Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency Physician

The Patient Protection and Affordable Care Bill, commonly referred to as the “Health Care Bill” or the “Health Care Reform Bill,” was enacted in March 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the Bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part I presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care

Evaluating Parents\u27 Decisions Regarding Recommended Childhood Vaccinations

Vaccinations are among the greatest accomplishments of public health. However, many parents are choosing not to vaccinate. The purpose of this study was to explore the association between social media influence and parents\u27 decisions to vaccinate their children. The health belief model indicates that individuals\u27 likelihood of engaging in a health-related behavior is determined by their perceptions of susceptibility, severity, benefits, and barriers. The research questions addressed whether there is an association between parents\u27 perception of their children\u27s disease susceptibility and their decisions about vaccination, and whether there is an association between exposure to messaging from social media and parents\u27 decision to vaccinate. A quantitative, cross-sectional research design was used. The primary dependent variable was vaccination choices, and the primary independent variable was exposure to information about vaccination through social media. Data were gathered through a questionnaire administered to 269 White parents residing in Illinois with their own children between the ages of 0 and 18 years living with them. Binomial logistic regression showed that there was not a statistically significant relationship between parents\u27 perception of disease susceptibility and vaccination choice or between parents\u27 vaccination choice and exposure to online antivaccine advertisements. These study findings help in defining an overall picture of vaccine hesitancy in the United States. By focusing on the predictors of this behavior, it may be possible to implement interventions to combat the antivaccine movement with the goal of increasing vaccine compliance among parents

Resident Attitudes Towards Women Owned and Operated Tourism Businesses in an Emerging Destination

This paper investigates resident attitudes towards women owned and operated, tourism related businesses in a rural and emerging destination. This study used social exchange theory (SET) to access whether attitudes about women owned and operated tourism businesses (WOOTB) differ with respect to residents’ opinions related to perceptions of associated costs and benefits, and whether attitudes differ with respect to demographics. The majority of respondents agreed that women-owned businesses would have an effect on tourism in the community. Residents agree that WOOTB will preserve local culture and contribute to women’s capacity building, yet would also disrupt family life and damage the peaceful, rural character of the community

Cost-Effectiveness of an Emergency Department Based Early Sepsis Resuscitation Protocol

Background Guidelines recommend that sepsis be treated with an early resuscitation protocol, such as early goal directed therapy (EGDT). Our objective was to assess the cost-effectiveness of implementing EGDT as a routine protocol. Design Prospective before and after study. Setting Large urban hospital ED with >110,000 visits/year. Patients The target population was patients with consensus criteria for septic shock. We excluded those with age <18 yrs, no aggressive care desired, or need for immediate surgery. Interventions Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before and 2) 2 yrs after implementing EGDT as standard-of-care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were one year mortality, discounted life expectancy, and quality adjusted life years (QALYs). Using costs and QALYs, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit (NMB) analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a QALY. Results 285 subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with EGDT was associated with an increased hospital cost of $7028 and an increase in both discounted sepsis-adjusted life expectancy and QALYs of 1.5 and 1.3 yrs, respectively. EGDT use was associated with a cost of$5397 per QALY gained and the NMB analysis indicates a 98% probability (p = .038) that EGDT is cost-effective at a willingness to pay of $50,000 per QALY. Conclusion Implementation of EGDT in the ED care of severe sepsis patients is cost effective

Expression of 14-3-3 protein isoforms in mouse oocytes, eggs and ovarian follicular development

<p>Abstract</p> <p>Background</p> <p>The 14-3-3 (YWHA) proteins are a highly conserved, ubiquitously expressed family of proteins. Seven mammalian isoforms of 14-3-3 are known (β, γ, ε, ζ, η, τ and, σ). These proteins associate with many intracellular proteins involved in a variety of cellular processes including regulation of the cell cycle, metabolism and protein trafficking. We are particularly interested in the role of 14-3-3 in meiosis in mammalian eggs and the role 14-3-3 proteins may play in ovarian function. Therefore, we examined the expression of 14-3-3 proteins in mouse oocyte and egg extracts by Western blotting after polyacrylamide gel electrophoresis, viewed fixed cells by indirect immunofluorescence, and examined mouse ovarian cells by immunohistochemical staining to study the expression of the different 14-3-3 isoforms.</p> <p>Results</p> <p>We have determined that all of the mammalian 14-3-3 isoforms are expressed in mouse eggs and ovarian follicular cells including oocytes. Immunofluorescence confocal microscopy of isolated oocytes and eggs confirmed the presence of all of the isoforms with characteristic differences in some of their intracellular localizations. For example, some isoforms (β, ε, γ, and ζ) are expressed more prominently in peripheral cytoplasm compared to the germinal vesicles in oocytes, but are uniformly dispersed within eggs. On the other hand, 14-3-3η is diffusely dispersed in the oocyte, but attains a uniform punctate distribution in the egg with marked accumulation in the region of the meiotic spindle apparatus. Immunohistochemical staining detected all isoforms within ovarian follicles, with some similarities as well as notable differences in relative amounts, localizations and patterns of expression in multiple cell types at various stages of follicular development.</p> <p>Conclusions</p> <p>We found that mouse oocytes, eggs and follicular cells within the ovary express all seven isoforms of the 14-3-3 protein. Examination of the differential expression of these 14-3-3 isoforms in female germ cells and ovarian follicles provides the foundation for further investigating 14-3-3 isoform-specific interactions with key proteins involved in ovarian development, meiosis and oocyte maturation. This will lead to a better understanding of the individual functional roles of the 14-3-3 protein isoforms in mammalian oogenesis and female reproductive development.</p

Peptide-Based Inhibition of NF-κB Rescues Diaphragm Muscle Contractile Dysfunction in a Murine Model of Duchenne Muscular Dystrophy

Deterioration of diaphragm function is one of the prominent factors that contributes to the susceptibility of serious respiratory infections and development of respiratory failure in patients with Duchenne Muscular Dystrophy (DMD). The NF-κB signaling pathway has been implicated as a contributing factor of dystrophic pathology, making it a potential therapeutic target. Previously, we demonstrated that pharmacological inhibition of NF-κB via a small NEMO Binding Domain (NBD) peptide was beneficial for reducing pathological features of mdx mice. Now, we stringently test the effectiveness and clinical potential of NBD by treating mdx mice with various formulations of NBD and use diaphragm function as our primary outcome criteria. We found that administering DMSO-soluble NBD rescued 78% of the contractile deficit between mdx and wild-type (WT) diaphragm. Interestingly, synthesis of a GLP NBD peptide as an acetate salt permitted its solubility in water, but as a negative consequence, also greatly attenuated functional efficacy. However, replacing the acetic acid counterion of the NBD peptide with trifluoroacetic acid retained the peptide’s water solubility and significantly restored mdx diaphragm contractile function and improved histopathological indices of disease in both diaphragm and limb muscle. Together, these results support the feasibility of using a mass-produced, water-soluble NBD peptide for clinical use

Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire

A valid, reliable measure of family caregivers’ knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides

Friends or Strangers? A Feasibility Study of an Innovative Focus Group Methodology

Focus groups are useful tools for examining perceptions, feelings, and suggestions about topics, products, or issues. Typically, focus groups are held in formal facilities with “strangers” or participants who do not know each other. Recent work suggests that “friendship groups” may provide an innovative alternative for collecting group-level qualitative data. This approach involves recruiting a single “source participant” who hosts a group in his/her home and recruits friends possessing the characteristics desired for the study. In order to examine the feasibility of friendship groups as a defensible research methodology, we conducted a series of four friendship groups as a feasibility study. Our analysis examined data from questionnaires about demographics, levels of acquaintanceship, and experience taking part in the group; transcripts; observational data; and the time and costs for recruiting. Using these data, we examined group dynamics, implementation issues, and recruitment time and costs. Based on these analyses, our study determined that friendship groups have the potential to be a viable and cost-effective method of qualitative inquiry

Pediatric Emergency Medicine Physicians’ Use of Point‐of‐care Ultrasound and Barriers to Implementation: A Regional Pilot Study

ObjectivesPoint‐of‐care ultrasound (POCUS) has been identified as a critical skill for pediatric emergency medicine (PEM) physicians. The purpose of this study was to profile the current status of PEM POCUS in pediatric emergency departments (EDs).MethodsAn electronic survey was distributed to PEM fellows and attending physicians at four major pediatric academic health centers. The 24‐item questionnaire covered professional demographics, POCUS experience and proficiency, and barriers to the use of POCUS in pediatric EDs. We used descriptive and inferential statistics to profile respondent’s PEM POCUS experience and proficiency and Rasch analysis to evaluate barriers to implementation.ResultsOur return rate was 92.8% (128/138). Respondents were attending physicians (68%) and fellows (28%). Most completed pediatric residencies prior to PEM fellowship (83.6%). Almost all had some form of ultrasound education (113/128, 88.3%). Approximately half (46.9%) completed a formal ultrasound curriculum. More than half (53.2%) said their ultrasound education was pediatric‐specific. Most participants (67%) rated their POCUS proficiency low (Levels 1–2), while rating proficiency in other professional competencies (procedures 52%, emergency stabilization 70%) high (Levels 4–5). There were statistically significant differences in POCUS proficiency between those with formal versus informal ultrasound education (p < 0.001) and those from pediatric versus emergency medicine residencies (p < 0.05). Participants identified both personal barriers discomfort with POCUS skills (76.7%), insufficient educational time to learn POCUS (65%), and negative impact of POCUS on efficiency (58.5%)—and institutional barriers to the use of ultrasound‐consultants will not use ultrasound findings from the ED (60%); insufficient mentoring (64.7%), and POCUS not being a departmental priority (57%).ConclusionsWhile POCUS utilization continues to grow in PEM, significant barriers to full implementation still persist. One significant barrier relates to the need for dedicated time to learn and practice POCUS to achieve sufficient levels of proficiency for use in practice.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138938/1/aet210049_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138938/2/aet210049-sup-0001-SupInfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138938/3/aet210049.pd