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A consensus on Bantu-speaking populations being genetically similar has emerged in the last few years, but the demographic scenarios associated with their dispersal are still a matter of debate. The frontier model proposed by archeologists postulates different degrees of interaction among incoming agropastoralist and resident foraging groups in the presence of “static” and “moving” frontiers. By combining mitochondrial DNA and Y chromosome data collected from several southern African populations, we show that Bantu-speaking populations from regions characterized by a moving frontier developing after a long-term static frontier have larger hunter-gatherer contributions than groups from areas where a static frontier was not followed by further spatial expansion. Differences in the female and male components suggest that the process of assimilation of the long-term resident groups into agropastoralist societies was gender biased. Our results show that the diffusion of Bantu languages and culture in Southern Africa was a process more complex than previously described and suggest that the admixture dynamics between farmers and foragers played an important role in shaping the current patterns of genetic diversity.

We aimed to derive and test abbreviated versions of the Shortened Assessment of Health Literacy-Spanish and English (SAHL-S&E) that accurately identify English- or Spanish-speaking lower health literacy adult emergency department (ED) patients. Recursive partitioning of the SAHL-S&E was used to derive four abbreviated versions of the SAHL-S&E by mode of administration (self-administered or staff-administered) and language (English or Spanish). Test performance characteristics of the four abbreviated versions of the SAHL-S&E in distinguishing persons with lower health literacy from those with higher health literacy were assessed against the original full version of the SAHL-S&E. The test performance characteristics of the self-administered English abbreviated SAHL-S&E were: AUC 0.84 (0.79, 0.89), sensitivity 0.84 (0.76, 0.91), and specificity 0.68 (0.61, 0.75); and for the self-administered Spanish version were: AUC 0.88 (0.85, 0.92), sensitivity 0.88 (0.82, 0.93), and specificity 0.78 (0.73, 0.83). For the staff-administered English version, the performance characteristics were: AUC 0.94 (0.91, 0.96), sensitivity 0.98 (0.95, 1.00), and specificity 0.74 (0.69, 0.80), and for the staff-administered Spanish version were AUC 0.89 (0.85, 0.92), sensitivity 0.89 (0.84, 0.94), and specificity 0.80 (0.75, 0.85). Although the four abbreviated versions of the SAHL-S&E performed well they differed by content, length, language and how they are administered, which could add complexity in their routine administration in emergency medicine practice.

HIV incidence among young adult men-who-have-sex-with-men (YMSM) is among the highest in the United States (US), yet YMSM have lower rates of HIV testing than most other MSM. Among 1,835 U.S. Black, Hispanic, and White YMSM who reported condomless anal intercourse (CAI) in the prior year, 30% (95% confidence interval [CI]: [28%, 32%]) had not been tested for HIV in the past year as recommended by national guidelines, and 19% (95% CI: [17%, 21%]) had never been tested. Factors associated with not being tested in the past year included not having a primary care provider (PCP)) (odds ratio [OR]: 2.00, 95% CI: [1.53, 2.60]), discomfort with asking a PCP for an HIV test (OR: 2.66, 95% CI: [2.05, 3.44]), living in a smaller community (OR: 1.71, 95% CI: [1.35, 2.18]), younger age (OR: 2.00, 95% CI: [1.53, 2.60]), and greater self-perception of having an undiagnosed HIV infection (OR: 1.46, 95% CI: [1.07, 1.99]). YMSM who had not been tested in the prior year were less likely to know where to get tested, yet were interested in trying home-based HIV self-testing. This study shows that knowledge, clinician-relationship, geographic, and perceptional barriers must be overcome to improve HIV testing among YMSM. Home-based HIV self-testing may address some of these barriers, particularly for YMSM living in smaller communities.

Background Falls are the leading cause of fatal and non-fatal injuries among older adults. Older emergency department (ED) patients who present for evaluations after falls have a 30% higher risk of falling again in the subsequent 6 months than age-matched controls. Although EDs frequently evaluate older adults after their falls, the typical evaluation consists of an injury assessment alone. As such, an opportunity is lost to assess and address the potential causes of falls in this vulnerable population. In this manuscript, we present a multidisciplinary fall prevention protocol for a pilot study of older adult ED patients who recently sustained a fall (GAPcare: the Geriatric Acute and Post-acute Fall Prevention Intervention). Methods GAPcare is a randomized single-blinded pilot study. Participants in GAPcare are 120 older adults (≥ 65 years old) who present to 1 of 2 academic US EDs after a fall. We randomly assign participants 1:1 to an intervention or a usual care (control) arm. In the intervention arm, the patient’s ED physician, a pharmacist, and a physical therapist (PT) collaborate to identify and address any risk factors that may have contributed to the fall. Intervention arm participants and their caregivers return home with a medication-related action plan to taper or stop potentially inappropriate medications and to address polypharmacy and a PT assessment and plan. Participants in the usual care arm receive standard assessments and care in the ED and a home safety brochure. Participants in both study arms complete fall calendars for 6 months to document the number of falls and healthcare visits during follow-up. The primary outcome is feasibility of the GAPcare fall prevention intervention (number and proportion of screened participants who are eligible, recruited, and retained; impact on ED length of stay), while the secondary outcome is to estimate its initial efficacy. Discussion The GAPcare-ED fall prevention intervention has the potential to promote older adult-sensitive care for millions of Americans presenting to EDs after falls and establish a protocol for a future large-scale randomized controlled trial on this topic. Trial registration ClinicalTrials.gov, NCT03360305 . Trial registration date: December 4, 2017. Protocol version: 1

The need for HIV testing in US emergency departments (EDs) has not been assessed, particularly among Latino immigrants and Blacks. We surveyed Latino immigrant and Black 18 to 64-year-old patients at 4 EDs about demographic characteristics, HIV testing history, and health literacy. A subset of patients was further surveyed on HIV risk-taking behaviors. Of the 2,265 participants, 24% had never been tested for HIV. Latino immigrants were more likely than Blacks never to have been tested for HIV (28% vs. 16%). In multivariable logistic regression, for Latino immigrants, male gender and lower health literacy were associated with no previous HIV testing. Among the 1,141-participant subset providing HIV risk-taking behavior data, 23% reported at least one risk factor and of those with at least one risk factor, 23% had never been tested for HIV. There remains a need for HIV testing among adult Latino immigrant and Black patients in US EDs.

Medicaid managed care organization (MCO) care coordinators play a crucial role in assisting high-need Medicaid members with substance use disorder (SUD) and facilitating their connections with medical and social services. This study assessed challenges faced by care coordinators serving patients with SUD, including the types and frequencies of barriers, associated care coordinator and patient factors, and their relationship with burnout and job satisfaction. Web-based survey data from 322 Virginia Medicaid MCO care coordinators. Coordinators rated 15 barriers related to providing services to patients with SUD. Principal components analysis (PCA) identified 3 subscales categorizing these challenges (challenges accessing resources, administrative and regulatory burden, and data integration). Multivariable linear regression explored associations between coordinator and patient factors and subscales for categories of barriers. Pearson correlations were used to examine the relationship between these barriers and job satisfaction. Coordinators reported a high frequency of challenges in many care coordinating activities: Between 49% and 82% reported each barrier as \"somewhat\" of a problem or a \"major\" problem. Using PCA, 3 main categories of barriers were identified. Having a high proportion of patients with SUD was associated with greater difficulties in accessing resources (P < .01) and data integration issues (P < .05), and working for specific MCOs was associated with all 3 categories of barriers (P < .05). Job satisfaction and burnout were correlated with all 3 categories as well and were most strongly associated with administrative and regulatory burden. Care coordinators face multiple challenges serving Medicaid members, particularly those with SUD. State-level Medicaid policies supporting care coordinators may help.

Among HIV-uninfected, social media–using black, Hispanic, and white young men who have sex with men (YMSM) who had condomless anal sex but had not been HIV tested within the past year, we aimed to determine the extent of discordance between perception of having an undiagnosed HIV infection and HIV risk-taking behaviors. Despite reporting condomless anal sex without HIV testing, 64% of 358 YMSM participants perceived having an undiagnosed HIV infection as “unlikely” and 12% as “impossible.” Having a primary care provider and being Hispanic were associated with greater discordance. Interventions to decrease the discordance between perceived and actual HIV risk are needed for this higher HIV risk population.

The Montpellier protocol for intubating patients in the intensive care unit (ICU) is associated with a decrease in intubation-related complications. We sought to determine if implementation of a simplified version of the Montpellier protocol that removed selected components and allowed for a variety of pre-oxygenation modalities increased first-pass intubation success and reduced intubation-related complications. A prospective pre/post-comparison of a modified Montpellier protocol in two medical and one medical/surgical/cardiac ICU within a hospital system. The modified eight-point protocol included: fluid administration, ordering sedation, two intubation trained providers, pre-oxygenation with non-invasive positive pressure ventilation, nasal high flow cannula or non-rebreather mask, rapid sequence intubation, capnography, sedation administration, and vasopressors for shock. Patient characteristics and indications for intubation were similar for the 275 intubations in the control (137) and intervention (138) periods. In the intervention vs. control periods, the modified Montpellier protocol was associated with a significant 16.2% [95% CI: 5.1–30.0%] increase in first-pass intubation success and a 12.6% [95% CI: 1.2–23.6%] reduction in all intubation-related complications. A simplified version of the Montpellier intubation protocol for intubating ICU patients was associated with an improvement in first-pass intubation success rates and a reduction in the rate of intubation-related complications. •Our modified Montpellier Protocol is readily adapted and easily adhered to in the ICU setting.•Our modified Montpellier protocol was associated with a 16.2% [95% CI: 5.1-30.0%] increase in first-pass intubation success.•Additionally, it was associated with a 12.6% [95% CI: 1.2-23.6%] reduction in all intubation-related complications.

Introduction Emergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear. Aim In this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP. Methods From September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP ≥ 120/80 mmHg and no history of HTN into this prospective cohort observational study. After their ED visit, participants obtained BP measurements for two weeks using a validated HBPM. HTN was considered probable if the average HBPM BP was ≥ 135/85 mmHg. We calculated the proportion of participants whose ED BP measurement accurately predicted HTN using HBPM after discharge. Results Of 136 participants enrolled, 93 (68%) returned the HBPM with at least four home BP measurements [mean number of measurements obtained: 29 (SD: 17, range 4–59)]. Participants’ median age was 40 years-old (IQR 34–48); 55% were female, 19% were black, and 58% were white. Forty-six percent of participants with elevated in-ED BP had HTN in follow-up. Conclusions For patients with elevated BP in the ED, HBPM could be valuable for determining which patients have HTN and require expedient follow-up.

To describe a) the length of nursing home (NH) to emergency department (ED) transfer correspondences and b) determine the relationship between NH-ED transfer correspondence length and ED length of stay (LOS). This is a secondary analysis of a retrospective cohort study that examined the health records of NH patients who visited one of three Rhode Island EDs included in the study. We used descriptive statistics to examine correspondence length and ED LOS and median quantile regression to evaluate the association between correspondence length and ED LOS. Of the 456 ED visits, the median correspondence length was 12 pages (25th, 75th percentile: 8.5, 17 pages). For every one-page increase in correspondence length, the median ED LOS was not significantly changed (Coefficient: 0.82 minutes, 95% CI: -0.56, 2.19). While correspondence length was not associated with ED LOS, this study suggests that stakeholders should work to decrease documentation burden.