The more things change the more they stay the same: Factors influencing emergency medicine residency selection in the virtual era.

Background: Interviews for emergency medicine (EM) residency positions largely transitioned to a virtual-only format in 2020-2021. The impact of virtual interview factors on applicants' rank of programs is unknown. Objective: We sought to assess the impact of modifiable factors in virtual interviews on applicants' rank of EM residency programs. Methods: We conducted a cross-sectional mixed-methods survey of students applying to at least one of seven study authors' EM residency programs in the United States during the 2020-2021 application cycle. The survey was developed using an interactive Delphi process and piloted prior to implementation. The survey was administered from May to June 2021 with up to four email reminders. Quantitative analysis included descriptive statistics. Three authors performed a thematic qualitative analysis of free-text responses. Results: A total of 664 of 2281 (29.1%) students completed the survey, including 335 (50.5%) male, 316 (47.7%) female, and six (0.9%) nonbinary. A total of 143 (21.6%) respondents identified as underrepresented in medicine and 84 (12.7%) identified as LGBTQIA+. Respondents participated in a median of 14 interviews and ranked a median of 14 programs. Most respondents (335, 50.6%) preferred a choice of in-person or virtual, while 183 (27.6%) preferred all in-person, and 144 (21.8%) preferred all virtual. The program website and interview social were the most important factors influencing respondent ranking. Qualitative analysis revealed several positive aspects of virtual interviews including logistical ease and comfort. Negative aspects include technical issues, perceived interview hoarding, and barriers to applicant assessment and performance. Demonstrated effort by the program, effective information delivery, communication of resident culture, and a well-implemented interview day positively influenced respondents' rank of programs. Conclusions: This study identified characteristics of the virtual interview format that impact applicants' rank of programs. These results can inform future recruitment practices.

Care of Acute Gastrointestinal Conditions in the Observation Unit.

The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built.

Determination of artificial sweeteners in beverages with green mobile phases and high temperature liquid chromatography-tandem mass spectrometry.

A new analytical procedure involving the use of water and a low percentage of ethanol combined to high temperature liquid chromatography-tandem mass spectrometry has been developed for the determination of nine high-intensity sweeteners in a variety of drink samples. The method permitted the analysis in 23min (including column reequilibration) and consuming only 0.85mL of a green organic solvent (ethanol). This methodology provided limits of detection (after 50-fold dilution) in the 0.05-10mg/L range, with recoveries (obtained from five different types of beverages) being in the 86-110% range and relative standard deviation values lower than 12%. Finally, the method was applied to 25 different samples purchased in Spain, where acesulfame and sucralose were the most frequently detected analytes (>50% of the samples) and cyclamate was found over the legislation limit set by the European Union in a sample and at the regulation boundary in three others.

Recommendations for the evaluation and management of observation services: a consensus white paper: the Society of Cardiovascular Patient Care.

Observation Services (OS) was founded by emergency physicians in an attempt to manage "boarding" issues faced by emergency departments throughout the United States. As a result, OS have proven to be an effective strategy in reducing costs and decreasing lengths of stay while improving patient outcomes. When OS are appropriately leveraged for maximum efficiency, patients presenting to emergency departments with common disease processes can be effectively treated in a timely manner. A well-structured observation program will help hospitals reduce the number of inappropriate, costly inpatient admissions while avoiding the potential of inappropriate discharges. Observation medicine is a complicated multidimensional issue that has generated much confusion. This service is designed to provide the best possible patient care in a value-based purchasing environment where quality, cost, and patient satisfaction must continually be addressed. Observation medicine is a service not a status. Therefore, patients are admitted to the service as outpatients no matter whether they are placed in a virtual or dedicated observation unit. The key to a successful observation program is to determine how to maximize efficiencies. This white paper provides the reader with the foundational guidance for observational services. It defines how to set up an observational service program, which diagnoses are most appropriate for admission, and what the future holds. The goal is to help care providers from any hospital deliver the most appropriate level of treatment, to the most appropriate patient, in the most appropriate location while controlling costs.

Determination of artificial sweeteners in sewage sludge samples using pressurised liquid extraction and liquid chromatography-tandem mass spectrometry.

An analytical method for the determination of six artificial sweeteners in sewage sludge has been developed. The procedure is based on pressurised liquid extraction (PLE) with water followed by solid-phase extraction (SPE) and subsequent liquid chromatography-tandem mass spectrometry analysis. After optimisation of the different PLE parameters, extraction with aqueous 500mM formate buffer (pH 3.5) at 80°C during a single static cycle of 21min proved to be best conditions. After a subsequent SPE, quantification limits, referred to dry weight (dw) of sewage sludge, ranged from 0.3ng/g for acesulfame (ACE) to 16ng/g for saccharin (SAC) and neohespiridine dihydrochalcone. The trueness, expressed as recovery, ranged between 72% and 105% and the precision, expressed as relative standard deviation, was lower than 16%. Moreover, the method proved its linearity up to the 2µg/g range. Finally, the described method was applied to the determination of the artificial sweeteners in primary and secondary sewage sludge from urban wastewater treatment plants. Four of the six studied artificial sweeteners (ACE, cyclamate, SAC and sucralose) were found in the samples at concentrations ranging from 17 to 628ng/g dw.

Determination of artificial sweeteners in water samples by solid-phase extraction and liquid chromatography-tandem mass spectrometry.

The development and performance evaluation of an analytical method for the determination of six artificial sweeteners in environmental waters using solid-phase extraction (SPE) followed by liquid chromatography-tandem mass spectrometry are presented. To this end, different SPE alternatives have been evaluated: polymeric reversed-phase (Oasis HLB, Env+, Plexa and Strata X), and mixed-mode with either weak (Oasis WAX) or strong anionic-exchange (Oasis MAX and Plexa PAX) sorbents. Among them, reversed-phase sorbents, particularly Oasis HLB and Strata X, showed the best performance. Oasis HLB provided good trueness (recoveries: 73-112%), precision (RSD<10%) and limits of quantification (LOQ: 0.01-0.5 µg/L). Moreover, two LC separation mechanisms were evaluated: reversed-phase (RPLC) and hydrophilic interaction (HILIC), with RPLC providing better performance than HILIC. The final application of the method showed the presence of acesulfame, cyclamate, saccharin and sucralose in the wastewater and surface water samples analyzed at concentrations up to 54 µg/L.

Computer assisted optimization of liquid chromatographic separations of small molecules using mixed-mode stationary phases.

Mixed-mode stationary phases are gaining adepts in liquid chromatography (LC) as more and more applications are published and new commercial columns appear in the market ought to their ability to retain and separate analytes with multiple functionalities. The increased number of adjustable variables gives these columns an enhanced value for the chromatographer, but, on the other hand, it complicates the process of developing satisfactory separations when complex samples must be analyzed. Thus, the availability of computer assisted methods development (CAMD) tools is highly desirable in this field. Therefore, the first specific tool for the CAMD of LC separations in mixed-mode columns is presented. The tool consists in two processes. The first one develops a retention model for peaks in a predefined experimental domain of pH and buffer concentration. In this domain, the retention as a function of the proportion of organic modifier is modeled using a two-stage re-calibration process departing from isocratic retention data and then, from gradient elutions. With this two-stage approach, reliability is gained. In the second process, the model is finally interpolated and used for the unattended optimization of the different possible elution modes available in these columns. This optimization process is driven by an evolutionary algorithm. The development and application of this new chemometrics tool is demonstrated by the optimization of a mixture of neutral and ionizable compounds. Hence, several different types of gradients were generated, showing a good agreement between simulated and experimental data, with retention time errors lower than 5% in most cases. On the other hand, classical CAMD tools, such as design of experiments, were unable to efficiently deal with mixed-mode optimizations, rendering errors above 30% for several compounds.

[Effects of vegetal oil supplementation on the lipid profile of Wistar rats ]. / Efecto del suplemento de aceites vegetales sobre el perfil lipídico en ratas wistar.

BACKGROUND: Dietary tocopherols, tocotrienols and saturated, mono and polyunsaturated fatty acids have been reported to have an effect on blood lipid profiles. In Colombia, vegetable oils (palm, soy, corn, sunflower, and canola) are a common dietary constituent and consumed in high quantities. OBJECTIVE: In the current study, the effects of vegetable oil consumption was examined by measuring blood concentrations of triglycerides (TG), total cholesterol (TC) and HDL cholesterol (HDL-C) in male Wistar rats. METHODS: The concentrations of tocopherols, tocotrienols, and fatty acids in each oil was quantified by High Performance Liquid Chromatography (HPLC). Each rat diet was supplemented with 0.2 ml/day with one oil type. Over a 4-week period, groups of animals were sacrificed weekly and blood samples were obtained to quantify TC, TG and HDL-C for each oil class. Statistical analyses included mean, standard deviation, ANOVA and Bonferroni comparisons tests. RESULTS: Triglyceride content was not affected except in the control and the soy group in the third treatment week, although a tendency for decreased TG was noted in the palm oil group and for increased TG in the sunflower oil and canola oil groups. No significant differences in total cholesterol were observed. In HDL-C, significant differences were present for every treatment week (p = 0.005); this represented a decreasing trend in palm oil group and an increasing trend in the sunflower and corn oil groups. CONCLUSION: The oils effected changes in the blood lipid profile. A small amount of saturated fatty acids (tocopherol and tocotrienol) were favourable for the HDL-C increase. The presenct of tocorienols tended to decrease the TG and probably helped attenuate the unfavorable effects of the saturated fatty acids.

Efecto del suplemento de aceites vegetales sobre el perfil lipídico en ratas Wistar / Effects of vegetal oil supplementation on the lipid profile of Wistar rats

Introducción. Se informan efectos sobre el perfil lipídico por acción de los tocoferoles, tocotrienoles y ácidos grasos saturados, monoinsaturados y poliinsaturados. Objetivo. Evaluar el efecto del consumo de aceites vegetales de alta utilización en Colombia (palma, soya, maíz, girasol y canola) sobre las concentraciones sanguíneas de triglicéridos, colesterol total y colesterol-HDL en ratas Wistar. Metodología. Se cuantificaron tocoferoles, tocotrienoles y ácidos grasos de los aceites por cromatografía líquida de alta resolución. A los animales se les suministró un suplemento de 0,2 ml/día de aceite durante 4 semanas; se sacrificó un grupo de cada tratamiento (grupos tratados con aceite de palma, aceite de soya, aceite de maíz, aceite de girasol y aceite de canola) para obtener muestras de sangre y cuantificar triglicéridos, colesterol total y colesterol-HDL. Los datos se analizaron según media, desviación estándar, análisis de varianza y Bonferroni. Resultados. No se presentaron diferencias en los triglicéridos a excepción del grupo control versus soya en la tercera semana de tratamiento; se observó también una tendencia a la disminución en el grupo de palma y al aumento en los de girasol y canola. No se encontraron diferencias significativas en colesterol total en ninguna de las semanas de intervención. Se presentaron diferencias en las concentraciones de colesterol HDL en las semanas de tratamiento (p=0,005), una tendencia a la disminución en el grupo de palma y al aumento en el grupo de girasol y maíz. Conclusión. Los aceites modifican el perfil lipídico; el bajo contenido de ácidos grasos saturados, el contenido de tocoferoles y tocotrienoles son favorables para el aumento del colesterol HDL; los tocotrienoles probablemente disminuyen los troglicéridos y atenúan las respuestas desfavorables de los ácidos grasos saturados

Influencia de la posición con respecto a la fuerza de gravedad sobre la hidrodinámica de un modelo experimental de aneurisma sacular / Influence of the position in respecto to the gravitation force,upon the hydrodynamics of an experimental model of sacular aneurism

Para confirmar la hipótesis de que la hidrodinámica de los aneurismas cerebrales depende en parte de la posición de éstos, respecto a la fuerza de la gravedad, se desarrolló un modelo experimental de aneurisma en látex, sometido a flujo pulsátil. Con inyección de tintes y radioisótopos, se hicieron registros en 4 posiciones diferentes. Se diseñó un modelo físico que permitió el análisis cuantitativo de los resultados y que abre además la posibilidad de analizar matemáticamente la hidrodinámica de los aneurismas. Los resultados sugieren que cuando el aneurisma se encuentra orientado en contra de la fuerza de gravedad, tiene muy bajo riesgo de trombosis y la escasa turbulencia de su flujo condiciona un menor riesgo de crecimiento y ruptura respecto a cualquier otra posición. La mayor turbulencia en el flujo de la pared la tiene el aneurisma orientado hacia abajo, es decir, paralelo a la fuerza de gravedad. El aneurisma orientado hacia abajo es el que por su hidrodinámica, tiene más posibilidades de complicarse, ya que se tiene: a) un mayor riesgo de ruptura debido al impacto del chorro sobre la pared y la turbulencia que este impacto produce, b) un mayor riesgo de trombosis producida por la éstasis circulatoria que tiene en su cúpula. Esta combinación de factores (ruptura y trombosis) hace que estos aneurismas tiendan a crecer más que otros