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Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center

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World Journal of Emergency Medicine 2020年第1期11卷 12-17页

作者： Samantha Shwe Lauren Witchey Shadi Lahham Ethan Kunstadt Inna Shniter john c.fox School of Medicine University of CaliforniaIrvine 92697USA Department of Emergency Medicine University of CaliforniaIrvineOrangeCA 92868USA

BAcKGROUND:Point-of-care ultrasound(POcUS)has become increasingly integrated into the practice of emergency medicine.A common application is the extended focused assessment with sonography in trauma(eFAST)*** American college of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate *** objective of this study was to conduct a review of performed,documented and billed eFAST ultrasounds on trauma activation ***:This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center.A list comparing all trauma activations was crossreferenced with a list of all billed eFAST *** records were reviewed to determine whether an eFAST was indicated,performed,and appropriately ***:We found that 1,507 of 1,597 trauma patients had indications for eFAST,but 396(27%)of these patients did not have a billed *** these 396 patients,87(22%)had documentation in the provider note that an eFAST was performed but there was no separate procedure *** remaining 309(78%)did not have any documentation of the eFAST in the patient’s chart although an eFAST was recorded and reviewed during ultrasound quality ***:A significant proportion of trauma patients had eFAST exams performed but were not documented or *** of documentation was *** ultrasound programs require appropriate reimbursement to support training,credentialing,equipment,quality assurance,and device *** study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.

关键词： Point-of-care ultrasound Emergency medicine Focused assessment withsonography in trauma Trauma activation Blunt trauma

Simpli?ed point-of-care ultrasound protocol to con?rm central venous catheter placement:A prospective study

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World Journal of Emergency Medicine 2017年第1期8卷 25-28页

作者： Scan P.Wilson Samer Assaf Shadi Lahham Mohammad Subeh Alan chiem craig Anderson Samantha Shwe Ryan Nguyen john c.fox Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA Department of Emergency Medicine University of CaliforniaSylmarLos AngelesCalifornia 91342USA

BAcKGROUND: The current standard for con? rmation of correct supra-diaphragmatic central venous catheter(cVc) placement is with plain ? lm chest radiography(cXR). We hypothesized that a simple point-of-care ultrasound(POcUS) protocol could effectively con? rm placement and reduce time to con? ***: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required cVc placement. correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the ***: Seventy-eight patients were enrolled. POcUS had a sensitivity of 86.8%(95%cI 77.1%–93.5%) and speci? city of 100%(95%cI 15.8%–100.0%) for identifying correct central venous catheter placement. Median POcUS and cXR completion were 16 minutes(IQR 10–29) and 32 minutes(IQR 19–45), ***: Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a con? rmatory cXR.

关键词： Point-of-care ultrasound Emergency ultrasound central venous access

Prospective evaluation of point-of-care ultrasound for pre-procedure identification of landmarks versus traditional palpation for lumbar puncture

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World Journal of Emergency Medicine 2016年第3期7卷 173-177页

作者： shadi lahham priel schmalbach sean p.wilson lori ludeman mohammad subeh jocelyn chao nadeem albadawi niki mohammadi john c.fox Emergency Medicine University of California Irvine Orange California 92868 USA

BAcKGROUND: The objective of this study is to determine if point-of-care ultrasound(POcUS) pre-procedure identification of landmarks can decrease failure rate, reduce procedural time, and decrease the number of needle redirections and reinsertions when performing a lumbar puncture(LP).METHODS: This was a prospective, randomized controlled trial comparing POcUS preprocedure identifi cation of landmarks versus traditional palpation for LP in a cohort of patients in the emergency department and intensive care ***: A total of 158 patients were enrolled. No signifi cant difference was found in time to completion, needle re-direction, or needle re-insertion when using POcUS when compared to the traditional method of ***: consistent with fi ndings of previous studies, our data indicate that there was no observed benefi t of using POcUS to identify pre-procedure landmarks when performing an LP.

关键词： Ultrasound Lumbar puncture Spinal tap

Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by fi rst-year medical students

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World Journal of Emergency Medicine 2017年第4期8卷 281-286页

作者： Jonathan B.Lee christina Tse Thomas Keown Michael Louthan christopher Gabriel Alexander Anshus Bima Hasjim Katrina Lee Esther Kim Luke Yu Allen Yu Shadi Lahham Steven Bunch Maili Alvarado Abdulatif Gari john c.fox School of Medicine University of CaliforniaIrvineUSA Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA

BAcKGROUND: The purpose of this study was to assess the short-term efficacy of a 4-week ultrasound curriculum taught by American first-year medical students to general practitioners working in public health care clinics, or puskesmas, in Bandung, ***: We performed a prospective, observational study of Indonesian health care practitioners from public clinics in Bandung, Indonesia. These practitioners were enrolled in a 4-week ultrasound training course taught by first-year American medical students. A total of six sessions were held comprising of 38 ultrasound milestones. A pre-course and post-course written exam and practical exam was taken by each ***: We enrolled 41 clinicians in the course. The average pre-course exam score was 35.2% with a 2.4% pass rate, whereas the average post-course exam score was 82.0% with a 92.7% pass rate. The average practical score at the completion of the course was 83.2%(SD=0.145) with 82.9% of the class passing(score above 75.0%).cONcLUSION: Our data suggests that first-year medical students can effectively teach ultrasound to physicians in Indonesia using a 4-week intensive ultrasound training course. Future studies are needed to determine the amount of training required for proficiency and to evaluate the physicians' perceptions of the student-instructors' depth of knowledge and skill in point of care ultrasound.

关键词： Ultrasound education Ultrasound teaching Indonesia

Procedural simulation:medical student preference and value of three task trainers for ultrasound guided regional anesthesia

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World Journal of Emergency Medicine 2017年第4期8卷 287-291页

作者： Shadi Lahham Taylaur Smith Jessa Baker Amanda Purdy Erica Frumin Bret Winners Sean P.Wilson Abdulatif Gari john c.fox Department of Emergency Medicine University of CaliforniaIrvineOrangeCalifornia 92868USA Uc Irvine School of Medicine IrvineCaliforniaUSA

BAcKGROUND: Ultrasound guided regional anesthesia is widely taught using task trainer models. commercially available models are often used; however, they can be cost prohibitive. Therefore, alternative "homemade" models with similar fidelity are often used. We hypothesize that professional task trainers will be preferred over homemade models. The purpose of this study is to determine realism, durability and cleanliness of three different task trainers for ultrasound guided nerve ***: This was a prospective observational study using a convenience sample of medical student participants in an ultrasound guided nerve block training session on January 24 th, 2015. Participants were asked to perform simulated nerve blocks on three different task trainers including, 1 commercial and 2 homemade. A questionnaire was then given to all participants to rate their experiences both with and without the knowledge on the cost of the simulator ***: Data was collected from 25 participants. The Blue Phantom model was found to have the highest fidelity. Initially, 10(40%) of the participants preferred the Blue Phantom model, while 10(40%) preferred the homemade gelatin model and 5(20%) preferred the homemade tofu model. After cost awareness, the majority, 18(72%) preferred the gelatin ***: The Blue Phantom model was thought to have the highest fidelity, but after cost consideration the homemade gelatin model was preferred.

关键词： Ultrasound guided nerve block Task trainer Regional anesthesia

Micromorphology of Surface crusts in the Knersvlakte,South Africa

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Journal of Mountain Science 2009年第2期6卷 189-196页

作者： Sarah-Jane c.fox Anthony J.Mills Rosa M.Poch Department of Soil Science Stellenbosch UniversityStellenbosch South Africa Department of Environment and Soil Science University of LleidaRovira Roure 191 Lleida

Soils in the Knersvlakte are particularly prone to crusting and have lower inherent infiltrability than other soils across western southern Africa. Micromorphological techniques were used to examine the structure and porosity of soil crusts in the Knersvlakte to ascertain why crusting is so intense in this region. Quantile regression using boundary lines was employed to examine the relationships between infiltrability and soil properties for all samples （n = 67）. This analysis showed that infiltrability is potentially maximal at low water- dispersible ＇clay plus silt＇ content and low silt content （r^2 = 0.72 and 0.64; respectively, n = 67）（Figure 2）. The strength of crusts, pH, Ec, clay mineralogy, and water-dispersible clay, silt and ＇clay plus silt＇ content were compared, and a pore analysis using optical microscopy was undertaken on images of six soil thin sections （n = 6）（circular and parallel polarizers）. Pore analysis was further undertaken on five horizontal slices of equal dimensions taken through each soil thin section. The porosity samples with low infiltrability （〈 100 mm·hr^-1, n = 4） had greater crust strength, lower porosity （both total and in the least porous slice） and greater water-dispersible ＇day plus silt＇ and silt content than the porosity samples with high infiltrability （〉 100mm·hr^-1, n = 2）. The porosity samples with low infiltrability showed a trend of lower pH and greater water dispersible clay percentage. Porosity varied within the porosity samples due to the presence of dense clay/silt bands （〈 0.5 mm in width） with relatively few air vesicles. The porosity samples with horizontal slices of low porosity （but large numbers of air vesicles） had low infiltrability, while those without slices of low porosity （and relatively few air vesicles） had high infiltrability. We conclude that the intense crusting and resultant low infiltrability of soils in the Knersvlakte appears to be related to the formation of thin, dense clay/silt bands in the

关键词： Infiltrability optical microscopy porosity air vesicles

Targeting TrkB–PSD-95 coupling to mitigate neurological disorders

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Neural Regeneration Research 2025年第3期20卷 715-724页

作者： Xin Yang Yu-Wen Alvin Huang john Marshall Department of Molecular Biology Cell Biology and BiochemistryBrown UniversityProvidenceRIUSA Department of Neurology Warren Alpert Medical School of Brown UniversityProvidenceRIUSA center for Translational Neuroscience Robert J.and Nancy D.Carney Institute for Brain Science and Brown Institute for Translational ScienceBrown UniversityProvidenceRIUSA

Tropomyosin receptor kinase B(TrkB)signaling plays a pivotal role in dendritic growth and dendritic spine formation to promote learning and *** activity-dependent release of brain-derived neurotrophic factor at synapses binds to pre-or postsynaptic TrkB resulting in the strengthening of synapses,reflected by long-term ***,the association of postsynaptic density protein-95 with TrkB enhances phospholipase cγ-ca^(2+)/calmodulin-dependent protein kinaseⅡand phosphatidylinositol 3-kinase-mechanistic target of rapamycin signaling required for long-term *** this review,we discuss TrkB-postsynaptic density protein-95 coupling as a promising strategy to magnify brain-derived neurotrophic factor signaling towards the development of novel therapeutics for specific neurological disorders.A reduction of TrkB signaling has been observed in neurodegenerative disorders,such as Alzheimer's disease and Huntington's disease,and enhancement of postsynaptic density protein-95 association with TrkB signaling could mitigate the observed deficiency of neuronal connectivity in schizophrenia and *** with brain-derived neurotrophic factor is problematic,due to poor pharmacokinetics,low brain penetration,and side effects resulting from activation of the p75 neurotrophin receptor or the truncated TrkB.T1 *** TrkB agonists and antibodies that activate TrkB are being intensively investigated,they cannot distinguish the multiple human TrkB splicing isoforms or cell type-specific *** TrkB–postsynaptic density protein-95 coupling provides an alternative approach to specifically boost TrkB signaling at localized synaptic sites versus global stimulation that risks many adverse side effects.

关键词： Angelman syndrome autism brain-derived neurotrophic factor depression neurodegenerative disorder neurodevelopmental disorder postsynaptic density protein-95 synaptic plasticity TrkB

A comparison of simulation versus didactics for teaching ultrasound to Swiss medical students

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World Journal of Emergency Medicine 2019年第3期10卷 169-176页

作者： Sagar Shah Steven Tohmasi Emily Frisch Amanda Anderson Roy Almog Shadi Lahham Roland Bingisser john c. fox School of Medicine University of California Irvine USA Department of Emergency Medicine University of California Irvine Irvine USA University Hospital Basel Basel Switzerland

BAcKGROUND: Point-of-care ultrasound is an increasingly common imaging modality that is used in a variety of clinical settings. Understanding how to most effectively teach ultrasound is important to ensure that medical students learn pre-clinical content in a manner that promotes retention and clinical competence. We aim to assess the effectiveness of simulation-based ultrasound education in improving medical student competence in physiology in comparison to a traditional didactic ultrasound curriculum. METHODS: Subjects were given a pre and post-test of physiology questions. Subjects were taught various ultrasound techniques via 7 hours of lectures over two days. The control group received 2 additional hours of practice time while the experimental group received 2 hours of case-based simulations. A physiology post-test was administered to all students to complete the two-day course. RESULTS: Totally 115 Swiss medical students were enrolled in our study. The mean precourse ultrasound exam score was 39.5% for the simulation group and 41.6% for the didactic group (P>0.05). The mean pre-course physiology exam score was 54.1% for the simulation group and 59.3% for the didactic group (P>0.05). The simulation group showed statistically significant improvement on the physiology exam, improving from 54.1% to 75.3%(Pctic group also showed statistically signifi cant improvement on the physiology exam, improving from 59.3% to 70.0%(PcONcLUSION: Our data indicates that both simulation curriculum and standard didactic curriculum can be used to teach ultrasound. Simulation based training showed statistically signifi cant improvement in physiology learning when compared to standard didactic curriculum.

关键词： Ultrasound education POcUS Switzerland Medical education

An adaptive range-query optimization technique with distributed replicas

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Journal of central South University 2014年第1期21卷 190-198页

作者： Sayar Ahmet Pierce Marlon fox c.Geoffrey Department of computer Engineering Kocaeli University Department of computer Science Indiana University community Grids Lab Indiana University School of Informatics and computing Indiana University

Replication is an approach often used to speed up the execution of queries submitted to a large dataset.A compile-time/run-time approach is presented for minimizing the response time of 2-dimensional range when a distributed replica of a dataset *** aim is to partition the query payload(and its range) into subsets and distribute those to the replica nodes in a way that minimizes a client's response ***,since query size and distribution characteristics of data(data dense/sparse regions) in varying ranges are not known a priori,performing efficient load balancing and parallel processing over the unpredictable workload is difficult.A technique based on the creation and manipulation of dynamic spatial indexes for query payload estimation in distributed queries was *** effectiveness of this technique was demonstrated on queries for analysis of archived earthquake-generated seismic data records.

关键词： distributed systems load balancing range query query optimization