Gastric outlet obstruction (GOO) is a rare condition occurring as a consequence of numerous processesthat prevent gastric emptying. Presenting symptoms of GOO are non-specific and include nausea, vomiting, epigastric discomfort and decreased appetite. The diagnosis of GOO is often challenging. Emergency physicians must have a heightened awareness of GOO to ensure proper diagnosis and rapid treatment. Although the gold standard for diagnoses of GOO is endoscopy, many patients are identified by computerized tomography imaging. Point-of-care ultrasound (POCUS) is a rapid and non-invasive technique for evaluating patients in the emergency department. Previous literature has validated the use of ultrasound in diagnosing various intra-abdominal pathologies including bowel obstructions and appendicitis; however, there is limited research on evaluating gastric disease.1 We report three cases of GOO diagnosed with the “black-and-white cookie” sign on POCUS.

The Energy Sciences Network (ESnet) is the high-performance network user facility for the US Department of Energy (DOE) Office of Science (SC) and delivers highly reliable data transport capabilities optimized for the requirements of data-intensive science. In essence, ESnet is the circulatory system that enables the DOE science mission by connecting all of its laboratories and facilities in the US and abroad. ESnet is funded and stewarded by the Advanced Scientific Computing Research (ASCR) program and managed and operated by the Scientific Networking Division at Lawrence Berkeley National Laboratory (LBNL). ESnet is widely regarded as a global leader in the research and education networking community. Throughout 2021, ESnet and the Office of Fusion Energy Sciences (FES) of the DOE SC organized an ESnet requirements review of FES-supported activities. Preparation for these events included identification of key stakeholders: program and facility management, research groups, and technology providers. Each stakeholder group was asked to prepare formal case study documents about their relationship to the FES program to build a complete understanding of the current, near-term, and long-term status, expectations, and processes that will support the science going forward.