Introduction: Among adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed.

Methods: We estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18-64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST.

Results: Of 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population differed by how it was measured (lifetime use, past three-month use, past three-month frequency of use, or need for interventions). As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use. A strategy asking about daily/near-daily use was better in identifying patients needing intensive interventions. However, some patients needing interventions were missed when using these simplified strategies.

Conclusion: Substance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used. EDs should carefully select strategies to identify patients in need of substance use interventions.

The Wordie Ice Shelf-Fleming Glacier system in the southern Antarctic Peninsula has experienced a long-term retreat and disintegration of its ice shelf in the past 50 years. Increases in the glacier velocity and dynamic thinning have been observed over the past two decades, especially after 2008 when only a small ice shelf remained at the Fleming Glacier front. It is important to know whether the substantial further speed-up and greater surface draw-down of the glacier since 2008 is a direct response to ocean forcing, or driven by feedbacks within the grounded marine-based glacier system, or both. Recent observational studies have suggested the 2008-2015 velocity change was due to the ungrounding of the Fleming Glacier front. To explore the mechanisms underlying the recent changes, we use a full-Stokes ice sheet model to simulate the basal shear stress distribution of the Fleming system in 2008 and 2015. This study is part of the first high resolution modelling campaign of this system. Comparison of inversions for basal shear stresses for 2008 and 2015 suggests the migration of the grounding line ĝ1/4 9 km upstream by 2015 from the 2008 ice front/grounding line positions, which virtually coincided with the 1996 grounding line position. This migration is consistent with the change in floating area deduced from the calculated height above buoyancy in 2015. The retrograde submarine bed underneath the lowest part of the Fleming Glacier may have promoted retreat of the grounding line. Grounding line retreat may also be enhanced by a feedback mechanism upstream of the grounding line by which increased basal lubrication due to increasing frictional heating enhances sliding and thinning. Improved knowledge of bed topography near the grounding line and further transient simulations with oceanic forcing are required to accurately predict the future movement of the Fleming Glacier system grounding line and better understand its ice dynamics and future contribution to sea level.

Many glaciers in the Antarctic Peninsula are now rapidly losing mass. Understanding of the dynamics of these fast-flowing glaciers, and their potential future behaviour, can be improved through ice sheet modelling studies. Inverse methods are commonly used in ice sheet models to infer the spatial distribution of a basal friction coefficient, which has a large effect on the basal velocity and ice deformation. Here we use the full-Stokes Elmer/Ice model to simulate the Wordie Ice Shelf-Fleming Glacier system in the southern Antarctic Peninsula. With an inverse method, we infer the pattern of the basal friction coefficient from surface velocities observed in 2008. We propose a multi-cycle spin-up scheme to reduce the influence of the assumed initial englacial temperature field on the final inversion. This is particularly important for glaciers like the Fleming Glacier, which have areas of strongly temperature-dependent deformational flow in the fast-flowing regions. Sensitivity tests using various bed elevation datasets, ice front positions and boundary conditions demonstrate the importance of high-accuracy ice thickness/bed geometry data and precise location of the ice front boundary.

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Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain. 

Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge. 

Results: Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three. 

Conclusion: Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis.

Background: Treatment for partners of patients diagnosed with sexually transmitted infections (STI), referred to as expedited partner therapy (EPT), is infrequently used in the emergency department (ED). This was a pilot program to initiate and evaluate EPT through medication-in-hand (“take-home”) kits or paper prescriptions. In this study we aimed to assess the frequency of EPT prescribing, the efficacy of a randomized best practice advisory (BPA) on the uptake, perceptions of emergency clinicians regarding the EPT pilot, and factors associated with EPT prescribing.

Methods: We conducted this pilot study at an academic ED in the midwestern US between August–October 2021. The primary outcome of EPT prescription uptake and the BPA impact was measured via chart abstraction and analyzed through summary statistics and the Fisher exact test. We analyzed the secondary outcome of barriers and facilitators to program implementation through ED staff interviews (physicians, physician assistants, and nurses). We used a rapid qualitative assessment method for the analysis of the interviews.

Results: During the study period, 52 ED patients were treated for chlamydia/gonorrhea, and EPT was offered to 25% (95% CI 15%–39%) of them. Expedited partner therapy was prescribed significantly more often (42% vs 8%; P < 0.01) when the interruptive pop-up alert BPA was shown compared to not shown. Barriers identified in the interviews included workflow constraints and knowledge of EPT availability. The BPA was viewed positively by the majority of participants.

Conclusion: In this pilot EPT program, expedited partner therapy was provided to 25% of ED patients who appeared eligible to receive it. The interruptive pop-up alert BPA significantly increased EPT prescribing. Barriers identified to EPT prescribing should be the subject of future interventions to improve provision of EPT from the emergency department.

Introduction: Blacks in the United States experience greater persistent pain than non-Hispanic Whites across a range of medical conditions, but to our knowledge no longitudinal studies have examined the risk factors or incidence of persistent pain among Blacks experiencing common traumatic stress exposures such as after a motor vehicle collision (MVC). We evaluated the incidence and predictors of moderate to severe axial musculoskeletal pain (MSAP) and widespread pain six weeks after a MVC in a large cohort of Black adults presenting to the emergency department (ED) for care.

Methods: This prospective, multi-center, cohort study enrolled Black adults who presented to one of 13 EDs across the US within 24 hours of a MVC and were discharged home after their evaluation. Data were collected at the ED visit via patient interview and self-report surveys at six weeks after the ED visit via internet-based, self-report survey, or telephone interview. We assessed MSAP pain at ED visit and persistence at six weeks. Multivariable models examined factors associated with MSAP persistence at six weeks post-MVC.

Results: Among 787 participants, less than 1% reported no pain in the ED after their MVC, while 79.8 (95% confidence interval [CI], 77.1 – 82.2) reported MSAP and 28.3 (95% CI, 25.5 – 31.3) had widespread pain. At six weeks, 67% (95% CI, 64, 70%) had MSAP and 31% (95% CI, 28, 34%) had widespread pain. ED characteristics predicting MSAP at six weeks post-MVC (area under the curve  = 0.74; 95% CI, 0.72, 0.74) were older age, peritraumatic dissociation, moderate to severe pain in the ED, feeling uncertain about recovery, and symptoms of depression.

Conclusion: These data indicate that Blacks presenting to the ED for evaluation after MVCs are at high risk for persistent and widespread musculoskeletal pain. Preventive interventions are needed to improve outcomes for this high-risk group.