Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition.

Background: For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation.

Commentary: In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access - thereby hindering access to healthcare for thousands of predominantly unhoused individuals.

Responding to the Opioid Epidemic: Educational Competencies for Pain and Substance Use Disorder from the Medical Schools of the University of California.

Objective: The University of California (UC) leadership sought to develop a robust educational response to the epidemic of opioid-related deaths. Because the contributors to this current crisis are multifactorial, a comprehensive response requires educating future physicians about safe and effective management of pain, safer opioid prescribing, and identification and treatment of substance use disorder (SUD).

Methods: The six UC medical schools appointed an opioid crisis workgroup to develop educational strategies and a coordinated response to the opioid epidemic.

A Multiple-Mini Interview (MMI) for Emergency Medicine Residency Admissions: A Brief Report and Qualitative Analysis.

Introduction: A multiple-mini interview (MMI) is a type of structured interview, which may assess many non-cognitive domains in residency applicants. There are few studies on MMI during the emergency medicine (EM) residency admissions process in the United States. We sought to determine the strengths, weaknesses, and acceptability of a pilot MMI for EM residency admissions.

Contribution of serum ethanol concentration to the osmol gap: a prospective volunteer study.

Background: The contribution of ethanol ([EtOH]) to the osmol gap (OG) is commonly described by the formula [EtOH (mg/dL)]/k, where k is assumed to be 4.6 (one-tenth of its molecular weight) if ethanol behaves ideally in solution. However, several studies on convenience samples of patients suggest that ethanol does not behave ideally and that k may be significantly different from this ideal constant.

Fatalities due to dichloromethane in paint strippers: a continuing problem.

Background: Exposure to dichloromethane (DCM or methylene chloride - CH₂ Cl₂ ) in paint strippers continues to be an avoidable source of morbidity and mortality. DCM has been under regulatory scrutiny by occupational and consumer product agencies since the identification of its carcinogenicity in the mid-1980s.

Methods: We investigated two independent workplace incidents that resulted in three cases of DCM intoxication from paint stripper use.

"Spider bite" lesions are usually diagnosed as skin and soft-tissue infections.

Background: Many people seek medical attention for skin lesions and other conditions they attribute to spider bites. Prior experience suggests that many of these lesions have alternate causes, especially infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).

Objectives: This study determined the percentage of emergency department (ED) patients reporting a "spider bite" who received a clinical diagnosis of spider bite by their physician vs.

1,4-Butanediol content of aqua dots children's craft toy beads.

Introduction: The U.S. Consumer Product Safety Commission announced a recall of Aqua Dots (Spin Master Ltd.

Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation.

Objectives: Report of delayed significant coagulopathy, thrombocytopenia, and bleeding after Crotaline envenomation.

Methods: Recurrent coagulopathy and thrombocytopenia have been described after treatment of Crotaline envenomation with Crotalidae polyvalent immune Fab (CroFab). Until now, there have been no reports of significant spontaneous bleeding despite these abnormalities.

Ultrastructural changes in rat thyroid tissue after acute organophosphate poisoning and effects of antidotal therapy with atropine and pralidoxime: A single-blind, ex vivo study.

Background: Organophosphate (OP) insecticides are widely used in both agricultural and landscape pest control, and the potential for human exposure to these compounds is significant.

Objectives: The aims of this study were to investigate the effects of acute poisoning with the OP methamidophos and the effects of antidotal therapy with atropine and pralidoxime on rat thyroid tissue ultrastructure.

Methods: In this single-blind, ex vivo study, male Wistar albino rats weighing 220 to 230 g were divided into 4 treatment groups.

Ultrastructural effects of acute organophosphate poisoning on rat kidney.

We investigated the ultrastructural effects of the organophosphate compound methamidophos and treatment with atropine and pralidoxime (2-PAM) on rat kidneys. Male Wistar albino rats were assigned to four groups. Group 1 received 30 mg/kg methamidophos, the LD50 for this compound in rats, via oral gavage.

Physician knowledge of herbal toxicities and adverse herb-drug interactions.

Objective: To determine how knowledgeable physicians are regarding the toxic effects and drug interactions of herbal remedies.

Methods: An anonymous voluntary demographic survey and 16-question, multiple-choice quiz was distributed at educational meetings of emergency medicine and internal medicine physicians. The primary outcome measures were to determine whether significant associations existed between quiz scores and the amount of clinical experience, or between quiz scores and self-assessed familiarity with the topic of herbal toxicities and adverse herb-drug interactions.