Medicine and Health Sciences Commons^™

Ultrasound On The Frontlines Of Covid-19: Report From An International Webinar, Rb Liu, Vs Tayal, Nl Panebianco, Y Tung-Chen, A Nagdev, S Shah, E Pivetta, Pc Henwood, Mj Nelson, Cl Moore

Journal Articles

No abstract provided.

Presenting Characteristics, Comorbidities, And Outcomes Among 5700 Patients Hospitalized With Covid-19 In The New York City Area, S Richardson, Js Hirsch, M Narasimhan, Jm Crawford, T Mcginn, Kw Davidson, Northwell Covid-19 Research Consortium

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No abstract provided.

Covid-19 And Older Adults: What We Know, Z Shahid, R Kalayanamitra, B Mcclafferty, D Kepko, D Ramgobin, R Patel, Cs Aggarwal, R Vunnam, N Sahu, R Jain, +3 Additional Authors

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No abstract provided.

A Case Report Of Coronavirus Disease 2019 Presenting With Tremors And Gait Disturbance., S. Klein, F. Davis, A. Berman, S. Koti, J. D'Angelo, N. Kwon

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INTRODUCTION:Neurologic symptoms present as significant complications of coronavirus disease 2019 (COVID-19) infection. This report describes a novel manifestation of tremors triggered by severe acute respiratory syndrome coronavirus 2 infection. CASE PRESENTATION:We describe a case of a 46-year-old man with COVID-19 infection complicated by a bilateral intention tremor and wide-based gait. Although neurological manifestations have been reported related to COVID-19, tremulousness has not yet been described. CONCLUSION:Considering the evolving diversity of neurologic manifestations in this infection, emergency physicians should be vigilant of possible COVID-19 infection in patients presenting with unexplained neurologic symptoms.

Machine Learning To Assist Clinical Decision-Making During The Covid-19 Pandemic., S. Debnath, D. P. Barnaby, K. Coppa, A. Makhnevich, E. J. Kim, S. Chatterjee, V. Tóth, T. J. Levy, M. D. Paradis, S. L. Cohen, J. S. Hirsch, T. P. Zanos, Northwell Covid-19 Research Consortium

Journal Articles

Background:The number of cases from the coronavirus disease 2019 (COVID-19) global pandemic has overwhelmed existing medical facilities and forced clinicians, patients, and families to make pivotal decisions with limited time and information. Main body:While machine learning (ML) methods have been previously used to augment clinical decisions, there is now a demand for "Emergency ML." Throughout the patient care pathway, there are opportunities for ML-supported decisions based on collected vitals, laboratory results, medication orders, and comorbidities. With rapidly growing datasets, there also remain important considerations when developing and validating ML models. Conclusion:This perspective highlights the utility of evidence-based prediction tools in …

Monoclonal Antibodies Capable Of Binding Sars-Cov-2 Spike Protein Receptor Binding Motif Specifically Prevent Gm-Csf Induction., X. Qiang, S. Zhu, J. Li, P. Wang, K. J. Tracey, H. Wang

Journal Articles

A severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2) has recently caused a pandemic COVID-19 disease that infected more than 25.6 million and killed 852,000 people worldwide. Like the SARS-CoV, SARS-CoV-2 also employs a receptor-binding motif (RBM) of its envelope spike protein for binding the host angiotensin-converting enzyme 2 (ACE2) to gain viral entry. Currently, extensive efforts are being made to produce vaccines against a surface fragment of a SARS-CoV-2, such as the spike protein, in order to boost protective antibody responses. It was previously unknown how spike protein-targeting antibodies would affect innate inflammatory responses to SARS-CoV-2 infections. Here we generated …

Interim Guidance For Basic And Advanced Life Support In Adults, Children, And Neonates With Suspected Or Confirmed Covid-19 From The Emergency Cardiovascular Care Committee And Get With The Guidelines-Resuscitation Adult And Pediatric Task Forces Of The American Heart Association, D. P. Edelson, C. Sasson, P. S. Chan, D. L. Atkins, K. Aziz, L. B. Becker, R. A. Berg, S. M. Bradley, S. C. Brooks, A. A. Topjian, +17 Additional Authors

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No abstract provided.

Spontaneous Pneumothorax As A Complication Of Covid-19 Pneumonia: A Case Report., L. Perice, Z. Roit, I. Llovera, M. G. Flanagan-Kundle

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INTRODUCTION:Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2. It typically presents with respiratory symptoms such as fevers, cough, and shortness of breath. As the number of cases increases, however, COVID-19 is being increasingly recognized as being associated with a variety of other respiratory pathologies. CASE REPORT:We present the case of a 59-year-old man with COVID-19 pneumonia who acutely decompensated after having been on the medicine floor for two weeks. He was found to have a tension pneumothorax. This was treated with a needle decompression followed by a chest tube insertion. The patient subsequently recovered …

Escape The Trauma Room, M. Podlog, A. Husain, J. Greenstein, S. Sanghvi

Journal Articles

© 2019 by the Society for Academic Emergency Medicine Traditional conference didactics may not be effectively meeting the learning needs of today's emergency medicine (EM) residents, and educators are employing various interactive approaches to engage learners. Escape Room is a popular adventure game in which participants must work together to solve a series of puzzles to escape a locked room. Our aim was to adapt this game design to teach core EM content and procedural aptitude. Upon entering the “locked” room residents were faced with a series of puzzles involving concepts such as toxicology antidotes, ventilator management, echocardiogram interpretations, airway …

Consensus Guidelines For Digital Scholarship In Academic Promotion, A. Husain, Z. Repanshek, M. Singh, F. Ankel, J. Beck-Esmay, D. Cabrera, T. M. Chan, R. Cooney, M. Gisondi, E. Brumfield, +8 Additional Authors

Journal Articles

Copyright: © 2020 Husain et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ Introduction: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship. Methods: We conducted a blended, …

Intention To Leave Emergency Medicine: Mid-Career Women Are At Increased Risk, M. D. Lall, S. M. Perman, N. Garg, N. Kohn, K. Whyte, A. Gips, T. Madsen, J. M. Baren, J. Linden

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No abstract provided.

Stories To Communicate Individual Risk For Opioid Prescriptions For Back And Kidney Stone Pain: Protocol For The Life Storried Multicenter Randomized Clinical Trial, Z. F. Meisel, E. B. Goldberg, A. R. Dolan, E. Bansal, K. V. Rhodes, E. P. Hess, C. C. Cannuscio, M. M. Schapira, J. Perrone, F. S. Shofer, +4 Additional Authors

Journal Articles

© 2020 JMIR Publications. All rights reserved. Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain. Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain. Methods: This …

Quantitative Estimation Of Nerve Fiber Engagement By Vagus Nerve Stimulation Using Physiological Markers, Y. C. Chang, M. Cracchiolo, U. Ahmed, I. Mughrabi, A. Gabalski, L. Becker, T. Datta-Chaudhuri, Y. Al-Abed, T. P. Zanos, S. Zanos, +2 Additional Authors

Journal Articles

© 2020 The Author(s) Background: Cervical vagus nerve stimulation (VNS) is an emerging bioelectronic treatment for brain, metabolic, cardiovascular and immune disorders. Its desired and off-target effects are mediated by different nerve fiber populations and knowledge of their engagement could guide calibration and monitoring of VNS therapies. Objective: Stimulus-evoked compound action potentials (eCAPs) directly provide fiber engagement information but are currently not feasible in humans. A method to estimate fiber engagement through common, noninvasive physiological readouts could be used in place of eCAP measurements. Methods: In anesthetized rats, we recorded eCAPs while registering acute physiological response markers to VNS: cervical …

The Irresponsible Use Of Social Media Among Medical Students, M. Curato, A. Husain, K. Shah, M. Kanter, D. Egan, H. Thompson, M. Silverberg, M. Jones, T. Dulani, P. Mukherji, +8 Additional Authors

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No abstract provided.

The New York City Pandemic Resuscitation Equitable Allocation Principles, K. V. Rhodes, E. K. Wei, R. J. Salway, S. Natsui, D. Silvestri, C. K. Cassel

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No abstract provided.

Gut Microbiota Metabolite Fights Against Dietary Polysorbate 80-Aggravated Radiation Enteritis, Y. Li, H. Xiao, J. Dong, D. Luo, H. Wang, S. Zhang, T. Zhu, C. Zhu, M. Cui, S. Fan

Journal Articles

© Copyright © 2020 Li, Xiao, Dong, Luo, Wang, Zhang, Zhu, Zhu, Cui and Fan. Radiation therapy is a cornerstone of modern management methods for malignancies but is accompanied by diverse side effects. In the present study, we showed that food additives such as polysorbate 80 (P80) exacerbate irradiation-induced gastrointestinal (GI) tract toxicity. A 16S ribosomal RNA high-throughput sequencing analysis indicated that P80 consumption altered the abundance and composition of the gut microbiota, leading to severe radiation-induced GI tract injury. Mice harboring fecal microbes from P80-treated mice were highly susceptible to irradiation, and antibiotics-challenged mice also represented more sensitive to …

Time To Develop Therapeutic Antibodies Against Harmless Proteins Colluding With Sepsis Mediators?, J. Li, G. Bao, H. Wang

Journal Articles

Sepsis refers to a systemic inflammatory response syndrome resulting from microbial infections, and is partly attributable to dysregulated inflammation and associated immunosuppression. A ubiquitous nuclear protein, HMGB1, is secreted by activated leukocytes to orchestrate inflammatory responses during early stages of sepsis. When it is released by injured somatic cells at overwhelmingly higher quantities, HMGB1 may induce macrophage pyroptosis and immunosuppression, thereby impairing the host's ability to eradicate microbial infections. A number of endogenous proteins have been shown to bind HMGB1 to modulate its extracellular functions. Here, we discuss an emerging possibility to develop therapeutic antibodies against harmless proteins that collude …

Man With Foot Pain, B. Hahn, D. Langhan, D. Miller, J. Greenstein

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No abstract provided.

Supervised Machine Learning Applied To Automate Flash And Prolonged Capillary Refill Detection By Pulse Oximetry, R. B. Hunter, S. Jiang, A. Nishisaki, A. J. Nickel, N. Napolitano, K. Shinozaki, T. Li, K. Saeki, L. B. Becker, A. J. Masino, +1 Additional Author

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No abstract provided.

Hmgb1 As A Potential Biomarker And Therapeutic Target For Severe Covid-19, R. Chen, Y. Huang, J. Quan, J. Liu, H. Wang, T. R. Billiar, M. T. Lotze, H. J. Zeh, R. Kang, D. Tang

Journal Articles

© 2020 The Author(s) HMGB1; COVID-19; Cell culture; Cell death; Inflammation; Infectious disease; Immunology; Microbiology; Virology

Dedicated Area Within The Emergency Department Versus An Outside Dedicated Area For Evaluation And Management Of Suspected Coronavirus Disease 2019., G. Garra, S. Gupta, S. Ferrante, W. Apterbach

Journal Articles

Background

The circumstances of the coronavirus disease 2019 pandemic necessitated an alternate operations strategy for efficient patient management. Alternate care sites were a viable option for managing emergency department (ED) surge in previous epidemics and disasters.

Objective

This study describes the development of an alternate care site and evaluates efficiency by comparing key performance indicators between an ad hoc nested respiratory evaluation unit (NRU) within the ED and an alternate care site outside the ED.

Methods

This was a cohort study of 2 care models in the same ED during 2 different time periods. As coronavirus disease 2019 surged in …

Author Correction: Caspase-11 Signaling Enhances Graft-Versus-Host Disease (Nature Communications, (2019), 10, 1, (4044), 10.1038/S41467-019-11895-2), Y. Lu, R. Meng, X. Wang, Y. Xu, Y. Tang, J. Wu, Q. Xue, S. Yu, H. Wang, B. Lu, +6 Additional Authors

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© 2020, The Author(s). In the original version of this Article, the following author affiliations were inadvertently switched. Affiliation of Qingde Wang and Timothy R. Billiar should be: “Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213 USA”. Haichao Wang's affiliation should be: “The Feinstein Institute for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY11030, USA”. The errors have been corrected in the HTML and PDF versions of this article.

Interim Guidance For Basic And Advanced Life Support In Adults, Children, And Neonates With Suspected Or Confirmed Covid-19: From The Emergency Cardiovascular Care Committee And Get With The Guidelines®-Resuscitation Adult And Pediatric Task Forces Of The American Heart Association In Collaboration With The American Academy Of Pediatrics, American Association For Respiratory Care, American College Of Emergency Physicians, The Society Of Critical Care Anesthesiologists, And American Society Of Anesthesiologists: Supporting Organizations: American Association Of Critical Care Nurses And National Ems Physicians., D. P. Edelson, C. Sasson, P. S. Chan, D. L. Atkins, K. Aziz, L. B. Becker, R. A. Berg, S. M. Bradley, S. C. Brooks, A. Topjian, +17 Additional Authors

Journal Articles

No abstract provided.

Gut Microbiota-Derived Indole 3-Propionic Acid Protects Against Radiation Toxicity Via Retaining Acyl-Coa-Binding Protein, H. W. Xiao, M. Cui, Y. Li, J. L. Dong, S. Q. Zhang, C. C. Zhu, M. Jiang, T. Zhu, H. C. Wang, S. J. Fan, +1 Additional Author

Journal Articles

© 2020 The Author(s). Background: We have proved fecal microbiota transplantation (FMT) is an efficacious remedy to mitigate acute radiation syndrome (ARS); however, the mechanisms remain incompletely characterized. Here, we aimed to tease apart the gut microbiota-produced metabolites, underpin the therapeutic effects of FMT to radiation injuries, and elucidate the underlying molecular mechanisms. Results: FMT elevated the level of microbial-derived indole 3-propionic acid (IPA) in fecal pellets from irradiated mice. IPA replenishment via oral route attenuated hematopoietic system and gastrointestinal (GI) tract injuries intertwined with radiation exposure without precipitating tumor growth in male and female mice. Specifically, IPA-treated mice represented …

Erratum: Assessment Of Physician Well-Being, Part Two: Beyond Burnout (Western Journal Of Emergency Medicine (2019) 20:2 (291-304) Doi: 10.5811/Westjem.2019.1.39666), M. D. Lall, T. J. Gaeta, A. S. Chung, S. A. Chinai, M. Garg, A. Husain, C. Kanter, S. Khandelwal, C. S. Rublee, N. T. Himelfarb, +3 Additional Authors

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© 2020 eScholarship. All rights reserved. Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Potential Impacts Of A Novel Integrated Extracorporeal-Cpr Workflow Using An Interventional Radiology And Immediate Whole-Body Computed Tomography System In The Emergency Department, K. Hayashida, T. Kinoshita, K. Yamakawa, S. J. Miyara, L. B. Becker, S. Fujimi

Journal Articles

Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that utilizes a sliding computed tomography (CT) scanner and interventional radiology (IR) system, named a hybrid emergency room system (HERS), allowing emergency therapeutic interventions and CT examination without relocating trauma patients, has recently evolved in Japan. HERS can drastically shorten the ECPR implementation time and more quickly facilitate definitive interventions than the conventional advanced cardiovascular life support …

Time To Intra-Arrest Therapeutic Hypothermia In Out-Of-Hospital Cardiac Arrest Patients And Its Association With Neurologic Outcome: A Propensity Matched Sub-Analysis Of The Princess Trial, A. Awad, F. S. Taccone, M. Jonsson, S. Forsberg, J. Hollenberg, A. Truhlar, M. Ringh, B. S. Abella, L. B. Becker, P. Nordberg, +2 Additional Authors

Journal Articles

© 2020, The Author(s). Purpose: To study the association between early initiation of intra-arrest therapeutic hypothermia and neurologic outcome in out-of-hospital cardiac arrest. Methods: A prespecified sub-analysis of the PRINCESS trial (NCT01400373) that randomized 677 bystander-witnessed cardiac arrests to transnasal evaporative intra-arrest cooling initiated by emergency medical services or cooling started after hospital arrival. Early cooling (intervention) was defined as intra-arrest cooling initiated < 20 min from collapse (i.e., ≤ median time to cooling in PRINCESS). Propensity score matching established comparable control patients. Primary outcome was favorable neurologic outcome, Cerebral Performance Category (CPC) 1–2 at 90 days. Complete recovery (CPC 1) was among secondary outcomes. Results: In total, 300 patients were analyzed and the proportion with CPC 1–2 at 90 days was 35/150 (23.3%) in the intervention group versus 24/150 (16%) in the control group, odds ratio (OR) 1.92, 95% confidence interval (CI) 0.95–3.85, p =.07. In patients with shockable rhythm, CPC 1–2 was 29/57 (50.9%) versus 17/57 (29.8%), OR 3.25, 95%, CI 1.06–9.97, p =.04. The proportion with CPC 1 at 90 days was 31/150 (20.7%) in the intervention group and 17/150 (11.3%) in controls, OR 2.27, 95% CI 1.12–4.62, p =.02. In patients with shockable rhythms, the proportion with CPC 1 was 27/57 (47.4%) versus 12/57 (21.1%), OR 5.33, 95% CI 1.55–18.3, p =.008. Conclusions: In the whole study population, intra-arrest cooling initiated < 20 min from collapse compared to cooling initiated at hospital was not associated with improved favorable neurologic outcome. In the subgroup with shockable rhythms, early cooling was associated with improved favorable outcome and complete recovery.

Ultrasound On The Frontlines Of Covid-19: Report From An International Webinar, R. B. Liu, V. S. Tayal, N. L. Panebianco, Y. Tung-Chen, A. Nagdev, S. Shah, E. Pivetta, P. C. Henwood, M. J. Nelson, C. L. Moore

Journal Articles

No abstract provided.

Targeting Inflammation Driven By Hmgb1, H. Yang, H. Wang, U. Andersson

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© Copyright © 2020 Yang, Wang and Andersson. High mobility group box 1 (HMGB1) is a highly conserved, nuclear protein present in all cell types. It is a multi-facet protein exerting functions both inside and outside of cells. Extracellular HMGB1 has been extensively studied for its prototypical alarmin functions activating innate immunity, after being actively released from cells or passively released upon cell death. TLR4 and RAGE operate as the main HMGB1 receptors. Disulfide HMGB1 activates the TLR4 complex by binding to MD-2. The binding site is separate from that of LPS and it is now feasible to specifically interrupt …

The Role Of Type 1 Interferons In Coagulation Induced By Gram-Negative Bacteria, X. Yang, X. Cheng, Y. Tang, X. Qiu, Z. Wang, G. Fu, J. Wu, H. Kang, H. Wang, B. Lu, +4 Additional Authors

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No abstract provided.