Table of Contents

SECTION I Invasive & Emerging Pests Page 3. Denny J. Bruck, Jana Lee & David Edwards (USDA-ARS Horticulture Crops Research Lab) “Update on USDA-ARS Research of the Spotted Wing Drosophila”. 3. Eric LaGasa & Chris Looney (WSDA Pest & Plant Protection) “Exotic & Emerging Fruit Pests New to WA State in 2009: Dogwood Borer, Spotted Wing Drosophila & American Plum Borer”. 4. B.T. Huffman & P.W. Mitchell (Oregon Dept. of Ag. Portland Field Office) “Relationship between Air Cargo Interceptions & Trap Catches of Japanese Beetle at PDX” 6. H.W. Rogg, R.L. Westcott (Oregon Dept. of Agriculture) “Apple Maggot: Update on the Pendleton Eradication Project” 7. H.W. Rogg & Josh Vlach (Oregon Dept. of Agriculture) “Spotted Wing Drosophila: Potential Threat to Oregon’s Agriculture” 8. B. Simko, D. Heckathorne, M. Fujishin (Idaho Dept. of Ag.) “2009 Idaho Surveys for Exotic or Emerging pests of Grapes” 10. Amy J. Dreves (OSU-Crop & Soil Science) “Spotted Wing Drosophila: A New Invasive Pest in Fruits on the West Coast”

Error in medicine is a subject of continuing interest among physicians, patients, policymakers, and the general public. We examine the issue of disclosure of medical errors in the context of emergency medicine. We review the concept of medical error; propose the professional duty of truthfulness as a justification for error disclosure; examine barriers to error disclosure posed by health care systems, patients, physicians, and the law; suggest system changes to address the issue of medical error; offer practical guidelines to promote the practice of error disclosure; and discuss the issue of disclosure of errors made by another clinician.
532 Art, Chaos, Ethics, and Science (ACES): A Doctoring Curriculum for Emergency Medicine (Concepts) AA Van Groenou, K Bakes "ACES" (Art, Chaos, Ethics, and Science) is a curriculum developed by 2 residents and a faculty mentor at the Denver Health Medical Center Emergency Medicine Residency Program. The goal of the ACES curriculum is 2-fold: (1) to discuss areas of clinical consequence typically outside the scope of the regular academic curriculum, such as ethical dilemmas and the challenges of professionalism; and (2) to encourage reflection on our roles as caregivers on a personal, public health, and political level. We discuss the aim of the program, the curriculum, and how the ACES program enriches the residency's educational goals.

I Aisic, C Auerbach, P Gennis
What is already known on this topic: Development of new clinical decision rules depends on analysis of large sets of clinical data. Use of free-text data, such as radiology reports, for this purpose is particularly difficult and labor intensive. Natural-language-processing systems, if sufficiently accurate, can identify discrete findings in free-text reports. What question this study addressed: The authors sought to determine whether a natural-language-processing system could accurately detect whether or not a head computed tomography report from a head trauma case declared the presence of a clinically important subdural or epidural hematoma. What this study adds to our knowledge: The study adds head trauma to the growing list of clinical domains in which natural-language-processing systems can effectively interpret free-text reports for screening or research purposes. The system was able to make a confident determination only on about four fifths of the test reports but had a sensitivity of roughly 96% and very high specificity when it did so. How this might change clinical practice: Natural language processing of radiology reports has no immediate clinical application but could reduce the manual review work needed to screen large numbers of reports for analysis, such as in developing new clinical decision rules. The emergency department (ED) is an essential component of the public health response plan for control of acute respiratory infectious threats. Effective respiratory hygiene in the ED is imperative to limit the spread of dangerous respiratory pathogens, including influenza, severe acute respiratory syndrome, avian influenza, and bioterrorism agents, particularly given that these agents may not be immediately identifiable. Sustaining effective respiratory control measures is especially challenging in the ED because of patient crowding, inadequate staffing and resources, and ever-increasing numbers of immunocompromised patients. We present a summary of the most current information available in the literature about respiratory hygiene in the ED, including administrative, patient, and legal issues. This brief synopsis should help clinicians and administrators understand, develop, and implement appropriate policies and procedures to address respiratory hygiene in the ED.

The Association of Sepsis Syndrome and Organ Dysfunction With Mortality in Emergency Department Patients With Suspected Infection (Original Research) N Shapiro, MD Howell, DW Bates, DC Angus, L Ngo, D Talmor
What is already known on this topic: Although well characterized in ICU patients, the prognostic utility of the systemic inflammatory response syndrome (SIRS)/sepsis syndrome/organ dysfunction classification scheme has not been well evaluated in the emergency department (ED) environment.
What question this study addressed: What are the prognostic implications of this classification scheme for inhospital and 1-year survival among ED patients suspected of having infection as evidenced by blood cultures being taken? What this study adds to our knowledge: Among this 3,000-person high-risk ED population with suspected infection, SIRS did not portend a worse prognosis, whereas severe sepsis, septic shock, and a higher number of dysfunctional organs were associated with increased mortality. How this might change clinical practice: This study demonstrates that ED patients with severe sepsis, septic shock, or dysfunctional organs in the setting of infection are at greater risk of death. Such patients might be targeted for specific interventions to treat these conditions. What is already known on this topic: Nonprescription analgesics, such as acetaminophen and ibuprofen, have been shown to decrease musculoskeletal pain resulting from trauma. They have infrequently been compared in randomized trials, and their relative efficacy is not known. What question this study addressed: This randomized controlled trial of 260 patients with grade I or II lateral ankle sprains compared nonprescription-strength acetaminophen and ibuprofen therapy to determine whether acetaminophen was less effective than ibuprofen. What this study adds to our knowledge: Over-thecounter acetaminophen and ibuprofen treatments seem to result in similar relief from pain on walking and resumption of normal activities after ankle sprain injury. How this might change clinical practice: This study supports the use of acetaminophen for ankle sprain injury, particularly if the patient is at risk for nonsteroidal antiinflammatory drug-related adverse effects.