Time matters greatly in acute stroke care

Stroke is a leading cause of morbidity worldwide. ‘Time is brain’ is a slogan that characterises contemporary stroke care. Rapid evaluation of stroke begins with community education to better recognise the signs and symptoms of stroke, an organised system of care by first responders and the emergency department, prompt evaluation by the stroke team, and the timely administration of reperfusion including intravenous thrombolysis and endovascular thrombectomy (EVT). In their new study [1], Novak et al. have shown that a shorter time from stroke onset to groin puncture is associated with better recanalisation. This underlines the crucial importance of time in stroke care

A 2-Question Summative Score Correlates with the Maslach Burnout Inventory

Introduction: There is a high prevalence of burnout among emergency medicine (EM) residents. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) is a widely used tool to measure burnout. The objective of this study was to compare the MBI-HSS and a two-question tool to determine burnout in the EM resident population.Methods: Based on data from the 2017 National Emergency Medicine Resident Wellness Survey study, we determined the correlation between two single-item questions with their respective MBI subscales and the full MBI-HSS. We then compared a 2-Question Summative Score to the full MBI-HSS with respect to primary, more restrictive, and more inclusive definitions of burnout previously reported in the literature.Results: Of 1,522 residents who completed the survey 37.0% reported “I feel burned out from my work,” and 47.1% reported “I have become more callous toward people since I took this job” once a week or more (each item >3 on a scale of 0-6). A 2-Question Summative Score totaling >3 correlated most closely with the primary definition of burnout (Spearman’s rho 0.65 [95% confidence interval 0.62-0.68]). Using the summative score, 77.7% of residents were identified as burned out, compared to 76.1% using the full MBI-HSS, with a sensitivity and specificity of 93.6% and 73.0%, respectively.Conclusion: An abbreviated 2-Question Summative Score correlates well with the full MBI-HSS tool in assessing EM resident physician burnout and could be considered a rapid screening tool to identify at-risk residents experiencing burnout

Three sonatas for piano by Emma Lou Diemer

Emma Lou Diemer (1927- ), an eclectic, still active American composer, has composed in many different musical genres for both professional and amateur groups. She is well-known for her vocal music Three Madrigals (1962) and her Concerto in One Movement for Piano (1991), which won Kennedy Center Friedheim Awards in 1992. Diemer’s piano music includes pedagogical works as well as concert pieces. Her piano sonatas are sophisticated compositions for piano which combine both advanced technical elements and musical complexities. Of her three piano sonatas, Piano Sonata No.3 is particularly accessible to listeners. The Sonata for Piano in One Movement was submitted successfully for a Fulbright Scholarship for study in Belgium (1952-53) and the Second Sonata for Piano won the Missouri Federation of Music Clubs Award (1955). Piano Sonata No. 3 (2000) is her most recent publication. The purpose of this project is to provide a stylistic and analytic guide helpful to the preparation and performance of the three sonatas by Diemer. The opening chapter provides a biography of the composer, the following chapter centers on various influences on her compositional style, and her transformation from early Romanticism and Neo-Classicism to her later use of electronic and pop music. The subsequent chapter is an analytical observation of the three sonatas in addition to the particular characteristics of each sonata. The last chapter focuses on performance and interpretive issues._x000C

Cerebral aneurysm treatment: modern neurovascular techniques.

Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years

ALiEM AIR-Pro Series: Identifying Quality Content from Blogs and Podcasts for the Senior Emergency Medicine Resident

Introduction: In 2008, the Accreditation Council for Graduate Medical Education endorsed a change such that EM residency programs can now decrease their synchronous conference experiences by up to 20% in exchange for asynchronous learning termed Individualized Interactive Instruction (III). Identifying quality online resources that would also fulfill III’s reporting criteria (program director monitoring, evaluation component, faculty oversight, program effectiveness) is challenging. Using crowdsourced expertise, the Approved Instructional Resources (AIR) series from Academic Life in Emergency Medicine (ALiEM) was created in 2014 to provide a credible method to identify quality educational blogs and podcasts. The identified resources, however, focused on basic content with limited utility for more senior residents. We thus created the AIR-Pro series in 2015, an offshoot of the original AIR series, aimed to cover more advanced concepts. Method: The AIR-Pro series is a continuously building curriculum covering a new subject area every 2 months. For each area, 6 EM Chief Residents identify 3-5 advanced clinical questions. Using FOAMsearch.net to search blogs and podcasts, relevant posts are scored by 8 reviewers from the AIR-Pro Board (faculty and chief residents at various institutions). The scoring instrument contains 5 measurement outcomes (7-point Likert scale): recency, accuracy, educational utility, evidence based, and references. The AIR-Pro Approved label is given to posts with a score of ≥28 (out of 35) points and these are featured in the blog posting. For scores of 26-27, an Honorable Mention label is given if Board members collectively felt that they were valuable. For each AIR-Pro subject area, a multiple choice quiz is written based on the featured posts. Educator dashboard access of the Google Drive quizzes is given to program directors for monitoring. If approved by their program director, EM residents receive official III credit upon completion of each quiz. Curriculum/Tool/Material: As of Jan 1, 2016, there have been 2 modules published on ALiEM with 1,220 (Cardiovascular) and 1,059 (Trauma) pageviews worldwide. Although early in development, 21 different institutions are using the AIR-Pro Series with over 150 residents completed the cardiovascular and trauma quizzes. We anticipate more because the original AIR Series has over 73 programs using it for III credit. Conclusions: The AIR-Pro series is a novel, objective, crowdsourced approach towards identifying quality, educational, social media content for the advanced EM resident

Resonant Scattering of Surface Plasmon Polaritons by Dressed Quantum Dots

The resonant scattering of surface plasmon-polariton waves by embedded semiconductor quantum dots above the dielectric/metal interface is explored in the strong-coupling regime. In contrast to non-resonant scattering by a localized dielectric surface defect, a strong resonant peak in the scattering field spectrum is predicted and accompanied by two side valleys. The peak height depends nonlinearly on the amplitude of surface plasmon-polariton waves, reflecting the feedback dynamics from a photon-dressed electron-hole plasma inside the quantum dots. This unique behavior in the scattering field peak strength is correlated with the occurrence of a resonant dip in the absorption spectrum of surface plasmon-polariton waves due to interband photon-dressing effect. Our result on the scattering of surface plasmon-polariton waves may be experimentally observable and applied to spatially selective illumination and imaging of individual molecules.Comment: 15 pages, 3 figure

Controlling quantum-dot light absorption and emission by a surface-plasmon field

The possibility for controlling the probe-field optical gain and absorption switching and photon conversion by a surface-plasmon-polariton near field is explored for a quantum dot above the surface of a metal. In contrast to the linear response in the weak-coupling regime, the calculated spectra show an induced optical gain and a triply-split spontaneous emission peak resulting from the interference between the surface-plasmon field and the probe or self-emitted light field in such a strongly-coupled nonlinear system. Our result on the control of the mediated photon-photon interaction, very similar to the `gate' control in an optical transistor, may be experimentally observable and applied to ultra-fast intrachip/interchip optical interconnects, improvement in the performance of fiber-optic communication networks and developments of optical digital computers and quantum communications.Comment: 7 pages, 15 figure