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Addiction, Emergency Medicine, Health Costs, Patient Care, Research

Questionnaire bests blood test at identifying patients with risky drinking behaviors

Questionnaire bests blood test at identifying patients with risky drinking behaviors

3144132736_9de39a590d_zAs many as half of the patients who visit the emergency room with traumatic injuries have alcohol in their bloodstream, and roughly 10 percent of these patients will return to the ER within a year. Today, many emergency rooms use blood alcohol tests to screen for patients with risky drinking behaviors. Yet a new study by researchers from Loyola University Medical Center suggests that a questionnaire may be a better way to identify at-risk patients.

In the study, researchers reviewed 222 records from patients 18 years of age and older that were admitted to Loyola University Medical Center’s level I trauma center between May 2013 and June 2014. Each of the patients in the study had a blood alcohol test and had answered the World Health Organization‘s 10-point questionnaire, called the Alcohol Use Disorders Identification Test (AUDIT). The research team compared the results of the blood test to that of the AUDIT test and found that the questionnaire was 20 percent more effective at identifying at-risk patients with dangerous drinking habits than the blood test.

As the researchers explain in their study, blood alcohol tests only provide “a snapshot of the patient’s recent drinking behaviors” by measuring of the amount of alcohol in the patient’s system at the instant the test is taken. In contrast, the questionnaire assesses the patient’s overall drinking behaviors by asking questions such as, how often they drink, how much they drink per day and if they have feelings of guilt or remorse after drinking.

These findings are significant because blood alcohol tests are often the only tool used to assess at-risk drinking behavior in ER patients. Their findings call this common practice into question and suggest that the AUDIT questionnaire may be a better way to identify, and ultimately prevent, potentially dangerous drinking behaviors.

Previously: Alcohol-use disorder can be inherited: But why?Could better alcohol screening during doctor visits reduce underage drinking? and How to make alcoholics in recovery feel welcome this holiday season
Via: Business Wire
Photo by: Julie °_°

Emergency Medicine, Ethics, Global Health, Medicine and Society, Patient Care

After Haiyan: Stanford med student makes film about post-typhoon Philippines

After Haiyan: Stanford med student makes film about post-typhoon Philippines

Multi-talented Stanford Medicine student Michael Nedelman has been featured on Scope before for his filmmaking and storytelling abilities. His new film, “After Haiyan: Health narratives in the aftermath of the typhoon,” is a series of vignettes about the November 2013 disaster in the Philippines. The film, which will be released soon, connects socioeconomic and structural issues of access to health in times of crisis.

It was filmed primarily in Tacloban, Leyte, in July and August of 2014, and Nedelman made a follow-up visit in November and December to premiere and promote the project. Despite his busy end-of-school-year schedule, Nedelman answered some questions for me about his work in a recent email exchange.

What was it like filming in the wake of a tragedy? 

Phil Delrosario said it best. He’s the cinematographer and editor I met here at Stanford. Knowing when to turn on the camera was a “huge balancing act” between our drive to document the truth, and our obligation to be compassionate storytellers. We couldn’t ignore the emotional weight of Typhoon Haiyan, and we couldn’t ignore the fact that we weren’t part of the communities we were documenting. So we sought out people who not only wanted to share their stories with us, but who could also provide some insight as to how they wanted those stories to be seen… For one of the videos, Deaf advocates like Noemi Pamintuan-Jara reached out to us first, not the other way around… That was really special for us, to be able to work alongside a community that has been promoting Deaf accessibility and culture long before we ever arrived on the scene. And we had these new partners who could give meaningful feedback on our filmmaking decisions.

Filming in the wake of a tragedy doesn’t mean everything is tragic. The shadow of Haiyan is still there, but there’s also a sense of living in the moment and moving forward. All over the city, you’ll see posters and graffiti that say, “Tindog Tacloban!” (“Rise Tacloban!”) That’s something that really resonated with our team and the ethos of our project. You can’t tell the full story of Tacloban without optimism and resilience.

How does this film link storytelling and health, and what is special about that for you?

When I was first discussing the project with one of the producers, Roxanne Paredes, we asked ourselves a similar question: How would our project add to or nuance the coverage of the typhoon? Right after the storm, Haiyan was all over the news. Tacloban was in survival mode. But months later, after many of those cameras had left, there was a different set of long-term challenges and a focus on recovery. Those were the issues we wanted to explore, which tend to be less covered by the media but still have profound implications for community health and future disaster preparedness. In short, just because the cameras stopped rolling doesn’t mean there weren’t more stories to tell. That really broadened the way in which I think of health stories.

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Emergency Medicine, Medical Education

“We are a team”: Advice for new residents from chief residents, in their own words

"We are a team": Advice for new residents from chief residents, in their own words

1024px-Flickr_-_Official_U.S._Navy_Imagery_-_U.S._Naval_Academy_plebes_carry_a_log_as_part_of_teamwork_training_during_Sea_Trials.There are many things chief residents want new residents to know right out the gate, but much of that goes unsaid. So the blog Academic Life in Emergency Medicine recently put together a list titled “Dear Residents: 10 Things Your New Chiefs Want You to Know.” Each one was written by a different chief resident, as part of the blog’s Chief Resident Incubator project.

It’s a thoughtful collection of reflections that offers an interesting mix of poignant comments and practical advice. The full list is worth a read, but a few stand out:

 “WHEN YOU FEEL LIKE CRYING, CRY TO ME.”

…Know that every one of your attendings and senior residents continue to go through these same trials. When you find yourself on the ropes and feeling utterly alone, call us. We might not be able to make that Surgical ICU rotation any less painful, but we’ll at least buy you a beer and share some stories from our own days working the surgery salt mine.

(Rory Stuart, Chief Resident, Wright State University, Dayton, OH)

WE ARE A TEAM

…Our learning should not only take place during scheduled conference time; we can all learn from each other. Share your successes and failures. Teach us all what you know, and what you wish you would have known. When we get out on our own, we all represent this residency program. Together we can make each other and this program better.

(Valerie Cohen, Chief Resident, Christiana Care Health System, Newark, DE)

NEITHER RESIDENCY NOR LIFE ARE FAIR. USE IT AS AN OPPORTUNITY TO SHINE

…Your week long string of night shifts was not borne of malice or vendetta. We try to make decisions that are in the best interest of the program and we ALWAYS consider your requests.

Your faculty, chiefs, and colleagues are paying attention to how you react to these perceived slights. When you take that extra shift in stride, we’ll notice. When you take on a task that nobody else stepped up for, we’ll notice. When you swap into a weekend night shift so a co-resident can celebrate an anniversary or birthday, we’ll notice.

(Jimmy Lindsey, Chief Resident, University of Chicago, Chicago, IL)

Previously: Soon-to-be medicine resident reflects on what makes a good teacher, Keeping an even keel: Stanford surgery residents learn to balance work and life and A call to action to improve balance and reduce stress in the lives of resident physicians
Via Wing of Zock
Photo by U.S. Navy

Emergency Medicine, Nutrition, Pediatrics, Rural Health

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Study finds arm circumference is accurate measure of malnutrition in children with diarrheal illnesses

Malnutrition is a leading cause of mortality in children under the age of five, contributing to approximately 3.5 million child deaths worldwide each year. Currently, the World Health Organization and Doctors Without Borders recommend using calculations based on the patient’s body weight or arm circumference to assess their nutritional status. But, it’s not known if they are reliable measures of malnutrition in children that suffer from diarrhea and dehydration — two symptoms that can affect body weight and are common in undernourished kids.

Now, a study (subscription required) published this month in the Journal of Nutrition shows that mid-upper arm circumference can accurately assess malnutrition in children with diarrhea and dehydration and it’s better at assessing malnutrition than weight-based measures.

In the study, Rhode Island Hospital emergency medicine physician Adam Levine, MD, and his team analyzed 721 records of children (under the age of five) who were examined at an urban hospital in Dhaka, Bangladesh for acute diarrhea. They found that measurements based on a child’s mid-upper arm circumference accurately diagnosed malnutrition, but measurements based on weight were unreliable and misdiagnosed about 12-14 percent of the cases when the patient had diarrhea and dehydration.

“Because dehydration lowers a child’s weight, using weight-based assessments in children presenting with diarrhea may be misleading,” Levine said in a press release. “When children are rehydrated and returned to a stable, pre-illness weight, they may still suffer from severe acute malnutrition.”

Since poor nutrition is a common problem in areas where medical resources are limited, the best tools to diagnose malnutrition are effective and inexpensive. Tape measures are cheaper and are often easier to come by than scales, so the results of this study are especially encouraging for people who want the best and most affordable way to measure malnutrition in children. “Based on our results, clinicians and community health workers can confidently use the mid-upper arm measurement to guide nutritional supplementation for children with diarrhea,” said Levine.

Previously: Stanford physician Sanjay Basu on using data to prevent chronic disease in the developing worldMalnourished children have young guts and Seeking solutions to childhood anemia in China
Photo by European Commission DG ECHO

Emergency Medicine, Global Health, Haiti, Stanford News

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

A tale of two earthquakes: Stanford doctor discusses responses to the Nepal and Haiti disasters

boy in Nepal - 560

Nepal’s 7.8 earthquake in late April killed 8,000 people and displaced thousands more. Paul Auerbach, MD, a professor of emergency medicine at Stanford, spent about a week caring for the people of Kathmandu and recently sat down for a Q&A session with Shana Lynch of Stanford’s Graduate School of Business, where Auerbach earned a master’s degree in 1989.

Auerbach was also part of the medical response team in Haiti after the 2010 earthquake there killed hundreds of thousands. While talking with Lynch, he compares the two earthquakes and the very different medical responses they needed:

When you come in, you need to find the victims. You need to treat them. You need medical supplies. You need adequate personnel in order to manage the life- and limb-threatening injuries in the first few days. From the moment of the earthquake and forward, there’s a need for water and food. In Haiti, the supplies initially weren’t there. Everything needed to be carried in. In Kathmandu, for the most part, the supplies were available. Of course, they needed supplementation, and that happened and will continue to happen. In Kathmandu, they never were in a situation where they had nothing, which was unfortunately the situation in Port-au-Prince.

He also discusses some of the challenges of coordinating an appropriate disaster response plan:

There comes a point when you have enough people and enough supplies. At that point, you need to start storing things and sending people home.

The responses are never perfect because you discover that you need more of something and less of something else. The same holds true for people. For example, the changing nature of medical conditions following an earthquake causes you to need emergency medicine specialists early on, but then orthopedic surgeons and reconstructive surgeons later during the response.

Lynch and Auerbach’s conversation also touches on why community leaders need to plan for disasters, regardless of where they are. It’s an interesting inside look into how medical teams think about and respond to natural disasters.

Previously: “Still many unknowns”: Stanford physician reflects on post-earthquake Nepal, Day 6: Heading for home after treating Nepal earthquake victims, Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims, Day 2: “We have heard tales of miraculous survival” following Nepal earthquake, Day 1: Arriving in Nepal to aid earthquake victims and Reports from Stanford medical team in Haiti
Photo courtesy of Paul Auerbach

Big data, Emergency Medicine, Genetics, Infectious Disease, Research, Stanford News

Study means an early, accurate, life-saving sepsis diagnosis could be coming soon

Study means an early, accurate, life-saving sepsis diagnosis could be coming soon

image.img.320.highA blood test for quickly and accurately detecting sepsis, a deadly immune-system panic attack set off when our body wildly overreacts to the presence of infectious pathogens, may soon be at hand.

Sepsis is the leading cause of hospital deaths in the United States and is tied to the early deaths of at least 750,000 Americans each year. Usually caused by bacterial rather than viral infections, this intense, dangerous and rapidly progressing whole-body inflammatory syndrome is best treated with antibiotics.

The trouble is, sepsis is exceedingly difficult to distinguish from its non-infectious doppelganger: an outwardly similar but pathogen-free systemic syndrome called sterile inflammation, which can arise in response to traumatic injuries, surgery, blood clots or other noninfectious causes.

In a recent news release, I wrote:

[H]ospital clinicians are pressured to treat anybody showing signs of systemic inflammation with antibiotics. That can encourage bacterial drug resistance and, by killing off harmless bacteria in the gut, lead to colonization by pathogenic bacteria, such as Clostridium difficile.

Not ideal. When a patient has a sterile inflammation, antibiotics not only don’t help but are counterproductive. However, the occasion for my news release was the identification, by Stanford biomedical informatics wizard Purvesh Khatri, PhD, and his colleagues, of a tiny set of genes that act differently under the onslaught of sepsis from they way they behave when a patient is undergoing sterile inflammation instead.

In a study published in Science Translational Medicine, Khatri’s team pulled a needle out of a haystack – activity levels of more than 80 percent of all of a person’s genes change markedly, and in a chaotically fluctuating manner over time, in response to both sepsis and sterile inflammation. To cut through the chaos, the investigators applied some clever analytical logic to a “big data” search of gene-activity results on more than 2,900 blood samples from nearly 1,600 patients in 27 different data sets containing medical information on diverse patient groups: men and women, young and old, some suffering from sterile inflammation and other experiencing sepsis,  and (as a control) healthy people.

The needle that emerged from that 20,000-gene-strong haystack of haywire fluctuations in gene activity consisted of an 11-gene “signature” that, Khatri thinks, could serve up a speedy, sensitive, and specific diagnosis of sepsis in the form of a simple blood test.

The 11-gene blood test still has to be validated by independent researchers, licensed to manufacturers, and approved by the FDA. Let’s hope for smooth sailing. Every hour saved in figuring out a possible sepsis sufferer’s actual condition represents, potentially, thousands of lives saved annually in the United States alone, not to mention billions of dollars in savings to the U.S. health-care system.

Previously: Extracting signal from noise to combat organ rejection and Can battling sepsis in a game improve the odds for material world wins?
Photo by Lightspring/Shutterstock

Emergency Medicine, Global Health, Stanford News

“Still many unknowns”: Stanford physician reflects on post-earthquake Nepal

"Still many unknowns": Stanford physician reflects on post-earthquake Nepal

Paul Auerbach recently traveled to Nepal to aid victims of the April 25 earthquake; he wrote this post over the weekend.

17313678335_5f5d15dc04_zI’m on my way back to the U.S. now and getting information from people who are still in Nepal. Because I’m inundated with requests to provide information from people who have read my previous posts, I’ll keep writing, but only if there’s something useful to report. Please let me emphasize that this is no longer firsthand, but rather, based on communications from persons in Nepal whom I very much trust. They are working really hard, so it is “above and beyond” (and very much appreciated) that they find time to keep us all informed.

Surrounding Kathmandu and seen from the air, there are many remote villages that have been devastated, with all or nearly all dwellings demolished by the earthquake. These buildings had mostly been constructed of bricks mortared with mud. They crumbled during the shaking and may have been struck by rock slides. Anyone caught within the buildings could have been mortally wounded or severely injured.

Many villages are situated one or more days’ walk from the nearest vehicle (4-wheel drive truck or SUV)-accessible roadway, so rapid access will need to be by helicopter if there is a suitable landing site or the ability to carry out long-line rescues (this requires the appropriate equipment and operators with technical expertise, both on the ground and in the helicopter). Helicopters are in short supply relative to the need, so that is a rate-limiting part of the operation. The helicopters will be needed both to get teams in and to get patients out. The first step will be to provide on-site triage in order to prioritize where to deploy medical and other resources. Patients will be assessed in order to determine whom to transport and in what order. Treatment will be initiated when possible. The possibility of trekking into villages will be dictated by the condition of the paths normally used for foot travel. The paths are often narrow, rocky, and steep. It is likely that there have been rock-and-dirt slides that will render traversing some of these paths extremely difficult or impossible. If the paths are passable, that may be how some of these villages will eventually be reached, and people and supplies delivered. The delays will be overcome by cooperation and perseverance.

Medical teams from around the globe have come into Kathmandu and are assisting or prepared to assist. They will be responsive to the Nepal government, global-health agencies such as the World Health Organization, and non-governmental organizations such as International Medical Corps. The search and rescue (SAR) component intended to find victims trapped in rubble will expect from this point forward to find only a few miraculous survivors of the initial event, so the role of SAR to extricate buried people will diminish. From this point forward, it will be about getting to the injured and sustaining them until they can be extracted to a higher level of medical care, if this is what they need. Reaching all the affected villages and injured persons may take weeks. To assist displaced (e.g., no longer have a home) persons, there is need to provide food, sheltering materials, and water disinfection supplies.

The public-health mission, in particular trying to prevent the spread of potentially epidemic infectious disease (particularly diarrheal disease) is hugely important. This is essential now and particularly as the monsoon season approaches. This includes human-waste management, providing safe drinking water, possibly providing immunizations, and surveillance that promotes early detection of disease.

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Emergency Medicine, Global Health, Stanford News

Day 6: Heading for home after treating Nepal earthquake victims

Day 6: Heading for home after treating Nepal earthquake victims

Paul Auerbach has been in Nepal to aid victims of the recent earthquake; he wrote this account over the weekend.

Nepal earthquake2 - smallThe last few days have been action-packed, and my work in Nepal is coming to a close. As an emergency physician, my skills will soon be much less needed than those of orthopedic and plastic surgeons, and primary care and infectious disease specialists. Because of the incredible outpouring of active interest from people who are friends of Nepal, many health-care professionals have arrived, and more are on the way. The government of Nepal has recommended that all persons, particularly those in large groups or teams, wishing to help by coming to Nepal do so under the auspices of a government-approved organization. This is important to maintain an effective response and deploy resources where they are most needed.

It has been a bit unnerving to experience three significant aftershocks over the past few days. Each was accompanied by a jolt or shaking of the ground or building and rumbling noise, followed by silence, followed by the sounds of commotion as people fled their dwellings. Fortunately, none of the aftershocks was prolonged or destructive, but they serve as a reminder of what happened, and what will undoubtedly happen again sometime in the future. The cycle for a major earthquake in this country in modern times is approximately every 75 years.

Today we traveled to Hatia, a community close to Dhading, in order to assess need and provide care. We were greeted by approximately 100 residents with earthquake-related situations, illnesses, and injuries. Nearly all of them are now displaced from their homes. With the monsoon on the horizon beginning the end of this month or early in June, combined with the number of persons requiring new shelter, the timetable is set for an aggressive attempt to provide adequate housing, essential public health education, and water-sanitation-hygiene (WASH) programs. More victims of the earthquake will undoubtedly be found as helicopters are deployed to approach very difficult-to-reach areas, so there will continue to be an immediate medical response as long as the public health efforts.

I have witnessed many acts of selflessness and heard tales of amazing bravery, including what transpired at Everest Base Camp. The details of everything that has happened in this country related to the earthquake will be best told by those who experienced it first-hand. From a personal perspective, I’m impressed by the number of participants in the events and response that has come from the wilderness medicine community. These are some of my dearest friends and colleagues, and my admiration for them has grown by leaps and bounds. Working with my lifelong friend Luanne Freer, MD, has been a privilege. Her knowledge of Nepal and love for the country permeated everything she did this past week. There are many people like her who have come to help, and behind every person here there are dozens at home supporting their efforts.

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Emergency Medicine, Global Health, Stanford News

Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims

Day 4: Reaching beyond Kathmandu in treating Nepal earthquake victims

Paul Auerbach is in Nepal to aid victims of the recent earthquake and has been sending periodic reports.

The earthquake in Nepal caused immense damage to people and property not only in Kathmandu, but in a widespread area extending to Mt. Everest and in many other directions. Victims on Mt. Everest and in Kathmandu proper appropriately received a great deal of attention, but equally important has been the plight of persons trapped in villages remote from the big city. These communities are located in steep and isolated terrain, so that it is difficult to reach them by road, and sometimes even by helicopter. Part of the mission of International Medical Corps (IMC) and the other responding organizations has been to identify these areas of need and attempt to locate and treat the victims.

We continue to see improvement each day, and the number of volunteers from around the world is impressive

After a discussion with three health officials – the senior district health officer for Dhading, a pediatrician assigned to lead the district medical response to the earthquake, and the medical supervisor for the Dharding District Hospital, we were asked to consider finding a way to approach one of several villages that were reported to have urgent medical needs, but which had not yet been visited by rescuers and medical professionals. We selected Kumpur, a rugged 90-minute approach requiring a 4-wheel drive vehicle. We excluded others that required helicopter access, because these aircraft have been in short supply.

At the Dhading District Hospital, we witnessed arrival of a dozen earthquake victims choppered in from Darkha, which is at a high elevation in this region. They were suffering from trauma, with broken limbs and wounds in various stages of infection. The Nepalese doctors who volunteered their time by leaving Bangladesh to respond at the request of IMC, alongside a (literally) busload of surgeons and other medical professionals volunteering from India were skilled and swift in delivering treatment despite the limited resources and surge of patients.

The next day, we took a team into Kumpur and witnessed widespread destruction amid the beautiful surroundings. Many dwellings composed of mud and stone had collapsed, and the residents are now living in tents. With the monsoon season approaching, they will need assistance to rapidly create more suitable structures. They were busy clearing the remains of their homes and other structures, but always gave us a smile and a greeting. Their resilience and work ethic are amazing.

The health outpost has been rendered largely unusable, with large cracks in its side, holes in the wall, and instability in every direction. So, we worked mostly in the single safe room remaining and on the porch leading to the entryway. With a stellar support team, including two recently graduated doctors from Nepal, we were able to interview and examine many of the villagers, dealing with complaints both related to injuries sustained in the earthquake and medical conditions for which they sought advice.

As the days pass, fewer patients will present with acute earthquake-related injuries, and the medical care will shift to resumption of adequate primary care, surgeries related to orthopedic and soft tissue injuries, and aggressive detection and management of infectious diseases that might cause an epidemic. Public-health experts are on-scene, as are epidemiologists and other experts in sanitation systems, water disinfection, and so forth. Given the large geographic area affected by the earthquake and difficulty reaching many locations, the logistics are extremely important.

We continue to see improvement each day, and the number of volunteers from around the world is impressive. We hope for the best and appreciate all the support we’ve received from family and friends.

Paul Auerbach, MD, is a professor and chief of emergency medicine who works with the Stanford Emergency Medicine Program for Emergency Response (SEMPER).

Click here for a statement on Nepal from Michele Barry, MD, senior associate dean of global health and director of the Center for Innovation in Global Health (CIGH). Additional updates related to the Stanford relief efforts will be shared on the CIGH website in the coming days and weeks.

Previously: Day 2: “We have heard tales of miraculous survival” following Nepal earthquake and Day 1: Arriving in Nepal to aid earthquake victims

Emergency Medicine, Global Health, Stanford News

Day 2: “We have heard tales of miraculous survival” following Nepal earthquake

Day 2: "We have heard tales of miraculous survival" following Nepal earthquake

Paul Auerbach is in Nepal to aid victims of the recent earthquake and has been sending periodic reports.

Today in Kathmandu was quite different from yesterday. The city has certainly sprung back remarkably. Although its citizens face enormous challenges, the streets were nearly full with traffic, rubble was actively being cleared from obstructing piles, and people were walking and resuming commerce. There are an estimated 16 camps within the boundaries of Kathmandu, where people are either forced to seek housing or prefer to remain, certainly for sleeping at night, until homes can be replaced or cleared with respect to structural integrity. The camps are orderly and treated with dignity by the occupants and passers-by. We visited one this afternoon to perform a clinic, examining patients who wished to see a physician. Because the hospitals in Kathmandu received the injured soon after the earthquake, we mostly served persons with “routine” medical ailments. They were kind to us and appreciated the attention.

International Medical Corps continues to grow its staff and operations to meet the evolving situation. Side by side with other entities that have responded, including large national emergency response teams, there will be increasing focus on the communities outside Kathmandu, where there is sparse medical care and distances to hospitals mean walks of hours. Some of these will need to be approached by helicopter because of distances, mud- and rockslides caused by the earthquakes that have obstructed roadways, and calls for urgent assistance. It’s anticipated that some teams may need to trek for days to reach certain villages. Much of the coming days’ and weeks’ activities will be intended to avoid the spread of infectious diseases.

We have heard tales of miraculous survival, sadly posed against the grief of many lost family members and friends. Driving through the city past enormous mounds of rubble that last week were sacred temples and monuments, it is striking to think about how much there is to be done worldwide to prepare for cataclysmic natural events. There will be many lessons learned from this catastrophe, and we should take them to heart. One of them is how much better is a world focused on mutual aid and skillful compassion than upon dominance and conflict.

Paul Auerbach, MD, is a professor and chief of emergency medicine who works with the Stanford Emergency Medicine Program for Emergency Response (SEMPER).

Click here for a statement on Nepal from Michele Barry, MD, senior associate dean of global health and director of the Center for Innovation in Global Health (CIGH). Additional updates related to the Stanford relief efforts will be shared on the CIGH website in the coming days and weeks.

Previously: Day 1: Arriving in Nepal to aid earthquake victims

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