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Introduction: Digital health technologies are increasingly being used in emergency medicine, many of which utilize smartphones and computers. Patient willingness to use these modalities is an important factor in successful implementation. Therefore, this study aimed to assess emergency department (ED) patients' use of and attitudes towards technology. Methods: This was a pooled sub-analysis of ED patients (≥18 years old) that were enrolled in two studies evaluating the ED patient experience in response to novel technological interventions. Participants completed the Media and Technology Usage and Attitudes Scale (MTUAS) that assessed computer and smartphone ownership; frequency of use of phone calls, texting, email, and smartphones; and anxiety and dependence attitudes on these technologies. Results: One hundred and forty-four participants completed the survey. Mean age was 47.2 years (SD 17.94); 61.8% were female; and 61.1% were white. There was high usage of smartphones (93.1%) and computers (74.3%). Participants most frequently used phone calling and texting and least commonly used email. Participants had a positive attitude (mean 3.9/5, SD 0.68) towards the use of these technologies. Discussion: ED patients reported high ownership of smartphones and computers, had a positive attitude towards their use, and had varying frequency with which they used different technologies. Future studies can use this information to inform the development of digital health interventions that utilize technologies that patients find most acceptable.

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Introduction: Despite their popularity in many EDs, little is known regarding perceptions of turkey sandwiches among patients. Given the importance of turkey sandwiches as a form of nutrition provided in EDs, we sought to quantify the composition and taste of ED turkey sandwiches through a quantitative assessment of turkey sandwiches by ED staff. Methods: This was a blinded observational study performed at a tertiary, urban academic medical center in Boston, MA. We collected ED turkey sandwiches up to 48 hours prior to study days from 4 emergency departments in the Boston area (2 community hospitals and 2 academic medical centers). We enrolled ED physicians, nurses, physician assistants, and staff who were exposed to four sandwiches in a random fashion. Participants were asked to assess sandwiches on a Likert scale of 1 to 5 on a variety of factors including, nutritional value "goodness", smell "olfactory", texture "bite", ingredient distribution "balance", appearance "look", and flavor "edibility" to produce a composite score for sandwich quality (GOBBLE score). Next, participants were asked standardized questions surrounding suitability for consumption and nutrition on a 10 point Likert scale. We calculated mean scores and measured differences using t-tests. Results: We enrolled 22 participants over the study period. Twenty-one participants completed all measures. GOBBLE scores were calculated and averaged for sandwiches. A One-way ANOVA test was performed to measure statistically significant differences between mean GOBBLE scores (p<0.05) with a post hoc Tukey HSD procedure used to assess for statistically significant difference for pairwise comparison. A significant difference (p=0.009) was noted between the 4 sandwiches being compared, with a single site outperforming the others. Aggregating for academic and community sites demonstrated no statistically significant difference (p=0.08). Sandwiches in general were not considered healthy or palatable by study subjects. Conclusion: Despite out-performance by a single ED, there is no significant difference in the quality of sandwiches provided to patients in EDs between academic and community hospitals. ED turkey sandwiches do not appear to be food items that are viewed as healthy or recommended to patients by ED staff who participated in this study.

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The unprovoked invasion of Ukraine by the Russian Federation has resulted in the largest humanitarian crisis in Europe since World War II. As fighting intensifies throughout Ukraine, there is an increasing concern that the Russian Federation may consider the direct use of chemical or radiological weapons against military personnel and civilians in Ukraine. Despite prohibition of chemical weapons from the Chemical Weapons Convention of 1997, recent evidence has demonstrated that state actors will continue to use these agents as weapons of war and terror, despite publicly denying their use. We review chemical weapons produced and used by the Russian Federation (or its allies) to identify plausible risks in the Russian war in Ukraine. We also provide rapid assessment and treatment guidelines to recognize and manage these acute exposures.

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Colchicine is commonly prescribed for treatment of inflammatory conditions but has a narrow therapeutic window and dangerous toxicity profile. Here we describe a case of survival after massive unintentional colchicine overdose treated with plasmapheresis and renal replacement therapy. A 37 year old male with history of pericarditis presented to the Emergency Department with a chief complaint of nausea, vomiting, and diarrhea after unintentionally ingesting 36 mg of colchicine 17 h prior to arrival. An initial colchicine concentration resulted at 5.1 ng/mL (30 h post-ingestion) and peaked at 12 ng/mL (40 h post-ingestion). He was treated with continuous kidney replacement therapy (CKRT) beginning on his first day of hospitalization and with plasmapheresis on hospital days two through four. The patient's course was complicated by multiorgan failure including coagulopathy, respiratory failure, neuropathy, renal failure, pancytopenia, and heart failure. He was discharged to inpatient rehabilitation on hospital day 24. On clinical follow up four months after discharge the patient was found to have no significant persistent morbidity related to colchicine overdose.

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In this study we define for the first time the distribution of alpha-fetoprotein levels and acetylcholinesterase ratios in amniotic fluid samples associated with fetal gastroschisis. Elevated alpha-fetoprotein levels and positive acetylcholinesterase measurements are found in virtually all cases, indicating that these combined measurements are highly reliable in detecting this lesion.

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We have been studying the development of hypertension in spontaneously hypertensive rats (SHR) fed a low protein diet. The effects of a low protein diet upon food and water intake were examined. Body weight gain, food and water intake were measured in three to twenty-three week-old SHR and Wistar Kyoto rats (WKY) fed diets containing 8%, 15% or 25% casein. Body weights of SHR and WKY fed an 8% casein diet were significantly lower at 23 weeks than rats on the higher protein diets, although both groups on the 8% diet consumed more food and water per g of body weight. In addition, SHR fed an 8% casein diet drank less water per gram of food than WKY or SHR fed 15% and 25% casein diets. These results indicate that changes in food and water intake, as a consequence of low protein diets, should be an additional consideration when examining the effects of dietary protein on the development of hypertension.

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In the present study, a recently reported immunochemical technique for measuring acetylcholinesterase (AChE) in amniotic fluid utilizing the 4F19 antibody was compared with the widely utilized polyacrylamide gel technique to determine whether the immunochemical assay provided an advantage in separating unaffected pregnancies from those associated with open spina bifida (OSB) and open ventral wall defects (OVWD). The study included (1) 73 amniotic fluid samples from unaffected pregnancies [alpha-fetoprotein (AFP) less than 2 MoM] with no visible gel AChE band, (2) nine bloodstained samples from unaffected pregnancies (AFP 2.2-4.0 MoM) with visible gel AChE bands, (3) 18 samples associated with OSB (AFP 2.2-7.0 MoM) with visible gel AChE bands, and (4) 20 samples associated with OVWD (AFP 3.2-53.5 MoM) with visible gel AChE bands. The immunochemical assay produced ranges of measurements in the four respective categories as follows: (1) 2-60 arbitrary units (AU): (2) 14-69 AU, (3) 61-593 AU, and (4) 22-476 AU. Eight of the nine unaffected pregnancies with visible gel AChE bands had immunochemical measurements below the highest measurement for the samples with no visible AChE band (60 AU), as did five out of 20 OVWD pregnancies. Two of the OSB cases had values of 61 and 62 AU. These data indicate that the 4F19 specific monoclonal antibody to AChE is capable of distinguishing unaffected from affected pregnancies with reasonable reliability but that more work needs to be done to establish the extent of overlap between the unaffected and affected populations.

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Amniotic fluid samples from eight pregnancies associated with exomphalos or gastroschisis and 24 with open spina bifida were used to confirm the hypothesis that when the alpha-fetoprotein and gel acetylcholinesterase tests are positive in an amniotic fluid not visibly contaminated with blood, the two defects can be distinguished by scanning densitometry of the electrophoretic gel. The ratio of the density for the acetylcholinesterase band in the gel to that of the pseudocholinesterase band was less than or equal to 0.10 for the open abdominal wall defects and 0.27 or more for open spina bifida. Based on this and a previously reported series, a cut-off level of about 0.15 is suggested.

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Densitometry was used to measure gel acetyl- and pseudocholinesterase bands in a selection of amniotic fluid samples yielding positive alpha-fetoprotein and positive gel acetylcholinesterase results. The samples were associated with the following conditions: 28 anencephaly (10 stained with fetal blood), 20 open spina bifida (3 stained with fetal blood), 10 open ventral-wall defects (2 stained with fetal blood) and 5 unaffected pregnancies (all stained with fetal blood). In samples not visibly stained with fetal blood, the ratio of the acetylcholinesterase density to the pseudocholinesterase density distinguished between open ventral-wall defects and open neural-tube defects: the former group all had values less than 0.13, while the latter all had values greater than that. In amniotic fluid samples which were stained with fetal blood the acetylcholinesterase/pseudocholinesterase ratio did not offer useful diagnostic information; results from unaffected pregnancies overlapped with those from pregnancies with both ventral-wall defects and open neural-tube defects.

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We have performed gel acetylcholinesterase analysis blindly on 1,300 consecutive amniotic fluid samples sent to our laboratory for alpha-fetoprotein measurement. Faint acetylcholinesterase bands were identified in nine of 1,300 samples, and all of these were associated with pregnancies free of major fetal malformations. Dense acetylcholinesterase bands were identified in four samples, and all were associated with major fetal malformations. Densitometric analysis of acetylcholinesterase bands provided additional objectivity in classifying band density.

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