Point-of-Care Ultrasound of a Nasal Septal Abscess.

ABSTRACT: Although nasal septal abscesses (NSA) are rare, complications can be significant and devastating. Thus, timely diagnosis of NSA is critical. In this case report, we describe the use of point-of-care ultrasound in diagnosing NSA in a healthy boy presenting with viral upper respiratory infection symptoms and fever. Point-of-care ultrasound findings resulted in expediting this patient's treatment and transfer to a quaternary care center for definitive treatment.

Multisystem Inflammatory Syndrome in an Adult.

BACKGROUND: Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults. CASE REPORT: We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.

Toxic leukoencephalopathy-When a Boxer's fracture requires an MRI and LP.

This case report describes a young patient presenting to the ED with altered mental status several days after being diagnosed with a Boxer's fracture and ultimately discovered to have toxic leukoencephalopathy. We review the clinical features in his presentation leading to his diagnosis, as well as MRI imaging findings frequently found in his condition.

A novel technique for retrieval of a broken biopsy needle.

A broken needle is a rare complication of bone biopsy. We describe an easily applied technique of retrieval of a retained biopsy needle fragment using a cannulated drill typically used for internal fixation of femoral neck fractures. This approach allows for removal under moderate conscious sedation and can be performed by a radiologist using fluoroscopic or CT-fluoroscopic guidance in the radiology suite.

Electric-Field-Assisted Directed Assembly of Transition Metal Dichalcogenide Monolayer Sheets.

Directed assembly of two-dimensional (2D) layered materials, such as transition metal dichalcogenides, holds great promise for large-scale electronic and optoelectronic applications. Here, we demonstrate controlled placement of solution-suspended monolayer tungsten disulfide (WS2) sheets on a substrate using electric-field-assisted assembly. Micrometer-sized triangular WS2 monolayers are selectively positioned on a lithographically defined interdigitated guiding electrode structure using the dielectrophoretic force induced on the sheets in a nonuniform field. Triangular sheets with sizes comparable to the interelectrode gap assemble with an observed preferential orientation where one side of the triangle spans across the electrode gap. This orientation of the sheets relative to the guiding electrode is confirmed to be the lowest energy configuration using semianalytical calculations. Nearly all sheets assemble without observable physical deformation, and postassembly photoluminescence and Raman spectroscopy characterization of the monolayers reveal that they retain their as-grown crystalline quality. These results show that the field-assisted assembly process may be used for large-area bottom-up integration of 2D monolayer materials for nanodevice applications.

Barriers and Incentives to Rural Health Department Accreditation.

CONTEXT: Accreditation of local health departments has been identified as a crucial strategy for strengthening the public health infrastructure. Rural local health departments (RLHDs) face many challenges including lower levels of staffing and funding than local health departments serving metropolitan or urban areas; simultaneously their populations experience health disparities related to risky health behaviors, health outcomes, and access to medical care. Through accreditation, rural local health departments can become better equipped to meet the needs of their communities. OBJECTIVE: To better understand the needs of communities by assessing barriers and incentives to state-level accreditation in Missouri from the RLHD perspective. DESIGN: Qualitative analysis of semistructured key informant interviews with Missouri local health departments serving rural communities. PARTICIPANTS: Eleven administrators of RLHDs, 7 from accredited and 4 from unaccredited departments, were interviewed. Population size served ranged from 6400 to 52,000 for accredited RLHDs and from 7200 to 73,000 for unaccredited RLHDs. RESULTS: Unaccredited RLHDs identified more barriers to accreditation than accredited RLHDs. Time was a major barrier to seeking accreditation. Unaccredited RLHDs overall did not see accreditation as a priority for their agency and failed to the see value of accreditation. Accredited RLHDs listed more incentives than their unaccredited counterparts. Unaccredited RLHDs identified accountability, becoming more effective and efficient, staff development, and eventual funding as incentives to accreditation. CONCLUSIONS: There is a need for better documentation of measurable benefits in order for an RLHD to pursue voluntary accreditation. Those who pursue accreditation are likely to see benefits after the fact, but those who do not pursue do not see the immediate and direct benefits of voluntary accreditation. The finding from this study of state-level accreditation in Missouri provides insight that can be translated to national accreditation.

Formation and frequency response of two-dimensional nanowire lattices in an applied electric field.

Ordered two-dimensional (2D) lattices were formed by assembling silica-coated solid and segmented Au nanowires between coplanar electrodes using alternating current (ac) electric fields. Dielectrophoretic forces from the ac field concentrated wires between the electrodes, with their long axis aligned parallel to the field lines. After reaching a sufficient particle density, field-induced dipolar interactions resulted in the assembly of dense 2D lattices that spanned the electrodes, a distance of at least ten wire lengths. The ends of neighboring Au wires or segments overlapped a fraction of their length to form lattice structures with a "running bond" brickwork-like pattern. The observed lattice structures were tunable in three distinct ways: (1) particle segmentation pattern, which fixed the lattice periodicity for a given field condition; (2) ac frequency, which varied lattice periodicity in real time; and (3) switching the field on/off, which converted between lattice and smectic particle organizations. Electric field simulations were performed to understand how the observed lattice periodicity depends on the assembly conditions and particle segmentation. Directed self-assembly of well-ordered 2D metallic nanowire lattices that can be designed by Au striping pattern and reconfigured by changes in field conditions could enable new types of switchable optical or electronic devices.

Patterns and predictors of local health department accreditation in Missouri.

BACKGROUND: The Healthy People 2020 goal for the public health system is "to ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services." To address this goal, Missouri established the first statewide, voluntary accreditation program of local health departments (LHDs) and began accrediting the LHDs in 2003. The purpose of this study was to identify organizational, structural, and workforce factors related to accreditation status of LHDs in Missouri. METHODS: Using data from the National Association of County & City Health Officials (2010) and the Missouri Department of Health & Senior Services (2012), binary logistic regression analysis was performed to predict accreditation status of LHDs. Likelihood ratio tests were used to examine whether the addition of each predictor added significantly to the model compared with a model including total revenues alone. Adjusted odds ratios (aORs), 95% confidence intervals, the significance level of the likelihood ratio test, and the overall Nagelkerke pseudo-R for each model are reported. RESULTS: Having a community health improvement plan (aOR = 6.2), a strategic plan (aOR = 7.9), evaluating programs (aOR = 3.6), being in a region with a high proportion of accredited LHDs (aOR = 5.5), and participating in multijurisdictional collaborations (aOR = 6.4) all increased the likelihood of accreditation. Barriers of time (aOR = 0.1) and cost (aOR = 0.3) were negatively associated with accreditation. CONCLUSIONS: Accredited LHDs were more likely to have completed the prerequisites for accreditation and collaborate with other LHDs. These activities help LHDs meet the accreditation standards. In addition, with shrinking budgets, LHDs will need additional financial and technical support to achieve accreditation. Assisting LHDs to find ways to increase the staff is important. Through collaborations with other LHDs, regional or multicounty positions can be created. Also collaborations with universities, specifically colleges or schools of public health, can provide opportunities for internships at LHDs giving practical experience while providing important assistance to LHDs.

Construct validity of the core competencies for public health professionals.

Measuring the competency of the public health workforce is critical to improving the functioning of the public health system. This study investigated the construct validity and reliability of the Core Competencies for Public Health Professionals, as promulgated by the Council on Linkages Between Academia and Public Health (COL). Principal component analysis, correlation and reliability analysis and known-groups comparisons were utilized. Results suggest omitting six items and moving six items to arrive at a 65 item, eight factor solution that corresponds with the eight COL domains. Additional evidence of construct validity was provided by known-groups comparisons that effectively discriminated between respondents known to differ on job type, education and practice experience. This study provides substantial support for the validity of the Core Competencies as a tool for assessing the competency of professionals in the public health workforce while suggesting some revisions to improve the measurement properties of the competency set.

Are the public health workforce competencies predictive of essential service performance? A test at a large metropolitan local health department.

Since many training initiatives employ the core public health workforce competencies as objectives, it is important to demonstrate an association between competency and essential service job performance. A cross-sectional survey of 420 employees of a local health department was conducted in 1999, with a response rate of 76 percent. Each of ten essential service performance measures was regressed on four core competency measures, controlling for employee experience and education. The competencies explained 2 percent to 20 percent of the variance in essential service performance. While offering support for the core competencies as a foundation for training program content, the results also make clear the large role that other individual, organizational, and community influences may have. Explaining additional variance in performance will require incorporating these variables into future studies.