The Chief Resident Role in Emergency Medicine Residency Programs

Study Objectives: Although other specialties have examined the role of the chief resident (CR), the role and training of the emergency medicine (EM) CR has largely been undefined.Methods: A survey was mailed to all EM CRs and their respective program directors (PD) in 124 EM residency programs. The survey consisted of questions defining demographics, duties of the typical CR, and opinions regarding the level of support and training received. Multiple choice, Likert scale (1 strong agreement, 5 strong disagreement) and short-answer responses were used. We analyzed associations between CR and PD responses using Chi-square, Student’s T and Mann-Whitney U tests.Results: Seventy-six percent of CRs and 65% of PDs responded and were similar except for age (31 vs. 42 years; p<0.001). CR respondents were most often male, in year 3 of training and held the position for 12 months. CRs and PDs agreed that the assigned level of responsibility is appropriate (2.63 vs. 2.73, p=0.15); but CRs underestimate their influence in the residency program (1.94 vs. 2.34, p=0.002) and the emergency department (2.61 vs. 3.03, p=0.002). The majority of CRs (70%) and PDs (77%) report participating in an extramural training program, and those CRs who participated in training felt more prepared for their job duties (2.26 vs. 2.73; p=0.03).Conclusion: EM CRs feel they have appropriate job responsibility but believe they are less influential in program and department administration than PD respondents. Extramural training programs for incoming CRs are widely used and felt to be helpful. [West J Emerg Med. 2010; 11(2):120-125.

Sexual Dimorphisms of Adrenal Steroids, Sex Hormones, and Immunological Biomarkers and Possible Risk Factors for Developing Rheumatoid Arthritis

Innate immunity and immunological biomarkers are believed to be interrelated with sex hormones and other neuroendocrine factors. Sexual dimorphism mechanisms may be operating in certain rheumatic and inflammatory diseases which occur more frequently in women than men, as rheumatoid arthritis (RA). Less data have been available on altered interrelations of the combined neuroendocrine and immune (NEI) systems as risk factors for development of certain diseases. In this study, serological interrelations of NEI biomarkers are analyzed before symptomatic onset of RA (pre-RA) versus control (CN) subjects, stratified by sex. Sexual dimorphism was found in serum levels of acute serum amyloid A (ASAA), soluble interleukin-2 receptor alpha (sIL-2Rα), and soluble tumor necrosis factor receptor 1 (sTNF-R1). Multiple steroidal and hormonal (neuroendocrine) factors also showed highly (p<0.001) significant sexual dimorphism in their assayed values, but less for cortisol (p=0.012), and not for 17-hydroxyprogesterone (p=0.176). After stratification by sex and risk of developing RA, differential NEI correlational patterns were observed in the interplay of the NEI systems between the pre-RA and CN groups, which deserve further investigation

Fibromyalgia in men: Comparison of psychological features with women

Fibromyalgia syndrome (FM) is a musculoskeletal pain disorder characterized by chronic widespread pain, hypersensitivity to pain upon palpation, and a range of functional disorders 1 . Although there is controversy regarding the frequency of psychological distress in FM, a majority of investigations suggest that patients with FM have significantly more psychological problems than healthy controls and patients with chronic pain diseases with structural pathology, such as rheumatoid arthritis (RA) 2-8 . The vast majority of patients in the FM literature have been female and in epidemiological studies, women have been shown to be more significantly depressed than men 9 . Psychological factors play an important role in FM 2,10 . However, the psychological status of male patients with FM compared with female patients has not been specifically studied. Our study addresses the issue of gender difference in common and important psychological factors in FM. Based on available literature on gender difference in chronic conditions similar to FM, e.g., headaches and irritable bowel syndrome, we hypothesized that there would be no gender difference in psychological status in FM. MATERIALS AND METHODS Forty men and 160 women with FM were included in the study. All patients fulfilled the 1990 American College of Rheumatology (ACR) criteria for the classification of FM 1 . Male study participants were consecutively seen in the outpatient rheumatology clinic of the University of Illinois College of Medicine at Peoria (UICOMP); female participants, seen in the same clinic during the same period of time (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002), were randomly selected. Clinical and psychological variables of the patients were assessed by the same protocol in both groups. Duration of disease, education, and tender points (TP) were recorded as continuous variables. A visual analog scale (VAS) was used to evaluate global severity of disease, fatigue, and aches and pains. The items were scored on a 0-100 scale, with 100 denoting the worst possible condition. The severity of pain, sleep disturbance, morning fatigue, anxiety, stress, and depression in the previous month were scored on a 1-4 point scale (1 = none, 2 = mild, 3 = moderate, 4 = severe). These variables were dichotomized as none or mild (no) or moderate and severe (yes) as in our previous studies; the decision for this dichotomization was based on the observation that most symptoms among healthy controls were either none or mild, whereas most symptoms among the patients were either moderate or severe 11 . In addition to measuring psychological variables on ordinal scales 1-4 , they were also assessed by Spielberger State-Trait Anxiety Inventory Scale for anxiety (STAI) 12 , Hassles Scale (HS) for current mental stress 13 , and Zung Self-rating Depression Index (ZSDI) for depression 14 . Health status and physical function were assessed by self-administered Health Assessment Questionnaire (HAQ) STAI contains scales that measure state (SAI) and trait anxiety (TAI). SAI comprises 20 items that assess the intensity of current anxiety symptoms. TAI consists of 20 items and measures the level and symptoms of anxiety across situations over a long-standing period. Scale scores are obtained on a 4-point Likert-type scale and by summing the ratings for scale items. Scores range from 20 to 80 for both, with higher scores indicating higher levels of anxiety ZSDI includes 20 statements; one of the 4 responses is chosen for each statement (1 = none or a little of the time, 2 = some of the time, 3 = good part of the time, 4 = most or all of the time). This scale has been found to Personal, non-commercial use only. The Journal of Rheumatology

Angular Differential and Total Cross Sections for the Excitation of Atomic Hydrogen to Its n=2 State by Helium Ions

Differential cross sections for 15-100 keV He+ excitation of atomic hydrogen to its n=2 level have been determined for c.m. angles from 0 to 8 mrad. The differential cross sections are obtained from an analysis of the angular distribution of the scattered ions which have lost an energy corresponding to the excitation of the target to its n=2 level. The shape of the differential cross section changes rapidly with increasing incident energy. At 15 keV, the differential cross section falls off by a factor of 5 in 6 mrad. At 100 keV, the differential cross section decreases by nearly six orders of magnitude in the same angular range. The higher-energy results are in fair agreement with a recent symmetrized first-order Glauber approximation calculation of the process. Total cross section results are given for the same process in the 15-200 keV range

Angular Differential and Total Cross Sections for the Excitation of Atomic Hydrogen to Its n=2 Level by 25-150-kev Hydrogen Molecular Ions

Experimentally and theoretically determined differential and total cross sections are reported for excitation of atomic hydrogen to its n=2 level by 25-150-keV hydrogen molecular ions. The differential cross sections decrease 3-4 orders of magnitude over the measured center-of-mass scattering-angular range from 0 to 4.5 mrad. The results of a first Born approximation and two other theoretical calculations based upon the Glauber approximation are presented and compared with the experimental results. Both calculations based on the Glauber approximation agree fairly well with the experimental results. The Born approximation agrees moderately well with the experimental results at the very small scattering angles but is well below the experimental results at the larger scattering angles. None of the theoretical calculations presented agree well with the total cross section. However, the results for the total cross section of the two calculations based on the Glauber approximation agree with the experimental results in curve shape better than the Born-approximation results

Parental genome unification is highly error-prone in mammalian embryos

Most human embryos are aneuploid. Aneuploidy frequently arises during the early mitotic divisions of the embryo, but its origin remains elusive. Human zygotes that cluster their nucleoli at the pronuclear interface are thought to be more likely to develop into healthy euploid embryos. Here, we show that the parental genomes cluster with nucleoli in each pronucleus within human and bovine zygotes, and clustering is required for the reliable unification of the parental genomes after fertilization. During migration of intact pronuclei, the parental genomes polarize toward each other in a process driven by centrosomes, dynein, microtubules, and nuclear pore complexes. The maternal and paternal chromosomes eventually cluster at the pronuclear interface, in direct proximity to each other, yet separated. Parental genome clustering ensures the rapid unification of the parental genomes on nuclear envelope breakdown. However, clustering often fails, leading to chromosome segregation errors and micronuclei, incompatible with healthy embryo development

A novel malaria vaccine candidate antigen expressed in Tetrahymena thermophila

Development of effective malaria vaccines is hampered by the problem of producing correctly folded Plasmodium proteins for use as vaccine components. We have investigated the use of a novel ciliate expression system, Tetrahymena thermophila, as a P. falciparum vaccine antigen platform. A synthetic vaccine antigen composed of N-terminal and C-terminal regions of merozoite surface protein-1 (MSP-1) was expressed in Tetrahymena thermophila. The recombinant antigen was secreted into the culture medium and purified by monoclonal antibody (mAb) affinity chromatography. The vaccine was immunogenic in MF1 mice, eliciting high antibody titers against both N- and C-terminal components. Sera from immunized animals reacted strongly with P. falciparum parasites from three antigenically different strains by immunofluorescence assays, confirming that the antibodies produced are able to recognize parasite antigens in their native form. Epitope mapping of serum reactivity with a peptide library derived from all three MSP-1 Block 2 serotypes confirmed that the MSP-1 Block 2 hybrid component of the vaccine had effectively targeted all three serotypes of this polymorphic region of MSP-1. This study has successfully demonstrated the use of Tetrahymena thermophila as a recombinant protein expression platform for the production of malaria vaccine antigens

Detection of early sub-clinical lung disease in children with cystic fibrosis by lung ventilation imaging with hyperpolarized gas MRI

Hyperpolarised 3He ventilation-MRI, anatomical lung MRI, lung clearance index (LCI), low-dose CT and spirometry were performed on 19 children (6–16 years) with clinically stable mild cystic fibrosis (CF) (FEV1>−1.96), and 10 controls. All controls had normal spirometry, MRI and LCI. Ventilation-MRI was the most sensitive method of detecting abnormalities, present in 89% of patients with CF, compared with CT abnormalities in 68%, LCI 47% and conventional MRI 22%. Ventilation defects were present in the absence of CT abnormalities and in patients with normal physiology, including LCI. Ventilation-MRI is thus feasible in young children, highly sensitive and provides additional information about lung structure–function relationships

Epidemiology of community-onset Staphylococcus aureus infections in pediatric patients: an experience at a Children's Hospital in central Illinois

<p>Abstract</p> <p>Background</p> <p>The nation-wide concern over methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) has prompted many clinicians to use vancomycin when approaching patients with suspected staphylococcal infections. We sought to characterize the epidemiology of community-onset <it>S. aureus </it>infections in hospitalized children to assist local clinicians in providing appropriate empiric antimicrobial therapy.</p> <p>Methods</p> <p>From January 2005–June 2008, children (0–18 years old) admitted to the Children's Hospital of Illinois with community-onset <it>S. aureus </it>infections were identified by a computer-assisted laboratory-based surveillance and medical record review.</p> <p>Results</p> <p>Of 199 patients, 67 (34%) had invasive infections, and 132 (66%) had skin and soft tissue infections (SSTIs). Among patients with invasive infections, <it>S. aureus </it>isolates were more likely to be susceptible to methicillin (MSSA 63% vs. MRSA 37%), whereas patients with SSTIs, <it>S. aureus </it>isolates were more likely to be resistant to methicillin (MRSA 64% vs. MSSA 36%). Bacteremia and musculoskeletal infections were the most common invasive infections in both groups of <it>S. aureus</it>. Pneumonia with empyema was more likely to be caused by MRSA (<it>P </it>= 0.02). The majority (~90%) of MRSA isolates were non-multidrug resistant, even in the presence of healthcare-associated risk factors.</p> <p>Conclusion</p> <p>Epidemiological data at the local level is important for antimicrobial decision-making. MSSA remains an important pathogen causing invasive community-onset <it>S. aureus </it>infections among hospitalized children. In our hospital, nafcillin in combination with vancomycin is recommended empiric therapy in critically ill patients with suspected invasive staphylococcal infections. Because up to 25% of MSSA circulating in our area are clindamycin-resistant, clindamycin should be used cautiously as empiric monotherapy in patients with suspected invasive staphylococcal infections.</p