Recent uci items

Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.

Methods: We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage,...

Intubation Practices and Outcomes in Diverse Emergency Departments Within a Single Health System

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Endotracheal intubation (ETI) is a life-saving procedure commonly performed in emergency departments (ED). Prior research has demonstrated significant variability in ETI experience, practices, and outcomes across EDs. Health systems often include a mix of ED environments, from large academic hospitals to community-based and freestanding EDs. However, little is known about how ETI experiences and outcomes vary within a single health system. Our objective in this study was to compare first-attempt success across three EDs representing different practice environments but within one health system.

Methods: This retrospective observational study used institutional data from 1,659 ETI events between November 2021–January 2025 to compare ETI-related outcomes across three EDs representing a spectrum of settings: an academic Level I trauma center (A); a community teaching hospital (B); and a nonteaching community site (C). Our primary...

Emergency Severity Index Stratified by Post-Triage Lactate: Association with In-Hospital Mortality in Admitted Patients

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: The Emergency Severity Index (ESI) is a widely used triage tool in emergency departments (EDs) and is associated with adverse outcomes. Lactate has also been associated with mortality in various ED populations. This study evaluated whether lactate levels measured after triage at the treating physician’s discretion are associated with in-hospital mortality across ESI levels in admitted ED patients.

Methods: This study is a secondary analysis of prospectively collected data from adult patients presenting to the ED of a Swiss tertiary care center in 2013, 2015, 2017, and 2019. The study included admitted patients who underwent post-triage lactate measurement at the treating physician’s discretion. Only the first lactate value measured in the ED was analyzed and categorized as < 2.0, 2.0–3.9, and ≥ 4.0 mmol/L. The primary outcome was in-hospital mortality; secondary outcomes were 30-day mortality and intensive care unit...

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

Sat, 26 Sep 2026 00:00:00 +0000

From Stress to Strength: Fostering a Positive Learning Climate to Promote Learning, Performance, and Well-Being

Sustainability in Quality Improvement: Outcomes of a Novel Pediatric Virtual Urgent Care in Ontario, Canada

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Virtual care is expected to play an increasingly important role in the Canadian healthcare system, with the 2023-2024 Health Canada Departmental Plan outlining the advancement of digital health solutions as a focal point. However, key outcomes of transitioning from traditional in-person healthcare appointments to a virtual model of care are not yet well-described. Here, we apply the Sustainability in Quality Improvement (SusQI) framework to patients seen in a novel pediatric virtual urgent care (VUC) program to quantify the environmental, economic, and social impacts of virtual care.

Methods: We conducted a retrospective analysis of provincial pediatric VUC visits staffed by pediatric emergency physicians and nurse practitioners during the 2020-2025 fiscal years. We focused on three key metrics: (1) economic value, measured as travel costs avoided; (2) environmental value, measured in fuel saved (L) and carbon emissions...

Hemodynamic Effects of Interfacility Dexmedetomidine Infusions During Transport of Patients with Alpha-2-adrenergic Agonist Withdrawal

Sat, 26 Sep 2026 00:00:00 +0000

Background: In the Philadelphia region, there has been an increase in the potency of illicit opioids as well as the addition of nonopioid adulterants. Currently, medetomidine, a veterinary anesthetic that acts as an alpha-2-adrenergic agonist, is a common adulterant in the illicit opioid supply, causing both unique overdose and withdrawal syndromes. Although opioid withdrawal alone is not deadly, with added adulterants, especially medetomidine, this is no longer the case. Dexmedetomidine is an alpha-2-adrenergic agonist frequently used for sedation in the emergency department and intensive care unit. Dexmedetomidine is also used off-label to treat the life-threatening withdrawal from alpha-2-agonists.

Objective: This study describes the dosing and hemodynamic effects associated with the interfacility administration of dexmedetomidine in patients with alpha-2 adrenergic agonist withdrawal. Secondarily, we describe the safety of dexmedetomidine...

Hepatitis C Care Cascade in Opioid-Dependent Emergency Department Patients

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Emergency departments (ED) have become important venues for hepatitis C (HCV) screening. Similarly, EDs have had increasing engagement in the management and treatment of opioid use disorder (OUD). Persons with OUD are at disproportionate risk for acquiring HCV. We sought to assess the intersection between OUD and HCV care through observing the uptake of HCV screening and subsequent steps in the HCV care cascade in an ED-OUD cohort.

Methods: This retrospective cohort study analyzed patients enrolled in an ED-OUD treatment program as a convenience sample subgroup of a larger institutional ED opt-out HCV screening program conducted at a single urban site in Alabama between July 2019–June 2022. Opt-out, nonfocused HCV screening provision was standardized at triage, excluding pregnant and incarcerated individuals. Descriptive analyses were conducted to ascertain screening uptake, positive screening, confirmatory testing, linkage...

Climate Change and Heat-related Illness in Older Adults: Implications for Emergency Medicine

Sat, 26 Sep 2026 00:00:00 +0000

Climate change is increasing the frequency, duration, and intensity of extreme heat events, creating a growing public health threat for older adults. Age-related physiologic decline, comorbid chronic diseases, polypharmacy, and social vulnerability all contribute to reduced heat tolerance and higher rates of heat-related morbidity and mortality. Emergency departments (ED) are increasingly encountering older adults presenting with minor heat illness, heat stroke, and exacerbations of chronic illnesses triggered by heat exposure. This review synthesizes current evidence describing why older adults are disproportionately affected by extreme heat, highlights key social and environmental determinants of vulnerability, and outlines clinical and public health strategies that emergency clinicians and EDs can assist with to reduce risk. As global temperatures rise, proactive prevention, early recognition, and coordinated community interventions are essential to protect this high-risk...

Polysubstance-Induced Vasoplegia Managed with Venoarterial Extracorporeal Membrane Oxygenation: A Case Report

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: While the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) becomes increasingly commonplace in overdose, questions about its role in various shock states remain. The application of VA-ECMO with impaired myocardial function is well established, and use in cardiogenic shock precipitated by poisoning has continued to increase. In poison-induced vasoplegia with preserved myocardial function, the role of VA-ECMO remains undefined. Many atypical antipsychotic and antidepressant agents are known to cause mild hypotension via alpha-1 adrenergic blockade. Intravenous fluids and vasopressors alone are generally effective for single-substance ingestions. In the setting of polysubstance intoxication, synergism leading to bradycardia and refractory vasoplegia refractory to conventional therapies may result, prompting consideration for extracorporeal support.

Case Report: A 71-year-old woman presented to the emergency...

Evaluating the Impact of a Sustainability Education Intervention on Emergency Medicine Residents

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Healthcare is a significant contributor to global greenhouse gas emissions, with emergency departments being among the most resource-intensive settings. Despite increasing awareness of climate change and its health implications, structured sustainability education remains lacking in emergency medicine graduate medical education training. We evaluated the impact of a brief, educational intervention on emergency medicine (EM) residents’ knowledge, attitudes, and self-reported behaviors related to sustainability.

Methods: We conducted a prospective pre/post interventional study at two community-based EM residency programs. Emergency medicine residents completed a baseline survey assessing sustainability-related knowledge, attitudes, and self-reported behaviors, followed by a video on sustainable clinical practice and a peer-reviewed paper on the environmental impact of inhalers. Immediate postcourse and one-month follow-up...

Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Prehospital triage challenges often lead to suboptimal choices and delayed treatment for stroke patients. The objective of the study was to evaluate whether a decision-support interface to assist in stroke triage to an appropriate hospital could reduce emergency medical technicians’ (EMT) mental workload.

Methods: This randomized crossover study was conducted between February and March 2025. Each participant completed two 12-minute simulated trials in randomized order: current dispatch orders without decision support and a decision-support interface. We assessed mental workload—the mental effort required to make hospital transport decisions under time pressure during prehospital stroke triage—using heart rate variability (HRV) metrics and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). System usability was assessed using the System Usability Scale. The primary outcome was the root mean square...

Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.

Methods: This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021–December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using...

Impact of Street Medicine on Emergency Department Use: A Three-Year Evaluation of People Experiencing Homelessness

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: People experiencing homelessness (PEH) frequently utilize the emergency department (ED) for acute and primary healthcare needs. Loyola Street Medicine is a multidisciplinary team comprised of physicians, students, and other professionals who provide weekly healthcare services to PEH at a train station in Chicago. The objective of the study was to identify the specific patient demographics, chief complaints, and clinical interventions associated with increased odds of these patients reporting that they would have sought care at an ED had Loyola Street Medicine been unavailable.

Methods: We conducted a retrospective review of patients seen by Loyola Street Medicine between September 2021 and September 2024, with 2,121 total encounters and a subset of 1,565 with identifying data. The primary outcome measure was whether the patient reported they would have gone to the ED for care, and the secondary outcome measures were patient...

Idiopathic Left Anterior Fascicular Ventricular Tachycardia in the Emergency Department: A Case Report

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Idiopathic fascicular ventricular tachycardia is a rare form of ventricular tachycardia that is commonly seen in young, otherwise healthy individuals without structural heart disease. This rhythm can be difficult to distinguish from other forms of tachyarrhythmia, including supraventricular tachycardia, yet acute pharmacologic management of this condition varies significantly from more common forms.

Case Report: We describe a 42-year-old woman with no cardiac history who presented with palpitations and lightheadedness. She was found to be in a hemodynamically stable, wide-complex tachycardia. Given no prior cardiac history, supraventricular tachycardia with aberrancy was initially considered as a leading diagnosis; however, a trial of adenosine and lidocaine was ineffective. Her electrocardiogram revealed a regular wide complex tachycardia at 262 beats per minute with a right bundle branch block morphology and right axis...

Intravenous Ketamine for Depressed and Suicidal Adolescents in the Emergency Department: A Randomized Double-Blind Trial

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Adolescents frequently seek care in the emergency department (ED) for behavioral health emergencies. Due to national shortages in staffing, limited opportunities to begin treatment on site in most centers and, thus, the frequent default to elusive inpatient psychiatric beds as a means of stabilization, adolescents may spend prolonged amounts of time boarding in the ED, often without treatment. Ketamine is a rapid-acting antidepressant with emerging evidence in adults, but data are limited on its effectiveness in suicidal youth. We aimed to evaluate the effectiveness of a single dose of intravenous (IV) ketamine on depression and suicidality scores compared to placebo in adolescents with treatment-resistant depression presenting to the ED with suicidal ideation.

Methods: We conducted a two-arm randomized double-blind placebo controlled trial on a convenience sample of adolescents 12–17 years of age with treatment-resistant...

Effect of Real-time Feedback on the Quality of Cardiopulmonary Resuscitation for Medical Studentsin Colombia

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential to improve survival in cases of cardiac arrest. However, skill acquisition based solely on instructor observation has proven to be limited. In this context, real-time feedback devices emerge as promising tools to optimize CPR training.
Objective: In this study our goal was to evaluate the effect of using a real-time feedback device on the quality of CPR performed by medical students at a public university in Colombia.

Methods: This was an experimental study with fourth-year medical students, randomly assigned to two groups. Both groups received the same initial theoretical and practical training in basic CPR. Subsequently, the intervention group practiced with a real-time feedback device, while the control group trained without technological feedback. The primary outcome measure was the target of chest compressions, simultaneously meeting both a rate of 100-120...

From De-escalation to Restraint: A Qualitative Study of Emergency Clinician Decision-Making in Patient Agitation

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Managing agitation in the emergency department (ED) is challenging and frequently involves decisions about physical restraints and emergent medications. While institutional protocols and behavioral response teams exist, little is known about how individual clinicians make decisions about restraint use—decisions with significant implications for safety, ethics, and equity. The objective of the study was to explore how emergency physicians, residents, and nurses make decisions about physical restraint and emergent medication use during episodes of patient agitation in the ED.

Methods: We conducted a qualitative study using semi-structured interviews with 35 emergency clinicians (18 attending physicians, 7 senior residents, and 10 nurses) at an urban academic ED. Interviews were transcribed and analyzed using inductive thematic analysis.

Results: Clinicians described three key factors informing restraint...

A Procedural Faculty Development Course for Emergency Physicians Practicing in Community and Academic Settings

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Maintaining competence in high-acuity, low-occurrence (HALO) procedures poses a challenge for emergency physicians as they progress past residency training or practice in lower-acuity settings. Simulation-based deliberate practice offers a feasible method to sustain procedural competence. We developed and evaluated a blended, faculty development procedural curriculum designed to improve confidence and clinical application of HALO skills across a five-hospital emergency medicine (EM) network.

Methods: A faculty needs assessment and departmental quality data informed the creation of a 4-hour procedural curriculum course. The blended curriculum included asynchronous precourse procedural guides and videos followed by a 4-hour, in-person deliberate practice session led by peer EM faculty instructors. Year one procedures included cricothyroidotomy, transvenous pacing, catheter thoracostomy, neonatal resuscitation, and peritonsillar...

Impact of Live Preferential Music on Pain in the Emergency Care Setting: A Randomized Controlled Trial

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Pain is the most prevalent complaint for the more than 155 million patients accessing emergency care in the United States. Appropriate and timely management of pain is a measure of quality emergency care. However, the opioid crisis has created a need for multimodal and alternative approaches to successful pain management. Models for integrating such approaches in emergency departments (ED) are understudied. Therefore, we chose to investigate the impact of live preferential music (LPM) in the management of acute musculoskeletal pain.

Methods: This prospective, randomized, double-blind intervention study was designed with block randomization clustered by day of the week to live preferred music versus usual care. To ensure blinding, patients were deceived that the study focus was on pain assessment without disclosure that there was an intervention. A total of 2,262 patients were screened, and 272 patients (94 interventions,...

WestJEM Full-Text Issue

Sat, 26 Sep 2026 00:00:00 +0000

WestJEM Full-Text Issue

Implementation Science to Advance Equity in Climate-Driven Disaster Response

Sat, 26 Sep 2026 00:00:00 +0000

Climate hazards are causing increasingly frequent and severe disasters. The populations most impacted by the health and social costs of disasters include language minorities, displaced individuals, and low-income communities. This commentary explores three key issues. First, climate hazards lead to displacement and increase vulnerability by disrupting housing, livelihoods, and access to care. Second, current emergency and disaster frameworks often overlook equity in communication, access to care, and recovery. Third, practical solutions can prioritize equity across mitigation, preparedness, response, and recovery. We review evidence on climate displacement, legal protections, and the roles of the health system. We highlight recurring operational opportunities, such as language access, navigation barriers, and fragmented recovery efforts. We also propose feasible strategies aligned with implementation science, including multilingual warning systems, interpreter-ready triage,...

Rural-Urban Parity and Socioeconomic Gaps in Traumatic Brain Injury Outcomes

Sat, 26 Sep 2026 00:00:00 +0000

Background: Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Rural residence and low community income are independently associated with poorer health outcomes, mediated by variations in injury mechanism and healthcare access. We evaluated the impact of geographic location on injury patterns and acute‐care metrics in adults with TBI treated at Maryland’s statewide Level I trauma center.

Methods: Adults (≥18 years of age) with radiographically confirmed TBI admitted between 2017 and 2021 were identified retrospectively from the institutional trauma registry. Rural residence was defined using Rural-Urban Commuting Area codes. This single-center study included only patients surviving to hospital admission. Primary outcomes included hospital length of stay (LOS) and discharge to hospice or death. Secondary outcomes included intensive care unit (ICU) and ventilator days and discharge disposition.

Results:...

Mechanical Small Bowel Obstruction Secondary to Deflated and Migrated Intragastric Balloon

Sat, 26 Sep 2026 00:00:00 +0000

Case presentation: A 29-year-old woman presented to the emergency department three months after intragastric balloon placement with nausea, vomiting, constipation, and abdominal pain. Computed tomography (CT) demonstrated spontaneous deflation and migration of the device into the small bowel with resultant mechanical small bowel obstruction. The patient was managed conservatively with bowel rest, intravenous fluids, electrolyte repletion, and nasogastric decompression. Repeat CT on hospital day 2 confirmed distal migration of the balloon into the descending colon with interval decompression of the small bowel. On hospital day 3, the patient reported spontaneous passage of the balloon per rectum with complete resolution of symptoms.

Discussion: Spontaneous deflation and distal migration of an intragastric balloon causing small bowel obstruction is a rare but potentially life-threatening complication. Most reported cases require surgical...

Impact of a Rapid Assessment Zone on Patient Throughput in an Urban Pediatric Emergency Department

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: The rapid assessment zone is a newer model for optimizing emergency department (ED) throughput. Similar models implemented in adult ED settings have shown improvements in throughput parameters. However, few studies have taken place in the pediatric ED setting. Our study objective was to assess the impact of implementing a rapid assessment zone on throughput in an urban pediatric ED. We hypothesized that length of stay (LOS), time to bed placement, and time to see a clinician would decrease after the intervention and remain sustainable over long-term follow-up.

Methods: This retrospective study assessed the effect of rapid implementation from May 2012–April 2018 on LOS for ED visits for three two-year time periods: pre- and post-rapid assessment zone and post-follow-up. Our primary outcome measures were LOS, time from registration to bed, and time from registration to first clinician evaluation. Secondary outcome measures...

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

Sat, 26 Sep 2026 00:00:00 +0000

From AUC to Action: AI Sepsis Alerts as Quality Improvement Tools in the Emergency Department

A Decade Later: Trends in Fellowship Training and Secondary Board Certification Among Emergency Medicine Residency Leaders

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Residency program leaders shape the academic pipeline in emergency medicine (EM). We assessed current demographics and postgraduate training among EM residency leadership in the United States.

Methods: We conducted a national, cross-sectional survey of all Accreditation Council for Graduate Medical Education–accredited EM residency program leadership via an online, confidential questionnaire. Primary outcomes were the prevalence of any postgraduate fellowship training and any secondary board certification (ie, additional board certification beyond EM) as a complementary marker of advanced credentialing distinct from fellowship training. Programs were grouped by National Resident Matching Program (NRMP) region.

Results: We received 103 program responses (35.9%). Any fellowship training was reported by 25.5% of program directors (PD), 40.0% of associate program directors (APD), and 42.8% of assistant...

Impact of a Residency-Run Emergency Medicine Podcast Summary on Learning Retention and Engagement

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Podcasts have become a widely used educational tool in emergency medicine. In this study, a podcast was used as the intervention. This podcast consisted of a brief audio summary of weekly in-person conference content produced by residents and faculty. We assessed whether a resident-led, curriculum-based podcast summary improved knowledge retention and learner engagement compared to a standard written summary format.

Methods: This mixed-methods prospective cohort study conducted at a single urban academic hospital included 54 emergency medicine residents and approximately 66 attending physicians. The study unfolded in three phases: eight weeks of standard written conference summaries (control); followed by eight weeks of written plus podcast conference summaries (intervention); and a four-week post-intervention period with surveys. The primary outcome was knowledge retention, measured by weekly postconference quiz scores...

Efficiency and Humanism: The Impact of the Humanistic Charting Tool on Patient Experience in the Emergency Department

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Emphasis on documentation challenges clinicians to strike a balance between efficiency and individualized care, often leading to the depersonalization of patient interactions. The Humanistic Charting Tool (HCT) addresses this by integrating the patient’s voice into the electronic medical record (EHR). The objective of this study was to examine whether use of the HCT during emergency department (ED) visits is feasible and improves key patient experience metrics.

Methods: The study took place in an urban, academic hospital. Patients in the ED completed the HCT while waiting to see a clinician. The patient’s responses were condensed into a two-page summary and uploaded into their EHR. Clinicians were asked whether they used the HCT for each patient at the end of the encounter, and patients completed precare and postcare surveys assessing key experience metrics. Our primary outcome measure was changes in patient experience...

Impact of Ultrasound-Guided Peripheral Intravenous Training on Central Line Placement in the Emergency Department

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Central venous catheters are placed in the emergency department (ED) when difficult peripheral access limits care or when critical medications require central access because of their sclerotic nature or incompatibility with other drugs. Ultrasound-guided peripheral intravenous (IV) access offers a less invasive alternative. We evaluated whether implementation of a structured ultrasound-guided peripheral intravenous training program for ED nurses and technicians was associated with changes in ED central venous catheter use.

Methods: We performed a retrospective chart review at our 50-bed academic community ED, which holds a Level II trauma designation. This center has an ED census of 80,000 patients per year, a 4:1 nursing to patient ratio with an admission rate of 20-25% with expected monthly variation. A structured ultrasound-guided peripheral IV curriculum for nurses and technicians launched in November 2023. The primary...

Partial Immersion Using Body Bags for Exertional Hyperthermia: A Randomized Crossover Study

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Recent recommendations suggest emergency medical personnel should consider rapid whole-body cooling for heat stroke patients. Cold-water immersion maximizes cooling rate and subsequent outcomes following heat stroke. Body bags filled with ice and water may provide portable, accessible partial cold-water immersion for this setting. The purpose of this study was to determine whole-body cooling rates when using body bags to facilitate partial cold-water immersion to treat exertional hyperthermia.

Methods: A total of 9 healthy participants (8 male; mean [SD] age, 24 [4] years; height, 175 [7] cm; body mass, 83.6 [21.6] kg) completed our randomized-crossover field study. Following hydration verification, participants completed a self-paced 400 warm-up run, 1,609 m run, and 10-m sprints until rectal temperature (T-rec) reached 39.2 °C or volitional exhaustion. Following exercise, participants were cooled for a maximum of 30 minutes...

Effectiveness of a Nurse-Led Ambulatory Care Clinic in Reducing Emergency Department Visits and Hospitalizations

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Gaps in care integration and coordination contribute to emergency department (ED) crowding and preventable hospitalizations, necessitating innovative solutions to improve care transitions and reduce acute care use. This study evaluates whether attendance at a nurse-led ambulatory intermediate care clinic (AICC) reduces three-month ED visits and hospitalizations compared to missed AICC appointments.

Methods: This retrospective cohort study at a single academic center analyzed AICC appointments from the first three years of clinic operations using multivariable logistic regression models, controlling for demographic, socioeconomic, and clinical factors. Our primary outcome measure was an ED visit within three months of the AICC appointment; our secondary outcome measure was hospitalization within three months. Robustness was assessed using Poisson, negative binomial, and zero-inflated models.

Results: Among...

Changing Risk Factors in Patients Diagnosed with Human Immunodeficiency Virus

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Since 2019, transmission risk factors among patients diagnosed with HIV have changed, although the trends and reasons behind them have not been fully elucidated. The objective of this study was to assess changes in HIV transmission risk factors among patients newly diagnosed with HIV to inform future targeted HIV testing programs.

Methods: This study site is New England’s largest essential hospital and a major reporter of new HIV cases in Massachusetts. We performed a retrospective chart review of patients diagnosed with HIV infection at our medical center between January 2019 and December 2023. Demographic and clinical variables were collected and analyzed using descriptive and comparative statistics to evaluate trends in primary risk factor for HIV. Our primary outcome measure was incident HIV diagnosis with a primary risk factor of injection drug use (IDU), men who have sex with men (MSM), or heterosexual contact. A...

A Case Report of Meningitis due to Borrelia Species in Arizona

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Lyme disease is most prevalent in the Northeast and Midwest regions of the United States, as well as northern California; however, cases have been reported in nonendemic areas, including the Southwestern United States. Atypical presentations or underreporting can cause delay in diagnosis.

Case Report: We present the case of a 22-year-old previously healthy man, who presented to our emergency department in metropolitan Phoenix with five days of headache, fever, meningismus, and photophobia, and later developed focal neurologic deficits consistent with Lyme meningitis. Cerebrospinal fluid was notable for lymphocytic pleocytosis, and Western blot for Borrelia burgdorferi Immunoglobulin-M antibodies was positive, which led us to Lyme meningitis as the unifying diagnosis. He was treated with intravenous ceftriaxone and his symptoms resolved.

Conclusion: This case highlights the importance...

Emergency Department Evaluation and Care of Hepatic Encephalopathy: ACEP Expert Panel Recommendations

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Patients with hepatic encephalopathy frequently visit the emergency department, and these visits are expected to rise in the coming years due to an increased prevalence of liver disease in the United States. Accordingly, we sought to define a comprehensive and efficient approach for emergency physicians to evaluate, treat, and determine the optimal disposition of patients presenting with possible or confirmed hepatic encephalopathy and its complications.

Methods: We reached consensus recommendations through a structured literature review and a modified Delphi technique, informing an expert panel of academic and community emergency physicians convened by the American College of Emergency Physicians.

Results: We created the assess, look, treat, evaluate risk, reassess, disposition (ALTERD) framework as a digital point-of-care tool to support clinicians in guiding key bedside steps involved in the diagnosis...

Efficiency of Early Warning Scores in Adult Emergency Department and Inpatient Populations: Overview of Reviews

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Early Warning Scores (EWS) are used to support decisions regarding triage and early intervention of patient deterioration in emergency departments (ED) and other clinical environments. We synthesized evidence from systematic reviews on the predictive performance and clinical impact of EWS and their modifications in adult in-hospital populations.

Methods: We conducted and reported an overview of reviews following the Joanna Briggs Institute (JBI) methodology, PRIOR statement, and our predefined protocol. A systematic search of MEDLINE (Ovid) and Epistemonikos was performed in May 2025. Two reviewers independently screened studies, extracted data, and critically appraised systematic reviews. We included systematic reviews of adult in-hospital populations evaluating EWS as either prognostic tools for deterioration or mortality, or as interventions implemented within track-and-trigger or rapid response systems. Primary study...

Traumatic Extremity Amputations in Children: Causes and Outcomes Based on a Regional Experience

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Pediatric traumatic extremity or digit amputations are preventable causes of morbidity. The object of this study was to evaluate the etiology and outcomes of these injuries in our region. We used the Childhood Opportunity Index to explore the role of social determinants of health.

Methods: We performed a retrospective cohort study at an academic children’s hospital on all pediatric patients younger than 18 years who presented with a traumatic digit or extremity amputation between January 1, 2014, to July 31, 2024. Metrics such as patient demographics, injury severity, prehospital course, hospital events and follow-up were abstracted. The Childhood Opportunity Index assigns a 0-100 composite score of region-based childhood opportunity determined from home ZIP codes. Our primary outcome measure was mechanism of injury. Secondary outcomes included length of stay, need for initial surgical intervention, subsequent operations,...

Clinical and Financial Value of Cardiac Point-of-Care Ultrasound During Traumatic Cardiac Arrest

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Traumatic cardiac arrest is associated with poor survival and significant consumption of hospital resources. Determining which patients have survivable injuries allows for judicious use of resources. Our aim was to determine whether cardiac activity on point-of-care ultrasound (POCUS) during traumatic cardiac arrest was associated with increased patient survival and the charges of continued resuscitation in patients that do have cardiac activity on POCUS.

Methods: We conducted this single-center retrospective study at an urban, Level I trauma center of consecutive patients arriving in traumatic cardiac arrest from August 2016–December 2023 who had a cardiac POCUS performed during the initial resuscitation efforts. Our primary outcome was to determine whether cardiac activity on POCUS during the arrest was associated with increased patient survival to neurologically intact hospital discharge. Secondary objectives included...

Introducing the Climate Change Special Issue

Sat, 26 Sep 2026 00:00:00 +0000

Introducing the Climate Change Special Issue

Prehospital Flumazenil: Five-Year Review of Use, Indications, Outcomes, and Adverse Events in Suspected Benzodiazepine Overdose

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Historically, flumazenil was employed as both a diagnostic aid in unresponsive patients and as an antidote for suspected benzodiazepine overdose in both emergency departments and out-of-hospital settings. However, its prehospital application has been historically constrained by long-standing concerns regarding adverse events, leading many emergency medical service (EMS) systems to restrict or avoid its use. The use of flumazenil in the prehospital setting remains underreported in the literature, despite its inclusion in the treatment protocols of various EMS agencies. We conducted a descriptive analysis of the use of flumazenil by EMS in the out-of-hospital setting across the state of Kansas over a five-year period. We characterize the frequency, indications, patient outcomes, and associated adverse events of flumazenil administration, thereby contributing to a better understanding of its role, safety, and clinical relevance in prehospital care.

Methods:...

Artificial Intelligence-Driven Cost Savings from Emergency Department Chest Pain Patient Evaluation: A Monte Carlo Simulation

Sat, 26 Sep 2026 00:00:00 +0000

Introduction: Chest pain patients presenting to the emergency department (ED) often require risk stratification through stress testing, which may necessitate hospitalization. This practice contributes to ED crowding by occupying beds with low-risk patients who may derive limited benefit from testing, thereby increasing bed occupancy, prolonging ED boarding times, amplifying crowding, and resource strain. Use of an artificial intelligence (AI)-driven clinical decision support tool improves the detection of obstructive coronary artery disease and focuses diagnostic testing on those most likely to benefit.

Methods: We created a Monte Carlo simulation informed by available published inputs and ran 1,000 trials to estimate the national impact of using an AI-driven decision-support tool to reduce avoidable downstream cardiac testing among eligible U.S. ED patients with chest pain. Model inputs included patient demographics, chest pain history,...

Assessment of Gender Bias of Emergency Medicine Resident Physicians

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25 Abstract

SIPdb: a stable isotope probing database and analytical dashboard for linking amplicon sequences to microbial activity using reverse ecology

Fri, 25 Sep 2026 00:00:00 +0000

Stable isotope probing (SIP) connects microbial sequence data to diverse metabolic activities, but the lack of a unifying framework for SIP-derived data has limited its integration into broader strategies for ecological inference. Here, we introduce the SIPdb, an extensible SQLite database of curated nucleic acid SIP experiments (also in phyloseq format) paired with an interactive RShiny dashboard for analysis and visualization. The initial release compiles 22 studies covering 21 isotopolog substrates across diverse environments, standardized using the MISIP metadata standard. SIPdb provides a standardized pipeline accommodating the three most common SIP gradient fractionation strategies (binary, multi-fraction, and density-resolved), two incorporator designation strategies (fixed- and sliding-window), and four complementary differential abundance methods (DESeq2, edgeR, limma-voom, and ALDEx2). Using this pipeline, we identified over 42 000 unique amplicon sequence variants as...

Does Sharing Data On The Rate At Which Clinicians Work Alter Their Practice? A Study In A UK ED.

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25 Abstract

EMS Administration of Aspirin to Chest Pain and AMI/STEMI Patients: Disparities in Care?

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Accuracy of Parental Reporting in Pediatric Immunization Status in the Emergency Department.

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Physician Attitudes on Integration of Prehospital Patient Care Report into Hospital Medical Record

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Expanding Stroke Screening for EMS Patients with Altered Mental Status: A Predictive Model Analysis

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Natural Projectibility and the Self-Assembly of Learning

Fri, 25 Sep 2026 00:00:00 +0000

Issues of projectibility are central to the philosophy of induction. The basic problem goes like this. Inductive learning involves projecting regularities in past experience onto unobserved cases. But any body of experience can be described as exhibiting any number of regularities, and depending on which of these we project, induction will yield different beliefs and predictions. A principled procedure for identifying regularities that provide good guidance for belief and prediction—i.e., projectible ones—has proven elusive. Nevertheless, the impressive track record of human and animal learning suggests that nature has found ways to deliver us assumptions of projectibility that track stable, practically relevant regularities in many contexts. This dissertation uses computational models to show how simple natural adaptive processes might accomplish this critical task. Specifically, the goal is to explain how such assumptions might emerge from trial-and-error learning in kinds of...

Artificial Intelligence is Capable of Accurately Detecting OMI in the ED

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

From Backcountry to Bedside: Training EM Residents in Decision-Making Under Pressure

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25 Abstract

Self-Directed Blended Learning- Novel Tool To Teach Neonatal Bag-Mask Ventilation To Students

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Development of a Geriatric Order Set in a Safety-Net Emergency Department

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Indirect Exposure to Atrocities and PTSD among Aid Workers: Hemispheric Lateralization Matters

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Adapting Citizens’ Panels for Under-Resourced Rural Settings: A Community-Based Participatory Approach to Identify Feasible Health Policy

Fri, 25 Sep 2026 00:00:00 +0000

Community-based participatory strategies can help academics and practitioners identify and prioritize health policies that are timely and responsive to local public health needs. These approaches may need to be adapted when used in rural or under-resourced communities due to contextual factors, resource availability, and communication needs that shape local health issues. In this article, we describe how we modified the citizens’ panels approach to engage rural communities in policy formulation and feasibility in a rural region in California. We adapted a deliberative citizen panel approach to present viable policy options that were contextually feasible, considering local socio-political and demographic factors (i.e., predominantly Latino, rural population), to address key public health concerns identified by participants. Key adaptations included: (1) partnering with an established community network; (2) presenting culturally relevant policy options to address participant concerns;...

A sequence motif enables widespread use of noncanonical redox cofactors in natural enzymes

Fri, 25 Sep 2026 00:00:00 +0000

Noncanonical redox cofactors (NRCs) are low-cost alternatives to the natural redox cofactors nicotinamide adenine dinucleotide (NAD+) and nicotinamide adenine dinucleotide phosphate (NADP+) for biomanufacturing, offering exquisite electron-delivery control, yet their adoption is limited by the scarcity of compatible enzymes. Screening the aldehyde dehydrogenase (ALDH) family, we identified a conserved RH/QxxR motif that enables widespread NRC activity among natural enzymes. Bostaurus ALDH3a1 exhibits unprecedented turnover with nicotinamide mononucleotide (NMN+), with kcat values exceeding NAD+ and surpassing most engineered NRC-active enzymes by 10–105-fold. Structural analyses reveal that this motif reinforces cofactor positioning and preorganizes the active site independently of the NAD+ adenosine monophosphate moiety. This motif supports activity across simple-synthetic NRCs such as 1-(2-carbamoylmethyl)nicotinamide and, when introduced into diverse ALDH scaffolds, enhances...

Unveiling the Underlying Mechanisms of Airineme-Mediated Cell-Cell Communication During Pigment Pattern Development in Zebrafish

Fri, 25 Sep 2026 00:00:00 +0000

Cell-cell communication (CCC) is essential for coordinating important developmental processes, including tissue patterning. Although cells can communicate through well-characterized mechanisms such as endocrine, synaptic, juxtacrine, and paracrine signaling, these are not the only signaling modalities that exist in nature. Cells can also communicate via specialized filopodia, allowing for direct targeting. There are several subclasses of signaling filopodia, including airinemes, which are the focus of this dissertation. Airinemes are a unique class of specialized filopodia that mediate signaling during zebrafish pigment pattern development through the coordinated activities of xanthoblasts, macrophages, and melanophores. Airinemes originate as surface blebs (airineme blebs) on xanthoblasts that are recognized and extracted by migrating macrophages, which transport airineme vesicles and deposit them onto target melanophores. Despite previous work establishing the importance of...

Current State of Emergency Department Boarding: A Call to Reimagine Resources to Meet Patient Needs

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Downstream Effects of Armed Conflict on Civilian Inter-Hospital Transfer

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Rekindling Curiosity: Harnessing Autonomy and Creativity to Revitalize Physician Engagement

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Linking Personal Practices to Academic Success and Professional Development - A Qualitative Analysis

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

GEDI - Geriatric service in the ED. Feel the Force

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25

Patterns in Duration of Emergency Department Boarding and Variation by Sociodemographic Factors

Fri, 25 Sep 2026 00:00:00 +0000

MEMC25 Abstract

Impact of Secure Electronic Health Record Chat on Physician Communication in the Emergency Department

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Effective communication in the emergency department (ED) is essential for safe patient care. Electronic health record (EHR)-integrated secure messaging may improve communication workflows, but limited evidence exists comparing clinician satisfaction across modalities in the ED. This study evaluated physician satisfaction with an EHR-integrated secure messaging tool compared to existing communication methods for non-emergent communication.

Methods: We conducted an electronic pre-post survey study at an urban academic ED following implementation of an EHR-integrated secure messaging tool in October 2024. The primary outcome was overall communication satisfaction pre-post implementation. We also compared nursing communication satisfaction and repeat consult order proportions. Survey domains (ease of use, efficiency, timeliness, clarity, overall satisfaction) were graded using a four-point forced-choice Likert scale.

Results: Response...

Tokens, Writing and (Ac)counting: A Conversation with Denise Schmandt-Besserat and Bill Maurer

Thu, 24 Sep 2026 00:00:00 +0000

In her foundational study of Neolithic clay tokens, the renowned archaeologist Denise Schmandt-Besserat identified that different token shapes represented different goods and were used in accounting and distribution. When these tokens came to be stored in sealed clay envelopes (likely representing a debt), each token was impressed on the outside of the envelope before being placed inside (thus allowing people to see quickly what was within). Three-dimensional objects were thus reduced to two-dimensional representations, the first form of writing (and contributing to cuneiform script). These clay envelopes in turn developed into pictographic tablets; here each token did not have to be impressed into the clay in a 'one, one, one' system, but instead quantity was indicated by a numerical symbol - abstract number was born. Much of Schmandt-Besserat’s work can be found online at https://sites.utexas.edu/dsb/. Her book ‘How Writing Came About’ was listed by American Scientist magazine...

A Novel Projection-Wise Quantization Method and A Custom Accelerator Design for Efficient Sub-4-Bit Large Language Model Inference

Thu, 24 Sep 2026 00:00:00 +0000

Modern Large Language Models (LLMs) offer exceptional inference accuracy but remain severely restricted by high resource and power requirements. Post-Training Quantization (PTQ) mitigates these memory bottlenecks by compressing weights to sub-4-bit regimes; however, existing Hadamard rotation-based methods that enable nearly lossless 4-bit weight and activation quantization (W4A4) does not push weight quantization below INT4, thereby limiting the memory size reduction potential of Hadamard transform. Furthermore, many GPU-based mixed-precision approaches lack native hardware support for integer to floating point multiplication and custom low-bit multiplication kernels. This requires runtime upcasting of integer weights and fails to leverage the resource saving potentials of low-bit representations during computation, leaving custom FPGA accelerators as the most efficient platform for low-bit mixed precision execution. To address these problems, this paper presents a projection-wise...

A Novel Multistage Extraction Method of Rare Earth Elements Using Macrocyclic Chelators and Organophosphorus Extractants

Thu, 24 Sep 2026 00:00:00 +0000

This work develops a targeted liquid–liquid extraction method for recovering rare earth elements (REEs) by combining the macrocyclic chelator Macropa with conventional organophosphorus extractants. A systematic baseline study was conducted to characterize the extraction and stripping behavior of four REEs- Neodymium (Nd), Samarium (Sm), Dysprosium (Dy), and Yttrium (Y) across three pH (2, 5, and 7) at a concentration of 1 ppm to reflect the low concentration found in Berkeley pit water, an acid mine drainage using four industrially available organic extractants (Cyanex 302, Cyanex 923, Cyanex 272, and D2EPHA), Stripping efficiency was optimized by comparing hydrochloric, nitric, and sulfuric acids, with sulfuric acid identified as the most effective stripping agent. Key parameters such as ligand concentration, mixing time, phase ratios, and acid conditions are optimized using synthetic solutions to achieve the selectivity trend for light and heavy REEs. This optimized...

Standardized Exam of the Abdomen Protocol Through Telemedicine in the Emergency Department

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Abdominal pain is a common emergency department (ED) presentation, and virtual assessment of such complaints remains a challenge due to the limitations of remote physical examination. The standardized exam of the abdomen protocol (SEAP) was developed to guide patients in performing a self-abdominal examination during telemedicine consultations. We aimed to evaluate agreement between patient-performed abdominal self-examinations using the SEAP and physician-performed abdominal examinations.

Methods: We conducted a prospective, single-center study at the American University of Beirut Medical Center ED in Lebanon from August 2023–August 2024. Adult patients who presented with abdominal pain and met the inclusion criteria were enrolled. Each patient performed a video-guided abdominal self-examination by following a brief instructional video (SEAP). The SEAP was developed by an emergency medicine faculty at our institution using...

Resident Exposure to Acutely Ill Patients Over the Course of Residency

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Emergency medicine literature has long debated the “black cloud” and “white cloud” phenomena, which suggest individual variability in exposure to acutely ill patients. If true, this variation may have significant implications for resident training. This study investigates whether emergency medicine (EM) residents consistently encounter differing volumes of high-acuity clinical encounters throughout their training.

Methods: This retrospective cohort study analyzed 11 years of electronic health record (HER) data from a Midwestern academic emergency department to quantify the number of acutely ill adult patients seen by EM residents across three years of training, using a consensus-based set of clinical criteria. Our primary outcome was the concordance of the ranking of each resident within their cohort by number of acutely ill patients seen during postgraduate year one (PGY 1) compared to PGY 3. Statistical analyses...

Experimental evolution reveals contrasting adaptive landscapes in lab and field environments.

Thu, 24 Sep 2026 00:00:00 +0000

Experimental evolution is widely used to infer microbial responses to environmental change, yet most laboratory studies impose constant, well-mixed conditions that differ fundamentally from fluctuating, spatially structured field environments. We compared genomic evolution in the leaf litter-associated bacterium Curtobacterium strain MMLR14_002 under control and warming treatments in laboratory culture and in a complementary field experiment. Laboratory-derived isolates accumulated more mutations per genome and exhibited stronger locus-level parallelism, with mutations recurring in a small number of coding loci. Field-derived isolates accumulated fewer mutations per genome, and these mutations rarely occurred in the same coding loci across replicate populations. Instead, field isolates exhibited a higher proportion of intergenic mutations, with mutations recurring in the same intergenic regions across independent field deployments. When coding mutations were detected in...

Some pig! Exchanging NFTs for the perspective of regeneration

Thu, 24 Sep 2026 00:00:00 +0000

There are a thousand more silly ideas for every utopian blockchain project to heal the planet, foster financial justice, transform cultural production or democratize practically anything and everything. Non‐fungible tokens (NFTs) are one of them. The funny thing is that the more you pick at them, the more they harmonize with certain longstanding anthropological arguments. Non‐fungibility lurks in the anthropological imagination of non‐capitalist economies. This article uses the common law of fungibility to explore the elevation of the very idea of non‐fungibility presumed in many NFTs. This idea might have more in common with saints’ incorruptible flesh or the Crown Jewels than the standard fictions of capitalist finance. They cut social ties by insisting on their singularity and immutability. In doing so, they crowd out other blockchain conversations about regeneration and ways to reckon the debts we owe any number of possible futures.

Payments are Getting Political Again

Thu, 24 Sep 2026 00:00:00 +0000

Payments are political in that they are a function of state sovereignty, and also an extension of it. This is old news, of course: money itself emanates from state sovereignty. But digital payments, obviating the anonymity of cash transactions and generating vast quantities of data in their wake, provide new opportunities for states to extend their reach. These politics of payments are not, of course, limited to authoritarian regimes. Payment providers have been enlisted into government service almost since their inception, whether in the tracking of cash to hamper criminal activities or in the regulations around customer due diligence and identification for cross‐boundary payments of all kinds. With more attention to payments, and payment data, people can also hear the rumblings of another politics. Data activism has emerged as a potential social movement and political force.

Blockchain

Thu, 24 Sep 2026 00:00:00 +0000

Blockchain

Three-Dimensional Two-Phase PEM Water Electrolysis Model for Parallel Flow Field Design Improvement with Fully Resolved MEA

Thu, 24 Sep 2026 00:00:00 +0000

As hydrogen becomes an important alternative fuel to fossil fuels, Proton Exchange Membrane Water Electrolysis (PEMWE) is a promising technology to produce hydrogen from water using sustainable energy resources. PEMWE cells operate with high efficiency, long lifetimes, and at a large range of current density. However, the final cost of hydrogen is expensive and economically unviable compared to hydrogen produced from fossil fuels. To reduce production costs, it is advantageous to run PEMWE at high current densities, which requires effective flow field design. In PEMWE, the parallel flow field is widely used due to its simplicity and low pressure drop; nevertheless, it struggles with mass transport and non-uniformity in current density and temperature distributions. This study aims to improve the mass transport performance of parallel flow fields while maintaining their advantage in pressure drop. In this master’s thesis, a full-scale, three-dimensional, two phases model was developed...

Acute Headache Management and Emergency Department Throughput: A Multicenter Retrospective Analysis

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Headache is a common presentation to the emergency department (ED), requiring both accurate diagnosis and efficient management. Although consensus guidelines exist, real-world treatment practices and their associations with operational outcomes remain variable. We evaluated the association between acute headache management strategies—including medications, diagnostic imaging, and consultations—and ED length of stay (LOS), using both unadjusted and multivariable-adjusted analyses.

Methods: We conducted a multicenter retrospective observational study using data from 79,527 adult ED encounters for headache across 22 EDs in the southwestern and upper Midwestern United States between 2018 and 2024. The primary outcome was ED LOS. Secondary outcomes included LOS differences associated with medication classes, imaging modalities, procedures, and specialty consultations. Length of stay differences by treatment strategy were compared...

Introduction: Curating Transactional Things

Thu, 24 Sep 2026 00:00:00 +0000

Consider this book a catalog for an exhibition that never happened. Each contribution takes up an ephemeral object connected to the act of payment, a transactional thing that unlike metal coins or paper banknotes would rarely make it into a display case-or, in some cases, even be impossible to curate. Money is the most obvious transactional thing. It is used for billions of transactions every minute, the sum total of which we call an “economy.” Museums have money galleries, displaying coins, notes, and some of the other objects that people have used historically to conduct transactions—pretty things like beads, shells, stones, and metal ingots. Such items have been displaced by coins and cash, and commentators today predict the imminent demise of those transactional things, too, heralding a cashless future in the face of digital technologies of payment. Supposedly, the pretty things will get replaced by pure data. Increasingly, however, monetary transactions have begun to require...

Primitive and Nonmetallic Money

Thu, 24 Sep 2026 00:00:00 +0000

Feathers, beads, shells, copper bracelets, and giant stones – objects that Western observers have assumed serve the functions of money in so-called simple societies and other non-Western contexts – come in all shapes and sizes. This chapter reviews the literature on “primitive” currencies, from early ethnology to contemporary anthropology and archeology. Showing how analysts frequently misunderstood the use of such objects in context, it hones in on the social relationships and political systems those objects operated within and reflects back on the limitations of the Western imagination of currency revealed by what collectors call “odd and curious money.” It also takes up the question of whether and how standards determine value and expands the social scientific vocabulary for the diversity of forms of political authority that constitute money.

Series Preface

Thu, 24 Sep 2026 00:00:00 +0000

Series Preface

Money, Rank and the Frailty of Authority: Schurtz’s World and Ours. An Outline of the Origins of Money By Heinrich Schurtz. Translated and Annotated and With an Introduction by Enrique Martino and Mario Schmidt (eds.), HAU Books, London. 2024. 274 pp. ISBN: 9781914363078 [paperback]; ISBN: 9781914363276 [PDF]; ISBN: 9781914363283 [e‐book].

Thu, 24 Sep 2026 00:00:00 +0000

Money, Rank and the Frailty of Authority: Schurtz’s World and Ours. An Outline of the Origins of Money By Heinrich Schurtz. Translated and Annotated and With an Introduction by Enrique Martino and Mario Schmidt (eds.), HAU Books, London. 2024. 274 pp. ISBN: 9781914363078 [paperback]; ISBN: 9781914363276 [PDF]; ISBN: 9781914363283 [e‐book].

Impact of Physician Patient Load on Imaging Use in the Emergency Department

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Emergency department (ED) crowding may alter physician decision-making, yet little is known about how real-time physician workload affects diagnostic imaging use. We examined the association between physician patient load and the proportion of patients who received diagnostic imaging, including computed tomography (CT), CT with intravenous (IV) contrast, CT without contrast, plain radiography, magnetic resonance imaging (MRI), and ultrasound (US).

Methods: We conducted a retrospective cohort study of all ED visits at an academic tertiary care center (January 2019–December 2024). Physician workload was defined as the sequential patient assignment order per physician per day (range 1–17). Our primary outcome measures were binary indicators of whether each imaging modality was ordered during the ED visit: CT (any); CT with IV contrast; CT without IV contrast; radiograph, MRI; and US. Multivariable logistic regression with...

Bill Maurer

Thu, 24 Sep 2026 00:00:00 +0000

Professor Bill Maurer is a renowned cultural anthropologist who conducts research on law, property, money and finance, focusing on the technological infrastructures and social relations of exchange and payment. Professor Maurer graduated from Stanford University in 1994 with a PhD in Anthropology. He moved to UC Irvine in 1996 as Assistant Professor, going on to become Chair of UC Irvine’s Department of Anthropology (2005-2011) and Associate Dean for Research and Graduate Studies in the Social Sciences (2011-2013). In July 2013 he assumed his current role as Dean of UC Irvine’s School of Social Sciences. Professor Maurer has published on topics ranging from offshore financial services to mobile phone-enabled money transfers, Islamic finance, alternative currencies, and the future of money. He is founding director of the Institute for Money, Technology and Financial Inclusion, funded by the Bill and Melinda Gates Foundation, and was the founding co-director of the Intel Science...

Channels and Codes, Rails and Freight: Can You Hear Me Now?

Thu, 24 Sep 2026 00:00:00 +0000

Channels and Codes, Rails and Freight: Can You Hear Me Now?

Impact of Increasing Ambient Temperatures on Emergency Department Trauma Presentations at a Level I Trauma Center

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Global temperatures are increasing because of climate change, affecting human health. Elevated ambient temperature has been shown to increase rates of trauma presentations in emergency departments and to increase antisocial behavior, such as violent crime. To better understand how to reduce the burden on trauma hospitals, we must better understand the relationship between ambient temperature, trauma patients, and intentional injury. We sought to examine the relationship between trauma rates and minimum and maximum daily temperatures and assess whether the assault trauma mechanism had the strongest association between weather and trauma rates.

Methods: We conducted a retrospective cohort study of full and partial trauma team activations that presented to a Level I trauma center in New York from 2012 to 2019, inclusive. Daily maximum and minimum temperatures were divided into quintile ranges. Traumas were classified by injury...

Point-of-Care Ultrasound After Medical Screening Exam Reduces Time to Ruptured Ectopic Pregnancy Diagnosis and Surgery

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Ectopic pregnancy remains the leading cause of first-trimester maternal mortality. Delays in diagnosis and operative management increase morbidity and may be exacerbated by emergency department (ED) crowding. We evaluated whether integration of point-of-care ultrasound (POCUS) into the medical screening exam of pregnant patients—the obstetric medical screening exam—was associated with improved timeliness of care for patients with surgically managed ectopic pregnancy.

Methods: We conducted a single-center retrospective cohort study of adult patients undergoing operative management for ruptured ectopic pregnancy between January 1, 2019, and December 31, 2023, at a county safety-net hospital. The obstetric screening exam was implemented July 12, 2021, and incorporated focused transabdominal pelvic and right upper quadrant ultrasound into the initial ED evaluation, often prior to bed assignment. The primary outcome was time...

A promise is a promise: A love letter from the ACH to the world of 2050†

Thu, 24 Sep 2026 00:00:00 +0000

ABSTRACT Experiments in money often recapitulate long‐standing human concerns over finality and fixity, despite money's reference points in political authority, trust, and the memorialization of relationships of credit and debt. From the point of view of the primary set of infrastructures facilitating the movement of money in 2050, those concerns are misplaced. Recounting the history of those infrastructures, this love letter from a future intelligence is addressed to those humans who would reimagine money so that they will recognize the human and technical infrastructures on which it has always depended.

Crypto, charisma, and Trump's chaos economy

Thu, 24 Sep 2026 00:00:00 +0000

Crypto, charisma, and Trump's chaos economy

Interview with Bill Maurer

Thu, 24 Sep 2026 00:00:00 +0000

Interview with Bill Maurer

Low-Energy Chest Trauma in Older Adults: Prospective Study of Indications for Chest Computed Tomography

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Older adults frequently present to the emergency department (ED) with low-energy blunt chest trauma, and clinically important intrathoracic injuries may be under-detected during the initial evaluation. We aimed to evaluate whether bedside findings—particularly focal chest tenderness patterns (including anterior chest wall tenderness [ACWT] and lateral compression tenderness)—were associated with computed tomography (CT)-confirmed intrathoracic injury in older adults with low-energy blunt chest trauma, while also examining chest pain and early warning scores (EWS) as adjunct clinical variables.

Methods: A single-center prospective study included 136 patients 65 years or older presenting within 24 hours of low-energy blunt trauma that did not meet prespecified high-energy criteria. The primary outcome was any intrathoracic pathology on chest CT during the index ED visit. Secondary analyses examined associations between...

Money: Anthropological Aspects

Thu, 24 Sep 2026 00:00:00 +0000

From its traditional concern with ‘primitive’ moneys and definitional quandaries over the nature of money in small-scale and nonmarket societies, anthropology more recently has considered money’s meanings in multiple, overlapping spatial, cultural, and temporal milieu, as well as the pragmatics of money – what it does and how it signifies, rather than what it is or what it signifies. Early twenty-first century business interests in divesting the state of its monopoly over the legitimate means of exchange open new frontiers for the anthropology of money and value.

Higher Intensity Quality Improvement Campaign Yields Greater Reduction in Medical Glove Use: The “Gloves Off!” Campaign

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: The healthcare sector contributes 5.4–7.0% of Australia’s total carbon dioxide (CO₂) emissions. Among the most ubiquitous items used in healthcare organisations, whether it be hospital, clinic, or community health centres, are gloves.

Methods: We reviewed two case studies of the “Gloves Off!” sustainability initiative to compare reduction in glove use and improvement in hand hygiene practice—one that featured a “low-intensity” campaign (Hospital A) and the other a “high-intensity” campaign (Hospital B).

Results: A comparison of glove use over the year before and after implementation of the Gloves Off! campaign shows that Hospital A achieved a 2.6% reduction (0.4% reduction per patient), while Hospital B achieved an 11.4% reduction in total glove consumption (7.8% reduction in glove use per patient).

Conclusion: Sustainability initiatives can be initiated within...

Signatures

Thu, 24 Sep 2026 00:00:00 +0000

Signatures

Blow that Mausoleum Down

Thu, 24 Sep 2026 00:00:00 +0000

Abstract Drawing on anthropological perspectives, this paper argues that the fungibility of objects and the ability to exchange them for money is a defining characteristic of capitalist markets. In contrast, other systems of reckoning value emphasize the unique relationships within which objects are embedded and their inability to stand for just any other thing. This paper further highlights the role of slavery in the origins and continued dominance of capitalism and the existence of alternative systems such as cooperativism and sharing that are often overlooked. This paper then examines the Saussurean and Peircean semiotics underlying the concept of money as an abstract sign and argues that non-fungible tokens (NFTs) in blockchain technology contradict these theories by emphasizing pure uniqueness and rendering objects non-transformable or inconvertible. This paper concludes by warning against the dangers of a future where fungibility is absent, as it is necessary for life and...

Memory Poisoning and Semantic Deception: Adversarial Attacks against Referring Multi-Object Tracking

Thu, 24 Sep 2026 00:00:00 +0000

Language–vision understanding has driven the development of advanced perception systems, most notably the emerging paradigm of Referring Multi-Object Tracking (RMOT). By leveraging natural-language queries, RMOT systems can selectively track objects that satisfy a given semantic description, guided through Transformer-based spatial–temporal reasoning modules. End-to-End (E2E) RMOT models further unify feature extraction, temporal memory, and spatial reasoning within a Transformer backbone, enabling long-range spatial–temporal modeling over fused textual–visual representations. Despite these advances, the reliability and robustness of RMOT remain underexplored. In this paper, we examine the security implications of RMOT systems from a design-logic perspective, identifying adversarial vulnerabilities that compromise both the linguistic-visual referring and trackobject matching components. Additionally, we uncover a novel vulnerability in advanced RMOT models employing FIFO-based...

Adapting Research Protocols During War: The ANCHOR (Analysis of Network Composition, Health Outcomes, and Resilience) Study

Thu, 24 Sep 2026 00:00:00 +0000

BackgroundConducting longitudinal infectious disease research during armed conflicts is important for understanding transmission dynamics and preventing outbreaks. War in Ukraine started in 2014, with the escalation to full-scale invasion in 2022, resulting in massive population displacement, infrastructure destruction, mobility restriction for men, and reduced access to healthcare. The ANCHOR (Analysis of Network Composition, Health Outcomes, and Resilience) study, launched in November 2024, examines how war- and displacement-driven changes affect social networks, HIV risks, and HIV care engagement. Here, we report implementation challenges and adaptations as practical lessons that may inform infectious disease surveillance and research in conflict settings.MethodsANCHOR is a cohort study conducted in Kyiv and Lviv in 2024–2026 that enrolled sexual minority men (SMM) using respondent-driven sampling, with 6- and 12-month follow up of participants testing positive for HIV. Data...

Leveraging Virtual Reality to Assess Walking Gait Performance in Altered Depth Perception Walking Tasks

Thu, 24 Sep 2026 00:00:00 +0000

Vision contributes to the control of walking, balance regulation, orientation, and anticipatory control, which are important for spatial navigation. How the amount of visual information available, as distinct from its accuracy, shapes balance control during walking remains poorly understood. This study used virtual reality to determine how graded visual occlusion, imposed alongside visual and physical gait speed perturbations, affects gait and balance control during treadmill walking. Eight healthy adults (Age 20.6 ± 2.8 years) completed nine 5-minute walking trials on a split-belt treadmill in a custom virtual environment using a 3×3 design consisting of three walking conditions crossed with three levels of visual occlusion. During baseline walking, participants walked at 1.0 m/s with the optical flow matched to the treadmill speed. During optical flow trials, participants continued to walk at 1.0 m/s while we sinusoidally varied the relative translation speed of the visual environment...

Why retracted articles can have an influential afterlife—and what to do about it

Thu, 24 Sep 2026 00:00:00 +0000

Retractions of published journal articles are an increasingly common means by which the research community ensures the quality and integrity of publications and addresses research misconduct missed during pre-publication peer review. Retractions are intended to notify the public of issues that undermine the integrity of these publications so that readers will not rely on their findings and conclusions. Continued citation and other uses of these publications without acknowledging their retracted status are therefore problematic and suggest shortcomings in retraction processes. In this commentary, we use the examples of retracted articles published in this journal to outline ways in which retracted articles can maintain an influential afterlife in the academic literature, online materials from non-profit organizations and private businesses, and responses from generative artificial intelligence. Given that this ongoing influence compounds the harms of these publications, we recommend...

Money, Ritual, and Religion: Reason, Race, and the Re-Enchantment of the World

Thu, 24 Sep 2026 00:00:00 +0000

Money, Ritual, and Religion: Reason, Race, and the Re-Enchantment of the World

Molecular Reporters for Mammalian Sugars via Hydrogen Bonding Auxiliaries

Thu, 24 Sep 2026 00:00:00 +0000

Glycans are essential transmitters of biological information. However, their complex and dynamic structures remain difficult to characterize, posing a major barrier to fully understanding their biological functions. Here, we demonstrate that hydrogen bonding auxiliaries positioned adjacent to the boron site of turn-on fluorogenic phenylboronic acid reporters serve as key modulators of sensitivity to mammalian sugars, providing a new design principle analogous to the hydrogen bonding networks found in lectin binding pockets. We show that these auxiliaries tune sensitivity both globally and for individual mammalian sugars and reveal a striking differential turn-on response between the anomeric forms of monosaccharides. The versatility of these selective and reversible molecular reporters is demonstrated through in-gel glycoprotein imaging, flow cytometry, and cell-surface visualization, establishing them as a generalizable chemical platform for interrogating mammalian glycans.

Retrospective Comparison of the Pericapsular Nerve Group Block Versus the Fascia Iliaca Block for Hip Fractures in the Emergency Department

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Hip fractures are a common injury among the elderly and a substantial cause of morbidity and mortality worldwide. Pain management is an essential component of care for patients with hip fractures, particularly for improving patient outcomes. Ultrasound-guided nerve blocks such as the fascia iliaca block (FIB) are evidence-based means of providing perioperative analgesia and reducing opioid use. Newer nerve blocks, such as the pericapsular nerve group (PENG) block, may serve as alternatives to the FIB. The objective of this study was to retrospectively compare pain reduction following the PENG block and FIB in patients with hip fractures treated in our emergency department. Secondary objectives included block-related complications such as local anesthetic systemic toxicity (LAST), greater hospital length of stay, and increase in mortality.

Methods: The primary outcome measure was to investigate whether the PENG block...

Respiratory Viral Positivity Is Associated with Decreased Risk of Serious Bacterial Infections in Febrile Infants

Thu, 24 Sep 2026 00:00:00 +0000

Introduction: Febrile infants ≤ 60 days of age are at increased risk for serious bacterial infections (SBIs), often necessitating extensive diagnostic evaluation and hospitalization. Although respiratory viral infections are common in this population and may influence the likelihood of concurrent bacterial infection, the relationship between respiratory viral panel (RVP) results and SBI risk remains an important consideration in clinical decision-making. The objective of this study was to evaluate the association between RVP results and the occurrence of SBIs among febrile infants ≤ 60 days of age.

Methods: In this single-center, retrospective study we analyzed data from infants ≤ 60 days of age who presented to the emergency department with fever (temperature > 100.4 °F/38 °C) between September 2020–May 2024. Infants were divided into two subgroups based on RVP results: positive or negative for any viral infections via a multiplex...

Viscoelastic Hydrogels from Physically Entangled Polyethylene Glycol: Synthesis and Rheological Characterization

Thu, 24 Sep 2026 00:00:00 +0000

Age-related macular degeneration (AMD) is a leading cause of severe vision loss in the elderly and one of the major contributors to this disease is the structural and functional breakdown of the Bruch’s membrane, and because of this, retinal pigment epithelial (RPE) cells degenerate shortly after. The Bruch’s membrane is viscoelastic in nature and RPE cells are sensitive to those mechanical cues, therefore scaffolds that replicate this behavior may better support RPE health than purely elastic counterparts. Polyethylene glycol (PEG) offers an adjustable, biologically inert platform for this need, however most methods for implementing viscoelasticity into PEG hydrogels rely on complex reactions. This thesis presents a viscoelastic PEG hydrogel made by combining PEG-propionaldehyde and PEG-amine (5 kDa each), which then crosslinks through dynamic imine bonds while also going through physical chain entanglement during gelation. Elastic PEG diacrylate (PEGDA) hydrogels served as controls....