Primary palliative care education in emergency medicine residency: A mixed-methods analysis of a yearlong, multimodal intervention.

Background: Emergency medicine (EM) physicians frequently care for seriously ill patients at the end of life. Palliative care initiated in the emergency department (ED) can improve symptom management and quality of life, align treatments with patient preferences, and reduce length of hospitalization. We evaluated an educational intervention with digital tools for palliative care discussions in an urban EM residency using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework.

Telemedicine for Cranial Radiosurgery Patients in a Rural U.S. Population: Patterns and Predictors of Patient Utilization.

Telemedicine retains potential for increasing access to specialty providers in underserved and rural communities. COVID-19 accelerated adoption of telehealth beyond rural populations, serving as a primary modality of patient-provider encounters for many nonemergent diagnoses. From 2020 to 2021, telemedicine was incorporated in management of stereotactic radiosurgery patients.

The Low-Wage Essential Worker: Occupational Concerns and Needs in the COVID-19 Pandemic-A Round Table.

Background: Planning occupational health and wellness services and support directed toward low-wage, essential workers in the COVID-19 pandemic has posed a number of challenges across work settings. This article explores the concerns and needs of low-wage essential workers as understood by experts in the field.

Methods: Leading experts in the areas of occupational health and safety, risk management, insurance, and professional education/training were identified and invited to participate in a Round Table discussion.

Variability in the Massive Open Cluster NGC 1817 from : A Rich Population of Asteroseismic Red Clump, Eclipsing Binary, and Main-sequence Pulsating Stars.

We present a survey of variable stars detected in Campaign 13 within the massive intermediate-age (~1 Gyr) open cluster NGC 1817. We identify a complete sample of 44 red clump stars in the cluster, and have measured asteroseismic quantities ( and/or Δ) for 29 of them. Five stars showed suppressed dipole modes, and the occurrence rates indicate that mode suppression is unaffected by evolution through core helium burning.

Planning for Active Learning in the Didactic Classroom.

Driven by the convergence of the exponential growth of medical knowledge and the dated medical education delivery system, educators in physician assistant (PA) programs are striving to create teaching practices that actively engage students, improve knowledge retention, and prepare students for a career that requires lifelong learning and reflection. The emphasis on professor-directed teaching and learning activities is shifting toward a more learner-centered approach. To incorporate appropriate active learning exercises into the PA classroom, instructors must plan, design, and execute pedagogically sound practices.

Adenomyoma With Pseudoinvasive Growth Pattern and Serosal Penetration Mimicking Endometrial Carcinoma.

We present a novel case of a 48-yr-old female with a uterine adenomyoma with an unusual pseudoinvasive growth pattern displaying full-thickness penetration beyond the serosal surface in association with a dehisced Caesarian scar. Before hysterectomy, magnetic resonance imaging findings showed an infiltrative lesion suggestive of endometrial carcinoma. An endometrial biopsy was benign but definitive operative management was pursued given the concerning imaging.

Pediatric lead exposure and the water crisis in Flint, Michigan.

Changing the source of the water supply to save money had the unintended consequence of exposing residents of Flint, Mich., to elevated lead levels in their drinking water. A study done at Flint's Hurley Children's Hospital demonstrated that the incidence of elevated blood lead levels of children living in the affected area nearly doubled after the change in the water source.

Mild traumatic brain injury in a gymnast.

Primary care providers often are responsible for the initial evaluation and management plan of young patients with mild traumatic brain injury (mild TBI, also called concussion), and need to be familiar with new protocols and how to incorporate them into a patient's treatment plan. This article describes a patient who suffered a mild TBI and returned to sports too early, and discusses the appropriate protocols for managing concussion in children.

Informed Practice: Students' Clinical Experiences in the Undergraduate Phase of an Accelerated Physician Assistant Program.

This qualitative study explored the clinical experiences of students in an accelerated physician assistant (PA) program. The participants were either certified nursing assistants (CNAs) or emergency medical technicians-basic (EMTs-B). The study was designed to elicit (1) how the participants perceived their older patients and (2) how the participants' experiences might affect their own future communications, bedside manner, and clinical preparedness as PAs.

Posterior chondrolabral cleft: clinical significance and associations with shoulder instability.

Background: A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.

Questions/purposes: The purposes of this study were to determine if posterior chondrolabral clefts are associated with variations in glenoid morphology, and to determine if they are associated with shoulder instability.

CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed?

Objective: The purpose of this study is to compare CT urography (CTU) with unenhanced CT in the evaluation of upper urinary tracts in adults younger than 50 years with asymptomatic microscopic hematuria.

Materials And Methods: In this study, 1516 CTU examinations were reviewed in adults younger than 50 years. Inclusion criteria were no significant prior urologic disease and asymptomatic microscopic hematuria with at least one urinalysis with greater than or equal to 3 RBCs/high-power field and less than or equal to 50 RBCs/high-power field.

Emergency Optically Stimulated Luminescence Dosimetry Using Different Materials.

Several materials were tested as possible individual emergency dosimeters using Optically Stimulated Luminescence (OSL) as means to assess the exposure. Materials investigated included human nails, business cards and plastic buttons. The OSL properties of these materials were studied in comparison with those of teeth.

Emergency Dose Estimation Using Optically Stimulated Luminescence from Human Tooth Enamel.

Human teeth were studied for potential use as emergency Optically Stimulated Luminescence (OSL) dosimeters. By using multiple-teeth samples in combination with a custom-built sensitive OSL reader, (60)Co-equivalent doses below 0.64 Gy were measured immediately after exposure with the lowest value being 27 mGy for the most sensitive sample.

Optically stimulated luminescence dosimetry with gypsum wallboard (drywall).

Gypsum wallboard (drywall) represents an attractive target for retrospective dosimetry by optically stimulated luminescence (OSL) in the event of a radiological accident or malicious use of nuclear material. In this study, wallboard is shown to display a radiation-induced luminescence signal (RIS) as well as a natural background signal (NS), which is comparable in intensity to the RIS. Excitation and emission spectra show that maximum luminescence intensity is obtained for stimulation with blue light-emitting diodes (470 nm) and for detection in the ultraviolet region (290-370 nm).

Optically stimulated luminescence (OSL) of tooth enamel and its potential use in post-radiation exposure triage.

Optically stimulated luminescence (OSL) properties of dental enamel are discussed with a view to the development of an in vivo dose assessment technique for medical triage following a radiological/nuclear accident or terrorist event. In the OSL technique, past radiation exposure is assessed by stimulating the sample with light of one wavelength and monitoring the luminescence at another wavelength, under the assumption that the luminescence originates from the recombination of radiation-induced charges trapped at metastable defects in the enamel and that the intensity of the luminescence signal is in proportion to the absorbed radiation dose. Several primary findings emerged from this research: (a) sensitivities varied considerably between different teeth and also between fragments of the same tooth, (b) OSL signals were found to decay rapidly during the first 12 h after irradiation and more slowly afterward, (c) the fading rate of the luminescence signal varied between fragments, and (d) blue light stimulation yields greater sensitivity than infra-red stimulation, while the OSL signal obtained with a high-intensity pulsed green-light laser was found not to be correlated with the radiation dose.

The influence of muscle action on heart rate, RPE, and affective responses after upper-body resistance exercise.

Ratings of perceived exertion (RPE) are routinely used to monitor, assess, and prescribe aerobic exercise. Heart rate (HR) is another measure used to evaluate exercise intensity. Additionally, affective responses to aerobic exercise have been studied and seem to be influenced by the intensity of the exercise.

Electromyographic analysis of traditional and nontraditional abdominal exercises: implications for rehabilitation and training.

Background And Purpose: Performing nontraditional abdominal exercises with devices such as abdominal straps, the Power Wheel, and the Ab Revolutionizer has been suggested as a way to activate abdominal and extraneous (nonabdominal) musculature as effectively as more traditional abdominal exercises, such as the crunch and bent-knee sit-up. The purpose of this study was to test the effectiveness of traditional and nontraditional abdominal exercises in activating abdominal and extraneous musculature.

Subjects: Twenty-one men and women who were healthy and between 23 and 43 years of age were recruited for this study.

Magnetic resonance imaging appearance of a double anterior cruciate ligament associated with a displaced tear of the lateral meniscus.

The aim of this study is to report a novel description of a displaced tear of the lateral meniscus as a curvilinear low signal intensity band parallel and posteroinferior to the anterior cruciate ligament (ACL) on midline oblique sagittal magnetic resonance (MR) images, resulting in the appearance of a "double ACL." The appearance of a double ACL may potentially be a specific indicator for a lateral meniscal displaced tear. Increased awareness of this characteristic MR finding may increase accuracy in the diagnosis of displaced tears of the lateral meniscus.

An electromyographic analysis of commercial and common abdominal exercises: implications for rehabilitation and training.

Study Design: A repeated-measures, counterbalanced design.

Objectives: To test the effectiveness of 7 commercial abdominal machines (Ab Slide, Ab Twister, Ab Rocker, Ab Roller, Ab Doer, Torso Track, SAM) and 2 common abdominal exercises (crunch, bent-knee sit-up) on activating abdominal and extraneous (nonabdominal) musculature.

Background: Numerous abdominal machine exercises are believed to be effective in activating abdominal musculature and minimizing low back stress, but there are minimal data to substantiate these claims.

Celiomesenteric trunk compression and absence of collateral vessels in the large intestine--a case report.

The authors report the case of a rare mesenteric anomaly in a 71-year-old man who presented with a preexisting abdominal aortic aneurysm (AAA) and a progressive history of postprandial abdominal pain and 10-lb weight loss. Aortography revealed a common celiomesenteric trunk, an absent middle colic artery, and a stenotic inferior mesenteric artery. At operation, neural fibers compressing the common celiomesenteric trunk were lysed, the AAA was repaired, and the inferior mesenteric artery was subjected to endarterectomy and then reimplanted.

Use of cardiopulmonary bypass for tracheal resection: a case report.

Although ventilatory support can be life-saving, it also has adverse effects, including postintubation tracheal stenosis caused by damage to the larynx and trachea. Cardiopulmonary bypass is generally not used for the surgical management of tracheal stenosis; however, we have found that the use of cardiopulmonary bypass can be advantageous during tracheal resection and reconstruction.

Preoperative albumin and surgical site identify surgical risk for major postoperative complications.

Background: Although malnutrition contributes to morbidity, studies of pre- and postoperative nutrition often include well-nourished patients unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology. This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with postoperative complications and resource use in patients who receive no preoperative nutrition support and reinterprets the results of several conflicting randomized, prospective studies in this context.

Methods: This is a retrospective cohort study of 526 surgical patients who had preoperative serum albumin levels measured and were undergoing elective esophageal, gastric, pancreaticoduodenal, or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not.

TPN decreases IL-4 and IL-10 mRNA expression in lipopolysaccharide stimulated intestinal lamina propria cells but glutamine supplementation preserves the expression.

Total parenteral nutrition (TPN) decreases intestinal IgA and levels of Th2 cytokines, interleukin (IL)-4, and IL-10 within the supernatants of intestinal homogenates. These cytokines are known to stimulate IgA production in vitro by cells of the gut-associated lymphoid tissue (GALT). Glutamine (GLN) supplementation of TPN normalizes GALT mass and cytokine levels.

Impairment of mucosal immunity by total parenteral nutrition: requirement for IgA in murine nasotracheal anti-influenza immunity.

Secretory IgA (SIgA) is the primary mucosal Ig and has been shown to mediate nasotracheal (NT) mucosal immunity in normal immune BALB/c mice. This finding has been challenged by a report of NT immunity without IgA in knockout mice, suggesting that IgA may not be necessary for the protection of mucosal surfaces. Although other protective mechanisms may become active in the congenital absence of SIgA, these mechanisms are not the primary means of protection in normal mice.