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Audience:This scenario was developed to educate emergency medicine residents on the diagnosis and management of patients with an inhalational airway injury secondary to a house fire. Background: Burn injuries are a common occurrence encountered by the emergency physician. According to the National Hospital Ambulatory Medical Care Survey, around 371,000 patients were treated in emergency departments for fire or burn injuries across the United States in 2020. This represents around 1% of emergency department visits related to injury, poisoning, or adverse effects.1 One of the most dangerous and time critical aspects of managing severely burned patients is inhalation injury. Inhalation injury is a relatively vague term which may refer to pulmonary exposure to a wide range of chemicals in various forms. In the context of burn patients, this is most often smoke exposure. It is critical that the emergency medicine provider rapidly identifies the potential for an inhalational injury in order to determine the need for definitive airway management. It is also important that the provider has the necessary skills and systematic approach to manage what is likely to be a difficult airway. Furthermore, providers must then have the knowledge of how to best manage and resuscitate these severely burned patients post-intubation. Educational Objectives:At the conclusion of the simulation session, learners will be able to: 1) recognize the indications for intubation in a thermal burn/inhalation injury patient; 2) develop a systematic approach to an inhalational injury airway; and 3) recognize indications for transfer to burn center. Educational Methods: This session was conducted using high-fidelity simulation, followed by a debriefing session and lecture on the diagnosis, differential diagnosis, and management of inhalational airway injury secondary to a house fire. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This scenario may also be run as an oral board case. Research Methods: Our residents are provided a survey at the completion of the debriefing session so they may rate different aspects of the simulation, as well as provide qualitative feedback on the scenario. The local institution’s simulation center’s electronic feedback form is based on the Center of Medical Simulation’s Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form2with the inclusion of required qualitative feedback if an element was scored less than a 6 or 7. Results: Nine learners completed a feedback form. This session received all 6 & 7 scores (consistently effective/very good and extremely effective/outstanding, respectively) other than one isolated 5 score. Discussion: This is a cost-effective method for reviewing inhalational airway injury diagnosis and management. The case may be modified for targeted audiences, expected resources, and learning objectives, such as removal of a bronchoscope availability in settings which are expected to be resource-limited. Some readers may choose to focus on other aspects of burn management instead of airway securement such as cyanide and/or carbon monoxide toxicity. We encourage readers to limit the number of learning objectives because airway algorithms and troubleshooting for this scenario was a rich, stand-alone debriefing. There was not enough time to review in detail all nuanced aspects of the burned patient, including: Lund-Browder versus rule of 9’s, modified Brooke versus Parkland formulas, indications for and completion of escharotomies, and/or identification and treatment of cyanide and carbon monoxide toxicity. Topics: Medical simulation, burns, airway emergencies, emergency medicine.

Introduction: Endophthalmitis is a rare intraocular infection caused by numerous organisms from several possible sources. Fungal endophthalmitis is a rare subset of this pathology with limited diagnostics available. One of the few options to make this diagnosis is vitreous sampling, which is invasive, and results are not immediately available.Case Report: This case report describes the successful use of point-of-care ultrasound to visualize an intraocular fungal mass in a 60-year-old male who presented to the emergency department (ED) with two weeks of left eye pain and erythema approximately two months postoperative from a cataract extraction surgery.Conclusion: Fungal endophthalmitis is a rare and challenging diagnosis. Methods of diagnosing this pathology are not readily available in the ED. Point-of-care ultrasound may be a useful adjunct for the prompt diagnosis of fungal endophthalmitis.

Abstract Background Indonesian peatlands have been drained for agricultural development for several decades. This development has made a major contribution to economic development. At the same time, peatland drainage is causing significant air pollution resulting from peatland fires. Peatland fires occur every year, even though their extent is much larger in dry (El Niño) years. We examine the health effects of long-term exposure to fine particles (PM2.5) from all types of peatland fires (including the burning of above and below ground biomass) in Sumatra and Kalimantan, where most peatland fires in Indonesia take place. Methods We derive PM2.5 concentrations from satellite imagery calibrated and validated with Indonesian Government data on air pollution, and link increases in these concentrations to peatland fires, as observed in satellite imagery. Subsequently, we apply available epidemiological studies to relate PM2.5 exposure to a range of health outcomes. The model utilizes the age distribution and disease prevalence of the impacted population. Results We find that PM2.5 air pollution from peatland fires, causes, on average, around 33,100 adults and 2900 infants to die prematurely each year from air pollution. In addition, peatland fires cause on average around 4390 additional hospitalizations related to respiratory diseases, 635,000 severe cases of asthma in children, and 8.9 million lost workdays. The majority of these impacts occur in Sumatra because of its much higher population density compared to Kalimantan. A main source of uncertainty is in the Concentration Response Functions (CRFs) that we use, with different CRFs leading to annual premature adult mortality ranging from 19,900 to 64,800 deaths. Currently, the population of both regions is relatively young. With aging of the population over time, vulnerabilities to air pollution and health effects from peatland fires will increase. Conclusions Peatland fire health impacts provide a further argument to combat fires in peatlands, and gradually transition to peatland management models that do not require drainage and are therefore not prone to fire risks.

Este artigo busca contribuir com os estudos sobre práticas investigativas para o Ensino Médio. A pesquisa se vale de análises bibliográficas para a produção de uma Sequência de Ensino Investigativa (SEI) com atividades interdisciplinares e contextualizadas sobre recursos hídricos. Os estudantes participantes eram de uma escola pública da rede estadual do Rio Grande do Sul. Para compreender o envolvimento nas atividades e as ideias dos estudantes sobre a SEI, aplicou-se um questionário. Dentre os principais resultados, destaca-se que os estudantes valorizam as práticas de ensino que relacionam os conceitos científicos à sua realidade, construindo aprendizagens mais significativas quando se envolvem ativamente na aprendizagem. As opiniões dos estudantes revelam que as abordagens interdisciplinares dão maior significado aos conteúdos porque rompe-se com a visão fragmentada do conhecimento, partindo para uma interpretação integral dos fenômenos e situações reais.

It is well documented that young children need social Interaction, self-determination, and play to learn. But in the time of the COVID-19 pandemic, how does that translate to online learning? Psychologist and professor Wendy Ostroff suggests strategies and tips for engaging our youngest learners remotely.

Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

ABSTRACT: Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was designed to educate our emergency medicine (EM) residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2013, chest pain alone was the principal reason for visit for over 6 million Emergency Department visits in the United States. This represents 4.9% of all Emergency Department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of cardiovascular emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University Wexner Medical Center EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,11,13Aims/Goals: We aim to teach the presentation and management of cardiovascular emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents. Methods: The educational strategies used in this curriculum include small group modules authored by education faculty and content experts based on the core emergency medicine content. This program also includes resident-submitted questions that were developed during review of the content. The question and answer format of the Socratic Method--with a focus on fostering an open learning environment, not negative “pimping”-type questionin--is used during small group sessions to encourage active participation and discussion; small groups also focus on the synthesis and application of knowledge through the discussion of real life experiences. The use of free open access medical education (FOAM) resources allows learners to work at their own pace and maximize autonomy. Topics: Emergency medicine, flipped classroom, medical education, cardiovascular emergencies, pedagogy, teaching.

BackgroundStudies have reported associations between long-term air pollution exposures and cardiovascular mortality. The biological mechanisms connecting them remain uncertain.MethodsWe examined associations of fine particles (PM2.5) and ozone with serum markers of cardiovascular disease risk in a cohort of midlife women. We obtained information from women enrolled at six sites in the multi-ethnic, longitudinal Study of Women's Health Across the Nation, including repeated measurements of high-sensitivity C-reactive protein, fibrinogen, tissue-type plasminogen activator antigen, plasminogen activator inhibitor type 1, and factor VIIc (factor VII coagulant activity). We obtained residence-proximate PM2.5 and ozone monitoring data for a maximum five annual visits, calculating prior year, 6-month, 1-month, and 1-day exposures and their relations to serum markers using longitudinal mixed models.ResultsFor the 2,086 women studied from 1999 to 2004, PM2.5 exposures were associated with all blood markers except factor VIIc after adjusting for age, race/ethnicity, education, site, body mass index, smoking, and recent alcohol use. Adjusted associations were strongest for prior year exposures for high-sensitivity C-reactive protein (21% increase per 10 μg/m³ PM2.5, 95% confidence interval [CI]: 6.6, 37), tissue-type plasminogen activator antigen (8.6%, 95% CI: 1.8, 16), and plasminogen activator inhibitor (35%, 95% CI: 19, 53). An association was also observed between year prior ozone exposure and factor VIIc (5.7% increase per 10 ppb ozone, 95% CI: 2.9, 8.5).ConclusionsOur findings suggest that prior year exposures to PM2.5 and ozone are associated with adverse effects on inflammatory and hemostatic pathways for cardiovascular outcomes in midlife women.

BackgroundAlthough several cohort studies report associations between chronic exposure to fine particles (PM2.5) and mortality, few have studied the effects of chronic exposure to ultrafine (UF) particles. In addition, few studies have estimated the effects of the constituents of either PM2.5 or UF particles.MethodsWe used a statewide cohort of > 100,000 women from the California Teachers Study who were followed from 2001 through 2007. Exposure data at the residential level were provided by a chemical transport model that computed pollutant concentrations from > 900 sources in California. Besides particle mass, monthly concentrations of 11 species and 8 sources or primary particles were generated at 4-km grids. We used a Cox proportional hazards model to estimate the association between the pollutants and all-cause, cardiovascular, ischemic heart disease (IHD), and respiratory mortality.ResultsWe observed statistically significant (p < 0.05) associations of IHD with PM2.5 mass, nitrate, elemental carbon (EC), copper (Cu), and secondary organics and the sources gas- and diesel-fueled vehicles, meat cooking, and high-sulfur fuel combustion. The hazard ratio estimate of 1.19 (95% CI: 1.08, 1.31) for IHD in association with a 10-μg/m3 increase in PM2.5 is consistent with findings from the American Cancer Society cohort. We also observed significant positive associations between IHD and several UF components including EC, Cu, metals, and mobile sources.ConclusionsUsing an emissions-based model with a 4-km spatial scale, we observed significant positive associations between IHD mortality and both fine and ultrafine particle species and sources. Our results suggest that the exposure model effectively measured local exposures and facilitated the examination of the relative toxicity of particle species.

BackgroundSeveral cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated.MethodsWe investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3mg/l, a level of clinical significance.ResultsWe found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m(3) increase in annual PM2.5 more than doubled the risk of CRP greater than 3mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol.ConclusionsIn this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.

Advance Illinois is an independent, objective voice for a healthy public education system that prepares all students in Illinois for success in college, careers, and civic life. Advocacy efforts have focused on securing equitable funding for schools, Common Core State Standards, high-quality assessments, and teacher quality efforts. As advocates for the building blocks of Illinois's education system, Advance Illinois saw Every Student Succeeds Act's (ESSA's) passage as a generational opportunity to develop a more robust, refined accountability system and improve results for students--especially students of color and low income students--and to ensure that the state's system of supports and assistance truly helps struggling schools. Advance Illinois saw ESSA as a new day for education, and an opportunity to evaluate schools fairly by uncovering true academic growth and reinforcing the belief that all students can learn. With ESSA, the state could develop new mechanisms to assist schools and lift achievement for every student. Illinois State Board of Education's (ISBE) final ESSA plan ultimately adopted many of the recommendations proposed by Advance Illinois and the array of partners that came together through the P-20 Council, Illinois Balanced Accountability Measures (IBAM), and ISBE meetings. Yet all agreed the work was not over when the plan was submitted. The partnership, trust, and working relationships built during the ESSA planning process will be the foundation for work going forward as the plan is refined and implementation begins.

We determine the three-dimensional shape of near-Earth Asteroid (101955) Bennu based on radar images and optical lightcurves. Bennu was observed both in 1999 at its discovery apparition, and in 2005 using the 12.6-cm radar at the Arecibo Observatory and the 3.5-cm radar at the Goldstone tracking station. Data obtained in both apparitions were used to construct a shape model of this object. Observations were also obtained at many other wavelengths to characterize this object, some of which were used to further constrain the shape modeling. The lightcurve data, along with an initial determination of the rotation period derived from them, simplified and improved the shape modeling.Below we briefly describe the observations and shape modeling process. We discuss the shape model and the implications for the possible formation and evolution of this object. We also describe the importance and limitations of the shape model in view of the fact that this object is the target of the OSIRIS-REx spacecraft mission. © 2013 Elsevier Inc.

We observed the near-Earth ASTEROID 2008 EV5 with the Arecibo and Goldstone planetary radars and the Very Long Baseline Array during December 2008. EV5 rotates retrograde and its overall shape is a 400 ± 50 m oblate spheroid. The most prominent surface feature is a ridge parallel to the asteroid's equator that is broken by a concavity about 150. m in diameter. Otherwise the asteroid's surface is notably smooth on decameter scales. EV5's radar and optical albedos are consistent with either rocky or stony-iron composition. The equatorial ridge is similar to structure seen on the rubble-pile near-Earth asteroid (66391) 1999 KW4 and is consistent with YORP spin-up reconfiguring the asteroid in the past. We interpret the concavity as an impact crater. Shaking during the impact and later regolith redistribution may have erased smaller features, explaining the general lack of decameter-scale surface structure. © 2011 Elsevier Inc.

Several investigators have documented the effect of temperature on mortality, although fewer have studied its impact on morbidity. In addition, little is known about the effectiveness of mitigation strategies such as use of air conditioners (AC). We investigated the association between temperatures and hospital admissions in California from 1999 to 2005. We also determined whether AC ownership and usage, assessed at the zip code level, mitigates this association. Because of the unique spatial pattern of income and climate in the state, confounding of AC effects by other local factors is less likely. We only included individuals who had a temperature monitor within 25 kilometers of their residential zip codes. Using a time-stratified case-crossover approach, we observed a significantly increased risk for hospitalization for multiple diseases including cardiovascular, ischemic heart disease, ischemic stroke, respiratory disease, pneumonia, dehydration, heat stroke, diabetes and acute renal failure with same-day apparent temperature. We also found that ownership and usage of air conditioning significantly reduced the effects of temperature on these health outcomes, after controlling for the potential confounding effects of family income and other socioeconomic factors. Our results demonstrate important effects of temperature on public health and the potential for mitigation.Several investigators have documented the acute effect of temperature on mortality in the U.S. and Europe, and in developing nations(1-3). There are far fewer studies, however, on the effects of temperature on morbidity outcomes, such as hospitalizations (4-6). According to the recent IPCC report (7), temperatures are expected to increase in the future with more frequent and severe heat waves. Therefore, it is important to obtain a better understanding of these heat-associated health risks and susceptible populations for future surveillance and targeted interventions. In addition, relatively little is known about the effectiveness of proposed mitigation strategies, such as cooling shelters, and personal use of air conditioners (AC). Studies on the effects of actual AC use on temperature-related health outcomes, however, are limited, since data are typically available for AC prevalence, rather than AC use, and only for broad geographic regions. Thus, effects of AC may be confounded by other regional characteristics (8) such as demographic and economic factors. As a result, there is need for more localized estimates of the effects of temperature on morbidity and on the effectiveness of AC use in mitigating these effects.For several reasons, California serves as an ideal study area for examining the effects of AC use on temperature-related adverse health. First, it includes a large and diverse population, residing within a wide array of climatic regions. Second, individual-level data at small levels of spatial scale over a majority of the state are available from surveys conducted by the California Public Utilities Commission (9). Finally, income is less likely to confound the estimates of the effects of AC. In general, incomes are higher in the coastal regions, but lower in the inland areas, such as the Central Valley. However, AC use is greater in the Central Valley where the summers are much hotter, and many homes in the coastal areas of California lack AC (9). In this study, we used temperature data during the warm season in California to estimate the impact on several disease-specific categories of hospitalizations. To limit exposure misclassification, we limited our study to buffer areas with individuals living in zip codes within 25 kilometers (km) of a temperature monitor. Next, we quantified the likely reduction in health impacts based on both ownership and use of ACs using individual-level data for each buffer. Finally, we examined the potential confounding effect that local measures of family income may have on our effect estimates.