bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between physical activity and smoking behavior among college students
Authors:   Department of Physiology, Bajkul Milani Mahavidyalaya, Kismat Bajkul, Purba Medinipure- 721655, West Bengal, India, Maiti Monoj , Samanta Gour Chandra ,   Department of Physiology, Bajkul Milani Mahavidyalaya, Kismat Bajkul, Purba Medinipure- 721655, West Bengal, India
Published: November 2021

Poor diet, alcohol consumption and cigarette smoking constitute a major public health concern for West Bengal, India. These behaviours are increased among day by day among students which are problematic particularly in their concentration and physical fitness. It is well documented that cigarette smoking has negative impacts on body health, as well as social health, economy, culture, etc. So, the purpose of this study was to examine smoking behaviour and physical activity (PA) in Purba Medinipur, India and to examine cigarette smoking among young students based on education status. 50 young students (35 male, 15 female & aged 18-21 years old) from various colleges who are started cigarette smoking (minimum 2-3 cigarette / day) for 1-2 years continuously were selected. The study period was from July, 2015 to June 2016. Standardized questionnaires were supplied. The tests were used to record anthropometric data, health-related information, smoking behaviour, dietary habits and PA status. Smoking causes both immediate and long-standing effects on exercise and physical activity. Smokers also have less endurance, poorer physical performance, increased rates of injury and complications. As the college students are suffers with addiction of nicotine as well as smoking so their physical activity is reduced significantly.
Structural studies on ligand binding ability of Siglec-2 using molecular modeling techniques
Authors:   Department of Chemistry, Acharya Prafulla Chandra College, Kolkata-700131, West Bengal, India, Patra Madhumita Dandopath
Published: November 2021

Siglecs are attractive therapeutic target of the major homologous subfamily of I-type lectins. The primary role of Siglecs may actually lie in the recognition and phagocytosis of bacterial pathogens that express sialic acids, maintenance of myelin organization, and inhibition of neurite outgrowth, cell-cell interactions between neurons and glial cells etc. Siglec-2, a member of the Siglec family expressed on the surface of maturing B cells and B cell lymphomas and regulates signal transduction. In this work, 3-D structure of human Siglec-2 was predicted using molecular modeling techniques. The structure of the complex in solution of Siglec-2 with ligand, 6′-Sialyl-N-acetyl lactose (6′-SialylLacNAc) was predicted using a novel docking technique. The structural analysis of the complex and calculation of theoretical dissociation constant value will help to ascertain functional roles of such sugar binding protein.
Analisis Physical Fitness Terhadap Kemampuan Lompat Jauh
Authors: Susila Linda
Published: November 2021

Tujuan Penelitian. Untuk mengetahui sejauh mana pengaruh komponen fisik (fhysical fitness) yang meliputi kecepatan, daya ledak tungkai dan keseimbangan terhadap kemampuan lompat jauh.

Metode Penelitian. Penelitian ini bersifat deskriptif dengan teknik regresi memberikan gambaran umum tentang kelincahan, daya ledak tungkai dan keseimbangan dengan kemampuan lompat jauh. Subjek penelitian yang digunakan berjumlah 40 orang. Dengan teknih random sampling, dengan data diolah menggunakan teknik korelasi melalui bantuan program SPSS.

Hasil Penelitian. Dari analisis data yang diperoleh hasilnya:  (1). Ada pengaruh yang signifikan kecepatan Terhadap Kemampuan Lompat Jauh, dengan nilai  r hitung (r0) =  0,687 (P < 0,05) dengan nilai kontribusi 47,2%  (2). Ada pengaruh yang signifikan daya ledak tungkai terhadap Kemampuan Lompat Jauh. dengan nilai  r hitung (r0) =  0,504 (P < 0,05) dengan nilai kontribusi 25,4%   (3). Ada pengaruh yang signifikan keseimbangan Kemampuan Lompat Jauh, dengan nilai  r hitung (r0) =  0,415 (P < 0,05) dengan nilai kontribusi 17,2%  (4). Ada pengaruh yang signifikan secara bersama-sama ditinjau dari kecepatan, daya ledak tungkai, keseimbangan terhadap Kemampuan Lompat Jauh, dengan nilai nilai  r hitung (r0) =  0,725 (P < 0,05) dengan nilai kontribusi 52,6%.

Kesimpulan. Dari hasil pengolahan data, menunjukkan memiliki pengaruh yang signifikan dari  analisis data yaitu kecepatan, daya ledak tungkai dan keseimbangan terhadap kemampuan lompat jauh.
A Comprehensive Survey on Machine Learning
Authors:   Amity School of Engineering and technology, Amity University, Lucknow, India, Singh Astha , Singh Pawan ,   Amity School of Engineering and technology, Amity University, Lucknow, India, Tiwari Anil Kr ,   Amity School of Engineering and technology, Amity University, Lucknow, India
Published: November 2021

The objective of this briefing is to present an overview of the topic, machine learning techniques currently in use or in consideration at statistical agencies worldwide. It is important to know the main reason why real-world scenarios should start exploring the use of machine learning techniques, terminology, approach and about few popular libraries in python, what regression is, by completely throwing light on simple as well as multiple linear and non-linear regression models and their applications, classification techniques, various clustering techniques. The material presented in this paper is the result of a study based on different models and the study of various datasets (analysis and choice of the correct model are important). While Machine Learning involves concepts of automation, it requires human guidance. Machine Learning involves a high level of generalization to get a system that performs well on yet-unseen data instances. Topics like regression, classification, and clustering, the report covers the insight of various techniques and their applications.
The Impact of Gambling on Families in Hong Kong: The Role of Family Functioning
Authors: Chan Elda Mei Lo , Dowling Nicki A. , Jackson Alun C. , Shek Daniel Tan-lei
Published: November 2021

Despite substantial evidence that problem gambling is associated with a wide range of family difficulties, limited effort has been devoted to studying the negative impacts on family members as a result of problem gambling, particularly in Chinese communities. It was hypothesized that significant negative relationships would be found between family member impacts and family functioning; and significant positive relationship would be found between family functioning and health and psychological wellbeing. A total of 103 family members of problem gamblers who sought help from Tung Wah Group of Hospitals Even Centre in Hong Kong were interviewed. Results showed that a majority of family members were partners or ex-partners of the gambler with low or no income. Family functioning was negatively correlated to gambling-related family impacts and psychological distress, and was positively correlated to health and psychological wellbeing. The results provide preliminary support for patterns of family functioning that could protect families from negative impacts of addictions. It is suggested that a culturally-sensitive treatment modality that focuses on enhancing family functioning will facilitate improvement in gambling related family impacts.
Artificial Intelligence enabled virtual sixth sense application for the disabled
Authors:   Information Technology Bharati Vidyapeeth's College of Engg,New Delhi, India, .. Aditya ,   Information Technology Bharati Vidyapeeth's College of Engg,New Delhi, India,   Information Technology Bharati Vidyapeeth's College of Engg,New Delhi, India,   Information Technology Bharati Vidyapeeth's College of Engg,New Delhi, india, .. Aditya , .. Shiv Shankar , Kaur Surinder
Published: November 2021

The sixth sense is a multi-platform app for aiding the people in need that is people who are handicapped in the form of lack of speech (dumb), lack of hearing (deaf), lack of sight (blind), lack of judicial power to differentiate between objects (visual agnosia) and people suffering from autism (characterized by great difficulty in communicating and forming relationships with other people and in using language and abstract concepts). Our current implementation of the product is on two platforms, namely, mobile and a web app. The mobile app even works for object detection cases in offline mode. What we want to achieve using this is to make a better world for the people suffering from disabilities as well as an educational end for people with cognitive disabilities using our app. The current implementation deals with object recognition and text to speech and a speech to text converter. The speech to text converter and text to speech converter utilized the Web Speech API (Application Program Interface) for the website and text to speech and speech to text library for the mobile platform. The object recognition wouldn't fetch enough use out of a website. Hence, it has been implemented on the mobile app utilizing the Firebase ML toolkit and different pre-trained models, which are both available offline as well as online.
Study of Multi-Prime RSA
Authors:   Information Technology Bharati Vidyapeeth's College of Engg, New Delhi, India, .. Surinder ,   Information Technology Bharati Vidyapeeth's College of Engg, New Delhi, India,   Information Technology Bharati Vidyapeeth's College of Engg, New Delhi, India, Mankotia Shivani , Bharadwaj Pooja
Published: November 2021

This paper studies and analyses the encryption and decryption times of a popular variant of the RSA algorithm, the multi-prime RSA. This algorithm uses more than two prime numbers for the encryption process. In this paper, 3, 4, and 5 prime RSA algorithms have been implemented and studied. The rate of increase of encryption and decryption times with respect to the number of primes used is also illustrated and compared graphically.
Kemampuan Mahasiswa Menulis Laporan Hasil Praktikum pada Matakuliah Biologi Air Tawar
Authors: Yani Ahmad , Haerunnisa Haerunnisa , Sahriah Sahriah
Published: November 2021

Penelitian ini merupakan penelitian deskriptif untuk mengetahui kemampuan mahasiswa menulis laporan hasil praktikum mahasiswa S1 Program Studi Pendidikan Biologi STKIP Prima Sengkang pada matakuliah Biologi Air Tawar. Populasi dalam penelitian yaitu mahasiswa pendidikan biologi semester tiga tahun akademik 2016/2017 dan dosen pengampuh. Sampel yang digunakan dalam penelitian ini mahasiswa yang meprogramkan matakuliah Biologi Air Tawar berjumlah 87 mahasiswa, teknik pengambilan sampel dilakukan secara purposive sampling sehingga jumlah sampel digunakan sebanyak 38 mahasiswa. Instrumen yang digunakan berupa pedoman penilaian penyusunan laporan praktikum yang digunakan untuk menilai laporan praktikum mahasiswa dengan menggunakan model CARS Swales. Data dianalisis secara deskriptif. Berdasarkan hasil penelitian kemampuan mahasiswa menulis laporan hasil praktikum masih dianggap cukup dan perlu ditingkatkan lagi terutama dalam hal ketepatan menganalisis data temuan dan relevansi teori dalam menganalisis data ekprimen.
Psychometric Properties of the Academic Self Concept Scale among Indian CBSE School Students
Authors: Iyengar R. Gayatri , Gouri G. Padma , Kumar Mahendra
Published: November 2021

Introduction: Psychometrically sound instruments are required to reliably measure academy self concept for school students. For this study, we validate the academy self concept scale (ASCS) with students 16+ years. The objective of this study is to examine the factor structure, validity, and reliability of the 57-item academic self- concept scale in a Indian School Students.

Methods: The participants of the study are constituted by 581 students studying in CBSE Private School in 2021-2022 education year. All of the participants were subjected to the academic self- concept scale. Confirmatory factor analysis methods were used to examine the structural validity of academic self- concept scale. The reliability of academic self- concept scale was examined with, internal consistency.

Results: Confirmatory factor analysis in the sample confirmed an 8-factor model with indices of fitness that indicated a satisfactory model fit (goodness of fit index = 0.99; Tucker-Lewis index = 0.89; comparative fit index = 0.92; root mean square error of approximation = 0.1173; Standardized root mean square residual=0.0445). Our analyses support a eight-factor model of responses to the ASCS (Academic Ability, Academic Interest, Study, Examination, Academic Interactions, Academic efforts, Curriculum and Academic future) measuring a higher order latent construct. It was seen that the factor loads of the scale varied between 0.5952 and 0.8690. The internal consistency of the scale was 0.918.

Conclusion: The findings obtained in this study indicate that the academic self- concept scale has a eight-factor structure and this form can be used as a valid and reliable measuring means in evaluating academic self- concept in CBSE school students.
Assessment of morphological, biochemical and rheological blood indicators in men after a 24-hour stay in a thermo-climatic chamber -50°C
Authors: Teległów Aneta , Marchewka Jakub , Ptaszek Bartłomiej , Mardyła Mateusz , Mazur-Kurach Paulina , Rychlik Urszula , Wójcik Ewa , Golec Joanna , Dąbrowski Zbigniew , Marchewka Anna
Published: November 2021

Purpose: The aim of the study was to evaluate morphological, biochemical, and rheological blood indicators in men staying in a cryochamber at a temperature of -50°C for 24 hours. In 2018, a scientific-survival project ‘Taming the Frost’ was conducted at the Technoclimatic Research and Working Machines Laboratory of the Cracow University of Technology, under the scientific patronage of the Rector of the Cracow University of Technology, Prof. Jan Kazior, PhD, as well as the Rector of the University of Physical Education in Krakow, the late Prof. Aleksander Tyka, PhD, and the Vice-Rector for Science, Prof. Anna Marchewka, PhD.

Material and methods: The blood for the tests was collected from an ulnar vein in fasting participants by a qualified nurse, in the morning, before entering the cryochamber and after 24 hours, i.e. on leaving the cryochamber. Morphological, biochemical, and rheological blood indicators were evaluated. The study group of the scientific-survival project ‘Taming the Frost’ involved men (n=6) who stayed in a cryochamber at a temperature of -50°C for 24 hours. For each participant, a 5-ml blood sample was placed in a tube (BD Vacutainer) with EDTA K2 anticoagulant for blood morphology and blood rheological evaluations in the Blood Physiology Laboratory of the Central Research and Development Laboratory, University of Physical Education in Krakow. Another 5-ml blood sample was placed in a Vacuette tube with a clotting activator for the remaining biochemical analyses in the Department of Clinical Biochemistry of the Krakow Branch of Maria Skłodowska-Curie National Research Institute of Oncology.

Results: After leaving the cryochamber with a temperature of –50°C, the participants presented statistically significant increases in monocyte count and high-density lipoprotein and creatine kinase values, as well as decreases in IgA, total cholesterol, and triglycerides. In the assessment of blood rheological indicators, statistically significant increases in the elongation index at the shear stress of 0.30, 0.58, 1.13, and 2.19 Pa and decreases in the elongation index at the shear stress of 31.03 and 60.3 Pa were observed. For red cell aggregation indicators, a statistically significant increase in total aggregation time was reported. The other indicators exhibited a significance level of p>0.05.

Conclusions: Staying in a cryochamber at a temperature of -50°C for 24 hours did not exert a negative impact on morphological, biochemical, or rheological blood indicators, which implies the subjects’ adaptation to the arranged conditions.
Accuracy of Landmark-guided Glenohumeral Joint Injections as Assessed by Ultrasound in Anterior Shoulder Dislocations
Authors: Omer Talib , Perez Michael , Berona Kristen , Nok Lam Chun , Sajed Dana , Brandon Caroline , Falkenstein Jeffrey , Kang Tarina , Mailhot Thomas
Published: November 2021

Introduction: To determine the accuracy of landmark-guided shoulder joint injections (LGI) with point-of-care ultrasound for patients with anterior shoulder dislocations.

Methods: Patients with anterior shoulder dislocations who underwent LGI were enrolled at our tertiary-care and trauma center. LGI attempts were recorded by an ultrasound fellowship-trained ED physician who determined if they were placed successfully. Pain and satisfaction scores were recorded.

Results: A total of 34 patients with anterior shoulder dislocation and their treating ED physicians were enrolled. 41.1% of all LGI were determined to be misplaced (n=14). Patients with successful LGI had a greater decrease in mean pain scores post-LGI.

Conclusions: LGI had a substantial failure rate in our study. Using ultrasound-guidance to assist intra-articular injections may increase its accuracy and thus reduce pain and the need for subsequent procedural sedation.
Epidemiology of Patients with Head Injury at a Tertiary Hospital in Rwanda
Authors: Karim Naz , Mumporeze Lise , Nsengimana Vizir , Gray Ashley , Kearney Alexis , Aluisio Adam , Mutabazi Zeta , Baird Janette , Clancy Camille , Lubetkin Derek , Eric Uwitonze Jean , D'Arc Nyinawankusi Jeanne , Nkeshimana Menelas , Claude Byiringiro Jean , Levine Adam
Published: November 2021

Introduction: Traumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation’s acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d’Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking.

Methods: We conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury.

Results: Of the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days.

Conclusion: In this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients. These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.
A Scoping Review of Current Social Emergency Medicine Research
Authors: Shah Ruhee , Della Porta Alessandra , Leung Sherman , Samuels-Kalow Margaret , Schoenfeld Elizabeth , Richardson Lynne , Lin Michelle
Published: November 2021

Introduction: Social emergency medicine (EM) is an emerging field that examines the intersection of emergency care and social factors that influence health outcomes. We conducted a scoping review to explore the breadth and content of existing research pertaining to social EM to identify potential areas where future social EM research efforts should be directed.

Methods: We conducted a comprehensive PubMed search using Medical Subject Heading terms and phrases pertaining to social EM topic areas (e.g., “homelessness,” “housing instability”) based on previously published expert consensus. For searches that yielded fewer than 100 total publications, we used the PubMed “similar publications” tool to expand the search and ensure no relevant publications were missed. Studies were independently abstracted by two investigators and classified as relevant if they were conducted in US or Canadian emergency departments (ED). We classified relevant publications by study design type (observational or interventional research, systematic review, or commentary), publication site, and year. Discrepancies in relevant publications or classification were reviewed by a third investigator.

Results: Our search strategy yielded 1,571 publications, of which 590 (38%) were relevant to social EM; among relevant publications, 58 (10%) were interventional studies, 410 (69%) were observational studies, 26 (4%) were systematic reviews, and 96 (16%) were commentaries. The majority (68%) of studies were published between 2010–2020. Firearm research and lesbian, gay, bisexual, transgender, and queer (LGBTQ) health research in particular grew rapidly over the last five years. The human trafficking topic area had the highest percentage (21%) of interventional studies. A significant portion of publications -- as high as 42% in the firearm violence topic area – included observational data or interventions related to children or the pediatric ED. Areas with more search results often included many publications describing disparities known to predispose ED patients to adverse outcomes (e.g., socioeconomic or racial disparities), or the influence of social determinants on ED utilization.

Conclusion: Social emergency medicine research has been growing over the past 10 years, although areas such as firearm violence and LGBTQ health have had more research activity than other topics. The field would benefit from a consensus-driven research agenda.
The Association of Demographic, Socioeconomic, and Geographic Factors with Potentially Preventable Emergency Department Utilization
Authors: Carlson Lucas , Zachrison Kori , Yun Brian , Ciccolo Gia , White Benjamin , Camargo Jr Carlos , Samuels-Kalow Margaret
Published: November 2021

Introduction: Prevention quality indicators (PQI) are a set of measures used to characterize healthcare utilization for conditions identified as being potentially preventable with high quality ambulatory care. These indicators have recently been adapted for emergency department (ED) patient presentations. In this study the authors sought to identify opportunities to potentially prevent emergency conditions and to strengthen systems of ambulatory care by analyzing patterns of ED utilization for PQI conditions.

Methods: Using multivariable logistic regression, the authors analyzed the relationship of patient demographics and neighborhood-level socioeconomic indicators with ED utilization for PQI conditions based on ED visits at an urban, academic medical center in 2017. We also used multilevel modeling to assess the contribution of these variables to neighborhood-level variation in the likelihood of an ED visit for a PQI condition.

Results: Of the included 98,522 visits, 17.5% were categorized as potentially preventable based on the ED PQI definition. On multivariate analysis, age < 18 years, Black race, and Medicare insurance had the strongest positive associations with PQI visits, with adjusted odds ratios (aOR) of 1.41 (95% confidence interval [CI], 1.29, 1.56), 1.40 (95% CI, 1.22, 1.61), and 1.40 (95% CI, 1.28, 1.54), respectively. All included neighborhood-level socioeconomic variables were significantly associated with PQI visit likelihood on univariable analysis; however; only level of education attainment and private car ownership remained significantly associated in the multivariable model, with aOR of 1.13 (95% CI, 1.10, 1.17) and 0.96 (95% CI, 0.93, 0.99) per quartile increase, respectively. This multilevel model demonstrated significant variation in PQI visit likelihood attributable to neighborhood, with interclass correlation decreasing from 5.92% (95% CI, 5.20, 6.73) in our unadjusted model to 4.12% (95% CI, 3.47, 4.87) in our fully adjusted model and median OR similarly decreasing from 1.54 to 1.43.

Conclusion: Demographic and local socioeconomic factors were significantly associated with ED utilization for PQI conditions. Future public health efforts can bolster efforts to target underlying social drivers of health and support access to primary care for patients who are Black, Latino, pediatric, or Medicare-dependent to potentially prevent emergency conditions (and the need for emergency care). Further research is needed to explore other factors beyond demographics and socioeconomic characteristics driving spatial variation in ED PQI visit likelihood.
Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study
Authors: Le Tinh , Cordial Parker , Sankoe Mackenzie , Purnode Charlotte , Parekh Ankur , Baker Thomas , Hiestand Brian , Peacock W.F. , Neuenschwander James
Published: November 2021

Introduction: Recent studies from urban academic centers have shown the promise of emergency physician-initiated buprenorphine for improving outcomes in opioid use disorder (OUD) patients. We investigated whether emergency physician-initiated buprenorphine in a rural, community setting decreases subsequent healthcare utilization for OUD patients.

Methods: We performed a retrospective chart review of patients presenting to a community hospital emergency department (ED) who received a prescription for buprenorphine from June 15, 2018–June 15, 2019. Demographic and opioid-related International Classification of Diseases, 10th Revision, (ICD-10) codes were documented and used to create a case-matched control cohort of demographically matched patients who presented in a similar time frame with similar ICD-10 codes but did not receive buprenorphine. We recorded 12-month rates of ED visits, all-cause hospitalizations, and opioid overdoses. Differences in event occurrences between groups were assessed with Poisson regression.

Results: Overall 117 patients were included in the study: 59 who received buprenorphine vs 58 controls. The groups were well matched, both roughly 90% White and 60% male, with an average age of 33.4 years for both groups. Controls had a median two ED visits (range 0-33), median 0.5 hospitalizations (range 0-8), and 0 overdoses (range 0-3), vs median one ED visit (range 0-8), median 0 hospitalizations (range 0-4), and median 0 overdoses (range 0-3) in the treatment group. The incidence rate ratio (IRR) for counts of ED visits was 0.61, 95% confidence interval (CI), 0.49, 0.75, favoring medication-assisted treatment (MAT). For hospitalizations, IRR was 0.34, 95% CI, 0.22, 0.52 favoring MAT, and for overdoses was 1.04, 95% CI, 0.53, 2.07.

Conclusion: Initiation of buprenorphine by ED providers was associated with lower 12-month ED visit and all-cause hospitalization rates with comparable overdose rates compared to controls. These findings show the ED’s potential as an initiation point for medication-assisted treatment in OUD patients.
Estimated Cost Effectiveness of Influenza Vaccination for Emergency Medical Services Professionals
Authors: Hubble Michael , Renkiewicz Ginny
Published: November 2021

Introduction: Because of their frequent contact with compromised patients, vaccination against influenza is recommended for all healthcare workers. Recent studies suggest that vaccination decreases influenza transmission to patients and reduces worker illness and absenteeism. However, few emergency medical services (EMS) agencies provide annual vaccination, and the vaccination rate among EMS personnel remains low. Reticence among EMS agencies to provide influenza vaccination to their employees may be due in part to the unknown fiscal consequences of implementing a vaccination program. In this study, we sought to estimate the cost effectiveness of an employer-provided influenza vaccination program for EMS personnel.

Methods: Using data from published reports on influenza vaccination, we developed a cost-effectiveness model of vaccination for a hypothesized EMS system of 100 employees. Model inputs included vaccination costs, vaccination rate, infection rate, costs associated with absenteeism, lost productivity due to working while ill (presenteeism), and medical care for treating illness. To assess the robustness of the model we performed a series of sensitivity analyses on the input variables.

Results: The proportion of employees contracting influenza or influenza-like illness (ILI) was estimated at 19% among vaccinated employees compared to 26% among non-vaccinated employees. The costs of the vaccine, consumables, and employee time for vaccination totaled $44.19 per vaccinated employee, with a total system cost of $4,419. Compared to no vaccination, a mandatory vaccination program would save $20,745 in lost productivity and medical costs, or $16,325 in net savings after accounting for vaccination costs. The savings were 3.7 times the cost of the vaccination program and were derived from avoided absenteeism ($7,988), avoided presenteeism productivity losses ($10,303), and avoided medical costs of treating employees with influenza/ILI ($2,454). Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. The net monetary benefits were positive across all ranges of input assumptions, but cost savings were most sensitive to the vaccination uptake rate, ILI rate, and presenteeism productivity losses.

Conclusion: This cost-effectiveness analysis suggests that an employer-provided influenza vaccination program is a financially favorable strategy for reducing costs associated with influenza/ILI employee absenteeism, presenteeism, and medical care.
Assessment and Diagnosis of Mental Illness in EDs Among Individuals Without a Home: Findings from the National Hospital Ambulatory Care Survey
Authors: Ahmed Hijab , Dennis Jeff
Published: November 2021

Introduction: Homeless individuals lack resources for primary healthcare and as a result use the emergency department (ED) as a social safety net. Our primary objective in this study was to identify the differences between features of visits to United States (US) EDs made by patients without a home and patients who live in a private residence presenting with mental health symptoms or no mental health symptoms at triage.

Methods: Data for this study come from the 2009-2017 National Health and Ambulatory Medical Care Survey, a nationally representative cross-sectional survey of ED visits in the US. We examined differences in waiting time, length of visit, and triage score among homeless patients, and privately housed and nursing home residents. We used logistic regression to determine the odds of receiving a mental health diagnosis. Residence, age, gender, race, urgency, and whether the person was seen in the ED in the previous 72 hours were controlled.

Results: Homeless individuals made up less than 1% of all ED visits during this period. Of these visits, 47.2% resulted in a mental health diagnosis compared to those who live in a private residence. Adjusting for age, race, gender, triage score, and whether the person had been seen in the prior 72 hours, homeless individuals were still six times more likely to receive a mental health diagnosis despite reporting no mental health symptoms compared to individuals who lived in a private residence. Homeless individuals reporting mental health symptoms were two times more likely to receive a mental health diagnosis compared to privately housed and nursing home residents.

Conclusions: Homeless individuals are more likely to receive a mental health diagnosis in the ED whether or not they present with mental health symptoms at triage. This study suggests that homelessness as a status impacts how these individuals receive care in the ED. Community coordination is needed to expand treatment options for individuals experiencing emergent mental health symptoms.
Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening
Authors: Valdez Gonzalez Jaqueline , Hartford Emily , Moore Jennifer , Brown Julie
Published: November 2021

Introduction: Children with food insecurity (FI) experience adverse health outcomes due to inadequate quantity or quality of food. Food insecurity may be high among families seeking emergency care. The Hunger Vital Sign (HVS) is a two-question validated tool used to screen families for FI. Our goal in this study was to assess prevalence of FI among emergency department (ED) patients, patient-level risk factors for FI, and the feasibility of screening.

Methods: This was a cross-sectional analysis of FI in the ED. Parents or guardians of ED patients and adult patients (18 years or older) were approached for screening using the HVS during screening periods spanning weekdays/weekends and days/evenings. All ED patients were eligible, excluding siblings, repeat visits, critically ill patients, minors without a guardian, and families that healthcare staff asked us not to disturb. Families answered the HVS questions verbally or in writing, based on preference. Families with positive screens received information about food resources. We summarized patient and visit characteristics and defined medical complexity using a published algorithm. Multivariable logistic regression was used to assess FI risk factors.

Results: In July-August 2019, 527 patients presented during screening periods: 439 agreed to screening, 18 declined, 19 met exclusions, and 51 were missed. On average the screening tool required five minutes (range 3-10 minutes) to complete. Most families (328; 75%) preferred to answer in writing rather than verbally. Overall, 77 participants (17.5%) screened positive for FI. In regression analyses, FI was associated with self-reported race/ethnicity (combined variable) of African American or Black (odds ratio [OR] 5.21, 95% confidence interval [CI], 2.13-12.77), Hispanic (OR 3.47, 95% CI, 1.48-8.15), or mixed/other (OR 3.81, 95% CI, 1.54-9.39), compared to non-Hispanic white. FI was also associated with public insurance type (OR 5.74, 95% CI, 2.52-13.07, reference: private insurance), and each year of increasing patient age (OR 1.05, 95% CI, 1.01-1.09). There were no associations between FI and medical complexity or preferred language.

Conclusion: Food insecurity was common among our ED patients. Race and ethnicity, insurance status, and increasing patient age were associated with increased odds of FI. Efforts to include universal FI screening for ED patients with immediate connection to resources will enhance overall care quality and address important health needs.
Gender-based Barriers in the Advancement of Women Leaders in Emergency Medicine: A Multi-institutional Qualitative Study
Authors: Graham Emily , Ferrel Meganne , Wells Katie , Egan Daniel , MacVane Casey , Gisondi Michael , Burns Boyd , Madsen Troy , Fix Megan
Published: November 2021

Introduction: Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups.

Methods: An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions.

Results: The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents’ response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career.

Conclusion: Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.
A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting
Authors: Albright Amy , Gross Karen , Hunter Michael , O'Connor Laurel
Published: November 2021

Introduction: Emergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage.

Methods: This study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1–July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients’ COVID-19 testing, and documentation of crew fidelity to PPE guidelines.

Results: The sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21-80.03) and a specificity of 67.7% (CI, 66.91-68.50). The positive predictive value was 4.5% (CI, 4.17-4.80), and the negative predictive value was 99.3% (CI, 99.09-99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters.

Conclusion: This dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.
A Retrospective Cohort Study of Acute Epiglottitis in Adults
Authors: Felton Patrick , Lutfy-Clayton Lucienne , Gonen Smith Liza , Visintainer Paul , Rathlev Niels
Published: November 2021

Introduction: Adult epiglottitis is a disease process distinct from pediatric epiglottitis in microbiology, presentation, and clinical course. While traditionally considered more indolent and benign than in children, adult epiglottitis remains a cause of acute airway compromise with a mortality rate from 1-20%. Our objective was to characterize the disease course and evaluate the rate and type of airway management in this population at a tertiary, academic referral center.

Methods: We conducted a retrospective chart review of all adult patients (age ≥ 18) who were definitively diagnosed with infectious “epiglottitis,” “supraglottitis,” or “epiglottic abscess” by direct or indirect laryngoscopy during a nine-year period. Double data abstraction and a standardized data collection form were used to assess patient demographic characteristics, presenting features, and clinical course. The primary outcome was airway intervention by intubation, cricothyroidotomy, or tracheostomy, and the secondary outcome was mortality related to the disease.

Results: Seventy patients met inclusion criteria. The mean age was 50.2 years (standard deviation ± 16.7), 60% of the patients were male, and 14.3% were diabetic. Fifty percent had symptoms that were present for ≥ 48 hours; 38.6% had voice changes, 13.1% had stridor, 12.9% had fever, 45.7% had odynophagia, and 47.1% had dysphagia noted in the ED. Twelve patients (17.1%) received an acute airway intervention including three who underwent emergent cricothyroidotomy, and one who had a tracheostomy. Two patients died and one suffered anoxic brain injury related to complications following difficult airway management.

Conclusion: In this case series the majority of patients (82.9%) did not require airway intervention, but a third of those requiring intervention (5.7% of total) had a surgical airway performed with two deaths and one anoxic brain injury. Clinicians must remain vigilant to identify signs of impending airway compromise in acute adult epiglottitis and be familiar with difficult and failed airway algorithms to prevent morbidity and mortality in these patients.
Survey-based Evaluation of Resident and Attending Financial Literacy
Authors: Huebinger Ryan , Hussain Rahat , Tupchong Keegan , Walia Shabana , Fairbrother Hilary , Rogg Jonathan
Published: November 2021

Introduction: Physician finances are linked to wellness and burnout. However, few physicians receive financial management education. We sought to determine the financial literacy and educational need of attending and resident physician at an academic emergency medicine (EM) residency.

Methods: We performed a cross-sectional, survey study at an academic EM residency. We devised a 49-question survey with four major domains: demographics (16 questions); Likert-scale questions evaluating value placed on personal finances (3 questions); Likert-scale questions evaluating perceived financial literacy (11 questions); and a financial literacy test based on previously developed and widely used financial literacy questions (19 questions). We administered the survey to EM attendings and residents. We analyzed the data using descriptive statistics and compared attending and resident test question responses.

Results: A total of 44 residents and 24 attendings responded to the survey. Few (9.0% of residents, 12.5% of attendings) reported prior formal financial education. However, most respondents (70.5% of residents and 79.2% of attendings) participated in financial self-learning. On a five-point Likert scale (not at all important: very important), respondents felt that financial independence (4.7 ± 0.8) and their finances (4.7±0.8) were important for their well-being. Additionally, they valued being prepared for retirement (4.7±0.9). Regarding perceived financial literacy (very uncomfortable: very comfortable), respondents had the lowest comfort level with investing in the stock market (2.7±1.5), applying for a mortgage (2.8±1.6), and managing their retirement (3.0±1.4). Residents scored significantly lower than attendings on the financial literacy test (70.8% vs 79.6%, P<0.01), and residents scored lower on questions pertaining to investment (78.8% v 88.9%, P<0.01) and insurance and taxes (47.0% v 70.8%, P<0.01). Overall, respondents scored lower on questions about retirement (58.8%, P<0.01) and insurance and taxes (54.7%, P<0.01).

Conclusion: Emergency physicians’ value of financial literacy exceeded confidence in financial literacy, and residents reported poorer confidence than attendings. We identified deficiencies in emergency physicians’ financial literacy for retirement, insurance, and taxes.
Viral Coinfection is Associated with Improved Outcomes in Emergency Department Patients with SARS-CoV-2
Authors: Goldberg Elizabeth , Hasegawa Kohei , Lawrence Alexis , Kline Jeffrey , Camargo Carlos
Published: November 2021

Introduction: Coinfection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and another virus may influence the clinical trajectory of emergency department (ED) patients. However, little empirical data exists on the clinical outcomes of coinfection with SARS-CoV-2

Methods: In this retrospective cohort analysis, we included adults presenting to the ED with confirmed, symptomatic coronavirus 2019 who also underwent testing for additional viral pathogens within 24 hours. To investigate the association between coinfection status with each of the outcomes, we performed logistic regression.

Results: Of 6,913 ED patients, 5.7% had coinfection. Coinfected individuals were less likely to experience index visit or 30-day hospitalization (odds ratio [OR] 0.57; 95% confidence interval [CI], 0.36-0.90 and OR 0.39; 95% CI, 0.25–0.62, respectively).

Conclusion: Coinfection is relatively uncommon in symptomatic ED patients with SARS-CoV-2 and the clinical short- and long-term outcomes are more favorable in coinfected individuals.
A Positive Depression Screen Is Associated with Emergency Medicine Resident Burnout and Is not Affected by the Implementation of a Wellness Curriculum
Authors: Williamson Kelly , Lank Patrick , Olson Adriana , Cheema Navneet , Lovell Elise
Published: November 2021

Introduction: While burnout is occupation-specific, depression affects individuals comprehensively. Research on interventions for depression in emergency medicine (EM) residents is limited.

Objectives: We sought to obtain longitudinal data on positive depression screens in EM residents, assess their association with burnout, and determine whether implementation of a wellness curriculum affected the rate of positive screens.

Methods: In February 2017, we administered the Maslach Burnout Inventory and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire two-question depression screen at 10 EM residencies. At five intervention sites, a year-long wellness curriculum was then introduced while five control sites agreed not to introduce new wellness initiatives during the study period. Study instruments were re-administered in August 2017 and February 2018.

Results: Of 382 residents, 285 participated in February 2017; 40% screened positive for depression. In August 2017, 247/386 residents participated; 27.9% screened positive for depression. In February 2018, 228/386 residents participated; 36.2% screened positive. A positive depression screen was associated with higher burnout. There were similar rates of positive screens at the intervention and control sites.

Conclusion: Rates of positive depression screens in EM residents ranged between 27.9% and 40%. Residents with a positive screen reported higher levels of burnout. Rates of a positive screen were unaffected by introduction of a wellness curriculum.