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Case Presentation: We describe a case of persistent odynophagia due to a retained foreign body 27 days after emergent intubation.Discussion: Dentures constitute a potential esophageal foreign body and warrant special consideration during airway management. Odynophagia, dysphagia, and changes in phonation should prompt consideration of retained esophageal foreign bodies, especially in the post-intubation setting.

Case Presentation: We describe a case of persistent odynophagia due to a retained foreign body 27 days after emergent intubation. Discussion: Dentures constitute a potential esophageal foreign body and warrant special consideration during airway management. Odynophagia, dysphagia, and changes in phonation should prompt consideration of retained esophageal foreign bodies, especially in the post-intubation setting.

ABSTRACT: The black grouse (Tetrao tetrix) is an endangered species facing challenges in breeding and reintroduction programs, including parasitic infestations. This study aimed to assess natural infestations by various Eimeria species and infestation dynamics in female, male, and young black grouse kept in a stationary aviary. Faecal samples were collected from adult grouses between April and the time of chicks’ hatching and rearing (September). Faecal samples from young birds were collected from the hatching for a period of 1 year. The prevalence of Eimeria spp. was determined by a qualitative method (Fulleborn's flotation) and a quantitative method (McMaster's method with Raynaud's modification). The following Eimeria species were identified: E. lyruri, E. nadsoni and E. nonbrumpti. The average percentages of Eimeria spp. in the cock were 80.52%, 9.27%, and 10.21%, respectively; in the hen, they were 86.19%, 9.28%, and 4.53%, respectively; in the young black grouses they were 84.60%, 9.34% and 6.06%, respectively. The highest E. lyruri infestation was observed in the cock in June (144227 OPG) and July (129365 OPG). In the hen, the infestation intensity increased in May (304302 OPG) and then decreased in June (39583 OPG). Furthermore, an additional increase was observed in July (216533 OPG). Two increases in infestation intensity were also observed in young birds, with peaks in January (91387 OPG) and July (126178 OPG). A positive strong correlation was identified between Eimeria spp. in the cock and the young birds. A statistically significant positive correlation was identified in the hen between E. lyruri and E. nadsoni. No correlation was demonstrated between the infestation intensity and the age of the birds or season of the year in all the grouses under study. Despite some attempts, a comprehensive approach to the issue of coccidiosis in the black grouse as a disease that may affect the success of reintroduction has yet to be established. It seems crucial to monitor the level of Eimeria spp. invasion, and the proposed faecal sampling scheme is an important tool for achieving this goal.

Introduction: Diabetes screening traditionally occurs in primary care settings, but many who are at high risk face barriers to accessing care and therefore delays in diagnosis and treatment. These same high-risk patients do frequently visit emergency departments (ED) and, therefore, might benefit from screening at that time. Our objective in this study was to analyze one year of results from a multisite, ED-based diabetes screening program.Methods: We assessed the demographics of patients screened, identified differences in rates of newly diagnosed diabetes by clinical site, and the geographic distribution of high and low hemoglobin A1c (HbA1c) results.Results: We performed diabetes screening (HbA1c) among 4,211 ED patients 40–70 years old, with a body mass index ≥25, and no prior history of diabetes. Of these patients screened for diabetes, 9% had a HbA1c result consistent with undiagnosed diabetes, and nearly half of these patients had a HbA1c ≥9.0%. Rates of newly diagnosed diabetes were notably higher at EDs located in neighborhoods of lower socioeconomic status.Conclusion: Emergency department-based diabetes screening may be a practical and scalable solution to screen high-risk patients and reduce health disparities experienced in specific neighborhoods and demographic groups.

Case Presentation: We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein.Discussion: Central venous access is a frequently used procedure by emergency physicians for a variety of indications. Emergency physicians must be facile with both the technical process of central venous catheter placement, as well as possible pitfalls and complications of the procedure. Common complications, such as bleeding, pneumothorax, arterial injury, infection, and hematomas, are usually well known; less frequently encountered is malposition of the catheter despite seemingly appropriate placement.

Introduction: Diabetes screening traditionally occurs in primary care settings, but many who are at high risk face barriers to accessing care and therefore delays in diagnosis and treatment. These same high-risk patients do frequently visit emergency departments (ED) and, therefore, might benefit from screening at that time. Our objective in this study was to analyze one year of results from a multisite, ED-based diabetes screening program. Methods: We assessed the demographics of patients screened, identified differences in rates of newly diagnosed diabetes by clinical site, and the geographic distribution of high and low hemoglobin A1c (HbA1c) results. Results: We performed diabetes screening (HbA1c) among 4,211 ED patients 40–70 years old, with a body mass index ≥25, and no prior history of diabetes. Of these patients screened for diabetes, 9% had a HbA1c result consistent with undiagnosed diabetes, and nearly half of these patients had a HbA1c ≥9.0%. Rates of newly diagnosed diabetes were notably higher at EDs located in neighborhoods of lower socioeconomic status. Conclusion: Emergency department-based diabetes screening may be a practical and scalable solution to screen high-risk patients and reduce health disparities experienced in specific neighborhoods and demographic groups.

Introduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement.Methods: This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as >4 liters per minute) and mechanical ventilation among admitted patients and bounceback admissions among discharged patients. We also performed logistic regression and compared the performance of different ambulatory oxygen saturation cutoffs in predicting these outcomes.Results: Between March 15–April 14, 2020, 6194 patients presented with fever, cough, or shortness of breath at our EDs. Of these patients, 648 (11%) had a documented ambulatory oxygen saturation, of which 165 (24%) were admitted. Notably, admitted and discharged patients had similar initial vital signs. However, the average ambulatory oxygen saturation among admitted patients was significantly lower at 89% compared to 96% among discharged patients (p

Background: In December 2019 the coronavirus disease of 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, was identified in Wuhan, China. In the ensuing months, the COVID-19 pandemic has spread globally and case load is exponentially increasing across the United States. Emergency departments  have adopted screening and triage procedures to identify potential cases and isolate them during evaluation.Case Presentation: We describe a case of COVID-19 pneumonia requiring hospitalization that presented with fever and extensive rash as the primary presenting symptoms. Rash has only been rarely reported in COVID-19 patients, and has not been previously described.

Introduction: Emergency department (ED) patient care often hinges on the result of a diagnostic test. Frequently there is a lag time between a test result becoming available for review and physician decision-making or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch- push notification. We hypothesized this would reduce the time from result to clinical decision-making.Methods: We retrospectively assessed the impact of the implementation of a push notification system at three EDs on time-to-disposition or time-to-follow-up order in six clinical scenarios of interest: chest radiograph (CXR) to disposition, basic metabolic panel (BMP) to disposition, urinalysis (UA) to disposition, respiratory pathogen panel (RPP) to disposition, hemoglobin (Hb) to blood transfusion order, and abnormal D-dimer to computed tomography pulmonary angiography (CTPA) order. All ED patients during a one-year period of push-notification availability were included in the study. The primary outcome was median time in each scenario from result availability to either disposition order or defined follow-up order. The secondary outcome was the overall usage rate of the opt-in push notification system by providers.Results: During the study period there were 6115 push notifications from 4183 ED encounters (2.7% of all encounters). Of the six clinical scenarios examined in this study, five were associated with a decrease in median time from test result availability to patient disposition or follow-up order when push notifications were employed: CXR to disposition, 80 minutes (interquartile range [IQR] 32-162 minutes) vs 56 minutes (IQR 18-141 minutes), difference 24 minutes (p

Case Presentation: We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein. Discussion: Central venous access is a frequently used procedure by emergency physicians for a variety of indications. Emergency physicians must be facile with both the technical process of central venous catheter placement, as well as possible pitfalls and complications of the procedure. Common complications, such as bleeding, pneumothorax, arterial injury, infection, and hematomas, are usually well known; less frequently encountered is malposition of the catheter despite seemingly appropriate placement.

Case Presentation: We describe a case of persistent odynophagia due to a retained foreign body 27 days after emergent intubation. Discussion: Dentures constitute a potential esophageal foreign body and warrant special consideration during airway management. Odynophagia, dysphagia, and changes in phonation should prompt consideration of retained esophageal foreign bodies, especially in the post-intubation setting. [ABSTRACT FROM AUTHOR]

(1) Background: The blood-feeding mite Dermanyssus gallinae (De Geer 1778) continues to attract wide interest from researchers and bird breeders. The aim of this study was to evaluate the genetic diversity of D. gallinae populations in five commercial laying hen farms in Poland and to determine their similarity with isolates from other countries. The study involved an analysis of a fragment of the cytochrome c oxidase subunit I gene (COI). A total of 38 isolates obtained from Polish farms and 338 sequences deposited in GenBank were analyzed. (2) Results: Haplotype No. 46 was dominant (90%) in Polish isolates and was homologous with the isolates from Great Britain, the Netherlands, Belgium, Japan, and South Korea. These results are indicative of high genetic homogeneity and common ancestry of the poultry red mite and point to a common source of infestation in the examined farms. (3) Conclusions: The genetic diversity of D. gallinae should be further studied to promote a better understanding of how this parasite is disseminated within and between countries.

Introduction: It is difficult to determine illness severity for coronavirus disease 2019 (COVID-19) patients, especially among stable-appearing emergency department (ED) patients. We evaluated patient outcomes among ED patients with a documented ambulatory oxygen saturation measurement. Methods: This was a retrospective chart review of ED patients seen at New York University Langone Health during the peak of the COVID-19 pandemic in New York City. We identified ED patients who had a documented ambulatory oxygen saturation. We studied the outcomes of high oxygen requirement (defined as >4 liters per minute) and mechanical ventilation among admitted patients and bounceback admissions among discharged patients. We also performed logistic regression and compared the performance of different ambulatory oxygen saturation cutoffs in predicting these outcomes. Results: Between March 15–April 14, 2020, 6194 patients presented with fever, cough, or shortness of breath at our EDs. Of these patients, 648 (11%) had a documented ambulatory oxygen saturation, of which 165 (24%) were admitted. Notably, admitted and discharged patients had similar initial vital signs. However, the average ambulatory oxygen saturation among admitted patients was significantly lower at 89% compared to 96% among discharged patients (p

Background: In December 2019 the coronavirus disease of 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, was identified in Wuhan, China. In the ensuing months, the COVID-19 pandemic has spread globally and case load is exponentially increasing across the United States. Emergency departments have adopted screening and triage procedures to identify potential cases and isolate them during evaluation. Case Presentation: We describe a case of COVID-19 pneumonia requiring hospitalization that presented with fever and extensive rash as the primary presenting symptoms. Rash has only been rarely reported in COVID-19 patients, and has not been previously described.

Objectives Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level.Design We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York’s rural Sullivan County.Setting Sullivan County, a rural county ranked second-to-last for health outcomes in New York State.Participants Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017–2018 or had at least one ED visit in 2011–2015.Outcome measures We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas.Results Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011–2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23–0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses.Conclusions For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.

Introduction: Emergency department (ED) patient care often hinges on the result of a diagnostic test. Frequently there is a lag time between a test result becoming available for review and physician decision-making or disposition based on that result. We implemented a system that electronically alerts ED providers when test results are available for review via a smartphone- and smartwatch-push notification. We hypothesized this would reduce the time from result to clinical decision-making. Methods: We retrospectively assessed the impact of the implementation of a push notification system at three EDs on time-to-disposition or time-to-follow-up order in six clinical scenarios of interest: chest radiograph (CXR) to disposition, basic metabolic panel (BMP) to disposition, urinalysis (UA) to disposition, respiratory pathogen panel (RPP) to disposition, hemoglobin (Hb) to blood transfusion order, and abnormal D-dimer to computed tomography pulmonary angiography (CTPA) order. All ED patients during a one-year period of push-notification availability were included in the study. The primary outcome was median time in each scenario from result availability to either disposition order or defined follow-up order. The secondary outcome was the overall usage rate of the opt-in push notification system by providers. Results: During the study period there were 6115 push notifications from 4183 ED encounters (2.7% of all encounters). Of the six clinical scenarios examined in this study, five were associated with a decrease in median time from test result availability to patient disposition or follow-up order when push notifications were employed: CXR to disposition, 80 minutes (interquartile range [IQR] 32–162 minutes) vs 56 minutes (IQR 18–141 minutes), difference 24 minutes (p

With growing populations, economic pressures, and the need for sustainable practices, many urban regions are rapidly densifying developments in the vertical built dimension with mid- and high-rise buildings. The location of these buildings can be projected based on key factors that are attractive to urban planners, developers, and potential buyers. Current research in this area includes various modelling approaches, such as cellular automata and agent-based modelling, but the results are mostly linked to raster grids as the smallest spatial units that operate in two spatial dimensions. Therefore, the objective of this research is to develop a geospatial model that operates on irregular spatial tessellations to model mid- and high-rise buildings in three spatial dimensions (3D). The proposed model is based on the integration of GIS, fuzzy multi-criteria evaluation (MCE), and 3D GIS-based procedural modelling. Part of the City of Surrey, within the Metro Vancouver Region, Canada, has been used to present the simulations of the generated 3D building objects. The proposed 3D modelling approach was developed using ESRI’s CityEngine software and the Computer Generated Architecture (CGA) language.

(1) Background: Dermanyssus gallinae, a hematophagous ectoparasite, adversely affects the health status of laying hens, leading to reduced egg production and significant economic losses in commercial farms. The aim of this study was to determine the effect of D. gallinae on the development of post-vaccination immune responses in layer hens. (2) Methods: A total of 80 blood samples were collected at four time-points (B1–B4) from 10 Hy-Line Brown hens, randomly selected from a commercial layer farm. The flock was naturally infested with D. gallinae and treated twice with Biobeck PA 910 (AI silicon dioxide). The samples were collected before and after each treatment. The percentages of IgM+ B cells, CD3+/CD4+ T cells and CD3+/CD8a+ T cells were determined by flow cytometry; the titres of antibodies against avian encephalomyelitis, infectious bronchitis virus, Newcastle disease virus, Ornithobacterium rhinotracheale, reticuloendotheliosis virus and avian reovirus were determined by the immunoenzymatic method. (3) Results: The percentage of Th cells and post-vaccination anti-IBV and anti-NDV antibodies decreased significantly at the second infestation peak when the number of parasites was twice higher than at the first infestation peak. Non-significant negative correlations were found between the number of mites and the percentage of B cells (R = −0.845, p > 0.05) and between the number of mites and the percentage of Th cells (R = −0.522, p > 0.05), and a significant positive correlation was noted between the number of mites and the percentage of Tc cells (R = −0.982, p < 0.05). There were non-significant correlations between the number of mites and antibody titres. (4) Conclusion: The present findings suggested that D. gallinae might inhibit immune responses since the percentages of B cells and Th cells were negatively correlated with the number of mites. The percentage of Tc cells was positively correlated with the number of mites, which indicated that D. gallinae could stimulate cellular immune responses in infested laying hens. However, further research is needed to determine whether D. gallinae suppresses the production of vaccine-induced antibodies.

Recent years have witnessed an increase in the mortality of honey bees in many regions of the world. The observed decrease in the bee population results from a combination of factors, and microsporidian parasites Nosema apis and N. ceranae are among the main contributors. Those parasites cause a microsporidian infection that shortens the lifespan of bees and reduces the productivity of bee colonies. The aim of this study was to evaluate the effectiveness of Nozevit, Api Herb and ApiX (acetylsalicylic acid + Artemisia absinthium L. extract) in the control of infections caused by Nosema spp. in a field experiment. Two groups of worker bees were evaluated - hive bees and forager bees returning to the hive. The effect of the analyzed therapies on the number of spores and the microsporidia species were analyzed by the hemocytometric method and duplex PCR. A statistical analysis revealed that the applied treatments had reduced the number of spores by 31.15% on average. In hive bees, Nosema spp. infection was most effectively reduced by Nozevit (67.85%) and ApiX (63.36%). Coinfections (N. ceranae and N. apis) were affirmed in all bee samples before treatments. However, after the treatments, single infection of N. apis and N. ceranae were detected. The tested treatments were more effective in the control of N. apis than N. ceranae.