Gender Differences in Emergency Medicine Attending Physician Comments to Residents: A Qualitative Analysis.

Importance: Prior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents. Objective: To explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents. Design, Setting, and Participants: This multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021. Main Outcomes and Measures: Differences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident. Results: In this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills. Conclusions and Relevance: In this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.

Firework injuries remain high in years after legalisation: its impact on children.

PURPOSE: We evaluated the impact of Senate Bill 489 passed in May 2017, allowing the sale and use of fireworks in Iowa 1 June to 8 July and 10 December to 3 January, on hospital presentations for firework injuries in the state. To identify the public health implications of this law, we conducted a detailed subanalysis of hospital presentations to the two level I trauma centres. METHODS: Hospital presentations for firework injuries from 1 June 2014 to 31 July 2019 were identified using the Iowa Hospital Admission database and registries and medical records of Iowa's two level 1 trauma centres. Trauma centres' data were reviewed to obtain demographics, injury information and hospital course. Prefirework and postfirework legalisation state data were compared using negative binomial regression analysis. Trauma centre data detailing injuries were compared using χ2 and Mann-Whitney U tests as appropriate. RESULTS: Emergency department (ED) visits and hospital admissions for firework injuries increased in Iowa post-legalisation (B-estimate=0.598±0.073, p<0.001 and B-estimate=0.612±0.322, p=0.058, respectively). ED visits increased postlegalisation in July (73.6% vs 64.5%; p=0.008), reflecting an increase in paediatric admissions (81.8% vs 62.5%; p=0.006). Trauma centres' data showed similar trends. The most common injury site across both study periods was the hands (48.5%), followed by the eyes (34.3%) and face (28.3%). Amputations increased from 0 prelegalisation to 16.2% postlegalisation. CONCLUSION: Firework legalisation led to an increase in the number of admissions and more severe injuries.

Adjunctive homeopathic treatment of hospitalized COVID-19 patients (COVIHOM): A retrospective case series.

BACKGROUND: and purpose. COVID-19 is a novel viral disease causing worldwide pandemia. The aim of this study was to describe the effect of adjunctive individualized homeopathic treatment delivered to hospitalized patients with confirmed symptomatic SARS-CoV-2 infection. PATIENT PRESENTATION: Thirteen patients with COVID-19 were admitted. Mean age was 73.4 ± 15.0 (SD) years. Twelve (92.3%) were speedily discharged without relevant sequelae after 14.4 ± 8.9 days. A single patient admitted in an advanced stage of septic disease died in hospital. A time-dependent improvement of relevant clinical symptoms was observed in the 12 surviving patients. Six (46.2%) were critically ill and treated in the intensive care unit (ICU). Mean stay at the ICU of the 5 surviving patients was 18.8 ± 6.8 days. In six patients (46.2%) gastrointestinal disorders accompanied COVID-19. CONCLUSION: The observations suggest that adjunctive homeopathic treatment may be helpful to treat patients with confirmed COVID-19 even in high - risk patients especially since there is no conventional treatment of COVID-19 available at present.

Breeding Centers, Private Ranches, and Genomics for Creating Sustainable Wildlife Populations.

Human-induced changes to environments are causing species declines. Beyond preserving habitat (in situ), insurance (ex situ) populations are essential to prevent species extinctions. The Conservation Centers for Species Survival (C2S2) is leveraging space of breeding centers and private ranches to produce "source populations"-genetically diverse reservoirs that also support research and reintroductions. The initial focus is on four African antelopes. C2S2 has developed a program, the Source Population Alliance, that emphasizes animals living in spacious, naturalistic conditions in greater numbers than can be accommodated by urban zoos. Simulation modeling demonstrates how herds can rapidly increase population abundance and retain genetic diversity. Advances in genomics and resulting DNA data allow monitoring of genetic diversity and parentage as well as refined decision-making. This approach, neither pure in situ nor ex situ, but rather "sorta situ", is an innovative way of linking public and private sector resources to ensure that endangered species survive.

Extracorporeal Life Support as Salvage Therapy for Massive Pulmonary Embolus and Cardiac Arrest in Pregnancy.

BACKGROUND: Massive pulmonary embolus (PE) with prolonged cardiac arrest in the setting of pregnancy has few treatment options. Selections are further restricted if there are contraindications to the standard therapies of embolectomy and thrombolysis. We report a case of extracorporeal life support (ECLS) used as salvage therapy for a critically ill pregnant patient. CASE REPORT: A 21-year-old woman presented to a small rural hospital with chest pain, dyspnea, hypoxia, and syncope. In their emergency department, she suffered 2 episodes of cardiac arrest requiring cardiopulmonary resuscitation, and fetal demise followed. A computed tomography scan revealed a saddle PE. She was transferred to our tertiary care hospital and arrived critically ill, on multiple vasopressors, and in cardiogenic shock. Because standard treatments, namely thrombolysis and embolectomy, were contraindicated in this case, ECLS was employed for 7 days. She was discharged home after 23 days, and at follow-up 5 months after her admission, she was found to have made a near-complete recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ECLS is a viable option as salvage therapy for pregnant patients with massive PE who have contraindications to thrombolysis and embolectomy.

Design principles of perovskites for solar-driven thermochemical splitting of CO2.

Perovskites are attractive redox materials for thermo/electrochemical fuel synthesis. To design perovskites with balanced redox energetics for thermochemically splitting CO2, the activity of lattice oxygen vacancies and stability against crystal phase changes and detrimental carbonate formation are predicted for a representative range of perovskites by electronic structure computations. Systematic trends in these materials properties when doping with selected metal cations are described in the free energy range defined for isothermal and temperature-swing redox cycles. To confirm that the predicted materials properties root in the bulk chemical composition, selected perovskites are synthesized and characterized by X-ray diffraction, transmission electron microscopy, and thermogravimetric analysis. On one hand, due to the oxidation equilibrium, none of the investigated compositions outperforms non-stoichiometric ceria - the benchmark redox material for CO2 splitting with temperature-swings in the range of 800-1500 °C. On the other hand, certain promising perovskites remain redox-active at relatively low oxide reduction temperatures at which ceria is redox-inactive. This trade-off in the redox energetics is established for YFeO3, YCo0.5Fe0.5O3 and LaFe0.5Ni0.5O3, identified as stable against phase changes and capable to convert CO2 to CO at 600 °C and 10 mbar CO in CO2, and to being decomposed at 1400 °C and 0.1 mbar O2 with an enthalpy change of 440-630 kJ mol-1 O2.

Resuscitation in the pediatric trauma population: admission base deficit remains an important prognostic indicator.

BACKGROUND: Base deficit (BD), as an endpoint for trauma resuscitation, has been extensively studied in the adult trauma patient but not in the pediatric population. We proposed that admission BD would correlate with outcomes after trauma in a pediatric population. METHODS: This study was a retrospective review of all patients admitted to the pediatric intensive care unit in an adult trauma center with pediatric commitment in whom an admission BD was available, over the 5-year period ending June 2001. RESULTS: A total of 65 patients formed the study population. Overall mortality was 20%. Patients who died were younger (6 +/- 5 vs. 9 +/- 5 years; p = 0.009), had lower Glasgow Coma Scale scores at admission (7 +/- 5 vs. 10 +/- 5; p < 0.0001), had higher Injury Severity Scores (24 +/- 14 vs. 14 +/- 9; p < 0.0001), and had lower Pediatric Trauma Scores (7 +/- 4 vs. 10 +/- 2; p < 0.0001). No patient with a BD less negative than -5 died, whereas 13 of 37 patients with a BD of -5 or higher died (37%) (p < 0.0001). Of the 13 patients who died, 8 never cleared their BD and died within 33 +/- 18 hours of admission. Failure to clear BD was associated with 100% mortality. Five patients who normalized their BD died of isolated closed head injuries (time to death, 37 +/- 18 hours; p = not significant). All surviving patients normalized their BD within 43 +/- 41 hours of admission. Seventy-five percent of patients who survived (39 of 52) had a normal BD within 48 hours of admission. CONCLUSION: Admission BD in the pediatric trauma patient is a strong indicator of posttraumatic shock. An admission BD of < or = -5 is predictive of severe injury and of poor outcome, with a 37% mortality in this series. Failure to clear BD is an extremely poor prognostic indicator.