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Methanogens often inhabit sulfidic environments that favor the precipitation of transition metals such as iron (Fe) as metal sulfides, including mackinawite (FeS) and pyrite (FeS2). These metal sulfides have historically been considered biologically unavailable. Nonetheless, methanogens are commonly cultivated with sulfide (HS-) as a sulfur source, a condition that would be expected to favor metal precipitation and thus limit metal availability. Recent studies have shown that methanogens can access Fe and sulfur (S) from FeS and FeS2 to sustain growth. As such, medium supplied with FeS2 should lead to higher availability of transition metals when compared to medium supplied with HS-. Here, we examined how transition metal availability under sulfidic (i.e., cells provided with HS- as sole S source) versus non-sulfidic (cells provided with FeS2 as sole S source) conditions impact the metalloproteome of Methanosarcina barkeri Fusaro. To achieve this, we employed size exclusion chromatography coupled with inductively coupled plasma mass spectrometry and shotgun proteomics. Significant changes were observed in the composition and abundance of iron, cobalt, nickel, zinc, and molybdenum proteins. Among the differences were alterations in the stoichiometry and abundance of multisubunit protein complexes involved in methanogenesis and electron transport chains. Our data suggest that M. barkeri utilizes the minimal iron-sulfur cluster complex and canonical cysteine biosynthesis proteins when grown on FeS2 but uses the canonical Suf pathway in conjunction with the tRNA-Sep cysteine pathway for iron-sulfur cluster and cysteine biosynthesis under sulfidic growth conditions.IMPORTANCEProteins that catalyze biochemical reactions often require transition metals that can have a high affinity for sulfur, another required element for life. Thus, the availability of metals and sulfur are intertwined and can have large impacts on an organismismal biochemistry. Methanogens often occupy anoxic, sulfide-rich (euxinic) environments that favor the precipitation of transition metals as metal sulfides, thereby creating presumed metal limitation. Recently, several methanogens have been shown to acquire iron and sulfur from pyrite, an abundant iron-sulfide mineral that was traditionally considered to be unavailable to biology. The work presented here provides new insights into the distribution of metalloproteins, and metal uptake of Methanosarcina barkeri Fusaro grown under euxinic or pyritic growth conditions. Thorough characterizations of this methanogen under different metal and sulfur conditions increase our understanding of the influence of metal availability on methanogens, and presumably other anaerobes, that inhabit euxinic environments.
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Hierro , Metaloproteínas , Methanosarcina barkeri , Sulfuros , Azufre , Azufre/metabolismo , Hierro/metabolismo , Methanosarcina barkeri/metabolismo , Methanosarcina barkeri/crecimiento & desarrollo , Metaloproteínas/metabolismo , Sulfuros/metabolismo , Proteínas Arqueales/metabolismo , Proteínas Arqueales/genética , Minerales/metabolismo , ProteómicaRESUMEN
Ecosystems that are coupled by reciprocal flows of energy and nutrient subsidies can be viewed as a single "meta-ecosystem." Despite these connections, the reciprocal flow of subsidies is greatly asymmetrical and seasonally pulsed. Here, we synthesize existing literature on stream-riparian meta-ecosystems to quantify global patterns of the amount of subsidy consumption by organisms, known as "allochthony." These resource flows are important since they can comprise a large portion of consumer diets, but can be disrupted by human modification of streams and riparian zones. Despite asymmetrical subsidy flows, we found stream and riparian consumer allochthony to be equivalent. Although both fish and stream invertebrates rely on seasonally pulsed allochthonous resources, we find allochthony varies seasonally only for fish, being nearly three times greater during the summer and fall than during the winter and spring. We also find that consumer allochthony varies with feeding traits for aquatic invertebrates, fish, and terrestrial arthropods, but not for terrestrial vertebrates. Finally, we find that allochthony varies by climate for aquatic invertebrates, being nearly twice as great in arid climates than in tropical climates, but not for fish. These findings are critical to understanding the consequences of global change, as ecosystem connections are being increasingly disrupted.
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Ecosistema , Ríos , Animales , Humanos , Cadena Alimentaria , Invertebrados , PecesRESUMEN
Acetone carboxylases (ACs) catalyze the metal- and ATP-dependent conversion of acetone and bicarbonate to form acetoacetate. Interestingly, two homologous ACs that have been biochemically characterized have been reported to have different metal complements, implicating different metal dependencies in catalysis. ACs from proteobacteria Xanthobacter autotrophicus and Aromatoleum aromaticum share 68% sequence identity but have been proposed to have different catalytic metals. In this work, the two ACs were expressed under the same conditions in Escherichia coli and were subjected to parallel chelation and reconstitution experiments with Mn(II) or Fe(II). Electron paramagnetic and Mössbauer spectroscopies identified signatures, respectively, of Mn(II) or Fe(II) bound at the active site. These experiments showed that the respective ACs, without the assistance of chaperones, second metal sites, or post-translational modifications facilitate correct metal incorporation, and despite the expected thermodynamic preference for Fe(II), each preferred a distinct metal. Catalysis was likewise associated uniquely with the cognate metal, though either could potentially serve the proposed Lewis acidic role. Subtle differences in the protein structure are implicated in serving as a selectivity filter for Mn(II) or Fe(II).IMPORTANCEThe Irving-Williams series refers to the predicted stabilities of transition metal complexes where the observed general stability for divalent first-row transition metal complexes increase across the row. Acetone carboxylases (ACs) use a coordinated divalent metal at their active site in the catalytic conversion of bicarbonate and acetone to form acetoacetate. Highly homologous ACs discriminate among different divalent metals at their active sites such that variations of the enzyme prefer Mn(II) over Fe(II), defying Irving-Williams-predicted behavior. Defining the determinants that promote metal discrimination within the first-row transition metals is of broad fundamental importance in understanding metal-mediated catalysis and metal catalyst design.
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Acetona , Complejos de Coordinación , Acetona/metabolismo , Acetoacetatos , Manganeso/metabolismo , Bicarbonatos , Metales/metabolismo , Compuestos Ferrosos/metabolismo , CatálisisRESUMEN
Reactions of anthracene in Ln/T eutectic mixtures (Ln = La, Yb; T = Ni, Cu) have produced crystals of new complex lanthanide carbide hydride phases. The thermal decomposition of anthracene provides a source of both carbon and hydrogen. LaCHx forms in space group Pnma with unit cell parameters a = 7.2736(4) Å, b = 3.7218(2) Å, and c = 13.0727(7) Å. Yb2CHx forms in space group P-3m1 with unit cell parameters a = 3.5659(4) Å and c = 5.8000(8) Å, with a structure related to that of Ho2CF2. The presence of hydride in interstitial sites is supported by the formation of different compounds in the absence of hydrogen and by comparison to known hydride structures. 1H nuclear magnetic resonance (NMR) spectra collected on LaCHx show two unique hydride resonances, in agreement with the two available interstitial sites. Density of states calculations show that filling the tetrahedral sites in LaCHx with hydrogen increases metallic behavior, while adding hydrogen into the tetrahedral sites in Yb2CHx induces the formation of a band gap.
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River-to-lake transitional areas are biogeochemically active ecosystems that can alter the amount and composition of dissolved organic matter (DOM) as it moves through the aquatic continuum. However, few studies have directly measured carbon processing and assessed the carbon budget of freshwater rivermouths. We compiled measurements of dissolved organic carbon (DOC) and DOM in several water column (light and dark) and sediment incubation experiments conducted in the mouth of the Fox river (Fox rivermouth) upstream from Green Bay, Lake Michigan. Despite variation in the direction of DOC fluxes from sediments, we found that the Fox rivermouth was a net sink of DOC where water column DOC mineralization outweighed the release of DOC from sediments at the rivermouth scale. Although we found DOM composition also changed during our experiments, alterations in DOM optical properties were largely independent of the direction of sediment DOC fluxes. We found a consistent decrease in humic-like and fulvic-like terrestrial DOM and a consistent increase in the overall microbial composition of rivermouth DOM during our incubations. Moreover, greater ambient total dissolved phosphorus concentrations were positively associated with the consumption of terrestrial humic-like, microbial protein-like, and more recently derived DOM but had no effect on bulk DOC in the water column. Unexplained variation indicates that other environmental controls and water column processes affect the processing of DOM in this rivermouth. Nonetheless, the Fox rivermouth appears capable of substantial DOM transformation with implications for the composition of DOM entering Lake Michigan. Supplementary Information: The online version contains supplementary material available at 10.1007/s10533-022-01000-z.
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Arsenic is a toxic metalloid with differential biological effects, depending on speciation and concentration. Trivalent arsenic (arsenite, AsIII) is more toxic at lower concentrations than the pentavalent form (arsenate, AsV). In E. coli, the proteins encoded by the arsRBC operon are the major arsenic detoxification mechanism. Our previous transcriptional analyses indicate broad changes in metal uptake and regulation upon arsenic exposure. Currently, it is not known how arsenic exposure impacts the cellular distribution of other metals. This study examines the metalloproteome of E. coli strains with and without the arsRBC operon in response to sublethal doses of AsIII and AsV. Size exclusion chromatography coupled with inductively coupled plasma mass spectrometry (SEC-ICPMS) was used to investigate the distribution of five metals (56Fe, 24Mg, 66Zn, 75As, and 63Cu) in proteins and protein complexes under native conditions. Parallel analysis by SEC-UV-Vis spectroscopy monitored the presence of protein cofactors. Together, these data reveal global changes in the metalloproteome, proteome, protein cofactors, and soluble intracellular metal pools in response to arsenic stress in E. coli. This work brings to light one outcome of metal exposure and suggests that metal toxicity on the cellular level arises from direct and indirect effects.
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La15(FeC6)4F2 was grown as large crystals by reacting iron in a La/Ni eutectic flux in the presence of decafluorobiphenyl (C12F10) which acts as both a carbon and fluoride source. This mild fluorinating technique enables the isolation of an intermetallic product containing fluoride interstitials, as opposed to forming ionic metal fluorides. The compound adopts a structure in the hexagonal crystal system with space group P6Ì which features FeC6 units composed of a central iron atom coordinated by three ethylenide units in a trigonal planar configuration. The structure is related to the previously reported La15(FeC6)4H, but with fluoride fully occupying the interstitial hydride positions, which induces partial occupancies and site splitting disorder in the adjacent layers of lanthanide ions. No supercell formation is observed.
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In North America, native unionid mussels are imperiled due to factors such as habitat degradation, pollution, and invasive species. One of the most substantial threats is that posed by dreissenid mussels, which are invasive mussels that attach to hard substrates including unionid shells and can restrict movement and feeding of unionids. This dreissenid mussel biofouling of unionids varies spatially in large ecosystems, such as the Great Lakes, with some areas having low enough biofouling to form effective refugia where unionid mussels might persist. Here, we measured biofouling on mussels suspended in cages over the growing season (generally first week in June to last week of August) over 3 years in nearshore areas in Lake Erie (2014-2016), Lake Michigan (Grand Traverse Bay, 2015 and Green Bay, 2016), and Lake Huron (2015). Biofouling varied substantially by years within Lake Erie, with increasingly higher biofouling rates each year. Although dreissenid mussels are present throughout these lakes, we observed very low biofouling in Grand Traverse Bay (Lake Michigan) and Saginaw Bay (Lake Huron), with no dreissenid mussels in 8 of 9 sites across these two bays. Sampling in the rivermouth of the Fox River (Wisconsin) and the Maumee River (Ohio) both showed very high biofouling in areas adjacent to the outlet of these tributaries into Green Bay and Maumee Bay (Lake Erie), respectively. These watersheds are dominated by agriculture, and we would expect high growth of primary producers (i.e., mussel food) and primary consumers (unionids and zebra mussels) in these areas compared to the other sampled bays or the open waters of the Great Lakes.
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SignificanceMore than 400 million tons of plastic waste is produced each year, the overwhelming majority of which ends up in landfills. Bioconversion strategies aimed at plastics have emerged as important components of enabling a circular economy for synthetic plastics, especially those that exhibit chemically similar linkages to those found in nature, such as polyesters. The enzyme system described in this work is essential for mineralization of the xenobiotic components of poly(ethylene terephthalate) (PET) in the biosphere. Our description of its structure and substrate preferences lays the groundwork for in vivo or ex vivo engineering of this system for PET upcycling.
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Dioxigenasas , Ácidos Ftálicos , Plásticos/química , Tereftalatos Polietilenos/químicaRESUMEN
Since the early 2000s, Lake Erie has been experiencing annual cyanobacterial blooms that often cover large portions of the western basin and even reach into the central basin. These blooms have affected several ecosystem services provided by Lake Erie to surrounding communities (notably drinking water quality). Several modeling efforts have identified the springtime total bioavailable phosphorus (TBP) load as a major driver of maximum cyanobacterial biomass in western Lake Erie, and on this basis, international water management bodies have set a phosphorus (P) reduction goal. This P reduction goal is intended to reduce maximum cyanobacterial biomass, but there has been very limited effort to identify the specific locations within the western basin of Lake Erie that will likely experience the most benefits. Here, we used pixel-specific linear regression to identify where annual variation in spring TBP loads is most strongly associated with cyanobacterial abundance, as inferred from satellite imagery. Using this approach, we find that annual TBP loads are most strongly associated with cyanobacterial abundance in the central and southern areas of the western basin. At the location of the Toledo water intake, the association between TBP load and cyanobacterial abundance is moderate, and in Maumee Bay (near Toledo, Ohio), the association between TBP and cyanobacterial abundance is no better than a null model. Both of these locations are important for the delivery of specific ecosystem services, but this analysis indicates that P load reductions would not be expected to substantially improve maximum annual cyanobacterial abundance in these locations. These results are preliminary in the sense that only a limited set of models were tested in this analysis, but these results illustrate the importance of identifying whether the spatial distribution of management benefits (in this case P load reduction) matches the spatial distribution of management goals (reducing the effects of cyanobacteria on important ecosystem services).
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INTRODUCTION: Aortoenteric fistula (AEF) is a rare condition and consists of an abnormal communication between the aorta and the gastrointestinal (GI) tract. The duodenum is the most common location. Fistulas involving the stomach are very uncommon and account for only 2% of the cases. AEF typically results in rapid and fatal exsanguination as diagnosis is frequently missed or made too late (Bixby et al., 2018; Kougias et al., 2003; Lookman, 1959; Genc et al., 2000; Ong et al., 2019; Li et al., 2020). PRESENTATION OF CASE: A 59 years old female with a history of Nissen fundoplication presented with lower gastrointestinal bleeding. Esophagogastroduodenoscopy (EGD) showed a large blood clot in the gastric fundus with no visible source of active bleeding. A mesenteric angiogram, performed for persistent gastro-intestinal bleeding and following two episodes of cardiac arrest, showed no evidence of active bleeding. The left gastric artery was prophylactically embolized. Persistent hemorrhage prompted an exploratory laparotomy followed by a left thoracotomy and confirmed the diagnosis of an aortogastric fistula (AGF). The patient expired intra-operatively. DISCUSSION: AGF is a very rare but often fatal condition (Busuttil and Goldstone, 2001). Computerized tomography angiography (CTA) can be a key to the diagnosis (Raman et al., 2012). EGD and catheter angiography have low sensitivity (Kuhara et al., 2015; Manduch et al., 2008). Definitive diagnosis is usually made during surgical exploration or autopsy (Wasvary et al., 1997). While open surgical repair is considered the gold standard therapy, endovascular therapy is becoming the preferred initial treatment option (Bixby et al., 2018). CONCLUSION: AGF should be considered in the differential diagnosis of GI bleeding, especially in patients with massive hemorrhage where EGD and mesenteric angiography are not diagnostic.
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OBJECTIVE: Medical errors in the emergency department (ED) occur frequently. Yet, common adverse event detection methods, such as voluntary reporting, miss 90% of adverse events. Our objective was to demonstrate the use of patient-reported data in the ED to assess patient safety, including medical errors. METHODS: Analysis of patient-reported survey data collected over a 1-year period in a large, academic emergency department. All patients who provided a valid e-mail or cell phone number received a brief electronic survey within 24 hours of their ED encounter by e-mail or text message with Web link. Patients were asked about ED safety-related processes. RESULTS: From Aug 2012 to July 2013, we sent 52,693 surveys and received 7103 responses (e-mail response rate 25.8%), including 2836 free-text comments (44% of respondents). Approximately 242 (8.5%) of 2836 comments were classified as potential safety issues, including 12 adverse events, 40 near-misses, 23 errors with minimal risk of harm, and 167 general safety issues (eg, gaps in care transitions). Of the 40 near misses, 35 (75.0%) of 40 were preventable. Of the 52 adverse events or near misses, 5 (9.6%) were also identified via an existing patient occurrence reporting system. CONCLUSIONS: A patient-reported approach to assess ED-patient safety yields important, complementary, and potentially actionable safety information.
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Servicio de Urgencia en Hospital/normas , Errores Médicos/tendencias , Medición de Resultados Informados por el Paciente , Seguridad del Paciente/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Similarity in community composition declines as distance between locations increases, a phenomenon that has been observed in a wide variety of freshwater, marine and terrestrial ecosystems. One driver of the distance-similarity relationship is the presence of environmental gradients that alter the suitability of sites for particular species. Although some environmental gradients, such as geology, do not change on a year-to-year basis, others, such as temperature, vary annually and over longer time periods. Here, we used a 21-year dataset of fish communities in the upper Mississippi River to examine the effect of distance on variation in community composition and to assess whether the effect of distance is primarily due to its effect on thermal regime. Because the Mississippi River is aligned mostly north-to-south, larger distances along the river roughly correspond to larger differences in latitude and therefore thermal regime. As expected, there was a moderate distance-similarity relationship, suggesting greater distance leads to less similarity. The effect of distance appeared to increase slightly over time. Using a subset of data for which air temperature was available, we compared models that incorporated both difference among sites in degree days (a surrogate for thermal regime) and physical distance (river km). Although physical distance presumably incorporates more environmental gradients than just temperature (and other potential mechanisms), temperature alone appears to be more strongly associated with differences in the Mississippi River fish community than distance.
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Migración Animal , Biota , Seguimiento de Parámetros Ecológicos/estadística & datos numéricos , Peces , Temperatura , Animales , Conjuntos de Datos como Asunto , Mississippi , RíosRESUMEN
BACKGROUND: Epicormic branches arise from dormant buds patterned during the growth of previous years. Dormant epicormic buds remain just below the surface of trees, pushed outward from the pith during secondary growth, but maintain vascular connections. Epicormic buds can be activated to elongate into a new shoot, either through natural processes or horticultural intervention, to potentially rejuvenate orchards and restructure tree architecture. Because epicormic structures are embedded within secondary growth, tomographic approaches are a useful method to study them and understand their development. RESULTS: We apply techniques from image processing to determine the locations of epicormic vascular traces embedded within secondary growth of sweet cherry (Prunus avium L.), revealing the juvenile phyllotactic pattern in the trunk of an adult tree. Techniques include the flood fill algorithm to find the pith of the tree, edge detection to approximate the radius, and a conversion to polar coordinates to threshold and segment phyllotactic features. Intensity values from magnetic resonance imaging (MRI) of the trunk are projected onto the surface of a perfect cylinder to find the locations of traces in the "boundary image". Mathematical phyllotaxy provides a means to capture the patterns in the boundary image by modeling phyllotactic parameters. Our cherry tree specimen has the conspicuous parastichy pair (2,3), phyllotactic fraction 2/5, and divergence angle of approximately 143°. CONCLUSIONS: The methods described provide a framework not only for studying phyllotaxy, but also for processing of volumetric image data in plants. Our results have practical implications for orchard rejuvenation and directed approaches to influence tree architecture. The study of epicormic structures, which are hidden within secondary growth, using tomographic methods also opens the possibility of studying genetic and environmental influences such structures.
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The recovery of piscivorous birds around the world is touted as one of the great conservation successes of the 21st century, but for some species, this success was short-lived. Bald eagles, ospreys and great blue herons began repatriating Voyageurs National Park, USA, in the mid-20th century. However, after 1990, only eagles continued their recovery, while osprey and heron recovery failed for unknown reasons. We aimed to evaluate whether top-down effects of bald eagles and bottom-up effects of inclement weather, habitat quality and fish resources contributed to the failed recovery of ospreys and herons in a protected area. We quantified the relative influence of top-down and bottom-up factors on nest colonization, persistence (i.e., nest reuse) and success for ospreys, and occurrence and size of heronries using 26 years (1986-2012) of spatially explicit monitoring data coupled with multi-response hierarchical models and Bayesian variable selection approaches. Bald eagles were previously shown to recover faster due to intensive nest protection and management. Increased numbers of eagles were associated with a reduction in the numbers of osprey nests, their nesting success and heronry size, while higher local densities of nesting eagles deterred heronries nearby. We found little evidence of bottom-up limitations on the failed recovery of herons and ospreys. We present a conservation conundrum: bald eagles are top predators and a flagship species of conservation that have benefited from intensive protection, but this likely hindered the recovery of ospreys and herons. Returning top predators, or rewilding, is widely promoted as a conservation strategy for top-down ecosystem recovery, but managing top predators in isolation of jointly recovering species can halt or reverse ecosystem recovery. Previous studies warn of the potential consequences of ignoring biotic interactions amongst recovering species, but we go further by quantifying how these interactions contributed to failed recoveries via impacts on the nesting demography of jointly recovering species. Multi-species management is paramount to realizing the ecosystem benefits of top predator recovery.
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Águilas , Animales , Teorema de Bayes , Demografía , EcosistemaRESUMEN
Water level (WL) fluctuations in lakes influence many aspects of ecosystem processes. Concern about the potential impact of WL fluctuations on fisheries was one of the factors that motivated the decision in 2000 to alter the management of WL in the Rainy-Namakan reservoir complex (on the border between the U.S. state of Minnesota and the Canadian province of Ontario). We used a Before-After, Control-Impact (BACI) framework to identify potential impacts of the change in WL management to Walleye, Northern Pike and Yellow Perch catch per unit effort (CPUE). The CPUE of these species from 1990-1999 and from 2005-2014 were compared in four impact lakes (Lake Kabetogama, Namakan Lake, Rainy Lake and Sand Point Lake) and two control lakes (Lake of the Woods and Lake Vermilion) using a simple Bayesian model. Changes in fish CPUE in the impact lakes were often similar to changes that occurred in at least one control lake. The only change that was not similar to changes in control lakes was an increase of Yellow Perch in Lake Kabetogama. The two control lakes often differed substantially from each other, such that if only one had been available our conclusions about the role of WL management on fisheries would be very different. In general, identifying cause-and-effect relationships in observational field data is very difficult, and the BACI analysis used here does not specify a causative mechanism, so co-occurring environmental and management changes may obscure the effect of WL management.
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Esocidae , Explotaciones Pesqueras/estadística & datos numéricos , Lagos , Percas , Movimientos del Agua , Animales , Teorema de Bayes , Minnesota , OntarioRESUMEN
OBJECTIVE: The purpose of this study was to further explore the effect of EHRs on emergency department (ED) attending and resident physicians' perceived workload, satisfaction, and productivity through the completion of six EHR patient scenarios combined with workload, productivity, and satisfaction surveys. METHODS: To examine EHR usability, we used a live observational design combined with post observation surveys conducted over 3 days, observing emergency physicians' interactions with the EHR during a 1-hour period. Physicians were asked to complete six patient scenarios in the EHR, and then participants filled two surveys to assess the perceived workload and satisfaction with the EHR interface. RESULTS: Fourteen physicians participated, equally distributed by gender (50% females) and experience (43% residents, 57% attendings). Frustration levels associated to the EHR were significantly higher for attending physicians compared with residents. Among the factors causing high EHR frustrations are: (1) remembering menu and button names and commands use; (2) performing tasks that are not straightforward; (3) system speed; and (4) system reliability. In comparisons between attending and resident physicians, time to complete half of the cases as well as the overall reaction to the EHR were statistically different. CONCLUSION: ED physicians already have the highest levels of burnout and fourth lowest level of satisfaction among physicians and, hence, particular attention is needed to study the impact of EHR on ED physicians. This study investigated key EHR usability barriers in the ED particularly, the assess frustration levels among physicians based on experience, and identifying factors impacting those levels of frustrations. In our findings, we highlight the most favorable and most frustrating EHR functionalities between both groups of physicians.
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Registros Electrónicos de Salud , Servicio de Urgencia en Hospital , Percepción , Médicos/psicología , Agotamiento Profesional , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Programas Informáticos , Carga de TrabajoRESUMEN
Given their significance to school violence, this study quantifies the association between bullying victimization and perceptions of safety separately for victimization where the type is not specified versus victimization that is physical in nature. Generalized liner mixed modeling was employed with 5,138 sixth- to eighth-grade students in 24 schools who self-reported on their bullying victimization and perceptions of school safety on an anonymous survey in fall 2015. Results indicate a multiplicative interaction exists with regard to the odds of feeling unsafe at school among those who were bullied at all (odds ratio [ OR] = 3.1) compared to those who were bullied physically ( OR = 9.12). For school nurses who work with students with a variety of concerns and health issues, this research indicates that the use of bullying victimization as an outcome, proxy and/or predictor, requires inquiry into the type of bullying experienced to aid in the care and support received.
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Conducta del Adolescente/psicología , Acoso Escolar/estadística & datos numéricos , Víctimas de Crimen/psicología , Estudiantes/psicología , Adolescente , Víctimas de Crimen/estadística & datos numéricos , Femenino , Humanos , Masculino , Seguridad , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricosRESUMEN
Recent trends indicate that a greater number of orthopaedic surgeons who complete their residency and/or fellowship training are accepting employment positions at hospitals. Moreover, established orthopaedic surgeons with successful private practices have begun to consider whether aligning with hospitals and larger health systems can be effectively accomplished. A comprehensive evaluation of institution-based employment opportunities is essential for orthopaedic surgeons considering hospital-based employment. Surgeons should be aware of the healthcare, clinical, and administrative opportunities of private practice employment versus hospital-based employment before accepting a clinical position.