Andrew Grock
University of California, Los Angeles
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Proceedings of the National Academy of Sciences of the United States of America | 2010
Mike C. Wolf; Alexander N. Freiberg; Tinghu Zhang; Zeynep Akyol-Ataman; Andrew Grock; Patrick Hong; Jianrong Li; Natalya F. Watson; Angela Q. Fang; Hector C. Aguilar; Matteo Porotto; Anna N. Honko; Robert Damoiseaux; John P. Miller; Sara E. Woodson; Steven Chantasirivisal; Vanessa Fontanes; Oscar A. Negrete; Paul Krogstad; Asim Dasgupta; Anne Moscona; Lisa E. Hensley; Sean P. J. Whelan; Kym F. Faull; Michael E. Jung; Benhur Lee
We describe an antiviral small molecule, LJ001, effective against numerous enveloped viruses including Influenza A, filoviruses, poxviruses, arenaviruses, bunyaviruses, paramyxoviruses, flaviviruses, and HIV-1. In sharp contrast, the compound had no effect on the infection of nonenveloped viruses. In vitro and in vivo assays showed no overt toxicity. LJ001 specifically intercalated into viral membranes, irreversibly inactivated virions while leaving functionally intact envelope proteins, and inhibited viral entry at a step after virus binding but before virus–cell fusion. LJ001 pretreatment also prevented virus-induced mortality from Ebola and Rift Valley fever viruses. Structure–activity relationship analyses of LJ001, a rhodanine derivative, implicated both the polar and nonpolar ends of LJ001 in its antiviral activity. LJ001 specifically inhibited virus–cell but not cell–cell fusion, and further studies with lipid biosynthesis inhibitors indicated that LJ001 exploits the therapeutic window that exists between static viral membranes and biogenic cellular membranes with reparative capacity. In sum, our data reveal a class of broad-spectrum antivirals effective against enveloped viruses that target the viral lipid membrane and compromises its ability to mediate virus–cell fusion.
Journal of Graduate Medical Education | 2016
Michelle Lin; Nikita Joshi; Andrew Grock; Anand Swaminathan; Eric J. Morley; Jeremy B. Branzetti; Taku Taira; Felix Ankel; Lalena M. Yarris
Background Emergency medicine (EM) residency programs can provide up to 20% of their planned didactic experiences asynchronously through the Individualized Interactive Instruction (III) initiative. Although blogs and podcasts provide potential material for III content, programs often struggle with identifying quality online content. Objective To develop and implement a process to curate quality EM content on blogs and podcasts for resident education and III credit. Methods We developed the Approved Instructional Resources (AIR) Series on the Academic Life in Emergency Medicine website. Monthly, an editorial board identifies, peer reviews, and writes assessment questions for high-quality blog/podcast content. Eight educators rate each post using a standardized scoring instrument. Posts scoring ≥ 30 of 35 points are awarded an AIR badge and featured in the series. Enrolled residents can complete an assessment quiz for III credit. After 12 months of implementation, we report on program feasibility, enrollment rate, web analytics, and resident satisfaction scores. Results As of June 2015, 65 EM residency programs are enrolled in the AIR Series, and 2140 AIR quizzes have been completed. A total of 96% (2064 of 2140) of participants agree or strongly agree that the activity would improve their clinical competency, 98% (2098 of 2140) plan to use the AIR Series for III credit, and 97% (2077 of 2140) plan to use it again in the future. Conclusions The AIR Series is a national asynchronous EM curriculum featuring quality blogs and podcasts. It uses a national expert panel and novel scoring instrument to peer review web-based educational resources.
Teaching and Learning in Medicine | 2018
Stefanie S. Sebok-Syer; Isabelle Colmers-Gray; Jonathan Sherbino; Felix Ankel; N. Seth Trueger; Andrew Grock; Marshall Siemens; Michael Paddock; Eve Purdy; William K. Milne; Teresa M. Chan
ABSTRACT Construct: We investigated the quality of emergency medicine (EM) blogs as educational resources. Purpose: Online medical education resources such as blogs are increasingly used by EM trainees and clinicians. However, quality evaluations of these resources using gestalt are unreliable. We investigated the reliability of two previously derived quality evaluation instruments for blogs. Approach: Sixty English-language EM websites that published clinically oriented blog posts between January 1 and February 24, 2016, were identified. A random number generator selected 10 websites, and the 2 most recent clinically oriented blog posts from each site were evaluated using gestalt, the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) score, and the Medical Education Translational Resources: Impact and Quality (METRIQ-8) score, by a sample of medical students, EM residents, and EM attendings. Each rater evaluated all 20 blog posts with gestalt and 15 of the 20 blog posts with the ALiEM AIR and METRIQ-8 scores. Pearsons correlations were calculated between the average scores for each metric. Single-measure intraclass correlation coefficients (ICCs) evaluated the reliability of each instrument. Results: Our study included 121 medical students, 88 EM residents, and 100 EM attendings who completed ratings. The average gestalt rating of each blog post correlated strongly with the average scores for ALiEM AIR (r = .94) and METRIQ-8 (r = .91). Single-measure ICCs were fair for gestalt (0.37, IQR 0.25–0.56), ALiEM AIR (0.41, IQR 0.29–0.60) and METRIQ-8 (0.40, IQR 0.28–0.59). Conclusion: The average scores of each blog post correlated strongly with gestalt ratings. However, neither ALiEM AIR nor METRIQ-8 showed higher reliability than gestalt. Improved reliability may be possible through rater training and instrument refinement.
Annals of Emergency Medicine | 2018
Guy Carmelli; Andrew Grock; Enid Picart; Jessica Mason
ANNALS CASE How are clinical decision rules (CDRs) applied (and maybe misapplied) in emergency medicine? This question arose after we read the article by Babl et al. Here, they compared clinician gestalt with 3 decision rules for head injury in children. Surprisingly, CDR use would not have increased sensitivity and may have led to increased use of imaging! Aren’t CDRs supposed to aid judgment and reduce unnecessary testing? We had hoped yes, but unfortunately, they sometimes lead us astray. CDRs, otherwise known as prediction rules or prediction models, combine multiple patient historical and examination variables, test results, and other disease characteristics to estimate the probability of either a diagnosis or a prognosis. The term “rule” is a misnomer in that CDRs are not inflexible or absolute, but should function more to supplement clinical judgment. Hence, many providers prefer the term “clinical decision tools.” (To avoid a superfluous acronym, we will stick with CDRs.)
Annals of Emergency Medicine | 2017
Nikita Joshi; Bryan D. Hayes; Jessica Mason; Andrew Grock
ANNALS CASE Medication Route Options Physicians and scientists have developed creative and varied routes of medication administration to patients. Some of the many options include intravenous, intramuscular, intrathecal, intraosseous, per os, subcutaneous, intravaginal, and per rectum routes. The intravenous route is further divided into peripheral and central and use, depending on the clinical situation. For example, line infiltration of specific drugs can lead to necrosis; thus, these drugs should be given only through central access. Another intravenous access, the umbilical line, is available only at certain times, typically only within the first week of life. The latest up-and-comer is the intranasal route, which has increased application in many different clinical scenarios and is potentially underused in many emergency departments (EDs). But does it pass the sniff test? How do we choose the ideal route for each medication and each patient? There are so many factors to consider that we may not even consciously acknowledge the many decision points in choosing a route. Different routes vary in bioavailability and time of onset of drug effect. Some routes are more operator dependent and some take longer to obtain. Some routes cause more discomfort, are more invasive, or can put patients at risk for adverse events. Certain drugs can be administered to target specific body parts and limit systemic absorption and adverse effects, such as the intrathecal route or nebulized medications. In a pinch, the intraosseous route can be lifesaving for many
Cureus | 2018
Lynn P. Roppolo; Chris Gaafary; Jay Khadpe; Kaushal Shah; Andrew Grock
To address the needs for curation of online educational content as well as the development of a nationally available curriculum that meets individualized interactive instruction, the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series and AIR-Pro Series were created in 2014 and 2015, respectively. Using an expert-based, crowd-sourced approach, these two programs identify trustworthy, high-quality, educational blog, and podcast content. Here, we summarize the accredited posts that met our a priori determined quality criteria and evaluated by eight attending physicians.
Cureus | 2018
Alice Min; Eric J. Morley; Salim Rezaie; Sean M Fox; Andrew Grock
The Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) Series and Approved Instruction Resources Professional (AIR-Pro) Series were created in 2014 and 2015, respectively, to address the need for curation of online educational content as well as a nationally available curriculum that meets individualized interactive instruction criteria. These two programs identify high-quality educational blog and podcast content using an expert-based approach. We summarize the accredited posts on respiratory emergencies that met our a priori determined quality criteria per evaluation by eight experienced faculty educators in emergency medicine.
Annals of Emergency Medicine | 2018
Amir Rouhani; Ilene Claudius; Solomon Behar; Jessica Mason; Andrew Grock
It is no surprise that the winter months bring a host of pediatric patients with fever. In fact, 1 in 5 pediatric emergency department (ED) visits is for fever, and most involve little more than parental reassurance and good return precautions. With this volume, you would think that as emergency providers we would be able to simply and confidently risk stratify febrile infants younger than 90 days. Unfortunately, risk stratification continues to be a moving target. In this month’s issue of Annals of Emergency Medicine, the article by Powell et al on the epidemiology of bacteremia in febrile infants sheds some new light on the ever-changing picture of serious bacterial infections in this population.
Annals of Emergency Medicine | 2018
Rais Vohra; Stacy Sawtelle Vohra; Andrew Grock; Jessica Mason
INTRODUCTION: MTX[WTF Although it won’t be the most common “meth” toxicity that youmanage in your emergency department (ED),MTXrelated complaints are common, affecting 16% of patients who receive it for rheumatoid arthritis. Although single acute overdoses of MTX are well tolerated, long-term overdoses, or accidental misadventures because of dosing errors, are frequent. It is these exposures that commonly cause severe toxicity, as illustrated in the case above. MTX seems to fit perfectly the paradox of clinical medicine: every problem has a solution, but every solution comes with its own set of problems. More specifically, the same pharmacologic properties make MTX both very useful and also quite dangerous. It is beneficial in a broad variety of illnesses, and yet it can damage almost any organ in the body when things run afoul. To cloud things a bit more, MTX toxicity in one patient presentation may not at all resemble that in the next, and toxicity with long-term
Annals of Emergency Medicine | 2018
Kai Li; Patil Armenian; Jessica Mason; Andrew Grock
ANNALS CASE Your next patient is a 34-year-old man with a history of intravenous drugusewhowasbrought inby emergencymedical services. In the field, he had a respiratory rate of 5 breaths/min, decreased mental status, and pinpoint pupils, all of which significantly improved with out-of-hospital naloxone. He now has normal mental status and normal vital signs, and admits to intravenous fentanyl (or so he was told) use. After downing 3 hospital tuna salad sandwiches, he requests discharge. Sound familiar? Well, it should. Drug overdose is now the leading cause of injury death in the United States, with frequency tripling from 1999 to 2014. Illicit opioids contribute to the significant increase in opioid-associated deaths. The result: you have probably administered naloxone recently once, twice, or even dozens of times to reverse acute opioid overdoses. But what is the “standard” dose again? And how long do patients need to be observed? For somethingwe do frequently, the lack of evidence-based dosing and observation times is troubling. Lucky for us, the recent publication by Scheuermeyer et al examines the safety of an empiric emergency department (ED) protocol for the management of patients with presumed fentanyl intoxication. After primarily intravenous fentanyl use, the majority of patients were safely discharged after a 2-hour observation period.