Evaluation of Secondary Overtriage at a Rural Level 1 Trauma Center.

OBJECTIVE: To retrospectively assess the prevalence of secondary overtriage (SO) within a rural regional Appalachian health care system. METHODS: Trauma registry data was extracted for all trauma activation transfer patients from 2017 to 2022. Transferred patients were then stratified into two groups, non-secondary overtriage (non-SO) or SO. Patients were considered SO if they met three criteria following transfer: an Injury Severity Score (ISS) of less than 15, no required operative intervention, and discharge within 48 hours of arrival. Descriptive statistics were compared for age, length of stay (LOS), ICU LOS, and ISS. Surgical subspecialty consultations were compared between the two groups. Patients in the SO group were further assessed by body region of injury and Abbreviated Injury Score (AIS). RESULTS: Among 3,291 trauma activation transfer patients, 43% (1,407) were considered SO transfers. Patients in the SO group were significantly younger, had shorter average hospital and ICU LOS, and lower ISS compared to the non-SO group. Additionally, 25.7% of patients in the SO group had injuries to the head or neck of which 8.96% have an AIS ≥3. 21% of patients had injuries to the face, with 0.14% having an AIS ≥3. CONCLUSIONS: 43% of transfer patients in this study met our definition of SO. Although no optimal rate of SO has been universally established, limiting SO stands to benefit both patients and trauma systems. This study highlights how institutional analysis of transfer patients may help inform transfer protocols to reduce secondary overtriage and overutilization of scarce resources.

Examining the potential impacts of a coastal renourishment project on the presence and abundance of Escherichia coli.

Erosion poses a significant threat to oceanic beaches worldwide. To combat this threat, management agencies often utilize renourishment, which supplements eroded beaches with offsite sand. This process can alter the physical characteristics of the beach and can influence the presence and abundance of microbial communities. In this study, we examined how an oceanic beach renourishment project may have impacted the presence and abundance of Escherichia coli (E. coli), a common bacteria species, and sand grain size, a sediment characteristic that can influence bacterial persistence. Using an observational field approach, we quantified the presence and abundance of E. coli in sand (from sub-tidal, intertidal, and dune zones on the beach) and water samples at study sites in both renourished and non-renourished sections of Folly Beach, South Carolina, USA in 2014 and 2015. In addition, we also measured how renourishment may have impacted sand grain size by quantifying the relative frequency of grain sizes (from sub-tidal, intertidal, and dune zones on the beach) at both renourished and non-renourished sites. Using this approach, we found that E. coli was present in sand samples in all zones of the beach and at each of our study sites in both years of sampling but never in water samples. Additionally, we found that in comparison to non-renourished sections, renourished sites had significantly higher abundances of E. coli and coarser sand grains in the intertidal zone, which is where renourished sand is typically placed. However, these differences were only present in 2014 and were not detected when we resampled the study sites in 2015. Collectively, our findings show that E. coli can be commonly found in this sandy beach microbial community. In addition, our results suggest that renourishment has the potential to alter both the physical structure of the beach and the microbial community but that these impacts may be short-lived.

Effects of Trauma Center Consolidation on Adult Trauma at a Rural Level 1 Trauma Center.

OBJECTIVE: The aim was to determine the impact of consolidation of two rural level 1 trauma centers on adult trauma patients presenting to the remaining level 1 trauma center. To our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed. METHODS: A single institution, retrospective study was conducted at a rural level 1 trauma center. Adult trauma patients who presented to our center from January 2017 to January 2022 were included. The cohorts spanned 33 months pre- and post-consolidation. Multiple demographic and outcome measures were gathered. Data were analyzed using the student's t-test and Chi-squared testing. RESULTS: There was a 33% increase in overall trauma activations and 9% increase in transfers from outside facilities post-consolidation. The post-consolidation group was significantly older, had higher mean injury severity score, and decreased hospital-free days. The post-consolidation group also saw an increase in ICU admission and surgical intervention. While there were no significant differences in ICU-free days or ventilator days, patients in the post-consolidation group with the highest level of activation who required both surgical intervention and ICU admission experienced decreased mortality. CONCLUSION: The consolidation of trauma services to a single level 1 trauma center in a rural Appalachian health system led to higher trauma volume and acuity, but most importantly decreased mortality for the most severely injured trauma patients.

Modelling the impact of forest management and CO2-fertilisation on growth and demography in a Sitka spruce plantation.

Afforestation and reforestation to meet 'Net Zero' emissions targets are considered a necessary policy by many countries. Their potential benefits are usually assessed through forest carbon and growth models. The implementation of vegetation demography gives scope to represent forest management and other size-dependent processes within land surface models (LSMs). In this paper, we evaluate the impact of including management within an LSM that represents demography, using both in-situ and reanalysis climate drivers at a mature, upland Sitka spruce plantation in Northumberland, UK. We compare historical simulations with fixed and variable CO2 concentrations, and with and without tree thinning implemented. Simulations are evaluated against the observed vegetation structure and carbon fluxes. Including thinning and the impact of increasing CO2 concentration ('CO2 fertilisation') gave more realistic estimates of stand-structure and physical characteristics. Historical CO2 fertilisation had a noticeable effect on the Gross Primary Productivity seasonal-diurnal cycle and contributed to approximately 7% higher stand biomass by 2018. The net effect of both processes resulted in a decrease of tree density and biomass, but an increase in tree height and leaf area index.

Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction.

Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.

Poor Outcomes of Patients From Delayed Care After Ground Level Falls.

BACKGROUND: Ground level falls are a common cause of morbidity and mortality in trauma patients. Delayed presentation in many conditions has been proven to lead to worsened outcomes. Currently, there are limited data on outcomes of those who have a delayed presentation after a ground level fall. MATERIALS AND METHODS: This study was a retrospective analysis of the Trauma Registry at our center. Any adult patient who presented after a ground level fall was grouped based on their time to presentation post-injury: less than or greater than 24 h. Age, gender, hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation days, Injury Severity Score, and mortality were patient characteristics gathered. A Student's t-test and Chi-squared testing were utilized to determine the presence of significant differences between the groups. Significance was set at P < .05. RESULTS: Two hundred of 4018 patients had delayed presentation. Those with delayed presentation were more likely to be male (P = .028), younger in age (71 vs 74 years old, P < .01), had greater hospital LOS (6 vs. 5, P < .01), ICU LOS (5 vs. 3, P < .01), and mechanical ventilation days (13 vs. 5 days, P < .01). They also had higher ISS (8 vs. 7, P < .01), and mortality was significantly higher in those who presented after 24 h (P = .034). CONCLUSION: Patients with delayed presentation after a ground level fall have worsened Injury Severity Scores and outcomes to include hospital and ICU LOS, ventilator days, and overall mortality.

Effects of Trauma Center Consolidation on Pediatric Trauma at an Appalachian Pediatric Hospital.

With the increase in hospital consolidation over the past decade, multiple studies have been performed evaluating patient outcomes after consolidation. To date, there have not been studies performed to assess outcomes in pediatric trauma patients. The goal was to assess pediatric patient outcomes in a children's hospital after consolidation of two Level 1 Trauma centers in a rural Appalachian health system. A retrospective analysis of data from the Trauma Registry between October 2015 - September 2020 was performed. The variables included in analysis were age, injury severity score (ISS), hospital days, intensive care unit days, ventilator days, mortality, discharge disposition, consults, and hospital visit cost. Despite increased ISS, there was no difference in in-patient outcomes. However, these patients were more likely to require orthopedic evaluation and further outpatient care after discharge, suggesting more severely injured patients were evaluated by the trauma service post consolidation.

Identifying Attitudes Toward and Acceptance of Osteopathic Graduates in Surgical Residency Programs in the Era of Single Accreditation: Results of the American College of Osteopathic Surgeons Medical Student Section Questionnaire of Program Directors.

Purpose The purpose of this study was to quantify the number of surgical programs currently training osteopathic residents and to solicit advice for current osteopathic medical students who are interested in pursuing a surgical residency.  Methods A questionnaire was sent to all listed Electronic Residency Application Service® (ERAS®) email contacts for the following specialties: General Surgery, Neurological Surgery, Orthopedic Surgery, Otolaryngology, Urology, Integrated Vascular Surgery, Integrated Plastic Surgery, and Integrated Thoracic Surgery. The questionnaire was sent a total of three times. Results Two hundred sixty-four of the 1,040 surgical residency programs responded to the questionnaire. Of these responses, 19% were formerly American Osteopathic Association (AOA) accredited programs. About 47.3% of responding programs indicated they are not currently training an osteopathic physician. One hundred thirteen programs provided additional comments on how osteopathic medical students may improve the competitiveness of their residency applications. These comments included increasing volumes of research activities, performing well on the United States Medical Licensing Exam (USMLE), and completing a sub-internship in the desired field or at a specific institution.  Conclusion Osteopathic students still face many barriers to matching into surgical residencies. This study provides concrete steps students may take to increase the competitiveness of their application.

From Then to now: Diversity, Equity, and Inclusion in the Association of Southeastern Biologists.

The Association of Southeastern Biologists was founded in 1937 with the goal of increasing the contact and collaboration between scientists in the southeastern United States (US). With the exception of two years during World War II and one year during the COVID-19 pandemic, the Association has met annually to promote research and education in the biological sciences by providing a student-friendly networking environment. In recent years, the Association has placed an increased focus on diversity, equity, and inclusion among elected and appointed leaders, among participants in the annual meeting, and in the development of funding and other opportunities for students. This work prompted us to review the history of our Association, including periods of racial segregation and inequity, and focus on our current efforts to promote access and inclusion by students and scientists from myriad underrepresented groups. In so doing, the past provides us with the opportunity to cast a vision for the future of the Association. In this paper, we seek to share the journey of the Association of Southeastern Biologists in this regard so that we may be transparent, exposing the missteps and amplifying the successes of our organization. We envision this work as a first step toward creating a more open and inclusive scientific community for the future.

Sourcing Antibiotic-Resistant Escherichia coli in Aquatic Ecosystems: A Combined Laboratory and Field Module.

The emergence of antibiotic-resistant bacteria represents a growing threat in aquatic ecosystems. In this combined field and laboratory activity, students will determine whether Escherichia coli, an indicator bacteria species commonly found in aquatic ecosystems, shows signs of resistance to common antibiotics. In addition, students will use molecular biology techniques to identify whether Escherichia coli cells sourced from different hosts (i.e., phylogroups) show different patterns of antibiotic resistance. This activity will help students to gain experience in environmental microbiology, environmental science, molecular biology, and public health. This module is also designed to provide instructors with flexibility to pick and choose activities that best meet the needs of their class or research program.

Borane catalysed cyclopropenation of arylacetylenes.

Triarylboranes have gained substantial attention as catalysts for C-C bond forming reactions due to their remarkable catalytic activities. Herein, we report B(C6F5)3 catalysed cyclopropenation of a wide variety of arylacetylenes using donor-acceptor diazoesters. A mild reaction protocol has been developed for the synthesis of functionalised cyclopropenes (33 examples) in good to excellent yields.

Hybrid auditory fMRI: In pursuit of increasing data acquisition while decreasing the impact of scanner noise.

BACKGROUND: Two challenges in auditory fMRI include the loud scanner noise during sound presentation and slow data acquisition. Here, we introduce a new auditory imaging protocol, termed "hybrid", that alleviates these obstacles. NEW METHOD: We designed a within-subject experiment (N = 14) wherein language-driven activity was measured by hybrid, interleaved silent (ISSS), and continuous multiband acquisition. To determine the advantage of noise attenuation during sound presentation, hybrid was compared to multiband. To identify the benefits of increased temporal resolution, hybrid was compared to ISSS. Data were evaluated by whole-brain univariate general linear modeling (GLM) and multivariate pattern analysis (MVPA). RESULTS: Comparison with existing methods: CONCLUSIONS: Our data revealed that hybrid imaging restored neural activity in the canonical language network that was absent due to the loud noise or slow sampling in the conventional imaging protocols. With its noise-attenuated sound presentation windows and increased acquisition speed, the hybrid protocol is well-suited for auditory fMRI research tracking neural activity pertaining to fast, time-varying acoustic events.

Acute Rheumatic Fever: A Review of Essential Cutaneous and Histological Findings.

Acute rheumatic fever (ARF) is an autoimmune response that may occur after infection with group A Streptococcus. Clinical manifestations are protean, making the syndrome difficult to recognize in the 21st century. Secondary prophylaxis with benzathine penicillin is given for 10 years after an episode of ARF to prevent recurrence and reduce the risk of rheumatic heart disease. This case highlights the importance of providing a detailed clinical history to the dermatopathologist when considering ARF in the differential diagnosis.

Promoting Access of Osteopathic Medical Students to Surgical Residency Training Programs.

The COVID-19 pandemic has uncovered disparities for allopathic and osteopathic surgical applicants for the upcoming 2021 residency application cycle. It has provided an opportunity for change to the current paradigm in surgical resident selection. This study seeks to quantify the disproportionality of opportunities between allopathic and osteopathic students and provides solutions to level the playing field for all applicants.

An Alternative Technique in Laparoscopic Cholecystectomies: Removal Without a Specimen Bag.

The use of specimen retrieval bags in elective laparoscopic cholecystectomies remains a customary practice intended to reduce surgical site infections. The lack of supporting evidence suggests that specimen bags may not be necessary. Thus, we present an alternative approach without the use of disposable instruments to reduce excessive healthcare costs while maintaining comparable surgical outcomes.

Variation in the presence and abundance of anthropogenic microfibers in the Cumberland River in Nashville, TN, USA.

Anthropogenic microfibers (thread-like pieces of litter < 5 mm in size) including microplastic fibers have been suggested to pose a growing threat to urban rivers across the world. However, in most urban rivers, we have a limited understanding of how anthropogenic microfibers vary in presence and abundance over time. In this study, we examined how the presence and abundance of anthropogenic microfibers varied in the Cumberland River in Nashville, TN, a growing city with more than one million residents. To measure anthropogenic microfibers, we collected grab samples of surface water weekly from three locations along the Cumberland River in Nashville, TN (one upstream of the city, one in downtown, and one downstream of the city), over a 7-week period in summer of 2018 (n = 151 total samples). We found that anthropogenic microfibers were present at all study sites over time (mean of all samples = 27.9 microfibers/L) and that the mean abundance of anthropogenic microfibers significantly increased in the city and downstream of the city relative to our upstream collection site. In addition, we found that anthropogenic microfiber abundance was significantly variable over time (sample values ranged from 0 to 195 pieces/L) and that multiple factors including the presence of wastewater treatment plants may be contributing to the abundance and distribution of anthropogenic microfibers in this urban river.

A Case of Cocaine-Induced Uvular Edema.

A 26-year-old male presented to the emergency department with a chief complaint of globus sensation and sore throat in the setting of recent cocaine use. On physical examination, he was found to have isolated uvular edema and erythema. After excluding other potential inciting mechanisms of Quincke's disease, he was treated with anti-inflammatory medication and was observed for any development of airway compromise prior to discharge.

Shared neural resources of rhythm and syntax: An ALE meta-analysis.

A growing body of evidence has highlighted behavioral connections between musical rhythm and linguistic syntax, suggesting that these abilities may be mediated by common neural resources. Here, we performed a quantitative meta-analysis of neuroimaging studies using activation likelihood estimate (ALE) to localize the shared neural structures engaged in a representative set of musical rhythm (rhythm, beat, and meter) and linguistic syntax (merge movement, and reanalysis) operations. Rhythm engaged a bilateral sensorimotor network throughout the brain consisting of the inferior frontal gyri, supplementary motor area, superior temporal gyri/temporoparietal junction, insula, intraparietal lobule, and putamen. By contrast, syntax mostly recruited the left sensorimotor network including the inferior frontal gyrus, posterior superior temporal gyrus, premotor cortex, and supplementary motor area. Intersections between rhythm and syntax maps yielded overlapping regions in the left inferior frontal gyrus, left supplementary motor area, and bilateral insula-neural substrates involved in temporal hierarchy processing and predictive coding. Together, this is the first neuroimaging meta-analysis providing detailed anatomical overlap of sensorimotor regions recruited for musical rhythm and linguistic syntax.