Phenotypic Plasticity Drives Seasonal Thermal Tolerance in a Baltic Copepod.

Seasonal changes in environmental conditions require substantial physiological responses for population persistence. Phenotypic plasticity is a common mechanism to tolerate these changes, but for organisms with short generation times rapid adaptation may also be a contributing factor. Here, we aimed to disentangle the impacts of adaptation from phenotypic plasticity on thermal tolerance of the calanoid copepod Acartia hudsonica collected throughout spring and summer of a single year. We used a common garden (11 °C and 18 °C) design to determine the relative impacts of plasticity versus adaptation. Acartia hudsonica were collected from five time points across the season and thermal tolerance was determined using critical thermal maximum (CTmax) followed by additional measurements after one generation of common garden. As sea surface temperature increased through the season, field collected individuals showed corresponding increases in thermal tolerance but decreases in body size. Despite different thermal tolerances of wild collections, common garden animals did not differ in CTmax within thermal treatments. Instead, there was evidence of phenotypic plasticity where higher temperatures were tolerated by the 18 °C versus the 11 °C treatment animals across all collections. Acclimation also had significant effects on body size, with higher temperatures resulting in smaller individuals, consistent with the temperature size rule. Therefore, the differences in thermal tolerance and body size observed in field collected A. hudsonica were likely driven by plasticity rather than adaptation. However, the observed decrease in body size suggests that nutrient availability and ecosystem functioning could be impacted if temperatures consistently increase with no change in copepod abundance. This is the first record of A. hudsonica in the Baltic Sea known to the authors.

Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial.

OBJECTIVE: This study aimed to determine whether lower extremity fracture fixation technique and timing (≤24 vs. >24 hours) impact neurologic outcomes in TBI patients. METHODS: A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age 18 years and older, head Abbreviated Injury Scale (AIS) score of >2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN), or open reduction and internal fixation (ORIF). The analysis was conducted using analysis of variamce, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Scale (RLAS-R). RESULTS: Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN, or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe lower extremity injuries (AIS score, 4-5) compared with the IMN group (16% vs. 3%, p = 0.01) but not the ORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohorts with the longest time to intervention for the IMN group (median hours: Ex-Fix, 15 [8-24] vs. ORIF, 26 [12-85] vs. IMN, 31 [12-70]; p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of lower extremity fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS score were associated with a lower discharge RLAS-R score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002-1.03 and OR, 2.37; 95% CI, 1.75-3.22), and a higher Glasgow Coma Scale motor score on admission (OR, 0.84; 95% CI, 0.73-0.97) was associated with higher RLAS-R score at discharge. CONCLUSION: Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of lower extremity fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.

Examining the Factors Influencing Applicants' Placement on One General Surgery Program's Rank Order List.

PURPOSE: Surgery residency applications include variables that determine an individual's rank on a program's match list. We performed this study to determine which residency application variables are the most impactful in creating our program's rank order list. METHODS: We completed a retrospective examination of all interviewed applicants for the 2019 match. We recorded United States Medical Licensing Examinations (USMLE) step I and II scores, class quartile rank from the Medical Student Performance Evaluation (MSPE), Alpha Omega Alpha (AOA) membership, geographic region, surgery clerkship grade, and grades on other clerkships. The MSPE and letters of recommendation were reviewed by two of the authors and assigned a score of 1 to 3, where 1 was weak and 3 was strong. The same two authors reviewed the assessments from each applicant's interview and assigned a score from 1-5, where 1 was poor and 5 was excellent. Univariate analysis was performed, and the significant variables were used to construct an adjusted multivariate model with significance measured at P < .05. RESULTS: Univariate analysis for all 92 interviewed applicants demonstrated that USMLE step 2 scores (P = .002), class quartile rank (P = .004), AOA status (P = .014), geographic location (P < .001), letters of recommendation (P < .001), and interview rating (P < .001) were significant in predicting an applicant's position on the rank list. On multivariate analysis only USMLE step 2 (P = .018) and interview (P < .001) remained significant. CONCLUSION: USMLE step 2 and an excellent interview were the most important factors in constructing our rank order list. Applicants with a demonstrated strong clinical fund of knowledge that develop a rapport with our faculty and residents receive the highest level of consideration for our program.

The use of occupation based interventions among certified hand therapists.

BACKGROUND: The effectiveness of occupation-based hand therapy and the barriers to the use of occupation-based interventions (OBIs) have been established, but the current experience of hand therapists using OBIs and the extent of the use of OBIs in practice is unknown. OBJECTIVE: This study aimed to identify the frequency that occupational therapists who are Certified Hand Therapists (CHTs) utilized OBIs, how occupational therapists who are CHTs described their application of OBIs, and identify the supports and barriers to the application of OBIs. METHODS: Twenty-nine participants completed a survey that included 27 questions. The questions consisted of close ended, Likert scale, and multiple-choice questions which were analyzed quantitatively, and open-ended questions which were analyzed qualitatively. RESULTS: The majority of the participants, 57.7%, reported implementing OBI at least 75% of the time. Barriers and supports to the use of OBIs reported include a lack of equipment and therapist creativity, and support for the use of OBIs included the therapist's creativity, support from the facility, the availability of equipment, and the intrinsic motivation of therapists. Descriptions of OBI application included activity simulation, adaptive equipment use, and participation in meaningful activity. CONCLUSION: Although the use of OBIs in hand therapy may be expanding, occupational therapy practitioners and educators have a role to play in overcoming the remaining barriers to occupation-based hand therapy. Additional research is needed to gain further insight into use of occupation-based intervention by occupational therapists who are CHTs and explore the effect of education on promoting the use of OBIs.

How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

INTRODUCTION: The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. METHODS: A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. RESULTS: A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed (P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). DISCUSSION: During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

The Change in Surgical Case Diversity Over the Past 15 Years and the Influence on the Pursuit of Surgical Fellowship.

The surgical community has expressed concern that residents do not receive the same caliber training as their predecessors and the increase in fellowships have been described as secondary to perceived lack of preparation. Yet, data show no change in total cases even after implementation of the 80-hour workweek. It is hypothesized that the increasing subspecialization of general surgery may decrease in certain resident case numbers. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) General Surgery Case Logs National Data Report (1999-2014) of mean number of procedures per resident for 19 surgical categories. Statistical analysis was performed with analysis of variance over three time periods between 1999 and 2014. The number of total cases performed by residents has not changed significantly. There was a statistically significant difference observed in the variety of cases: vascular, esophageal, breast, and trauma cases decreased (P < 0.01), whereas major intestinal, hernia, liver, pancreatic, and biliary cases increased (P < 0.01). There are many reasons to pursue additional training after residency. The demonstrated change in case variability, presumably secondary to increasing fellowships, may play a significant role on training and preparation. Close monitoring of curriculums is essential to ensure a comprehensive general surgical education.