False Elevation of Volume Determined by Bladder Scanner Secondary to Bowel Obstruction

Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a falsely elevated BV. We believe this is the first case report of a SBO causing an elevated BV by bladder scanner. Emergency physicians should be aware of the pitfalls of using bladder scanners, and use their point-of-care ultrasound skills when possible to expand their differential

Haemophilus influenzae Sepsis and Placental Abruption in an Unvaccinated Immigrant

Background: Haemophilus influenzae infections have declined dramatically in the United States sinceimplementation of the conjugate vaccine. However, in countries where widespread immunization is notroutine, H influenzae remains a significant cause of morbidity and mortality. We report a case of apreviously unvaccinated immigrant with confirmed H influenzae sepsis and placental abruption leadingto spontaneous abortion.Objectives: To alert emergency medicine practitioners that H influenzae should be recognized as amaternal, fetal, and neonatal pathogen. Clinicians should consider this diagnosis in immigrants presentingwith uncertain vaccination history, as H influenzae can cause significant morbidity and mortality.Case Presentation: A 36-year-old female was referred to our emergency department (ED) with lowerabdominal pain with some vaginal spotting. The patient had an initial visit with normal laboratoryinvestigations and normal imaging results, with complete resolution of symptoms. The patient returned tothe ED with sudden onset of vaginal bleeding and abdominal pain. She presented at this time with sepsis,which progressed to septic shock, causing placental abruption and ultimately, spontaneous abortion. Thepatient was treated with pressors and antibiotics and was admitted to the medical intensive care unitwhere she received ampicillin, gentamycin, and clindamycin for suspected chorioamnionitis. The patient’sblood cultures came back positive after 1 day for H influenzae. The patient did well and was dischargedfrom the hospital 4 days later.Conclusion: Haemophilus influenzae should be recognized as a neonatal and maternal pathogen.Clinicians should consider this diagnosis in immigrants presenting with uncertain vaccination history,especially in pregnant females, as H influenzae can cause significant morbidity and mortality. [West JEmerg Med. 2012;13(1):133–135.

Atmospheric neutrino oscillations with three neutrinos and a mass hierarchy

A comprehensive formalism for the description of neutrino oscillations in the Earth in a general scheme with three massive neutrinos and the mass hierarchy m_1<<m_2<<m_3 is presented. Using this formalism, which is valid both in vacuum and in a medium, the matter effect on the oscillations of low-energy neutrinos is discussed, pointing out the existence of very long oscillations which are independent of the neutrino masses and the neutrino energy, and are very sensitive to the matter density along the neutrino trajectory. As an example of application of the formulation, a fit of the Kamiokande atmospheric neutrino data with the matter effect taken into account for neutrinos propagating in the Earth is presented. The results of the fit indicate that 4*10^{-3} eV^2 < m_3^2 nu_e, nu_munu_tau, nu_enu_tau) could be large. Hence, long-baseline experiments with reactor (CHOOZ and Palo Verde) and accelerator (K2K, MINOS and ICARUS) neutrinos could observe neutrino oscillations in all channels with a relatively large statistics.Comment: 42 pages, including 7 figure

Empirical support for a multi-dimensional model of sensations experienced by youth during their initial smoking episodes

Aims: To examine the dimensionality of sensations experienced during initial tobacco smoking. Design: Cross-sectional survey. Setting: Thirteen secondary schools located in British Columbia, Canada. Participants: Data from 1187 adolescents who responded ‘yes’ to the question: ‘Have you ever tried cigarette smoking, even one or two puffs?’. Measurements: Participants answered questions about their demographic characteristics, tobacco smoking history and sensations experienced during their initial smoking episodes. Findings: The sensations appear to represent the following three separate but modestly correlated dimensions: a pleasant dimension defined by feeling good and relaxed; an unpleasant dimension defined by coughing, feeling sick and nervous; and a ‘buzz’ dimension defined by feeling high and dizzy. The three factors made statistically significant contributions to the prediction of transition to regular smoking (defined as having smoked at least 100 cigarettes in one\u27s life-time) after adjusting for age, sex and age at first puff. Conclusions: The results suggest that three relatively distinct physiological systems appear to explain the relationship between initial smoking sensations and probability of becoming a regular smoker. Researchers examining sensations experienced during initial tobacco smoking episodes should consider using a three-dimensional profile of symptoms composed of pleasant, unpleasant and buzz dimensions

Impact of lifting school mask mandates on community SARS-CoV-2 cases, hospitalizations, and deaths: a retrospective observational study

BackgroundSchool masking mandates were widely adopted as a pandemic control measure, however, limited data are available regarding their effectiveness as a strategy for reducing burden of disease in the surrounding community.ObjectiveTo evaluate the impact of school masking policy de-adoption (mask-lifting) on SARS-CoV-2 incidence rates, hospitalizations, and deaths in the surrounding community.MethodsDesign: Retrospective observational study with an event study design, a difference-in-difference method; a target trial emulation (TTE) framework was applied as a secondary analysis. Cohort creation: Data collected from 9/2021 to 6/2022 on SARS-CoV-2 cases, hospitalizations, deaths and vaccination rates were combined with district-level masking policy data. Analysis: In the event study, the impact of masking policy de-adoption on SARS-CoV-2 cases per 100,000 county residents stratified by age during the 8-week period following the policy change was estimated. Effects on hospitalization and deaths per 1,000,000 residents were secondarily estimated. In a secondary analysis, a target trial emulation framework was applied to estimate average treatment effects.ResultsN = 3,970 districts composed of 53,453 schools were included in the cohort. In the event study, no consistent trends for COVID-19 case rates were identified for the whole cohort or for any age group. For the whole cohort, there was a statistically significant increase found 6–8 weeks following the policy change (maximum increase, 1.91 hospitalizations per 1,000,000 county residents); increases in hospitalizations were also found in the stratified analysis for all age groups, although absolute impacts were small. An increase in deaths was found during the period from 4 to 7 weeks following the policy change (maximum increase 0.62 deaths per 1,000,000 residents). In the stratified analysis, small increases in death rates were seen in 50–69 year olds (range, 0.088–1.49) and &gt;70 year olds (range, 0.23–2.58) but not in younger groups. In the TTE framework, cases, hospitalizations, and deaths were similar in control and intervention counties.ConclusionThis study evaluating the impact of lifting of mask mandates in schools, analyzed in two ways, was consistent results ranging from no impact to a small but statistically significant impact of the policy change on SARS-CoV-2 case and severe outcomes rates in the surrounding community. Findings can be used to inform future pandemic policy responses for elementary and secondary schools

Fungal malignant otitis externa

An 89-year-old man presented to the outpatient clinic with a 2-month history of persistent unilateral left-sided otalgia, otorrhoea and reduced hearing despite oral and topical antibiotics. Treatment was protracted, requiring a 4-month hospital admission for intravenous antifungal medication as well as 3 further months of oral antifungal treatment. We describe the clinical presentation, complications and treatment of this potentially fatal condition in the context of an unusual, and easily missed, causative organism