The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department

Nearly eight million emergency department (ED) visits are attributed to alcohol every year in the United States. A substantial proportion is due to trauma. In 2005, 16,885 people were killed as a result of alcohol-related motor vehicle crashes. Patients with alcohol-use problems (AUPs) are not only more likely to drive after drinking but are also at greater risk for serious alcohol-related illness and injury. Emergency departments have an important and unique opportunity to identify these patients and intervene during the “teachable moment” of an ED visit. The American College of Emergency Physicians, Emergency Nurses Association, American College of Surgeons-Committee on Trauma, American Public Health Association, and the National Highway Traffic Safety Administration, have identified Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) as a pivotal injury- and illness-prevention strategy to improve the health and well-being of ED patients. We provide a general overview of the basis and need for integrating SBIRT into EDs. Models of SBIRT, as well as benefits and challenges to its implementation, are also discussed

Pedestrian Injuries: Emergency Care Considerations

Traffic-related pedestrian injuries are a growing public health threat worldwide. The global economic burden of motor vehicle collisions and pedestrian injuries totals $500 billion.1 In 2004, there were 4,641 pedestrian deaths and over 70,000 injuries in the United States.2 Injury patterns vary depending on the age, gender and socioeconomic status of the individual. Children, older adults, and those of lower socioeconomic status are most affected. The burden of injury upon the individual, families and society is frequently overwhelming. Although pedestrian injuries and deaths are relatively on the decline in the United States, this is not universally true throughout the world. It requires particular attention by emergency medicine physicians, public health experts and policy makers

Radioactive impact in sediments from an estuarine system affected by industrial wastes releases

A big fertilizer industrial complex and a vast extension of phosphogypsum piles (12 km2), sited in the estuary formed by the Odiel and Tinto river mouths (southwest of Spain), are producing an unambiguous radioactive impact in their surrounding aquatic environment through radionuclides from the U-series. The levels and distribution of radionuclides in sediments from this estuarine system have been determined. The analyses of radionuclide concentrations and activity ratios have provided us with an interesting information to evaluate the extension, degree and routes of the radioactive impact, as well as for the knowledge of the different pathways followed for the radioactive contamination to disturb this natural system. The obtained results indicate that the main pathway of radioactive contamination of the estuary is through the dissolution in its waters of the radionuclides released by the industrial activities and their later fixation on the particulate materials. Tidal activity also plays an important role in the transport and homogenization along the estuary of the radioactivity released from the fertilizer plants. D 2002 Elsevier Science Ltd. All rights reserved.Junta de Andalucia (España) project 1FD97-0900-C02-02 (AMB

The Crisis in Emergency and Trauma Care in California and the United States

A crisis affecting every geographic region and every socioeconomic segment of the United States is threatening the future viability of emergency and trauma care in America. As the financial and social burden of providing trauma care has fallen on individual states, hospitals and physicians, record numbers of emergency departments and trauma centers have been forced to close. The ultimate cost of these closures falls upon patients who will receive inadequate emergency and trauma care. In the fall of 2004 King Drew Medical Center Trauma Services, the second largest trauma center in Los Angeles County, closed. Continuing on this path may threaten the emergency and trauma care in the United States, touted as one of the finest in the world. This article provides a general overview of the trauma center crisis in California and reviews the history of the problem and its future implications in California as well as the United States

Need for Injury-Prevention Education in Medical School Curriculum

Injury is the leading cause of death and disability among the U.S. population aged 1 to 44 years. In 2006 more than 179,000 fatalities were attributed to injury. Despite increasing awareness of the global epidemic of injury and violence, a considerable gap remains between advances in injury-prevention research and prevention knowledge that is taught to medical students. This article discusses the growing need for U.S medical schools to train future physicians in the fundamentals of injury prevention and control. Teaching medical students to implement injury prevention in their future practice should help reduce injury morbidity and mortality. Deliberate efforts should be made to integrate injury-prevention education into existing curriculum. Key resources are available to do this. Emergency physicians can be essential advocates in establishing injury prevention training because of their clinical expertise in treating injury. Increasing the number of physicians with injury- and violence- prevention knowledge and skills is ultimately an important strategy to reduce the national and global burden of injury

Quality and Publication of Emergency Medicine Trials Registered in ClinicalTrials.gov

Introduction: Promoting emergency medicine (EM) clinical trials research remains a priority. To characterize the status of clinical EM research, this study assessed trial quality, funding source, and publication of EM clinical trials and compared EM and non-EM trials on these key metrics. We also examined the volume of EM trials and their subspecialty areas.Methods: We abstracted data from ClinicalTrials.gov (February 2000 - September 2013) and used individual study National Clinical Trial numbers to identify published trials (January 2007 - September 2016). We used descriptive statistics and chi-square tests to examine study characteristics by EM and non-EM status, and Kaplan-Meier curves and log-rank tests to compare time to publication of completed EM and non-EM studies.Results: We found 638 interventional EM trials and 59,512 non-EM interventional trials conducted in the United States between February 2000 and September 2013, registered on ClinicalTrials.gov. EM studies were significantly less likely than non-EM studies to be National Institutes of Health-funded or to evaluate a drug or biologic. However, EM studies had significantly larger sample sizes, and were significantly more likely to use randomization and blinding. Overall, 34.3% of EM and 26.0% of non-EM studies were published in peer-reviewed journals. By subspecialty, more EM trials concerned medical/surgical and psychiatric/neurological conditions than trauma.Conclusion: Although EM studies were less likely to have received federal or industry funding, and the EM portfolio consisted of only 638 trials over the 14-year study period, the quality of EM trials surpassed that of non-EM trials, based on indices such as randomization and blinding. This novel finding bodes well for the future of clinical EM research, as does the higher proportion of published EM than non-EM trials. Our study also revealed that trauma studies were under-represented among EM studies. Periodic assessment of EM trials with the metrics used here could provide an informative and valuable longitudinal view of progress in clinical EM research

The geochemical behavior of natural radionuclides in coastal waters: A modeling study for the Huelva estuary

A numerical model to study the behavior and distribution of natural radionuclides in sediments of an estuary (Odiel and Tinto rivers, SW Spain) affected by acid mine drainage and industrial activities has been developed. The model solves water circulation due to tides and river stream flows. The dispersion model includes uptake/ release reactions of radionuclides between the dissolved phase and bed sediments in a dynamic way, using kinetic transfer coefficients. Seasonal pH and chlorinity distributions are simulated, and a formulation has been developed to consider these seasonal variations on kinetic coefficients. Calculated concentrations of 226Ra and 238U in sediments have been compared with measurements from four seasonal sampling campaigns. Numerical experiments have been carried out to study the relative significance of the different radionuclides sources into the estuary as well as the effect of the two components of water circulation (tides are river flows) on radionuclide dispersion patterns.Ministerio de Ciencia e Innovación CTM2009-14321-C02-01Junta de Andalucía RNM-630

Polycystic Kidney Disease with Renal failure Presenting as Incarcerated Inguinal Hernia in the ED

Autosomal dominant polycystic kidney disease may present to the emergency department (ED) with vomiting, abdominal pain or hernias, renal insufficiency or failure, or bleeding from cerebral aneurysms. A 37-year-old man presented to the ED with signs and symptoms of incarcerated inguinal hernia. Laboratory studies showed renal failure with anion gap acidosis, and bedside ultrasound showed multicystic kidneys. Computed tomography confirmed the diagnosis. Emergency physicians should be aware of this common connective tissue defect and its serious associated conditions

Determination of The Ecological Water Quality in The Orienco Stream Using Benthic Macroinvertebrates in The Northern Ecuadorian Amazon

In recent years, pollution of watercourses in nearby protected ecosystems has increased due to urbanization. Standard physiochemical methods and probes are one way to monitor watercourses for quality. However, they often do not provide the full ecological status of the body of water. In this work, we set out to assess the ecological water quality of an urban stream by using benthic macroinvertebrates as bioindicators. We conducted the work on the Orienco stream in Lago Agrio in the province of Sucumbíos in the Northern Ecuadorian Amazon (NEA). The stream has become a sink of raw domestic sanitary wastewater from rural and urban areas. A total of 4511 macroinvertebrates from 10 families were identified across 17 sampling points. We compared our results from the biotic indices derived from the macroinvertebrates to standard water-quality parameters (temperature, conductivity, dissolved oxygen, biochemical oxygen demand, chemical oxygen demand, total suspended solids, ammonia–nitrogen, and pH) simultaneously sampled in the stream. The standard parameter results indicated that the water-quality levels of the stream met the Ecuadorian water-quality criteria most of the time. However, the results from the biotic indices classified the stream water as poor or very poor water quality. The results from the Biological Monitoring Working Party, Average Score per Taxon, and Family Biotic Indices had overall scores of heavily polluted waters of 45, 4.5, and 8.74, respectively. Furthermore, these results were consistent with reduced richness and evenness, and overall lower Shannon diversity and relatively higher Simpson Dominance indices of 0.71 and 2.56, respectively. We conclude that the macroinvertebrates were better indicators of the ecological water quality of the Orienco stream than the water-quality parameters from standard methods and probes alone. Our findings highlight the need for more integrated ecological assessments, which can provide critical information to the management and conservation strategies of urban watercourses in the NEA region. Integr Environ Assess Manag 2022;00:1–11. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)