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Background Trauma patients undergo a standardized history and physical, however identification of mental health risk factors is not typically included. We aimed to assess the feasibility of using a modified version of Psychological Simple Triage and Rapid Treatment (PsySTART) to identify post-traumatic stress disorder (PTSD) risk factors in pediatric trauma patients. We hypothesized that PsySTART could identify risk factors and be integrated into the electronic medical record (EMR). Methods Trauma patients 10–17 years old at a level II pediatric trauma center from 2014 to 2015 were screened. PsySTART was used on a pilot cohort to determine if risk factors were present. PsySTART was then integrated into an automated EMR workflow and completion rates were evaluated. Results PsySTART was completed in a pilot cohort of 63 patients with the following findings: 33.3% (n = 21) with 1 risk factor, 22.2% (n = 14) with 2 risk factors, and 19.1% (n = 12) with ≥3 risk factors. The most commonly identified risk factor was, “felt or expressed extreme fear or panic” (n = 27, 43.0%). After EMR integration, PsySTART was successfully completed with automatic consults in 156 of 198 patients (78.8%). Conclusions PsySTART identified risk factors in pediatric trauma patients. EMR integration was feasible and led to proactive psychological management and intervention. Level of Evidence IV

Objective Guided by a functional account of awe, we aimed to test the hypothesis that people who often feel awe are also more curious (Studies 1 and 2), and that this relationship in turn relates to academic outcomes (Study 3). Method In Study 1 (n = 1,005), we used a self-report approach to test the relationship between dispositional awe and curiosity. In Study 2 (n = 100), we used a peer-report approach to test if participants' dispositional awe related to how curious they were rated by their friends. In Study 3, in a sample of 447 high school adolescents we tested if dispositional awe related to academic outcomes via curiosity. Results We found that dispositional awe was positively related to people's self-rated curiosity (Study 1) and how curious they were rated by their friends (Study 2). In Study 3, we found that dispositional awe was related to academic outcomes via curiosity. Conclusions We conclude that among the seven positive emotion dispositions tested, awe was related to unique variance in curiosity, and this link in turn predicted academic outcomes. This work further characterizes awe as an epistemic emotion and suggests that activities that inspire awe may improve academic outcomes.

Whole-body computed tomography (CT) for blunt trauma patients is common. Chest CT (CCT) identifies “occult” pneumo- (PTX) and hemothorax (HTX) not seen on chest radiograph (CXR), one-third of whom get chest tubes, while CXR identifies “non-occult” PTX/HTX. To assess chest tube value for occult injury vs. expectant management, we compared output, duration, and length of stay (LOS) for chest tubes placed for occult vs. non-occult (CXR-visible) injury. We compared chest tube output and duration, and patient length of stay for occult vs. non-occult PTX/HTX. This was a retrospective analysis of 5451 consecutive Level I blunt trauma patients, from 2010 to 2013. Of these blunt trauma patients, 402 patients (7.4%) had PTX, HTX or both, and both CXR and CCT. One third (n = 136, 33.8%) had chest tubes placed in 163 hemithoraces (27 bilateral). Non-occult chest tube output for all patients was 1558 ± 1919 cc (n = 54), similar to occult at 1123 ± 1076 cc (n = 109, p = 0.126). Outputs were similar for HTX-only patients, with non-occult (n = 34) at 1917 ± 2130 cc, vs. occult (n = 54) at 1449 ± 1131 cc (p = 0.24). Chest tube duration for all patients was 6.3 ± 4.9 days for non-occult vs. 5.0 ± 3.3 for occult (p = 0.096). LOS was similar between all occult injury patients (n = 46) and non-occult (n = 90, 17.0 ± 15.8 vs. 13.7 ± 11.9 days, p = 0.23). Mature clinical judgment may dictate which patients need chest tubes and explain the similarity between groups.

We compared the effect of two commonly-studied reappraisal techniques on authenticity during a lab-based social interaction: emotion-focused reappraisal, which explicitly instructs people to change...

It is widely assumed that experiences of awe transform the meaning of daily stresses. Across six studies we tested whether and how the experience of awe is associated with reduced daily stress levels in the moment and, in so doing, leads to elevated life satisfaction. We first documented that individuals who tend to experience greater awe on a daily basis (Study 1) or who report higher levels of trait-like awe (Study 2) report lower levels of daily stress, even after controlling for other positive emotions. In follow-up experiments, after primed with awe (compared with amusement, joy, and pride), individuals reported lower levels of daily stress (Studies 3 and 5) and exhibited lower levels of sympathetic autonomic arousal when talking about their daily stresses (Study 4). Finally, in a naturalistic study, participants who took in an awe-inspiring view at the top of a 200-foot tower reported reduced levels of daily stress and central everyday concerns (Study 6). Mediation analyses revealed that (a) the association between awe and reduced daily stress can be explained by an appraisal of vastness vis-a-vis the self and (b) that the relationship between awe and decreased daily stress levels helps explain awe's positive influence upon life satisfaction. Overall, these findings suggest that experiencing awe can put daily stressors into perspective in the moment and, in so doing, increase well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Dispositional Positive Emotions Scales (DPES) are seven separate research scales that measure joy, awe, amusement, pride, contentment, compassion, and love. Despite widespread use of these scales, no comprehensive examination of the psychometric properties of DPES scores has been conducted. In this paper, we examined the internal consistency and structural validity of DPES scores in four independent American samples. In Study 1, exploratory factor analyses indicated that scores on the seven scales had a 1-factor structure, and these scores were found to be internally consistent. In Study 2, confirmatory factor analyses provided evidence that DPES scores were structurally valid (although evidence was mixed on the Love scale) and that the seven scales were distinct constructs. In addition, DPES scores were found to be internally consistent. Finally, evidence of convergent validity and discriminant validity was also found via comparing DPES scores with those on the Positive and Negative Affect Schedule-Short Form.

Wirachin Hoonpongsimanont,1 Maja Feldman,1 Nicholas Bove,1 Preet Kaur Sahota,1 Irene Velarde,1,2 Craig L Anderson,1 Warren Wiechmann1 1Department of Emergency Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA; 2TouroUniversity College ofOsteopathicMedicine, Vallejo, CA, USA Purpose: Providing feedback to students in the emergency department during their emergency medicine clerkship can be challenging due to time constraints, the logistics of direct observation, and limitations of privacy. The authors aimed to evaluate the effectiveness of first-person video, captured via Google Glass™, to enhance feedback quality in medical student education. Material and methods: As a clerkship requirement, students asked patients and attending physicians to wear the Google Glass™ device to record patient encounters and patient presentations, respectively. Afterwards, students reviewed the recordings with faculty, who provided formative and summative feedback, during a private, one-on-one session. We introduced the intervention to 45, fourth-year medical students who completed their mandatory emergency medicine clerkships at a United States medical school during the 2015–2016 academic year.Results: Students assessed their performances before and after the review sessions using standardized medical school evaluation forms. We compared students’ self-assessment scores to faculty assessment scores in 14 categories using descriptive statistics and symmetric tests. The overall mean scores, for each of the 14 categories, ranged between 3 and 4 (out of 5) for the self-assessment forms. When evaluating the propensity of self-assessment scores toward the faculty assessment scores, we found no significant changes in all 14 categories. Although not statistically significant, one fifth of students changed perspectives of their clinical skills (history taking, performing physical exams, presenting cases, and developing differential diagnoses and plans) toward faculty assessments after reviewing the video recordings.Conclusion: First-person video recording still initiated the feedback process, allocated specific time and space for feedback, and possibly substituted for the direct observation procedure. Additional studies, with different outcomes and larger sample sizes, are needed to understand the effectiveness of first-person video in improving feedback quality. Keywords: clerkship, emergency medicine, feedback, medical student education, first-person video

Background Measurement of the common bile duct (CBD) is considered a fundamental component of biliary point-of-care ultrasound (POCUS), but can be technically challenging. Objective The primary objective of this study was to determine whether CBD diameter contributes to the diagnosis of complicated biliary pathology in emergency department (ED) patients with normal laboratory values and no abnormal biliary POCUS findings aside from cholelithiasis. Methods We performed a prospective, observational study of adult ED patients undergoing POCUS of the right upper quadrant (RUQ) and serum laboratory studies for suspected biliary pathology. The primary outcome was complicated biliary pathology occurring in the setting of normal laboratory values and a POCUS demonstrating the absence of gallbladder wall thickening (GWT), pericholecystic fluid (PCF) and sonographic Murphy's sign (SMS). The association between CBD dilation and complicated biliary pathology was assessed using logistic regression to control for other factors, including laboratory findings, cholelithiasis and other sonographic abnormalities. Results A total of 158 patients were included in the study. 76 (48.1%) received non-biliary diagnoses and 82 (51.9%) were diagnosed with biliary pathology. Complicated biliary pathology was diagnosed in 39 patients. Sensitivity of CBD dilation for complicated biliary pathology was 23.7% and specificity was 77.9%. Conclusion Of patients diagnosed with biliary pathology, none had isolated CBD dilatation. In the absence of abnormal laboratory values and GWT, PCF or SMS on POCUS, obtaining a CBD measurement is unlikely to contribute to the evaluation of this patient population.

Emotional expressions communicate information about the individual's internal state and evoke responses in others that enable coordinated action. The current work investigated the informative and evocative properties of fear vocalizations in a sample of youth from underserved communities and military veterans while white-water rafting. Video-taped footage of participants rafting through white-water rapids was coded for vocal and facial expressions of fear, amusement, pride, and awe, yielding more than 1,300 coded expressions, which were then related to measures of subjective emotion and cortisol response. Consistent with informative properties of emotional expressions, fear vocalizations were positively and significantly related to facial expressions of fear, subjective reports of fear, and individuals' cortisol levels measured after the rafting trip. It is important to note that this coherent pattern was unique to fear vocalizations; vocalizations of amusement, pride, and awe were not significantly related to fear expressions in the face, subjective reports of fear, or cortisol levels. Demonstrating the evocative properties of emotional expression, fear vocalizations of individuals appeared to evoke fear vocalizations in other people in their raft, and cortisol levels of individuals within rafts similarly converged at the end of the trip. We discuss how the study of spontaneous emotion expressions in naturalistic settings can help address basic yet controversial questions about emotions. (PsycINFO Database Record

Background and Objectives:In severe circulatory failure agreement between arterial and mixed venous or central venous values is poor; venous values are more reflective of tissue acid–base imbalance. No prior study has examined the relationship between peripheral venous blood gas (VBG) values and arterial blood gas (ABG) values in hemodynamic compromise. The objective of this study was to examine the correlation between hemodynamic parameters, specifically systolic blood pressure (SBP) and the arterial–peripheral venous (A-PV) difference for all commonly used acid–base parameters (pH, Pco2, and bicarbonate).Design, Setting, Participants, and Measurements:Data were obtained prospectively from adult patients with trauma. When an ABG was obtained for clinical purposes, a VBG was drawn as soon as possible. Patients were excluded if the ABG and VBG were drawn >10 minutes apart.Results:The correlations between A-PV pH, A-PV Pco2, and A-PV bicarbonate and SBP were not statistically significant ( P = .55, .17, and .09, respectively). Although patients with hypotension had a lower mean arterial and peripheral venous pH and bicarbonate compared to hemodynamically stable patients, mean A-PV differences for pH and Pco2were not statistically different ( P = .24 and .16, respectively) between hypotensive and normotensive groups.Conclusions:In hypovolemic shock, the peripheral VBG does not demonstrate a higher CO2concentration and lower pH compared to arterial blood. Therefore, the peripheral VBG is not a surrogate for the tissue acid–base status in hypovolemic shock, likely due to peripheral vasoconstriction and central shunting of blood to essential organs. This contrasts with the selective venous respiratory acidosis previously demonstrated in central venous and mixed venous measurements in circulatory failure, which is more reflective of acid–base imbalance at the tissue level than arterial blood. Further work needs to be done to better define the relationship between ABG and both central and peripheral VBG values in various types of shock.

Humility is a foundational virtue that counters selfish inclinations such as entitlement, arrogance, and narcissism (Tangney, 2000). We hypothesize that experiences of awe promote greater humility. Guided by an appraisal-tendency framework of emotion, we propose that when individuals encounter an entity that is vast and challenges their worldview, they feel awe, which leads to self-diminishment and subsequently humility. In support of these claims, awe-prone individuals were rated as more humble by friends (Study 1) and reported greater humility across a 2-week period (Study 2), controlling for other positive emotions. Inducing awe led participants to present a more balanced view of their strengths and weaknesses to others (Study 3) and acknowledge, to a greater degree, the contribution of outside forces in their own personal accomplishments (Study 4), compared with neutral and positive control conditions. Finally, an awe-inducing expansive view elicited greater reported humility than a neutral view (Study 5). We also elucidated the process by which awe leads to humility. Feelings of awe mediated the relationship between appraisals (perceptions of vastness and a challenge to one's world view) and humility (Study 4), and self-diminishment mediated the relationship between awe and humility (Study 5). Taken together, these results reveal that awe offers one path to greater humility. (PsycINFO Database Record

OBJECTIVES: Pediatric mental illness poses a significant burden with an overall prevalence of approximately 10%. Increasingly, children with mental disorders seek care in the emergency department (ED). However, the ED is not an ideal setting. Pediatric mental health patients receive limited treatment and experience significantly longer length of stay (LOS) than other patients seen in the ED. This study examines patient and hospital factors associated with LOS and prolonged LOS (PLOS). METHODS: This is a retrospective chart review of patients between the ages of 3 and 17 presenting at 2 participating urban EDs with a psychiatric diagnosis from May 2010 to May 2012. RESULTS: This study includes 939 patients with an average age of 14.1 years and a median LOS of 295 minutes. The diagnosis was the strongest predictor of LOS and PLOS. Patients with a psychotic disorder or suicide attempt or ideation experienced a longer LOS, 35% and 55% increases, respectively, and an increased odds of PLOS (odds ratio, 3.07 and 8.36, respectively). Patient sex, previous history of self-harm, and the daily census were associated with both a longer LOS and PLOS. Ethnicity, site of admission, and year of admission were only associated with LOS. CONCLUSIONS: Diagnosis-specific management factors are the primary determinant of LOS. However, some patient characteristics and hospital operational factors are also associated with LOS. Organizational reforms and an evaluation of the required human and material resources are necessary to improve access to and availability of pediatric mental health care. Language: en

In this article we review the emerging literature on the self-transcendent emotions. We discuss how the self-transcendent emotions differ from other positive emotions and outline the defining features of this category. We then provide an analysis of three specific self-transcendent emotions—compassion, gratitude, and awe—detailing what has been learned about their expressive behavior, physiology, and likely evolutionary origins. We propose that these emotions emerged to help humans solve unique problems related to caretaking, cooperation, and group coordination in social interactions. In our final section we offer predictions about the self-transcendent emotions that can guide future research.

Objectives Hypertrophic cardiomyopathy (HCM) is a life-threatening genetic cardiovascular disease that often goes undetected in young athletes. Neither history nor physical examination are reliable to identify those at risk. The objective of this study is to determine whether minimally trained medical student volunteers can use ultrasound to screen for HCM. Methods This was a prospective enrollment of young athletes performed at 12 area high schools and three area colleges, between May 2012 and August 2013. All participants underwent point-of-care ultrasound performed screening for HCM by trained medical students and reviewed by a pediatric cardiologist. An interventricular septum to left ventricular posterior wall ratio greater than 1.25 was considered to be abnormal (positive screen). Results A total of 2332 participants were enrolled. There were 137 (5.8%) with a positive screening for HCM, of which 7 (5.1%) were confirmed to have HCM by a pediatric cardiologist. In a small cohort with positive screen for HCM, there was a 100% sensitivity (95% confidence interval, 59.04 to 100%) and 4.86% (95% confidence interval, 1.98 to 9.76%) positive predictive value of for having HCM. Conclusions Volunteer medical students, using point-of-care ultrasound, were able to effectively screen for HCM in young athletes.

Introduction With a nationwide increase in Emergency Department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study is to determine whether there is a significant difference in hospital admission rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an emergency department observation unit (EDOU) under an abdominal pain protocol by a physician-in-triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission). Methods This was a retrospective cohort study of patients admitted to a protocol driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. Compiled data was obtained for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. Data for each cohort was then divided into age, gender, payer status, and LOS. This data was then analyzed to assess any significant differences between the cohorts. Results There were 327 total patients eligible for this study (85 physician-in-triage group, 242 traditional ED group). The total success rate (defined as discharge home) was 90.8% (n=297) and failure rate (defined as admission or transfer) was 9.2% (n= 30). There were no significant differences observed in success rates between those dispositioned to the EDOU by physicians-in-triage (90.6%) versus via the traditional route (90.5 % p) = 0.98. There was also a significant difference found between the two groups regarding total LOS with significantly shorter main ED times and EDOU times amongst patients sent to the EDOU by the physician-in- triage group (p

Empathy often occurs when individuals witness another suffer. Researchers who study empathy have tried to identify reliable behavioral outcomes, affective responses, and physiological changes associated with its experience. However to date, these markers of empathy have remained elusive. We propose that failing to take into account the features of the suffering that elicited the empathy has contributed to this problem. We hypothesized that emotional and physical suffering generate diverging profiles of empathy with different behavioral, affective, and physiological markers. We first examined how observer's rated 75 different types of suffering. Ratings produced 2 independent clusters-primarily emotional and primarily physical, which classified 80% of suffering events (Study 1). Next we measured behavioral, affective, and physiological markers of empathy for emotional and physical suffering. In a 2-step exploratory (Study 2a) and confirmatory (Study 2b; preregistered) process, participants generated open-ended behavioral responses to suffering scenarios, which were coded, classified into thematic categories, and presented to new participants. We found that emotional suffering elicited more comforting and interpersonal emotion regulation behaviors in others, whereas physical suffering elicited more emergency mobilization behaviors. In Study 3, participants viewed pictures of suffering. Self-reports and coded expressions of compassion were stronger for emotional suffering; anxiety and distress were stronger for physical suffering. In Study 4, participants watched videos of suffering. Emotional and physical suffering elicited increased parasympathetic and sympathetic activation, though coactivation was greater for physical suffering. This work generates a more nuanced and comprehensive understanding of empathy, which addresses current debates and reconciles inconsistencies in its conceptualization. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Author(s): Le, Brittany; Figueroa, Cesar; Anderson, Craig; Lotfipour, Shahram; Barrios, Cristobal | Abstract: BACKGROUND:The use of distracting technology is an increasing source of risk for injury among trauma patients. Both drivers and pedestrians show increased unsafe behavior. The data for prevalence and risk for distraction in trauma has varied widely. Our hypothesis is that distraction is more highly prevalent and widely distributed among all mechanisms of injury and variety of trauma patients. METHODS:A 10-question survey of adult trauma victims at a Level I trauma center regarding distraction at time of event was performed, examining age, sex, ethnicity, education level, mode of injury and role in the accident (driver, passenger, pedestrian, bicyclist, motorcyclist). Multiple-variable logistic regression was performed to identify risk factors for distraction. RESULTS:From June 2016 to October 2018, 1,316 patients were surveyed, and 1,011 (76.8%) patients reported their role in the traffic accident. The prevalence of distraction was 21.73% among drivers, 9.01% among passengers, 16.50% among pedestrians, 20.00% among bicyclists, and 8.09% among motorcyclists. Males (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.26-2.67) as well as all Others (OR, 2.09; 95% CI, 1.10-3.98) showed statistically significant increased risk for distraction. Motorcyclist (OR, 0.25; 95% CI, 0.13-0.50) and passenger (OR, 0.37; 95% CI, 0.18-0.77) roles during collision were a lowered risk of distraction. Furthermore, Asian/Pacific Islanders (OR, 1.62; 95% CI, 0.94-2.79) trended toward being at greater risk for distraction. CONCLUSION:Distraction is prevalent among a wide range of traffic accident victims, not just drivers. Males as well as all Others are more likely to be distracted. In contrast, motorcyclists and passengers are less likely to be distracted. Further studies to assist in determining effective interventions and public safety efforts aimed at specific at-risk groups beyond motor vehicle drivers are warranted. LEVEL OF EVIDENCE:Epidemiological, level V.

We examine the relationship of hope with exercise using Snyder’s hope model, which defines hope as a combination of goal-directed planning (pathways) and motivation (agency). We surveyed 102 participants online via Amazon MTurk. The Adult Hope Scale and Goal-Specific Hope Scale assessed general hope and hope regarding exercise. The Leisure-Time Exercise Questionnaire assessed frequency of exercise and of any activity “long enough to work up a sweat.” We also measured optimism, exercise self-efficacy, depression, anxiety, and stress. Because hope emphasizes planning and motivation (both likely needed in fitness regimens), we expected it to relate to exercise frequency after controlling for these other variables. Indeed, exercise goal-specific hope was correlated with frequency of exercise and activity long enough to sweat, though general hope was not. This relationship held after controlling for all other variables. Future research may be useful in investigating causality, including whether hope-based interventions result in increased exercise engagement.

Whole-body computed tomography (CT) for blunt trauma patients is common. Chest CT (CCT) identifies "occult" pneumo- (PTX) and hemothorax (HTX) not seen on chest radiograph (CXR), one-third of whom get chest tubes, while CXR identifies "non-occult" PTX/HTX. To assess chest tube value for occult injury vs. expectant management, we compared output, duration, and length of stay (LOS) for chest tubes placed for occult vs. non-occult (CXR-visible) injury.We compared chest tube output and duration, and patient length of stay for occult vs. non-occult PTX/HTX. This was a retrospective analysis of 5451 consecutive Level I blunt trauma patients, from 2010 to 2013.Of these blunt trauma patients, 402 patients (7.4%) had PTX, HTX or both, and both CXR and CCT. One third (n = 136, 33.8%) had chest tubes placed in 163 hemithoraces (27 bilateral). Non-occult chest tube output for all patients was 1558 ± 1919 cc (n = 54), similar to occult at 1123 ± 1076 cc (n = 109, p = 0.126). Outputs were similar for HTX-only patients, with non-occult (n = 34) at 1917 ± 2130 cc, vs. occult (n = 54) at 1449 ± 1131 cc (p = 0.24). Chest tube duration for all patients was 6.3 ± 4.9 days for non-occult vs. 5.0 ± 3.3 for occult (p = 0.096). LOS was similar between all occult injury patients (n = 46) and non-occult (n = 90, 17.0 ± 15.8 vs. 13.7 ± 11.9 days, p = 0.23).Mature clinical judgment may dictate which patients need chest tubes and explain the similarity between groups.

Author(s): McCoy, C. Eric; Rahman, Asif; Rendon, Juan C.; Anderson, Craig L.; Langdorf, Mark I.; Lotfipour, Shahram; Chakravarthy, Bharath | Abstract: Introduction: Most medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR. Methods: This was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual. Results: Students in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30-4.82]) for SIM and 3.89 cm (95% CI [3.50-4.27]) for STD, p=0.02. Mean compression fraction was 0.724 (95% CI [0.699-0.751]) for SIM group and 0.679 (95% CI [0.655-0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7-40.8]) for SIM group and 79.5 s (95% CI [44.8-119.6]) for STD group, p=0.007. Conclusion: High-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.

Author(s): McCoy, C. Eric; Alrabah, Rola; Wiechmann, Warren; Langdorf, Mark I.; Ricks, Cameron; Chakravarthy, Bharath; Anderson, Craig; Lotfipour, Shahram | Abstract: Introduction: Our goal was to evaluate the feasibility and effectiveness of using telesimulation to deliver an emergency medical services (EMS) course on mass casualty incident (MCI) training to healthcare providers overseas.Methods: We conducted a feasibility study to establish the process for successful delivery of educational content to learners overseas via telesimulation over a five-month period. Participants were registrants in an EMS course on MCI triage broadcast from University of California, Irvine Medical Simulation Center. The intervention was a Simple Triage and Rapid Treatment (START) course. The primary outcome was successful implementation of the course via telesimulation. The secondary outcome was an assessment of participant thoughts, feelings, and attitudes via a qualitative survey. We also sought to obtain quantitative data that would allow for the assessment of triage accuracy. Descriptive statistics were used to express the percentage of participants with favorable responses to survey questions.Results: All 32 participants enrolled in the course provided a favorable response to all questions on the survey regarding their thoughts, feelings, and attitudes toward learning via telesimulation with wearable/mobile technology. Key barriers and challenges identified included dependability of Internet connection, choosing appropriate software platforms to deliver content, and intercontinental time difference considerations. The protocol detailed in this study demonstrated the successful implementation and feasibility of providing education and training to learners at an off-site location.Conclusion: In this feasibility study, we were able to demonstrate the successful implementation of an intercontinental MCI triage course using telesimulation and wearable/mobile technology. Healthcare providers expressed a positive favorability toward learning MCI triage via telesimulation. We were also able to establish a process to obtain quantitative data that would allow for the calculation of triage accuracy for further experimental study designs.

Background: Reports indicate a geographic effect of socioeconomic inequalities on the occurrence of opioid-related fatal overdoses. This study aims to (1) estimate the rates of opioid-related overdoses, (2) estimate the association of benzodiazepine co-ingestion with opioid-related deaths, (3) estimate associations between socioeconomic indicators and opioid-related deaths, and (4) map the distribution of fatal overdoses, in Orange County (OC), California. Methods: An ecologic study was conducted of all opioid- related deaths (1205 total) from 2010 to 2014 obtained from the OC Coroner Division database (1065 OC residents, 55 nonresidents, 85 OC homeless) (analyzed 2016–2017). Rates of opioid overdose, benzodiazepine co-ingestion prevalence, and associations with socioeconomic status (SES; education, poverty, median income) using ZIP code analysis in the residential and homeless communities were calculated. Results: Of 1205 deaths, 904 involved prescription-type opioids, 223 involved heroin, 39 involved both, and 39 not stated; 973 were classified unintentional overdoses, 180 suicides, and 52 undetermined; 49% of cases involved benzodiazepines. Prescription-type opioid and heroin death rates for residents were 5.4/ 100,000 person-years (95% confidence interval [CI]: 5.0–5.8) and 1.2/100,000 person-years (95% CI: 1.0–1.4), respectively. Males, age group 45–54, and Caucasian race had the highest rate (13.6/100,000) of opioid mortality. The highest death rates were seen in homeless adults, at 136/100,000 person-years for prescription-type opioids (95% CI: 99.0–185.5) and 156/100,000 person-years for heroin (95% CI: 116.8–209.5). Conclusions: The burden of prescription-type opioid–related deaths in OC affects all demographics and levels of SES; there is a disproportionately high rate of opioid-related deaths in the OC homeless population.

PurposeTo examine the variability among medical schools in ranking systems used in medical student performance evaluations (MSPEs).MethodThe authors reviewed MSPEs from U.S. MD-granting medical schools received by the University of California, Irvine emergency medicine and internal medicine residenc

Over the past 2 decades, a major focus in psychological research has been on pursuing happiness, positivity, and optimal human flourishing. Interestingly, little attention has been paid to contentment, which, according to over 4,000 years of spiritual, philosophical, and theoretical discourse, is an emotion that sits at the deepest core of human wellbeing and is foundational to the experience of fulfillment in life. This article synthesizes etymological, religious, philosophical, and psychological treatments of contentment from multiple languages and traditions. Derived from these perspectives, it also presents a prototype approach to contentment, its core affect features and cross-cultural variations. Finally, it presents theory-grounded hypotheses intended to initiate future research on the topic. We propose a primary appraisal theme that is at the root of all experiences of contentment: perceived completeness, which refers to the perception that the present situation is enough and entire.

Objective: Although earlier work has shown a link between mind-wandering and ADHD symptoms, this relationship has not been further investigated by taking into account recent advances in mind-wandering research. Method: The present study provides a comprehensive assessment of the relationship between mind-wandering and ADHD symptomatology in an adult community sample ( N = 105, 71 females, M age = 23.1) using laboratory measures and experience sampling during daily life. Results: Mind-wandering and detrimental mind-wandering were positively associated with ADHD symptoms. Meta-awareness of mind-wandering mediated the relationship between ADHD symptomatology and detrimental mind-wandering, suggesting that some of the negative consequences can be ameliorated by strategies that facilitate meta-awareness. Interestingly, participants with low ADHD scores showed a positive relationship between detrimental mind-wandering and useful mind-wandering; however, participants with high ADHD scores failed to engage in this type of “strategic” mind-wandering. Conclusion: These results provide new insights into the relationship between ADHD symptomatology and mind-wandering that could have important clinical implications.

Author(s): Hosseini Farahabadi, M; Chakravarthy, B; Hoonpongsimanont, W; Vaca, FE; McCoy, CE; Anderson, CL; Imani, G; Wong, P; Lotfipour, S | Abstract: Many studies have evaluated the effectiveness of alcohol screening and brief intervention (SBI) but most of them have reported substantial loss to follow-up without investigating the characteristics of those lost to follow-up. We examined the association between Alcohol Use Disorders Identification Test (AUDIT) scores, readiness-to-change scores and the demographic factors with lost to follow-up. This retrospective study compared demographic characteristics, AUDIT and readiness-to-change scores for 190 lost to follow-up patients to 221 completed follow-up patients who participated in SBI in the Emergency Department between June 2006 and May 2007. Comparing the association between baseline characteristics and completed follow-up rate, those 30–39, 40–49 and 50 years and older had 0.46 (95% CI 0.32–0.91), 0.49 (95% CI 0.29–0.90) and 0.58 (95%CI 0.22–0.79) lower odds of completing follow-up, respectively, in comparison to those 18–29 years of age. The loss to follow-up group reported more negative consequences of alcohol and binge drinking than the completed follow-up group (p = 0.04). Using logistic regression, patients who experienced more negative effects of alcohol had 0.87 lower odds of completing follow-up (95% CI 0.79–0.96). The patients lost to follow-up in this study were significantly different in age and alcohol drinking habits compared to those completed follow-ups. It is important to consider differential loss to follow-up in assessing the validity and generalizability of intervention studies. This could help in tailoring methods of approaching patients based on target population characteristics.

The power of nature to both heal and inspire awe has been noted by many great thinkers. However, no study has examined how the impact of nature on well-being and stress-related symptoms is explained by experiences of awe. In the present investigation, we examine this process in studies of extraordinary and everyday nature experiences. In Study 1, awe experienced by military veterans and youth from underserved communities while whitewater rafting, above and beyond all the other positive emotions measured, predicted changes in well-being and stress-related symptoms one week later. In Study 2, the nature experiences that undergraduate students had during their everyday lives led to more awe, which mediated the effect of nature experience on improvements in well-being. We discuss how accounting for people's emotional experiences during outdoors activities can increase our understanding of how nature impacts people's well-being. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objectives We sought to further determine whether cognitive test results changed for advanced cardiac life support (ACLS) taught in the team-based learning/flipped classroom format (TBL/FC) versus a lecture-based (LB) control. Methods We delivered 2010 ACLS to two classes of fourth-year medical students in the TBL/FC format (2015-2016), compared to three classes in the LB format (2012-2014). There were 27.5 hours of instruction for the TBL/FC model (TBL - 10.5 hours, podcasts - nine hours, small-group simulation - eight hours), and 20 hours (lectures - 12 hours, simulation - eight hours) in LB. We taught TBL for 13 cardiac cases while LB had none. Didactic content and seven simulated cases were the same in lecture (2012-2014) or in podcast formats (2015-2016). Testing was the same using 50 multiple-choice (MC) format questions, 20 rhythm-matching questions, and seven fill-in management of simulated cases. Results Some 468 students enrolled in the course 259 (55.4%) in the LB format in 2012-2014, and 209 (44.6%) in the TBL/FC format in 2015-2016. The scores for two out of three tests (MC and fill-in) increased with TBL/FC. Combined, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.5, 96.8, p = 0.0001). More students did not pass one of three tests with LB versus TBL/FC (24.7% versus 18.2%), and two or three parts of the test (8.1% versus 4.3%, p = 0.01). On the contrary, 77.5% passed all three with TBL/FC versus 67.2% with LB (change 10.3%, 95% CI 2.2%-18.2%). Conclusion TBL/FC teaching for ACLS improved written test results compared with the LB format.

Negative emotions are reliably associated with poorer health (e.g., Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002), but only recently has research begun to acknowledge the important role of positive emotions for our physical health (Fredrickson, 2003). We examine the link between dispositional positive affect and one potential biological pathway between positive emotions and health-proinflammatory cytokines, specifically levels of interleukin-6 (IL-6). We hypothesized that greater trait positive affect would be associated with lower levels of IL-6 in a healthy sample. We found support for this hypothesis across two studies. We also explored the relationship between discrete positive emotions and IL-6 levels, finding that awe, measured in two different ways, was the strongest predictor of lower levels of proinflammatory cytokines. These effects held when controlling for relevant personality and health variables. This work suggests a potential biological pathway between positive emotions and health through proinflammatory cytokines.

Introduction: Our objective was to evaluate the effectiveness of hands-on training at a bedside ultrasound (US) symposium (“Ultrafest”) to improve both clinical knowledge and image acquisition skills of medical students. Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma (FAST) US knowledge. Secondary outcome was improvement in image acquisition for either pulmonary or FAST. Methods: Prospective cohort study of 48 volunteers at “Ultrafest,” a free symposium where students received five contact training hours. Students were evaluated before and after training for proficiency in either pulmonary US or FAST. Proficiency was assessed by clinical knowledge through written multiple-choice exam, and clinical skills through accuracy of image acquisition. We used paired sample t-tests with students as their own controls. Results: Pulmonary knowledge scores increased by a mean of 10.1 points (95% CI [8.9-11.3], p

Author(s): McCoy, C Eric; Sayegh, Julie; Rahman, Asif; Landgorf, Mark; Anderson, Craig; Lotfipour, Shahram | Abstract: ObjectiveThe objective was to evaluate the comparative effectiveness of telesimulation versus standard simulation in teaching medical students the management of critically ill patients.MethodsProspective, randomized crossover study of 32 fourth-year medical students at a university medical simulation center. Students were randomized to the standard simulation (SIM) or telesimulation (TeleSIM) group between September 2014 and February 2015. The SIM group experience included participating in a live, fully immersive simulation case followed by debriefing with their SIM cohort and a live TV Internet connection to the TeleSIM group. The TeleSIM group experience included remotely observing the live simulation case at an off-site location, followed by a shared group debriefing via live TV Internet connection. Subject assessment was performed with a written evaluation tool. During a second instructional session, the students crossed over and participated in a different simulation scenario and assessment. Mean evaluation scores were calculated along with 95% confidence intervals (CIs) and were analyzed via linear regression. Our secondary outcome was a survey evaluating the perceptions and attitudes held between the two simulation modalities.ResultsOf 33 eligible students, 32 participated in the study (97.0%). We found no significant difference in the mean evaluation scores of the two groups: SIM group meann= 96.6% (95% CIn= 94.5%-98.6%) and TeleSIM group meann= 96.8% (95% CIn= 94.8%-98.9%). We also found no significant difference in the favorability of teaching modality (TeleSIM vs. SIM) on the survey.ConclusionIn our prospective randomized crossover study evaluating telesimulation versus standard simulation, we found no significant difference in evaluation scores among the two groups. There was also no significant difference found in the favorability of one teaching modality on a posteducational session survey. Our data support and highlight the capability of telesimulation to provide educational benefit to learners who do not have direct access to simulation resources.

Introduction: Urolithiasis is a common medical condition that accounts for a large number of emergency department (ED) visits each year and contributes significantly to annual healthcare costs. Urinalysis is an important screening test for patients presenting with symptoms suspicious for urolithiasis. At present there is a paucity of medical literature examining the characteristics of ureteral stones in patients who have microscopic hematuria on urinalysis versus those who do not. The purpose of this study was to examine mean ureteral stone size and its relationship to the incidence of clinically significant hydronephrosis in patients with and without microscopic hematuria. Methods: This is a retrospective chart review of patient visits to a single, tertiary academic medical center ED between July 1, 2008, and August 1, 2013, of patients who underwent non-contrast computed tomography of the abdomen and pelvis and urinalysis. For patient visits meeting inclusion criteria, we compared mean stone size and the rate of moderate-to-severe hydronephrosis found on imaging in patients with and without microscopic hematuria on urinalysis. Results: Out of a total of 2,370 patient visits 393 (16.6%) met inclusion criteria. Of those, 321 (82%) had microscopic hematuria present on urinalysis. Patient visits without microscopic hematuria had a higher rate of moderate-to-severe hydronephrosis (42%), when compared to patients with microscopic hematuria present (25%, p=.005). Mean ureteral stone size among patient visits without microscopic hematuria was 5.7 mm; it was 4.7 mm for those patients with microscopic hematuria (p=.09). For ureteral stones 5 mm or larger, the incidence of moderate-to-severe hydronephrosis was 49%, whereas for ureteral calculi less than 5 mm in size, the incidence of moderate-to-severe hydronephrosis was 14% (p < 0.0001). Conclusion: Patients visiting the ED with single-stone ureterolithiasis without microscopic hematuria on urinalysis could be at increased risk of having moderate-to-severe hydronephrosis compared to similar patients presenting with microscopic hematuria on urinalysis. Although the presence of hematuria on urinalysis is a moderately sensitive screening test for urolithiasis, these results suggest patients without hematuria tend to have more clinically significant ureteral calculi, making their detection more important. Clinicians should maintain a high index of suspicion for urolithiasis, even in the absence of hematuria, since ureteral stones in these patients were found to be associated with a higher incidence of obstructive uropathy.

Context Emergency physicians (EPs) often need to make a decision whether or not to intubate a terminal cancer patient. Objective The objective of this study was to explore EPs' attitudes about intubating critically ill, terminal cancer patients. Methods Fifty EPs at three emergency departments (one university based, one community, and one Health Maintenance Organization) in Southern California participated in an anonymous survey that presented a hypothetical case of an end-stage lung cancer patient in pending respiratory failure. Fourteen questions along a five-point Likert scale asked EPs about prognosis and factors that influence their decision to intubate or not. Results A convenience sampling of 50 EPs yielded a 100% survey response rate. Ninety-four percent believed intubation would not provide an overall survival benefit. If the family insisted, 26% would intubate the patient even with a do-not-intubate (DNI) status. Ninety-four percent would postpone intubation if palliative consultation were available in the ED. Sixty-eight percent believed that a discussion about goals of care was more time consuming than intubation. Only 16% believed they had sufficient training in palliative care. Although 29% who felt they had inadequate palliative care training would intubate the patient with a DNI, only 13% of EPs with self-perceived adequate palliative care training would intubate that patient. Conclusion EPs vary in their attitudes about intubating dying cancer patients when families demanded it, even when they believed it was nonbeneficial and against the patient's wishes. Palliative care education has the potential to influence that decision making. Intubation could be mitigated by the availability of palliative consultation in the ED.

BackgroundAlcohol abuse is recognized as a significant contributor to injury. It is therefore essential that trauma centers implement screening and brief intervention (SBI) to identify patients who are problem drinkers. Although, the utility of SBI in identifying at-risk drinkers have been widely studied in level 1 trauma centers, few studies have been done in level 2 centers. This study evaluates the usefulness of SBI in identifying at-risk drinkers and to investigate the pattern of alcohol drinking among level 2 trauma patients.MethodsThis is a retrospective study of a convenience sample of trauma patients participating in computerized alcohol screening, brief intervention, and referral to treatment (CASI) in an academic level 1 trauma center and a nearby suburban community hospital level 2 trauma center. CASI utilized Alcohol Use Disorders Identification Test (AUDIT) to screen patients. We compared the pattern of alcohol drinking, demographic factors, and readiness-to-change scores between those screened in a level 2 and 1 trauma center.ResultsA total of 3,850 and 1,933 admitted trauma patients were screened in level 1 and 2 trauma centers respectively. There was no difference in mean age, gender, and language between the two centers. Of those screened, 10.2% of the level 1 and 14.4% of the level 2 trauma patients scored at-risk (AUDIT 8-19) (p =20) (p

Introduction: Cost and radiation risk have prompted intense examination of trauma patient imaging. A proposed decision instrument (DI) for the use of chest computed tomography (CT), (CCT) in blunt trauma patients includes thoracic spine (TS) tenderness, altered mental status (AMS) and distracting painful injury (DPI) as potential predictor variables. TS CT is a separate, costly study whose value is currently ill-defined. The objective of this study is to determine test characteristics of these predictor variables alone, and in combination, to derive a TS injury DI. Methods: Prospective cohort study of blunt trauma patients age > 14 in a Level I Trauma Center who had either CCT or TS CT. Results: Of 1,798 blunt trauma patients, 1,174 (65.3%) had CCT, and 46 (2.6%) had a TS CT at physician discretion. CCT identified 58 TS injuries in 1,220 patients (4.8%). For 1,032 patients without AMS, 18/35 had TS tenderness, for sensitivity of 51.4%, specificity 84.7%, positive (PPV) and negative predictive values (NPV) of 10.5% and 98.0%. Positive likelihood ratio (+LR) was 3.35, with negative (-LR) 0.57. Among the 58 TS injuries, 23 had AMS for sensitivity of 39.7%, with other test characteristics of 85.8%, 12.2%, 96.6%, with +LR 2.79 and -LR 0.70. Thirty-eight of 58 had DPI, for sensitivity 65.5%, with other test characteristics 65.7%, 8.7%, and 97.4%, with +LR 1.91 and -LR 0.52. Combining 3 predictor variables into a proposed DI found 56/58 injuries for test characteristics of 96.6% (95% CI 88.1-99.6%), 49.1% (46.1-52.0%), 8.6% (6.6-11.1%) and 99.7% (CI 98.7-100%), with +LR 1.90 (1.76-2.04) and -LR 0.07 (0.02-0.28). If validated, the DI would exclude 572/1,220 CCT patients from separate TS CT (46.9%, CI 44.1-49.7%), and 141/511 (27.6%, CI 23.8-31.7%) patients who actually had TS CT in our cohort. Medicare payment at our center for sagittal reconstructions of TS CT is $280 for professional plus technical charges ($3,312 per study). The DI, if validated, would save $39,000 –$160,000 in TS imaging payments. Conclusion: TS CT is low yield and costly. Patients who are alert, have no TS tenderness and no DPI have a very low likelihood of TS injury (NPV 99.7% 95% CI lower limit 98.7%) with –LR=0.07, 95% CI upper limit 0.28). Avoiding TS CT may save considerable charges and payments. [West J Emerg Med. 2014;15(4):465–470.]

Background: Many suicidal and depressed patients are seen in emergency departments (EDs), whereas outpatient visits for depression remain high. Study objective The primary objective of the study is to determine a relationship between the incidence of suicidal and depressed patients presenting to EDs and the incidence of depressed patients presenting to outpatient clinics. The secondary objective is to analyze trends among suicidal patients. Methods: The National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey were screened to provide a sampling of ED and outpatient visits, respectively. Suicidal and depressed patients presenting to EDs were compared with depressed patients presenting to outpatient clinics. Subgroup analyses included age, sex, race/ethnicity, method of payment, regional variation, and urban verses rural distribution. Results: Emergency department visits for depression (1.16% of visits in 2002) and suicide attempts (0.51% of visits in 2002) remained stable over the years. Office visits for depression decreased from 3.14% of visits in 2002 to 2.65% of visits in 2008. Non-Latino whites had a higher percentage of ED visits for depression and suicide attempt and office visits for depression than other groups. The percentage of ED visits for suicide attempt resulting in hospital admission decreased by 2.06% per year. Conclusion: From 2002 to 2008, the percentage of outpatient visits for depression decreased, whereas ED visits for depression and suicide remained stable. When examined in the context of a decreasing prevalence of depression among adults, we conclude that an increasing percentage of the total patients with depression are being evaluated in the ED, vs outpatient clinics. © 2014 Elsevier Inc. All rights reserved.