Educating Health Care Professionals on Human Trafficking
PEDIATRIC EMERGENCY CARE
2014; 30 (12): 856-861
Pain Control in Disaster Settings: A Role for Ultrasound-Guided Nerve Blocks
ANNALS OF EMERGENCY MEDICINE
2013; 61 (6): 690-696
Perceptions of Conflict of Interest Disclosures among Peer Reviewers
2011; 6 (11)
The US Department of State estimates that there are between 4 and 27 million individuals worldwide in some form of modern slavery. Recent studies have demonstrated that 28% to 50% of trafficking victims in the United States encountered health care professionals while in captivity, but were not identified and recognized. This study aimed to determine whether an educational presentation increased emergency department (ED) providers' recognition of human trafficking (HT) victims and knowledge of resources to manage cases of HT.The 20 largest San Francisco Bay Area EDs were randomized into intervention (10 EDs) or delayed intervention comparison groups (10 EDs) to receive a standardized educational presentation containing the following: background about HT, relevance of HT to health care, clinical signs in potential victims, and referral options for potential victims. Participants in the delayed intervention group completed a pretest in the period the immediate intervention group received the educational presentation, and all participants were assessed immediately before (pretest) and after (posttest) the intervention. The intervention effect was tested by comparing the pre-post change in the intervention group to the change in 2 pretests in the delayed intervention group adjusted for the effect of clustering within EDs. The 4 primary outcomes were importance of knowledge of HT to the participant's profession (5-point Likert scale), self-rated knowledge of HT (5-point Likert scale), knowledge of who to call for potential HT victims (yes/no), and suspecting that a patient was a victim of HT (yes/no).There were 258 study participants from 14 EDs; 141 from 8 EDs in the intervention group and 117 from 7 EDs in the delayed intervention comparison group, of which 20 served as the delayed intervention comparison group. Participants in the intervention group reported greater increases in their level of knowledge about HT versus those in the delayed intervention comparison group (1.42 vs -0.15; adjusted difference = 1.57 [95% confidence interval, 1.02-2.12]; P < 0.001). Pretest ratings of the importance of knowledge about HT to the participant's profession were high in both groups and there was no intervention effect (0.31 vs 0.55; -0.24 [-0.90-0.42], P = 0.49). Knowing who to call for potential HT victims increased from 7.2% to 59% in the intervention group and was unchanged (15%) in the delayed intervention comparison group (61.4% [28.5%-94.4%]; P < 0.01). The proportion of participants who suspected their patient was a victim of HT increased from 17% to 38% in the intervention group and remained unchanged (10%) in the delayed intervention comparison group (20.9 [8.6%-33.1%]; P < 0.01).A brief educational intervention increased ED provider knowledge and self-reported recognition of HT victims.
View details for Web of Science ID 000345912500005
View details for PubMedID 25407038
Maternal prenatal and child organophosphate pesticide exposures and children's autonomic function
2011; 32 (5): 646-655
Disclosure of financial conflicts of interest (COI) is intended to help reviewers assess the impact of potential bias on the validity of research results; however, there have been no empiric assessments of how reviewers understand and use disclosures in article evaluation. We investigate reviewers' perceptions of potential bias introduced by particular author disclosures, and whether reviewer characteristics are associated with a greater likelihood of perceiving bias.Of the 911 active reviewers from the Annals of Emergency Medicine, 410 were randomly selected and invited to complete our web-based, 3-part survey. We completed descriptive analysis of all survey responses and compared those responses across reviewer characteristics using 2 × 2 analyses and the Fisher exact test. We had a response rate of 54%. The majority of reviewers surveyed reported a high level of skepticism regarding financial relationships between authors and industry without a clear or consistent translation of that skepticism into the self-reported actions that characterize manuscript assessment. Only 13% of respondents believed physician consultants authoring articles based on company data are likely to have unlimited data access. 54% believed that bias most likely exists with any honorarium, regardless of monetary amount. Between 46% and 64%, depending on the type of financial relationship disclosed, reported that their recommendation for publication remains unchanged. Respondents reporting personal financial ties to industry were less likely to perceive bias in industry relationships and less likely to believe that bias exists with any monetary amount of honoraria.We recommend that the monetary amount of all financial relationships be reported with manuscript submissions, lead authors certify that they have unrestricted access to data, and reviewers disclose any financial ties to industry whether or not they are related to the manuscript under review. Further research is required to better understand reviewers' perceptions of financial relationships between authors and industry in order to develop clear and consistent guidelines for incorporating the perception of potential bias into manuscript assessments.
View details for DOI 10.1371/journal.pone.0026900
View details for Web of Science ID 000297154900051
View details for PubMedID 22073216
International Emergency Medicine: A Review of the Literature From 2010
ACADEMIC EMERGENCY MEDICINE
2011; 18 (8): 872-879
Organophosphate pesticides (OP), because of their effects on cholinergic fibers, may interfere with the functions of the autonomic nervous system (ANS). We conducted a study to assess the relation of in utero and child OP pesticide exposures and children's autonomic nervous system (ANS) dysregulation under resting and challenge conditions. We hypothesized that children with high OP levels would show parasympathetic activation and no sympathetic activation during rest and concomitant parasympathetic and sympathetic activation during challenging conditions.OP exposures were assessed by measuring urinary dialkylphosphate metabolites (DAPs, total diethyls-DEs, and total dimethyls-DMs) in maternal and children's spot urine samples. ANS regulation was examined in relation to maternal and child DAPs in 149 children at 6 months and 1 year, 97 at 3 1/2 years and 274 at 5 years. We assessed resting and reactivity (i.e., challenge minus rest) measures using heart rate (HR), respiratory sinus arrhythmia (RSA), and preejection period (PEP) during the administration of a standardized protocol. Cross-sectional (at each age) and longitudinal regression models were conducted to assess OP and ANS associations. To estimate cumulative exposure at 5 years, we used an area-under-the-concentration-time-curve (AUC) methodology. We also evaluated whether children with consistently high versus low DAP concentrations had significantly different mean ANS scores at 5 years.Child DMs and DAPs were significantly negatively associated with resting RSA at 6 months and maternal DMs and child DEs were significantly positively associated with resting PEP at 1 year. No associations with resting were observed in 3 1/2- or 5-year-old children nor with reactivity at any age. There was no significant relationship between the reactivity profiles and maternal or child DAPs. Cumulative maternal total DEs were associated with low HR (-3.19 bpm decrease; 95% CI: -6.29 to -0.09, p=0.04) only at 5 years. In addition, there were no significant differences in ANS measures for 5-year-olds with consistently high versus low DAPs.Although we observe some evidence of ANS dysregulation in infancy, we report no consistent associations of maternal and child OP pesticide exposure, as measured by urinary DAPs, on children's ANS (HR, RSA, and PEP) regulation during resting and challenging conditions up to age 5 years.
View details for DOI 10.1016/j.neuro.2011.05.017
View details for Web of Science ID 000296671800018
View details for PubMedID 21741403
International Emergency Medicine: A Review of the Literature From 2009
ACADEMIC EMERGENCY MEDICINE
2011; 18 (1): 86-92
The International Emergency Medicine (IEM) Literature Review aims to highlight and disseminate high-quality global EM research in the fields of EM development, disaster and humanitarian response, and emergency care in resource-limited settings. For this review, we conducted a Medline search for articles published between January 1 and December 31, 2010, using a set of international and EM search terms and a manual search of journals that have produced large numbers of IEM articles for past reviews. This search produced 6,936 articles, which were divided among 20 reviewers who screened them using established inclusion and exclusion criteria to select articles relevant to the field of IEM. Two-hundred articles were selected by at least one reviewer and approved by an editor for scoring. Two independent reviewers using a standardized and predetermined set of criteria then scored each of the 200 articles. The 27 top-scoring articles were chosen for full review. The articles this year trended toward evidence-based research for treatment and care options in resource-limited settings, with an emphasis on childhood illness and obstetric care. These articles represent examples of high-quality international emergency research that is currently ongoing in high-, middle-, and low-income countries alike. This article is not intended to serve as a systematic review or clinical guideline but is instead meant to be a selection of current high-quality IEM literature, with the hope that it will foster further growth in the field, highlight evidence-based practice, and encourage discourse.
View details for DOI 10.1111/j.1553-2712.2011.01129.x
View details for Web of Science ID 000293860400013
View details for PubMedID 21790839
As the specialty of emergency medicine evolves in countries around the world, and as interest in international emergency medicine (IEM) grows within the United States, the IEM Literature Review Group recognizes an ongoing need for a high-quality, consolidated, and easily accessible evidence base of literature. The IEM Literature Review Group produces an annual publication that strives to provide readers with access to the highest quality and most relevant IEM research from the previous year. This publication represents our fifth annual review, covering the top 24 IEM research articles published in 2009. Articles were selected for the review according to explicit, predetermined criteria that emphasize both methodologic quality and impact of the research. It is our hope that this annual review acts as a forum for disseminating best practices, while also stimulating further research in the field of IEM.
View details for DOI 10.1111/j.1553-2712.2010.00961.x
View details for Web of Science ID 000286053700013
View details for PubMedID 21182567