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Introduction: Seizures are a common presenting complaint and account for approximately 1% of total emergency department (ED) visits. Seizures are especially common in children less than five years old as they have a lower seizure threshold as compared to adults. One potentially dangerous etiology that is far less common, especially in children, is thyroid storm, the extreme manifestationof hyperthyroidism.Case Report: We describe the case of a 3-year-old girl who presented to the ED with an afebrile seizure but was found to be in thyroid storm. This case should serve as a reminder for emergency physicians to consider thyroid disease when evaluating patients presenting with seizures.Conclusion: Although most pediatric seizures are self-limited and frequently benign, it is imperative that the emergency physician evaluate for and rule out any potentially associated dangerous conditions such as thyroid storm.

The prevalence of urinary stone disease (USD) is rapidly rising. However, the factors driving this increase are unknown. Recent microbiome studies suggest that dysbiosis may in part contribute to the increasing prevalence. The objective of the current study was to determine the nature and location of dysbiosis associated with USD. We conducted microbiome analysis from the gastrointestinal and urinary tracts, along with a metabolomic analysis of the urinary metabolome, from subjects with an active episode of USD or no history of the disease. Higher rates of antibiotic use among USD patients along with integrated microbiome and metabolomic results support the hypothesis that USD is associated with an antibiotic-driven shift in the microbiome from one that protects against USD to one that promotes the disease. Specifically, our study implicates urinary tract Lactobacillus and Enterobacteriaceae in protective and pathogenic roles for USD, respectively, which conventional, culture-based methods of bacterial analysis from urine and kidney stones would not necessarily detect. Results suggest that antibiotics produce a long-term shift in the microbiome that may increase the risk for USD, with the urinary tract microbiome holding more relevance for USD than the gut microbiome.

This article has been withdrawn due to an error that caused the article to be duplicated. The definitive version of this article is published under https://doi.org/10.1093/indlaw/dwae020.By Emily RoseReported by Author[email protected] [Extracted from the article]

We analyse household telecommunications spending in Australia over the period 2006–2021 using Household Income and Labour Dynamics in Australia (HILDA) survey data. We find the affordability of telecommunications is improving, and that telecommunications spending behaves like other core necessities, such as food. We find households in which members are not employed, have relatively low education, are elderly, Aboriginal or Torres Strait Islanders or immigrants, speak English poorly, reside alone, or have long‐term health conditions are at heightened risk of digital exclusion due to lower spending on telecommunications. Households located in rural areas, with children or with members that work from home are at higher risk of digital exclusion as a consequence of overspending on telecommunications. Overall, the number of people at risk of digital exclusion from inadequate spending or overspending is quite small in Australia. The risks appear to have decreased during COVID‐19. Telecommunications is a core necessity but given the small number of people at risk of exclusion, policies addressing affordability should be highly targeted. [ABSTRACT FROM AUTHOR]

Introduction: The emergency medicine clerkship curriculum at Los Angeles County + University of Southern California Medical Center includes monthly lectures on pediatric fever and shortness of breath (SOB). This educational innovation evaluated if learning could be enhanced by “priming” the students with educational online videos prior to an in-class session. Factors that impacted completion rates were also evaluated (planned specialty and time given for video viewing).Methods: Twenty minute videos were to be viewed prior to the didactic session. Students were assigned to either the fever or SOB group and received links to those respective videos. All participating students took a pre-test prior to viewing the online lectures. For analysis, test scores were placed into concordant groups (test results on fever questions in the group assigned the fever video and test results on SOB questions in the group assigned the SOB video) and discordant groups (crossover between video assigned and topic tested). Each subject contributed one set of concordant results and one set of discordant results. Descriptive statistics were performed with the Mann-Whitney U test. Lecture links were distributed to students two weeks prior to the in-class session for 7 months and three days prior to the in-class session for 8 months (in which both groups included both EM-bound and non-EM bound students).Results: In the 15 months study period, 64% of students rotating through the EM elective prepared for the in class session by watching the videos. During 10 months where exclusively EM-bound students were rotating (n=144), 71.5% of students viewed the lectures. In 4 months where students were not EM-bound (n=54), 55.6% of students viewed the lectures (p=0.033). Participation was 60.2% when lecture links were given three days in advance and 68.7% when links were given two weeks in advance (p=0.197). In the analysis of concordant scores, the pre-test averaged 56.7% correct, the immediate post-test averaged 78.1% correct, and the delayed post-test was 67.2%. In the discordant groups, the pretest averaged 51.9%, the immediate posttest was 67.1% and the delayed by 68.8%. In the concordant groups, the immediate post-test scores improved by 21.4%, compared with 15.2% in the discordant groups (p = 0.655). In the delayed post-test the concordant scores improved by 10.5% and discordant scores by 16.9 percent (p=0.609). Sixty-two percent of students surveyed preferred the format of online videos with in-class case discussion to a traditional lecture format.Conclusion: Immediate post-tests and delayed post-tests improved but priming was not demonstrated to be a statistically superior educational method in this study. Medical student completion of the preparatory materials for the emergency medicine rotation session increased when the students were emergency medicine-bound. Participation rates were not significantly different when given at 2 weeks versus 3 days.

ABSTRACT Species lacking distinct secondary sex characteristics, such as differences in size or morphology, are often thought to experience lower levels of sex‐specific selection in comparison to highly sexually dimorphic organisms. However, monomorphism in classic visible traits could be a result of genetic or physiological constraints that prevent the sexes from reaching divergent fitness optima. Additionally, biochemical and molecular work have revealed a variety of less easily observed phenotypes that nonetheless exhibit profound dimorphism. Sex‐specific selection could act on these more subtle, less visible, traits. We investigate sex‐specific selection in the polygynandrous dusky pipefish (Syngnathus floridae), which lacks distinct secondary sexual characteristics such as size, colour and morphological dimorphism. Using experimental breeding populations, we revealed that although males and females have similar opportunities for sexual selection, only males experience significant sexual selection pressures on body size. We also investigated patterns of sex‐biased and sex‐specific gene expression in gonads, livers and gills, and tested whether genes with highly divergent expression patterns between the sexes are more likely to be tissue‐specific, and therefore relieved of genetic constraints. Sex bias in gene expression was widespread, although the reproductive organs had the most sex‐biased and sex‐specific genes. Sex‐specific selection on gene expression in gills was primarily related to immune response, whereas the liver and gonads had a wide variety of cellular processes, as well as reproductive proteins, showing sex‐biased expression. These sex‐biased genes showed higher organ‐specificity in their expression patterns, suggesting that pleiotropic constraints might have historically impacted the evolution of sex‐specific expression patterns. Altogether, we find evidence for ongoing and historical sex‐specific selection in the dusky pipefish. [ABSTRACT FROM AUTHOR]

Introduction: Peer review, a cornerstone of academia, promotes rigor and relevance in scientificpublishing. As educators are encouraged to adopt a more scholarly approach to medical education,peer review is becoming increasingly important. Junior educators both receive the reviews of theirpeers, and are also asked to participate as reviewers themselves. As such, it is imperative for juniorclinician educators to be well-versed in the art of peer reviewing their colleagues’ work. In thisarticle, our goal was to identify and summarize key papers that may be helpful for faculty membersinterested in learning more about the peer-review process and how to improve their reviewing skills.Methods: The online discussions of the 2016-17 Academic Life in Emergency Medicine (ALiEM)Faculty Incubator program included a robust discussion about peer review, which highlighted anumber of papers on that topic. We sought to augment this list with further suggestions by guestexperts and by an open call on Twitter for other important papers. Via this process, we created a listof 24 total papers on the topic of peer review. After gathering these papers, our authorship groupengaged in a consensus-building process incorporating Delphi methods to identify the papers thatbest described peer review, and also highlighted important tips for new reviewers.Results: We found and reviewed 24 papers. In our results section, we present our authorshipgroup’s top five most highly rated papers on the topic of peer review. We also summarize thesepapers with respect to their relevance to junior faculty members and to faculty developers.Conclusion: We present five key papers on peer review that can be used for faculty development fornovice writers and reviewers. These papers represent a mix of foundational and explanatory papersthat may provide some basis from which junior faculty members might build upon as they both undergothe peer-review process and act as reviewers in turn.

IntroductionTeam collaboration is an essential part of success both within academics and the clinical environment. Often, team collaboration is not taught during medical school or even residency and must be learned during one’s postgraduate career. In this article, we aim to summarize five key papers about team collaboration for early career clinician educators. MethodsWe conducted a consensus building process amongst the writing team to generate a list of key papers that describe the importance or significance of team collaboration, seeking input from social media sources. The authors then used a three-round voting methodology akin to a Delphi study to determine the most important papers from the general list. ResultsThe five most important papers on the topic of team collaboration, as determined by this mixed group of junior faculty members and faculty developers, is presented in this paper. For each included publication, a summary was provided along with its relevance to junior faculty members and faculty developers. ConclusionFive key papers about team collaboration are presented in this paper. These papers provide a foundational background to help junior faculty members with collaborating in teams both clinically and academically. This list may also inform senior faculty and faculty developers about the needs of junior faculty members.