Christopher Bennett

All Publications

• HIV Screening in a Sample of US Emergency Departments, 2022-2023. Public health reports (Washington, D.C. : 1974) Bennett, C. L., Clay, C. E., Espinola, J. A., Camargo, C. A. 2024: 333549241288374

  Abstract

  Despite serving populations emphasized in the Ending the HIV Epidemic Initiative, emergency departments (EDs) infrequently offer routine HIV screening. The objective of this study was to characterize US EDs by whether they screen for HIV and to explore factors associated with screening. We surveyed a random sample of US ED directors to obtain data on ED-level and patient-level characteristics, as well as information on directors' perceived barriers to implementing preventive health services. Using descriptive statistics and regression modeling, we found that EDs that routinely screen for HIV, compared with those that do not, had higher median visit volumes (21 000 vs 12 600), were more often a teaching hospital (12.7% vs 4.3%), and had more availability of social workers (23.6% vs 9.4% had 24 hour/day coverage); their directors also less often expressed strong worry about costs (5.9% vs 28.2%), all significant at P < .05; in the regression analysis, only worry about costs was significant (relative risk = 0.13; 95% CI, 0.03-0.51). Our findings may reflect a need for additional funding and resources allocated to EDs to promote HIV screening.

  View details for DOI 10.1177/00333549241288374

  View details for PubMedID 39508374

• Preventive Health Services Offered in a Sampling of US Emergency Departments, 2022-2023. The western journal of emergency medicine Bennett, C. L., Kit Delgado, M., Pasao, M., Espinola, J. A., Boggs, K. M., Camargo, C. A. 2024; 25 (5): 823-827

  Abstract

  In the United States, more chronic and preventive healthcare is being delivered in the emergency department (ED) setting. Understanding the availability of preventive health services in the ED setting is crucial. Our goal was to understand the availability of a subset of preventive health services in US EDs and explore how that has changed over time.In 2022-2023, using the National Emergency Department Inventory (NEDI)-USA, we surveyed a random 20% (1,064) sampling of all 5,613 US EDs. We asked directors of these EDs about the availability of and preference for 12 preventive health services, social worker availability, self-reported percentage of uninsured ED patients, and measures of ED crowding. We also asked about perceptions of barriers to implementing preventive health services in the ED. We used unadjusted and multivariable logistic regression models to compare service frequency in 2022-2023 to prior findings from 2008-2009 that represented a 5.7% random sampling of all EDs.Among 302 responders to the 2022-2023 survey (5.4% random sampling, 28.4% response rate), 94% reported offering at least one preventive health service, with a median of five services. The most common service offered was intimate partner violence screening (83%), while the least common was routine HIV screening (19%). Seven services (eg, intimate partner violence, alcohol risk, and smoking cessation screening) had a higher odds of being offered in 2022-2023 than in 2008-2009; findings were unchanged in sensitivity analyses. A small proportion of directors opposed offering preventive health services. However, many expressed concerns that preventive health services in the ED would lead to longer lengths of stay (56%), increased costs to their ED (58%), a diversion of staff time from providing acute care (50%), or that their patients would not have access to adequate follow-up (49%).Nearly all EDs offer at least one preventive health service. Many offer multiple services; rates were higher than those identified in 2008-2009, in both unadjusted and multivariable models. Although limited by the response rate, this work provides the most recent and comprehensive snapshot of the type and frequency of a subset of preventive health services currently offered in US EDs.

  View details for DOI 10.5811/westjem.18488

  View details for PubMedID 39319815

• Association Between Social Vulnerability and US HIV Priority Jurisdictions. Journal of acquired immune deficiency syndromes (1999) Bennett, C. L., Saxena, M., Boothroyd, D., Mahmoud-Werthmann, S., Lin, M. P. 2024; 96 (2): e4-e6

  View details for DOI 10.1097/QAI.0000000000003415

  View details for PubMedID 38771755

• Hepatitis screening in a sampling of US emergency departments, 2022-2023. Sexually transmitted infections Bennett, C. L., Clay, C., Delgado, M. K., Espinola, J. A., Camargo, C. A. 2024

  View details for DOI 10.1136/sextrans-2024-056197

  View details for PubMedID 38782580

• Estimating the size and scope of the academic emergency physician workforce. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Gettel, C. J., Camargo, C. A., Bennett, C. L., Courtney, D. M., Kaji, A. H., Fermann, G. J., Gallahue, F. E., Nelson, L. S., Hebbard, C. F., Rothenberg, C., Raja, A. S., Venkatesh, A. K. 2024

  Abstract

  Academic emergency medicine (EM) is foundational to the EM specialty through the development of new knowledge and clinical training of resident physicians. Despite recent increased attention to the future of the EM workforce, no evaluations have specifically characterized the U.S. academic EM workforce. We sought to estimate the national proportion of emergency physicians (EPs) identified as academic and the proportion of emergency department (ED) visits that take place at academic sites.We performed a cross-sectional analysis of EPs and EDs using data from the American Hospital Association, the Centers for Medicare & Medicaid Services, and Doximity's Residency Navigator. EPs were identified as "academic" if they were affiliated with at least one facility determined to be academic, defined as EDs officially designated by the Accreditation Council for Graduate Medical Education (ACGME) as clinical training sites at accredited EM residency programs. Our primary outcomes were to estimate the national proportion of EPs identified as academic and the proportion of ED visits performed at academic sites.Our analytic sample included 26,937 EPs practicing clinically across 4920 EDs and providing care during 130,471,386 ED visits. Among EPs, 11,720 (43.5%) were identified as academic, and among EDs, 635 (12.9%) were identified as academic sites, including 585 adult/general sites, 45 pediatric-specific sites, and 10 sites affiliated with the Department of Veterans Affairs. In 2021, academic EDs provided care for 42,794,106 ED visits or 32.8% of all ED visits nationally.Approximately four in 10 EPs practice in at least one clinical training site affiliated with an ACGME-accredited EM residency program, and approximately one in three ED visits nationally occur in these academic EDs. We encourage further work using alternative definitions of an academic EPs and EDs, along with longitudinal research to identify trends in the workforce's composition.

  View details for DOI 10.1111/acem.14931

  View details for PubMedID 38769602

• HIV testing at visits to US emergency departments: 2021 update. Sexually transmitted infections Clay, C., Kuglen, B. C., Bennett, C. L. 2024

  Abstract

  In this updated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey, we found that among the 2.5 million more weighted emergency department (ED) visits in 2021 compared with 2020, there was an insignificant increase in HIV testing per ED visit in 2021 compared with 2020 (0.81% to 0.86%). This suggests HIV testing during ED visits did not increase in line with rebounding visit volumes after the pandemic nadir.

  View details for DOI 10.1136/sextrans-2024-056128

  View details for PubMedID 38531613

• Challenges surrounding the emergency physician workforce and their impact on the Emergency Medicine Match. Clinical and experimental emergency medicine Bennett, C. L., Lin, M., Camargo, C. A. 2023

  View details for DOI 10.15441/ceem.23.118

  View details for PubMedID 38012818

• Comparison of US emergency departments by HIV priority jurisdiction designation: A case for geographically targeted screening in teaching hospitals. PloS one Bennett, C. L., Detsky, A. S., Clay, C. E., Espinola, J. A., Parsonnet, J., Camargo, C. A. 2023; 18 (10): e0292869

  Abstract

  The Ending the HIV Epidemic (EHE) Initiative targets a subset of United States (US) priority jurisdictions hardest hit by HIV. It remains unclear which emergency departments (EDs) are the most appropriate targets for EHE-related efforts. To explore this, we used the 2001-2019 National Emergency Department Inventories (NEDI)-USA as a framework to characterize all US EDs, focusing on those in priority jurisdictions and those affiliated with a teaching hospital. We then incorporate multivariable regression to explore the association between ED characteristics and location in an HIV priority jurisdiction. Further, to provide context on the communities these EDs serve, demographic and socioeconomic information and sexually transmitted infection case rate data were included. This reflected 2019 US Census Bureau data on age, race, ethnicity, and proportion uninsured and living in poverty along with 2001-2019 Centers for Disease Control and Prevention case rate data on chlamydia, gonorrhea, and syphilis. We found that EDs in priority jurisdictions (compared to EDs not in priority jurisdictions) more often served populations emphasized in HIV-related efforts (i.e., Black or African American or Hispanic or Latino populations), communities with higher proportions uninsured and living in poverty, and counties with higher rates of chlamydia, gonorrhea, and syphilis. Further, of the groups studied, EDs with teaching hospital affiliations had the highest visit volumes and had steady visit volume growth. In regression, ED annual visit volume was associated with an increased odds of an ED being located in a priority jurisdiction. Our results suggest that geographically targeted screening for HIV in a subset of US priority jurisdiction EDs with a teaching hospital affiliation could be an efficient means to reach vulnerable populations and reduce the burden of undiagnosed HIV in the US.

  View details for DOI 10.1371/journal.pone.0292869

  View details for PubMedID 37851641

• Estimates of HIV testing at Visits to U.S. emergency departments, 2014-2020. AIDS (London, England) Clay, C. E., Hoover, K. W., Le Guen, Y., Bennett, C. L. 2023

  Abstract

  Emergency department (ED)-based HIV testing rates are historically low, but recent testing trends surrounding the COVID-19 pandemic and launch of the Ending the HIV Epidemic (EHE) initiative are unknown. The objective of the study is to estimate recent trends in the proportion of ED visits that included HIV testing.We performed a cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted nationally representative survey of US EDs, from 2014 to 2020. Given EHE's focus on several rural Southern jurisdictions as well as populations disproportionately affected by HIV, we stratified by characteristics including US region and visit-listed race and ethnicity.The proportion of ED visits that included HIV testing increased from 2014 (0.6%) to 2018 (1.1%) but was lower in 2019 and 2020 (0.8%). Compared to other regions the South had the lowest rates of testing in both 2019 (0.6%) and 2020 (0.5%); testing rates in the non-metropolitan South remained ≤0.1% across all years. Testing rates for ED visits by persons who identified as Hispanic/Latino were highest in 2018 (2.2%) but were sharply lower in 2019 and 2020 (0.8%).After a small but insufficient increase in ED-based HIV testing since 2014, rates decreased between 2018 and 2019 and were stable between 2019 and 2020. Overall, very few ED visits during our entire study period included an HIV test and there were persistently low rates of HIV testing for populations prioritized in national efforts and during visits in rural jurisdictions in the South.

  View details for DOI 10.1097/QAD.0000000000003750

  View details for PubMedID 37830905

• Unfilled in emergency medicine: An analysis of the 2022 and 2023 Match by program accreditation, ownership, and geography. AEM education and training Gettel, C. J., Bennett, C. L., Rothenberg, C., Smith, J. L., Goldflam, K., Sun, W. W., Venkatesh, A. K. 2023; 7 (4): e10902

  Abstract

  The two most recent National Resident Matching Program (NRMP) Match cycles saw a high number of initially unfilled emergency medicine (EM) residency positions. We sought to identify the risk of EM residency program characteristics including accreditation duration, primary clinical site ownership status, and geography pertaining to not initially filling all positions.We performed a repeated cross-sectional observational study of EM residency programs participating in the 2022 and 2023 NRMP Match cycles and used publicly available data from the NRMP, the Accreditation Council for Graduate Medical Education, the Centers for Medicare & Medicaid Services, and the U.S. Department of Housing and Urban Development. Our primary outcome was the proportion of EM residency programs that did not initially fill positions, with analyses stratified by accreditation duration (>5 or ≤5 years), primary clinical site ownership status, and geographic core-based statistical areas (CBSAs).A total of 219 of 2921 (7.5%) positions in the 2022 Match and 554 of 3010 (18.4%) positions in the 2023 Match were initially unfilled. Over the 2-year period, EM residency programs accredited within the past 5 years had more than double the risk (relative risk [RR] 2.08, 95% confidence interval [CI] 1.69-2.57, chi-square p < 0.001) of not filling all positions compared to those accredited more than 5 years previously. EM residency programs with a primary clinical site under for-profit ownership had a 50% greater risk of not filling all positions when compared to those under nonprofit or governmental ownership (RR 1.50, 95% CI 1.14-1.98, chi-square p = 0.009). In 2023, several CBSAs had a high number of both offered and unfilled positions.EM residency programs accredited within the past 5 years or those with a primary clinical site under for-profit ownership had a greater risk of not filling all positions within the past two Match cycles.

  View details for DOI 10.1002/aet2.10902

  View details for PubMedID 37600854

  View details for PubMedCentralID PMC10436034

• Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic. Annals of emergency medicine Gettel, C. J., Courtney, D. M., Bennett, C. L., Keim, S. M., Camargo, C. A., Venkatesh, A. K. 2023

  View details for DOI 10.1016/j.annemergmed.2023.03.002

  View details for PubMedID 37140492

  View details for PubMedCentralID PMC10153599

• Membership in the Council of Teaching Hospitals and Health Systems Among Emergency Medicine Residency Program-Sponsoring Institutions, 2001-2020. JAMA network open Bennett, C. L., Boggs, K. M., Gettel, C. J., Sun, W. W., Venkatesh, A. K., Camargo, C. A. 2023; 6 (5): e2312457

  View details for DOI 10.1001/jamanetworkopen.2023.12457

  View details for PubMedID 37159203

• Trends of Academic Faculty Identifying as Hispanic at US Medical Schools, 1990-2021. Journal of graduate medical education Saxena, M. R., Ling, A. Y., Carrillo, E., Alvarez, A., Yiadom, M. Y., Bennett, C. L., Gallegos, M. 2023; 15 (2): 175-179

  Abstract

  Background: According to recent census data, Hispanic and Latino populations comprise the largest minority group in the United States. Despite ongoing efforts for improved diversity, equity, and inclusion, Hispanics remain underrepresented in medicine (UIM). In addition to well-established benefits to patient care and health systems, physician diversity and increased representation in academic faculty positively impact the recruitment of trainees from UIM backgrounds. Disproportionate representation (as compared to increases of certain underrepresented groups in the US population) has direct implications for recruitment of UIM trainees to residency programs.Objective: To examine the number of full-time US medical school faculty physicians who self-identify as Hispanic in light of the increasing Hispanic population in the United States.Methods: We analyzed data from the Association of American Medical Colleges from 1990 to 2021, looking at those academic faculty who were classified as Hispanic, Latino, of Spanish Origin, or of Multiple Race-Hispanic. We used descriptive statistics and visualizations to illustrate the level of representation of Hispanic faculty by sex, rank, and clinical specialty over time.Results: Overall, the proportion of faculty studied who identified as Hispanic increased from 3.1% (1990) to 6.01% (2021). Moreover, while the proportion of female Hispanic academic faculty increased, there remains a lag between females versus males.Conclusions: Our analysis shows that the number of full-time US medical school faculty who self-identify as Hispanic has not increased, though the population of Hispanics in the United States has increased.

  View details for DOI 10.4300/JGME-D-22-00384.1

  View details for PubMedID 37139207

• Characteristics of California Emergency Departments in Centers for Disease Control and Prevention-Designated HIV Priority Counties. The Journal of emergency medicine Bennett, C. L., Clay, C. E., Siddiqi, K. A., Olatosi, B. A., Parsonnet, J., Camargo, J. C. 2023

  Abstract

  Refocused national HIV testing initiatives include a geographic focus.Using a geographic focus, we sought to identify which emergency departments (EDs) might be the most efficient targets for future HIV testing efforts, using California as an example.Retrospective analysis of California EDs, emergency physicians, and patients served, along with county-level estimates of HIV prevalence and proportion of the population living in poverty. Emphasis was placed on characterizing EDs affiliated with teaching hospitals and those located in Centers for Disease Control (CDC) and Prevention HIV priority counties.Of the 320 EDs studied, 178 were in priority counties, 29 were affiliated with teaching hospitals, and 24 had both characteristics. Of the 12,869,889 ED visits included, 61.8% occurred in priority counties, 14.7% in EDs affiliated with teaching hospitals, and 12.0% in EDs with both characteristics. The subset of EDs in priority counties with teaching hospital affiliations (compared with priority and nonpriority county ED groups without a teaching hospital affiliation) had higher overall median visit volumes and higher proportions of visits by at-risk and CDC-targeted populations (e.g., individuals who were homeless, those who identified as Black or African American race, and those who identified as Hispanic or Latino ethnicity, all p < 0.01).EDs in priority counties affiliated with teaching hospitals are major sources of health care in California. These EDs more often serve populations disproportionately impacted by HIV. These departments are efficient targets to direct testing efforts. Increasing testing in these EDs could reduce the burden of undiagnosed HIV in California.

  View details for DOI 10.1016/j.jemermed.2022.10.020

  View details for PubMedID 36650074

• Attrition From Emergency Medicine Clinical Practice in the United States, 2020. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Bennett, C. L., Espinola, J. A., Ginde, A. A., Camargo, C. A. 2022

  View details for DOI 10.1111/acem.14640

  View details for PubMedID 36482871

• Trends in female first-author abstracts at the Society for Academic Emergency Medicine Annual Meeting, 1990-2020. The American journal of emergency medicine Cash, R. E., Bennett, C. L., Boggs, K. M., Samuels-Kalow, M. E., Saxena, M., Pasao, M., Raja, A. S., Camargo, C. A. 2022; 63: 22-28

  Abstract

  To describe first author gender differences and characteristics in 1) Society for Academic Emergency Medicine (SAEM) Annual Meeting abstracts and 2) resulting manuscript publications.We performed cross-sectional evaluation of SAEM abstracts from 1990, 1995, 2000, 2005, 2010, 2015, and 2020, compiling and reviewing a random sample of 100 abstracts for each year (total n = 700 abstracts). We documented abstract characteristics, including first author gender, and used the 2020 SAEM scoring rubric. We then searched PubMed to identify manuscript publications resulting from abstracts from 1990 to 2015 (n = 600). Finally, among abstracts that resulted in manuscript publication, we identified first and last author gender on both the abstracts and the resulting publication.Overall, 29% (202/695; n = 5 missing gender) of abstracts had female first authors. Female first authors increased over time (e.g., 17% in 1990 to 35% in 2020). Abstract quality scores were similar (both median [interquartile range] of 11 ([9-12]). Overall, 42% (n = 254/600) of abstracts resulted in a manuscript publication, 39% (n = 65/202) with female and 44% (n = 189/493) with male first authors (p = 0.26). The median time (IQR) from abstract to manuscript publication was longer for abstracts with female first authors vs. those with male first authors (2 [1-3] years and 1 [1, 2] years, p < 0.02); 77% and 78% of publications resulting from abstracts with female and male first authors, respectively, had the same first author. Female first author abstracts more often converted to a male first author manuscript publication (18%, n = 12/65) compared to male first author abstracts converting to female first author publications (7%, n = 14/189).A minority of SAEM abstracts, and manuscript publications resulting from them, had female first authors. Abstracts with female first authors took longer to achieve manuscript publication, and almost a fifth of female first author abstracts resulted in male first author manuscript publication.

  View details for DOI 10.1016/j.ajem.2022.10.028

  View details for PubMedID 36306648

• Three decades of demographic trends among academic emergency physicians. Journal of the American College of Emergency Physicians open Cleveland Manchanda, E. C., Ling, A. Y., Bottcher, J. L., Marsh, R. H., Brown, D. F., Bennett, C. L., Yiadom, M. Y. 2022; 3 (4): e12781

  Abstract

  Purpose: To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time.Methods: Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups.Results: The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n=3, 1.40% in 1990 to n=326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N=9, 4.21% in 1990 and N=266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00).Conclusions: Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.

  View details for DOI 10.1002/emp2.12781

  View details for PubMedID 35982985

• Journal update monthly top five. Emergency medicine journal : EMJ Saxena, M., Altamirano, J., Rose, C., Bennett, C., Govindarajan, P., Lumba-Brown, A., Hirst, R. 2022; 39 (7): 561-562

  View details for DOI 10.1136/emermed-2022-212603

  View details for PubMedID 35732304

• How we compare: Society for Academic Emergency Medicine faculty membership demographics AEM EDUCATION AND TRAINING Bennett, C. L., Ling, A. Y., Agrawal, P., Pierce, A., Pasao, M. A., Ray, D., Manchanda, E. 2022; 6: S93-S96

  View details for DOI 10.1002/aet2.10747

  View details for Web of Science ID 000814785300001

• United States 2020 Emergency Medicine Resident Workforce Analysis. Annals of emergency medicine Bennett, C. L., Clay, C. E., Espinola, J. A., Krzyzaniak, S. M., Egan, D. J., Camargo, C. A. 2022

  Abstract

  STUDY OBJECTIVE: To characterize the emergency medicine resident physician workforce and the residency programs training them.METHODS: We identified emergency medicine residents in the 2020 American Medical Association (AMA) Physician Masterfile, analyzed demographic information, mapped both county-level population-adjusted and hospital referral region densities, and compared 2020 versus 2008 resident physician densities. We also analyzed all Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency programs from 2013 to 2020, mapped state-level population-adjusted densities, and identified temporal trends in program location and state-level program densities. All population-adjusted densities were calculated using the US Census Bureau resident population estimates.RESULTS: There were 6,993 emergency medicine residents in the 2020 AMA dataset with complete information. Most of them (98%) were in urban areas. Compared with 2008, per 100,000 US population, this represents disproportionate increases in urban areas (total [0.5], urban [0.5], large rural [0.2] and small rural [0.05]). We further identified 160 (2013) to 265 (2020) residency programs using the ACGME data. The new programs were 3-year training programs that were disproportionately added to states with an already higher number of programs (Florida [5 to 19], Michigan [11 to 25], New York [21 to 31], Ohio [9 to 18], Pennsylvania [12 to 21], California [14 to 22]).CONCLUSION: The number of emergency medicine residency programs has increased; most new programs were added to the states that already had emergency medicine residency programs. There is an emergency physician "desert" in the rural United States, lacking both residents and residency training programs. This analysis provides essential context to the ongoing conversation about the future of the emergency physician workforce.

  View details for DOI 10.1016/j.annemergmed.2022.03.007

  View details for PubMedID 35570180

• External validation of the 4C Mortality Score for hospitalised patients with COVID-19 in the RECOVER network. BMJ open Gordon, A. J., Govindarajan, P., Bennett, C. L., Matheson, L., Kohn, M. A., Camargo, C., Kline, J. 2022; 12 (4): e054700

  Abstract

  Estimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated the discrimination and calibration of the 4C Score. This was a retrospective cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of suspected COVID-19 in EmeRgency care) network.99 emergency departments (EDs) across the USA.Patients ≥18 years old, positive for SARS-CoV-2 in the ED, and hospitalised.Death within 30 days of the index visit. We performed logistic regression analysis, reporting multivariable risk ratios (MVRRs) and calculated the area under the ROC curve (AUROC) and mean prediction error for the original 4C Score and after dropping the C reactive protein (CRP) component.Of 6802 hospitalised patients with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). Score-specific mortalities in our sample were lower than in the 4C validation sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score did not substantially affect discrimination and 4C risk estimates were now close (mean prediction error 0.7%).We independently validated 4C Score as predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We recommend dropping the CRP component of the score and using our recalibrated mortality risk estimates.

  View details for DOI 10.1136/bmjopen-2021-054700

  View details for PubMedID 35450898

• HIV Testing at Visits to United States Emergency Departments, 2018. Journal of acquired immune deficiency syndromes (1999) Clay, C. E., Ling, A., Bennett, C. L. 2022

  Abstract

  BACKGROUND: Early HIV diagnosis improves patient outcomes, reduces the burden of undiagnosed HIV, and limits transmission. There is a need for an updated assessment of HIV testing rates in the Emergency Department (ED).SETTING: National Hospital Ambulatory Medical Care Survey (NHAMCS) sampling ED visits, weighted to give an estimate of ED visits across all US states in 2018.METHODS: We analyzed patients aged 13-64 years without known HIV and estimated ED visits with HIV testing, and then stratified by race, ethnicity, and region. Descriptive statistics and mapping were used to illustrate and compare patient, visit, and hospital characteristics for visits with HIV testing.RESULTS: Out of 83.0 million weighted visits to EDs in 2018 by patients aged 13-64 without a known HIV infection (based on 13,237 NHAMCS sample visits), HIV testing was performed in 1.05% of visits. HIV testing was more frequent for patients aged 13-34 compared to patients aged 35-64 (1.32% vs. 0.82%, p=0.056), Black patients compared to White and Other patients (1.73% vs. 0.79% and 0.41%, p=0.002), Hispanic or Latino patients compared to non-Hispanic or Latino patients (2.18% vs. 0.84%, p=0.001), and patients insured by Medicaid compared to private or other insurance (1.71% vs. 0.64% and 0.96%, p=0.003). HIV testing rates were highest in the Northeast (1.72%), followed by the South (1.05%).CONCLUSION: HIV testing occurred in a minority of ED visits. There are differences in rates of HIV testing by race, ethnicity, and location. Although rates of testing have increased, rates of ED-based HIV testing remain low.

  View details for DOI 10.1097/QAI.0000000000002945

  View details for PubMedID 35234735

• Evaluation of Three Commercial and Two Non-Commercial Immunoassays for the Detection of Prior Infection to SARS-CoV-2. The journal of applied laboratory medicine Nilles, E. J., Karlson, E. W., Norman, M., Gilboa, T., Fischinger, S., Atyeo, C., Zhou, G., Bennett, C. L., Tolan, N. V., Oganezova, K., Walt, D. R., Alter, G., Simmons, D. P., Schur, P., Jarolim, P., Woolley, A. E., Baden, L. R. 2021; 6 (6): 1561-1570

  Abstract

  Serological testing provides a record of prior infection with SARS-CoV-2, but assay performance requires independent assessment.We evaluated 3 commercial (Roche Diagnostics pan-IG, and Epitope Diagnostics IgM and IgG) and 2 non-commercial (Simoa and Ragon/MGH IgG) immunoassays against 1083 unique samples that included 251 PCR-positive and 832 prepandemic samples.The Roche assay registered the highest specificity 99.6% (3/832 false positives), the Ragon/MGH assay 99.5% (4/832), the primary Simoa assay model 99.0% (8/832), and the Epitope IgG and IgM 99.0% (8/830) and 99.5% (4/830), respectively. Overall sensitivities for the Simoa, Roche pan-IG, Epitope IgG, Ragon/MGH IgG, and Epitope IgM were 92.0%, 82.9%, 82.5%, 64.5% and 47.0%, respectively. The Simoa immunoassay demonstrated the highest sensitivity among samples stratified by days postsymptom onset (PSO), <8 days PSO (57.69%) 8-14 days PSO (93.51%), 15-21 days PSO (100%), and > 21 days PSO (95.18%).All assays demonstrated high to very high specificities while sensitivities were variable across assays.

  View details for DOI 10.1093/jalm/jfab072

  View details for PubMedID 34196711

  View details for PubMedCentralID PMC8420636

• Multi-Center Study of Outcomes Among Persons with HIV who Presented to US Emergency Departments with suspected SARS-CoV-2. Journal of acquired immune deficiency syndromes (1999) Bennett, C. L., Ogele, E., Pettit, N. R., Bischof, J. J., Meng, T., Govindarajan, P., Camargo, C. A., Nordenholz, K., Kline, J. A., RECOVER Investigators 2021

  Abstract

  BACKGROUND: There is a need to characterize patients with HIV with suspected severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2).SETTING: Multicenter registry of patients from 116 emergency departments in 27 US states.METHODS: Planned secondary analysis of patients with suspected SARS-CoV-2, with (n=415) and without (n=25,306) HIV. Descriptive statistics were used to compare patient information and clinical characteristics by SARS-CoV-2 and HIV status. Unadjusted and multivariable models were used to explore factors associated with death, intubation, and hospital length of stay. Kaplan-Meier curves were used to estimate survival by SARS-CoV-2 and HIV infection status.RESULTS: Patients with both SARS-CoV-2 and HIV and patients with SARS-CoV-2 but without HIV had similar admission rates (62.7% versus 58.6%, p=0.24), hospitalization characteristics (e.g. rates of admission to the intensive care unit from the ED [5.0% versus 6.3%, p=0.45] and intubation [10% versus 13.3%, p=0.17]), and rates of death (13.9% versus 15.1%, p=0.65). They also had a similar cumulative risk of death (log-rank p=0.72). However, patients with both HIV and SARS-CoV-2 infections compared to patients with HIV but without SAR-CoV-2 had worsened outcomes, including increased mortality (13.9% versus 5.1%, p<0.01, log rank p<0.0001) and their deaths occurred sooner (median 11.5 days versus 34 days, p<0.01).CONCLUSION: Among ED patients with HIV, clinical outcomes associated with SARS-CoV-2 infection are not worse when compared to patients without HIV, but SARS-CoV-2 infection increased risk of death in patients with HIV.

  View details for DOI 10.1097/QAI.0000000000002795

  View details for PubMedID 34483295

• Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US. JAMA network open Bennett, C. L., Espinola, J. A., Sullivan, A. F., Boggs, K. M., Clay, C. E., Lee, M. O., Samuels-Kalow, M. E., Camargo, C. A. 2021; 4 (5): e2110084

  Abstract

  Importance: Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however.Objective: To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US.Design, Setting, and Participants: This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020.Main Outcomes and Measures: The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates.Results: A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P=.006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population.Conclusions and Relevance: This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.

  View details for DOI 10.1001/jamanetworkopen.2021.10084

  View details for PubMedID 34003272

• Clinical prediction rule for SARS-CoV-2 infection from 116 U.S. emergency departments 2-22-2021. PloS one Kline, J. A., Camargo, C. A., Courtney, D. M., Kabrhel, C., Nordenholz, K. E., Aufderheide, T., Baugh, J. J., Beiser, D. G., Bennett, C. L., Bledsoe, J., Castillo, E., Chisolm-Straker, M., Goldberg, E. M., House, H., House, S., Jang, T., Lim, S. C., Madsen, T. E., McCarthy, D. M., Meltzer, A., Moore, S., Newgard, C., Pagenhardt, J., Pettit, K. L., Pulia, M. S., Puskarich, M. A., Southerland, L. T., Sparks, S., Turner-Lawrence, D., Vrablik, M., Wang, A., Weekes, A. J., Westafer, L., Wilburn, J. 2021; 16 (3): e0248438

  Abstract

  OBJECTIVES: Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care.METHODS: Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables.RESULTS: Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79-0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8-96.3%), specificity of 20.0% (19.0-21.0%), negative likelihood ratio of 0.22 (0.19-0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points).CONCLUSION: Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints.

  View details for DOI 10.1371/journal.pone.0248438

  View details for PubMedID 33690722

• Proportions of Faculty Self-identifying as Black or African American at US Medical Schools, 1990-2020. JAMA Bennett, C. L., Ling, A. Y. 2021; 326 (7): 671-672

  View details for DOI 10.1001/jama.2021.10245

  View details for PubMedID 34402840

• Female emergency physician workforce in the United States, 2020. The American journal of emergency medicine Bennett, C. L., Espinola, J. A., Sullivan, A. F., Clay, C. E., Samuels-Kalow, M. E., Camargo, C. A. 2021

  View details for DOI 10.1016/j.ajem.2021.04.003

  View details for PubMedID 33863559

• National Study on the Contribution of Family Physicians to the US Emergency Physician Workforce in 2020. Journal of the American Board of Family Medicine : JABFM Bennett, C. L., Gerard, W. A., Cullen, J. S., Espinola, J. A., Sullivan, A. F., Clay, C. E., Camargo, C. A. 2021; 34 (6): 1221-1228

  Abstract

  Family physicians provide a sizable portion of emergency care in the United States. However, there is limited work characterizing this population.We completed a cross-sectional analysis of the 2020 American Medical Association Physician Masterfile that was inclusive of all clinically active physicians who designated emergency medicine as their primary or secondary specialty and had family medicine residency training and/or family medicine board certification. We used Accreditation Council for Graduate Medical Education information to determine family medicine residency training and data from the American Board of Medical Specialties to determine family medicine board certification status. We calculated physician density using US Census Bureau estimates; urban-rural assignments were based on Urban Influence Codes.We identified 4354 clinically active emergency physicians (9% of the overall emergency physician workforce). Of these, a majority were male (88%) and completed their training at least 20 years ago (84%), and a majority (59%) reported emergency medicine as their primary specialty. There is notable variation in physician density per 100,000 US population, and these densities declined compared with prior estimates from 2008.We find that family physicians represent a sizable portion of the overall emergency physician workforce despite decreases in physician densities across the United States.

  View details for DOI 10.3122/jabfm.2021.06.210166

  View details for PubMedID 34772778

• Examining Parity among Black and Hispanic Resident Physicians. Journal of general internal medicine Bennett, C. L., Yiadom, M. Y., Baker, O. n., Marsh, R. H. 2021

  Abstract

  The US physician workforce does not represent the racial or ethnic diversity of the population it serves.To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends.Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates.A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties.Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population.Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population.Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.

  View details for DOI 10.1007/s11606-021-06650-7

  View details for PubMedID 33629264

• Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments. Journal of the International Association of Providers of AIDS Care Bennett, C. L., Marks, S. J., Liu, T., Clark, M. A., Carey, M. P., Merchant, R. C. 2020; 19: 2325958220970827

  Abstract

  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.

  View details for DOI 10.1177/2325958220970827

  View details for PubMedID 33143525

  View details for PubMedCentralID PMC7675889

• Two decades of little change: An analysis of U.S. medical school basic science faculty by sex, race/ethnicity, and academic rank. PloS one Bennett, C. L., Salinas, R. Y., Locascio, J. J., Boyer, E. W. 2020; 15 (7): e0235190

  Abstract

  To examine changes in U.S. medical school basic science faculty over the last 20 years (1998-2018), we undertook an observational study utilizing data from the American Association of Medical Colleges Faculty Roster. Rank (Instructor, Assistant Professor, Associate Professor, and Professor), sex (Female), and race/ethnicity (Asian, Black or African American, Hispanic, Latino, Spanish Origin, or Multiple Race-Hispanic, and White) were analyzed; this reflected a population of 14,047 (1998) to 18,601 (2018) faculty. Summary percent of faculty in various gender, race/ethnicity origin categories were analyzed across years of the study using regression models. We found that females (24.47% to 35.32%) were underrepresented at all timepoints and a minority of faculty identified as Black or African American (1.57% to 1.99%), Hispanic, Latino, Spanish Origin, or Multiple Race-Hispanic (3.03% to 4.44%), or Asian (10.90% to 20.41%). The largest population at all time points was White Male Professors (30.53% to 20.85%), followed by White Male Associate Professors (15.67% to 9.34%), and White Male Assistant Professors (13.22% to 9.75%). Small statistically significant increases were observed among female faculty and faculty at multiple ranks who identified as Black or African American or Hispanic, Latino, Spanish Origin, or Multiple Race-Hispanic. We then completed secondary analyses looking at the interaction of race/ethnicity and Gender. We found: (1) a significant increase (p<0.0001) in both genders who identify as Asian although males had a higher rate of increase (6 point difference, p<0.0001); (2) a significant increase for Black or African American females (P<0.01) not found among males; (3) significant increases (p<0.0001) among both genders of faculty who identify as Hispanic, Latino, Spanish Origin, or Multiple Race-Hispanic although females had an approximately 1% higher rate of increase; and (4) among faculty who identify as White, males had a significant decrease (p<0.0001) while females demonstrated an increase (p<0.0001).

  View details for DOI 10.1371/journal.pone.0235190

  View details for PubMedID 32735593

  View details for PubMedCentralID PMC7394429

• The Gender Gap in Surgical Residencies. JAMA surgery Bennett, C. L., Baker, O., Rangel, E. L., Marsh, R. H. 2020

  View details for DOI 10.1001/jamasurg.2020.2171

  View details for PubMedID 32725179

• Factors Associated with the Discordance between Perception of Being HIV Infected and HIV Sexual Risk Taking among Social Media-Using Black, Hispanic, and White Young Men Who Have Sex with Men. Journal of the International Association of Providers of AIDS Care Bennett, C. L., Marks, S. J., Rosenberger, J. G., Bauermeister, J. A., Clark, M. A., Liu, T., Mayer, K. H., Merchant, R. C. 2020; 19: 2325958220919260

  Abstract

  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.

  View details for DOI 10.1177/2325958220919260

  View details for PubMedID 32314651

  View details for PubMedCentralID PMC7175048

• Supply and Demand of Emergency Medicine Board-certified Emergency Physicians by U.S. State, 2017. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Clay, C. E., Sullivan, A. F., Bennett, C. L., Boggs, K. M., Espinola, J. A., Camargo, C. A. 2020

  Abstract

  Our objective was to estimate the emergency medicine board-certified emergency physician (EMBC EP) workforce supply and demand by U.S. state.To estimate state demand, we applied the methodology from our 2005 analysis to calculate full-time equivalent (FTE) EMBC EP demand for each emergency department (ED). The 2017 National Emergency Department Inventory-USA provided visit volumes for all EDs, while the American Board of Medical Specialties supplied the 2017 number of EMBC EPs per state. Assuming at least one EMBC EP should be present 24/7 in each ED (requiring 5.35 FTEs minimum), we calculated the total FTEs required by dividing each ED's visit volume by the estimated average visits seen by an EMBC EP (3,548 visits per year), and then summed FTEs by state. The U.S. Census Bureau provided state demographic characteristics. We used multivariable linear regression to examine the association between state demographics and the density of EMBC EPs per state, and compared 2017 results to our prior 2005 analysis.There were 40,716 total EMBC EPs in 2017, fulfilling 77% of the estimated national demand. This was a substantial increase from 23,035 total EMBC EPs fulfilling 58% of demand in 2005. The 2017 supply ranged from 24% of demand in North Dakota to 142% in Hawaii. A lower density of EMBC EPs was associated with states in the Midwest and South (p<0.001) and with a more rural population (p=0.02). The absolute shortage of EMBC EPs worsened or remained the same in one-fourth of states.While the total number of EMBC EPs nearly doubled between 2005 and 2017, a shortage of full-time coverage persists. The supply and demand vary greatly by state. Worsening absolute shortages in several states show that the distribution of EMBC EPs is not meeting demand across the U.S, particularly in rural areas.

  View details for DOI 10.1111/acem.14157

  View details for PubMedID 33095959

• National Study of the Emergency Physician Workforce, 2020. Annals of emergency medicine Bennett, C. L., Sullivan, A. F., Ginde, A. A., Rogers, J. n., Espinola, J. A., Clay, C. E., Camargo, C. A. 2020

  Abstract

  We describe the current US emergency physician workforce.We analyzed the 2020 American Medical Association Physician Masterfile data set. All physicians who designated emergency medicine as their primary or secondary specialty were included; nonactive physicians, residents, primarily research or teaching faculty, or those primarily involved in administration or nonclinical work were excluded. We calculated emergency physician population density, using 2018 Census Bureau estimates of the US population; urban-rural assignments were based on Urban Influence Codes. We compared 2020 results with our previous analysis of the 2008 emergency physician workforce. Again, we were unable to account for American Osteopathic Board of Emergency Medicine certification.There were 48,835 clinically active emergency physicians in 2020. The median age was 50 years (interquartile range [IQR] 41 to 62 years) and 28% were women. Overall density of emergency physicians per 100,000 population was 14.9. Most emergency physicians were in urban areas (92%), whereas 2,730 (6%) were in large rural areas and 1,197 (2%) in small rural areas. Urban emergency physicians were younger (median age 50 years; IQR 41 to 61 years) than those in large rural areas (median age 58 years; IQR 47 to 67 years) or small rural areas (median age 62 years; IQR 51 to 68 years), and more likely to be women (29%, 20%, and 19%, respectively). Most emergency physicians in small rural areas (71%) completed their medical training more than 20 years ago. Compared with 2008, the total number of clinically active emergency physicians has increased by 9,774, but, per 100,000 US population in 2020, emergency physician density decreased in both large rural (-0.4) and small rural (-3.7) areas.Urban emergency physicians in 2020 remain substantially younger than rural emergency physicians, with many rural ones near the US retirement age. We did not observe a continued increase in the percentage of female physicians among emergency physicians. Given the ongoing demand for physicians in all US emergency departments, this analysis provides essential information for understanding the current emergency physician workforce and the challenges ahead.

  View details for DOI 10.1016/j.annemergmed.2020.06.039

  View details for PubMedID 32747085

• COVID-19: A Resident's Perspective AEM Education and Training Bennett, C. 2020; 4 (3)

  View details for DOI 10.1002/aet2.10457

• In Reply. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Bennett, C. L., Raja, A. S., Kass, D., Gross, N., Mills, A. M. 2019; 26 (11): 1303

  View details for DOI 10.1111/acem.13828

  View details for PubMedID 31286614

• Gender Differences in Faculty Rank Among Academic Emergency Physicians in the United States. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Bennett, C. L., Raja, A. S., Kapoor, N., Kass, D., Blumenthal, D. M., Gross, N., Mills, A. M. 2019; 26 (3): 281-285

  Abstract

  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.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.Our study included 3,600 academic physicians (28%, or 1,016, female). Female emergency physicians were younger than their male colleagues (mean [±SD] age was 43.8 [±8.7] years for females and 47.4 [±9.9] 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).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.

  View details for DOI 10.1111/acem.13685

  View details for PubMedID 30636377

• Changes in Sex, Race, and Ethnic Origin of Emergency Medicine Resident Physicians From 2007 to 2017. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Bennett, C. L., McDonald, D. A., Hurwitz, S., Zheng, H., Nadel, E., Ranney, M. L. 2019; 26 (3): 331-334

  View details for DOI 10.1111/acem.13674

  View details for PubMedID 30549375

• Annals Graphic Medicine - #ThisIsOurLane. Annals of internal medicine Bennett, C. L. 2019; 170 (4): W78-W79

  View details for DOI 10.7326/G18-0034

  View details for PubMedID 31380890

• ROBO4 variants predispose individuals to bicuspid aortic valve and thoracic aortic aneurysm. Nature genetics Gould, R. A., Aziz, H., Woods, C. E., Seman-Senderos, M. A., Sparks, E., Preuss, C., Wünnemann, F., Bedja, D., Moats, C. R., McClymont, S. A., Rose, R., Sobreira, N., Ling, H., MacCarrick, G., Kumar, A. A., Luyckx, I., Cannaerts, E., Verstraeten, A., Björk, H. M., Lehsau, A. C., Jaskula-Ranga, V., Lauridsen, H., Shah, A. A., Bennett, C. L., Ellinor, P. T., Lin, H., Isselbacher, E. M., Lino Cardenas, C. L., Butcher, J. T., Hughes, G. C., Lindsay, M. E., Mertens, L., Franco-Cereceda, A., Verhagen, J. M., Wessels, M., Mohamed, S. A., Eriksson, P., Mital, S., Van Laer, L., Loeys, B. L., Andelfinger, G., McCallion, A. S., Dietz, H. C. 2019; 51 (1): 42-50

  Abstract

  Bicuspid aortic valve (BAV) is a common congenital heart defect (population incidence, 1-2%)1-3 that frequently presents with ascending aortic aneurysm (AscAA)4. BAV/AscAA shows autosomal dominant inheritance with incomplete penetrance and male predominance. Causative gene mutations (for example, NOTCH1, SMAD6) are known for ≤1% of nonsyndromic BAV cases with and without AscAA5-8, impeding mechanistic insight and development of therapeutic strategies. Here, we report the identification of variants in ROBO4 (which encodes a factor known to contribute to endothelial performance) that segregate with disease in two families. Targeted sequencing of ROBO4 showed enrichment for rare variants in BAV/AscAA probands compared with controls. Targeted silencing of ROBO4 or mutant ROBO4 expression in endothelial cell lines results in impaired barrier function and a synthetic repertoire suggestive of endothelial-to-mesenchymal transition. This is consistent with BAV/AscAA-associated findings in patients and in animal models deficient for ROBO4. These data identify a novel endothelial etiology for this common human disease phenotype.

  View details for DOI 10.1038/s41588-018-0265-y

  View details for PubMedID 30455415

  View details for PubMedCentralID PMC6309588

• Association of the 2003 and 2011 ACGME Resident Duty Hour Reforms With Internal Medicine Initial Certification Examination Performance. Journal of graduate medical education Bennett, C. L., McDonald, D. A., Dorner, S. C., Nadel, E. S., McDonald, F. S., McPherson, J. A. 2017; 9 (6): 789-790

  View details for DOI 10.4300/JGME-D-17-00547.1

  View details for PubMedID 29270281

  View details for PubMedCentralID PMC5734346

• A National Cross-Sectional Study of Surgery Residents Who Underreport Duty Hours. Journal of surgical education Bennett, C. L., McDonald, D. A., Chang, Y., Finch, A., Vuong, K., Rennie, S., Nadel, E. S. 2017; 74 (6): 928-933

  Abstract

  Previous work demonstrates that many surgery residents underreport duty hours. The purpose of this study was to identify characteristics of these residents and better understand why they exceed duty hours.During the winter of 2015 we conducted an anonymous cross-sectional survey of Accreditation Council for Graduate Medical Education accredited general surgery programs.A total of 101 general surgery residency programs across the United States.A total of 1003 general surgery residents across the United States. Respondents' mean age was 29.9 ± 3.0 years; 53% were male.Study response rate was 31.9%. Residents age <30 were more likely to exceed duty hours to complete charting/documentation (68% vs. 54%, p < 0.001). Females more often cited guilt about leaving the hospital (32% vs. 24%, p = 0.014) as to why they exceed duty hours. Programs with >40 residents had the highest rates of underreporting (82% vs. 67% in other groups p < 0.001) and residents who worked >90 hours on an average week more frequently cited external pressure (p = 0.0001), guilt (p = 0.006), and feeling it was expected of them (p < 0.0001) as reasons why they underreport compared to those who worked fewer hours.Underreporting and duty-hour violations are a complex issue influenced by many variables including age, sex, and internal and external pressures.

  View details for DOI 10.1016/j.jsurg.2017.05.008

  View details for PubMedID 28529194

• Adult male with diffuse neck masses Visual Journal of Emergency Medicine Bennett, C. L., Hayden, E. M. 2017; 8

  View details for DOI 10.1016/j.visj.2017.04.019

• White (Coat) Lies: Bending the Truth to Stay Faithful to Patients. The American journal of bioethics : AJOB Bennett, C., Finch, A., Rennie, S. 2016; 16 (9): 15-7

  View details for DOI 10.1080/15265161.2016.1197342

  View details for PubMedID 27471929

• Surgical Resident Duty Hours. The New England journal of medicine Bennett, C. L., Finch, A., Vuong, K., McDonald, D., Rennie, S. 2016; 374 (24): 2399-401

  View details for DOI 10.1056/NEJMc1604659

  View details for PubMedID 27305199

• Massive hemoptysis in Loeys-Dietz syndrome. American journal of medical genetics. Part A Bennett, C. L., Aziz, H., Sparks, E., Shah, T., Yoder, M., MacCarrick, G., Dietz, H. C. 2016; 170 (3): 725-7

  Abstract

  We describe four unrelated individuals with Loeys-Dietz syndrome (LDS) who presented with massive hemoptysis of unknown etiology. LDS is an autosomal dominant connective-tissue disorder characterized by altered cardiovascular, craniofacial, and skeletal development that is attributed to mutations in the TGFBR1, TGFBR2, SMAD3, or TGFB2 genes. Massive hemoptysis (MH) is a rare and often fatal pulmonary medical emergency. This is the first report of MH in individuals with LDS and establishes it as part of the LDS spectrum. It compels providers to educate their LDS patients on MH, although much investigation needs to be done to determine etiology and appropriate treatment for this newly described LDS feature.

  View details for DOI 10.1002/ajmg.a.37487

  View details for PubMedID 26614122

• A 15-Year-Old Male with Enlarging “Breast Lump” Visual Journal of Emergency Medicine Bennett, C., Singh, S., Lobo, V. 2016; 3

  View details for DOI 10.1016/j.visj.2016.01.009

• Kaposi's Sarcoma-Associated Herpesvirus Viral Interferon Regulatory Factor 1 Interacts with a Member of the Interferon-Stimulated Gene 15 Pathway. Journal of virology Jacobs, S. R., Stopford, C. M., West, J. A., Bennett, C. L., Giffin, L., Damania, B. 2015; 89 (22): 11572-83

  Abstract

  Kaposi's sarcoma-associated herpesvirus (KSHV) is a gammaherpesvirus known to establish lifelong latency in the human host. We and others have previously shown that three KSHV homologs of cellular interferon regulatory factors (IRFs), known as viral IRFs (vIRFs), participate in evasion of the host interferon (IFN) response. We report that vIRF1 interacts with the cellular interferon-stimulated gene 15 (ISG15) E3 ligase, HERC5, in the context of Toll-like receptor 3 (TLR3) activation and IFN induction. The ISG15 protein is covalently conjugated to target proteins upon activation of the interferon response. Interaction between vIRF1 and HERC5 was confirmed by immunoprecipitation, and the region between amino acids 224 and 349 of vIRF1 was required for interaction with HERC5. We further report that expression of vIRF1 in the context of TLR3 activation results in decreased ISG15 conjugation of proteins. Specifically, TLR3-induced ISG15 conjugation and protein levels of cellular IRF3, a known ISG15 target, were decreased in the presence of vIRF1 compared to the control. vIRF1 itself was also identified as a target of ISG15 conjugation. KSHV-infected cells exhibited increased ISG15 conjugation upon reactivation from latency in coordination with increased IFN. Furthermore, knockdown of ISG15 in latently infected cells resulted in a higher level of KSHV reactivation and an increase in infectious virus. These data suggest that the KSHV vIRF1 protein affects ISG15 conjugation and interferon responses and may contribute to effective KSHV replication.The KSHV vIRF1 protein can inhibit interferon activation in response to viral infection. We identified a cellular protein named HERC5, which is the major ligase for ISG15, as a vIRF1 binding partner. vIRF1 association with HERC5 altered ISG15 modification of cellular proteins, and knockdown of ISG15 augmented reactivation of KSHV from latency.

  View details for DOI 10.1128/JVI.01482-15

  View details for PubMedID 26355087

  View details for PubMedCentralID PMC4645652

• The viral interferon regulatory factors of kaposi's sarcoma-associated herpesvirus differ in their inhibition of interferon activation mediated by toll-like receptor 3. Journal of virology Jacobs, S. R., Gregory, S. M., West, J. A., Wollish, A. C., Bennett, C. L., Blackbourn, D. J., Heise, M. T., Damania, B. 2013; 87 (2): 798-806

  Abstract

  Kaposi's sarcoma-associated herpesvirus (KSHV) infection is correlated with three human malignancies and can establish lifelong latent infection in multiple cell types within its human host. In order to establish and maintain infection, KSHV utilizes multiple mechanisms to evade the host immune response. One such mechanism is the expression of a family of genes with homology to cellular interferon (IFN) regulatory factors (IRFs), known as viral IRFs (vIRFs). We demonstrate here that KSHV vIRF1, -2, and -3 have a differential ability to block type I interferon signaling mediated by Toll-like receptor 3 (TLR3), a receptor we have previously shown to be activated upon KSHV infection. vIRF1, -2, and -3 inhibited TLR3-driven activation of IFN transcription reporters. However, only vIRF1 and vIRF2 inhibited increases in both IFN-β message and protein levels following TLR3 activation. The expression of vIRF1 and vIRF2 also allowed for increased replication of a virus known to activate TLR3 signaling. Furthermore, vIRF1 and vIRF2 may block TLR3-mediated signaling via different mechanisms. Altogether, this report indicates that vIRFs are able to block IFN mediated by TLRs but that each vIRF has a unique function and mechanism for blocking antiviral IFN responses.

  View details for DOI 10.1128/JVI.01851-12

  View details for PubMedID 23115281

  View details for PubMedCentralID PMC3554052

• A transition zone complex regulates mammalian ciliogenesis and ciliary membrane composition. Nature genetics Garcia-Gonzalo, F. R., Corbit, K. C., Sirerol-Piquer, M. S., Ramaswami, G., Otto, E. A., Noriega, T. R., Seol, A. D., Robinson, J. F., Bennett, C. L., Josifova, D. J., García-Verdugo, J. M., Katsanis, N., Hildebrandt, F., Reiter, J. F. 2011; 43 (8): 776-84

  Abstract

  Mutations affecting ciliary components cause ciliopathies. As described here, we investigated Tectonic1 (Tctn1), a regulator of mouse Hedgehog signaling, and found that it is essential for ciliogenesis in some, but not all, tissues. Cell types that do not require Tctn1 for ciliogenesis require it to localize select membrane-associated proteins to the cilium, including Arl13b, AC3, Smoothened and Pkd2. Tctn1 forms a complex with multiple ciliopathy proteins associated with Meckel and Joubert syndromes, including Mks1, Tmem216, Tmem67, Cep290, B9d1, Tctn2 and Cc2d2a. Components of this complex co-localize at the transition zone, a region between the basal body and ciliary axoneme. Like Tctn1, loss of Tctn2, Tmem67 or Cc2d2a causes tissue-specific defects in ciliogenesis and ciliary membrane composition. Consistent with a shared function for complex components, we identified a mutation in TCTN1 that causes Joubert syndrome. Thus, a transition zone complex of Meckel and Joubert syndrome proteins regulates ciliary assembly and trafficking, suggesting that transition zone dysfunction is the cause of these ciliopathies.

  View details for DOI 10.1038/ng.891

  View details for PubMedID 21725307

  View details for PubMedCentralID PMC3145011

• KIF7 mutations cause fetal hydrolethalus and acrocallosal syndromes. Nature genetics Putoux, A., Thomas, S., Coene, K. L., Davis, E. E., Alanay, Y., Ogur, G., Uz, E., Buzas, D., Gomes, C., Patrier, S., Bennett, C. L., Elkhartoufi, N., Frison, M. S., Rigonnot, L., Joyé, N., Pruvost, S., Utine, G. E., Boduroglu, K., Nitschke, P., Fertitta, L., Thauvin-Robinet, C., Munnich, A., Cormier-Daire, V., Hennekam, R., Colin, E., Akarsu, N. A., Bole-Feysot, C., Cagnard, N., Schmitt, A., Goudin, N., Lyonnet, S., Encha-Razavi, F., Siffroi, J. P., Winey, M., Katsanis, N., Gonzales, M., Vekemans, M., Beales, P. L., Attié-Bitach, T. 2011; 43 (6): 601-6

  Abstract

  KIF7, the human ortholog of Drosophila Costal2, is a key component of the Hedgehog signaling pathway. Here we report mutations in KIF7 in individuals with hydrolethalus and acrocallosal syndromes, two multiple malformation disorders with overlapping features that include polydactyly, brain abnormalities and cleft palate. Consistent with a role of KIF7 in Hedgehog signaling, we show deregulation of most GLI transcription factor targets and impaired GLI3 processing in tissues from individuals with KIF7 mutations. KIF7 is also a likely contributor of alleles across the ciliopathy spectrum, as sequencing of a diverse cohort identified several missense mutations detrimental to protein function. In addition, in vivo genetic interaction studies indicated that knockdown of KIF7 could exacerbate the phenotype induced by knockdown of other ciliopathy transcripts. Our data show the role of KIF7 in human primary cilia, especially in the Hedgehog pathway through the regulation of GLI targets, and expand the clinical spectrum of ciliopathies.

  View details for DOI 10.1038/ng.826

  View details for PubMedID 21552264

  View details for PubMedCentralID PMC3674836