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Background: This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives., Research Question: Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine?, Study Design and Methods: We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels., Results: A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM_240216/INFO)., Interpretation: Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: S. H. O. reports a relationship with Danish Society for Ultrasound in General Practice that includes travel reimbursement, and a relationship with USabcd that includes speaking and lecture fees. M. D. A. reports relationships with the Danish Society for Ultrasound in General Practice and the Danish Emergency Medical Conference 10 (DEMC10) that include travel reimbursement. J. W. reports a relationship with DEMC10 that includes travel reimbursement. I. W. Y. M. reports a relationship with Research Chair, the John A. Buchanan Chair in General Internal Medicine, University of Calgary that includes funding grants, relationships with the 3rd Vice President of the American Institute of Ultrasound in Medicine and with the Governor, Alberta Chapter, American College of Physicians that include board membership, and relationships with American College of Physicians, the American Institute of Ultrasound in Medicine, Cornell University, University of Alberta, Sonography Canada, the Canadian Society of Internal Medicine, the Canadian Thoracic Society, American Society of Regional Anesthesia and Pain Medicine, the International Pediatric Nephrology Association, and the Canadian Rheumatology Ultrasound Society that include: speaking and lecture fees. None declared (A. H. C., H. K., B. L., R. A., M. H. L., A. H. K., M. B. C., C. F., L. T., A. R., R. L., J. D.)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR ( p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard ( p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.

Introduction: This study aimed to quantify the contribution of various obstacles to timely reperfusion therapy in acute ST-elevation myocardial infarction (STEMI) and to improve performance in a mixed remote rural/urban region., Methods: From November 1, 2020 to April 23, 2021, patients with acute STEMI were prospectively monitored with the critical time intervals, treatment modalities, and outcomes registered. Selected clinical decision-makers in 11 hospitals were appointed as improvement agents and systematically provided with weekly updated information about absolute and relative performance. Suggestions for improvements were invited and shared., Results: Only 29% of the 146 patients received reperfusion therapy within recommended time limits [prehospital thrombolysis, 2/48; in-hospital thrombolysis, 0/20; primary percutaneous coronary intervention (pPCI), 37/68, with median intervals from the first medical contact of 44, 49, and 133 min, respectively]. Efficiency varied considerably between health trusts: median time from the first medical contact to prehospital thrombolysis ranged from 29 to 54 min (hazard ratio 4.89). The predominant, remediable causes for delays were erroneous tactical choices and protracted electrocardiographic diagnostication, decision-making, and administration of fibrinolytic medication. During the trial, the time to pPCI was non-significantly reduced., Conclusion: We found several targets for system improvements in order to mitigate reperfusion delays along the entire chain of care, regardless of reperfusion modality chosen. More patients should receive prehospital thrombolysis. The most important measures will be training to ensure a more efficient on-site workflow, improved protocols and infrastructure facilitating the communication between first responders and in-hospital clinicians, and education emphasizing prehospital transport times., Clinical Trials Identifier: NCT04614805., (© 2022. The Author(s).)

The nutritional supplement (NS) industry is one of the fastest growing in the world, and NS use in Denmark is among the highest in Europe. However, the exact use in elite athletes and fitness customers targeted for doping control is unknown. Information from 634 doping control forms obtained in 2014 was evaluated (elite athletes: n = 361; fitness customers: n = 273). The majority of female (92.6%) and male (85.0%) elite athletes and female (100.0%) and male (94.0%) fitness customers declared using one or more NS. The use of non-ergogenic NS was more prevalent in women than in men and in younger (15-34 years) compared with older (35-49 years) subjects, but it was less prevalent in intermittent compared with endurance and power/strength sports. Additionally, fitness customers who tested positive for doping also reported using more NS than subjects testing negative, indicating an association between NS and doping abuse. The present results demonstrate a very high prevalence of NS usage in both elite athletes and fitness customers. This highlights the importance of a strong national regulation of NS to avoid contamination of NS with doping substances., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Taking performance-enhancing drugs (PEDs) can cause serious and irreversible health consequences, which can ultimately lead to premature death. Some young people may take PEDs without fully understanding the ramifications of their actions or based on the advice from others. The purpose of this systematic review was to identify the main factors that predicted doping among young people. The literature was systematically reviewed using search engines, manually searching specialist journals, and pearl growing. Fifty-two studies, which included 187,288 young people aged between 10 and 21 years of age, 883 parents of adolescent athletes, and 11 adult coaches, who were interviewed regarding young athletes, were included in this review. Nine factors predicted doping among young people: gender; age; sports participation; sport type; psychological variables; entourage; ethnicity; nutritional supplements; and health harming behaviors. In regards to psychological variables, 22 different constructs were associated with doping among young people. Some psychological constructs were negatively associated with doping (e.g., self-esteem, resisting social pressure, and perfectionist strivings), whereas other were positively associated with doping (e.g., suicide risk, anticipated regret, and aggression). Policy makers and National Anti-Doping Organizations could use these findings to help identify athletes who are more at risk of doping and then expose these individuals to anti-doping education. Based on the current findings, it also appears that education programs should commence at the onset of adolescence or even late childhood, due to the young age in which some individuals start doping.

Introduction: The use of aspirin in patients without cardiovascular disease remains controversial. Patients' understanding of the risks and benefits of aspirin likely contribute to the decision of whether or not to use aspirin regularly. The purpose of this study is to assess patients' knowledge of aspirin and identify factors contributing to regular use., Methods: A survey of U.S. adults aged 45-75 years was performed to ascertain aspirin use and factors that may be associated with use. Multivariate logistic regression was used to identify predictors of current use of aspirin among those with a primary prevention indication. The survey was completed in 2012 with data analysis performed in 2013., Results: Among 2,509 respondents, 52% reported current aspirin use. Among 2,039 respondents without a history of cardiovascular disease, current use of aspirin was 47%. Regular use of aspirin for primary prevention was associated with the presence of major cardiovascular disease risk factors (OR=3.0, 95% CI=2.4, 3.7), high self-assessed knowledge of aspirin (OR=9.1, 95% CI=5.2, 15.7), and having discussed aspirin therapy with a provider (OR=25.9, 95% CI=19.7, 34.1). Several markers of healthy lifestyle choices were also associated with regular use. After multivariate analysis, the strongest independent predictor of regular aspirin use was having discussed aspirin therapy with a provider (OR=23.79, 95% CI=17.8, 31.5)., Conclusions: Approximately half of the nationwide survey of U.S. adults reported regular aspirin use. Among those with a primary prevention indication, having discussed aspirin with a provider was the strongest predictor of regular use., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Childhood obesity prevalence remains high in the U.S., especially among racial/ethnic minorities and low-income populations. Federal policy is important in improving public health given its broad reach. Information is needed about federal policies that could reduce childhood obesity rates and by how much., Purpose: To estimate the impact of three federal policies on childhood obesity prevalence in 2032, after 20 years of implementation., Methods: Criteria were used to select the three following policies to reduce childhood obesity from 26 recommended policies: afterschool physical activity programs, a $0.01/ounce sugar-sweetened beverage (SSB) excise tax, and a ban on child-directed fast food TV advertising. For each policy, the literature was reviewed from January 2000 through July 2012 to find evidence of effectiveness and create average effect sizes. In 2012, a Markov microsimulation model estimated each policy's impact on diet or physical activity, and then BMI, in a simulated school-aged population in 2032., Results: The microsimulation predicted that afterschool physical activity programs would reduce obesity the most among children aged 6-12 years (1.8 percentage points) and the advertising ban would reduce obesity the least (0.9 percentage points). The SSB excise tax would reduce obesity the most among adolescents aged 13-18 years (2.4 percentage points). All three policies would reduce obesity more among blacks and Hispanics than whites, with the SSB excise tax reducing obesity disparities the most., Conclusions: All three policies would reduce childhood obesity prevalence by 2032. However, a national $0.01/ounce SSB excise tax is the best option., (Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Quantifying the spatial variability of factors affecting natural attenuation of hydrocarbons in the unsaturated zone is important to (i) performing a reliable risk assessment and (ii) evaluating the possibility for bioremediation of petroleum-polluted sites. Most studies to date have focused on the shallow unsaturated zone. Based on a data set comprising analysis of about 100 soil samples taken in a 16 m-deep unsaturated zone polluted with volatile petroleum compounds, we statistically and geostatistically analysed values of essential soil properties. The subsurface of the site was highly layered, resulting in an accumulation of pollution within coarse sandy lenses. Air-filled porosity, readily available phosphorous, and the first-order rate constant (k(1)) of benzene obtained from slurry biodegradation experiments were found to depend on geologic sample characterization (P<0.05), while inorganic nitrogen was homogenously distributed across the soil stratigraphy. Semivariogram analysis showed a spatial continuity of 4-8.6 m in the vertical direction, while it was 2-5 times greater in the horizontal direction. Values of k(1) displayed strong spatial autocorrelation. Even so, the soil potential for biodegradation was highly variable, which from autoregressive state-space modeling was partly explained by changes in soil air-filled porosity and gravimetric water content. The results suggest considering biological heterogeneity when evaluating the fate of contaminants in the subsurface., (2010 Elsevier B.V. All rights reserved.)

Modeling gas-phase diffusion of volatile contaminants in the unsaturated zone relies on soil-gas diffusivity models often developed for repacked and structureless soil columns. These suffer from the flaw of not reflecting preferential diffusion through voids and fractures in the soil, thus possibly causing an underestimation of vapor migration towards building foundations and vapor intrusion to indoor environments. We measured the ratio of the gas diffusion coefficient in soil and in free air (D(p)/D(0)) for 42 variously structured, intact, and unsaturated soil cores taken from 6 Danish sites. Whilst the results from structureless fine sand were adequately described using previously proposed models, results that were obtained from glacial clay till and limestone exhibited a dual-porosity behavior. Instead, these data were successfully described using a dual-porosity model for gas-phase diffusivity, considering a presence of drained fractures surrounded by a lower diffusivity matrix. Based on individual model fits, the tortuosity of fractures in till and limestone was found to be highest in samples with a total porosity <40%, suggesting soil compaction to affect the geometry of the fractures. In summary, this study highlights a potential order of magnitude underestimation associated in the use of classical models for prediction of subsurface gas-phase diffusion coefficients in heterogeneous and fractured soils., (2010 Elsevier B.V. All rights reserved.)

Naturally occurring biodegradation of petroleum hydrocarbons in the vadose zone depends on the physical soil environment influencing field-scale gas exchange and pore-scale microbial metabolism. In this study, we evaluated the effect of soil physical heterogeneity on biodegradation of petroleum vapors in a 16-m-deep, layered vadose zone. Soil slurry experiments (soil/water ratio 10:30 w/w, 25°C) on benzene biodegradation under aerobic and well-mixed conditions indicated that the biodegradation potential in different textured soil samples was related to soil type rather than depth, in the order: sandy loam > fine sand > limestone. Similarly, O(2) consumption rates during in situ respiration tests performed at the site were higher in the sandy loam than in the fine sand, although the difference was less significant than in the slurries. Laboratory and field data generally agreed well and suggested a significant potential for aerobic biodegradation, even with nutrient-poor and deep subsurface conditions. In slurries of the sandy loam, the biodegradation potential declined with increasing in situ water saturation (i.e., decreasing air-filled porosity in the field). This showed a relation between antecedent undisturbed field conditions and the slurry biodegradation potential, and suggested airfilled porosity to be a key factor for the intrinsic biodegradation potential in the field.

Context: Most of the many clinical preventive services (CPS) recommended for adolescents by various national organizations lack good evidence of effectiveness. Improving adolescent preventive care will require focusing on those CPS for which there is such evidence and on developing better delivery strategies. The objective of the current study was to identify those CPS for adolescents that do have a strong evidence base, to update the literature review and summarize evidence gaps where research is needed, and to summarize current delivery prevalence and opportunities., Evidence Acquisition: A summary was conducted of the recommendations for adolescents of the U.S. Preventive Services Task Force (USPSTF) and the CDC's Advisory Committee on Immunization Practices (ACIP). An update is provided of the literature review for services with an inadequate evidence base to support a recommendation. A summary was prepared of the types of evidence still needed. A literature search was also conducted for current delivery prevalence of recommended services for those aged 11-17 years, and common gaps in the evidence were identified., Evidence Synthesis: Although 24 CPS for adolescents have been reviewed by the USPSTF, only ten received definite recommendations and only seven of these favored delivery of the service. In addition, the ACIP recommends four immunizations for all adolescents, and two additional ones for those at high risk. There are many gaps in the evidence supporting most of the other services as well as in the information about current delivery prevalence., Conclusions: There are too many CPS recommended for adolescents with insufficient evidence of effectiveness, and there is low delivery prevalence for the few services with good evidence of effectiveness. Both more research and more attention to the practice changes that might improve delivery prevalence are needed.

A survey of systemic treatment with antimicrobial drugs in general medical practice at Holstebro, Jutland, in March 1987 is presented. The two pharmacies of the town recorded all prescriptions to individual patients. The diagnoses were recorded by questionnaire, which was returned by all involved physicians. A total of 969 persons, equivalent to 2.4 per cent of the population and 5.7 per cent of all Health Service contributions, were treated: 39% for upper and 18% for lower respiratory infection, 18% for urogenital infection and 7% for skin infection. 6% were recorded under "miscellaneous". In 12% of the cases no diagnosis was stated. 48% were treated with V-penicillin, 20% with ampicillin, 17% with erythromycin and 3% with tetracycline. The investigation shows a tendency towards less than optimal strategies as regards infections of the respiratory passages and the urinary system. Too often a "wide-spectrum therapy" was chosen. This choice meant a prolonged term of treatment and larger day-and-night doses leading to unnecessary expense. Short-term treatment of uncomplicated infection of the urinary system and otitis media were not recorded.