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In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.

This study was conducted to studyprescribing pattern of drugs amongst mild to moderate COVID-19 patients in COVID dedicated medical college hospital in northern India. : A retrospective, descriptive study was conducted in a COVID dedicated medical college hospital at Uttar Pradesh India. Demographic data, hospitalization data, and drug utilization pattern of all laboratory confirmed mild to moderate COVID-19 patients of all age groups, either sex, and admitted between 01 July 20 to 30 September 2020 were retrieved and analyzed. Out of 767 COVID-19 patients 66.62% were male and 33.38% were female. Mean age of COVID-19 patients were 51 years. Average numbers of drug prescribed per patients were seven. Number of drug prescribed per patients increased in older COVID-19 patients and COVID-19 patients having co-morbidities. Most common prescribed drug was paracetamol (100%), followed by Vitamin C (99.08%), followed by multivitamins (97.78%), followed by protonpump inhibitors (74.84%), followed by antihistaminices in 51.89% cases followed by hydroxychloroquine and Ivermectin was prescribed in 47.84% cases. Most common antibiotic prescribed was Amoxicillin (40.94%), followed by Azithromycin (34.41%), and followed by Doxycycline (29.20%) cases. Flavipiravir was prescribed in 15.12% cases. Corticosteroids were prescribed in 16.30% cases. Drug used for admitted COVID-19 patients were diverse and were in accordance to existing guidelines.

Twin-twin transfusion syndrome occurs in multiple gestations and involves a chronic flow of blood from one twin to another twin and is a rare entity. We present a case of 32-years-old primigravida with a twin pregnancy who presented with increasing abdominal girth inappropriate with her gestational age at 21 weeks of her pregnancy. Ultrasound findings were suggestive of twin-twin transfusion syndrome. The patient was provided with treatment options but due to polyhydramnios and short cervix, the patient went into spontaneous labour the same day with a poor pregnancy outcome. Twin-twin transfusion syndrome leads to a high rate of perinatal morbidity due to its poorly understood aetiology and difficulty in diagnosing and treatment. Early diagnosis during antenatal ultrasound is important in reducing morbidity and mortality rates.

Objective: Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.Design: We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).Results: Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline implementation.Conclusions: This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.

Background Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. Objective Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. Methods We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. Results Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients’ odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. Conclusion Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.

The work presents optimized uncertainty and disturbance estimator (UDE) based robust controller to achieve the fixed wing micro-aerial vehicle (MAV) longitudinal and lateral stability. In the proposed control methodology, genetic algorithm (GA) is used to find the optimal value of UDE filter parameter (GAUDE) which is filter time constant. GA uses minimization of integral absolute time error (IATE) based fitness function. In this work, the proposed controller is GAUDE-based adaptive sliding mode control (SMC). The Lyapunov theory is used to establish the stability of the presented controller. The performance of proposed SMC-GAUDE controller is analyzed through comparative analysis using numerical simulations. The comparative analysis consists of the proposed controller performance evaluation with existing UDE-based and conventional controllers. The comparative study shows the faster response to attain desired states along with smooth and chattering free control efforts offered by SMC-GAUDE controller. The results present viability of the proposed controller. To show the robustness of the proposed controller, IATE performance index is evaluated. Also, the Monte Carlo simulations are done to highlight the efficacy of the proposed controller in the presence of parametric variations in MAV aerodynamic coefficients and velocity.

Posterior circulation strokes are potentially devastating events that carry a significant risk of morbidity and mortality. Acute basilar artery occlusion stroke is a rare posterior circulation stroke that needs emergent management. We report the case of a 67-year-old woman who developed an acute basilar artery occlusion. We achieved complete recanalization of the occluded basilar artery and its branches with endovascular mechanical thrombectomy. It is possible to achieve excellent results with mechanical thrombectomy in acute basilar artery occlusion if timely diagnosis and reperfusion can be done. We are not aware of any previous publication from Nepal describing this technique in acute basilar artery occlusion.

Objectives The objective was to describe the growth of physicians, nurse practitioners (NPs), and physician assistants (PAs) who practice full time in nursing homes, to assess resident and nursing home characteristics associated with receiving care from full-time providers, and describe variation among nursing homes in use of full-time providers. Design Retrospective cohort study. Setting and Participants A 20% national sample Medicare data on long-term care residents in 2008 to 2018 and the physicians, NPs, and PAs who submitted charges to Medicare for their care. Methods We measured the percentage of provider charges for services rendered in nursing homes, in addition to resident and facility characteristics. Results Full-time nursing home providers increased from 26.0% of all nursing home providers in 2008 to 44.6% in 2017. The largest increase was in NPs: from 1986 in 2008 to 4479 in 2017. Resident age, sex, Medicaid eligibility, and race/ethnicity had minimal association with the odds of having a full-time provider, whereas residents with an NP primary care provider were 23.0 times more likely (95% confidence interval = 21.6, 24.6) to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.6% in 2008 to 62.5% in 2018. There was large variation among facilities in the percentage of residents with full-time providers, from 5.72% of residents with full-time providers in the bottom quintile of facilities to 91.44% in the top quintile. Individual nursing homes accounted for 59% of the variation in whether a resident had a full-time provider. Conclusions and Implications The percentage of nursing home residents with full-time providers continues to grow, with very large variation among nursing homes.

Posterior fossa arteriovenous malformations represent 7–15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.

Imperforate hymen, though a congenital anomaly, usually presents late in puberty as lower abdominal pain, primary amenorrhea, and cyclical pain. Blood collects in vagina and uterus, proximal to imperforate hymen leading to their distention. Its presentation at infancy is a rare entity. We report such a rare case of symptomatic imperforate hymen in infancy, who presented with acute retention of urine, chills and rigor. Abdominal examination revealed an intra-abdominal mass in the lower abdomen and pelvis with the absence of vaginal opening on perineal examination. Contrast-enhanced computed tomography abdomen showed large abdominopelvic cystic lesion posterior to the urinary bladder and anterior to the rectum consistent with a highly distended vagina. She was managed by the incision of the imperforate hymen and drainage of the pus. A high index of suspicion is necessary whenever a female infant presents with abdomino-pelvic mass with symptoms of fever or urinary retention.

The Covid-19 virus pandemic is leading to a large number of deaths. There are forecasts that there will be an exponential increase in the number of such deaths across the globe because of this deadly virus. To arrest the spread of the virus in this situation, the supply of medical materials including PPE and body bags (also known as human remains pouch or cadaver bag) should be designed to stop the spread of the Covid-19 virus. Conventional body bags have shortcomings, which need to be addressed by a refined redesigning and use of appropriate materials to adequately match the requirements in the current Covid-19 situation. Current designs of the body bags do not allow the family member’s sentiments towards the deceased and to cater to the desire of the family members to view the face of the deceased without exposing them to a strong possibility of infection from the cadaver. This is, therefore, a very traumatic experience to the family and in many cases, the cadaver is not handled with respect due to the unavailability of safe design body bags, which also exposes health workers to avoidable risk from the infections. Technopark@iitk has proposed an integrated 5-layer body bag to tackle this situation for Covid-19 deceased such that it is (1) leak-proof, (2) impermeable/water-proof, (3) strong enough for the purpose, (4) ergonomically designed, and (5) has provision to view the face of the dead body for family viewing before cremation/burial. This new design would keep the handling of the deceased body to a minimum during transportation from the hospital/site of death to a mortuary, and then to the home of the deceased/burial ground/crematorium, where it may be disposed-off along with the body in it, in a respectable manner, without putting people involved to the risk of infection.

Giant intracranial aneurysms are defined as aneurysms that measure over 25 mm in the greatest dimension. They are rare vascular lesions that preferentially involve regions with high-velocity blood flow, such as the cavernous and supraclinoid segments of the internal carotid artery, the middle cerebral artery, the vertebrobasilar region, and the basilar apex. The treatment of giant aneurysms is challenging and associated with high rates of morbidity and mortality. Flow-diverter devices have revolutionized their treatment in recent times. We report the successful management of two patients with giant cavernous internal carotid artery aneurysms using flow-diverter devices for the first time in Nepal. Keywords: Endovascular; flow-diverter devices; giant aneurysm

Key Points Question Was the 2017 “Muslim ban” executive order associated with changes in health care utilization by people born in Muslim-majority countries living in Minneapolis-St. Paul, Minnesota? Findings This cohort study of 252 594 patients found that after the executive order was issued, there was an increase in missed primary care appointments and increased emergency department visits among people from Muslim-majority countries living in Minneapolis-St. Paul. Meaning Changes in health care utilization among people from Muslim-majority countries after the Muslim ban may reflect changes in population health influenced by federal immigration policy., This cohort study investigates the association between health care utilization and the so-called Muslim ban executive order for people born in Muslim-majority countries and living in Minneapolis-St. Paul, Minnesota., Importance The health effects of restrictive immigration and refugee policies targeting individuals from Muslim-majority countries are largely unknown. Objective To analyze whether President Trump’s 2017 executive order 13769, “Protecting the Nation from Foreign Terrorist Entry into the United States” (known as the “Muslim ban” executive order) was associated with changes in health care utilization by people born in targeted nations living in the US. Design, Setting, and Participants This retrospective cohort study included adult patients treated at Minneapolis-St. Paul HealthPartners primary care clinics or emergency departments (EDs) between January 1, 2016, and December 31, 2017. Patients were categorized as (1) born in Muslim ban–targeted nations, (2) born in Muslim-majority nations not listed in the executive order, or (3) non–Latinx and born in the US. Data were analyzed from October 1, 2019, to May 12, 2021. Exposures Executive order 13769, “Protecting the Nation from Foreign Terrorist Entry into the United States.” Main Outcomes and Measures Primary outcomes included the number of (1) primary care clinic visits, (2) missed primary care appointments, (3) primary care stress-responsive diagnoses, (4) ED visits, and (5) ED stress-responsive diagnoses. Visit trends were evaluated before and after the Muslim ban issuance using linear regression, and differences between the study groups after the executive order issuance were evaluated using difference-in-difference analyses. Results A total of 252 594 patients were included in the analysis: 5667 in group 1 (3367 women [59.4%]; 5233 Black individuals [92.3%]), 1254 in group 2 (627 women [50%]; 391 White individuals [31.2%]), and 245 673 in group 3 (133 882 women [54.5%]; 203 342 White individuals [82.8%]). Group 1 was predominantly born in Somalia (5231 of 5667 [92.3%]) and insured by Medicare or Medicaid (4428 [78.1%]). Before the Muslim ban, primary care visits and stress-responsive diagnoses were increasing for individuals from Muslim-majority nations (groups 1 and 2). In the year after the ban, there were approximately 101 additional missed primary care appointments among people from Muslim-majority countries not named in the ban (point estimate [SE], 6.73 [2.90]; P = .02) and approximately 232 additional ED visits by individuals from Muslim ban–targeted nations (point estimate [SE], 3.41 [1.53]; P = .03). Conclusions and Relevance Results of this cohort study suggest that after issuance of the Muslim ban executive order, missed primary care appointments and ED visits increased among people from Muslim-majority countries living in Minneapolis-St. Paul.

Objectives Organizations to promote career networking and mentorship among women are recommended as a best practice to support the recruitment and retention of women physicians; however, the impact of such organizations is unknown. Our primary objective is to describe the impact of a national woman-focused organization for academic emergency physicians on retention and advancement. Methods We conducted semistructured interviews of past and present organization leaders, as well as members at varying stages in their careers. Physicians with experience in qualitative methods conducted interviews and coded all transcripts using inductive content analysis techniques. Themes were reviewed and discussed to ensure consensus. Results We performed 17 interviews lasting 20 to 30 minutes each, resulting in 476 total minutes of transcript. Participants represented varying stages of career experience, ranging from 2 to 35 years since residency completion (median = 9.5 years). Median years of participation in the woman-focused organization was 10 years. Over half (53%) of participants were past presidents of the organization. The dominant themes encompassed facilitating academic advancement through scholarly productivity, leadership experiences, awards, and promotions; mentorship and sponsorship; peer support and collaborations; reduced professional isolation; and initiatives to address systemic gender inequities and challenges, including strategies to navigate bias, promote pay equity, and advocate for family-friendly workplace policies. Discussion Active participation in a woman-focused professional organization enhances members' career retention and advancement by creating opportunities and relationships that facilitate leadership, enabling scholarly work to advance equity and inclusion, and cultivating a sense of belonging. While challenges and barriers persist, the myriad benefits of a women-focused professional organization reported by members and leaders represent important steps toward greater equity for women and other underrepresented groups in academic medicine.

This work presents an optical flow composite guidance strategy for UAV navigation in unknown outdoor environments while seeking a predefined goal point. The proposed guidance logic is based on the relative optical flow in the right, left, and center regions of image. The resulting guidance strategy command uses balance and inverse strategies to navigate through different obstacle scenarios. Simulation studies are carried out in 3 D environment created in Virtual Reality Modelling Languages toolbox, MATLAB ® . In terms of initial heading and control efforts, the proposed composed strategy shows a better performance as compared to individual balance and inverse strategies.

As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems.

Objectives There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers. Methods An electronic survey was conducted of a purposive sample of Global Emergency Medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions. Results The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistical barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers; utilizing local research assistants or technological tools such as telemedicine for language translation; making use of new tools such as mobile health (mHealth) to standardize and streamline data collection; identifying alternatives to local institutional review board (IRB) approval and the use of community consent when appropriate; and increased advocacy for global emergency care research funding. Conclusions Significant barriers to the conduct of high-quality global emergency care research persist, and innovative strategies need to be adopted in order to promote and grow the field of global emergency care research. This paper provides a global consensus on the most important barriers identified, as well as recommendations for cost-effective strategies for overcoming these barriers with the overall goal of promoting high-quality research and improving emergency care worldwide. This article is protected by copyright. All rights reserved.

Background and Objectives: Cockroaches are offensive pests visually and expel unpleasant smelling secretion that spoils the flavor of food and environment. This trial was done to test Strikeout bait gel (fipronil 0.055%) developed by Parijat Industries (India) Pvt. Ltd. for its efficacy against Periplaneta americana and Blatella germanica, under field conditions in certain catering establishments of a city in Uttar Pradesh. Material and Methods: Ten catering establishments with high infestation based on pretreatment cockroach density assessment (Four for fipronil gel, four for imlprothrin+ cypermethrin aerosol and two without any treatment to act as a control) were considered for inclusion in trial. Single application of fipronil gel/ imlprothrin+ cypermethrin aerosol was used as crack and crevice treatment. The visual assessment data for cockroach density in treatment and control catering establishments were considered for computation of percent reduction of cockroach infestation in the respective catering establishments. Results: Single application of fipronil gel was able to reduce cockroach infestation up to 96.0% at the end of 12 weeks whereas it was 20% in imlprothrin+ cypermethrin aerosol treated areas. Differences were found statistically significant. However, imlprothrin+ cypermethrin aerosol was more effective (52.0%) in reducing the cockroach density by first week in comparison to fipronil gel (47.8%) but its efficacy started declining after 5th week onwards. Interpretation and Conclusion: The study reports the efficacy of Strikeout bait gel (fipronil 0.055%) for control of cockroaches in catering establishments. The application Strikeout bait gel (fipronil 0.055%) was found more convenient to both operators and clients and there was minimal disruption at workplace.