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Розглянуто дебютний роман американської письменниці, професійної копірайтерки Бонні Ґармус «Уроки хімії» (2022) в аспекті феміністичної критики. Наголошено на питанні гендерної нерівності та боротьбі за жіночі права в академічному топосі крізь призму біографічної оповіді про талановиту вчену-хімікиню, матір-одиначку Елізабет Зотт. Звернення до університетського середовища та зосередження на приватному житті й науковій діяльності головної героїні, а також фокусування на дослідній роботі всього Гейстінґського інституту дає підстави припускати, що Б. Ґармус інтегрує у текст синергетичну єдність двох жанрових різновидів – lablit та Professorroman. Акцентовано, що патріархальних утисків психологічного й фізичного характеру в академічному просторі роману «Уроки хімії» зазнають науковиця Елізабет Зотт та працівниця відділу кадрів міс Фреск. Натомість чоловіча персоносфера демонструє, як глибоко в цьому середовищі вкорінені гендерні упередження й агресія, токсична маскулінність, сексизм, а подекуди й мізогінія. Розвідка аналізує взаємодію протагоністки Елізабет з іншими персонажами. Зосередження авторки на гендерному паритеті стратифікує чоловічі образи Гейстінґського науково-дослідного інституту на негативні (доктор Маєрс – сексуальні домагання, квазінауковість, доктор Донатті й доктор Боривайц – порушення академічної доброчесності) та позитивні (талановитий Келвін Еванс, який пропагує рівноправні стосунки, однак не позбавлений патріархальних стереотипів), формуючи в такий спосіб у реципієнтів градацію у сприйнятті персонажів – від мізандрії (чоловіконенависництва) до співчуття та прихильності. Авторка підкреслює типові для наукового середовища 1950–60-х років ХХ ст. дискримінацію й упереджене ставлення до жінок у науці, критикує усталені маскулінні та фемінні ролі, засуджує академічні та суспільні перешкоди в досягненні жінками кар’єрного успіху, обмеженість їхнього особистісного розвитку. Підкреслено актуальність порушених у романі питань для сучасного академічного осередку (гендерна дискримінація, сексуальні домагання, деструктивний вплив патріархальної структури, порушення академічної доброчесності та етичних норм) та необхідність продовження боротьби жінок-науковиць за своє фахове визнання та емансипацію.

ObjectivesCholesterol may be protective in sepsis. Patients with early sepsis may have critically low cholesterol levels that are associated with poor outcomes. The study objective was to test the safety of a fish oil-containing lipid injectable emulsion for stabilizing early cholesterol levels in sepsis.MethodsPhase I Bayesian optimal interval design trial of adult patients with septic shock (Sequential Organ Failure Assessment score ≥4 or vasopressor dependence). Using sequential dose escalation, participants received 2 doses of 1.0 to 1.6 g/kg of lipid emulsion (Smoflipid 20% lipid emulsion) within 48 hours of enrollment. Cholesterol levels, function, and organ failure were assessed serially during the first 7 days of hospital admission.Measurements and main resultsA total of 10 patients with septic shock were enrolled. One patient withdrew for social reasons. Another patient had an unrelated medical complication and received 1 drug dose. Of 9 patients, mean age was 58 years (SD 16), median Sequential Organ Failure Assessment was 8, and 28-day mortality was 30%. No serious adverse events related to lipid infusion occurred. The six occurrences of non-serious adverse events possibly related to lipid infusion included hyperglycemia (1), elevated triglycerides (3), anemia (1), and vascular access redness/pain (1) for all doses. The mean change in total cholesterol levels from enrollment was -7 (SD 16.6) at 48 hours and 14 (SD 25.2) at 7 days.ConclusionsFish oil-containing lipid emulsion administration during early septic shock was safe. Further studies are needed to assess effects on cholesterol levels, function, and organ failure.Clinical trial registrationNCT03405870.

Introduction: Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS – State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED).Methods: We conducted a retrospective review of all patients less than 18 years old who received ED tetanus prophylaxis at two separate sites between January 2011–May 2015. The Florida SHOTS database was accessed to determine vaccination status for each patient in the study group at the time of the encounter. We compared vaccination status for each patient, as documented in the electronic health record (EHR), with Florida SHOTS data to determine whether tetanus prophylaxis was indicated. The proportion of patients receiving tetanus prophylaxis in the ED, who were subsequently identified as up to date with tetanus vaccination per Florida SHOTS, was determined.Results: We identified 743 patients who received ED tetanus prophylaxis. Forty-three (6%) were listed as “up to date” on the EHR and 656 (93%) were listed as “not up to date.” In comparison, 209 (30%) of the study group were identified as “up to date” via Florida SHOTS, and 477 (70%) were not. We accessed the Florida SHOTS record retrospectively to determine whether the vaccine was required. It was determined that 174 (25%) of the patients received tetanus prophylaxis unnecessarily as they were already up to date per Florida SHOTS documentation.Conclusions: Twenty-five percent of patients vaccinated for tetanus in the ED could have been spared if Florida SHOTS data had been used by providers at the time of the encounter. Access to Florida SHOTS provides valuable information regarding vaccination status that impacts patient care and resource utilization in the ED.

Простежено термінологічне навантаження словосполучення „зарубіжна / світова література”. Увагу акцентовано на семантичних, культурно-історичних, гносеологічних особливостях цього поняття. Література як словесне мистецтво, формуючись ще з часів усної народної творчості, відображає відповідний усталений канон в національному вираженні відповідно до динаміки світового літературного процесу. Наголошено, що саме розвиток національних літератур зміцнив природу експліцитно-імпліцитних літературних взаємозв’язків, сприяв формуванню нових жанрів, художніх смаків, розширенню світогляду реципієнта, а отже, й літературознавчих концепцій. Розглянуто суперечливі трактування ґетівського терміна „Weltliteratur”: прибічників, які сприймали літературу як один загальний світовий синтез (Ф. Моретті), та науковців, які прогнозували крах поглядів німецького класика (Е. Ауербах). Наведено притаманні науковому дискурсу ХХ ст. інтерпретації парадигми „всесвітня література” – зібрання всіх творів від античності до Нового часу; антологія найкращих літературних текстів (своєрідна канонізація); високоякісне культурне та інтелектуальне взаємозбагачення. Підкреслено вагомий внесок у формування парадигми „світова / зарубіжна література” компаративістичних студій та соціокультурних досліджень (праці П. Сорокіна, О. Білецького, Л. Гумільова, Г. Гачева, Д. Дюришина, Чернівецької школи ТСО А. Волкова). Щодо окреслення контурів світової / зарубіжної літератури у загальному літературному процесі прокоментовано сучасні концепції західних літературознавців (Е. Аурбаха, П. Казанової, К. Прадо і Т. Самуайо, Ф. Моретті, Д. Дамроша, Р. Томсена, Ж. Давида, Н. Есенліліоглу, С. Уліга та Ч. Чжана). Зроблено висновок, що різновекторність трактування терміна „світова / всесвітня / зарубіжна” література безпосередньо залежить від історико-культурних та епістемологічних підходів до розгляду цього питання, однак для всіх дослідників існують спільні критерії щодо номінативного визначення означеної парадигми – всеосяжність, канони певного методу, антропологічна цінність, участь у глобалізаційних процесах.

Теоретичну парадигму жанр в аспекті ґенези розглянуто на прикладі жанрового різновиду роману, який сьогодні ідентифікується під назвою „університетський роман” (campus novel, university fiction). Виокремлено матричні жанротворчі ознаки університетського роману: проблематика, специфіка сюжетики та персоносфери, часопростір, іронічний наратив, ідіостиль автора. Внутрішні видові формації жанру campus novel визначаються конкретною проблематикою та жанровою специфікою сюжетної організації – молодіжне середовище, професорсько-викладацький компонент персоносфери, а також детективний, фантастичний та ін. характер інтриги. Під впливом стилістичної практики конкретного напряму (приміром, реалізм або постмодернізм) університетський роман демонструє так звану жанрову метаморфність. Простежено ґенезу жанру в контексті його формо-змістової національної специфіки. На прикладі сучасних campus novel Ф. Рота „Людське клеймо”, З. Сміт „Про красу”, Ж. Альдекоа „Загадка”, А. Орехудо „Момент відпочинку”, В. Шостака „Сто днів без сонця”, В. Калити „Архаровці”, Галини Бабич „Тюті” та „Професор Шумейко”, Д. Березіної „Факультет” висновується, що саме фабула генерує і зберігає жанровий потенціал університетського роману. Вказано на перспективи функціонування цього жанру, появу його нових фантастичних і детективних сюжетних версій, похідних від тотального впливу новітніх технологій на соціум (виникнення нових хвороб і адаптація до них, загроза екологічних катастроф тощо). Увагу акцентовано на виразній культурологічній трансгресії тематичного поліваріантного жанрового ядра campus novel у такі сучасні види мистецтва, як манґа, комікс, кінофільм. З огляду на концепцію жанрологічної спіралі Н. Копистянської зроблено висновок щодо генетичної еволюції campus novel. Термінологічно конкретизувавшись як самостійний жанр у добу постмодернізму, цей жанр вирізняється авторським ідіостилем і порушує суспільно-політичні проблеми певної країни, не втрачаючи усталених ознак роману. Прогнозовано безпосередній вплив метамодернізму на університетський роман, що буде генерувати його деформацію та новий культурологічний формат, виходячи з жанротворчого потенціалу теми.

INTRODUCTION: Sepsis is a life-threatening, dysregulated response to infection. Both high-density lipoprotein and low-density lipoprotein cholesterol should protect against sepsis by several mechanisms; however, for partially unknown reasons, cholesterol levels become critically low in patients with early sepsis who experience poor outcomes. An anti-inflammatory lipid injectable emulsion containing fish oil is approved by the Food and Drug Administration as parenteral nutrition for critically ill patients and may prevent this decrease in serum cholesterol levels by providing substrate for cholesterol synthesis and may favourably modulate inflammation. This LIPid Intensive Drug therapy for Sepsis Pilot clinical trial is the first study to attempt to stabilise early cholesterol levels using lipid emulsion as a treatment modality for sepsis. METHODS AND ANALYSIS: This is a two-centre, phase I/II clinical trial. Phase I is a non-randomised dose-escalation study using a Bayesian optimal interval design in which up to 16 patients will be enrolled to evaluate the safest and most efficacious dose for stabilising cholesterol levels. Based on phase I results, the two best doses will be used to randomise 48 patients to either lipid injectable emulsion or active control (no treatment). Twenty-four patients will be randomised to one of two doses of the study drug, while 24 control group patients will receive no drug and will be followed during their hospitalisation. The control group will receive all standard treatments mandated by the institutional sepsis alert protocol. The phase II study will employ a permuted blocked randomisation technique, and the primary endpoint will be change in serum total cholesterol level (48 hours - enrolment). Secondary endpoints include change in cholesterol level from enrolment to 7 days, change in Sequential Organ Failure Assessment score over the first 48 hours and 7 days, in-hospital and 28-day mortality, lipid oxidation status, inflammatory biomarkers, and high-density lipoprotein function. ETHICS AND DISSEMINATION: Investigators are trained and follow good clinical practices, and each phase of the study was reviewed and approved by the institutional review boards of each institution. Results of each phase will be disseminated through presentations at national meetings and publication in peer-reviewed journals. If promising, data from the pilot study will be used for a larger, multicentre, phase II clinical trial. TRIAL REGISTRATION NUMBER: NCT03405870.

BackgroundProper functioning of high-density lipoprotein (HDL) is necessary for protection against sepsis. However, previous work has demonstrated that HDL becomes oxidized and dysfunctional (Dys-HDL) during sepsis. Older (aged >65 years) patients are at particularly high risk of sepsis and poor outcomes from sepsis.Study objectiveThe aim of the study was to compare functional properties of HDL (cholesterol efflux capacity and paraoxonase enzyme 1 [PON-1] activity) and Dys-HDL between older (aged >65 years) sepsis patients and older healthy volunteers.MethodsThis was a subanalysis of a prospective study in which patients with sepsis were prospectively enrolled from the emergency department within the first 24 h. Serum and plasma samples were drawn from septic patients and age- and sex-matched control subjects. Percent cholesterol efflux, HDL inflammatory index, and PON1 activity were measured. Data were analyzed using Student t test or Wilcoxon rank-sum test.ResultsTen sepsis and 10 healthy controls were analyzed. Mean age of sepsis patients (80 ± 2 years [SD]) and control subjects (77 ± 2 years) was similar (P = 0.31). Mean systolic blood pressures were significantly different in sepsis patients (113 ± 8 mmHg) compared with controls (133 ± 6 mmHg) (P = 0.049). Median SOFA scores for sepsis patients were 5.5 (interquartile range [IQR] 4-9). Mean percent cholesterol efflux was significantly reduced in sepsis (24.1 ± 1.2%) compared with controls (31.5 ± 1.0%) (P

ObjectiveHigh density lipoprotein (HDL) is important for defense against sepsis but becomes dysfunctional (Dys-HDL) during inflammation. We hypothesize that Dys-HDL correlates with organ dysfunction (sequential organ failure assessment (SOFA) score) early sepsis.MethodsA prospective cohort study of adult ED sepsis patients enrolled within 24 hours.ResultsEighty eight patients were analyzed. Dys-HDL (expressed as HDL inflammatory index (HII)) correlated with SOFA at enrollment (r = 0.23, p = 0.024) and at 48 hours (r = 0.24, p = 0.026) but HII change over the first 48 hours did not correlate with change in SOFA (r = 0.06, p = 0.56). Enrollment HII was significantly different in patients with most severe organ failure (2.31, IQR 1.33-5.2) compared to less severe organ failure (1.81, IQR 1.23-2.64, p = 0.043). Change in HII over 48 hours was significantly different for in-hospital non-survivors (-0.45, IQR-2.6, -0.14 p = 0.015) and for 28-day non-survivors (-1.12, IQR -1.52, 0.12, p = 0.044). In a multivariable linear regression equation (R2 = 0.13), for each unit HII increase, 48-hour SOFA increased by 0.72 (p = 0.009).ConclusionHII correlated with SOFA and predicted 48-hour SOFA score in early sepsis. Future studies are needed to delineate potential mechanisms.Trial registrationNCT02370186. Registered February 24, 2015.

Introduction The AGGME requires faculty to participate annually in faculty development sessions. Barriers to this requirement include faculty having a lack of time and not perceiving benefits to participating. Effective evaluation and feedback are integral to resident training. Faculty often feel ill prepared to deliver feedback, and residents find accepting and recognizing feedback challenging. We provided faculty with a spaced education program via email that used cognitive theory of multimedia learning solutions in instructional design. Methods The 14-week program consisted of one microlecture and 13 skills-based teaching tips. One tip reinforcing knowledge and skills from the microlecture was emailed each week for faculty to practice in the clinical environment with trainees. Participants completed a short quiz, course evaluation, and self-reflection. The new world Kirkpatrick model was used for program evaluation. Results Fifty-two physician participants received credit for participating; 34 completed the entire course. Of the 34, 32 (94%) identified at least one effective feedback technique, and 27 (79%) were able to define evaluation and recognize observation as the cornerstone of evaluation. Out of the 15 effective feedback characteristics taught, 13 (87%) were identified. Fifty-one participants (98%) rated the program as good/excellent, 52 (100%) wanted more Tuesday's Teaching Tips programs, and the majority recognized change in knowledge and/or skills. Discussion Participants rated the spaced education program as good/excellent and were able to meet the course objectives. This teaching strategy for faculty development was well received, as it was easily accessible and implemented in the clinical learning environment with trainees.

BackgroundHigh density lipoprotein (HDL) can be readily oxidized in inflammatory conditions and exhibit pro-inflammatory and dysfunctional (Dys-HDL) characteristics. We hypothesize that Dys-HDL may predict adverse outcomes and correlate with inflammatory cytokines in sepsis.MethodsEmergency department (ED) patients with sepsis were enrolled. Blood was drawn at enrollment and after 48 h. Dys-HDL, expressed as HDL inflammatory index (HII), and cytokines were measured. Multivariable logistic regression was used to determine the predictive ability of Dys-HDL for adverse outcomes (death, discharge to hospice, or nursing home).ResultsThirty-five patients were included in the study. HII was not significantly different at baseline or 48 h between patients with adverse outcomes versus those without. However, there was a significant difference in change in HII over the first 48 h between those with adverse outcomes (+0.21, 95% CI -0.13 to 0.31) versus those without (-0.11, 95% CI -1 to 0.11) (P = 0.025). Logistic regression revealed increasing HII to be an independent predictor of adverse outcomes (OR 5.2, 95% CI 1.1-25.1 P = 0.040). Of the 24 patents with cytokine measurements at both time points, significant inverse correlations between change in HII and change in GRO (rs = -0.52, P = 0.0088) and monocyte chemotactic protein-1 (rs = -0.61, P = 0.0014) concentrations over 48 h were observed.ConclusionIncreasing Dys-HDL concentrations in the first 48 h of sepsis are associated with an ongoing inflammatory response and adverse clinical outcomes. Early changes in HII may be a potential biomarker in ED patients admitted with sepsis.

Introduction: Older, chronically ill patients with limited health literacy are often under-engagedin managing their health and turn to the emergency department (ED) for healthcare needs. Wetested the impact of an ED-initiated coaching intervention on patient engagement and follow-updoctor visits in this high-risk population. We also explored patients’ care-seeking decisions.Methods: We conducted a mixed-methods study including a randomized controlled trial andin-depth interviews in two EDs in northern Florida. Participants were chronically ill older EDpatients with limited health literacy and Medicare as a payer source. Patients were assignedto an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitativeinterviews (n=9) explored patients’ reasons for ED use. We assessed average between-groupdifferences in patient engagement over time with the Patient Activation Measure (PAM) tool,using logistic regression and a difference-in-difference approach. Between-group differences infollow-up doctor visits were determined. We analyzed qualitative data using open coding andthematic analysis.Results: PAM scores fell in both groups after the ED visit but fell signi ficantly more in “usualcare” (average decline -4.64) than “intervention” participants (average decline -2.77) (β=1.87,p=0.043). There were no between-group differences in doctor visits. Patients described wellinformedreasons for ED visits including onset and severity of symptoms, lack of timely provideraccess, and immediate and comprehensive ED care.Conclusion: The coaching intervention significantly reduced declines in pati ent engagementobserved after usual post-ED care. Patients reported well-informed reasons for ED use andwill likely continue to make ED visits unless strategies, such as ED-initiated coaching, areimplemented to help vulnerable patients better manage their health and healthcare.

Pediatric firearm violence carries significant morbidity and mortality. Studies targeting children ≤14 years are limited. Our goal was to study the distribution and determinants of GSWs in the pediatric population. We performed a retrospective review of children ≤14 years presenting with GSWs at this level 1 trauma center. This cohort was split into younger children, 0–12 years, and older children, 13–14 years. Summary and bivariate statistics were calculated using Stata v10. 142 patients (68.3% black, 76.7% male) were identified. Injuries more often occurred at home (39.6%) by family or friends (60.7%). Older children often suffered handgun injuries (85.5%) and more often were sent immediately to the OR on presentation (29.2%). Younger children more often suffered from air-gun (50%) and pistols (40%). Younger children more commonly had blood transfusions (9.4%) compared to exploratory laparotomy in older children (13.5%). The most common disposition from the ED was home (36.2%). Descriptive data entailing incident specifics such as time of injury and CPS involvement were frequently missing in the healthcare record. Older children were more likely to be injured by strangers, have longer lengths of stay especially associated with surgical operations, and have a disposition of immediate arrest compared to their younger cohort. Consequently, this group may benefit from interventions typically aimed at older patients such as violence intervention programs. When available, differences in demographics and outcomes were identified which could shape novel prevention strategies for firearm injury.

Досліджено реалізацію парадигми „викладач = письменник” в інтерпретації американського викладача та письменника Джона Вільямса. Порівняння біографії автора з образом головного персонажа роману „Стоунер” (1965) виявило, що протагоніст є прототипом літератора. Разом з еволюцією професійного розвитку головного героя Вільяма Стоунера простежено удосконалення ним методики викладання, відтворене на сторінках роману. Увага читача логічно спрямовується на головні проблеми: тему війни та місію університету. Показано, як політичні події (Перша та Друга світові війни) послідовно відбивалися на функціонуванні вишу, безпосередньо впливаючи на поведінку студентства. Автор висуває власну концепцію справжньої природи академічного закладу, окреслюючи три моделі університету. Перша – „модель Стоунера” – відтворює закритий заклад, що згруповує обраних людей для втілення ідеальних концепцій наукової діяльності; друга – „модель Фінча” – демонструє відкриту установу, яка реалізує навчальну та духовну діяльність за відповідну винагороду; третя – „модель Мастерса” – передбачає університет як притулок для некомпетентних людей та нереалізованих особистостей похилого віку. Висновується думка про модель „ідеальної освіти”, яка для кожної епохи має бути специфічною. Зокрема, як свідчить роман Дж. Вільямса, нові реалії вимагають від університету оновлення концептів і пріоритетів, брак чого, у свою чергу, аргументує логіку конфлікту між минулим і теперішнім, із чим систематично має справу персонаж Вільям Стоунер, вочевидь повторюючи досвід самого автора.

Abstract Objective Studies suggest female physicians experience higher rates of infertility than the general population. The overall objective of this study was to determine the rate of impaired fecundity in a sample of female emergency physicians and compare it to the Centers for Disease Control and Prevention (CDC) National Survey of Family Growth (NSFG) data. Impaired fecundity is defined as physical difficulty in getting pregnant or carrying a pregnancy to live birth. Methods We performed a cross‐sectional survey of female emergency physicians to determine the rate of impaired fecundity. Survey questions were adapted from the NSFG to allow comparison to the general population. Statistical comparisons were made using contingency tables (with chi‐square and tau‐c assessments), 1‐sample t tests, and independent samples t tests, as appropriate. Results A total of 2072 women completed the survey with a mean (SD) current age of 38.9 (7.2) years. Data were analyzed for women of childbearing years (15–44 years old as defined by the CDC; n = 1705 [82% total responses]). The rate of impaired fecundity in emergency physicians was 24.9% as compared to the NSFG cohort (12.1%; P

Introduction: Few studies explore the clinical features of youth suicide by poisoning. The use of both social and clinical features of self-poisoning with suicidal intent could be helpful in enhancing existing and creating new prevention strategies. We sought to characterize self-poisonings with suicide intent in ages 0 to 21 years reported to three regional poison control centers from 2003-2012.Methods: This study was a blinded retrospective review of intentional self-poisonings by those age 21 or younger captured by the Poison Information Control Network. Age, sex, substance(s) used, medical outcome, management site, clinical effects, and therapies were described using counts and percentages and analyzed using chi-square tests. We analyzed the medical outcome ranging from no effect to death using the Wilcoxon rank-sum test. Serious medical outcome was defined as death or major outcome.Results: We analyzed a total of 29,737 cases. The majority were females (20,945;70.5%), of whom 274 (1.3%) were pregnant. Most cases were 15-18 year olds (15,520;52.2%). Many experienced no effects (9,068;30.5%) or minor medical outcomes (8,612;29%). Males had more serious medical outcomes (p

Introduction: In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge.Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%).Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain. [West J Emerg Med. 2014;15(2):180–183.]

Розглянуто причини студентських протестів 1968 року. Увага акцентується на передумовах виникнення французької травневої революції. Досліджено роман Р. Мерля „За склом” (1970) у ключі вузівської системи навчання. Визначено причинно-наслідковий процес соціальних подій в аспекті архаїчної традиції викладання у системі вишівського навчання Франції ХХ ст. Простежено, що назрілість термінового оновлення навчальних програм, лекційних та семінарських занять спровокувала бунтарські настрої студентів. Зроблено висновок, що студентські заворушення 1968 р. не лише змінили соціально-економічну сферу французького суспільства, а й суттєво оновили систему вишівського викладання.

Introduction: Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS – State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED). Methods: We conducted a retrospective review of all patients less than 18 years old who received ED tetanus prophylaxis at two separate sites between January 2011–May 2015. The Florida SHOTS database was accessed to determine vaccination status for each patient in the study group at the time of the encounter. We compared vaccination status for each patient, as documented in the electronic health record (EHR), with Florida SHOTS data to determine whether tetanus prophylaxis was indicated. The proportion of patients receiving tetanus prophylaxis in the ED, who were subsequently identified as up to date with tetanus vaccination per Florida SHOTS, was determined. Results: We identified 743 patients who received ED tetanus prophylaxis. Forty-three (6%) were listed as “up to date” on the EHR and 656 (93%) were listed as “not up to date.” In comparison, 209 (30%) of the study group were identified as “up to date” via Florida SHOTS, and 477 (70%) were not. We accessed the Florida SHOTS record retrospectively to determine whether the vaccine was required. It was determined that 174 (25%) of the patients received tetanus prophylaxis unnecessarily as they were already up to date per Florida SHOTS documentation. Conclusion: Twenty-five percent of patients vaccinated for tetanus in the ED could have been spared if Florida SHOTS data had been used by providers at the time of the encounter. Access to Florida SHOTS provides valuable information regarding vaccination status that impacts patient care and resource utilization in the ED.

Introduction Sepsis is a life-threatening, dysregulated response to infection. Both high-density lipoprotein and low-density lipoprotein cholesterol should protect against sepsis by several mechanisms; however, for partially unknown reasons, cholesterol levels become critically low in patients with early sepsis who experience poor outcomes. An anti-inflammatory lipid injectable emulsion containing fish oil is approved by the Food and Drug Administration as parenteral nutrition for critically ill patients and may prevent this decrease in serum cholesterol levels by providing substrate for cholesterol synthesis and may favourably modulate inflammation. This LIPid Intensive Drug therapy for Sepsis Pilot clinical trial is the first study to attempt to stabilise early cholesterol levels using lipid emulsion as a treatment modality for sepsis.Methods and analysis This is a two-centre, phase I/II clinical trial. Phase I is a non-randomised dose-escalation study using a Bayesian optimal interval design in which up to 16 patients will be enrolled to evaluate the safest and most efficacious dose for stabilising cholesterol levels. Based on phase I results, the two best doses will be used to randomise 48 patients to either lipid injectable emulsion or active control (no treatment). Twenty-four patients will be randomised to one of two doses of the study drug, while 24 control group patients will receive no drug and will be followed during their hospitalisation. The control group will receive all standard treatments mandated by the institutional sepsis alert protocol. The phase II study will employ a permuted blocked randomisation technique, and the primary endpoint will be change in serum total cholesterol level (48 hours − enrolment). Secondary endpoints include change in cholesterol level from enrolment to 7 days, change in Sequential Organ Failure Assessment score over the first 48 hours and 7 days, in-hospital and 28-day mortality, lipid oxidation status, inflammatory biomarkers, and high-density lipoprotein function.Ethics and dissemination Investigators are trained and follow good clinical practices, and each phase of the study was reviewed and approved by the institutional review boards of each institution. Results of each phase will be disseminated through presentations at national meetings and publication in peer-reviewed journals. If promising, data from the pilot study will be used for a larger, multicentre, phase II clinical trial.Trial registration number NCT03405870.

OBJECTIVE:High density lipoprotein (HDL) is important for defense against sepsis but becomes dysfunctional (Dys-HDL) during inflammation. We hypothesize that Dys-HDL correlates with organ dysfunction (sequential organ failure assessment (SOFA) score) early sepsis. METHODS:A prospective cohort study of adult ED sepsis patients enrolled within 24 hours. RESULTS:Eighty eight patients were analyzed. Dys-HDL (expressed as HDL inflammatory index (HII)) correlated with SOFA at enrollment (r = 0.23, p = 0.024) and at 48 hours (r = 0.24, p = 0.026) but HII change over the first 48 hours did not correlate with change in SOFA (r = 0.06, p = 0.56). Enrollment HII was significantly different in patients with most severe organ failure (2.31, IQR 1.33-5.2) compared to less severe organ failure (1.81, IQR 1.23-2.64, p = 0.043). Change in HII over 48 hours was significantly different for in-hospital non-survivors (-0.45, IQR-2.6, -0.14 p = 0.015) and for 28-day non-survivors (-1.12, IQR -1.52, 0.12, p = 0.044). In a multivariable linear regression equation (R2 = 0.13), for each unit HII increase, 48-hour SOFA increased by 0.72 (p = 0.009). CONCLUSION:HII correlated with SOFA and predicted 48-hour SOFA score in early sepsis. Future studies are needed to delineate potential mechanisms. TRIAL REGISTRATION:NCT02370186. Registered February 24, 2015.

OBJECTIVES/SPECIFIC AIMS: The objective of this research was to assess the clinical impact of simulation-based team leadership training on team leadership effectiveness and patient care during actual trauma resuscitations. This translational work addresses an important gap in simulation research and medical education research. METHODS/STUDY POPULATION: Eligible trauma team leaders were randomized to the intervention (4-hour simulation-based leadership training) or control (standard training) condition. Subject-led actual trauma patient resuscitations were video recorded and coded for leadership behaviors (primary outcome) and patient care (secondary outcome) using novel leadership and trauma patient care metrics. Patient outcomes for trauma resuscitations were obtained through the Harborview Medical Center Trauma Registry and analyzed descriptively. A one-way ANCOVA analysis was conducted to test the effectiveness of our training intervention versus a control group for each outcome (leadership effectiveness and patient care) while accounting for pre-training performance, injury severity score, postgraduate training year, and days since training occurred. Association between leadership effectiveness and patient care was evaluated using random coefficient modeling. RESULTS/ANTICIPATED RESULTS: Sixty team leaders, 30 in each condition, completed the study. There was a significant difference in post-training leadership effectiveness [F(1,54)=30.19, p

The profiles of sod-podzolic surface-gleyed soils (Stagnic Retisols) and brown podzolic soil profile (Neocambic Gleyic Retisols) are characterized by differentiation of gross Ferrum content and moderately low degree of Ferrum content. The composition of gross Ferrum is dominated by Fes, the maximum share of which is characteristic of A2B g horizon. The minimum content of Fes belongs to A1A2 g, which indicates the processes of destruction of primary and secondary minerals in the upper part of the profile. The accumulation of Ferrum oxides was diagnosed in the ortstein and nodules of the studied soils. The Schwertman coefficient in the neoplasms of the over-illuvial part of the profile is 0.6-0.7, which confirms the theory of their formation under the predominant action of the gleyish-eluvial process. The slight influence of modern gleiing process and their relict origin are observed in transition horizon. [ABSTRACT FROM AUTHOR]