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Background: Relatively little is understood about which factors influence students’ choice of specialty and when learners ultimately make this decision. Objective: The objective is to understand how experiences of medical students relate to the timing of selection of Emergency Medicine (EM) as a specialty. Of specific interest were factors such as how earlier and more positive specialty exposure may impact the decision-making process of medical students. Methods: A cross-sectional survey study of EM bound 4th year US medical students (MD and DO) was performed exploring when and why students choose EM as their specialty. An electronic survey was distributed in March 2015 to all medical students who applied to an EM residency at 4 programs representing different geographical regions. Descriptive analyses and multinomial logistic regressions were performed. Results: 793/1372 (58%) responded. Over half had EM experience prior to medical school. When students selected EM varied: 13.9% prior to, 50.4% during, and 35.7% after their M3 year. Early exposure, presence of an EM residency program, previous employment in the ED, experience as a pre-hospital provider, and completion of an M3 EM clerkship were associated with earlier selection. Delayed exposure to EM was associated with later selection of EM. Conclusions: Early exposure and prior life experiences were associated with choosing EM earlier in medical school. The third year was identified as the most common time for definitively choosing the specialty. [ABSTRACT FROM AUTHOR]

Abstract: An algal bloom caused by the dinoflagellate Akashiwo sanguinea was observed in October–November 2009 along the central Oregon coast (44.6°N), off Newport, Oregon, U.S.A. In this paper, the conditions are described which led to the development and demise of this bloom. The bloom was observed for 1 month from 5-October until 4-November with the peak of abundance on 19-October (347,615cellsL−1). The A. sanguinea bloom followed September blooms of the diatoms Pseudo-nitzschia spp, Chaetoceros debilis, and the dinoflagellate Prorocentrum gracile. The bloom occurred when nitrate and silicate concentrations were <2μM and <8μM, respectively, and when the water column was stratified. This A. sanguinea dinoflagellate bloom event was closely related to the anomalous upwelling conditions in 2009: upwelling ceased early, at the end of August, whereas a normal upwelling continues into early October. This relaxation extended to near the end of September as a prolonged downwelling event, but then active upwelling reappeared in October and November. The explanation for the occurrence of the A. sanguinea bloom in October may be related to a combination of a prior diatom bloom, a stratified water column with low nutrient concentration in September, and an active upwelling event in October. As for the ultimate source of the cells, the hypothesis is that the seed stock for the A sanguinea bloom off Oregon was southward transport of cells from the Washington coast where a massive bloom of A. sanguinea was first observed in September 2009. [Copyright &y& Elsevier]

This article contributes to enhancement of the engineering management discipline by documenting the start-up of a recognition-based honor society for students in the discipline. Engineering management faculty and practitioners, many with an affiliation to the American Society for Engineering Management, have founded/chartered this society as EpsilonMuEta,TheEngineeringManagementHonorSociety. This honor society (EMH) provides a mechanism for recognizing student achievement in EM programs and honoring individuals in the field of engineering management who have made significant contributions to the discipline and society. [ABSTRACT FROM AUTHOR]

Previous studies of zooplankton communities off the central Oregon coast have been primarily descriptive or have focused on only a few taxa. To more formally explore patterns in zooplankton community structure, we used cluster analysis, Non-metric Multidimensional Scaling (NMDS) ordination, and Indicator Species Analysis to examine seasonal, El Nin˜o/La Nin˜a, and onshore/offshore differences in community composition. Hydrographic and zooplankton data were collected off Newport, Oregon (44.7°N) at eight stations between 8 and 105 km from shore (60-2900 m water depth), on 15 cruises between Jan 1998 and Sept 2000 as part of the US GLOBEC Northeast Pacific Long-Term Observation Program. Zooplankton were collected with a 202 μm, 0.5 m diameter ring net lifted vertically at 30 m min−1 from 100 m, to the surface.The 1997/1998 El Nin˜o played an important role in structuring the zooplankton community from the beginning of our sampling in January 1998 through November 1998. The “El Nin˜o” group identified by cluster analysis and NMDS ordination was highly diverse and was characterized by taxa with offshore and subtropical neritic affinities. When the El Nin˜o group was present, there was no onshelf-offshelf gradient in community composition as was seen during “normal” summers. The “El Nin˜o” group was preceded and followed by a “Transitional” group with slightly lower diversity that existed through the spring of 1999. By summer 1999, conditions had returned to “normal.”Summer upwelling strongly affected the structure of zooplankton assemblages in the “normal” years of 1999 and 2000, leading to differences between nearshore and offshore zooplankton groups. The zooplankton assemblages sampled on the continental shelf during these summers were unique, composed of boreal neritic species (such as the copepods Calanus marshallae, Pseudocalanus mimus, and Acartia longiremis) and larvae of several meroplanktonic taxa, whereas the off-shelf assemblages resembled the winter zooplankton assemblages which were comprised of subtropical neritic and Transition Zone species. The spatial extent of the continental shelf group present during the summer upwelling season varied between early and late summer; differences may be related to the integrated strength and duration of the north winds over the upwelling season. [Copyright &y& Elsevier]

Hydrographic and ocean drifter measurements made along the Oregon coast indicate that the spatial structure of the coastal upwelling system differs in waters to the north and the south of Cape Blanco, Oregon. North of the Cape, a 10–30 km wide zone of coastal upwelling parallels the coast, but south of the Cape, increased wind stress leads to a seaward expansion of the upwelling system and cold upwelled water extends 50–100 km offshore. Because the hydrography and the transport differ, we hypothesize that zooplankton distributions will differ as well. In this paper we investigate differences in copepod distributions and copepod community composition between the waters north and south of Cape Blanco. Five cruises were conducted in 1998 and 1999, which were years of contrasting ocean conditions; there was a strong El Nin˜o in 1998, which was followed by a strong La Nin˜a in 1999. Copepod biomass did not differ between the El Nin˜o and La Nin˜a periods; however, species composition of the copepod assemblages differed vastly. During the 1998 El Nin˜o, the copepod community was dominated by subtropical neritic and warm-water offshore species. During the 1999 La Nin˜a, the zooplankton community was dominated by cold water boreal neritic species. The warm water species were widely distributed in shelf and slope waters in 1998, whereas in 1999, they were found primarily offshore of central Oregon, but over the shelf off northern California. During the summer upwelling season of both years, copepod community composition in shelf waters differed significantly from slope waters in the region to the north of the Cape, however, community composition was the same in shelf and slope waters in the region south of the Cape. These results lead us to suggest that offshore transport by the upwelling jet may be an important mechanism controlling copepod community structure south of Cape Blanco. When we examined these patterns in community composition on a species-by-species basis, among the dominant boreal copepod species, Pseudocalanus mimus and Acartia longiremis were displaced offshore and maintained high population densities in the waters south of Cape Blanco whereas densities of Calanus marshallae and Centropages abdominalis declined in the waters south of the Cape. Thus, the interaction between the boreal copepods and the waters north versus south of Blanco is species-specific. Species may be either lost or retained depending upon interactions between vertical current shear and their vertical distributions. Alternatively, there may be a differential ability among species to survive and reproduce in waters offshore and south of Cape Blanco. [Copyright &y& Elsevier]

Discusses the abortion law in the United States with reference to the Supreme Court case `Planned Parenthood v. Casey.' How the case illustrates difficult jurisprudential problems faced by the federal courts when the Supreme Court fails to clearly identify a law; Details on the cases; Reference to other abortion cases.

The article discusses political consequences of population change in the U.S. The realization of a static population will bring with it many problems, some quite serious and most related to the changed age structure. That young people will be relatively less numerous and the aged far more so will bring about changes in the culture that are difficult to foresee, but many of them are hardly to be welcomed. The shift in the economy will come faster; in education it has already become discernible.

This article examines the treatment of the American Navy at the hands of Congress, based on the premise that the political struggle between the Republicans and Democrats played the major role in the decline and rejuvenation of the fleet. The period of decline is described as the first decade following the Civil War: however, most of the article concerns the next 10 years. During this latter decade, Congress and the public became aware of the poor condition of the fleet and the first steps toward modernization began. Attempts by Republican administrations, however, were thwarted by the Democrats, who refused to support any construction bills offered by the party in power. It was not until the Democrats gained the White House—in 1885—that this policy began to change. The author contends that congressional politics was the determining factor in deciding when the fleet modernization would start. [ABSTRACT FROM AUTHOR]

Rhino-orbital cerebral mucormycosis (ROCM) is a rare infection caused by an invasive fungus and found predominantly in immunocompromised patients. The presentation of ROCM ranges from a mild headache, fever, and sinusitis to vision loss, altered mental status, and facial disfigurement secondary to local tissue invasion. ROCM can cause significant morbidity and mortality and requires prompt diagnosis with timely evaluation by surgical and infectious disease specialists. Cases of ROCM have been reported extensively in internal medicine, infectious disease, and otolaryngology literature. However, there are very few reports in emergency medicine literature in the United States. A 72-year-old woman presented to the Emergency Department (ED) with altered mental status, 4 days of left-sided facial numbness and weakness, and sudden facial pain, swelling, and erythema. Laboratory analysis was consistent with diabetic ketoacidosis. Noncontrast computed tomography of the head and magnetic resonance imaging of the brain demonstrated findings indicative of invasive fungal infection of the left sinus and orbit with extension to the cavernous sinus and surrounding cranial nerves. She was initiated on broad-spectrum antifungals, but based on the extent of the infection, was not a surgical candidate. She subsequently transitioned to a comfort-based plan of care and died 6 days after initial ED presentation. Early recognition and initiation of treatment can potentially mitigate the devastating outcomes of ROCM, therefore it is critical to be aware of this condition and have a high level of suspicion in susceptible patients. [ABSTRACT FROM AUTHOR]