Severely Painful and Pruritic Forearm Rash: A Case of Caterpillar Envenomation in South Florida.

Introduction: The asp caterpillar (Megalopyge opercularis) is endemic to the southeastern United States, with most sightings in Florida, Texas, and Louisiana. A few hundred caterpillar envenomations are reported annually with most cases occurring in July-November. Asp caterpillars have hollow spines along their backs that contain venom. Contact with these spines is what produces the characteristic "sting" resulting in contact dermatitis and a localized hypersensitivity reaction collectively referred to as lepidopterism. Symptoms of lepidopterism may include severe burning pain, pruritis, edema, nausea, vomiting, abdominal pain, and headache. Symptoms are often self limited, and treatment should focus on expedited removal of implanted spines and aggressive symptom management. Case Report: We present the case of a patient presenting to the emergency department (ED) with acute-onset severe left forearm pain with associated pruritic rash incurred while working in a retail store. Initial therapeutic management included administration of analgesics, antihistamines, and steroids. After obtaining a comprehensive history and consulting with the Poison Control Center, we suspected an asp caterpillar envenomation. Following extraction of the caterpillar spines with silk tape, the patient's symptoms improved. After a period of observation in the ED, the patient was discharged home without any known sequelae. Conclusion: Although asp caterpillars typically inhabit trees and foliage, human exposure to the caterpillar may occur in developed environments. Effective history-taking, prompt communication with toxicologic experts, and complete removal of intact spines are essential for early identification and effective clinical management of asp caterpillar envenomation.

Trends in carbon monoxide poisoning deaths in high frequency hurricane states from 2014-19: the need for prevention intervention strategies.

INTRODUCTION: Hurricanes often result in power outages, which increase generator usage and carbon monoxide (CO) deaths. We aim to identify states with the highest frequency of hurricanes and evaluate the number of unintentional CO poisoning deaths by region, age, race and metropolitan distribution. METHODS: The number of hurricanes was determined using the FEMA database, and the number of unintentional CO poisoning deaths was determined using the CDC WONDER database from 2014-19. Hurricane-associated consumer outages were obtained from the Department of Energy. RESULTS: The number of unintentional CO poisoning deaths was as follows: Florida, South Carolina, North Carolina, Georgia and Alabama. Adults displayed a significantly higher number of unintentional CO poisoning deaths than pediatrics (P < 0.001). The total number of unintentional CO poisoning deaths was highest in the White population (P < 0.001); however, unintentional CO poisoning death rates were nearly two times higher among Black population in adults (0.5 versus 0.3) and pediatrics (0.2 versus 0.1). Medium metropolitan areas exhibited significantly more unintentional CO poisoning deaths (P < 0.001). CONCLUSIONS: Hurricanes and unintentional CO poisoning deaths were most common in Florida. Death rates were higher among Black individuals. Medium metropolitan areas displayed significantly more unintentional CO poisoning deaths than all other areas.

A Closer Look at the Rising Epidemic of Mass Shootings in the United States and Its Association With Gun Legislation, Laws, and Sales.

INTRODUCTION: Mass shootings pose a considerable threat to public safety and significantly cost the United States in terms of lives and expenses. The following are the specific aims of this study: (1) to assess US mass shootings, firearm-related sales, laws, and regional differences from 2015 to 2021 and (2) to investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 pandemic. METHODS: A retrospective review was conducted of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the United States from 2015 to 2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015 to 2021 were selected for further analysis. RESULTS: Mass shootings correlated significantly with firearm sales from 2015 to 2021 nationwide (P < 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared to the years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. CONCLUSIONS: Firearm sales correlated significantly with mass shootings from 2015 to 2021. Mass shootings and gun sales increased at greater rates during the Coronavirus Disease 2019 pandemic compared to the years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

Gender Distribution of First and Senior Authorship Across Most Cited Studies Within the Top Ten Surgical Journals From 2015-2020: Cementing Women Academic Surgery Representation.

INTRODUCTION: The aim of this study is to investigate the gender distribution of first and senior authors in the most highly cited original research studies published in the top 10 surgical journals from 2015 to 2020 to identify disparities and changes over time. METHODS: A retrospective study analyzing the gender distribution of first and senior authors in the top 10 most cited studies from the top 10 surgical journals from 2015 to 2020. The genders of the first and senior authors of each study were assessed using National Provider Identifier (NPI) numbers or pronouns from institutional biographies or news articles. RESULTS: The genders of 1200 first and senior authors from 600 original research studies were assessed. First author gender distribution consisted of 71.8% men, 22.3% women, 0% non-binary, and 5.8% unknown. Senior author gender distribution was 82.3% men, 14.3% women, 0% non-binary, and 3.3% unknown. Studies published by first authors who are women received more citations than those published by first authors that are men in 2015 (169.1 versus 112.9, P = 0.002) and 2016 (144.2 versus 101.5, P = 0.011). There was an increase in first authorship among men from 2015 to 2020 (P = 0.035). CONCLUSIONS: Men represent a significantly higher proportion of both first and senior authorships in top surgical research and the gap has widened from 2015 to 2020. However, studies written by women first authors received significantly more citations than those written by men.

Evaluation of Citation Inaccuracies in Surgical Literature by Journal Type, Study Design, and Level of Evidence: Towards Safeguarding the Peer-Review Process.

BACKGROUND: Accurate citation practices are key to furthering knowledge in an efficient and valid manner. The aim of this study is to investigate the prevalence of citation inaccuracies in original research from the top-ranked surgical journals and to evaluate the impact level of evidence has on citation inaccuracy. METHODS: A retrospective study evaluating the citation accuracy of the top 10 ranked surgical journals using the SJCR indicators. For each year between 2015 and 2020, the top 10 cited studies were selected, totaling 60 studies from each journal. From each individual study, 10 citations were randomly selected and evaluated for accuracy. Categories of inaccuracy included fact not found, study not found, contradictory conclusion, citation of a citation, and inaccurate population. RESULTS: A total of 5973 citations were evaluated for accuracy. Of all the citations analyzed, 15.2% of them had an inaccuracy. There was no statistically significant difference in citations inaccuracy rates among the years studied (P = .38) or study level of evidence (P = .21). Annals of Surgery, Plastic and Reconstructive Surgery and Annals of Surgical Oncology had significantly more citation inaccuracies than other journals evaluated (P < .05). JAMA Surgery, The Journal of Endovascular Therapy and The Journal of Thoracic and Cardiovascular Surgery had significantly fewer citation inaccuracies. CONCLUSIONS: Although 84.8% of citations from 2015-2020 were determined to be accurate, citation inaccuracies continue to be prevalent throughout highly-ranked surgical literature. There were no significant differences identified in citation inaccuracy rates between the years evaluated or based on study level of evidence.

Mass Shootings and Their Proximity to a Public or Private School: Protecting the Health and Livelihood of Our Children.

INTRODUCTION: Firearm-related violence occupies the third leading age-adjusted mortality rate among all mechanisms of injury. We aim to analyze the distribution of mass shootings in relation to the distance to the nearest public/private school in the United States. METHODS: A retrospective study investigating mass shootings and proximity to school areas. Information regarding mass shootings was obtained from the Gun Violence Archive. The locations of public/private schools for the 2019-2020 school year were obtained from the National Center for Education Statistics and the Euclidian distance from a mass shooting to the nearest school was measured. RESULTS: There were 417 mass shootings in 2019 and 610 in 2020. The average distance from a mass shooting to the nearest public/private school was 0.52 miles in 2019 and 0.57 miles in 2020. Most mass shootings occurred within 0.30 miles of a school in 2019 and 0.40 miles in 2020. There was no significant association between average distance of a mass shooting to a public/private school and the population density in 2019 (P = .313) or 2020 (P = .351). CONCLUSION: The growing number of mass shootings from 2019-2020 was associated with an average distance of <0.60 miles from the location of a mass shooting to a public or private school, highlighting the danger posed to children living and learning in these areas. Mass shootings are prevalent throughout the country and the close proximity of these events to places of learning warrants further investigation into policies and preventive measures aimed at preventing gun violence occurring near schools.

The Affordable Care Act and its Effects on Trauma Care Access, Short- and Long-term Outcomes and Financial Impact: A Review Article.

Objective: The purpose of this study is to evaluate the current evidence regarding the impact of the ACA on trauma outcomes and the financial impact on trauma patients and trauma systems. Background: Traumatic injuries are the leading cause of death and disability between the ages of 1 to 47 years. Uninsured status has been associated with worse outcomes and higher financial strain. The Affordable Care Act (ACA) was signed into law with the aim of increasing health insurance coverage. Despite improvements in insured status, it is unclear how the ACA has affected trauma. Methods: We conducted a literature search using PubMed and Google Scholar for peer-reviewed studies investigating the impact of the ACA on trauma published between January 2017 and April 2021. Results: Our search identified 20 studies that evaluated the impact of ACA implementation on trauma. The evidence suggests ACA implementation has been associated with increased postacute care access but not significant changes in trauma mortality. ACA implementation has been associated with a decreased likelihood of catastrophic health expenditures for trauma patients. ACA was also associated with an increase in overall reimbursement and amount billed for trauma visits, but a decrease in Medicaid reimbursement. Conclusions: Some improvements on the financial impact of ACA implementation on trauma patients and trauma systems have been shown, but studies are limited by methods of calculating costs and by inconsistent pre-/post-ACA timeframes. Further studies on cost-effectiveness and cost-benefit analysis will need to be conducted to definitively determine the impact of ACA on trauma.

Effects of mode and time of EMS transport on the rate and distribution of dead on arrival among trauma population transported to ACSCOT-verified trauma centers in the United States.

BACKGROUND: Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury. METHODS: This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients. DOA was defined according to the data point, "arrived with no signs of life and did not recover". Patients with unknown vitals and patients with no EMS vitals at the scene (HR = 0, RR = 0, and SBP = 0) were excluded to identify DOAs who died during transport. The DOAs included for analysis were sorted into three groups based on injury severity score [low (ISS < 15), intermediate (ISS = 15-24), and severe (ISS ≥ 25)] and subdivided according to injury type (blunt vs. penetrating), EMS Mode of transport and transport times. Statistical significance was defined as p < 0.05. RESULTS: The majority of the evaluated 6030 adult DOA patients were male (73.3%) and 18-64 years of age (79.6%). Most patients sustained blunt injuries (58.2%), and the most common mechanism of injury was motor vehicle collisions (MVCs). Patients who traveled by helicopter EMS (HEMS) experienced less deaths than those traveling by ground EMS (GEMS) despite transporting more severely injured patients over longer time intervals. Median HEMS TTs were greater than their GEMS counterparts for blunt and penetrating injuries across all ISS groups but were associated with fewer deaths. CONCLUSION: Helicopter emergency medical service use with intermediate and severely injured patients with penetrating injuries is associated with a reduced number of DOAs. Future studies should prospectively investigate EMS performance to confirm the findings identified in this retrospective analysis. Additionally, other factors affecting pre-hospital EMS performance (e.g., geographic variations, weather-related characteristics, in-flight interventions/procedures) should be investigated. Finally, the results of this study highlight the need for standardized HEMS utilization triage criteria.

Single-Step Integration of Poly(3-Octylthiophene) and Single-Walled Carbon Nanotubes for Highly Reproducible Paper-Based Ion-Selective Electrodes.

Calibration of ion-selective electrodes (ISEs) is cumbersome, time-consuming, and constitutes a significant limitation for the development of single-use and wearable disposable sensors. To address this problem, we have studied the effect of ion-selective membrane solvent on ISE reproducibility by comparing tetrahydrofuran (THF) (a typical solvent for membrane preparation) and cyclohexanone. In addition, a single-step integration of semiconducting/transducer polymer poly(3-octylthiophene) (POT) with single-walled carbon nanotubes (SWCNTs) into the paper-based ISEs (PBISEs) substrate was introduced. PBISEs for potassium and sodium ions were developed, and these ISEs present outstanding sensor performance and high potential reproducibility, as low as ±1.0 mV (n = 3).