In 2015, disparities in salary and rank persist among full-time U.S. academic EM faculty. There were gender and URM disparities in rank and leadership positions. Women earned less than men regardless of rank, clinical hours, or training. Future efforts should focus on evaluating salary data by race and developing systemwide practices to eliminate disparities.

Background: The purpose of this study was to complete a comprehensive analysis of gender differences in faculty rank among U.S. emergency physicians that reflected all academic emergency physicians.Methods: We assembled a comprehensive list of academic emergency medicine (EM) physicians with U.S. medical school faculty appointments from Doximity.com linked to detailed information on physician gender, age, years since residency completion, scientific authorship, National Institutes of Health (NIH) research funding, and participation in clinical trials. To estimate gender differences in faculty rank, multivariable logistic regression models were used that adjusted for these factors.Results: Our study included 3,600 academic physicians (28%, or 1,016, female). Female emergency physicians were younger than their male colleagues (mean [AESD] age was 43.8 [AE8.7] years for females and 47.4 [AE9.9] years for males [p < 0.001]), had fewer years since residency completion (12.4 years vs. 15.6 years, p < 0.001), had fewer total and first/last author publications (4.7 vs. 8.6 total publications, p < 0.001; 4.3 vs. 7.1 first or last author publications, p < 0.001), and were less likely to be principal investigators on NIH grants (1.2% vs. 2.9%, p = 0.002) or clinical trials (1.8% vs. 4.4%, p < 0.001). In unadjusted analysis, male physicians were more likely than female physicians to hold the rank of associate or full professor versus assistant professor (13.7 percentage point difference, p < 0.001), a relationship that persisted after multivariable adjustment (5.5 percentage point difference, p = 0.001).Conclusions: Female academic EM physicians are less likely to hold the rank of associate or full professor compared to male physicians even after detailed adjustment for other factors that may influence faculty rank. W hile gender parity in academic medicine has improved since women were first admitted to medical school in 1849, there has been minimal progress over the past decade. [1][2][3][4] As few as one-third of medical school faculty are female and female faculty comprise a lower proportion of those who are full professors, have senior authorship, or have National Institutes of Health (NIH) funding. 4 This is an issue in multiple medical specialties and, despite attempts at promoting workforce diversity, includes academic emergency medicine (EM). [5][6][7][8] Recent work has demonstrated that as little as onethird of academic EM physicians are female and these

Background: Women in medicine continue to experience disparities in earnings, promotion, and leadership roles. There are few guidelines in place defining organization-level factors that promote a supportive workplace environment beneficial to women in emergency medicine (EM). We assembled a working group with the goal of developing specific and feasible recommendations to support women's professional development in both community and academic EM settings.

A change in urine color can be distressing for patients and physicians alike. Many of the causes of abnormal urine color are benign effects of medications and foods; however, a change in urine color may be a sign of an underlying pathological condition. The good news is that in many cases the diagnosis can be determined from a thorough history and urinalysis. This article presents many of the conditions physicians may encounter and will help them form a narrow differential diagnosis and treatment plan.

There is a large therapeutic gap in sickle cell disease (SCD). Hydroxyurea reduces acute sickle cell-related events, but does not appear to protect patients from cardiopulmonary complications, 1 which are the major causes of death in SCD patients. The long-term effects of newer agents such as crizanlizumab and L-glutamine on the disease course remain to be determined. The only cure currently available for SCD is allogeneic stem cell transplant (allo-SCT); however, many barriers 2 prevent allo-SCT from being readily offered to these patients.Investigations into other therapeutic approaches are, therefore, appropriate.Activated and circulating aged neutrophils (CANs) adhere to vascular endothelium and are pivotal for the pathogenesis of sickle cell vaso-occlusive crisis (VOC). CANs in mice are regulated by intestinal microbiota. 3 Treatment of SCD mice with a cocktail of ampicillin, neomycin, metronidazole, and vancomycin (ANMV) induced reduction in CANs and protected the mice from fatal tumor necrosis factorα-induced VOC. 3 Therefore, antibiotic therapy might be a potential therapeutic approach for SCD. It is, however, unclear whether the benefits of the ANMV cocktail were related to its effects on the intestinal microbiota or to the systemic effects of the absorbed ampicillin and metronidazole. Long-term use of the ANMV cocktail might also not be clinically practical and safe. An oral antibiotic that has a good safety track record for long-term use and is capable of reducing CANs would be ideal. The question of whether the benefits of the ANMV cocktail are due to its local effects on the intestinal microbiota or due to the systemic effects of the absorbed components of ANMV may also be answered if the candidate oral antibiotic is also not intestinally absorbed.Rifaximin is a minimally absorbed oral antibiotic and it fits the required safety profile. It has been used for a long term in patients with advanced liver disease. 4 Its long-term use is not associated with increased risks for the development of Clostridium difficile infection (CDI), an important consideration in order not to abrogate the protective effects from CDI that SCD patients enjoy. 5 To determine whether rifaximin was capable of reducing CANs in SCD, 11 patients (6 males and 5 females) with HbSS received rifaximin 550 mg twice a day (ClinicalTrials.gov Identifier: NCT03719729).The median age was 29 years (range 23-56). Median duration of therapy was 2 months (range 1-4). Five patients were taking hydroxyurea at the time of the study. CANs were measured by multicolor flow cytometry. Neutrophils were gated by Gr-1 hi CD115 lo SSC hi and CANs by CD62L lo CXCR4 hi within the neutrophil population.Rifaximin was well tolerated in all patients without significant side effects; in particular, we did not observe CDI during rifaximin therapy.There was a dramatic reduction in CANs after 2-4 weeks of rifaximin therapy (median 12.65% [range 6.07-40.05] vs 4.55% [range 2.63-20.25]) (two-tailed P = 0.0036) ( Figure 1A). CANs continued to decrease at the 3-month ...

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To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to prevent heart disease, HIV infection, substance abuse, and violence in US cities. The study's objectives were to describe the target populations, settings, and program characteristics of these interventions and to assess the extent to which these programs followed accepted principles for health promotion. Investigators searched five computerized databases and references of selected articles for articles published in peer-reviewed journals between 1980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at least 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systematic evaluation. However, many programs did not involve participants in planning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential effectiveness. Few programs addressed the unique characteristics of urban communities.

IntroductionAlthough a relatively young specialty, emergency medicine (EM) is popular among medical students and is one of the most competitive large specialties. Consequently, students increasingly seek more opportunity to differentiate themselves from their colleagues by pursuing more clerkships at the cost of taking out additional loans: this despite the fact that those who match in EM typically do so in their top three choices. We sought to ascertain what factors EM program directors seek in their typical candidate.MethodsWe recruited EM program directors via the Council of Emergency Medicine Residency Directors email listserv to participate in an anonymous survey regarding the United States Medical Licensing Examination (USMLE), the number of standardized letters of evaluation (SLOE), and the number of EM rotations during the fourth year.Results135 respondents completed the anonymous survey: 59% of respondents stated their program did not have a minimum USMLE Step 1 score, but 39% reported a minimum score of 210 or higher; 95% of programs do not require Step 2 to grant an interview, but 46% require it to place the student on the rank list; 80% require only one EM rotation to grant an interview and none require more than two; 95% of programs will accept two SLOEs for both application and rank list placement.ConclusionFor the typical EM applicant, there is likely little benefit to performing more than two rotations and obtaining more than two SLOEs. Students can defer USMLE Step 2 but must complete it by the time rank lists are due. Our study was limited by the anonymity of the survey, and comments by the respondents revealed the questions did not account for some nuances programs apply to their application review process.