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Item Difference‐Makers for Collecting Sexual Orientation and Gender Identity Data in Oncology Settings(Wiley, 2025) Pratt-Chapman, Mandi L.; Miech, Edward J.; Mullins, Megan A.; Chang, Shine; Quinn, Gwendolyn P.; Maingi, Shail; Schabath, Matthew B.; Kamen, Charles; Emergency Medicine, School of MedicinePurpose: The purpose of this analysis was to identify key difference-making conditions that distinguish oncology institutions that collect sexual orientation and gender identity (SOGI) data across a sample of American Society of Clinical Oncology (ASCO) members. Methods: From October to November 2020, an anonymous 54-item web-based survey was distributed to ASCO members. Coincidence analysis was used to identify difference-making conditions for the collection of SOGI data. Results: ASCO members' responses to just three items consistently distinguished practices that reported collecting both SO and GI data (n = 25) from those who did not (n = 20): (1)."Do you ask your patients what pronouns they want you to use for them?"; (2) "Institutional leadership supports collecting SOGI data from patients"; and (3)"Does the electronic health record (EHR) at your institution have a specific section to collect information about patients' SOGI?" The positive model exhibited both reliability (consistency = 0.87, or 20/23) and explanatory breadth (coverage = 0.80, or 20/25). The negative model for SOGI data collection consisted of different responses to the same three items and likewise showed both reliability (consistency = 0.94, or 16/17) and explanatory breadth (coverage = 0.80, or 16/20). Conclusions: Specific levels of leadership support, frequency of asking patients about pronouns, and the presence or absence of EHR record structure were difference-makers for collecting SOGI data in this sample. The study underscores the importance of leadership support, structured data fields, and attention to patient pronouns, which are aligned with the ASCO and National Institutes of Health calls to action.Item Virtual Interviews Correlate with Home and In-State Match Rates at One Emergency Medicine Program(University of California, 2025) Motzkus, Christine; Frey, Casey; Humbert, Aloysius; Emergency Medicine, School of MedicineIntroduction: Incorporating virtual interviews into residency recruitment may help diversify access to residency programs while reducing the cost involved with travel and lodging. Programs may be more likely to rank students they have met in person at an interview when compared to unknown virtual applicants. Our objective was to characterize home institution, in-state, and in-region match rates to emergency medicine (EM) residency programs for fourth-year medical students. Methods: We used National Residency Matching Program data available to the program director to identify medical school and match location of fourth-year medical students who interviewed at a large EM residency program in the Midwest from 2018-2023. Students' medical schools and ultimately matched programs were mapped to Electronic Residency Application Service geographic regions; subgroup analyses evaluated allopathic and osteopathic medical students separately. We used chi-square tests to compare proportions of students matching to home, in-state, or in-region programs across years. Results: There were 1,401 applicants with match information available. The percentage of students matching to a home institution remained stable over the course of the study. The percentage of students matching to an in-state institution increased over the first two years of virtual interviews rising from 23.2% in the 2020 match to 30.8% in-state matches for the 2022 match. Chi-square tests did not reveal any significant differences among groups for all applicants. Allopathic medical students demonstrated a significant increase in matches to home institutions. In-region matches stayed relatively stable over the study time frame regardless of subgroup. Conclusion: Virtual interviews changed the landscape of residency interviews. Home institution and in-state matches may be more likely for applicants from allopathic schools who participated in a virtual interview as both programs and applicants are more familiar with each other; however, our study did not find convincing evidence of this possibility among all applicants. Additional study is needed to determine ongoing effects of the transition to virtual interviews.Item Changes in Liver Function Tests, Congestion, and Prognosis After Acute Heart Failure: The STRONG-HF Trial(Elsevier, 2025) Myhre, Peder L.; Grupper, Avishay; Mebazaa, Alexandre; Davison, Beth; Edwards, Christopher; Takagi, Koji; Adamo, Marianna; Arrigo, Mattia; Barros, Marianela; Biegus, Jan; Celutkiene, Jelena; Čerlinskaitė-Bajorė, Kamilė; Chioncel, Ovidiu; Cohen-Solal, Alain; Damasceno, Albertino; Deniau, Benjamin; Diaz, Rafael; Filippatos, Gerasimos; Gayat, Etienne; Kimmoun, Antoine; Ter Maaten, Jozine M.; Metra, Marco; Novosadova, Maria; Pagnesi, Matteo; Pang, Peter S.; Ponikowski, Piotr; Saidu, Hadiza; Sliwa, Karen; Tomasoni, Daniela; Voors, Adriaan; Cotter, Gad; Lam, Carolyn S. P.; Emergency Medicine, School of MedicineBackground: Elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (tBil) may reflect congestion and liver dysfunction in acute heart failure (AHF), while lower ALT also associates with sarcopenia. Objectives: The purpose of this study was to assess ALT, AST, and tBil levels in AHF patients during high-intensity care (HIC) vs usual care (UC) follow-up. Methods: ALT, AST, and tBil were measured 1 to 2 days predischarge in 1,062 AHF patients, and again after 90 days of either HIC or UC according to the STRONG-HF (Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP testinG, of Heart Failure therapies) protocol. The primary endpoint was 180-day all-cause death or HF hospitalization. Results: Median (Q1-Q3) baseline ALT, AST, and tBil were 21 (15-32) U/L, 23 (17-32) U/L, and 14(10-21) umol/L, respectively. Patients with lower ALT had lower body mass index. Patients with lower ALT, but not tBil or AST, were more likely to have edema, elevated jugular venous pressure, and orthopnea, and use more diuretics prerandomization. A nonsignificant inverse association between ALT and the primary outcome (HR: 0.82 [95% CI: 0.66-1.01] per log-unit, P = 0.06) was observed. Greater reductions of ALT, AST, and tBil to 90 days were associated with greater improvement of edema, rales, NYHA functional class, and N-terminal pro-B-type natriuretic peptide. After 90 days, the HIC group had a greater reduction in AST and tBil than the UC group, while nonsignificant for ALT. The treatment effect of HIC over UC on the primary outcome was consistent across the baseline ALT, AST, and tBil range (all P interaction >0.10), but patients with lower ALT experienced greater health status improvement from HIC. Conclusions: Lower ALT was associated with lower body mass index and more congestion in AHF, supporting previous studies suggesting ALT as a sarcopenia marker. The beneficial effect of HIC on health status was greater in low baseline ALT patients.Item Therapy Dogs for Anxiety in Children in the Emergency Department: A Randomized Clinical Trial(American Medical Association, 2025-03-03) Kelker, Heather P.; Siddiqui, Huma K.; Beck, Alan M.; Kline, Jeffrey A.; Emergency Medicine, School of MedicineImportance: Prior evidence suggests that the use of therapy dogs in emergency care reduces anxiety in adults, but no trial has tested the use of therapy dogs in emergency care of children. Objective: To examine whether adjunctive use of therapy dogs in standard child-life therapy reduces child-reported and parent-reported child anxiety in a pediatric emergency department (ED). Design, setting, and participants: This randomized clinical trial was conducted from February 1, 2023, to June 30, 2024, at an academic pediatric ED. Children (aged 5-17 years) with suspected moderate to high anxiety were included. Intervention: All participants received standard child-life therapy, and the intervention group was randomly assigned to have exposure to a therapy dog and handler for approximately 10 minutes. Main outcomes and measures: Anxiety was measured using the 0- to 10-point FACES scale (with 0 indicating no anxiety and 10 indicating very severe anxiety) and salivary cortisol concentrations. Measurements were obtained at baseline (T0), 45 minutes (T1), and 120 minutes (T2) for both child and parents. Results: A total of 80 patients (mean [SD] age, 10.9 [3.8] years; 45 [56%] female) were enrolled (40 in the control group and 40 in the intervention group). At T0, the mean (SD) FACES scores were 5.4 (2.8) for child report and 6.4 (2.4) for parent report; the means were not different between groups. From T0 to T1, child-reported anxiety changed by a mean (SD) of -1.5 (3.4) points in the control group vs -2.7 (2.5) points in the intervention group (P = .02, Mann-Whitney U test); similarly, mean (SD) parent-estimated child anxiety changed by -1.8 (2.7) points in the control group vs -3.2 (2.3) points in the intervention group (P = .008). A total of 9 children (23%) in the control group had a greater than 2.5-point decrease in FACES score vs 18 (46%) in intervention group (P = .04, Fisher test). At T2, mean (SD) child-reported FACES scores decreased to 3.6 (3.4) points in the control group and 3.0 (2.7) points in the intervention group (P = .70). A total of 14 control participants (35%) received ketamine, midazolam, lorazepam, or droperidol vs 7 (18%) in the intervention group (P = .08, Fisher test). Child and parent salivary cortisol decreased from T0 to T1 in both groups but was not different between groups. Parental salivary cortisol was significantly consistently higher than their children's salivary cortisol (P < .001, unpaired t test, for comparisons of child vs parent at T0 and T1 in both groups). Conclusions and relevance: This study of adjunctive use of therapy dogs in standard child-life therapy found a modest but significantly greater reduction in both child-reported and parental-reported child anxiety in the pediatric ED for the intervention vs control group. These findings support the use of therapy dogs to help reduce pain and anxiety without the use of chemical or physical constraint.Item Emergency Medicine Faculty Utilization of Point-of-Care Ultrasound in the Clinical Setting(Springer Nature, 2025-02-11) Russell, Frances M.; Ferre, Robinson M.; Kennedy, Sarah K.; Nti, Benjamin; Frey, Drew; Brenner, Daniel; Emergency Medicine, School of MedicineIntroduction: Point-of-care ultrasound (POCUS) curricula for emergency medicine residents and faculty are guided by emergency medicine societal ultrasound guidelines. These guidelines lack clinical data to support them and are mainly based on expert consensus recommendations. Data are needed to address critical gaps in the literature to identify which POCUS studies are most commonly utilized in the clinical setting to help guide guideline recommendations and POCUS curricular design. The primary aim of this study was to determine the most utilized POCUS modalities in the emergency department clinical setting. The findings of this study may be used to guide the curricular design of future POCUS trainings. Methods: This was a retrospective study evaluating all clinically indicated and billed POCUS studies performed and interpreted by faculty in the emergency department setting across 10 emergency departments over a three-year period in Indianapolis, Indina, USA. The number of exams and modalities were extracted from the POCUS workflow solution. The frequency and percentage of exams were calculated. Results: A total of 5,324 POCUS examinations were performed. Cardiac, obstetric, soft tissue, and focused assessment with sonography in trauma (FAST) POCUS were the most billed modalities across all adult emergency departments regardless of academic or community setting. Although fewer data were available from the pediatric setting, we found that cardiac, soft tissue, FAST, and lung POCUS exams were the most utilized. Conclusion: These data from a single healthcare system would suggest that emergency physician POCUS curricula should focus on cardiac, obstetric, soft tissue, FAST, and lung exams. More data are needed from the pediatric setting to determine which scans are most utilized.Item Harder, Better, Faster, Stronger? Residents Seeing More Patients Per Hour See Lower Complexity(University of California, 2025) Jewell, Corlin M.; Bai, Guangyu (Anthony); Hekman, Dann J.; Nicholson, Adam M.; Lasarev, Michael R.; Alexandridis, Roxana; Schnapp, Benjamin H.; Emergency Medicine, School of MedicineIntroduction: Patients seen per hour (PPH) is a popular metric for emergency medicine (EM) resident efficiency, although it is likely insufficient for encapsulating overall efficiency. In this study we explored the relationship between higher patient complexity, acuity on shift, and markers of clinical efficiency. Methods: We performed a retrospective analysis using electronic health record data of the patients seen by EM residents during their final year of training who graduated between 2017-2020 at a single, urban, academic hospital. We compared the number of PPH seen during the third (final) year to patient acuity (Emergency Severity Index), complexity (Current Procedural Terminology codes [CPT]), propensity for admissions, and generated relative value units (RVU). Results: A total of 46 residents were included in the analysis, representing 178,037 total cases. The number of PPH increased from first to second year of residency and fell slightly during the third year of residency. Overall, for each 50% increase in the odds of treating a patient requiring high-level evaluation and management (CPT code 99215), there was a 7.4% decrease in mean PPH. Each 50% increase in odds of treating a case requiring hospital admission was associated with a 6.7% reduction (95% confidence interval [CI] 0.73-12%; P = 0.03) in mean PPH. Each 0.1-point increase in PPH was associated with a 262 (95% CI 157-367; P < 0.001) unit increase in average RVUs generated. Conclusion: Seeing a greater number of patients per hour was associated with a lower volume of complex patients and patients requiring admission among EM residents.Item Associations between residential segregation, ambient air pollution, and hippocampal features in recent trauma survivors(medRxiv, 2025-02-20) Liang, Sophia S.; Roeckner, Alyssa R.; Ely, Timothy D.; Lebois, Lauren A. M.; van Rooij, Sanne J. H.; Bruce, Steven E.; Jovanovic, Tanja; House, Stacey L.; Beaudoin, Francesca L.; An, Xinming; Neylan, Thomas C.; Clifford, Gari D.; Linnstaedt, Sarah D.; Germine, Laura T.; Rauch, Scott L.; Haran, John P.; Storrow, Alan B.; Lewandowski, Christopher; Musey, Paul I., Jr.; Hendry, Phyllis L.; Sheikh, Sophia; Pascual, Jose L.; Seamon, Mark J.; Harris, Erica; Pearson, Claire; Peak, David A.; Merchant, Roland C.; Domeier, Robert M.; Rathlev, Niels K.; O'Neil, Brian J.; Sergot, Paulina; Sanchez, Leon D.; Sheridan, John F.; Harte, Steven E.; Kessler, Ronald C.; Koenen, Karestan C.; McLean, Samuel A.; Ressler, Kerry J.; Stevens, Jennifer S.; Webb, E. Kate; Harnett, Nathaniel G.; Emergency Medicine, School of MedicineBackground: Residential segregation is associated with differential exposure to air pollution. Hippocampus structure and function are highly susceptible to pollutants and associated with posttraumatic stress disorder (PTSD) development. Therefore, we investigated associations between residential segregation, air pollutants, hippocampal neurobiology, and PTSD in recent trauma survivors. Methods: Participants (N = 278; 34% non-Hispanic white, 46% Non-Hispanic Black, 16% Hispanic) completed multimodal neuroimaging two weeks after trauma. Yearly averages of air pollutants (PM2.5 and NO2) and racial/economic segregation (Index of Concentration at the Extremes) were derived from each participant's address. Linear models assessed if air pollutants mediated associations between segregation and hippocampal volume, threat reactivity, or parahippocampal cingulum fractional anisotropy (FA) after covarying for age, sex, income, and 2-week PTSD symptoms. Further models evaluated if pollutants or segregation prospectively predicted PTSD symptoms six months post-trauma. Results: Non-Hispanic Black participants lived in neighborhoods with significantly greater segregation and air pollution compared to Hispanic and non-Hispanic white participants (ps<.001). There was a significant indirect effect of NO2 between segregation and FA values (β = 0.08, 95% CI[0.01, 0.15]), and an indirect effect of PM2.5 between segregation and threat reactivity (β = -0.08, 95% CI[-0.14, -0.01]). There was no direct effect of segregation on hippocampal features. Pollutants and segregation were not associated with PTSD symptoms . Conclusion: Residential segregation is associated with greater air pollution exposure, which is in turn associated with variability in hippocampal features among recent trauma survivors. Further research is needed to assess relationships between other environmental factors and trauma and stress-related disorders.Item Perceived Gaps in Oncologic Emergency Care for Patients with Cancer: A Qualitative Comparison of Emergency Medicine and Oncologist Physician Perspectives(MDPI, 2025-02-27) Wattana, Monica K.; Davenport, Moira; Bischof, Jason J.; Lindsay, Angela B.; Pettit, Nicholas R.; Menendez, Jazmin R.; Harper, Kelsey; Lipe, Demis N.; Qdaisat, Aiham; Emergency Medicine, School of MedicineObjective: Providing high-quality, safe, and consistent care for patients with cancer in the emergency department (ED) poses unique challenges. To better understand these challenges, we surveyed oncologists and emergency medicine (EM) physicians across five institutions to identify key areas for improvement in oncologic EM. Methods: In this multi-institutional, cross-sectional qualitative study, a semi-structured survey was administered to EM attending and resident physicians and medical and surgical oncologists across five institutions in 2023. We assessed the open-ended questionnaire responses using thematic analysis; codes were created and collated to generate initial themes. The themes were then reviewed according to specialty for coherence and non-repetition and finalized. Results: Of the 302 surveys accessed, 185 (61.3%) had complete responses. Three main domains of issues emerged: systems-based challenges, direct patient care-related issues, and knowledge gaps. The issues most frequently perceived by oncologist survey respondents were long delays in care (41%), variability in care (25%), and communication issues between the EM physician and oncologist (14%). The issues most frequently perceived by EM physician survey respondents were knowledge gaps in cancer therapeutics (40%) and in general oncologic emergencies (23%); physician comfort level (14%); the timing and/or location of initial discussions about goals of care (13%); and challenges with the follow-up process (12%). Conclusions: Incorporating an interdisciplinary approach to patient care in the ED, improved EM oncologic education, and the development of oncologic specialized EDs may enhance the quality, safety, and consistency of care for patients with cancer in the ED.Item Childhood adversity is associated with longitudinal white matter changes after adulthood trauma(medRxiv, 2025-03-14) Tianyi, Li; Huibregtse, Megan E.; Ely, Timothy D.; van Rooij, Sanne J. H.; Lebois, Lauren A. M.; Webb, E. Kate; Jovanovic, Tanja; House, Stacey L.; Bruce, Steven E.; Murty, Vishnu P.; Beaudoin, Francesca L.; An, Xinming; Neylan, Thomas C.; Clifford, Gari D.; Linnstaedt, Sarah D.; Bollen, Kenneth A.; Rauch, Scott L.; Haran, John P.; Storrow, Alan B.; Lewandowski, Christopher; Musey, Paul I., Jr.; Hendry, Phyllis L.; Sheikh, Sophia; Jones, Christopher W.; Punches, Brittany E.; Hudak, Lauren A.; Pascual, Jose L.; Seamon, Mark J.; Datner, Elizabeth M.; Pearson, Claire; Peak, David A.; Merchant, Roland C.; Domeier, Robert M.; Rathlev, Niels K.; O'Neil, Brian J.; Sergot, Paulina; Sanchez, Leon D.; Sheridan, John F.; Kessler, Ronald C.; Koenen, Karestan C.; Ressler, Kerry J.; McLean, Samuel A.; Stevens, Jennifer S.; Harnett, Nathaniel G.; Emergency Medicine, School of MedicineBackground: Childhood adversity is associated with susceptibility to posttraumatic stress disorder (PTSD) in adulthood. Both PTSD and adverse experiences in childhood are linked to disrupted white matter microstructure, yet the role of white matter as a potential neural mechanism connecting childhood adversity to PTSD remains unclear. The present study investigated the potential moderating role of previous childhood adversity on longitudinal changes in white matter microstructures and posttraumatic stress symptoms following a recent traumatic event in adulthood. Methods: As part of the AURORA Study, 114 recent trauma survivors completed diffusion weighted imaging at 2-weeks and 6-months after exposure. Participants reported on prior childhood adversity and PTSD symptoms at 2-weeks, 6-months, and 12-months post-trauma. We performed both region-of-interest (ROI) and whole-brain correlational tractography analyses to index associations between white matter microstructure changes and prior adversity. Results: Whole-brain correlational tractography revealed that greater childhood adversity moderated the changes in quantitative anisotropy (QA) over time across threat and visual processing tracts including the cingulum bundle and inferior fronto-occipital fasciculus (IFOF). Further, QA changes within cingulum bundle, IFOF, and inferior longitudinal fasciculus were associated with changes in PTSD symptoms between 2-weeks and 6-months. Conclusions: Our findings suggest temporal variability in threat and visual white matter tracts may be a potential neural pathway through which childhood adversity confers risk to PTSD symptoms after adulthood trauma. Future studies should take the temporal properties of white matter into consideration to better understand the neurobiology of childhood adversity and PTSD.Item Evaluating Congruence Between Laboratory LOINC Value Sets for Quality Measures, Public Health Reporting, and Mapping Common Tests(American Medical Informatics Association, 2013-11-16) Wu, Jianmin; Finnell, John T.; Vreeman, Daniel J.; Emergency Medicine, School of MedicineLaboratory test results are important for secondary data uses like quality measures and public health reporting, but mapping local laboratory codes to LOINC is a challenge. We evaluated the congruence between laboratory LOINC value sets for quality measures, public health reporting, and mapping common tests. We found a modest proportion of the LOINC codes from the Value Set Authority Center (VSAC) were present in the LOINC Top 2000 Results (16%) and the Reportable Condition Mapping Table (52%), and only 25 terms (3%) were shared with the Notifiable Condition Detector Top 129. More than a third of the VSAC Quality LOINCs were unique to that value set. A relatively small proportion of the VSAC Quality LOINCs were used by our hospital laboratories. Our results illustrate how mapping based only on test frequency might hinder these secondary uses of laboratory test results.