Current EM Research Articles

Global emergency medicine: four part series on best practices : Paper 1: Introduction and overview of global emergency medicine.

The Canadian Association of Emergency Physicians' (CAEP) Global Emergency Medicine committee presents a four-part series that builds upon the Academic Symposium recommendations from the CAEP 2018 meeting (Collier et al. in CJEM 21(5):600-606, 2019). This series presents best practices and offers practical tools for the development and practice of Global EM. This is the first paper of the series which provides an overview of current Global EM systems and development. The breadth and scope of the field is described, and key definitions are outlined. International efforts, initiatives, and organizations relating to public health and humanitarian response are introduced. Other key aspects of Global EM are explored in papers 2-4 including: developing partnerships, supporting centers of research and practice, and education and training.

The paucity of pediatric emergency medicine fellowship training programs in Africa.

Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.

진동감소 및 감쇠력 확보를 위한 와전류형 EM댐퍼 구조 설계

In this paper, we propose an eddy current type EM damper that can have the simple structure of an existing mechanical damper and the effective damping force of a magnetic fluid fluid damper at the same time. The proposed eddy current type EM damper has a structure similar to that of a mechanical damper, in which a permanent magnet is attached to a plunger and a conductor (copper) is provided on the outer wall of the cylinder to generate and generate an eddy current cutoff. Damping force. When the permanent magnet attached to the plunger vibrates up and down, an eddy current is generated, and a magnetic field having the opposite polarity to the magnetic field acting by the circulation of the eddy current is generated. In order to verify the reliability of the damping force of the eddy current type EM damper, analysis is performed using a finite element analysis method that applies axial symmetry analysis technology, and the direction in which the damping force is generated acts in the opposite direction to the vibration characteristics to generate external vibration. The damping ability to suppress was verified.

Gender Differences in Experiences of Leadership Emergence Among Emergency Medicine Department Chairs

The number of women entering medicine continues to increase, but women remain underrepresented at all tiers of academic rank and chair leadership in EM. The proportion of female chairs in EM has not exceeded 12% in 2 decades. To compare how male and female EM chairs experience leadership emergence, with attention to factors associated with support of the emergence of female chairs. This qualitative descriptive study was conducted between April 2020 and February 2021 at 36 US academic EM departments. Eligible participants were all current and emeritus female EM academic department chairs (with a possible cohort of 20 individuals) and an equal number of randomly selected male chairs. Semistructured interviews were conducted via teleconferencing with an 11-item interview guide. Qualitative findings identifying similarities and gender differences in leadership emergence were collected. Among 20 female chairs in EM, 19 women (mean [SD] age, 56.2 [7.1] years) participated in the study (95.0% response rate). There were 13 active chairs, and 6 women were within 5 years of chair leadership. Among 77 male chairs in EM identified and randomized, 37 men were invited to participate, among whom 19 individuals (51.4%) agreed to participate; 18 men (mean [SD] age, 52.2 [7.5] years) completed their interviews. Reflecting upon their experiences of leadership emergence, male chairs saw leadership as their destiny, were motivated to be chairs to gain influence, were dismissive of risks associated with chairing a department, and were sponsored by senior male leaders to advance in leadership. Female chairs saw leadership as something they had long prepared for, were motivated to be chairs to make a difference, were cautious of risks associated with chairing a department that could derail their careers, and relied on their own efforts to advance in leadership. This study found that experiences of leadership emergence differed by gender. These results suggest that leadership development strategies tailored to women should promote early internalization of leadership identity, tightly link leadership to purpose, cultivate active sponsorship, and encourage women's risk tolerance through leadership validation to support women's development as leaders and demonstrate a commitment to gender equity in EM leadership.

P141: Education innovation: Equity, Diversity, Advocacy, and Cultural Safety (EDACS) curriculum

Innovation Concept: Upon completion of training, Canadian physicians are expected to respond to patient needs to advocate for change both within and beyond the immediate clinical environment.1 In the current EM curriculum, residents are not explicitly taught skills necessary to engage in clinical care nor policy change that would improve the social determinants of health (SDOH) of patients. In response to this challenge, we have developed and are piloting a 2 year curriculum on “Equity, Diversity, Advocacy, and Cultural Safety (EDACS), to equip EM trainees with the knowledge and skills to advocate and influence policy - to empower residents to act on healthcare inequities rather than simply be aware of them. Methods: We developed the curriculum utilizing the Structural Competency paradigm, a theoretical framework within which clinical and advocacy skills to address the SDOH at a structural level can be taught and practiced. This paradigm includes five intersecting skill-sets, including recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, and imagining structural interventions. Curriculum, Tool, or Material: The educational intervention will consist of 8 hour-long sessions and one 3-hour long session held over a 2-year period. The 3-hour long session will consist of a walking tour of sites accessed by individuals living in poverty in the Toronto downtown core, including a homeless shelter, a needle exchange program, and others. This session will be facilitated by a physician lead, with input at each site from community organizers. Prior to the walking tour, residents will receive an introductory session outlining themes to reflect on during and after the walking tour. Hour-long sessions will be delivered by invited healthcare providers with specific clinical expertise in the topics of discussion, which will address the care of and advocacy for various marginalized populations. Conclusion: To our knowledge, this is the first curriculum of its kind being implemented in an EM training program in Canada. Upon completion of the curriculum, students will be able to apply the five skillsets outlined in the Structural Competency Framework to address and improve upon inequitable conditions that influence patients treated in the emergency department. We intend to use formal and informal feedback from residents, clinicians, and lecturers to refine future curriculum cycles, and hope to inform similar programs elsewhere.

Position within the hospital and role in the emergency department of emergency physicians in the Netherlands: a national survey

ObjectivesEmergency medicine (EM) in the Netherlands has developed rapidly and initially without central guidance. This has led to heterogeneity in current EM practice. Our aim was to quantify this heterogeneity by answering the following questions: (1) What is the current position of emergency physicians (EPs) within hospital organizations? (2) Which roles and responsibilities do EPs have across emergency departments (EDs)?MethodsDuring 2018, we conducted a survey among all EM consultant bodies (CBs, n = 56) in the Netherlands. Data was analyzed using descriptive statistics.ResultsThe response rate was 91.1%. Presence of EPs has been realized 24/7 in 23.1% of EDs. EPs were the main consultants for all ED patients in 9.8% of CBs, but never had this role in 13.7% of CBs. EPs supervised EM junior doctors in 78.5% of EDs, GPs in training in 80.0% of EDs, and junior doctors of other specialties in 41.5% of EDs. Procedures such as lumbar puncture (LP), procedural sedation and analgesia (PSA), and emergency ultrasound (US) were performed by all EPs in the CB in a range between 5.9 and 78.4%. In 36.9% of EDs, EPs did not analyze patients with presumed cardiac pathology due to a separate First Heart Aid.ConclusionWe conclude that there is a high degree of heterogeneity between emergency CBs in regard to the position in the hospital and the role or responsibilities in the ED. Lack of uniformity might inhibit emancipation of the profession.

Emergency medicine pharmacy practice in Australia: a national survey

AbstractBackgroundEmergency medicine (EM) clinical pharmacy is a rapidly growing area of practice. The purpose of this study was to describe current EM pharmacy services in Australia, specifically the number of clinical pharmacy services, services provided within the emergency department (ED), working hours and the qualifications of pharmacists practising in the ED.MethodsExperienced EM clinical pharmacists in collaboration with an emergency physician developed an online survey that was sent electronically to Australian hospital directors of pharmacy. The survey questions related to hospital demographics, EM pharmacy clinical service and EM pharmacist working hours, level of staffing and qualifications.ResultsBetween 4 November 2016 and 9 December 2016, 57 hospitals completed some or all of the survey from the 248 emails sent (response rate = 23%). Thirty‐five of 57 hospitals (61%) identified having a dedicated EM pharmacy service, and 11 of 35 hospitals (31%) indicated a 7‐day EM pharmacy service. All hospitals with a dedicated EM pharmacy service were involved in medication reconciliation, discharge counselling and clinical consultation for ED patients. Nine of 34 hospital responses (26.5%) indicated that the EM pharmacist was involved during resuscitation (stroke callouts, cardiopulmonary arrest and/or trauma) during weekdays. Two hospitals also provided this service on weekends.ConclusionCurrent clinical activities of EM pharmacists appear to be based on traditional areas of practice, but also include emerging roles of participation during resuscitation.

Supplemental Milestones for Emergency Medicine Residency Programs: A Validation Study.

IntroductionEmergency medicine (EM) residency programs may be 36 or 48 months in length. The Residency Review Committee for EM requires that 48-month programs provide educational justification for the additional 12 months. We developed additional milestones that EM training programs might use to assess outcomes in domains that meet this accreditation requirement. This study aims to assess for content validity of these supplemental milestones using a similar methodology to that of the original EM Milestones validation study.MethodsA panel of EM program directors (PD) and content experts at two institutions identified domains of additional training not covered by the existing EM Milestones. This led to the development of six novel subcompetencies: “Operations and Administration,” “Critical Care,” “Leadership and Management,” “Research,” “Teaching and Learning,” and “Career Development.” Subject-matter experts at other 48-month EM residency programs refined the milestones for these subcompetencies. PDs of all 48-month EM programs were then asked to order the proposed milestones using the Dreyfus model of skill acquisition for each subcompetency. Data analysis mirrored that used in the original EM Milestones validation study, leading to the final version of our supplemental milestones.ResultsTwenty of 33 subjects (58.8%) completed the study. No subcompetency or individual milestone met deletion criteria. Of the 97 proposed milestones, 67 (69.1%) required no further editing and remained at the same level as proposed by the study authors. Thirty milestones underwent level changes: 15 (15.5%) were moved one level up and 13 (13.4%) were moved one level down. One milestone (1.0%) in “Leadership and Management” was moved two levels up, and one milestone in “Operations and Administration” was moved two levels down. One milestone in “Research” was ranked by the survey respondents at one level higher than that proposed by the authors; however, this milestone was kept at its original level assignment.ConclusionSix additional subcompetencies were generated and assessed for content validity using the same methodology as was used to validate the current EM Milestones. These optional milestones may serve as an additional set of assessment tools that will allow EM residency programs to report these additional educational outcomes using a familiar milestone rubric.

Active manipulation of EM fields in open waveguides

The central question addressed in this paper is whether we can introduce an antenna array into a circular cylindrical waveguide to accurately control or determine the local field around the array with vanishingly small reflection from the boundary of the waveguide. We ask this question since we perceive the answer to be important to the applied community through its relevance for applications to electromagnetic shielding or slot antennas. We make use of the results presented in Onofrei (2014) for the scalar Helmholtz equation and show, by using the Debye representation in waveguides, how they apply to the current EM waveguide model. We prove the existence of a class of solutions and include a feasibility discussion for the antenna synthesis problem together with relevant simulations.

Entry mode and emerging market MNEs: An analysis of Chinese greenfield and acquisition FDI in the United States

A growing theoretical literature on emerging market MNEs argues they use aggressive acquisitions, often to psychically distant, developed host countries, to obtain strategic assets. The use of acquisitions as the dominant entry mode for strategic asset seeking, therefore, stands at heart of current EM MNE theorizing. To date, however, systematic empirical testing of the motivations for different entry modes by EM MNEs is limited. We address this gap by exploring the motivations for Chinese greenfield and acquisition investments in the United States. Our results are broadly supportive of the growing theoretical literature on EM MNEs, arguing acquisitions are the primary mode of strategic asset seeking in developed markets. We also find state ownership impacts strategic assets seeking and strategic asset seeking intensified in the post global financial crisis period.

3D anisotropic modeling for airborne EM systems using finite-difference method

Abstract Most current airborne EM data interpretations assume an isotropic model, which is sometimes inappropriate, especially in regions with distinct dipping anisotropy due to strong layering and stratifications. In this paper, we investigate airborne EM modeling and interpretation for a 3D earth with arbitrarily electrical anisotropy. We implement the staggered finite-difference algorithm to solve the coupled partial differential equations for the scattered electrical fields. Whereas the current density that is connected to the diagonal elements of the anisotropic conductivity tensor is discretized by using the volume weighted average, the current density that is connected to the non-diagonal elements is discretized by using the volume current density average. Further, we apply a divergence correction technique designed specifically for 3D anisotropic models to speed up the modeling process. For numerical experiments, we take both VMD and HMD transmitting dipoles for two typical anisotropic cases: 1) anisotropic anomalous inhomogeneities embedded in an isotropic half-space; and 2) isotropic anomalous inhomogeneities embedded in an anisotropic host rock. Model experiments show that our algorithm has high calculation accuracy, the divergence correction technique used in the modeling can greatly improve the convergence of the solutions, accelerating the calculation speed up to 2 times for the model presented in the paper. The characteristics inside the anisotropic earth, like the location of the anomalous body and the principal axis orientations, can also be clearly identified from AEM area surveys.

Characterizing the limited use of point-of-care ultrasound in Colombian emergency medicine residencies

BackgroundEmergency medicine (EM) is a growing specialty in Colombia with five residency programs in the country. EM leadership is interested in incorporating point-of-care (POC) ultrasound into a standardized national EM residency curriculum. This study is a nationwide survey of Colombian EM residents designed to explore the current state of POC ultrasound use within EM residencies and examine specific barriers preventing its expansion.MethodsWe conducted a mix-methodology study of all available current EM residents in the five EM residencies in Colombia. The quantitative survey assessed previous ultrasound experience, current use of various applications, desire for further training, and perceived barriers to expanded use. Focus group discussions (FGDs) were conducted with current EM residents to gather additional qualitative insight into their practice patterns and perceived barriers to clinician-performed ultrasound.ResultsSixty-nine EM residents completed the quantitative survey, a response rate of 85% of all current EM residents in Colombia; 52% of resident respondents had previously used ultrasound during their training. Of these, 58% indicated that they had performed <10 scans and 17% reported >40 scans. The most frequently used applications indicated by respondents were trauma, obstetrics, and procedures including vascular access. A quarter indicated they had previously received some ultrasound training, but almost all expressed an interest in learning more. Significant barriers included lack of trained teachers (indicated by 78% of respondents), absence of machines (57%), and limited time (41%). In FGDs, the barriers identified were inter-specialty conflicts over the control of ultrasonography, both institutionally and nationally, and program-specific curriculum decisions to include POC ultrasound.ConclusionWhile currently limited in their access, EM residents in Colombia have a strong interest in integrating POC ultrasound into their training. Current barriers to expanded use include traditional barriers such as a lack of equipment seen in many developing countries, as well as inter-specialty conflicts typical of developed countries. Further collaboration is underway to help overcome these obstacles and integrate POC ultrasound into Colombian EM residency training.

The Retention of IT Sales Professionals

The IT solutions industry has faced many challenges related to the retention of the sales force. This research evaluated many factors that influence the decisions of IT Solutions sales professionals to continue their employment with their current employer. It identifies the perceptive views of IT sales professionals on the effects of salary and non-salary factors on the voluntary turnover of these sales professionals. As Vice President of software sales at Freightcenter, Inc. and former director of global sales at Microdasys, Inc., the co-author Dr. David Hemmans finds the retention of IT sales profes- sionals to be a growing concern among today's IT solution sales organizations. As Associate Professor in Business Ad- ministration and with several years of experience in Marketing, Strategic Planning and Business Analytics, in various in- dustries such as pharmaceutical, telecommunications, consumer products, biotech as well as insurance the co-author Dr. Santosh Sambare sees direct application of the results of this study in addressing the concerns of turnover in the sales pro- fessionals not only in the IT industry but also other environments as well. This research concludes that several salary as well as several non-salary factors affect the decisions of IT sales professionals to maintain employment with their current em- ployer. This research indicates that companies need to provide support to their sales professionals by providing good leads, qualifying these leads, emphasizing sales training, having clearly articulated pricing policies, and promoting excellent in- stallation and customer service. This research concludes that job satisfaction is more important than base pay or commissions in influencing the IT sales professional to remain with their employer. The key recommendation to IT solutions companies from this research are that focusing on job satisfaction, recognition, and support services are more important than base pay and bonuses to maximize IT sales professional retention. The implication of the results of this study for IT sales management is to also focus beyond the traditional salary based factors such as base pay, commissions and bonus plans and concentrate on job satisfaction of their IT solutions sales managers. Also, it suggests sales management to show concern and care for their sales professionals and ensure that they have good scope for advancement in their organizations. In addition, sales man- agement should ensure that the sales position is challenging and provide training programs to help sales professionals meet their goals as well as to provide the support needed by the sales professionals to be successful in their positions. Such support includes access to accurate customer data, timely access to internal engineering and pre-sales resources, and assistance from upper management in closing major deals.

Evaluating emergency ultrasound training in India

Background:In countries with fully developed emergency medicine systems, emergency ultrasound (EUS) plays an important role in the assessment and treatment of critically ill patients.Methods:The authors sought to introduce EUS to a group of doctors working in the emergency departments (EDs) in India through an intensive 4-day adult and pediatric ultrasound course held at the Apex Trauma Center and EM division of the All India Institute of Medical Sciences in New Delhi. The workshop was evaluated with a survey questionnaire and a hands-on practical test. The questionnaire was designed to assess the current state of EUS in India's EDs, and to identify potential barriers to the incorporation of EUS into current EM practice. The EUS course consisted of a general introductory didactic session followed by pediatric, abdominal and trauma, cardiothoracic, obstetrical and gynecologic, and vascular modules. Each module had a didactic session followed by handson applications with live models and/or simulators. A post-course survey questionnaire was given to the participants, and there was a practical test on the final day of the course. The ultrasound images taken by the participants were digitally recorded, and were subsequently graded for their accuracy by independent observers, residency, and/or fellowship trained in EUS.Results:There were a total of 42 participants who completed the workshop and took the practical examination; 32 participants filled in the course evaluation survey. Twenty-four (75%) participants had no prior experience with EUS, 5 (16%) had some experience, and 3 (9%) had significant experience. During the practical examination, 38 of 42 participants (90%) were able to identify Morison's pouch on the focused abdominal sonography for trauma (FAST) examination, and 32 (76%) were able to obtain a parasternal long axis cardiac view and identify the left ventricle. The inferior vena cava was identified as it crosses the diaphragm into the right atrium by 20 (48%) participants. All participants felt they would be able to incorporate what they had learned into their practice, and indicated that they were advocates for further training of non-radiologist clinicians in the use of ED ultrasound.Conclusion:After this introductory workshop in EUS, the participants were comfortable in their ability to use the ultrasound machine. Participants deemed it particularly useful for certain ED applications, particularly the FAST examination, the lung examination, and vascular access.

Key Statistics for Health Care Reform

surveys (Census Bureau); the Medical Expenditures Panel Sur vey (AHRQ); National income and product and input-output accounts (Bureau of Economic Analysis (BEA)); Consumer Expenditures Survey, Consumer Price Index, Employment Com pensation Survey, Current Em ployment Statistics (Bureau of Labor Statistics); and surveys of research and development (Na tional Science Foundation). Pri vate sources used for the NHEA

Two field applications of the rotating current EM method : S. H. Hall, Geophysical Prospecting, 44(2), 1996, pp 251–277

Two field applications of the rotating current EM method : S. H. Hall, Geophysical Prospecting, 44(2), 1996, pp 251–277

Two field applications of the rotating current EM method1

AbstractThe rotating current EM method has been applied to the delineation of two conductive orebodies, Elura near Cobar, NSW, and Thalanga near Charter's Towers, Queensland. The field data were collected in the form of observations of the vertical magnetic field strength ratio and phase difference using a Turam‐style receiver with twin vertical coils. By reconstituting this data back to the ring source field and phase, i.e. the observed Hz, phasor, it is possible to present contoured maps of the EM field. Anomaly phasors are obtained by subtracting theoretical phasors from the observed phasors in the complex plane of the Hz phasor. The theoretical phasors for the finite source are based on horizontally layered, half‐space earth models, computed at each point of the survey grids, then normalized to selected points of the observed fields. Use is made of the intrinsic circular symmetry of the method in X–Y plots of field versus source‐receiver distance to ascertain geoelectric parameters for the earth models. A steel picket fence at Thalanga is modelled by a line source grounded at each end and its Hz, phasor is removed by the same process.A considerable improvement in anomaly delineation is gained over previous Turam‐style anomalies and the two survey examples illustrate the limitations of the method in the presence of a conductive overburden (Elura) and its abilities in the absence of a conductive overburden (Thalanga).

A study of the density of gap states in amorphous semiconductors from thermostimulated conductivity spectra

A theoretical analysis of thermostimulated conductivity spectra σTSC(T) has been applied to determine the density of gap states g(E) in a-Si: H and a-Si: H/a-SiNx: H multilayer structures. The results for g(E) are consistent with the results deduced from Fritzsche's analytical approach as well as other methods. A comparison has been made between the two different analytical approaches for σTSC(T). We discuss the relationship between the energy of maximum thermostimulated current emission Em and quasi-Fermi level Eq. We demonstrate that Eq could be a better parameter than Em in the general theoretical treatment of thermostimulated conductivity.

Economic Consequences of Divorce or Separation Among Women in Poverty

This study, using data from the National Longitudinal Survey's Young Women Cohort, looked at characteristics of low- income women following divorce or separation. Resources and characteristics that would help explain a woman's ability to move out of poverty in the year following divorce or separation were ana- lyzed. Discriminant anal sis results indicated that the most impor- tant discriminators of w K ether or not women would move out of poverty immediately following marital disruption were current em- ployment status, job training, education, race, and presence of a child under six years old.

AN INVESTIGATION OF DENSITY OF GAP STATES IN AMORPHOUS SEMICONDUCTORS BY THERMOSTI-MULATED CONDUCTIVITY SPECTRA

Determination of the density of states in the uper half of gap in a-Si:H film and a-Si:H/a-SiNx: H superlattices were obtained by a more comprehensive theoretical analysis of the thermostimulated comductivity. The results are consistent with that of Fritzsche's analysis. The main features of the two different analytical approaches and the correlation between maximnm chermostimulated current emission energy Em and quasi-Fermi level were discussed. The results show that the thermostimulated conductivity in a-Si: H should be analysed in weak recombination condition. In consequence, retrapping of the thermostimulated carriers can not be negleted. Theory of Gu et al. improves the analysis of measurement of thermostimulated conductivity.