Dangling Carrots and Twisting Arms: Incentivizing COVID-19 Vaccination for Community Benefit.

Using the behavioral economics framework, the current study assessed the effectiveness of compliance gaining techniques and social normative influences to reduce vaccine hesitancy and increase vaccination behavior among college students. A total of 1,283 students responded to a cross-sectional survey assessing the influence of compliance gaining techniques and normative pressures upon vaccine attitudes and behavior. Findings suggest that being female, a person of color, and politically liberal were associated with increased likelihood of vaccination behavior. Likelihood of getting vaccinated was influenced by previous influenza vaccine behavior and parents' vaccination status, suggesting the importance of parental social norms. Compliance gaining techniques may have strengthened attitudes for unvaccinated students but were less successful at motivating actual vaccine behavior.

Evaluation of a pharmacist-led penicillin allergy testing service in a community health system.

BACKGROUND: Roughly 10% of the U.S. population has a documented penicillin (PCN) allergy. Among these individuals, over 95% are able to tolerate PCNs. The inability to use PCNs can result in suboptimal outcomes. In August 2019, Lawrence Memorial Hospital Health System implemented a pharmacist-led PCN allergy testing service to assist with delabeling PCN allergies and increase access to this class of antibiotics. OBJECTIVES: The primary objective was to describe the number of patients who underwent PCN allergy testing and were delabeled from PCN allergy. A secondary objective was to report the number of patients who received and tolerated PCN antibiotics after being delabeled from PCN allergy. METHODS: This retrospective chart review was conducted during the initial 17 months of a pharmacist-led PCN allergy testing service. Eligible patients with a history of an immunoglobulin E (IgE)-mediated reaction underwent a 3-step test that consisted of a scratch test, an intradermal test, and an oral challenge. Eligible patients who did not have a history of IgE-mediated reaction underwent a 2-step graded oral challenge. Descriptive statistics were used for data analysis. RESULTS: Between August 2019 and January 2022, 70 patients underwent testing, and 66 patients were delabeled from PCN allergy. Four patients who underwent the 3-step test developed reactions of mild to moderate severity. All patients who underwent the graded oral challenge were delabeled from PCN allergy. The rate of PCN allergy was 5.7%, whereas the rate of type I IgE-mediated reaction was 1.4%. All 23 patients who received an antibiotic from the PCN class after a negative allergy test tolerated the PCN antibiotic without an incident. CONCLUSION: PCN allergy testing is an effective way to delabel PCN allergies from most patients presenting with a PCN allergy history. Skin testing followed by an oral challenge or a graded oral challenge alone are safe methods for conducting PCN allergy testing in the primary care setting.

Effect of Family Presence on Advanced Trauma Life Support Task Performance During Pediatric Trauma Team Evaluation.

IMPORTANCE: In many hospitals, family members are separated from their children during the early phases of trauma care. Including family members during this phase of trauma care varies by institution and is limited by concerns for adverse effects on clinical care. OBJECTIVE: The aim of this study is to evaluate the effect of family presence (FP) on advanced trauma life support primary and secondary survey task performance by pediatric trauma teams. We hypothesized that trauma care with FP would be noninferior to care when families were absent. DESIGN: We performed a retrospective video review of consecutive pediatric trauma evaluations. Family presence status was determined by availability of the family. SETTING: The study was conducted at an American College of Surgeons-designated level I pediatric trauma center that serves the Washington, DC, metropolitan area. PARTICIPANTS: Participants included patients younger than 16 years of age who met trauma activation criteria and were evaluated by the trauma team in our emergency department. OUTCOME MEASURES: We compared task performance between patients with and without FP. RESULTS: Video recordings of 135 trauma evaluations were reviewed. Family was present for 88 (65%) evaluations. Patients with FP were younger (mean age, 6.4 years [SD = 4.1] vs 9.0 years [SD = 4.9]; P < 0.001) and more likely to have sustained blunt injuries (95% vs 85%, P = 0.03). Noninferiority of frequency and timeliness of completion of all primary survey tasks were confirmed for evaluations with FP. Noninferiority of frequencies of secondary survey task completion was confirmed for most tasks except for examination of the neck, pelvis, and upper extremities. Family members did not directly interfere with patient care in any case. CONCLUSIONS: Performance of most advanced trauma life support tasks during pediatric trauma evaluation was not worsened by FP. Our data provide additional evidence supporting FP during the acute management of injured children.

Infrared spectroscopic characterization of monocytic microvesicles (microparticles) released upon lipopolysaccharide stimulation.

Microvesicles (MVs) are involved in cell-cell interactions, including disease pathogenesis. Nondestructive Fourier-transform infrared (FTIR) spectra from MVs were assessed as a technique to provide new biochemical insights into a LPS-induced monocyte model of septic shock. FTIR spectroscopy provided a quick method to investigate relative differences in biomolecular content of different MV populations that was complementary to traditional semiquantitative omics approaches, with which it is difficult to provide information on relative changes between classes (proteins, lipids, nucleic acids, carbohydrates) or protein conformations. Time-dependent changes were detected in biomolecular contents of MVs and in the monocytes from which they were released. Differences in phosphatidylcholine and phosphatidylserine contents were observed in MVs released under stimulation, and higher relative concentrations of RNA and α-helical structured proteins were present in stimulated MVs compared with MVs from resting cells. FTIR spectra of stimulated monocytes displayed changes that were consistent with those observed in the corresponding MVs they released. LPS-stimulated monocytes had reduced concentrations of nucleic acids, α-helical structured proteins, and phosphatidylcholine compared with resting monocytes but had an increase in total lipids. FTIR spectra of MV biomolecular content will be important in shedding new light on the mechanisms of MVs and the different roles they play in physiology and disease pathogenesis.-Lee, J., Wen, B., Carter, E. A., Combes, V., Grau, G. E. R., Lay, P. A. Infrared spectroscopic characterization of monocytic microvesicles (microparticles) released upon lipopolysaccharide stimulation.

Clinical impact of a novel ambulatory rhythm monitor in children.

Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor's impact in clinical practice. Patients aged 0-18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.

Helping Hispanic Dementia Caregivers Cope with Stress Using Technology-based Resources.

OBJECTIVES: The objectives of this study were to develop and evaluate a culturally appropriate intervention for Hispanic/Latino caregivers of individuals with dementia, using a structured online program without professional involvement to improve well-being, decrease stress, and reduce depression. METHODS: The Webnovela Mirela, an online Spanish-language telenovela, was designed specifically to teach caregivers how to cope with dementia caregiving. A prototype of Webnovela Mirela was tested in a pilot study with 25 Hispanic/Latino dementia caregivers, 19 of whom completed the study. RESULTS: Data were analyzed using paired-samples t-tests. Results indicated a significant decrease from pre- to post-treatment in levels of stress and symptoms of depression (p = .045). CONCLUSIONS: The pilot study indicated high potential of the Webnovela Mirela to help the target population and demonstrated that the telenovela format is acceptable and helpful for Hispanic dementia caregivers. CLINICAL IMPLICATIONS: Study outcomes suggested that self-paced approaches with culturally relevant content in an appealing format for the target population have the potential to implement effective interventions. Furthermore, technology enables support programs to reach a broader audience in a cost-effective manner. Of note is the fact that minimal professional and/or personal assistance was required for caregivers to complete this intervention.

Costs and Trends in Utilization of Low-value Services Among Older Adults With Commercial Insurance or Medicare Advantage.

BACKGROUND: Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. OBJECTIVES: To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. RESEARCH DESIGN: A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse. SUBJECTS: Adults 50 and older enrolled in commercial plans and adults 65 and older enrolled in MA plans between 2009 and 2014. MEASURES: Costs and utilization of 16 low-value services in the following categories: cancer screening, imaging, and invasive procedures. RESULTS: The most commonly performed low-value service was imaging of the head for syncope, at rates of 33%-39% in commercial enrollees and 45% in MA enrollees. The least common service was peripheral artery stenting (<1%) in commercial enrollees, and laminectomy (0.15% in 2009) and renal artery stenting in MA enrollees (0.07% in 2014). Renal artery stenting decreased by roughly 75% over the study period, the largest decrease in utilization, with ∼$30 million and $10 million in reduced spending for commercial and MA plans and enrollees, respectively. Spending on these services in 2014 totaled $317.6 million for commercial and $100.8 million for MA health plans. CONCLUSIONS: Clinicians, researchers, and policymakers should strive to reach consensus on methods for more reliably and accurately identifying low-value service utilization. Greater consistency would facilitate monitoring use of low-value services and changing clinical practice patterns over time.

Let's Get Involved! The Impact of Service Learning on Drinking Perceptions, Alcohol Use, and Protective Behaviors in College Students.

While there is mounting support for the efficacy of alcohol-based curriculum infusion (CI) programs, studies have yielded mixed results. Insufficient attention has been given to nuances in the types of CI. Using a two-group pretest-posttest quasi-experimental design, this study assessed two forms of CI, information-only (IO) and service learning (SL), on drinking perceptions, drinking behavior, and protective behaviors. When the entire sample was considered, CI significantly improved participants' drinking perceptions and behavior. SL was more effective than IO for one measure of drinking behavior and for protective behaviors. Interestingly, there was a greater decrease in men's drinking behavior and increase in women's protective behaviors in the SL group. This study may help guide health professionals, educators, and faculty members interested in developing alcohol-focused CI programs.

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

OBJECTIVES: Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population. METHODS: We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis. RESULTS: FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups. CONCLUSIONS: Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

Improving ATLS performance in simulated pediatric trauma resuscitation using a checklist.

OBJECTIVE: To develop a checklist for use during pediatric trauma resuscitation and test its effectiveness during simulated resuscitations. BACKGROUND: Checklists have been used to support a wide range of complex medical activities and have effectively reduced errors and improved outcomes in different medical settings. Checklists have not been evaluated in the domain of trauma resuscitation. METHODS: A focus group of trauma specialists was organized to develop a checklist for pediatric trauma resuscitation. This checklist was then tested in simulated trauma resuscitations to evaluate its impact on team performance. Resuscitations conducted with and without the checklist were compared using the Advanced Trauma Life Support (ATLS) performance score, designed to measure adherence to ATLS protocol, and surveys of team members' subjective workload. RESULTS: The focus group generated a checklist with 56 items divided into 5 sections corresponding to different phases of trauma resuscitation. In simulation testing, the total ATLS performance score was 4.9 points higher with a checklist than without (P < 0.001), with most of this difference related to improvement in performance of the secondary survey (+3.3 points, P < 0.001). Overall, workload scores were not affected by the addition of the checklist. CONCLUSIONS: Implementing a checklist during simulated pediatric trauma resuscitation improves adherence to the ATLS protocol without increasing the workload of trauma team members.

Electronic and vibronic properties of a discotic liquid-crystal and its charge transfer complex.

Discotic liquid crystalline (DLC) charge transfer (CT) complexes combine visible light absorption and rapid charge transfer characteristics, being favorable properties for photovoltaic (PV) applications. We present a detailed study of the electronic and vibrational properties of the prototypic 1:1 mixture of discotic 2,3,6,7,10,11-hexakishexyloxytriphenylene (HAT6) and 2,4,7-trinitro-9-fluorenone (TNF). It is shown that intermolecular charge transfer occurs in the ground state of the complex: a charge delocalization of about 10(-2) electron from the HAT6 core to TNF is deduced from both Raman and our previous NMR measurements [L. A. Haverkate, M. Zbiri, M. R. Johnson, B. Deme, H. J. M. de Groot, F. Lefeber, A. Kotlewski, S. J. Picken, F. M. Mulder, and G. J. Kearley, J. Phys. Chem. B 116, 13098 (2012)], implying the presence of permanent dipoles at the donor-acceptor interface. A combined analysis of density functional theory calculations, resonant Raman and UV-VIS absorption measurements indicate that fast relaxation occurs in the UV region due to intramolecular vibronic coupling of HAT6 quinoidal modes with lower lying electronic states. Relatively slower relaxation in the visible region the excited CT-band of the complex is also indicated, which likely involves motions of the TNF nitro groups. The fast quinoidal relaxation process in the hot UV band of HAT6 relates to pseudo-Jahn-Teller interactions in a single benzene unit, suggesting that the underlying vibronic coupling mechanism can be generic for polyaromatic hydrocarbons. Both the presence of ground state CT dipoles and relatively slow relaxation processes in the excited CT band can be relevant concerning the design of DLC based organic PV systems.

Factors affecting team size and task performance in pediatric trauma resuscitation.

OBJECTIVES: Varying team size based on anticipated injury acuity is a common method for limiting personnel during trauma resuscitation. While missing personnel may delay treatment, large teams may worsen care through role confusion and interference. This study investigates factors associated with varying team size and task completion during trauma resuscitation. METHODS: Video-recorded resuscitations of pediatric trauma patients (n = 201) were reviewed for team size (bedside and total) and completion of 24 resuscitation tasks. Additional patient characteristics were abstracted from our trauma registry. Linear regression was used to assess which characteristics were associated with varying team size and task completion. Task completion was then analyzed in relation to team size using best-fit curves. RESULTS: The average bedside team ranged from 2.7 to 10.0 members (mean, 6.5 [SD, 1.7]), with 4.3 to 17.7 (mean, 11.0 [SD, 2.8]) people total. More people were present during high-acuity activations (+4.9, P < 0.001) and for patients with a penetrating injury (+2.3, P = 0.002). Fewer people were present during activations without prearrival notification (-4.77, P < 0.001) and at night (-1.25, P = 0.002). Task completion in the first 2 minutes ranged from 4 to 19 (mean, 11.7 [SD, 3.8]). The maximum number of tasks was performed at our hospital by teams with 7 people at the bedside (13 total). CONCLUSIONS: Resuscitation task completion varies by team size, with a nonlinear association between number of team members and completed tasks. Management of team size during high-acuity activations, those without prior notification, and those in which the patient has a penetrating injury may help optimize performance.

Stress exposure histories revealed by biochemical changes along accentuated lines in teeth.

The regular incremental secretion of enamel and dentine can be interrupted during periods of stress resulting in accentuated growth lines. These accentuated lines, visible under light microscopy, provide a chronology of an individual's stress exposure. Previously, we showed that small biochemical changes along accentuated growth lines detected by Raman spectroscopy, coincided with the timing of medical history events and disruptions of weight trajectory in teeth from captive macaques. Here, we translate those techniques to study biochemical changes related to illness and prolonged medical treatment during early infancy in humans. Chemometric analysis revealed biochemical changes related to known stress-induced changes in circulating phenylalanine as well as other biomolecules. Changes in phenylalanine are also known to affect biomineralization which is reflected in changes in the wavenumbers of hydroxyapatite phosphate bands associated with stress in the crystal lattice. Raman spectroscopy mapping of teeth is an objective, minimally-destructive technique that can aid in the reconstruction of an individual's stress response history and provide important information on the mixture of circulating biochemicals associated with medical conditions, as applied in epidemiological and clinical samples.

Feasibility of pneumoperitoneum diagnosis using point-of-care ultrasound: a pilot study using a fresh cadaver model.

AIMS: To assess the accuracy of point-of-care ultrasound (PoCUS) in the hands of two trained and blinded emergency physicians (EPs) in detecting very small amounts of free intraperitoneal air injected intra-abdominally, using a fresh human cadaver model. MATERIAL AND METHODS: Fifteen cadavers were injected on 3 occasions with predefined quantities of free intraperitoneal air ranging from 0-10 mL. Seven cadavers were injected in the mid-epigastrium (ME), while 8 were injected in the left lower quadrant (LLQ). Each cadaver was scanned after each of the 3 injections by 2 trained and blinded EPs, resulting in 45 scans per sonographer. Scans were performed using previously validated and standardized techniques. All scans were recorded, time-stamped and labeled. For each scan the sonographers indicated "yes" or "no" to whether pneumoperitoneum was detected. A chi square analysis was performed to determine the sensitivity and specificity of PoCUS utilized by each sonographer of pneumoperitoneum based on the location and volume of air injected. RESULTS: Free air (0.25-10 mL) injected into the ME was successfully diagnosed in 36/42 instances (86% sensitivity), but only detected in 10/36 instances when injected into the LLQ (28% sensitivity). Both EPs detected all air injections of ≥2 mL into the ME. CONCLUSION: Detection of free air originating from the midepigastric region may become a future PoCUS indication for adequately trained EPs.

Exploring the neural correlates of goal-directed action and intention understanding.

Because we are a cooperative species, understanding the goals and intentions of others is critical for human survival. In this fMRI study, participants viewed reaching behaviors in which one of four animated characters moved a hand towards one of two objects and either (a) picked up the object, (b) missed the object, or (c) changed his path halfway to lift the other object. The characters included a human, a humanoid robot, stacked boxes with an arm, and a mechanical claw. The first three moved in an identical, human-like biological pattern. Right posterior superior temporal sulcus (pSTS) activity increased when the human or humanoid robot shifted goals or missed the target relative to obtaining the original goal. This suggests that the pSTS was engaged differentially for figures that appeared more human-like rather than for all human-like motion. Medial frontal areas that are part of a protagonist-monitoring network with the right pSTS (e.g., Mason and Just, 2006) were most engaged for the human character, followed by the robot character. The current data suggest that goal-directed action and intention understanding require this network and it is used similarly for the two processes. Moreover, it is modulated by character identity rather than only the presence of biological motion. We discuss the implications for behavioral theories of goal-directed action and intention understanding.

Chemical alterations to murine brain tissue induced by formalin fixation: implications for biospectroscopic imaging and mapping studies of disease pathogenesis.

Understanding biochemical mechanisms and changes associated with disease conditions and, therefore, development of improved clinical treatments, is relying increasingly on various biochemical mapping and imaging techniques on tissue sections. However, it is essential to be able to ascertain whether the sampling used provides the full biochemical information relevant to the disease and is free from artefacts. A multi-modal micro-spectroscopic approach, including FTIR imaging and PIXE elemental mapping, has been used to study the molecular and elemental profile within cryofixed and formalin-fixed murine brain tissue sections. The results provide strong evidence that amino acids, carbohydrates, lipids, phosphates, proteins and ions, such as Cl(-) and K(+), leach from tissue sections into the aqueous fixative medium during formalin fixation of the sections. Large changes in the concentrations and distributions of most of these components are also observed by washing in PBS even for short periods. The most likely source of the chemical species lost during fixation is the extra-cellular and intra-cellular fluid of tissues. The results highlight that, at best, analysis of formalin-fixed tissues gives only part of the complete biochemical "picture" of a tissue sample. Further, this investigation has highlighted that significant lipid peroxidation/oxidation may occur during formalin fixation and that the use of standard histological fixation reagents can result in significant and differential metal contamination of different regions of tissue sections. While a consistent and reproducible fixation method may be suitable for diagnostic purposes, the findings of this study strongly question the use of formalin fixation prior to spectroscopic studies of the molecular and elemental composition of biological samples, if the primary purpose is mechanistic studies of disease pathogenesis.

Exploring Non-Expert Robot Programming Through Crowdsourcing.

A longstanding barrier to deploying robots in the real world is the ongoing need to author robot behavior. Remote data collection-particularly crowdsourcing-is increasingly receiving interest. In this paper, we make the argument to scale robot programming to the crowd and present an initial investigation of the feasibility of this proposed method. Using an off-the-shelf visual programming interface, non-experts created simple robot programs for two typical robot tasks (navigation and pick-and-place). Each needed four subtasks with an increasing number of programming statements (if statement, while loop, variables) for successful completion of the programs. Initial findings of an online study (N = 279) indicate that non-experts, after minimal instruction, were able to create simple programs using an off-the-shelf visual programming interface. We discuss our findings and identify future avenues for this line of research.

Transdermal scopolamine patch with odansetron for the control of nausea after uterine artery embolization compared with odansetron alone: results of a randomized placebo-controlled trial.

PURPOSE: To determine whether the transdermal scopolamine patch in combination with odansetron is more effective than odansetron alone at reducing the nausea that occurs after uterine artery embolization (UAE). MATERIALS AND METHODS: Patients undergoing UAE at a single university medical center were randomly assigned to receive either a scopolamine patch (containing 1.5 mg of scopolamine) or a placebo. All participants and study personnel were blinded as to group assignment. The primary outcome was the degree of nausea in the first 24 hours after UAE as measured on a visual analog scale from 0 to 10. Nausea and pain at 24 and 72 hours after UAE and medication use were recorded. Baseline characteristics and outcomes were also analyzed. RESULTS: A total of 74 patients were enrolled; 37 were randomly assigned to receive scopolamine, and 37 received placebo. Although the overall level of nausea after UAE was low (mean score of 2.6 out of 10), there was a lower level of nausea with those treated with scopolamine compared with placebo during the first 24 hours after embolization; the difference was statistically significant (1.8 vs 3.4, P = .03). Adverse events were more common with the patch, with two patients experiencing episodes of profound disorientation and 71% reporting substantial dry mouth. The only predictor of greater nausea was the increasing severity of pain. CONCLUSIONS: The scopolamine patch provides a moderate reduction in the nausea associated with UAE but is associated with infrequent but notable episodes of patient disorientation.

Rapid Raman mapping of a fulgurite.

A fulgurite is a naturally occurring glass formed when lightning hits sand, rock, or soil. The formation of fulgurites is accompanied by mineralogical and sometimes compositional changes, and may record information about the environment in which they were formed. A previous investigation using Raman point spectroscopy discovered the presence of anatase, a low-temperature polymorph of TiO(2), and polyaromatic hydrocarbons within a fulgurite. These findings indicate that there were regions within the sample that were not subjected to temperatures of 2,000 K or more that the matrix is reported to attain when struck by lightning. This paper seeks to expand the previous research by utilizing the capabilities of a new Raman spectroscopic technological development that enables rapid mapping. The entire surface area of a cross-sectioned fulgurite (approximately 40 mm x 23 mm) sample was mapped allowing several regions of polyaromatic hydrocarbons and anatase to be located. Furthermore, shocked quartz was found within the boundary regions of the fulgurite, and is proposed to have resulted from contact with vaporized material during the lightning strike. Shocked quartz is typically indicative of extraterrestrial impact, yet its discovery here suggests that its formation is not exclusive to the impact process.