Enhancing Environmental Health Literacy about the Asthma- Air Pollution Connection at Childcare Centers in Asthma Prevalent Philadelphia Neighborhoods

Objective: To determine environmental health literacy of childcare providers about outdoor air quality alert resources, the connection between air pollution and asthma and determine if childcare providers would use the resource to benefit children in their care. Methods: We designed a free outreach program about asthma prevalence, dangers of poor air quality, and air quality alert resources for staff at childcare centers in Philadelphia, Pennsylvania during summer and fall of 2015-2017. Pre-surveys were administered to evaluate baseline understanding. Post-surveys were administered at 4 weeks and returned within 4-12 weeks. Summary statistics were calculated, and pre/post knowledge compared using a paired t-test. Results: 258 staffers at 45 childcare centers attended the presentations. 214 completed both pre/post surveys. 74% reported never/rarely using air quality alerts before the program. Post-survey, 40% reported signing up for alerts. Post-survey there was an 8% mean increase in knowledge score (95% CI: 6.3-9.5%, Conclusions: This easily administered program using freely available information was useful to childcare providers and increased their environmental health literacy to benefit children in their care. Keywords: Environmental Health Literacy; Air Pollution; Asthma; Community Engagement; Public Health Objective: To determine environmental health literacy of childcare providers about outdoor air quality alert resources, the connection between air pollution and asthma and determine if childcare providers would use the resource to benefit children in their care. Methods: We designed a free outreach program about asthma prevalence, dangers of poor air quality, and air quality alert resources for staff at childcare centers in Philadelphia, Pennsylvania during summer and fall of 2015-2017. Pre-surveys were administered to evaluate baseline understanding. Post-surveys were administered at 4 weeks and returned within 4-12 weeks. Summary statistics were calculated, and pre/post knowledge compared using a paired t-test. Results: 258 staffers at 45 childcare centers attended the presentations. 214 completed both pre/post surveys. 74% reported never/rarely using air quality alerts before the program. Post-survey, 40% reported signing up for alerts. Post-survey there was an 8% mean increase in knowledge score (95% CI: 6.3-9.5%, pConclusions: This easily administered program using freely available information was useful to childcare providers and increased their environmental health literacy to benefit children in their care

Medical Students in the Emergency Department and Patient Length of Stay

Quantitative assessments of how trainees affect patient care have been limited, especially in the emergency department (ED). A US study by Pitts et al found that supervised resident visits were associated with greater resource use, including longer length of stay (LOS) in the ED. As EDs host more core clerkship courses, less experienced students have become involved in bedside care. This study examined the association between the presence of medical students in the ED and patient LOS, an established patient-centered outcome and marker of ED performance

Mitochondrial Dynamics and Respiration Within Cells with Increased Open Pore Cytoskeletal Meshes

The cytoskeletal architecture directly affects the morphology, motility, and tensional homeostasis of the cell. In addition, the cytoskeleton is important for mitosis, intracellular traffic, organelle motility, and even cellular respiration. The organelle responsible for a majority of the energy conversion for the cell, the mitochondrion, has a dependence on the cytoskeleton for mobility and function. In previous studies, we established that cytoskeletal inhibitors altered the movement of the mitochondria, their morphology, and their respiration in human dermal fibroblasts. Here, we use this protocol to investigate applicability of power law diffusion to describe mitochondrial locomotion, assessment of rates of fission and fusion in healthy and diseased cells, and differences in mitochondria locomotion in more open networks either in response to cytoskeletal destabilizers or by cell line. We found that mitochondria within fibrosarcoma cells and within fibroblast cells treated with an actin-destabilizing toxin resulted in increased net travel, increased average velocity, and increased diffusion of mitochondria when compared to control fibroblasts. Although the mitochondria within the fibrosarcoma travel further than mitochondria within their healthy counterparts, fibroblasts, the dependence on mitochondria for respiration is much lower with higher rates ofhydrogen peroxide production and was confirmed using the OROBOROS O2K. We also found that rates of fission and fusion of the mitochondria equilibrate despite significant alteration of the cytoskeleton. Rates ranged from 15% to 25%, where the highest rates were observed within the fibrosarcoma cell line. This result is interesting because the fibrosarcoma cell line does not have increased respiration metrics including when compared to fibroblast. Mitochondria travel further, faster, and have an increase in percent mitochondria splitting or joining while not dependent on the mitochondria for a majority of its energy production. This study illustrates the complex interaction between mitochondrial movement and respiration through the disruption of the cytoskeleton

Click Worthy: Stories Encourage Emergency Physicians to Learn More About Opioid Prescribing Guidelines

Narrative vignettes outperform standard summaries in promoting engagement with opioid prescription guidelines among a national sample of emergency physicians

Early hemodynamic assessment using NICOM in patients at risk of developing Sepsis immediately after emergency department triage.

BACKGROUND: One factor leading to the high mortality rate seen in sepsis is the subtle, dynamic nature of the disease, which can lead to delayed detection and under-resuscitation. This study investigated whether serial hemodynamic parameters obtained from a non-invasive cardiac output monitor (NICOM) predicts disease severity in patients at risk for sepsis. METHODS: Prospective clinical trial of the NICOM device in a convenience sample of adult ED patients at risk for sepsis who did not have obvious organ dysfunction at the time of triage. Hemodynamic data were collected immediately following triage and 2 hours after initial measurement and compared in two outcome groupings: (1) admitted vs. dehydrated, febrile, hypovolemicdischarged patients; (2) infectious vs. non-infectious sources. Receiver operator characteristic (ROC) curves were calculated to determine whether the NICOM values predict hospital admission better than a serum lactate. RESULTS: 50 patients were enrolled, 32 (64 %) were admitted to the hospital. Mean age was 49.5 (± 16.5) years and 62 % were female. There were no significant associations between changes in hemodynamic variables and patient disposition from the ED or diagnosis of infection. Lactate was significantly higher in admitted patients and those with infection (p = 0.01, p = 0.01 respectively). The area under the ROC [95 % Confidence Intervals] for lactate was 0.83 [0.64-0.92] compared to 0.59 [0.41-0.73] for cardiac output (CO), 0.68 [0.49-0.80] for cardiac index (CI), and 0.63 [0.36-0.80] for heart rate (HR) for predicting hospital admission. CONCLUSIONS: CO and CI, obtained at two separate time points, do not help with early disease severity differentiation of patients at risk for severe sepsis. Although mean HR was higher in those patients who were admitted, a serum lactate still served as a better predictor of patient admission from the ED

Association between Electronic Medical Record Implementation of Default Opioid Prescription Quantities and Prescribing Behavior in Two Emergency Departments

Setting a low quantity of opioid tablets as the default option in electronic medical record prescribing orders may “nudge” clinicians to prescribe fewer opioids. When two emergency departments implemented a 10-tablet default instead of a manual entry, the proportion of 10-tablet prescriptions written more than doubled, from 20.6% to 43.3%. Conversely, 20-tablet prescriptions decreased from 22.8% to 16.1%, and prescriptions for 11-19 tablets decreased from 33.5% to 20.1%

Inter-Rater Reliability of Historical Data Collected by Non-Medical Research Assistants and Physicians in Patients with Acute Abdominal Pain

OBJECTIVES: In many academic emergency departments (ED), physicians are asked to record clinical data for research that may be time consuming and distracting from patient care. We hypothesized that non-medical research assistants (RAs) could obtain historical information from patients with acute abdominal pain as accurately as physicians.METHODS: Prospective comparative study conducted in an academic ED of 29 RAs to 32 resident physicians (RPs) to assess inter-rater reliability in obtaining historical information in abdominal pain patients. Historical features were independently recorded on standardized data forms by a RA and RP blinded to each others' answers. Discrepancies were resolved by a third person (RA) who asked the patient to state the correct answer on a third questionnaire, constituting the "criterion standard." Inter-rater reliability was assessed using kappa statistics (kappa) and percent crude agreement (CrA).RESULTS: Sixty-five patients were enrolled (mean age 43). Of 43 historical variables assessed, the median agreement was moderate (kappa 0.59 [Interquartile range 0.37-0.69]; CrA 85.9%) and varied across data categories: initial pain location (kappa 0.61 [0.59-0.73]; CrA 87.7%), current pain location (kappa 0.60 [0.47-0.67]; CrA 82.8%), past medical history (kappa 0.60 [0.48-0.74]; CrA 93.8%), associated symptoms (kappa 0.38 [0.37-0.74]; CrA 87.7%), and aggravating/alleviating factors (kappa 0.09 [-0.01-0.21]; CrA 61.5%). When there was disagreement between the RP and the RA, the RA more often agreed with the criterion standard (64% [55-71%]) than the RP (36% [29-45%]).CONCLUSION: Non-medical research assistants who focus on clinical research are often more accurate than physicians, who may be distracted by patient care responsibilities, at obtaining historical information from ED patients with abdominal pain

Congenital anomalies, labor/delivery complications, maternal risk factors and their relationship with perfluorooctanoic acid (PFOA)-contaminated public drinking water

We have previously examined the associations between perfluorooctanoic acid (PFOA) exposure, birth weight and gestational age in individuals exposed to PFOA-contaminated residential drinking water from the Little Hocking Water Association (LHWA). In this investigation, we expand the scope of our analysis to examine the associations between PFOA, congenital anomalies, labor and delivery complications and maternal risk factors

Malassezia pachydermatis Carriage in Dog Owners

Malassezia pachydermatis is commonly carried on the hands of dog owners and may cause disease in immunocompromised persons