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Introduction: Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population.Methods: We performed an exhaustively sampled cross-sectional survey of all healthcare facilities providing urgent and emergent care in the four largest cities surrounding Lake Atitlán using the Emergency Services Resource Assessment Tool (ESRAT). Results: Of 17 identified facilities, 16 agreed to participate and were surveyed: nine private hospitals; four public clinics; and three public hospitals, including the region’s public departmental hospital. All facilities provided emergency services 24/7, and a dedicated emergency unit was available at 67% of hospitals and 75% of clinics. A dedicated physician was present in the emergency unit during the day at 67% of hospitals and 75% of clinics. Hospitals had a significantly higher percentage of available equipment compared to clinics (85% vs 54%, mean difference 31%; 95% confidence interval (CI) 23-37%; P = 0.004). There was no difference in availability of laboratory tests between public and private hospitals or between cities. Private hospitals had access to a significantly higher percentage of medications compared to clinics (56% vs 27%, mean difference 29%; 95% CI 9-49%; P = 0.024). Conclusion: We found a high availability of emergency services and universal availability of personal protective equipment but a severe shortage of critical medications in clinics, and widespread shortage of pediatric equipment.

BackgroundNecrotizing meningoencephalitis (NME) in the pug dogs is a fatal neuroinflammatory disease associated with rapid progression and poor response to conventional immunosuppressive therapy. Diagnosis is typically made after severe neurological abnormalities have manifested.Hypothesis/objectivePug dogs at genetic risk for NME might manifest neurological abnormalities before developing pathognomonic clinical signs of NME.AnimalsThirty-six pug dogs less than 4 years of age asymptomatic for NME.MethodsProspective observational cohort study with germline genome-wide genotyping. Neurological examinations were performed 4 weeks apart to document reproducible findings of central nervous system disease. Magnetic resonance imaging, cerebrospinal fluid analysis, and testing for infectious diseases were performed in all pugs with reproducible abnormalities detected on neurological examination.ResultsThe overall risk allele frequency in this cohort was 40%; 5 (14%) dogs were high risk, 19 (53%) dogs were medium risk, and 12 (33%) dogs were low genetic risk for NME. Reproducible abnormalities detected on neurological examination were identified in 8/24 (33%) genetically at-risk dogs and 0/12 (0%) low risk dogs. Clinical abnormalities included multifocal spinal pain in 8/8, reduced menace response in 5/8, and lateralizing postural reaction deficits in 5/8 pugs. There was a strong association between genotype risk and the presence of this clinical phenotype (P = .03).Conclusions and clinical importanceOur findings suggest the presence of a novel early clinical phenotype of NME in apparently asymptomatic genetically at-risk pugs which might be used to plan early diagnostic and therapeutic clinical trials.

Background: Point-of-care ultrasound (POCUS) has an emerging presence in medical student education; however, there is limited evidence that this translates into appropriate clinical care. We aimed to evaluate the ability of medical students to integrate newly obtained POCUS knowledge into simulated clinical cases.Methods: We conducted an observational study of medical students participating in a mandatory rotation during their clinical years. Students in small groups underwent formalized lung POCUS lectures and hands-on training. Students participated in simulated “dyspnea” cases focused on either congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). They were observed for critical actions including elements related to medical decision-making and ultrasound use and interpretation. Ultrasound-specific written knowledge was gauged with a short assessment after the first lecture and at week 4.Results: A total of 62 students participated and were observed during simulations. All groups correctly identified and treated CHF in the simulated case. Most groups (7 out of 9) attempted to use ultrasound in the CHF case; five groups correctly recognized B-lines; and four groups correctly interpreted B-lines as pulmonary edema. No groups used ultrasound in the COPD case.Conclusion: Most students attempted to use ultrasound during simulated CHF cases after a brief didactic intervention; however, many students struggled with clinical application. Interestingly, no students recognized the need to apply ultrasound for diagnosis and management of COPD. Future studies are needed to better understand how to optimize teaching for medical students to improve translation into POCUS skills and improved clinical practice.

Cryptochrome 4a (Cry4a) has been proposed as the sensor at the heart of the magnetic compass in migratory songbirds. Blue-light excitation of this protein produces magnetically sensitive flavin–tryptophan radical pairs whose properties suggest that Cry4a could indeed be suitable as a magnetoreceptor. Here, we use cavity ring-down spectroscopy to measure magnetic field effects on the kinetics of these radical pairs in modified Cry4a proteins from the migratory European robin and from nonmigratory pigeon and chicken. B1/2, a parameter that characterizes the magnetic field-dependence of the reactions, was found to be larger than expected on the basis of hyperfine interactions and to increase with the delay between pump and probe laser pulses. Semiclassical spin dynamics simulations show that this behavior is consistent with a singlet–triplet dephasing (STD) relaxation mechanism. Analysis of the experimental data gives dephasing rate constants, rSTD, in the range 3–6 × 107 s−1. A simple "toy" model due to Maeda, Miura, and Arai [Mol. Phys. 104, 1779–1788 (2006)] is used to shed light on the origin of the time-dependence and the nature of the STD mechanism. Under the conditions of the experiments, STD results in an exponential approach to spin equilibrium at a rate considerably slower than rSTD. We attribute the loss of singlet–triplet coherence to electron hopping between the second and third tryptophans of the electron transfer chain and comment on whether this process could explain differences in the magnetic sensitivity of robin, chicken, and pigeon Cry4a's. [ABSTRACT FROM AUTHOR]

Night-migratory songbirds are remarkably proficient navigators.sup.1. Flying alone and often over great distances, they use various directional cues including, crucially, a light-dependent magnetic compass.sup.2,3. The mechanism of this compass has been suggested to rely on the quantum spin dynamics of photoinduced radical pairs in cryptochrome flavoproteins located in the retinas of the birds.sup.4-7. Here we show that the photochemistry of cryptochrome 4 (CRY4) from the night-migratory European robin (Erithacus rubecula) is magnetically sensitive in vitro, and more so than CRY4 from two non-migratory bird species, chicken (Gallus gallus) and pigeon (Columba livia). Site-specific mutations of ErCRY4 reveal the roles of four successive flavin-tryptophan radical pairs in generating magnetic field effects and in stabilizing potential signalling states in a way that could enable sensing and signalling functions to be independently optimized in night-migratory birds. Cryptochrome 4 from the night-migratory European robin displays magnetically sensitive photochemistry in vitro, in which four successive flavin-tryptophan radical pairs generate magnetic-field effects and stabilize potential signalling states., Author(s): Jingjing Xu [sup.1] , Lauren E. Jarocha [sup.2] , Tilo Zollitsch [sup.2] , Marcin Konowalczyk [sup.3] , Kevin B. Henbest [sup.2] [sup.3] , Sabine Richert [sup.4] , Matthew J. [...]

Introduction: Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution.  Methods: We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images.  Results: Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%.  Conclusion: Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.

Individuals with disabilities are underrepresented in science, technology, engineering, and math (STEM) fields. The purpose of this study was to experimentally evaluate the impact of a STEM mentor intervention and differences between students matched with mentors with or without disabilities on career planning outcomes. An independent groups × repeated measures design was used. Significant differences were found between mentored and nonmentored students for measures of STEM-related knowledge, engagement, confidence, and general career planning confidence, but not for STEM-related and disability-related self-efficacy. Significant differences were not found between students assigned to mentors with or without disabilities. This study contributes to research that demonstrates the positive impact of mentoring on career planning for students with disabilities, including those related to STEM.

Audience and Type of Curriculum: This curriculum is designed for emergency medicine fellows and first-year junior faculty. The curriculum covers core topics related to academic and professional success for an early career faculty member. Length of Curriculum: The curriculum is designed as quarterly sessions over the course of one academic year. Introduction: An increasing number of emergency medicine graduates are pursuing fellowship after completion of residency.1 Fellowship can be challenging as newly minted graduates begin to explore their academic niche, refine their clinical practice, and define their personal and professional spheres. We propose a structured curriculum to help guide fellows and new faculty to mitigate these challenges. Educational Goals: The aim of this curriculum is to develop relevant skills to promote academic success for fellows and first-year faculty at the start of their academic career and which could be completed during a one-year training timeline. We included topics relevant to all fellow and new faculty's expected personal and professional journey during this first year, including time management, academic productivity, resilience/wellness, and developing a national reputation. Educational Methods: The educational strategies used in this curriculum consist primarily of lecture seminars. There is one short individual activity associated with the lectures and one small group discussion. Research Methods: The course was assessed with pre- and post-test surveys following each lecture. Surveys assessed participants' reaction, learning, and behavior for each session. Evaluations were completed based on a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Results: Fifteen participants attended the seminar series encompassing fellows and first-year faculty/postfellows from ten different fellowship subspecialities. Average pre-assessment scores were low for many of the self-reported skills and confidence throughout the seminar series. Overall, participants reported increased confidence on the post-test for each of the seminar topics. In addition, participants reported that they learned new skills and planned to use the new ideas presented. All participants reported they would recommend these seminars to someone else on their same career path. Discussion: Overall, participants reported increased confidence, new skills, and plans to use the ideas presented in the seminar series. The content appears applicable to this learner set since all reported they would recommend the series to others on their career path. In conclusion, we believe our seminar series will build skills for fellows and first-year faculty which will promote academic success. [ABSTRACT FROM AUTHOR]