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The mycobacteriophages InvictusManeo (K5 subcluster) and Netyap (L2 subcluster) were isolated from soils in Cullowhee Creek, Cullowhee, North Carolina. Both exhibit Siphoviridae morphology and infect Mycobacterium smegmatis mc 2 155. The InvictusManeo genome is 61,147 bp and contains 96 predicted protein-coding genes, whereas the Netyap genome is 76,366 bp with 131 predicted protein-coding genes.

BackgroundVaccine hesitancy amongst pregnant women has been found to be a concern during past epidemics.ObjectivesThe aims of this study were to 1) estimate COVID-19 vaccination rates among pregnant women in Wales and their association with age, ethnicity, and area of deprivation, using electronic health records (EHR) linkage, and 2) explore pregnant women’s views on receiving the COVID-19 vaccine during pregnancy using data from a survey recruiting via social media (Facebook, Twitter), through midwives, and posters in hospitals (Born in Wales Cohort).DesignA mixed methods study utilising routinely collected linked data from the Secure Anonymised Information Linkage (SAIL) (Objective 1) and the Born In Wales Birth Cohort participants (Objective 2). SAIL combines data from general practice, hospital admissions, the national community child health dataset, maternal indicators dataset, and COVID-19 vaccination databases.Setting and participantsObjective 1) All women documented as being pregnant on or after 13th April 2021, aged 18 years or older, and eligible for COVID-19 vaccination were identified in routine health care. They were linked to the vaccination data up to and including 31st December 2021. Objective 2) Separately, a cross-section of pregnant women in Wales were invited to complete an online survey via social media advertising. The survey asked what their views were on having the COVID-19 vaccination during pregnancy, and if they had already received, or intended to receive, the COVID-19 vaccination during their pregnancies. They were also asked to give reasons for their decisions.Outcomes1 (a). Rate of vaccination uptake per month during pregnancy among women eligible for vaccination. 1 (b). Survival analysis was utilised to examine and compare the length of time to vaccination uptake in pregnancy, and variation in uptake by; age, ethnicity, and deprivation area was examined using hazard ratios (HR) from Cox regression. 2.Expectant mothers’ views of the COVID-19 vaccination during pregnancy.ResultsPopulation-level data linkage (objective 1)Within the population cohort, 32.7% (n = 8,203) were vaccinated (at least one dose of the vaccine) during pregnancy, 34.1% (n = 8,572) remained unvaccinated throughout follow-up period, and 33.2% (n = 8,336) received the vaccine postpartum. Younger women (Survey responses (objective 2)69% of participants stated that they would be happy to have the vaccine during pregnancy (n = 207). The remainder, 31%, indicated that they would not have the vaccine during pregnancy (n = 94). Reasons for having the vaccine related to protecting self and baby, perceived risk level, and receipt of sufficient evidence and advice. Reasons for vaccine refusal included lack of research about long-term outcomes for the baby, anxiety about vaccines, inconsistent advice/information, and preference to wait until after the pregnancy.ConclusionPotentially only 1 in 3 pregnant women would have the COVID-19 vaccine during pregnancy, even though 2 in 3 reported they would have the vaccination, thus it is critical to develop tailored strategies to increase its acceptance rate and to decrease vaccine hesitancy. A targeted approach to vaccinations may be required for groups such as younger people and those living in higher deprivation level areas.

Background Graduates of emergency medicine residency programs can seek certification from the American Board of Emergency Medicine (ABEM), yet the costs and perceived value by residents is not clear. Objective This report sought to better define the value of board certification by asking physicians taking the ABEM Oral Certification Examination (OCE) to describe its costs (eg, time, money) and perceived benefits. Methods A descriptive, cross-sectional, voluntary, anonymous survey was administered to physicians taking the 2018 spring and fall ABEM OCEs. Response frequencies were used to report response rates. Results There were 2016 physicians who participated in the 2018 OCEs, of whom 1565 (78%) completed a survey. With respect to preparation, 38% (599 of 1565 responses) spent more than 30 hours preparing for the examination. Regarding the expense of preparing for the examination, 21% (328) spent nothing, 50% (776) spent less than $1,000, and 2% (38) spent more than $3,000. Most physicians (80%, 1254) reported a learning benefit to preparing for and taking the OCE. There were 49% (765) of respondents who reported that preparing for the examination reinforced their knowledge of emergency medicine; 20% (311) reported no learning benefit. Most physicians (92%, 1442) reported that ABEM certification provided a career benefit, the most common of which was more career opportunities (69%, 1076). Conclusions Initial certification requires a considerable investment of time and money. Physicians seeking initial ABEM certification found both learning and professional benefits, with the most frequently reported being reinforcement of medical knowledge and more career opportunities.

Supplemental Digital Content is available in the text., Purpose To investigate whether clinical competency committees (CCCs) were consistent in applying milestone ratings for first-year residents over time or whether ratings increased or decreased. Method Beginning in December 2013, the Accreditation Council for Graduate Medical Education (ACGME) initiated a phased-in requirement for reporting milestones; emergency medicine (EM), diagnostic radiology (DR), and urology (UR) were among the earliest reporting specialties. The authors analyzed CCC milestone ratings of first-year residents from 2013 to 2016 from all ACGME-accredited EM, DR, and UR programs for which they had data. The number of first-year residents in these programs ranged from 2,838 to 2,928 over this time period. The program-level average milestone rating for each subcompetency was regressed onto the time of observation using a random coefficient multilevel regression model. Results National average program-level milestone ratings of first-year residents decreased significantly over the observed time period for 32 of the 56 subcompetencies examined. None of the other subcompetencies showed a significant change. National average in-training examination scores for each of the specialties remained essentially unchanged over the time period, suggesting that differences between the cohorts were not likely an explanatory factor. Conclusions The findings indicate that CCCs tend to become more stringent or maintain consistency in their ratings of beginning residents over time. One explanation for these results is that CCCs may become increasingly comfortable in assigning lower ratings when appropriate. This finding is consistent with an increase in confidence with the milestone rating process and the quality of feedback it provides.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, residents and fellows training in those programs, and all fellows for whom ABEM issues subspecialty certifications. We present the 2019 annual report on the status of US emergency medicine training programs.

This survey study examines the frequency, types, and sources of perceived workplace mistreatment and the prevalence of suicidal ideation among emergency medicine residents in the US., Key Points Question What is the prevalence of workplace mistreatment and suicidal thoughts among emergency medicine residents? Findings In this survey study of 7680 emergency medicine residents, 45.1% reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) and 2.5% reported having suicidal thoughts during the most recent academic year. The prevalence of workplace mistreatment and suicidal thoughts was similar by gender and race/ethnicity. Meaning The findings suggest that educational interventions are warranted to reduce workplace mistreatment and ensure emergency medicine residents’ well-being during training., Importance The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician’s career. Objective To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation. Design, Setting, and Participants In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts. Main Outcomes and Measures The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts. Results Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients’ families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]). Conclusions and Relevance In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Health care inequity is corrected more readily when safe, high-quality care is provided by physicians who reflect the gender, race, and ethnicity of patient communities. It is important to train and evaluate racially diverse physicians involved in residency training.This study sought to determine any test-taking differences for black Emergency Medicine (EM) residents and whether any such differences would narrow as residency progressed.This was an observational, cross-sectional study that reviewed performance (scaled scores) on the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) for 2018, 2019, and 2020. The study included EM residents in 3-year programs who took the ITE. A linear regression model was used for the variables of race, which included black physicians and white physicians (reference group), and level of training (EM resident year 1 [EM1] as the reference group).There were 9591 residents included; 539 were black and 9052 were white. Mean scaled scores were higher as a function of training level. Regression showed a scaled score intercept of 73.51. The ITE score increased for all groups as a function of training level (EM2 β = +5.45, p0.0001; EM3 β = +8.09, p0.0001). The regression coefficient for black residents was -5.87 (p0.0001). There was relative improvement by training level compared with improvement in the reference group, but this difference was not materially or statistically significant.In this study of the ABEM ITE, a test-taking performance gap identified early in residency for black physicians persisted into late residency.

INTRODUCTION: Beginning in 1999, residents in emergency medicine have been expected to demonstrate competence in the six Accreditation Council on Graduate Medical Education (ACGME) Core Competencies. Expectations were further refined and clarified through the introduction of the Milestones in 2013. Emerging research and data from milestone reporting has illustrated the need for modification of the original milestones. Against this backdrop, the ACGME convened a committee to review and revise the original milestones. METHODS: The working group was convened in December 2018 and consisted of representatives from the American Board of Emergency Medicine, American Osteopathic Association, Council of Residency Directors in Emergency Medicine, Association of American Medical Colleges, ACGME‐Emergency Medicine Review Committee, three community members, a resident member, and a public member. This group also included members from both academic and community emergency medicine programs. The group was overseen by the ACGME vice president for milestones development and met in person one time followed by four virtual sessions to revise and draft the Emergency Medicine Milestones and Supplemental Guide as part of the ACGME Milestones 2.0 Project. RESULTS: Using data from milestones reporting, needs assessment data, stakeholder interviews, and community commentary, the working group engaged in revisions and updates for the Emergency Medicine Milestones and created a supplemental guide to aid programs in the design of programmatic assessment for the milestones. CONCLUSION: The Emergency Medicine Milestones 2.0 provide updated specialty‐specific, competency‐based behavioral anchors to guide the assessment of residents, the design of curricula, and the advancement of emergency medicine training programs.

The American Board of Emergency Medicine gathers extensive background information on the Accreditation Council of Graduate Medical Education-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2022 annual report on the status of physicians training in Accreditation Council of Graduate Medical Education-accredited emergency medicine training programs in the United States.

Field emission cathodes, comprised of commercially available carbon fiber fabrics directly brazed to metal substrates, were fabricated and tested. Cathodes fabricated in this manner eliminate the need for an epoxy bond between the carbon fibers and the substrates and can be baked, in a vacuum, at high temperatures, limited by the re-melt temperature of the braze. Preliminary testing at mildly relativistic voltages (200 kV–300 kV) yielded average current emission densities of 100’s of A/cm2, which are in line with previously published results on epoxy-bonded carbon fiber field emission cathodes.

Objectives Burnout afflicts emergency physicians (EPs) to a significant degree. The impact of burnout spans from decreased clinical efficiency to increased medical errors to heightened risk of physician suicide. This large‐scale study captures responses from emergency medicine (EM) residents regarding two burnout items and examines the correlation between in‐training examination (ITE) scores and burnout risk as well as that between residency year and burnout risk. Methods This was a prospective, mixed‐methods, cross‐sectional cohort study. All residents in U.S. categorical EM residents who took the 2019 ITE were included. At the end of the ITE, residents were invited to complete a voluntary survey that included two items from the Maslach Burnout Inventory (MBI) that have been found to be strongly indicative of burnout: one about self‐perception of being burned out and one about feelings of callousness. Responses were on a 7‐level Likert scale (1–7), ranging from very low frequency (1) to very high frequency (7). Measurements included the number of residents in each year‐level of training (EM1–EM4), the MBI item ratings, and the ABEM ITE score. Performance, as measured by the scaled, equated score, was compared to the MBI item responses. A corrected Spearman’s correlation coefficient (ρ) was used to compare continuous data (score) against a discrete ordinal variable (MBI Likert response). Results There were 2,501 EM1 residents, 2,389 EM2 residents, 2,206 EM3 residents, and 616 EM4 residents in the study group. There were 7,206 (93.4%) physicians who completed the first MBI question about burnout; 7,172 (93%) completed the second MBI question about callousness. There was no statistically significant association between the burnout item response and ITE performance (ρ = –0.03; p = 0.015). There was a positive, statistically significant association between the callousness item response and higher ITE performance (ρ = 0.07; p < 0.001). There was a statistically significant association between the response to the burnout item and training level (ρ = 0.07; p

The American Board of Emergency Medicine gathers extensive background information on Accreditation Council for Graduate Medical Education (ACGME)–accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2020 annual report on the status of physicians training in ACGME-accredited emergency medicine training programs in the United States.

BACKGROUND: The field of clinical informatics (CI), and specifically the electronic health record, has been identified as a key facilitator to achieve a sustainable evidence‐based health care system for the future. International graduate medical education (GME) programs have been challenged to ensure that their trainees are provided with appropriate skills to deliver effective and efficient health care in an evolving environment. OBJECTIVES: This study explored how international emergency medicine (EM) specialist training standards address competencies and training in relevant areas of CI. METHODS: A list of categories of CI competencies relative to EM was developed following a thematic review of published references documenting CI curriculum and competencies. Publicly available documents outlining core content, curriculum, and competencies from international organizations responsible for specialty GME and/or credentialing in EM for Australasia, Canada, Europe, the United Kingdom, and the United States were identified. These EM training standards were reviewed to identify inclusion of topics related to the relevant categories of CI competencies. RESULTS: A total of 23 EM curriculum documents were included in the review. Curricula content related to critical appraisal/evidence‐based medicine, leadership, quality improvement, and privacy/security were included in all EM curricula. The CI topics related to fundamental computer skills, computerized provider order entry, and patient‐centered informatics were only included in the EM curricula documents for the United States and were absent for the other jurisdictions. CONCLUSION: There is variation in the CI‐related content of the international EM specialty training standards reviewed. Given the increasing importance of CI in the future delivery of health care, organizations responsible for training and credentialing specialist emergency physicians must ensure that their training standards incorporate relevant CI content, thus ensuring that their trainees gain competence in essential aspects of CI.

Background In 2013, milestone ratings became a reporting requirement for emergency medicine (EM) residency programs. Programs rate each resident in the fall and spring on 23 milestone subcompetencies. Objective This study examined the incidence of straight line scoring (SLS) for EM Milestone ratings, defined as a resident being assessed the same score across the milestone subcompetencies. Methods This descriptive analysis measured the frequencies of SLS for all Accreditation Council for Graduate Medical Education (ACGME)–accredited EM programs during the 2015–2016 academic year. Outcomes were the frequency of SLS in the fall and spring milestone assessments, changes in the number of SLS reports, and reporting trends. Chi-square analysis compared nominal variables. Results There were 6257 residents in the fall and 6588 in the spring. Milestone scores were reported for 6173 EM residents in the fall (99% of 6257) and spring (94% of 6588). In the fall, 93% (5753 residents) did not receive SLS ratings and 420 (7%) did, with no significant difference compared with the spring (5776 [94%] versus 397 [6%]). Subgroup analysis showed higher SLS results for residents' first ratings (183 of 2136 versus 237 of 4220, P < .0001) and for their final ratings (200 of 2019 versus 197 of 4354, P < .0001). Twenty percent of programs submitted 10% or more SLS ratings, and a small percentage submitted more than 50% of ratings as SLS. Conclusions Most programs did not submit SLS ratings. Because of the statistical improbability of SLS, any SLS ratings reduce the validity assertions of the milestone assessments.

A tunable electrically small antenna (ESA) designed to be naturally resonant at 100 MHz is evaluated for its range of tuning and feasibility for use in a mobile ionospheric heating (MIH) setup. The overarching goal is to match the ionospheric heating performance of the 180 element array at the high frequency active auroral research program (HAARP), which occupies approximately $1.2 \times 10^{5}~\text{m}^{2}$ of land in Gakona, Alaska. While each HAARP crossed dipole element occupies 440 $\text{m}^{2}$ of land and is tunable in the range of 2.7–10 MHz using automatic matching networks, the presented ESA approach is aimed toward enabling the fabrication of a transportable MIH array platform capable of high continuous wave (cw) power, albeit with a linear dimension five to ten times smaller than that of an equivalent dipole antenna. It is elucidated that the capacitively tuned ESA is continuously tunable to a frequency about 50% lower than that of the ESA’s base frequency, albeit the resonant antenna structure carries a fractional bandwidth of merely 1%–2%.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2017 annual report on the status of US emergency medicine training programs.

Author(s): Hart, Danielle; Franzen, Douglas; Beeson, Michael; Bhat, Rahul; Kulkarni, Miriam; Thibodeau, Lorraine; Weizberg, Moshe; Promes, Susan | Abstract: Introduction: Medical education is moving toward a competency-based framework with a focus on assessment using the Accreditation Council for Graduate Medical Education Milestones. Assessment of individual competencies through milestones can be challenging. While competencies describe characteristics of the person, the entrustable professional activities (EPAs) concept refers to work-related activities. EPAs would not replace the milestones but would be linked to them, integrating these frameworks. Many core specialties have already defined EPAs for resident trainees, but EPAs have not yet been created for emergency medicine (EM). This paper describes the development of milestone-linked EPAs for EM. Methods: Ten EM educators from across North America formed a consensus working group to draft EM EPAs, using a modified Glaser state-of-the-art approach. A reactor panel with EPA experts from the United States, Canada and the Netherlands was created, and an iterative process with multiple revisions was performed based on reactor panel input. Following this, the EPAs were sent to the Council of Residency Directors for EM (CORD-EM) listserv for additional feedback.Results: The product was 11 core EPAs that every trainee from every EM program should be able to perform independently by the time of graduation. Each EPA has associated knowledge, skills, attitudes and behaviors (KSAB), which are either milestones themselves or KSABs linked to individual milestones. We recognize that individual programs may have additional focus areas or work-based activities they want their trainees to achieve by graduation; therefore, programs are also encouraged to create additional program-specific EPAs. Conclusion: This set of 11 core, EM-resident EPAs can be used as an assessment tool by EM residency programs, allowing supervising physicians to document the multiple entrustment decisions they are already making during clinical shifts with trainees. The KSAB list within each EPA could assist supervisors in giving specific, actionable feedback to trainees and allow trainees to use this list as an assessment-for-learning tool. Linking each KSAB to individual EM milestones allows EPAs to directly inform milestone assessment for clinical competency committees. These EPAs serve as another option for workplace-based assessment, and are linked to the milestones to create an integrated framework.

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine–sponsored residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2018 annual report on the status of US emergency medicine training programs.

Background Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examination was released in 2011 and revised along with release of V2 in 2012. Each examination contains 50 multiple-choice questions designed to assess knowledge in the EM M4 clerkship curriculum. Development and initial performance data were described previously. Objective To provide updated V1 performance data, describe development and revision of V2, and to compare performance between academic years and examination forms, and within academic years. Methods Examinations are administered at www.saemtests.org with ongoing performance data provided. After 1 year of use, nine questions on V2 were revised, five because of low discriminatory ability and four because of excessive difficulty. Revision or replacement was done in accordance with the National Board of Medical Examiners (NBME) Item Writing Guidelines. Mean scores were compared for V1 between academic years (i.e., July 2011−June 2012 vs. July 2012−June 2013), V2 compared with V1, and for each examination version for early and late test takers. Results V1 has been administered >10,000 times since its release, and the current form mean is 81.5% (SD 3.7). Average discriminatory value (rpb) is 0.204. V2 has been administered >1500 times, with a mean score of 78.4% (SD 4.4) and average rpb 0.253. V1 and V2 current means differ statistically. Scores from examinees completing V1 or V2 early vs. late in the academic year differ statistically. Conclusions Performance data for V1 remain stable after 2 years. Revisions of poorly performing questions improved question performance on V2. Questions with low rpb or low pdiff will continue to be revised annually. While examination forms differ statistically, the practical utility of the differences is not defined.

In this issue an article, Goal Directed Focused Ultrasound Milestones Revised: A Multi-organizational Consensus, recommends significant change to the PC 12 subcompetency of the Emergency Medicine (EM) Milestones. The membership of this consensus group spans multiple organizations and individuals interested in emergency ultrasound (EUS) as well as resident education. This effort to improve this particular subcompetency is to be lauded. An iterative improvement to the progression of Milestones within PC12 can be justified on the basis of a large body of work produced after the introduction of the EM Milestones. However, there are a number of misperceptions within the article that deserve discussion. As a member of the original Emergency Medicine Milestone Working Group (EMMWG) I can address these suggested changes. This article is protected by copyright. All rights reserved.

The Model of the Clinical Practice of Emergency Medicine (the EM Model) is a three-dimensional representation of the clinical practice of emergency medicine. It is a product of successful collaboration involving the American Board of Emergency Medicine (ABEM), the American College of Emergency Physicians (ACEP), the Society for Academic Emergency Medicine (SAEM), the Emergency Medicine Residents' Association (EMRA), the Council of Emergency Medicine Residency Directors (CORD), the Residency Review Committee for Emergency Medicine (RRC-EM), and the American Academy of Emergency Medicine (AAEM). In 2017, the most recent update and revision of the EM Model will be published. This document will represent the culmination of nearly 40 years of evolution, from a simple listing of presenting patient complaints, clinical symptoms, and disease states into a three-dimensional representation of the clinical practice of emergency medicine. These dimensions include conditions and components, physician tasks, and patient acuity. In addition, over the years, two other documents have been developed, the Knowledge, Skills, and Abilities (KSAs) and the Emergency Medicine Milestones. Both serve as related and complementary educational and assessment tools. This article will review the development of the EM Model from its inception in 1979 to today.

Introduction: End-of-shift evaluation (ESE) forms, also known as daily encounter cards, represent a subset of encounter-based assessment forms. Encounter cards have become prevalent for formative evaluation, with some suggesting a potential for summative evaluation. Our objective was to evaluate the inter-rater agreement of ESE forms using a single scripted encounter at a conference of emergency medicine (EM) educators. Methods: Following institutional review board exemption, we created a scripted video simulating an encounter between an intern and a patient with an ankle injury. That video was shown during a lecture at the Council of EM Residency Director’s Academic Assembly with attendees asked to evaluate the “resident” using one of eight possible ESE forms randomly distributed. Descriptive statistics were used to analyze the results with Fleiss’ kappa to evaluate inter-rater agreement. Results: Most of the 324 respondents were leadership in residency programs (66%), with a range of 29-47 responses per evaluation form. Few individuals (5%) felt they were experts in assessing residents based on EM milestones. Fleiss’ kappa ranged from 0.157 - 0.308 and did not perform much better in two post-hoc subgroup analyses. Conclusion: The kappa ranges found show only slight to fair inter-rater agreement and raise concerns about the use of ESE forms in assessment of EM residents. Despite limitations present in this study, these results and a lack of other studies on inter-rater agreement of encounter cards should prompt further studies of such methods of assessment. Additionally, EM educators should focus research on methods to improve inter-rater agreement of ESE forms or other evaluating other methods of assessment of EM residents. [West J Emerg Med. 2017;18(3)518-524.]

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2016 annual report on the status of US emergency medicine training programs.

Experimental observation of photoionization capable extreme ultraviolet and vacuum ultraviolet emission from nanosecond timescale, developing low temperature plasmas (i.e. streamer discharges) in atmospheric air is presented. Applying short high voltage pulses enabled the observation of the onset of plasma formation exclusively by removing the external excitation before spark development was achieved. Contrary to the common assumption that radiative transitions from the b1∏u (Birge-Hopfield I) and b′1∑+ u (Birge-Hopfield II) singlet states of N2 are the primary contributors to photoionization events, these results indicate that radiative transitions from the c′4 1∑+ u (Carroll-Yoshino) singlet state of N2 are dominant in developing low temperature plasmas in air. In addition to c′4 transitions, photoionization capable transitions from atomic and singly ionized atomic oxygen were also observed. The inclusion of c′4 1∑+ u transitions into a statistical photoionization model coupled with a fluid model enabled streamer growth in the simulation of positive streamers.

Introduction: The field of Clinical Informatics (CI) and specifically the electronic health record, has been identified as a key facilitator to achieve a sustainable evidence-based healthcare system for the future. International graduate medical education programs have been challenged to ensure their trainees are provided with appropriate skills to deliver effective and efficient healthcare in an evolving environment. This study explored how international Emergency Medicine (EM) specialist training standards address training in relevant areas of CI. Methods: A list of categories of CI competencies relative to EM was developed following a thematic review of published references documenting CI curriculum and competencies. Publically available, published documents outlining core content, curriculum and competencies from international organizations responsible for specialty graduate medical education and/or credentialing in EM for the United States, Canada, Australasia, the United Kingdom and Europe. These EM training standards were reviewed to identify inclusion of topics related to the relevant categories of CI competencies. Results: A total of 23 EM curriculum documents were included in the thematic analysis. Curricula content related to critical appraisal/evidence based medicine, leadership, quality improvement and privacy/security were included in all EM curricula. The CI topics related to fundamental computer skills, computerized provider order entry and patient-centered informatics were only included in the EM curricula documents for the United States and were absent for each other organization. Conclusion: There is variation in the CI related content of the international EM specialty training standards which were reviewed. Given the increasing importance of CI in the future delivery of healthcare, organizations responsible for training and credentialing specialist emergency physicians must ensure their training standards incorporate relevant CI content, thus ensuring their trainees gain competence in essential aspects of CI.

A tunable, metamaterial-inspired, electrically small antenna topology is evaluated for a possible future use as the principle radiating element in a mobile Ionospheric Heating (MIH) system. The RF source signal is fed via a 50 Ω coaxial cable into a small semi-loop antenna (SLA). This inductively couples to a capacitively loaded loop (CLL) providing a natural 50 Ω match to the source. The resonant frequency of the antenna can be adjusted by varying the capacitance of the CLL via inserting a large permittivity dielectric. A simplified circuit model is used to show that the resonant frequency can be tuned between 40–100 MHz. Also, the maximum power handling capabilities achievable with this antenna topology at frequencies relevant to ionospheric heating (∼ 10 MHz and below) are estimated.

A 3 microsecond risetime, 300 μs fall time, 25 kV high voltage pulse, chosen to emulate lightning discharges is used to investigate breakdown in close proximity to a high permittivity rutile dielectric (Er ~ 100) cylinder with 1 cm diameter. A needle-plane electrode structure is utilized with 1.05 cm electrode separation. The dielectric location is varied from immediately under the needle, to more than a 1 cm away from the needle axis. Basic system design and simulation are presented, along with simulations of the electric field distribution for various dielectric locations. The dependence of breakdown voltage on dielectric proximity is presented in detail. For instance, a minimum in breakdown voltage is observed when the dielectric cylinder is placed slightly off-center from the needle’s center axis. Using high speed imaging, discharge inception and growth are presented with ~10 ns resolution.

Using a self-matched transmission line pulse generator, high voltage pulses with magnitude 10–25 kV and ∼25 ns pulse width are produced to excite low temperature plasma (LTP) formation. In using a short pulse, plasma formation is initiated, but the external excitation is removed before spark formation is completed, thus enabling a study of the LTP during its developmental phase. Using imaging in the visible spectrum and electrical diagnostics, this has been confirmed.

The mechanism of plasma formation under high power pulse (HPM) excitation in gases (nitrogen and argon) at atmospheric pressures is studied utilizing a fluid model verified against experimental data. A 2-D approximation was introduced to model the cylindrically shaped gas volume and the associated electric fields. Thus, the fluid equations and Poisson equation for space charge effects are updated in x and y directions only (setting the gradient in the z-direction to 0). The goal of this numerical simulation was to accurately predict the plasma formation delay time under different gas types and pressures based on the calculated evolution of the plasma conductivity.

A 4-port S-band waveguide structure was designed and fabricated such that a signal of any amplitude (less than 1 MW) can be switched from a normally closed state,0.5 dB insertion loss (IL), to an open state30 dB IL by initiating plasma in a gas cell situated at the junction of this waveguide and one propagating a megawatt level magnetron pulse. The 90/10 switching time is as low as 20 ns with a delay of ∼30 ns between the onset of the high power microwave pulse and the initial drop of the signal. Two ports of this device are for the high power triggering pulse while the other two ports are for the triggered signal in a Moreno-like coupler configuration. In order to maintain high isolation, these two sets of waveguides are rotated 90° from each other with a TE111 resonator/plasma cell located at the intersection. This manuscript describes the design and optimization of this structure using COMSOL 4.4 at the design frequency of 2.85 GHz, comparison of simulated scattering parameters with measured "cold tests" (testing without plasma), and finally the temporal waveforms of this device being used to successfully switch a low power CW signal from 2 W to5 mW on a sub-microsecond timescale.

In the Original Research article entitled “Correlation of the National Board of Medical Examiners Advanced Clinical Examination in Emergency Medicine and the National Emergency Medicine M4 Exams,” published in the January 2015 issue of the Western Journal of Emergency Medicine (2015;16(1):138–142. DOI: 10.5811/westjem.2014.11.24189), there were the following errors in the published article: On page 138, the 1st line of the results section of the abstract should read: 305 students took the EM-ACE and versions 1 (V1) or 2 (V2) of the EM M4 exams (281 and 24, respectively). On page 138, the 2nd line of the results section of the abstract should read: The mean percent correct for the exams were as follows: EM-ACE 74.9 (SD-9.82), V1 83.0 (SD-6.39), V2 78.5 (SD-7.70). On page 138, the 3rd line of the results section of the abstract should read: Pearson’s correlation coefficient for the V1/EM-ACE was 0.53 (0.43 scaled) and for the V2/EM-ACE was 0.58 (0.41 scaled). On page 138, the 4th line of the results section of the abstract should read: The coefficient of determination for V1/EM-ACE was 0.73 and for V2/EM-ACE 0.71 (0.65 and .49 for scaled scores) [ERRATUM]. The R-squared values were 0.28 and 0.30 (0.18 and 0.13 scaled), respectively. On page 140, the 1st line of the results section should read: Five institutions administered both the NBME EM-ACE and one version of the EM M4 exam to 305 fourth-year students at the end of their EM rotation. V1 of the EM M4 was administered to 281 students, and V2 to 24 students. On page 140, the fifth sentence of the results section should read: The mean NBME scaled score for the entire cohort was 68.3 (SD-9.66). On page 141 in the table, the Pearson’s Correlation coefficient for “NBME (raw) V1 EM M4” should be 0.53 and “NBME (scaled) V1 EM M4” 0.43. On page 141 in the table, the R-squared value for “NBME (raw) V1 EM M4” should be 0.28. The correct Figures for “Figure 1” and Figure 2” on page 140 are shown on the following page: Figure 1 Correlation of NBME EM-ACE and National EM M4 V1 and V2. Figure 2 Correlation of NBME EM-ACE and National EM M4 V1 and V2. We apologize for this error.

The self-produced light emission from pulsed plasma discharges and its impact on plasma development are challenging to characterize through simulation and modeling, chiefly due to the large number of radiating species and limited computer memory. Often, photo-processes, such as photo-ionization or photo-emission of electrons, are implemented through over-simplifying approximations or neglected altogether. Here, a method applicable to plasma simulations is implemented in a Particle-in-Cell /Monte Carlo Collision model, which is capable of discretely tracking photons and their corresponding wavelengths. Combined with the appropriate cross sections or quantum yields, a wavelength dependent model for photo-ionization or photo-emission may be implemented. Additionally, by resolving the wavelengths of each photon, an emission spectrum for a region of interest may be generated. Simulations for a pure nitrogen environment reveal that the calculated emission profile of the second positive system agrees well with the experimental spectrum of a pulsed, nanosecond discharge in the same spectral region.

Self-induced gaseous plasma is evaluated as active opening switch medium for pulsed high power microwave radiation. The self-induced plasma switch is investigated for N2 and Ar environments under pressure conditions ranging from 25 to 700 Torr. A multi-pass TE111 resonator is used to significantly reduce the delay time inherently associated with plasma generation. The plasma forms under the pulsed excitation of a 4 MW magnetron inside the central dielectric tube of the resonator, which isolates the inner atmospheric gas from the outer vacuum environment. The path from the power source to the load is designed such that the pulse passes through the plasma twice with a 35 ns delay between these two passes. In the first pass, initial plasma density is generated, while the second affects the transition to a highly reflective state with as much as 30 dB attenuation. Experimental data revealed that virtually zero delay time may be achieved for N2 at 25 Torr. A two-dimensional fluid model was developed to study the plasma formation times for comparison with experimental data. The delay time predicted from this model agrees well with the experimental values in the lower pressure regime (error