Location of Care Delivery for Pulmonary Arterial Hypertension in the United States.

Rationale: Guidelines recommend patients with pulmonary arterial hypertension (PAH) be referred to pulmonary hypertension (PH) centers, but little is known about where care is actually delivered in the United States (US).

Objectives: To use prescription patterns to estimate the proportion of PAH care delivered at US PH centers and explore factors associated with location of care.

Methods: This retrospective study analyzed claims from the Komodo database in adults who received ≥1 PAH prescription between March 2021 and February 2022.

Quantifying head impact biomechanical differences between commonly employed cleaning levels: a critical research interpretation consideration.

Introduction: Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes.

Objective: Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impacts recorded within start and end times, Level-2: impacts during pauses/breaks removed, Level-3: video verified) for male youth tackle football.

Youth Tackle Football Head-Impact Estimation by Players and Parents: Is the Perception the Reality?

Context: With growing concerns surrounding exposure to head impacts in youth tackle football, players and parents must understand the exposure level when assenting and consenting to participate.

Objective: To determine whether youth football players and parents could estimate on-field head-impact frequency, severity, and location.

Design: Prospective cohort study.

Influence of Society for Academic Emergency Medicine Foundation's Research Training Grant on postaward academic federal funding.

Objectives: The objective was to measure the impact of the Society for Academic Emergency Medicine Foundation's (SAEMF) Research Training Grant (RTG) by comparing academic success in grant recipients versus non-recipient applicants. Our primary outcome was subsequent federal funding as a principal investigator (PI) or multiple principal investigator (MPI). Our secondary outcomes included subsequent K-award funding, R-series funding, R01 funding, and academic productivity measured by first author peer-reviewed publications.

Safe Triage of STEMI Patients to General Telemetry Units After Successful Primary Percutaneous Coronary Intervention.

Objective: To analyze outcomes of patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (PCI) triaged to the cardiac intensive care unit (CICU) vs a general telemetry unit by a Zwolle risk score-based algorithm.

Methods: We introduced a quality improvement protocol in 2014 encouraging admission of STEMI patients with Zwolle score of 3 or less to general telemetry units unless they were hemodynamically unstable. We subsequently conducted a retrospective single-center cohort study of consecutive STEMI patients who had undergone primary PCI from January 1, 2014, to December 31, 2018.

King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes.

Context: The King-Devick (K-D) test is used to identify oculomotor impairment after concussion. However, the diagnostic accuracy of the K-D test over time has not been evaluated.

Objectives: To (1) examine the sensitivity and specificity of the K-D test at 0 to 6 hours postinjury, 24 to 48 hours postinjury, the beginning of a return-to-play (RTP) protocol (asymptomatic), unrestricted RTP, and 6 months postconcussion and (2) compare outcomes between athletes with and those without concussion across confounding factors (sex, age, sport contact level, academic year, learning disorder, attention-deficit/hyperactivity disorder, migraine history, concussion history, and test administration mode).

Head Impact Biomechanics in Youth Flag Football: A Prospective Cohort Study.

Background: Youth flag football participation has rapidly grown and is a potentially safer alternative to tackle football. However, limited research has quantitatively assessed youth flag football head impact biomechanics.

Purpose: To describe head impact biomechanics outcomes in youth flag football and explore factors associated with head impact magnitudes.

On-field Characteristics and Head Impact Magnitude in Youth Tackle Football.

Background: This study determined the effect of video-verified collision characteristics on head impact magnitudes in male youth tackle football.

Methods: Participants (n = 23, age = 10.9 ± 0.

The Effects of On-Field Heat Index and Altitude on Concussion Assessments and Recovery Among NCAA Athletes.

Background: Recent literature has indicated altitude may be a protective factor for concussion but it is unknown whether altitude or heat index affects recovery.

Objective: To examine whether on-field heat index and altitude at the time of injury alter acute (< 48 h) concussion assessments, days-to-asymptomatic, and days-to-return-to-play in collegiate athletes following concussion.

Methods: Collegiate athletes (n = 187; age = 19.

A Case of Hyperkalemia Versus Pseudohyperkalemia in Chronic Lymphocytic Leukemia.

Introduction: Both hyperkalemia and pseudohyperkalemia occur in the emergency department. True hyperkalemia necessitates emergent treatment while pseudohyperkalemia requires recognition to prevent inappropriate treatment. It is imperative that the emergency physician (EP) have an understanding of the causes and clinical presentations of both phenomena.

Sex differences in mechanisms of head impacts in collegiate soccer athletes.

Background: There has been growing interest in head impacts related to sports participation due to potential long- and short-term consequences of head injuries. Our purpose was to compare head impact magnitude and frequency between men's and women's intercollegiate soccer players based on head impact mechanism.

Methods: 28 collegiate soccer players (16 women: age = 19.

Clinical Outcomes of Various Management Strategies for Symptomatic Bradycardia.

Objective: To determine clinical outcomes of various management strategies for reversible and irreversible causes of symptomatic bradycardia in the inpatient setting.

Design: Retrospective observational study.

Setting: Emergency room and inpatient.

Artificial Light Increases Local Predator Abundance, Predation Rates, and Herbivory.

Human activity is rapidly increasing the radiance and geographic extent of artificial light at night (ALAN) leading to alterations in the development, behavior, and physiological state of many organisms. A limited number of community-scale studies investigating the effects of ALAN have allowed for spatial aggregation through positive phototaxis, the commonly observed phenomenon of arthropod movement toward light. We performed an open field study (without restricted arthropod access) to determine the effects of ALAN on local arthropod community composition, plant traits, and local herbivory and predation rates.

Differences in the Mechanism of Head Impacts Measured Between Men's and Women's Intercollegiate Lacrosse Athletes.

Background: Lacrosse is a rapidly growing sport in the United States. Comparing the magnitude and frequency of head impact mechanisms between sexes will provide data for injury prevention techniques and risk reduction of head injuries.

Purpose: To compare sex-specific differences in the magnitude and frequency of head impact mechanisms in National Collegiate Athletic Association (NCAA) Division III intercollegiate lacrosse athletes.

Thrombocytopenia independently predicts death in idiopathic PAH.

Background: Pulmonary arterial hypertension (PAH) is a progressive vascular disorder with a high mortality. Clinical experience and small case series suggest thrombocytopenia may be frequent in this population and associated with a poor prognosis. We sought to estimate the prevalence of thrombocytopenia in patients with PAH and characterize its association with disease characteristics and patient outcome.

Monitoring opioid and benzodiazepine use and abuse: Is oral fluid or urine the preferred specimen type?

Background: Oral fluid (OF) has become an increasingly popular matrix to assess compliance in pain management and addiction settings as it reduces the likelihood of adulteration. However, drug concentrations and windows of detection are not as well studied in OF as in urine (UR). We compared the clinical utility and analytical performance of OF and UR as matrices for detecting common benzodiazepines and opioids.

Multimodal Imaging of Anomalous Left Coronary Artery from the Pulmonary Artery in a 75-Year-Old Woman.

Anomalous origin of the left coronary artery from the pulmonary artery is rare and typically results in mitral regurgitation, ventricular arrhythmias, heart failure, and sudden death. The condition most often manifests itself in early childhood, but some individuals are diagnosed much later. We describe the case of a 75-year-old woman with heart failure in whom stepwise multimodal imaging revealed anomalous origin of the left coronary artery from the pulmonary artery.

The prognostic significance of tricuspid valve regurgitation in pulmonary arterial hypertension.

Introduction: Tricuspid valve regurgitation (TR) is a frequent finding in patients with pulmonary arterial hypertension (PAH). However, its prognostic significance and relation to PAH, while suspected, are poorly understood. We assessed 727 consecutive patients with newly diagnosed PAH who underwent transthoracic echocardiographic evaluation of tricuspid valve function.

Side Effects of CV Medications Following Hospitalization for ACS Are Associated With More Frequent Health-Care Contacts.

Background: Patients hospitalized for first acute coronary syndrome (ACS) are frequently discharged on multiple new medications. The short-term tolerability of these medications is unknown.

Methods: This single-center cohort study assessed 30-day health-care utilization and how it may be impacted by medication prescribing trends.

Significant Reduction in Preanalytical Errors for Nonphlebotomy Blood Draws After Implementation of a Novel Integrated Specimen Collection Module.

Objectives: Most preanalytical errors at our institution occur during nonphlebotomy blood draws. We implemented an electronic health record (EHR), interfaced the EHR to the laboratory information system, and designed a new specimen collection module. We studied the effects of the new system on nonphlebotomy preanalytical errors.

Clinical and financial impact of removing creatine kinase-MB from the routine testing menu in the emergency setting.

Context: Cardiac troponins T and I have replaced creatine kinase-MB (CK-MB) as the criterion standard for diagnosing myocardial injury. However, many laboratories still routinely perform a high volume of CK-MB testing in conjunction with troponin.

Purpose: The purpose of this study is to study the clinical and financial impact of removing CK-MB from the routine emergency department (ED) test menu at a large academic medical center.

Optimizing outpatient phlebotomy staffing: tools to assess staffing needs and monitor effectiveness.

Context: Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care.

Objective: To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows.

Using Lean principles to optimise inpatient phlebotomy services.

Background: In the USA, inpatient phlebotomy services are under constant operational pressure to optimise workflow, improve timeliness of blood draws, and decrease error in the context of increasing patient volume and complexity of work. To date, the principles of Lean continuous process improvement have been rarely applied to inpatient phlebotomy.

Aims: To optimise supply replenishment and cart standardisation, communication and workload management, blood draw process standardisation, and rounding schedules and assignments using Lean principles in inpatient phlebotomy services.