St. Anne Hospital in Burien

. However, to be used effectively for magnetoencephalography (MEG), dense arrays of these sensors are required to operate as an integrated turn-key system. In this study, we present the HEDscan, a 128-sensor OPM MEG system by FieldLine Medical, and evaluate its sensor performance with regard to bandwidth, linearity, and crosstalk. We report results from cross-validation studies with conventional cryogenic MEG, the Magnes 3,600 WH Biomagnetometer by 4-D Neuroimaging. Our results show high signal amplitudes captured by the OPM-MEG system during a standard auditory paradigm, where short tones at 1000 Hz were presented to the left ear of six healthy adult volunteers. We validate these findings through an event-related beamformer analysis, which is in line with existing literature results.

The coronavirus disease 2019 (COVID-19) pandemic has rapidly evolved and now dominates the attention and full efforts of the emergency medicine community, both domestic and abroad. Seattle is the site of the initial diagnosed COVID-19 cases and fatalities in the United States. We provide an overview of the system-level response of 6 Seattle emergency departments and the Washington state chapter of the American College of Emergency Physicians (ACEP) to the COVID-19 pandemic. Local efforts involved the spectrum of emergency response including on- and off-site triage strategies, an approach to personal protective equipment, testing and reporting protocols, early treatments, communication strategies, the impact on front-line providers, and ongoing work.

PURPOSE: We assessed the usefulness of endoscopic treatment of vesical fistulas. MATERIALS AND METHODS: Two bladder fistula patients underwent transurethral surgery in an attempt to close the fistula. RESULTS: Both patients were cured of the fistula, without undergoing an open procedure. CONCLUSIONS: Cystoscopically assisted suture closure of vesical fistulas can be a successful procedure in selected patients. Nontraditional instrumentation and technique allowed for transurethral closure of these fistulas.

The chromite deposits described in this report are in the southeastern part of the. Beartooth Range, near Red Lodge, Mont. In 1941, 1942, and 1943, the U. S. Vanadium Corp., the only producer in the district, shipped 21,958 tons of crude lump ore, averaging about 32 percent chromic oxide (CrgOs), and 11,689 tons of concentrates averaging about 40 percent CrgOs. The ore was mined almost entirely by open-cut methods and carried by truck to the mill and railhead at Red Lodge.

Acute drug-induced dystonia is commonly associated with antipsychotic drugs, antidepressants, antiemetics, and other medications. Bupropion (Wellbutrin and Zyban) is one of the most frequently prescribed antidepressants in the United States and Canada and smoking cessation aid. However, only few reported cases have been published of acute dystonia including dystonia after discontinuation of bupropion and even after a single dose of bupropion. Here, we report another case concerning an acute dystonia resulting from bupropion after dose escalation. To further assess this association, we used the Naranjo nomogram, which is a questionnaire designed for determining the likelihood of whether an adverse drug reaction is actually due to the drug rather than the result of other factors. Our patient's total score was seven, suggesting that our patient had probable adverse drug reaction. In summary, our case is that selected patients may experience dose-related acute dystonia as adverse reactions to bupropion sustained release (SR). Since it is one of the most commonly prescribed antidepressants and smoking cessation aids, clinicians should be aware of the potential dystonia associated with bupropion.

Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

OBJECTIVES: Emergency medicine (EM) is rapidly developing as a specialty in Vietnam. Point of care ultrasound (POCUS) is currently taught as part of formal EM curriculums though limited literature exists to describe current POCUS usage in EDs in Vietnam. A survey was developed to understand current POCUS utilisation and guide future training efforts. METHODS: A survey was administered to 104 Vietnamese physicians attending a national emergency medicine symposium regarding POCUS utilisation, access, training and preference. Data were analysed using multiple logistic regression to identify independent variables associated with POCUS usage. RESULTS: Increased access to ultrasound machines was significantly associated with increased POCUS usage, with 'all the time' access (OR = 92.9, 95% CI 7.15-1207.6, P = 0.001) being more strongly associated than 'sometimes' access (OR = 41.4, 95% CI 4.08-419.8, P = 0.002). Formal training did not significantly increase POCUS usage and 50.0% of respondents who regularly used POCUS had no formal training. There was no significant difference in physician preference or comfort for any single application of POCUS. There were 98.0% of trainees and 96.3% of independently practising physicians who reported a desire for additional POCUS training. CONCLUSIONS: Regular access to ultrasound machines increases the frequency of POCUS usage in EDs in Vietnam. POCUS training was not as clearly associated with POCUS usage as those without formal training were equally likely to use POCUS as those with formal training. No single POCUS application stood out as strongly preferred by physicians in this survey.

Sodium fluoride is an accessible and frequently used compound that if ingested can cause ventricular dysrhythmias, hemorrhage, and death. We present a case report of a 21-year-old female who presented following an intentional ingestion of a lethal dose of sodium fluoride, developing massive hemorrhage and cardiac arrest.

OBJECTIVE: The authors studied the effect of introducing etomidate on the airway management practices of their air transport crew and specifically considered the need for paralytic agents during rapid-sequence intubation. METHODS: A prospective observational review of the transport records for all patients aged greater than 10 years who required intubation transported by the air medical crew before (PRE) and after (POST) the introduction of etomidate into the authors' rapid-sequence induction protocol was conducted. Data were collected, including the method of intubation, indications for intubation, and complications from the procedure. The following outcomes were measured: the method used for intubation (nasotracheal or orotracheal), oral intubation success rate, number of attempts for oral intubation, need for paralytic agents, and complications with the procedure. RESULTS: Comparing the PRE and POST periods, nasotracheal intubation was performed in 27 of 70 (38.6%) versus 33 of 71 (46.4%; p=0.237997). The overall success rate for intubation in the PRE period was 67 of 70 (95.7%), with 95.3% of orotracheal intubations being successful. In the POST period, the overall success rate was 65 of 71 (91.5%), with 94.7% of orotracheal intubations being successful. Complication rates were similar between the groups. Etomidate reduced the use of paralytic agents from 46 of 62 (74.6%) of patients receiving midazolam to 10 of 22 (45.5%) intubated with etomidate (p=0.02). CONCLUSIONS: Etomidate did not appear to have an impact on the selection of intubation methods by the air medical transport crew. Etomidate significantly reduced the need for administration of paralytic agents used in an RSI.

Recent technological developments have brought optically pumped magnetometers (OPMs) within reach of the larger neuroscientific community. The current state-of-the-art consists of whole-head systems that measure the magnetic field at >100 locations. OPM sensors can be constructed to measure the field in either 1, 2, or 3 orientations. Consequently, the number of channels can differ from the number of sensors. This allows for magnetoencephalography (MEG) system designs with multiple measurement orientations at fewer locations, many locations with fewer orientations, or, ideally, many locations with multiple orientations. Yet, due to budget constraints, starting OPM groups are typically getting fewer sensors than what could, in principle, be accommodated in a whole head helmet-like arrangement. Furthermore, implementing multiple orientations in a single sensor comes at a cost and hardware companies are still optimizing the trade-offs between sensor designs. To guide the OPM systems design, it is relevant to know the optimal spatial distribution and sensing orientation of OPMs. We performed a simulation study in which we kept the total number of channels constant. We compared 3 synthetic 192-channel OPM arrays that were composed of either monoaxial, biaxial or triaxial sensors, where the sensors were placed at either 192, 96, or 64 measurement locations, respectively. We simulated multiple instances of an MEG signal due to a dipolar source in the brain, contaminated by various combinations of noise, considering sensor noise, brain noise, and noise induced by head (and sensor) movements in the residual ambient magnetic field. An optimal design of the MEG system serves both to record the activity of the brain, as well as the environmental noise that is to be suppressed. We performed dipole fits and evaluated the localization error and the amplitude of the estimated dipole moment. We cleaned the data using various spatio(temporal) cleaning strategies prior to fitting the dipoles. Our observations confirm earlier work, in that 1) the sensing orientation radial to the head is in general more optimal to pick up activity from the brain than tangential directions, but that 2) adding sensing orientations tangential to the head surface helps in suppressing ambient noise sources. Yet, we did not observe a clear improvement comparing triaxial with biaxial OPMs. Given that triaxial sensing may come at the expense of reduced spatial sampling over the head and reduced signal-to-noise for individual channels, we conclude that, given a fixed number of channels, biaxial sensors may be preferred with the currently available technology.

In the context of our work as literacy specialists, we taught teachers to use sentence frames to support ELL students’ writing. We then studied the impact of their instruction on students. Our analysis of student writing samples revealed no groupwide developmental trends so we posed deeper questions about their work using the data analysis methods learned through the action research process. We report our findings about the relationship between student writing development and language instruction. We discuss our learning as well as implications for our work supporting teacher instruction.

When children with disabilities have difficulty with written communication, members of their educational teams, including occupational therapists and physical therapists, often recommend use of a word processor. This annotated bibliography summarizes a variety of articles that describe the use of word processing technology with school-aged children. The articles include research reports, descriptions of special features used with word processing programs, and guidelines for using word processing with students. Implications for occupational therapists and physical therapists working with students who have written communication problems are discussed.

A 73-year-old female with a history of coronary artery disease, hypertension, and diabetes presented to the emergency department in cardiac arrest. After cardiopulmonary resuscitation (CPR) and return of spontaneous circulation (ROSC), a post-ROSC electrocardiogram demonstrated Accelerated Idioventricular Rhythm (AIVR). The patient was found to have hyperkalemia due to anuric acute renal failure and antecedent severe pancreatitis. After medical management and dialysis, the patient recovered with good neurological recovery. AIVR traditionally has been seen or documented as occurring after ischemia and subsequent coronary artery reperfusion. However, etiologies that promote ventricular automaticity must be considered as well. Electrolyte disturbances, drug toxicities such as digoxin, volatile anesthetics, cardiomyopathies, and ischemia can lead to AIVR. Treatment involves considering and correcting any underlying etiology with avoidance of antiarrhythmics, which may precipitate hemodynamic instability and asystole.

Health disparities among sexual minority groups exist worldwide. Lesbian and bisexual women face barriers to healthcare access and provision. Disparities are even more striking in Middle Eastern countries like Lebanon. This paper assesses healthcare resources and practices pertaining to sexual minority women in Lebanon. We found a significant scarcity of research on lesbian or bisexual women coming out of Lebanon or the Middle East. We call for enriching the literature with such research to better understand the needs of women and recommend effective interventions.

A systematic plan can streamline the certification process. A self-directed team identified, developed and implemented the components needed to make the workload manageable. The actual process for developing a unit-based credentialing system in a special care unit is described.

Abstract What does it mean that small children don’t see their interests in school, and older ones struggle even to engage the concept of interest while at school? This chapter explores what happens when we focus too much on accountability at the expense of learning who our students are and what they’re most curious about.

Objective. The authors studied the effect of introducing etomidate on the airway management practices of their air transport crew and specifically considered the need for paralytic agents during rapid-sequence intubation. Methods. A prospective observational review of the transport records for all patients aged greater than 10 years who required intubation transported by the air medical crew before (PRE) and after (POST) the introduction of etomidate into the authors' rapid-sequence induction protocol was conducted. Data were collected, including the method of intubation, indications for intubation, and complications from the procedure. The following outcomes were measured: the method used for intubation (nasotracheal or orotracheal), oral intubation success rate, number of attempts for oral intubation, need for paralytic agents, and complications with the procedure. Results. Comparing the PRE and POST periods, nasotracheal intubation was performed in 27 of 70 (38.6%) versus 33 of 71 (46.4%; p = 0.237997). The overall success rate for intubation in the PRE period was 67 of 70 (95.7%), with 95.3% of orotracheal intubations being successful. In the POST period, the overall success rate was 65 of 71 (91.5%), with 94.7% of orotracheal intubations being successful. Complication rates were similar between the groups. Etomidate reduced the use of paralytic agents from 46 of 62 (74.6%) of patients receiving midazolam to 10 of 22 (45.5%) intubated with etomidate (p = 0.02). Conclusions. Etomidate did not appear to have an impact on the selection of intubation methods by the air medical transport crew. Etomidate significantly reduced the need for administration of paralytic agents used in an RSI.

ABSTRACT Increasingly, art museums are seen as places that can support human flourishing. We describe a quasi‐experimental investigation of the impacts of a self‐directed art museum visit on adults' subjective well‐being. Data were collected from 363 adults at three art museums in Seattle, WA. Participants spent 60 min in the museum galleries. Researchers measured well‐being before and after their gallery experience, interviewing participants to collect both quantitative data through the Museum Well‐Being Measures Toolkit and qualitative data through open‐ended reflections on their feelings during their visit. Results show that after visiting the art museum, adults felt significantly more inspired and significantly less irritable and nervous. Well‐being impacts differed according to personal factors, including age, social group, relationship to the area, and art museum identity. People attributed changes in their inspiration to the artwork and changes in their irritation and nervousness to the museum environment or to factors outside the museum's control. Findings have implications for research and practice related to the role of art museums in fostering well‐being.

1Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand,2 Family Childbirth Center, Highline Medical Center, WA, USA,3 The Thailand Centre for Evidence-Based Nursing and Midwifery: An Affiliated Centre of the Joanna Briggs Institute Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand

Elementary teachers are challenged to maximize instructional time to cover standards in all content areas and to meet a wide variety of student needs including students who are not proficient in English. This action research looks at how one fourth-grade teacher improved achievement for English Language Learners by integrating social studies into the literacy block using a Project GLAD® unit and the school district Literacy Comprehension Frameworks. It describes the changes to the literacy instruction and examines the benefits to students, families, the teacher, and the school.