bluuebunny/crossref_metadata_2025 huggingface dataset:
Preferences for Juries Over Judges Across Racial and Ethnic Groups*
Authors: Rose Mary R. , Ellison Christopher , Diamond Shari Seidman
Published: May 2008

Objective. The objective of this article is to explore whether a preference for juries rather than judges to decide legal cases varies across racial and ethnic groups. We hypothesized that minorities (African Americans, Hispanics), who generally express less trust in the legal system, may also express less trust in juries than non‐Hispanic whites.

Method. A representative sample of 1,465 residents of Texas were surveyed and asked whether they would prefer a jury or a judge to be the decisionmaker in four hypothetical circumstances. Analyses control for a number of possible factors that might also predict views of the jury besides race and ethnicity.

Results. Consistent with expectations, non‐Hispanic whites favored juries over judges, particularly if they imagined themselves as a defendant in a criminal trial. By comparison, African Americans and some Hispanics showed a weaker preference for a jury over a judge. African Americans had markedly lower support for the civil jury, but jury support was higher among minorities with prior jury service. Among Hispanics, respondents who took the survey in Spanish typically preferred a judge to make legal decisions.

Conclusions. Faith in the jury as a more trustworthy decision‐making body is weakest among those groups that have a history of discriminatory treatment in the legal system and who are less acculturated on other measures, such as language dominance.
Personal Attributes and Latino Voting Behavior in Congress*
Authors: Rocca Michael S. , Sanchez Gabriel R. , Uscinski Joseph
Published: May 2008

Objective. Researchers have long examined the nature of representation, paying particular attention to the dynamics of descriptive and substantive representation in racial and ethnic communities. The objective of this article is to determine the extent to which personal attributes influence the voting behavior of Latino members of Congress.

Methods. We test the relationship between legislator's personal attributes and Poole and Rosenthal's DW‐NOMINATE scores for Latino members of the 101st–108th Congresses.

Results. After controlling for institutional and electoral factors, results show that education, gender, nativity, and generation have significant effects on Latino legislators' voting behavior. Religion and national origin appear not to have an effect.

Conclusions. This analysis shows that personal attributes predict Latino congressional voting even when controlling for district and institutional factors. As such, this study demonstrates that Latino legislators have in‐group differences and therefore should not be considered a monolithic group.
Anglo and Latino Differences in Willingness to Pay for Urban Public Services*
Authors: Alozie Nicholas O. , McNamara Catherine
Published: May 2008

Objective. This research explores Anglo and Latino differences in willingness to pay for urban public services, assuming differences will impact service delivery in local government as the Latino population increases and becomes more visible.

Methods. Survey data from a probability sample of Phoenix residents, now the nation's fifth largest city, are analyzed across 28 city services using multiple mechanisms that included a logit multivariate model.

Results. Latinos are substantially more likely than Anglos to report willingness to pay for urban public services. These differences cut across services and are not mitigated by Latino income levels.

Conclusions. Latinos are prepared to be full partners in improving service delivery in local government, even at the expense of out‐of‐pocket payment for services. Moreover, while increases in the Latino population will carry greater demand for more and high‐quality city services by Latinos, it is unlikely to alter the menu of preferred services along class or race/ethnic lines. The fact that Latinos seem generally more willing to pay for services also raises the possibility that Latinos are interested in investing in their communities, seeking more opportunities, and perhaps remaining in those communities.
Stagnation of Heights Among Second‐Generation U.S.‐Born Army Personnel*
Authors: Komlos John
Published: May 2008

Objectives.The physical stature of a population is a useful supplementary indicator of the living standards of children and youth insofar as it is sensitive to income and medical care. It is, thus, somewhat of a conundrum that U.S. heights tended to stagnate between around the mid‐1950s to the mid‐1970s birth cohorts, an otherwise economically prosperous period. Because of the controversial nature of the finding based on the NHANES data sets we seek independent corroborating evidence.

Methods.The height of U.S.‐born army personnel is analyzed in order to explore ethnic and second‐generation effects on height, in particular if these affect the trend among the birth cohorts of the 1950s and 1960s. We limit the regression analysis to U.S.‐born (non‐Hispanic) blacks and whites, controlling for ethnicity (own, mother's, and father's), foreign‐born parents, and region of their birth within the United States stratified by race and gender.

Results.We find that none of the above variables affect the trend meaningfully: the height of U.S. military personnel tended to stagnate during the period considered. Only black males showed some improvement in height. Hence, the army data support the trends obtained from the civilian population, which cannot be controlled for second‐generation effects.

Conclusion.The quality of nutritional intake and of medical care was not improving among children and youth in these decades in spite of the fact that the income of their parents was increasing.
Becoming a Dad: Employment Trajectories of Married, Cohabiting, and Nonresident Fathers*
Authors: Percheski Christine , Wildeman Christopher
Published: May 2008

Objectives. This article considers how becoming a father affects men's employment levels and tests whether the effects of fatherhood differ by the relationship of the father to the child's mother at the time of the birth.

Methods. We use data from the Fragile Families and Child Wellbeing Study to fit growth curve models of new fathers' employment trajectories for the first five years after they become fathers.

Results. Prior to becoming a father, married men worked more hours per week and more weeks per year than cohabiting and nonresident fathers. By five years after the birth, differences in employment between unmarried and married fathers had diminished.

Conclusions. The transition to fatherhood is associated with an increase in employment for unmarried fathers but is not associated with significant changes in employment for married fathers.
Framing Effects on Public Opinion During Prewar and Major Combat Phases of the U.S. Wars with Iraq*
Authors: Borrelli Stephen A. , Lockerbie Brad
Published: May 2008

Objectives.Our purpose was to develop and test several hypotheses concerning the impact of poll‐question wording on aggregate public support for war. We drew on general insights from framing theory and specific insights from various theories of public support for war.

Methods.Our database consisted of two collections of aggregate poll results drawn from the prewar and major combat phases of the Gulf War (1990–1991) and the Second War with Iraq (2002–2003). For each data set, we used multivariate OLS regression to gauge the impact of specific question‐wording variations on the percentage of respondents expressing support for war, controlling for systematic time and pollster effects.

Results.Most of the hypothesized wording effects were significant in the expected direction. Mentioning WMDs, terrorism, Saddam, hostages, and international support for war boosted aggregate war support in one or both wars; mentioning the president, oil or gasoline, international opposition to war, and U.S. or Iraqi casualties depressed support.

Conclusions.Various theories emphasizing different “rational” aspects of public attitudes toward war are supported. However, the significance of mentioning Saddam by name in the Second War with Iraq, and mentioning the president in both wars, would seem to imply framing effects based more on emotion and/or symbolism.
Single‐Mother Families and Air Pollution: A National Study*
Authors: Downey Liam , Hawkins Brian
Published: May 2008

Objective. This study uses tract‐level demographic data and toxicity‐weighted air pollutant concentration estimates for the continental United States to determine whether (1) single‐mother families are overrepresented in environmentally hazardous Census tracts and (2) the percentage of single‐mother families in a Census tract is a significant predictor of tract‐level toxic concentration estimates.

Methods. After calculating tract‐level toxic concentration estimates for the average female‐headed family, male‐headed family, and married‐couple family with and without children, we use fixed‐effects regression models to determine whether the percentage of single‐mother families in a tract is a significant predictor of tract‐level toxic concentration estimates.

Results. Single‐mother families are overrepresented in environmentally hazardous Census tracts, and the percentage of single‐mother families in a tract remains a significant predictor of estimated toxic concentration levels even after controlling for many of the most commonly used variables in the literature.

Conclusion. Environmental inequality researchers need to broaden their focus beyond race and income to include groups such as single‐mother families in their research.
Mapping Perceptions of Animal Experimentation: Trend and Explanatory Factors*
Authors: Crettaz von Roten Fabienne
Published: May 2008

Objective. The goal of this article is to map out attitudes toward animal experimentation in Switzerland, more specifically, to document the current attitudes, analyze the change of attitudes over the last 10 years, and explain these attitudes.

Methods. This study analyzes a series of Swiss surveys that measure public attitudes toward the environment and science (ISSP, 1994, 2000; EB, 2001, 2005).

Results. It is shown that the relative majority of Swiss are against animal research in 2005 and that refusals are increasing since 1994. Attitudes toward animal testing are explained by attitudes toward science, attitudes toward nature, and values.

Conclusions. The study of attitudes toward animal experimentation makes important contributions to sociology and, in particular, to the public understanding of science (PUS) research.
High‐Temperature Electrical Transport Behavior Observed in the La1.96M0.04CuO4 (M: Mg, Ca, Sr) Polycrystalline Ceramics
Authors: Liu Yong , Lin Yuan‐Hua , Zhang Bo‐Ping , Nan Ce‐Wen , Li Jing‐Feng
Published: May 2008

We prepared high‐density La1.96M0.04CuO4 (M: Mg, Ca, Sr) polycrystalline ceramics by a spark plasma sintering method, and investigated the temperature dependence of the electrical conductivity, Seebeck coefficient, and power factor. Our results indicate that the relative density of these sintered ceramic samples can reach nearly 100%, and alkaline earth metal ions doping can increase the activation energy (from 0.021 to 0.128 eV). All ceramic samples show high positive Seebeck coefficient (∼100–510 μV/K). The obtained Sr‐doped La2CuO4 ceramics show better thermoelectric properties, which potentially make them for thermoelectric applications.
Electronic, Magnetic, and Structural Properties of Sr2MnRuO6 and LaSrMnRuO6 Double Perovskites
Authors: Woodward Patrick M. , Goldberger Joshua , Stoltzfus Matthew W. , Eng Hank W. , Ricciardo Rebecca A. , Santhosh Padmam N. , Karen Pavel , Moodenbaugh Arnold R.
Published: May 2008

The perovskites Sr2MnRuO6 and LaSrMnRuO6 have been investigated and their properties compared with those of the broader family of A2MRuO6 double perovskites (A=Sr, La; M=Cr, Mn, Fe, Co, Ni). Neutron powder diffraction shows that both phases lack long‐range Mn/Ru order. Sr2MnRuO6 exhibits a cooperative Jahn–Teller distortion, conductivity that proceeds via variable‐range hopping, and antiferromagnetic (AFM) order (C‐type structure, TN≅200K, 2.05(1) μB per transition metal). LaSrMnRuO6 exhibits nearly undistorted octahedra, conductivity that proceeds via diffusion‐assisted small‐polaron hopping, and ferromagnetic (FM) order (TC≅220K, 1.60(4) μB transition metal). Band structure calculations show that AFM Mn–O–Ru coupling optimizes polarization of the Ru t2g orbitals, while FM coupling favors delocalization of the Ru t2g electrons. The transition from antiferromagnetism to ferromagnetism is linked to a loss of orbital order and stabilized over competing glassy states by delocalization of Ru t2g electrons.
High‐Dielectric‐Constant and Low‐Loss Microwave Dielectric in the (1−x)Nd(Zn1/2Ti1/2)O3–xSrTiO3 System with a Zero Temperature Coefficient of Resonant Frequency
Authors: Huang Cheng‐Liang , Tseng Ching‐Fang , Yang Wen‐Ruei , Yang Tung‐Jung
Published: May 2008

High‐dielectric‐constant and low‐loss ceramics in the (1−x)Nd(Zn1/2Ti1/2)O3–xSrTiO3 system have been prepared by the conventional mixed‐oxide route and their microwave dielectric properties have been investigated. A two‐phase system was confirmed by the X‐ray diffraction patterns, the energy‐dispersive X‐ray spectrometer analysis, and the measured lattice parameters. Addition of SrTiO3, having a much smaller grain size in comparison with that of Nd(Zn1/2Ti1/2)O3, could effectively hold back abnormal grain growth in the Nd(Zn1/2Ti1/2)O3 matrix. Evaporation of Zn at high temperatures caused an increase in the dielectric loss of the system. The temperature coefficient of resonant frequency increases with increasing SrTiO3 content and tunes through zero at x=0.52. Specimens with x=0.52 possessed an excellent combination of microwave dielectric properties: ɛr∼54.2, Q×f∼84 000 GHz, and τf∼0 ppm/°C. It is proposed as a suitable candidate material for today's 3G passive components and small‐sized GPS patch antennas.
Synthesis, Microstructure, and Mechanical Properties of Al3BC3
Authors: Li Fangzhi , Zhou Yanchun , He Lingfeng , Liu Bin , Wang Jingyang
Published: May 2008

In situsynthesis of bulk Al3BC3was achieved via a reactive hot‐pressing method using Al, B4C, and graphite powders at 1800°C for 2 h. The reaction path for synthesizing Al3BC3was investigated. It was found that Al3BC3formed via the reaction of C, B4C, and Al4C3above 1180°C. Dense Al3BC3was prepared with a little B4C and graphite remained. Microstructure observations revealed the plate‐like morphology of Al3BC3grains. Moreover, the mechanical properties of Al3BC3were characterized (Vickers hardness of 11.1 GPa, bending strength of 185 MPa, fracture toughness of 2.3 MPa·m1/2, and Young's modulus of 163 GPa). Young's modulus decreased slowly with increasing temperature, and at 1600°C remained 79% of that at ambient temperature. These results show that Al3BC3is a promising lightweight high temperature structural material.
Structure‐Property Phase Diagram of BaZrxTi1−xO3 System
Authors: Maiti Tanmoy , Guo R. , Bhalla A. S.
Published: May 2008

In the course of searching environmental friendly lead‐free relaxor ferroelectrics a complete phase diagram of barium zirconate titanate, Ba(ZrxTi1−x)O3 system with compositions 0.00≤x≤1.00 has been developed based on their dielectric behavior. It has been shown that BaZrxTi1−xO3 system depending on the composition, successively depicts the properties extending from simple dielectric (pure BaZrO3) to polar cluster dielectric, relaxor ferroelectric, second order like diffuse phase transition, ferroelectric with pinched phase transitions and then to a proper ferroelectric (pure BaTiO3). A comprehensive structure–property correlation of BaZrxTi1−xO3 ceramics has been studied to understand the various ferroelectric phenomena in the whole phase diagram.
Pediatric Resuscitation Mock Code Practice Impacts Selected Skills
Authors: Mackey Jennifer , D’Agostino James , Cherry Richard , Mihai Aurel , Grant William , Miner Bonnie
Published: May 2008

Objectives:  Determine the utility of a computer‐controlled mannequin in training and assessment of resident pediatric resuscitation skills. Determine if mock code practice is beneficial in maintaining mastery of critical pediatric resuscitation skills.

Methods:  A prospective randomized study of 22 interns (12 pediatric, 10 emergency medicine) randomized to: Group 1 (cases who participated in 3 mock codes over a 6 month period) and Group 2 (controls who did not receive mock code practice). Each intern was randomly paired in teams of two who participated at baseline in two code scenarios using the Laerdal Simbaby. The interns alternated airway and circulatory management responsibility. At 6 months all interns returned to the simulator in pairs to participate in another two pediatric code scenarios. All sessions were videotaped and time of computer initiation of scenario events recorded. Videos were examined by a pediatric emergency physician (blinded to Group participation) using a structured recording form. A general linear model was used to assess differences in response times and Fisher's exact tests for categorical data.

Results:  Whether in charge of airway or circulatory management, at post test interns who had completed mock codes required less time to: recognize the need for bag mask ventilation (Diff 5.6 seconds, p < 0.005), initiate BVM (Diff 2.7 seconds, p < 0.006), intubate (Diff 22 seconds, p < 0.03), and recognizing the need for chest compressions (Diff 24 seconds, p < 0.03). There were no differences in times for recognizing the need for fluid resuscitation or for factors such as appropriate mask size, rate of ventilation, intubation success (including number of attempts), compression techniques, or IO placement.

Conclusions:  Computer controlled mannequins provide reproducible measurable experiences. This study demonstrates that mock code practice may impact some, but not all, aspects of pediatric resuscitation skill retention.
Blood Pressure Response to the ImpedanceThreshold Device in Hypotensive Emergency Department Patients
Authors: Luber Samuel , Roppolo Lynn , Idris Ahamed , Sharda Rohit
Published: May 2008

Background:  An impedance threshold device (ITD) has been found to enhance circulation during CPR by increasing cardiac preload. Additionally, in the spontaneously breathing patient, the ITD has been found to create a small degree of inspiratory resistance (‐6 cm H2O at flow rate of 20L/min). Hypothesis: We sought to determine the effects of the ITD on awake patients with hypotension presenting to the emergency department. We hypothesized that the ITD would improve blood pressure when compared to standard therapy. The main outcome measure was the systolic blood pressure (SBP) change during 10 minutes of ITD use.

Methods:  A convenience sample of patients with SBPs <95 mmHg were randomized in double‐blind fashion to active or sham ITDs. Patients were enrolled if they were between the ages of 18 and 70 and their hypotension was felt to be due to non‐traumatic blood loss or dehydration by the treating physician. Patients were excluded if they were experiencing shortness of breath, chest pain, failed the abbreviated mini‐mental status exam, or had predefined cardiac/pulmonary history criteria. After consent and baseline measurements, patients spontaneously breathed through a mouthpiece attached to an active or sham ITD for a 10 minute period during which vital signs and patient status were recorded.

Results:  12 patients were enrolled (5 randomized to the active device, 7 to the sham device). Mean baseline SBPs were similar between groups with the active and sham devices having baseline SBPs of 84.5 mmHg (SD 5.45) and 83.67 mmHg (SD 10.02), respectively. The active ITD produced a statistically significant (p = 0.03) increase in SBP of 13.0 mmHg (SD 4.69) compared to the sham ITD, 2.33 mmHg (SD 0.58).

Conclusions:  In spontaneously breathing hypotensive ED patients, the ITD was well‐tolerated and increased the SBP. If these results are validated with a larger sample, the ITD may be a useful adjunct in the treatment of hypotension due to volume loss in the ED.
Assessment of a Cross‐Disciplinary Domestic Violence Training for Emergency Medicine Residents and Law Students
Authors: Crandall Cameron , Sedillo‐Lopez Antoinette , McLaughlin Steve , Rimple Diane , Campos Gabriel , McCarty Teresita
Published: May 2008

Objectives:  Domestic violence (DV) patients often have complex medical, social and legal issues that challenge assessment, treatment and referral. We designed a brief cross‐disciplinary training for emergency medicine residents and upper level law students to determine the baseline level of resident and law student competence in assessment and management of patients with a history of domestic violence.

Methods:  The study included 23 emergency medicine residents and 28 upper level law students at an urban university. The design included pretest, intervention, and retest with 4 standardized patient assessments. The intervention included for each 2 hours of cross‐disciplinary lectures on DV and one joint case‐based 2 hour learning session with the medical and legal learners. Communication skills (CSs) were assessed using a validated criterion standard. History taking competence (HX) was assessed with a prespecified checklist of critical elements designed to elicit key medico‐legal factors relevant to each case. Data were compared with t tests.

Results:  18 (78%) residents and 26 (93%) law students completed the study. Pre‐intervention, residents scored 63% (8% standard deviation (SD)) on CS and gathered 71% (13%) of critical HX elements. Law students scored 62% (8%) on CS and gathered 66% (8%) of critical HX elements. Residents (64% (6%)) and law students (63% (6%) showed similar post‐intervention CS scores. Both residents (77% (10%), improvement 6%, p = 0.13) and law students (71% (14%), improvement 8%, p = .15) showed modest but non‐significant improvement in critical HX gathering.

Conclusions:  A brief cross‐disciplinary training between medical and legal learners demonstrated low baseline scores in DV assessment for both learning groups with modest, but non‐significant improvements in gathering of critical HX elements following intervention. Longer didactic training or more focused skill building might improve skills.
1 YouTube for Ultrasound Education
Authors: Liao Michael , Young Randall
Published: May 2008

The internet has many free resources that can be leveraged for education. We wish to present the use of two popular and free websites to more effectively disseminate educational cases and videos within a residency program and alumni network. Traditionally, sharing video was limited by cost, equipment, and technical challenges. YouTube and similar video sharing websites are attractive in that they allow free, permanent, and widely compatible hosting of videos. Realizing this potential we began using YouTube to share interesting and important video clips of emergency ultrasound cases, thus reaching a broader audience within our residency than possible during conference or tape review sessions. YouTube, however, doesn't allow extensive text and descriptions. We initially used email to convey the case details, however, to better organize and consolidate our cases, we turned to popular free webpage hosting sites like officelive.com and blogger.com. We chose officelive.com for its simplicity, free domain registration, and online web design interface. By using YouTube's ability to embed video onto any website, we were able to present case and video together on one page. All this for free and with common and easy to use online tools. Please visit emugweb.com to see what we have done. We believe that continued and innovative usage of these free internet tools can make our job as educators easier and at the same time offer a more organized and accessible format to our students.
10 A Rapid, Simple and Inexpensive Method for Construction of Peripheral Vascular Ultrasound Phantoms
Authors: Minnigan Hal
Published: May 2008

Background and Introduction:  Emergency department bedside ultrasound has grown to include ultrasound guidance of vascular access, most recently, peripheral IV access has been described with ultrasound guidance. Simulation of procedures that are crucial to clinical practice is an efficient and reliable way to train and assess competency prior to performance on an actual patient. Ultrasound phantoms that simulate patient anatomy allow the development of hand‐eye coordination, orientation and manipulation of the instruments in a controlled setting. In an effort to obviate the cost of commercial products I have developed a very simple and rapid method for building vascular ultrasound phantoms for teaching ultrasound guided peripheral IV placement.

Materials and Methods:  Using easily obtainable and inexpensive materials, a simple method is described which allows construction of the phantom in less than 1 hour. This method requires no special tools or construction skills. The total cost for 1 phantom is about $30.00. Most of the components can be reused when the phantom needs to be repoured – the cost to repour a phantom is less than 2.

Results:  These phantoms are realistic in terms of visualization of deep upper extremity veins, and include fluid filled vessels which are gravity fed by colored saline. The system is versatile and can be customized to fit the needs of the individual user. Attendees will be provided with a CD comprising a complete materials list with sources of supply, a PowerPoint presentation to guide construction with each step detailed using digital photographs, and videos of use of the phantom.
11 Dawn Patrol Patient Follow‐up Protocol
Authors: Williams Justin
Published: May 2008

Follow‐up of patients after their emergency department course provides a rich educational experience for residents, but due to time and logistical constraints, is infrequently performed in a scheduled and rigorous manner. The Dawn Patrol initiative was added to our residency curriculum to facilitate and protocolize patient follow‐up for education and feedback on patient care. It also strives to improve communication with inpatient services, and provides a means of collection for morbidity / mortality and risk management cases. Our process functions by charging the clinical senior resident who is going off‐shift, with reviewing the admission record for the past 24 hours. Interesting, clinically important, or cryptic case presentations are selected via our electronic medical record for review at the end of Morning Report. Generally, 1‐3 new cases are selected for review each weekday morning. These cases are then recorded on a dry erase board in the Morning Report room, and the cases are followed until inpatient discharge, or are no longer of clinical interest. Visits to the inpatient wards are encouraged. Patient callbacks of outpatients are also eligible for inclusion. The cases are updated daily, and generally 5‐10 cases are reviewed per day in approximately 10 minutes. The staff member attending Morning Report is responsible for providing bulleted teaching points on each case. The Dawn Patrol patient follow‐up initiative seeks to improve emergency medicine resident education by facilitating and protocolizing patient follow‐up, and provides real‐time feedback on patient care performed in the emergency department.
12 Highly Interactive Teaching: A “HIT” with Residents
Authors: Regan Linda
Published: May 2008

Covering the core content of emergency medicine during residency training is both a time consuming and challenging endeavor. One of the more significant challenges in graduate medical education is to develop more interactive, less didactic teaching modalities. In an attempt to develop a more interactive educational curriculum, we interspersed weekly sessions titled “Highly Interactive Teaching” (HIT) with standard formal lecture didactics. A primary focus of many educators in emergency medicine is teaching residents how to manage the undifferentiated patient. To this end, we revised our curriculum to include 34 four‐hour symptom/chief complaint‐based sessions. The first hour is an introductory lecture on the general approach to a patient with the specified complaint. Residents then divide into small groups which rotate through specific case‐based sections covering varied diagnoses which might present with the symptom complaint. These faculty‐run small groups use a case‐based approach, either high or low simulation‐based or oral boards‐based format. Each faculty then is required to sum up the salient points of their section. The final hour of the day is an evidenced‐based review of supporting literature. Residents are required to read and critique selected articles for the audience so that the basis for diagnosis and management decisions can be discussed as a large group discussion. We believe this change in format will help residents not only to become more active learners, but also to become more astute clinicians.
13 Knowledge Translation Shift
Authors: Seupaul Rawle
Published: May 2008

Health care providers have demonstrated difficulty in adopting the latest information into their clinical practice patterns. This gap in “Knowledge Translation” (KT) is currently under broad discussion within the medical community and was the focus of SAEM's Consensus Conference in 2007. In an effort to bridge this gap, we implemented a novel “KT shift” for our PGY‐2 residents. PGY‐2 emergency medicine (EM) residents are required to work a nine hour KT shift during their scheduled EM rotation at one of two large urban training emergency departments (EDs). This shift has reduced patient responsibilities to allow for the development of clinical queries that are answered by searching for the best evidence to be applied to patient care. This process is summarized on a “KT Shift Log” that records the PICO question, databases searched, and level of evidence found to answer clinical questions. KT shift log sheets and search strategies are reviewed by EM faculty with expertise in evidence‐based medicine and KT principles. We believe that the implementation of a KT shift will improve residents’ ability to obtain high quality evidence to answer real‐time clinical questions. This may serve as an important measure in closing the knowledge to practice gap.
14 The Use of Medical Simulation to Enhance the Clinical Exposure to International Emergency Medicine
Authors: Bouslough David
Published: May 2008

Study Objectives:  Increasing numbers of immigrants and returned travelers use emergency departments for health care. Many physicians‐in‐training are interested in participating in health electives abroad, yet residency curricula generally address global health inadequately. Advanced medical simulation (SIM) is an educational modality used to artificially re‐create clinical experiences. Authors explored the application of SIM and standardized patient encounters to teach emergency medicine residents select topics in tropical medicine, public health, and decision‐making in varied‐resource settings.

Methods:  International Emergency Medicine (IEM) faculty created four case scenarios interspersed into the established residency simulation curriculum. Moulaged manikins and standardized patients in immersive IEM clinical settings provided history and physical exam cues to learners during the following clinical encounters:

‐ “Tent‐side” mobile clinic, East Africa: “Dizzy” pregnant patient (Hookworm).

‐ Rural health clinic, Southeast Asia: Infant with “altered mental status” (Dengue).

‐ Emergency department, North America: Central American immigrant with “dyspnea” (Chagas).

‐ Emergency department, North America: Returned traveler from East Africa with “fever” (Typhoid).

Post‐scenario debriefings addressed unique elements of IEM including
15 Assessing the Clinical Reasoning Skills of Emergency Medicine Clerkship Students Using a Script Concordance Test
Authors: Humbert Aloysius
Published: May 2008

Fourth‐year medical students in emergency medicine (EM) clerkships are evaluated by various methods. Multiple choice examinations are frequently used to supplement clinical evaluations. These are limited in their ability to evaluate students’ clinical reasoning skills. The Script Concordance Test (SCT) is an innovative assessment method developed to evaluate clinical reasoning. The SCT consists of a series of clinical vignettes, each followed by a series of specific questions that present an additional piece of data (a lab result, a physical finding, etc.) to the student. The students then indicate how the additional data affect their thinking regarding a possible diagnosis, an investigational strategy, or a therapeutic intervention, using a 5 point Likert scale (‐2,‐1,0,+1,+2). SCT questions have no single correct answer; instead, students receive credit based upon the level of agreement between their answers and those of a panel of 10 to 20 expert physicians who take the test to derive the answer key. The SCT is easily administered. In other disciplines, the SCT has demonstrated the ability to differentiate between the clinical reasoning skills of experienced and novice clinicians. The clerkship directors developed an EM SCT using an expert panel of 10 EM attending physicians. For the 07‐08 academic year, SCT questions have been incorporated into the EM clerkship end‐of‐rotation written examination. The EM SCT shows promise as a measure of a student's clinical reasoning ability. Future studies will assess in greater detail the performance and statistical properties of the SCT in the setting of the EM clerkship.
17 Our Patients, Our Residents, Their Case‐Based Evidence: Development of an Intradepartmental Medical Education Journal
Authors: Miller Christopher
Published: May 2008

As clinical educators, we place a premium on teaching at the bedside. This academic medicine hallmark has many competitors in today's challenging emergency department environment. We therefore sought to complement bedside teaching with the creation of a monthly, case‐based, best‐evidence‐practice, intra‐departmental medical education journal. Residents were encouraged to annotate interesting cases during their shifts in a written log found in the emergency department. Monthly, a senior EM resident reviewed the cases and earmarked a select few for detailed review based on their potential educational merit. Comprehensive, evidence‐based teaching summaries were presented in a case‐report format (see attached examples). The completed manuscript was distributed electronically to staff and residents as a monthly medical education journal. Survey methodology performed at the conclusion of the publication's first year assessed its educational impact and estimated resources required for publication. 90% of residents reported reading the journal monthly, and 80% felt it was of high educational value. The mean preparation time was 16 hours per month. To assess reproducible and lasting didactic benefit, the journal was introduced at a second EM academic institution. To date, 19 issues at the primary site and 7 issues at the second have been published. Multi‐institutional validation of its educational impact is ongoing, but interim analysis suggests continued success at both sites.
18 Graduate Medical Education and Knowledge Translation: One Problem‐Specific Approach in Residency
Authors: Carpenter Christopher
Published: May 2008

Traditional graduate medical education approaches to improving clinical performance based upon the latest research have included Journal Club and didactic lectures. Unfortunately, these educational interventions have rarely been demonstrated to change practice behavior or improve patient‐important outcomes. Using a structured approach to identifying a gap between best‐evidence knowledge and clinical practice, an illustrative one‐year residency‐wide translational research project was developed in a four year emergency medicine training program. Step one (assigned to the second year residents): identify and quantitatively justify a Knowledge Translation (KT) deficit within our institution. They identified steroids in adult bacterial meningitis as an unequivocal therapeutic option. Based upon a structured one‐year chart review, they next demonstrated that only 7% of meningitis patients received pre‐antimicrobial steroids. The next step (assigned to the first year residents): identify and quantify the physician “leaks” within the pipeline of information from publication to bedside utilization via an online survey. The third year residents hypothesized plugs for these information leaks, including examples of other specialties or institutions which have successfully navigated this specific clinical scenario. Finally, at an end‐of‐year Journal Club, the fourth year residents formulated a protocol for the appropriate use of steroids in suspected adult meningitis and brought together individuals from within the institution contributing to the best‐practice leak. Knowledge Translation involves multiple stages beyond simple evidence awareness and usually involves continuation beyond the emergency department. The Washington University KT project offers a structured, multidisciplinary example of moving beyond contemplation to implementation of an unequivocal therapy.
19 A Novel Approach to Residency Education in EMS: The MD‐PM Ambulance
Authors: Fiege Angela
Published: May 2008

Challenge:  Indiana University EM residents have actively provided prehospital care as crew members on a hospital‐based air ambulance service. This service functions as a secondary responder for high acuity patients who have already had first tier evaluation and care. First response, ground EMS experiences have been observational only as residents have ridden along with a two‐paramedic team on an urban ambulance service for 24 hours during their residency careers. Resident understanding of first response care and challenges faced by initial EMS providers has been limited to that gleaned during their observational period.

Solution:  Most EM residencies do not provide opportunities for residents to function as first response providers. Therefore, we developed a Physician‐Paramedic team to provide first response care within a busy metropolitan area. This two‐member team operates within a “geozone” that includes a diverse patient population with both medical and trauma complaints. Unlike other residency ground EMS programs, the MD‐PM truck responds primarily to all ambulance requests within their designated geozone and assists outside their designated geozone for multi‐patient casualties in which a physician response would benefit patient care (fires, motor vehicle accidents, multiple gunshot victims). Residents on the MD‐PM truck not only provide care equivalent to that expected of a nationally certified paramedic (IVs, drug administration, splinting, packaging), but also perform advanced skills such as RSI which is outside the scope of a traditional two‐paramedic team. Immersion into the first response ground EMS system will provide valuable insight into the challenges of providing care outside of the hospital.
2 Incorporation of Audience Participation Technology into Resident Curriculum Review
Authors: Sayger Brian , Kulstad Christine
Published: May 2008

We have incorporated audience participation technology (Turning Point) into our weekly curriculum review sessions. This audience response system consists of individual remote response keypads, a USB port‐compatible receiver, and software which integrates into PowerPoint. Board‐style questions are written into PowerPoint slides and presented by the speaker. Rather than selecting one resident to answer a question, all audience members select an answer using their keypad. The receiver registers the answers and immediately displays a graph of the audience's responses. Questions with more incorrect answers are discussed in detail while less time is spent on questions answered correctly by most of the audience. This encourages active participation for each question and eliminates the stress of a single resident giving an incorrect answer in front of a large number of peers. Audience members are engaged throughout the hour rather than concentrating only on questions assigned to them. Residents and students discover that challenging questions are answered incorrectly by a significant number of audience members. In a short time using this system, we’ve seen audience discussion increase dramatically. We plan to expand our use of this technology to other lectures. Speakers will administer end‐of‐lecture quizzes, immediately assessing how effectively their presentation achieved its learning objectives. All residents have an assigned keypad, and their percentage of correct answers is recorded during every session. This allows the program to monitor a resident's progress and to identify areas in which the resident may need more instruction. This system has potential applications for competency assessment.
4 A Multimedia Web‐based Interactive Quiz Module for the Education of Emergency Medical Personnel
Authors: D’Agostino James , Woo J. , Anderton T.
Published: May 2008

A dynamic database‐driven website was introduced in 2002. This site has served successfully as a learning tool with its annual update and addition of interactive case and quiz modules. To extend web‐based learning as an educational tool, we developed a multimedia web‐based module for emergency medicine, with video and audio enhancements to simulate patient encounters in the emergency ward setting. Central to the web‐module development is the creation of a relational database. We use FileMaker Pro with search, storage, retrieval, image, video and audio incorporation functions, and a built‐in interface that allows display of database contents in web templates. Initially the patient's history and presentation are presented with a 30–60 second video followed by key physical findings. The diagnostic studies and management of the patient are then available through sequential interactive quizzes and feedback replies, presented in audio‐, video‐ and image‐oriented formats. The format of the quizzes themselves simulates medical board questions. Initial feedback has been favorable. The majority of emergency medicine personnel feel that this module complements and enhances regular lecture sessions. In addition, it enables preservation of interesting and/or infrequently encountered cases for viewing by all residents in Emergency Medicine.
5 The Contraption: A Low‐Cost Participatory Hemodynamic Simulator
Authors: Ritchie James
Published: May 2008

A hemodynamic simulator assembled from readily‐available, inexpensive components can be used to demonstrate complex, clinically pertinent physiologic concepts in a hands‐on experiential setting. Our simulator is composed of clear plastic tubing, squeeze bulbs, Heimlich valves, simple plastic connectors, balloons, IV tubing, plastic storage containers, a low‐pressure gauge, and a child's water wheel. After a short introduction, student participants reproduce cardiac and systemic vascular function in a coordinated simulation. Normal functional physiology is demonstrated, followed by scripted changes in physiologic conditions. At least four students are simultaneously involved in managing the simulation, including squeezing the bulbs in simulating heart chamber contraction, modifying afterload, preload, and heart rate, and assessing output parameters such as blood pressure, cerebral blood flow, and cardiac output. Using this model, we are able to demonstrate and teach the following concepts: preload, afterload, hypertensive consequences, effects of dysrhythmias, valve disorders, preload criticality with disorders such as tamponade and right ventricular MI, gradual nature of change in physiology, normal compensation despite serious malfunction, relationship of blood pressure with cardiac output, shock state despite normal BP, neurogenic shock, septic shock, hypovolemic shock, cardiogenic shock, cardiac work, maximum blood pressure, vasopressor physiology, diastolic dysfunction coupled with decreased preload or atrial dysfunction, and CHF treatment options. Trainee feedback has been overwhelmingly positive. Trainees at all levels of training, including EMTs and senior EM residents, have grasped complex hemodynamic physiology concepts intuitively after participating with this trainer.
6 The AERIS Course: a Focused Abdominal CT Interpretation Course for Abdominal Emergencies Requiring Immediate Surgery
Authors: Schultz Eric
Published: May 2008

Emergency physicians rely heavily on CT scanning to guide their clinical decisions. A significant number of EDs do not have radiology coverage, especially at night, so the EM physician may be called on to interpret their own CT scans to guide patient management. Many EM physicians look at their CT scans but have never had any formal training. Especially in the setting of acute surgical emergencies such as expanding abdominal aortic aneurysms (AAAs), ruptured spleen or perforated viscus, delay for a radiologist interpretation may result in significant morbidity and mortality. In a collaboration between emergency medicine and radiology, our team created a systematic approach to abdominal CT interpretation designed to help EM physicians perform wet reads on CT scans in the setting of acute surgical emergencies. First, a general survey is done covering all of the important organs such as the aorta, liver, spleen, kidneys, pancreas, stomach and bowel, then a focused scan into the suspected pathology. We put this system onto a Power Point presentation. The two hour presentation covered basic CT anatomic pathology then taught the presentations of common surgical emergencies such as appendicitis, nephrolithiasis and surgical catastrophes such as ruptured AAAs and mesenteric ischemia. The Abdominal Emergencies Requiring Immediate Surgery (AERIS) scan is only intended to be a focused scan for acute surgical pathology, and not to replace the diagnostic scan of a radiologist. This course was given at a single University program, and will be given at residency programs throughout the New York metro area. Eventually we hope that focused CT interpretation will become part of the standardized EM curriculum.
7 Layered Simulation: A Novel Approach to Medical Malpractice Education
Authors: Schlicher Nathaniel
Published: May 2008

Overview:  We present a novel approach to the use of simulation in medical education with a two‐event layered simulation. A patient care simulation with an adverse outcome was followed by a delayed simulated deposition.

Process:  Senior residents in an academic emergency medicine program were solicited as simulation research volunteers. Other than stating that the research involved adverse outcomes, no identifying information was given. Seven volunteers participated in a simulation involving a forced error (nurse confederate gave an incorrect medication dose). Based on the initial simulation, one physician completed a simulated deposition in a teaching conference six weeks later conducted by a licensed attorney with malpractice experience. The audience, consisting of residents, attendings, and students, watched a recording of the patient care, witnessed the deposition, and evaluated the experience using a 13 question survey with five‐point Likert scales.

Outcome:  Participants felt that, overall, the training program was a useful educational tool (average Likert score of 4.63) that would change aspects of their practice (3.31). Participants stated that they would be more careful in their documentation (3.88), review high risk situations with staff (4.00), and monitor more carefully for errors (3.95). Overall, there was a degree of increased fear of the litigation process (3.95), but participants felt they would improve the risk profile of their practices (3.70).

Conclusion:  A novel approach to medical education was successful in changing attitudes and provided an expanded educational experience for participants. Layered simulation can be successfully incorporated into educational programs for numerous issues including medical malpractice.