School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity.

INTRODUCTION: Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income. METHODS: Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023. RESULTS: Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats. CONCLUSIONS: HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

Active and passive waiting in impulsive choice: Effects of fixed-interval and fixed-time delays.

Behavioral interventions to improve self-control, preference for a larger-later (LL) reward over a smaller-sooner (SS) reward, involve experience with delayed rewards. Whether they involve timing processes remains controversial. In rats, there have been inconsistent results on whether timing processes may be involved in intervention-induced improvements in self-control. Interventions that improved self-control with corresponding timing improvements used fixed-interval (FI) delays, whereas interventions that failed to find corresponding timing improvements used fixed-time (FT) delays. The FI schedule includes a response contingency (active waiting), whereas the FT schedule delivers reward automatically (passive waiting). The present study compared the effects of FI and FT schedules in interventions and impulsive choice tasks to evaluate effects on self-control and timing behavior. The impulsive choice task evaluated preference for an SS option (one pellet after 10-, 15-, 20-, 25-, and 30-s delays) versus an LL option (two pellets after a 30-s delay). The intervention task included forced-choice SS (one pellet after 10 s) and LL (two pellets after 30 s) sessions under FI or FT schedules. FI schedules produced greater sensitivity to SS delay in the impulsive choice task. Both FI and FT interventions increased LL choices. Following choice testing, temporal bisection and peak interval tasks revealed better timing precision for rats with an FI delay experience. Overall, the FI choice contingency was associated with improved temporal attention and timing precision.

Pro-Con Debate: Should Critically Ill Patients Undergo Procedures at Bedside or in the Operating Room?

Nonoperating room anesthesia (NORA) is a fast-growing field in anesthesiology, wherein anesthesia care is provided for surgical procedures performed outside the main operating room (OR) pavilion. Advances in medical science and technology have led to an increasing number of procedures being moved out of the operating room to procedural suites. One such NORA location is the intensive care unit (ICU), where a growing number of urgent and emergent procedures are being performed on medically unstable patients. ICU-NORA allows medical care to be provided to patients who are too sick to tolerate transport between the ICU and the OR. However, offering the same, high-quality, and safe care in this setting may be challenging. It requires special planning and a thorough consideration of the presence of life-threatening comorbidities and location-specific and ergonomic barriers. In this Pro-Con commentary article, we discuss these special considerations and argue in favor of and against routinely performing procedures at the bedside in the ICU versus in the OR.

Chronic Alcohol Use Associated Encephalopathy With a Nearly Identical Presentation to Normal Pressure Hydrocephalus.

We present the case of a 52-year-old male who arrived at the Emergency Department after several ground-level falls in the past month. He complained of urinary incontinence, mild confusion, headaches, and appetite loss in the past month as well. Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed, which showed enlarged ventricles with moderately prominent cortical atrophy and no acute abnormalities. It was decided to conduct a cisternogram study with serial scans. The study showed a type IIIa cerebrospinal fluid (CSF) flow pattern at 24 hours. At the 48- and 72-hour marks, the study displayed an absence of radiotracer activity within the ventricles, while all the activity was concentrated within the cerebral cortices. These findings successfully ruled out normal pressure hydrocephalus (NPH) due to the highly specific indication of normal CSF circulation pattern. The patient was treated with thiamine and advised to quit drinking, as well as return for follow-up in one month as an outpatient for a repeat brain CT.

Exploring public health education's integration of critical race theories: A scoping review.

Introduction: Public health has declared a commitment toward diversity as a whole, with a commitment toward addressing and dismantling racism being at the forefront. Although public health has admirably taken on this mission, and the foundational principles of public health align with social justice and health equity, public health as a discipline is vastly behind other fields in integrating and utilizing critical race theorizations. Of particular concern is the lack of critical race theorization within public health education materials. Public health education serves as a precursor to public health practice and situates topics and competencies that are essential to one's foundational public health knowledge and skillset, thus the use of strong theoretical groundings is critical in public health education. Objectives: Therefore, to explore the current landscape of public health educational research that employs critical race theories, this study sought to conduct a scoping review investigating the current literature of public health pedagogical, instructional, and curricular efforts that utilize race and antiracist theorization principles as a means to administer public health education. More specifically, we sought to investigate how have faculty and instructors published their integration of race theorization in public health curriculum/instruction within the United States since 2011. Results: We found 18 examples from peer-reviewed literature of curricular, pedagogical, or instructional practices and strategies that integrate critical theories of race, including contemplative pedagogy (n = 1), antiracism (n = 3), Public Health Critical Race praxis (n = 4), Critical Race (n = 5), critical service-learning/community engagement (n = 2), ethnic studies (n = 1), and intersectionality (n = 2). Conclusion: These articles present a wide breadth of innovative approaches to infusing critical race studies within public health higher education, ranging from individual assignments to course design and implementation to institutional culture change, thus demonstrating the multifaceted nature of critical race studies within micro-learning communities and macro-discipline practices. Identifying theoretically grounded, exemplary models and scholarly recommendations of pedagogical, instructional, and curricular practices provides readers the opportunity to borrow from successful practices and implement concepts of race, racism, antiracism, intersectionality, and more into their classrooms.

The Early Impact of Deciding to Take the United States Medical Licensing Examination Step 1 for Osteopathic Medical Students in the Pass/Fail Era.

INTRODUCTION: The United States Medical Licensing Examination (USMLE) Step 1 recently shifted from a three-digit scoring format to a pass/fail scoring rubric. Lake Erie College of Osteopathic Medicine (LECOM) is among a number of osteopathic medical schools that traditionally included passing Step 1 as a graduation requirement. However, LECOM removed this requirement following the change in scoring format. National Board of Medical Examiners (NBME) subject examinations have a significant impact on the clerkship grades of third-year medical students. Therefore, our pilot study compared NBME subject examination scores among third-year LECOM medical students that did and did not take and pass Step 1. We anticipate that both high pre-clinical grade point average (GPA) and having passed Step 1 will be associated with higher subject exam scores, but passing Step 1 will have a relationship with higher subject exam scores that is independent of pre-clinical GPA. METHODS: Using voluntary response sampling, 201 osteopathic medical students from LECOM completed an online survey through Google Forms regarding their pre-clinical GPA, subject exam scores, whether they took and passed USMLE Step 1, and their study resources used throughout clerkships.  Results: There was a positive correlation (p < 0.05) found between pre-clinical GPA and exam scores across all subjects among students that took Step 1. There was no relationship between pre-clinical GPA and exam scores across all subjects among students that did not take Step 1 (p > 0.05). Students that took Step 1 had a higher pre-clinical GPA than those that did not. Students that took and passed Step 1 scored higher on subject exams. Fifty-nine percent of respondents indicated they would have studied more for Step 1 if these exams were scored on the three-digit format, while zero respondents indicated they would have studied less. CONCLUSION: Although higher pre-clinical GPA and taking Step 1 were associated with higher scores on subject exams, taking Step 1 appears to have an independent influence on subject exams because there was no relationship found between pre-clinical GPA and subject exam scores among students that did not take Step 1. Therefore, there may be features related to preparing for this exam that better equip osteopathic medical students to perform well on subject exams.

Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy: A Randomized Clinical Trial.

Importance: Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood. Objective: To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics. Design, Setting, and Participants: Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment. Intervention: The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care). Main Outcomes and Measures: The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program. Results: The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, -13.0% [95% CI, -19.1% to -6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, -3.3% [95% CI, -6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, -6.3% [95% CI, -11.4% to -1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, -1.2% [95% CI, -3.1% to 0.7%]; P = .32). Conclusions and Relevance: In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy. Trial Registration: ClinicalTrials.gov Identifier: NCT03269994.

A Case Report of Nearly Missed Renal Tubular Acidosis in the Setting of Sjögren's Syndrome.

The association of renal tubular acidosis (RTA) and Sjögren's syndrome (SS) has been well-documented in the literature previously but is often undiagnosed in clinical practice. In this case report, we present a case of a woman with distal RTA who presented with nausea, vomiting, and confusion. The case shows the diagnostic value of urine studies when evaluating a patient who has exaggerated and unexplained electrolyte losses and how this will change management. Recognizing the extra glandular manifestations of patients with SS is important for patient care to prevent delays in care and treatment.

Mechanisms of impulsive choice: Experiments to explore and models to map the empirical terrain.

Impulsive choice is preference for a smaller-sooner (SS) outcome over a larger-later (LL) outcome when LL choices result in greater reinforcement maximization. Delay discounting is a model of impulsive choice that describes the decaying value of a reinforcer over time, with impulsive choice evident when the empirical choice-delay function is steep. Steep discounting is correlated with multiple diseases and disorders. Thus, understanding the processes underlying impulsive choice is a popular topic for investigation. Experimental research has explored the conditions that moderate impulsive choice, and quantitative models of impulsive choice have been developed that elegantly represent the underlying processes. This review spotlights experimental research in impulsive choice covering human and nonhuman animals across the domains of learning, motivation, and cognition. Contemporary models of delay discounting designed to explain the underlying mechanisms of impulsive choice are discussed. These models focus on potential candidate mechanisms, which include perception, delay and/or reinforcer sensitivity, reinforcement maximization, motivation, and cognitive systems. Although the models collectively explain multiple mechanistic phenomena, there are several cognitive processes, such as attention and working memory, that are overlooked. Future research and model development should focus on bridging the gap between quantitative models and empirical phenomena.

Temporal Artery Biopsy: When Is It Worth the Headache?

BACKGROUND: Temporal artery biopsy is ordered when clinical symptoms and an elevated C-reactive protein values and/or erythrocyte sedimentation rates suggest giant cell arteritis. The percentage of temporal artery biopsies positive for giant cell arteritis is low. The objectives of our study were to analyze the diagnostic yield of temporal artery biopsies at an independent academic medical center and to develop a risk stratification model for triaging patients for possible temporal artery biopsy. METHODS: We retrospectively reviewed the electronic health records of all patients who underwent temporal artery biopsy in our institution from January 2010 through February 2020. We compared clinical symptoms and inflammatory marker (C-reactive protein and erythrocyte sedimentation rate) values of patients whose specimens were positive for giant cell arteritis with those of patients with negative specimens. Statistical analysis included descriptive statistics, chi-square test, and multivariable logistic regression. A risk stratification tool, which included point assignments and measures of performance, was developed. RESULTS: Of 497 temporal artery biopsies for giant cell arteritis performed, 66 were positive and 431 were negative. Jaw/tongue claudication, elevated inflammatory marker values, and age were associated with a positive result. Using our risk stratification tool, 3.4% of low-risk patients, 14.5% of medium-risk patients, and 43.9% of high-risk patients were positive for giant cell arteritis. CONCLUSIONS: Jaw/tongue claudication, age, and elevated inflammatory markers were associated with positive biopsy results. Our diagnostic yield was much lower when compared with a benchmark yield determined in a published systematic review. A risk stratification tool was developed based on age and the presence of independent risk factors.

Nanoconfined Crystallization in Poly(lactic acid) (PLA) and Poly(ethylene terephthalate) (PET) Induced by Various Forms of Premelt-Deformation.

The processing-structure-property relationship using poly(lactic acid) (PLA) and poly(ethylene terephthalate) (PET) is explored. Specifically, both pre-extension and preshear of amorphous PLA and PET above their glass transition temperatures Tg , carried out in the affine deformation limit, can induce a specific type of cold crystallization during annealing, i.e., nanoconfined crystallization (NCC) where crystal sizes are limited to a nanoscopic scale in all dimensions so as to render the processed PLA and PET optically transparent. The new polymer structure after premelt deformation can show considerably enhanced mechanical properties. For example, premelt stretching produces geometric condensation of the chain network. This structural alternation can profoundly change the mechanical characteristics, e.g., turning brittle PLA ductile. In contrast, after preshear of amorphous PLA above Tg , the NCC containing PLA remains brittle, showing the importance to have geometric condensation from processing. Both AFM imaging and SAXS measurements are performed to verify that premelt deformation of PLA and PET indeed results in NCC from annealing that permits the strain-induced cold crystallization to take place on the length scale of the mesh size of the deformed chain network.

Diagnosis and Treatment of New-Onset Perioperative Atrial Fibrillation.

This article reviews medical and surgical risk factors for developing atrial fibrillation (AF), the most common sustained dysrhythmia in the United States. Evidence for assessment and management of patients with AF, including AF newly identified in the preoperative clinic, immediately preoperatively, intraoperatively, and unstable AF, is presented. A stepwise approach to guide anesthetic decision-making in the assessment of newly identified preoperative AF is proposed. Anesthetic considerations, including the potential impacts of anesthetic and vasopressor selection, and current evidence related to rate control and rhythm control via pharmacologic or electrical cardioversion as well as anticoagulation strategies are discussed.

A Case of Portal Vein Thrombosis in a Patient With Methylenetetrahydrofolate Reductase A1298C Polymorphism.

Portal vein thrombosis (PVT) is a prothrombotic state caused by blood flow stasis, vascular injury, and/or hypercoagulability, resulting in partial or complete occlusion of the portal vein. PVT is a rare diagnosis, particularly among those without liver disease. Typical risk factors for PVT include cirrhosis, hepatocellular carcinoma, myeloproliferative neoplasms, other malignancies, oral contraceptive use, bowel infections, and inherited hypercoagulable disorders. The goal of this study is to analyze a case of PVT in a patient in which no clear etiology could be identified and to evaluate whether the patient's methylenetetrahydrofolate reductase (MTHFR) polymorphism may have been a risk factor. This is a case of a 44-year-old female with a history of irritable bowel syndrome, hypertension, hyperlipidemia, sleep apnea, gastric bypass surgery, and MTHFR polymorphism who presented to a walk-in clinic with five days of severe abdominal pain associated with diarrhea, nausea, and anorexia. Hypertension and tenderness over the right lower quadrant prompted a referral to the emergency department for evaluation of possible appendicitis. A contrasted computerized tomography (CT) scan of the abdomen and pelvis revealed a normal appendix and acute portal vein thrombosis. She was then admitted for treatment with intravenous (IV) heparin, fluids, and pain management. After an uneventful three-day hospital course, the patient was discharged on rivaroxaban with a plan to continue anticoagulation therapy for six months and follow up with a hematologist, who later confirmed the patient did not have any inherited hypercoagulable disorders. It is unclear whether the patient's MTHFR polymorphism prompted her PVT as existing data on MTHFR's effects are limited and conflicting. One cannot conclude that MTHFR caused a state of hyperhomocysteinemia to prompt hypercoagulability, as this has not been consistently proven in current literature, and the patient's homocysteine levels were not measured at the time of diagnosis. This case illustrates that further research on the various MTHFR polymorphisms and their effects on coagulation, potentially via homocysteinemia, is warranted. Further research on the MTHFR polymorphisms may help determine whether providers should test for MTHFR in the evaluation of thrombotic risk factors and may help optimize the treatment of thrombotic events for affected individuals.

Plate Waste Evaluation of Plant-Based Protein Entrees in National School Lunch Program.

OBJECTIVE: To assess plate waste of plant-based protein entrees compared with regularly served meat-based entrees in the National School Lunch Program (NSLP). DESIGN: Plate waste data were collected before and after introducing the plant-based entrees, using digital photography and the quarter-waste method. PARTICIPANTS: National School Lunch Program participants in grades 6-8. INTERVENTION: Two newly developed plant-based protein entrees were introduced into the menu cycle by replacing 2 regularly served meat-based entrees. MAIN OUTCOME MEASURE: Student plate waste of plant-based entrees compared with entrees regularly served in the NSLP meal pattern. ANALYSIS: A total of 4,138 meal observations were analyzed. Ordinary least-squares regressions and 2-sample unpaired t tests were used to determine significant differences in waste. RESULTS: National School Lunch Program participants wasted plant-based entrees more than all other entrees served during lunch. Students wasted all or none of the plant-based entrees more than partial servings. There were no significant differences in waste between demographic groups for the plant-based entrees. CONCLUSIONS AND IMPLICATIONS: Plant-based entrees served as a part of the NSLP may lead to increased plate waste than meat-based entrees. Novel food pairings and visibility of legumes may have led to increased plate waste.

Generalizability of time-based interventions: Effects of choice procedure and smaller-sooner delay.

Interventions exposing rats to delayed-reward contingencies attenuate suboptimal impulsive choices, a preference for a smaller-sooner (SS) over a larger-later (LL) reward. Interventions may potentially improve delay-tolerance, timing of delays, and/or discrimination of reward magnitudes. Generalization from the intervention to impulsive choice under different procedures can provide insights into the processes that underlie the intervention effects. Experiment 1 tested intervention effects on systematic-delay (SYS) and adjusting-delay (ADJ) procedures, predicting that intervention effects would be more effective on the SYS procedure with predictable delays. The ADJ procedure did not benefit significantly from intervention, but the SYS procedure, unexpectedly, showed greater impulsive choices following intervention. Experiment 2 tested whether short (5 s) SS intervention delays may have promoted greater impulsivity in the SYS impulsive choice procedure in Experiment 1. Short SS delays in choice and intervention procedures increased impulsive choices in comparison to longer (10 s) delays. Incongruent SS delays in the intervention/choice procedures resulted in negative intervention effects. The results suggest that short SS delays are detrimental to self-control and that specific temporal information generalizes from the intervention to the SYS choice task, but not the ADJ choice task.

Predicting Osteopathic Medical Student Performance on the United States Medical Licensing Examination Step 2 Clinical Knowledge From Results of the Comprehensive Osteopathic Medical Licensing Examination Level 2-Cognitive Evaluation.

Background To improve their standing in residency selection, many osteopathic medical students choose to take the United States Medical Licensing Examination (USMLE). Although scores on USMLE Step 1 and Level 1 of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) are known to be highly correlated, scarce data exist on the association between COMLEX-USA Level 2-Cognitive Evaluation (CE) and USMLE Step 2 Clinical Knowledge (CK) scores. In this study, we aimed to determine the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores and derive an equation to predict performance on USMLE Step 2 CK for applicants who have only taken COMLEX-USA. Methodology We reviewed COMLEX-USA Level 2-CE and USMLE Step 2 CK scores for all students at the Lake Erie College of Osteopathic Medicine from May 2020 to April 2021. Linear regression was used to evaluate the relationship between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores. Results A total of 340 students took both COMLEX-USA Level 2-CE and USMLE Step 2 CK. There was a linear association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores such that every one-point increase in COMLEX-USA was associated with a 0.13-point increase in USMLE Step 2 CK score (standard error = 9.1; model R2 = 0.64). Conclusions Students or programs interested in predicting performance on USMLE Step 2 CK from performance on COMLEX-USA Level 2-CE can do so using the following equation: USMLE Step 2 CK = 0.13(COMLEX-USA Level 2-CE) + 163.5.

Standalone 2-D Nanosheets and the Consequent Hydrogel and Coacervate Phases Formed by 2.5 nm Spherical U60 Molecular Clusters in Dilute Aqueous Solution.

Unexpected hydrogel and coacervate are observed for dilute (1 mM) uranyl peroxide molecular cluster (Li68K12(OH)20[UO2(O2)(OH)]60, U60) solution in the presence of di- or trivalent salts. We report the mechanism as the formation of anisotropic two-dimensional (2-D) single-layer nanosheets, driven by counterion-mediated attraction due to the size disparity between U60 and small counterions. With weak monovalent cations, the nanosheets are bendable, resulting in hollow, spherical blackberry-type supramolecular assemblies in a homogeneous solution. With extra strong divalent or trivalent cations, the tough, free-standing sheets lead to gelation at ∼1 mM U60. These stiff nanosheets are difficult to bend into spherical blackberry-type structures; instead, they stay in solution and form hydrogel based on their significant excluded volumes. At higher ionic strength, the large, thin filmlike nanosheet structures stack together more compactly and consequently lead to the transition from gel phase to a coacervate phase, another surprise since it was formed without the presence of bulky polycations.

Hematocrit estimates comparing centrifugation to a point-of-care method in beef cattle living at high altitude.

BACKGROUND: The hematocrit (Hct) or packed cell volume (PCV) reflects the blood volume occupied by red blood cells. The development of point-of-care (PoC) instruments can accelerate the ease of measuring Hct/PCV compared with traditional capillary centrifugation (TCC) methods. However, no studies have compared Hct/PCV levels in cattle at high elevation with other measurement methods. OBJECTIVES: In this study, we aimed to compare methods to estimate Hcts/PCVs of rangeland cattle at high elevation. We specifically wanted to determine if Hct/PCV levels measured with a commercial PoC instrument (i-Stat with CHEM8+ cartridges [PoCi ]) were comparable to Hct/PCV levels measured with traditional laboratory methods. METHODS: We assessed the Hct/PCV of 94 mature beef cattle (black Angus; Bos taurus) at ~2195 m above sea level using paired analyses of the PoCi and TCC methods from each animal. We used paired samples t-tests to compare mean Hct/PCVs. Correlation analyses relative to the line of identity and Passing-Bablok regression were used to assess systematic and proportional differences, respectively, and Bland-Altman plots were used to assess agreement between the two methods. RESULTS: The PoCi estimated a Hct of 28.2% ± 0.7% (SE), which was lower than the TCC estimated PCV of 39.2% ± 0.5%. The Bland-Altman plot revealed poor agreement between the two methods in addition to a -11% bias for the PoCi . The Passing-Bablok regression revealed both systematic and proportional bias between the two methods. CONCLUSIONS: Point-of-care blood instruments were not comparable to TCC methods for quantifying Hct/PCVs of cattle living at high elevations.

A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome.

Children's naive immune systems allow for a unique course of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus when compared to adults. In multi-system inflammatory syndrome in children (MIS-C), a current or recent SARS-CoV-2 infection can cause fever and elevated inflammatory markers in individuals under the age of 21. Similar to Kawasaki disease, Kikuchi disease, systemic lupus erythematosus, toxic shock syndrome (TSS), and macrophage activation syndrome (MAS), there is an influx of inflammation associated with MIS-C that creates this pathologic state. Because MIS-C affects numerous organ systems, its presentation varies substantially, thus making it difficult to diagnose and treat in a timely fashion. In our case, a previously healthy four-year-old African American female initially presented to the emergency department (ED) with high fever, abdominal pain, and headache after recent SARS-Co-V-2 exposure. After initially being diagnosed with a urinary tract infection (UTI), she returned with a myriad of symptoms, including persistent fever, abdominal pain, and conjunctivitis. Her initial SARS-CoV-2 test returned positive, and she was admitted and placed on broad-spectrum antibiotics then requiring vasopressors, mechanical ventilation, and an appendectomy. Her workup revealed elevated inflammatory markers, elevated brain natriuretic peptide (BNP), anemia, thrombocytopenia, pyuria, and hypercoagulability meeting the criteria for MIS-C. In addition to antibiotics, her treatment included IV immunoglobulin and methylprednisolone until the patient was stabilized for discharge. As more is learned about SARS-CoV-2, it will become increasingly important to consider the development and implications of MIS-C. Educating providers on the wide range of MIS-C presentations can lead to more effective preventative measures and treatments.

Olefin metathesis-based chemically recyclable polymers enabled by fused-ring monomers.

A promising solution to address the challenges in plastics sustainability is to replace current polymers with chemically recyclable ones that can depolymerize into their constituent monomers to enable the circular use of materials. Despite some progress, few depolymerizable polymers exhibit the desirable thermal stability and strong mechanical properties of traditional polymers. Here we report a series of chemically recyclable polymers that show excellent thermal stability (decomposition temperature >370 °C) and tunable mechanical properties. The polymers are formed through ring-opening metathesis polymerization of cyclooctene with a trans-cyclobutane installed at the 5 and 6 positions. The additional ring converts the non-depolymerizable polycyclooctene into a depolymerizable polymer by reducing the ring strain energy in the monomer (from 8.2 kcal mol-1 in unsubstituted cyclooctene to 4.9 kcal mol-1 in the fused ring). The fused-ring monomer enables a broad scope of functionalities to be incorporated, providing access to chemically recyclable elastomers and plastics that show promise as next-generation sustainable materials.