glacial influenced river and estuary system.

In Arctic regions, glaciers are major sources of iron to rivers and streams; however, estuaries are considered iron sinks due to the coagulation and flocculation processes that occur at higher salinities. It is unknown how iron dynamics in a glacial influenced river and estuary environment affect microbial mechanisms for iron acquisition. Microbial taxonomic and functional sequencing was performed on samples taken throughout the year from the Kenai River and the estuary, Alaska.

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis.

Objective: To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.

Design: Individual participant data meta-analysis.

Setting: Prospective pregnancy studies from 24 low and middle income countries.

Performance characteristics of a prototype dialysate turbidity monitoring system to detect peritonitis in patients receiving peritoneal dialysis.

Background: The risk of peritonitis has limited wider adoption of peritoneal dialysis (PD) in the United States. We developed a prototype bedside dialysate turbidity monitoring system, aiming to improve diagnostic accuracy relative to conventional approaches which depend on visual inspection and reporting of insensitive and non-specific symptoms.

Methods: The prototype system was tested in a single-centre, proof-of-principle clinical study in patients receiving intermittent PD.

Impact of a Focused Online Teaching Module on Airway Intervention: Can an Online Teaching Module Enable Knowledge Acquisition and Increased Confidence in Airway Management?

Objective: Teaching procedural skills via digital platforms is challenging. There is a paucity of literature on the feasibility of implementing an online asynchronous web-based learning (WBL) module for endotracheal intubation in Emergency Medicine. Learners completed a pre-test questionnaire prior to reviewing the module to assess their current knowledge.

Risk factors for inadequate and excessive gestational weight gain in 25 low- and middle-income countries: An individual-level participant meta-analysis.

Background: Many women experience suboptimal gestational weight gain (GWG) in low- and middle-income countries (LMICs), but our understanding of risk factors associated with GWG in these settings is limited. We investigated the relationships between demographic, anthropometric, lifestyle, and clinical factors and GWG in prospectively collected data from LMICs.

Methods And Findings: We conducted an individual participant-level meta-analysis of risk factors for GWG outcomes among 138,286 pregnant women with singleton pregnancies in 55 studies (27 randomized controlled trials and 28 prospective cohorts from 25 LMICs).

Novel Approach to Improve the Identification of the Bleeding Phenotype in Noonan Syndrome and Related RASopathies.

Objectives: To characterize the bleeding phenotype in Noonan syndrome (NS), to test the utility of following national guidelines in detecting this phenotype, to evaluate thromboelastography (TEG) as a diagnostic tool, and to evaluate the cohort for genotype-phenotype correlations.

Study Design: Participants with a clinical diagnosis of NS or related RASopathies were enrolled in a cohort study. Study procedures included clinical bleeding assessment, coagulation testing per guidelines, and hematology consultation.

Abdominal and Pelvic Computed Tomography for the Diagnosis of ST-Elevation Myocardial Infarction: The Challenges of Acute Coronary Syndrome in Diabetic Patients.

Diabetes mellitus (DM) is a major independent risk factor for cardiovascular disease. Patients who present with the metabolic emergency of diabetic ketoacidosis (DKA) have similar symptoms of diaphoresis, nausea, emesis, and abdominal pain, which can conceal acute coronary syndrome (ACS). We present a unique case where computed tomography (CT) of the abdomen and pelvis with IV contrast played an integral role in diagnosing an acute myocardial infarction in a patient with no typical ischemic symptoms.

Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs.

Background: There are concerns that emergency health care workers are exposed to ionizing radiation as the result of frequent portable radiographs obtained in the emergency department (ED) during active patient care.

Objective: Our aim was to investigate whether ED staff are exposed to significant radiation due to scatter from portable radiography at a busy trauma center and whether exposure was related to factors such as location or distance.

Methods: This was a prospective cohort study performed during 3 consecutive months in the ED at a large, academic trauma center.

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data.

Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs).

Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs.

Assessing Moderate to Vigorous Physical Activity in Older Adults: Validity of a Commercial Activity Tracker.

Despite the potential for commercial activity devices to promote moderate to vigorous physical activity (MVPA), limited information is available in older adults, a high-priority target population with unique gait dynamics and energy expenditure. The study purpose was to investigate the content validity of the Garmin Vivosmart HR device for step counts and MVPA in adults ≥65 years of age in free-living conditions. Thirty-five participants ( age= 73.

Industrial construction safety policies and practices with cost impacts in a COVID-19 pandemic environment: A Louisiana DOW case study.

There are always significant challenges in improving the safety culture by changing and adding additional safety protocols. The unknown impacts of COVID-19 and how it quickly spreads led the industry to institute essential safety protocols. This paper addresses two problem statements.

Intern Orthopedic Rotation Versus Emergency Medicine Procedure Month: Which one Derives More Opportunity?

Introduction: The American College of Graduate Medical Education (ACGME) defines 18 "key procedures" as requirements in emergency medicine (EM) residency programs. The post-graduate year-1 (PGY-1) curriculum provides an early foundation for EM trainees to gain procedural experience, but traditional PGY-1 rotations may not provide robust procedural opportunities. Our objective was to replace a traditional orthopedic rotation with a 4-week rotation that emphasized EM procedure acquisition and comprehension.

Field and laboratory characterization of rotenone attenuation in eight lakes of the Kenai Peninsula, Alaska.

Rotenone is a pesticide commonly used to eradicate Northern Pike (Esox lucius), an invasive species, in Southcentral Alaska. The present work incorporates a field investigation of rotenone attenuation in eight lakes of the Kenai Peninsula, following a CFT Legumine® treatment in October 2018 and a laboratory simulation to determine persistence under light/dark and sterile/nonsterile conditions representative of Southcentral Alaskan winters. In the field, rotenone degraded within <60 days of application in all lakes, while rotenolone, the primary product of rotenone degradation, persisted for up to <280 days post-treatment at two locations.