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Objectives: Financial conflicts of interest have come under increasing scrutiny in medicine, but their impact has not been quantified. Our objective was to use the results of a national survey of academic emergency medicine (EM) faculty to determine if an association between money and personal opinion exists.Methods: We conducted a web-based survey of EM faculty. Opinion questions were analyzed with regard to whether the respondent had either 1) received research grant money or 2) received money from industry as a speaker, consultant, or advisor. Responses were unweighted, and tests of differences in proportions were made using Chi-squared tests, with p

Objective: Investigate the association between Telemental Health (TMH) uptake and sociodemographic characteristics, and how TMH uptake relates to health care resource utilization and Medicaid expenditures among Mississippi Medicaid enrollees with major depression. Methods: A retrospective cohort study was conducted (2019–2020), comparing those who utilized TMH and those who did not. Results: Among the 21,239 identified enrollees, 806 (3.79%) utilized TMH. The TMH cohort was more likely to be of older age, non-Hispanic White, comprehensive managed care organization enrollees, rural residents, and from areas with a higher area deprivation index, and have higher Charlson comorbidity index scores. The TMH cohort also exhibited higher mental health-related and all-cause outpatient and emergency department utilization, along with higher Medicaid expenditures. Conclusion: As the first study investigating telehealth utilization among Mississippi Medicaid enrollees, this study highlights sociodemographic disparities in telehealth adoption. Addressing barriers hindering telehealth adoption among vulnerable populations and ensuring the availability of quality data are vital for future research. [ABSTRACT FROM AUTHOR]

Introduction: The majority of patients seeking medical treatment for snakebites do not suffer from severe envenomation. However, no guidelines exist for ordering coagulation markers in patients with minimal or moderate envenomation, nor in those who do not receive antivenom. In this study, we sought to determine whether it was possible to limit the practice of ordering coagulation studies to those patients suffering severe envenomation, rattlesnake envenomation, or both.Methods: A retrospective chart review was performed on all cases of crotalid snakebite presenting to an adult emergency department (ED) from April 1998 to June 2006. Each chart was abstracted for patient’s age, gender, type of snake (if known), severity of envenomation at initial presentation, coagulation test results, whether antivenom was administered, and whether the patient was admitted.Results: Over an approximately 8-year period, 131 snakebite cases presented that met the inclusion criteria, of which 35 (26.7%) had some type of coagulation marker abnormality. Limiting coagulation testing to patients suffering severe envenomation or rattlesnake envenomation would have resulted in failure to identify 89% or 77%, respectively, of the 35 patients who were found to have at least 1 abnormal coagulation marker.Conclusion: Our study failed to identify a subset of patients that could be defined as low risk or for whom coagulation marker testing could be foregone. This study suggests that coagulation tests should be routinely performed on all patients presenting to the ED with complaints of envenomation by copperheads, moccasins, or rattlesnakes. Further clarification of when coagulation markers are indicated may require a prospective study that standardizes snake identification and the timing of coagulation marker testing. [West J Emerg Med. 2012;13(1):68–74.]

Background Valid, reliable and cross-cultural equivalent scales and measurement instruments that enable comparisons across diverse populations in different countries are important for global health research and practice. We developed a 10-step framework through a scoping review of the common strategies and techniques used for scale development and validation in a cross-cultural, multi-lingual, or multi-country setting, especially in health care research. Methods We searched MEDLINE, Embase, and PsycINFO for peer-reviewed studies that collected data from two or more countries or in two or more languages at any stages of scale development or validation and published between 2010–22. We categorised the techniques into three commonly used scale development and validation stages (item generation, scale development, and scale evaluation) as well as during the translation stage. We described the most commonly used techniques at each stage. Results We identified 141 studies that were included in the analysis. We summarised 14 common techniques and strategies, including focus groups or interviews with diverse target populations, and involvement of measurement experts and linguists for item content validity expert panel at the item generation stage; back-and-forth translation, collaborative team approach for the translation stage; cognitive interviews and different recruitment strategies and incentives in different settings for scale development stage; and three approaches for measurement invariance (multigroup confirmatory factor analysis, differential item functioning and multiple indicator multiple causes) for scale evaluation stage. Conclusions We provided a 10-step framework for cross-cultural, multi-lingual or multi-country scale development and validation based on these techniques and strategies. More research and synthesis are needed to make scale development more culturally competent and enable scale application to better meet local health and development needs. [ABSTRACT FROM AUTHOR]

Previous studies during have demonstrated a loss of ventricular mass after prolonged exposure to microgravity that is associated with changes in cardiac function. By Laplace's law, the geometry of the ventricle is important in determining the segmental wall stress. If microgravity exposure results in variations in the ventricular geometry then these changes could cause adjustments in the normal myocardial stress/strain patterns that might induce cardiac remodeling during extended spaceflights. This study analyzes the theoretical impact of microgravity on changes in the geometric conformation and stress strain patterns of a finite element mesh model (FEM) created from the 3- dimensional geometry of the left ventricle (LV) and attributed with material properties consistent with myocardial tissue. The Geometric Aspect Ratios (GAR, length to width quotient) of the LV were compared during simulations of the upright diastolic position in Earth's gravity and in microgravity. The application of microgravity conditions to the FEM model resulted in a 3.65% lower GAR of the LV as compared to that calculated for Earth's gravity. The stress and strain patterns of the myocardial wall were also modified especially around the base of the heart. This finding suggests that microgravity exposure could potentially result in changes in the ventricular radius of curvature and alter the segmental myocardial wall stress., INTRODUCTION Physiologic and anatomic adaptations to microgravity exposure are considered one of the greatest barriers for human space exploration. (1) One of the most concerning of these changes is the [...]