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Boarding of patients in the Emergency Department (ED) impedes patient flow through the department and deprives medical students of valuable educational opportunities. We designed a curriculum for medical students during their required Emergency Medicine (EM) clerkships aimed to circumvent lost educational opportunities. Participants should gain increased appreciation of interprofessional collaboration, procedural competency, and ED flow. Students learned of the optional curriculum as they began their required EM clerkship. From August 2023 through January 2024, 120 students were contacted for recruitment into the optional curriculum. Students were provided with an ED-BINGO card with 25 pre-identified patient care activities deemed relevant to EM across 5 different categories. Participants were surveyed regarding educational value and enjoyment on a 5-point Likert scale. The 32 fully completed surveys were evaluated (26.7%), and 16 students (13.4%) reported using the ED-BINGO card during their EM clerkships. Participants reported that the ED-BINGO card tasks were appropriate for their level of training (median: 5, interquartile range (IQR): 1, mean 4.56, standard deviation (STD) 0.68), enhanced their understanding of flow/throughput of the ED (median: 4, IQR: 1.75, mean 3.94, STD 1.22), improved their knowledge/skills (median: 4, IQR: 2, mean 4, STD 1.06), helped them feel more valuable to the team (median score: 5, IQR: 2, mean 3.89, STD 1.49), and should remain a permanent fixture of the rotation (median: 4.5, IQR: 1, mean 4.5, STD 1.01). The ED-BINGO activity for the EM clerkship was perceived by medical students as educationally beneficial and enjoyable. While the limited number of participant respondents precludes any definitive conclusions about its broader effectiveness or its suitability for formal incorporation into the clerkship, the warm reception, especially noted in our student narrative responses, shows promising opportunities for other clerkships to adopt similar activity-driven gamification for self-driven adult learners. Further study with greater response rates would determine whether gamified interventions can meaningfully mitigate the educational challenges posed by ED boarding.

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Hearing loss is a common congenital anomaly and there is clear evidence of the benefits of early diagnosis and then treatment. For maximum positive impact, the diagnosis needs to be made as early as possible, ideally in the first months of life-this is the rationale for the national newborn hearing screening programme in the UK. When diagnosis and treatment do not occur early, the opportunity for the child to develop spoken language is slowly diminished over time with potentially devastating consequences.A national review into children's hearing services in England was commissioned by the Secretary of State for Health and Social Care when it became clear that many children were being failed by these services. The scale of the harm may never be fully understood, but well over 300 children had their hearing loss missed, with likely lifelong consequences. Hearing services were found to be highly varied and outcomes unacceptably variable, with poor assurance of quality at trust and integrated care board level. The audiology workforce has been neglected for years with little professional governance and no coherent workforce planning.The Kingdon review has made 12 recommendations to place hearing services for children on a surer footing, underpinning services with a clear approach to commissioning and suggesting a networked model of service delivery. A structured data-driven quality assurance approach to monitoring of service quality is recommended, as is a wholescale review of education and training of the audiology workforce.

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Convergent evolution, or the independent acquisition of similar phenotypes in distinct lineages, provides a powerful framework for investigating genomic changes associated with a phenotype. This paper details an update to RERconverge, a powerful R package that tests for associations between gene relative evolutionary rates (RERs) and convergent phenotypes to infer genomic regions associated with traits or selective pressures. We introduce new customizable analysis choices and scalable and efficient algorithms that can process larger genomic datasets, a critical improvement as genomic data become available for more species. Modifications to core functions in the RERconverge pipeline resulted in an immense speedup (by a factor of up to 28.6). The function that tests for associations between phenotypes and RERs has been expanded to include two new analytical methods for outlier control; we also provide here a summary of the statistical tests users can perform, along with their use cases. The code and walkthrough vignettes for the package are available at https://github.com/nclark-lab/RERconverge . Nathan L. Clark nclark@pitt.edu ; Maria Chikina mchikina@pitt.edu.

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Biological emergencies strain health care facilities that are typically designed to accommodate routine surges. The SARS-CoV-2 pandemic exposed vulnerabilities in hospital oxygen delivery systems worldwide, resulting in ventilator failures and disruptions in patient care. At the American University of Beirut Medical Center (AUBMC), the Emergency Department experienced significant challenges in maintaining the oxygen delivery system due to the unprecedented oxygen demand, over-frosting of pipelines, and system-wide depressurization. In response, the AUBMC established the Emergency Engineering Response Team (EERT) to rapidly develop and implement innovative, engineering-based strategies. This report shares the challenges faced by the AUBMC during the SARS-CoV-2 pandemic, details the solutions implemented, and provides recommendations to strengthen health care facility preparedness for future biological emergencies.