Analysis of Factors Influencing Financial Cost and Morbidity in Nonfatal Firearm Injuries.

Representing 68% of firearm-related injuries, nonfatal firearm injuries cause substantial morbidity and are associated with high costs to patients and the health care system. A retrospective analysis was performed to evaluate 359 adults in the Southeastern United States from 2019 to 2021. IBM SPSS was used for descriptive and parametric statistical analysis. The mean total cost of stay (TCOS) was $36,639.12, length of stay (LOS) was 8.61 days, number of times to the operating room was 1.88, and number of follow-ups was 3.21. Vascular and traumatic brain injuries were associated with higher TCOS and LOS. Vascular injuries were associated with more operating room visits. Bony injuries and non-TBI neurological injuries were associated with more follow-up appointments. In this brief report, we aim to understand the effect injury types have on these factors to help inform trauma protocol development with the goal of decreasing financial burdens.

Guidance on Minimum Standards for Canine-Assisted Psychotherapy in Adolescent Mental Health: Delphi Expert Consensus on Health, Safety, and Canine Welfare.

As interest in animal-assisted therapy (AAT) and canine-assisted psychotherapy (CAP) grows, there are increasing calls for the management of related health, safety, and welfare concerns for canines, providers, and clients. Existing health and safety guidelines lack empirical support and are, at times, contradictory. Welfare is increasingly prioritized; however, tools to monitor and manage welfare are underutilized and under-reported. The aim of this study was to provide expert consensus on the minimum health, safety, and welfare standards required to develop and deliver a CAP group program to adolescents experiencing common mental health disorders. Diverse AAT experts were recruited globally. Using Delphi methodology, over two rounds, 40 panelists reached a consensus agreement to include 32 items from a possible 49 into the minimum standards. Health and safety measures included risk assessment, veterinary screening, preventative medicine, training in infection control, and first aid. Welfare measures included training in welfare assessment, documentation of welfare, and flexible, individualized responses to promote wellbeing. Intestinal screening for parasites and the prohibition of raw food were not supported. Flexible and individualized assessment and management of canine welfare were supported over fixed and time-limited work schedules. Clinical practice implications are discussed, and recommendations are made.

The root-lesion nematode, Pratylenchus penetrans, affects early growth and physiology of grafted M.9, G.41 and G.935 apple rootstocks similarly under field microplot conditions.

The root-lesion nematode, Pratylenchus penetrans, is a ubiquitous parasite of roots of temperate fruit trees. It affects early growth of trees replanted into former orchard sites where populations have built up, and may contribute to decline complexes of older trees. Most British Columbia, Canada apple acreage is planted with M.9 rootstock, but growers are increasingly considering Geneva-series rootstocks such as G.41 and G.935. Among these rootstocks, responses to P. penetrans, specifically, are poorly known. To compare the resistance and tolerance to P. penetrans of G.41, G.935 and M.9 rootstocks ('Ambrosia' scion), a field microplot experiment was established in spring of 2020 at the Summerland Research and Development Centre. The experimental design was a 2 x 3 factorial combination of: P. penetrans inoculation (+/-) and rootstock (G.41, G.935, M.9), with 20 replicate microplots of each of the six treatment combinations arranged in a randomized complete block design. The P. penetrans inoculum was 5400 nematodes per microplot (54 P. penetrans L-1 soil), which is below commonly accepted damage thresholds. Though P. penetrans population densities were lower for the G.41 rootstock by the end of the 2021 growing season, the effects of P. penetrans were similar among rootstocks. In the establishment year (2020), P. penetrans caused significant reductions in aboveground growth. In 2021, shoot growth and root weight were reduced by P. penetrans. The nematode also reduced rates of leaf gas exchange and stem water potential. These data suggest that while G.41 and G.935 may have other horticultural benefits over M.9, they are equally susceptible to P. penetrans at the early stages of tree growth.

The process and perspective of serious incident investigations in adult community mental health services: integrative review and synthesis.

AIMS AND METHOD: Serious incident management and organisational learning are international patient safety priorities. Little is known about the quality of suicide investigations and, in turn, the potential for organisational learning. Suicide risk assessment is acknowledged as a complex phenomenon, particularly in the context of adult community mental health services. Root cause analysis (RCA) is the dominant investigative approach, although the evidence base underpinning RCA is contested, with little attention paid to the patient in context and their cumulative risk over time. RESULTS: Recent literature proposes a safety-II approach in response to the limitations of RCA. The importance of applying these approaches within a mental healthcare system that advocates a zero suicide framework, grounded in a restorative just culture, is highlighted. CLINICAL IMPLICATIONS: Although integrative reviews and syntheses have clear methodological limitations, this approach facilitates the management of a disparate body of work to advance a critical understanding of patient safety in adult community mental healthcare.

Artificial intelligence in medical referrals triage based on Clinical Prioritization Criteria.

The clinical prioritisation criteria (CPC) are a clinical decision support tool that ensures patients referred for public specialist outpatient services to Queensland Health are assessed according to their clinical urgency. Medical referrals are manually triaged and prioritised into three categories by the associated health service before appointments are booked. We have developed a method using artificial intelligence to automate the process of categorizing medical referrals based on clinical prioritization criteria (CPC) guidelines. Using machine learning techniques, we have created a tool that can assist clinicians in sorting through the substantial number of referrals they receive each year, leading to more efficient use of clinical specialists' time and improved access to healthcare for patients. Our research included analyzing 17,378 ENT referrals from two hospitals in Queensland between 2019 and 2022. Our results show a level of agreement between referral categories and generated predictions of 53.8%.

Androgen Receptor Activation Induces Senescence in Thyroid Cancer Cells.

Thyroid cancer (TC) is the most common endocrine malignancy, with an approximately three-fold higher incidence in women. TCGA data indicate that androgen receptor (AR) RNA is significantly downregulated in PTC. In this study, AR-expressing 8505C (anaplastic TC) (84E7) and K1 (papillary TC) cells experienced an 80% decrease in proliferation over 6 days of exposure to physiological levels of 5α-dihydrotestosterone (DHT). In 84E7, continuous AR activation resulted in G1 growth arrest, accompanied by a flattened, vacuolized cell morphology, with enlargement of the cell and the nuclear area, which is indicative of senescence; this was substantiated by an increase in senescence-associated ß-galactosidase activity, total RNA and protein content, and reactive oxygen species. Additionally, the expression of tumor suppressor proteins p16, p21, and p27 was significantly increased. A non-inflammatory senescence-associated secretory profile was induced, significantly decreasing inflammatory cytokines and chemokines such as IL-6, IL-8, TNF, RANTES, and MCP-1; this is consistent with the lower incidence of thyroid inflammation and cancer in men. Migration increased six-fold, which is consistent with the clinical observation of increased lymph node metastasis in men. Proteolytic invasion potential was not significantly altered, which is consistent with unchanged MMP/TIMP expression. Our studies provide evidence that the induction of senescence is a novel function of AR activation in thyroid cancer cells, and may underlie the protective role of AR activation in the decreased incidence of TC in men.

The landscape of BRCA1 and BRCA2 large rearrangements in an international cohort of over 20 000 ovarian tumors identified using next-generation sequencing.

BACKGROUND: Approximately half of ovarian tumors have defects within the homologous recombination repair pathway. Tumors carrying pathogenic variants (PVs) in BRCA1/BRCA2 are more likely to respond to poly-ADP ribose polymerase (PARP) inhibitor treatment. Large rearrangements (LRs) are a challenging class of variants to identify and characterize in tumor specimens and may therefore be underreported. This study describes the prevalence of pathogenic BRCA1/BRCA2 LRs in ovarian tumors and discusses the importance of their identification using a comprehensive testing strategy. METHODS: Sequencing and LR analyses of BRCA1/BRCA2 were conducted in 20 692 ovarian tumors received between March 18, 2016 and February 14, 2023 for MyChoice CDx testing. MyChoice CDx uses NGS dosage analysis to detect LRs in BRCA1/BRCA2 genes using dense tiling throughout the coding regions and limited flanking regions. RESULTS: Of the 2217 PVs detected, 6.3% (N = 140) were LRs. Overall, 0.67% of tumors analyzed carried a pathogenic LR. The majority of detected LRs were deletions (89.3%), followed by complex LRs (5.7%), duplications (4.3%), and retroelement insertions (0.7%). Notably, 25% of detected LRs encompassed a single or partial single exon. This study identified 84 unique LRs, 2 samples each carried 2 unique LRs in the same gene. We identified 17 LRs that occurred in multiple samples, some of which were specific to certain ancestries. Several cases presented here illustrate the intricacies involved in characterizing LRs, particularly when multiple events occur within the same gene. CONCLUSIONS: Over 6% of PVs detected in the ovarian tumors analyzed were LRs. It is imperative for laboratories to utilize testing methodologies that will accurately detect LRs at a single exon resolution to optimize the identification of patients who may benefit from PARP inhibitor treatment.

Positive citation bias and overinterpreted results lead to misinformation on common mycorrhizal networks in forests.

A common mycorrhizal network (CMN) is formed when mycorrhizal fungal hyphae connect the roots of multiple plants of the same or different species belowground. Recently, CMNs have captured the interest of broad audiences, especially with respect to forest function and management. We are concerned, however, that recent claims in the popular media about CMNs in forests are disconnected from evidence, and that bias towards citing positive effects of CMNs has developed in the scientific literature. We first evaluated the evidence supporting three common claims. The claims that CMNs are widespread in forests and that resources are transferred through CMNs to increase seedling performance are insufficiently supported because results from field studies vary too widely, have alternative explanations or are too limited to support generalizations. The claim that mature trees preferentially send resources and defence signals to offspring through CMNs has no peer-reviewed, published evidence. We next examined how the results from CMN research are cited and found that unsupported claims have doubled in the past 25 years; a bias towards citing positive effects may obscure our understanding of the structure and function of CMNs in forests. We conclude that knowledge on CMNs is presently too sparse and unsettled to inform forest management.

Defining Terms Used for Animals Working in Support Roles for People with Support Needs.

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: "assistance animal", "companion animal", "educational/school support animal", "emotional support animal", "facility animal", "service animal", "skilled companion animal", "therapy animal", and "visiting/visitation animal". At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., "skilled companion animal" and "service animal") due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.

COVID-19 and the labour market outcomes of disabled people in the UK.

The economic impact of COVID-19 has exacerbated inequalities in society, but disability has been neglected. This paper contributes to this knowledge gap by providing a comprehensive analysis of the differential labour market impact of COVID-19 by disability in the UK. Using data from the Labour Force Survey before and during the pandemic it estimates disability gaps in pre-pandemic risk factors, as well as changes in labour market inequality nearly one year on. Disabled workers are found to face higher COVID-19-related economic and health risks, including being more likely to work in 'shutdown' industries, and in occupations with greater proximity to others and exposure to disease. However, established measures of inequality, including the disability employment and pay gap suggest limited impact of COVID-19 in 2020. Nevertheless, the increase in the probability of being temporarily away from work, even among otherwise comparable workers, is 40% higher for disabled workers and consistent with disproportionate use of the government's job retention scheme. While the reasons for this are likely to be complex, there is a risk that it will contribute to future disability-related labour market inequality.

Androgen Activity Is Associated With PD-L1 Downregulation in Thyroid Cancer.

Thyroid cancer is the most prevalent endocrine malignancy in the United States with greater than 53,000 new cases in 2020. There is a significant gender disparity in disease incidence as well, with women developing thyroid cancer three times more often than men; however, the underlying cause of this disparity is poorly understood. Using RNA-sequencing, we profiled the immune landscape of papillary thyroid cancer (PTC) and identified a significant inverse correlation between androgen receptor (AR) levels and the immune checkpoint molecule PD-L1. The expression of PD-L1 was then measured in an androgen responsive-thyroid cancer cell line. Dihydrotestosterone (DHT) treatment resulted in significant reduction in surface PD-L1 expression in a time and dose-dependent manner. To determine if androgen-mediated PD-L1 downregulation was AR-dependent, we treated cells with flutamide, a selective AR antagonist, and prior to DHT treatment to pharmacologically inhibit AR-induced signaling. This resulted in a > 90% restoration of cell surface PD-L1 expression, suggesting a potential role for AR activity in PD-L1 regulation. Investigation into the AR binding sites showed AR activation impacts NF-kB signaling by increasing IkBα and by possibly preventing NF-kB translocation into the nucleus, reducing PD-L1 promoter activation. This study provides evidence of sex-hormone mediated regulation of immune checkpoint molecules in vitro with potential ramification for immunotherapies.

Copy neutral absence of heterozygosity on chromosome 15 distal long arm: A surrogate marker for Prader-Willi/Angelman syndromes?

BACKGROUND: Copy-neutral absence of heterozygosity (CN-AOH) observed on a single chromosome or part of a chromosome may be indicative of uniparental disomy (UPD) and may require additional testing when such chromosomes or chromosome regions are known to harbor imprinted genes. CASE PRESENTATION: Here we report 2 cases of neonates that presented to clinic with hypotonia, poor oral skills including inability to feed by mouth, weak cry, no response to noxious stimulation and vertical plantar creases (case 1) and hypotonia and respiratory distress (case 2). A preliminary chromosome analysis showed normal karyotypes in both cases while the high-resolution single nucleotide polymorphism (SNP) microarray showed copy neutral absence of heterozygosity involving chromosome 15 distal long arm. In case 1, the CN-AOH involved a 28.7 Mb block from genomic coordinates 73703619_102429049. In case 2, the CN-AOH involved a 15.3 Mb block from genomic coordinates 54729197_70057534. In both cases, methylation-specific PCR did not detect an unmethylated allele for the SNRPN gene suggesting either a deletion of paternal allele or maternal UPD for chromosome 15. Since microarray analysis did not show any copy number alterations on chromosome 15, a microdeletion was ruled out. CONCLUSIONS: Based on our cases, we suggest that CN-AOH on chromosome 15, even if it does not involve the critical region of 15q12q13, should warrant additional studies for diagnosis of Prader-Willi/Angelman syndromes.

Soil organic carbon in irrigated agricultural systems: A meta-analysis.

Over the last 200 years, conversion of non-cultivated land for agriculture has substantially reduced global soil organic carbon (SOC) stocks in upper soil layers. Nevertheless, practices such as no- or reduced tillage, application of organic soil amendments, and maintenance of continuous cover can increase SOC in agricultural fields. While these management practices have been well studied, the effects on SOC of cropping systems that incorporate irrigation are poorly understood. Given the large, and expanding, agricultural landbase under irrigation across the globe, this is a critical knowledge gap for climate change mitigation. We undertook a systematic literature review and subsequent meta-analysis of data from studies that examined changes in SOC on irrigated agricultural sites through time. We investigated changes in SOC by climate (aridity), soil texture, and irrigation method with the following objectives: (i) to examine the impact of irrigated agriculture on SOC storage; and (ii) to identify the conditions under which irrigated agriculture is most likely to enhance SOC. Overall, irrigated agriculture increased SOC stocks by 5.9%, with little effect of study length (2-47 years). However, changes in SOC varied by climate and soil depth, with the greatest increase in SOC observed on irrigated semi-arid sites at the 0-10 cm depth (14.8%). Additionally, SOC increased in irrigated fine- and medium-textured soils but not coarse-textured soils. Furthermore, while there was no overall change to SOC in flood/furrow irrigated sites, SOC tended to increase in sprinkler irrigated sites, and decrease in drip irrigated sites, especially at depths below 10 cm. This work sheds light on the nuances of SOC change across irrigated agricultural systems, highlights the importance of studying SOC storage in deeper soils, and will help guide future research on the impacts of irrigated agriculture on SOC.

Androgen receptor activation decreases proliferation in thyroid cancer cells.

The American Cancer Society predicted more than 52 000 new cases of thyroid cancer in 2020, making it the most prevalent endocrine malignancy. Due to the approximately threefold higher incidence of thyroid cancer in women, we hypothesize that androgens and/or androgen receptors play a protective role and that thyroid cancer in men represents an escape from androgen-mediated cell regulation. The analysis of androgen receptor (AR) expression in patient tissue samples identified a 2.7-fold reduction in AR expression (p < 0.005) in papillary thyroid cancer compared with matched, normal tissue. An in vitro cell model was developed by stably transfecting AR into 8505C undifferentiated thyroid cancer cells (resulting in clone 84E7). The addition of DHT to the clone 84E7 resulted in AR translocation into the nucleus and a 70% reduction in proliferation, with a shift in the cell cycle toward G1 arrest. RNASeq analysis revealed significant changes in mRNA levels associated with proliferation, cell cycle, and cell cycle regulation. Furthermore, androgen significantly decreased the levels of the G1-associated cell cycle progression proteins cdc25a CDK6 CDK4 and CDK2 as well as increased the levels of the cell cycle inhibitors, p27 and p21. The data strongly suggest that DHT induces a G1 arrest in androgen-responsive thyroid cancer cells. Together, these data support our hypothesis that AR/androgen may play a protective, antiproliferative role and are consistent with younger men having a lower incidence of thyroid cancer than women.

Phosphorus deficiencies invoke optimal allocation of exoenzymes by ectomycorrhizas.

Ectomycorrhizal (EM) fungi can acquire phosphorus (P) through the production of extracellular hydrolytic enzymes (exoenzymes), but it is unclear as to the manner and extent native EM fungal communities respond to declining soil P availability. We examined the activity of six exoenzymes (xylosidase, N-acetyl glucosaminidase, ß-glucosidase, acid phosphomonoesterase, acid phosphodiesterase [APD], laccase) from EM roots of Pseudotsuga menzesii across a soil podzolization gradient of coastal British Columbia. We found that APD activity increased fourfold in a curvilinear association with declining inorganic P. Exoenzyme activity was not related to organic P content, but at a finer resolution using 31P-NMR, there was a strong positive relationship between APD activity and the ratio of phosphodiesters to orthophosphate of surface organic horizons (forest floors). Substantial increases (two- to fivefold) in most exoenzymes were aligned with declining foliar P concentrations of P. menzesii, but responses were statistically better in relation to foliar nitrogen (N):P ratios. EM fungal species with consistently high production of key exoenzymes were exclusive to Podzol plots. Phosphorus deficiencies in relation to N limitations may provide the best predictor of exoenzyme investment, reflecting an optimal allocation strategy for EM fungi. Resource constraints contribute to species turnover and the assembly of distinct, well-adapted EM fungal communities.

Rapid nitrogen loss from ectomycorrhizal pine germinants signaled by their fungal symbiont.

Ectomycorrhizal fungi supply their plant partners with nitrogen but can also retain substantial amounts. The concentration of nitrogen in the soil and the amount of carbon supplied from the host seem to influence the proportion of N retained by the fungus. In an experiment designed to determine whether differential supply of nitrogen to two plants influenced nitrogen transfer from fungus to plant within a mycorrhizal network, we observed rapid, substantial loss of nitrogen from pine seedlings. The loss occurred when the mycorrhizal fungus experienced a sudden increase in nitrogen supply. We grew Pinus contorta seedlings in association with Suillus tomentosus in low-nitrogen microcosms where some nitrogen was accessible only by hyphae. After 70 days, foliage of some seedlings was treated with nitrogen. Three days later, hyphal nutrient media were replaced with water or a solution containing nitrogen. Foliar treatment did not affect nitrogen transfer by the fungus to shoots, but by day 75, seedling nitrogen contents had dropped by 60% in microcosms where nitrogen had been added to the hyphal compartments. Those seedlings retained only 55% of the nitrogen originally present in the seed. Loss of nitrogen did not occur if water was added or the hyphae were severed. Because of the severing effect, we concluded that S. tomentosus triggered the loss of seedling nitrogen. Nitrogen may have been lost through increased root exudation or transfer to the fungus. Access to nitrogen from nutrient-rich germinants would benefit rhizosphere microorganisms, including ectomycorrhizal fungi colonizing pine from spores after wildfire.

Estimating the impact of disability onset on employment.

This paper examines the impact of disability onset on the probability of employment using an underexplored longitudinal dataset for Britain. It contrasts estimates based on a control group drawn from those not experiencing disability onset - a common approach in the literature - with estimates based on a control group drawn from those who do experience disability onset, but one year after the treatment group. Compared to the non-disabled control group, the control group of later-onsetters is likely to be more similar to the treatment group in terms of unobservables, with the resulting estimates therefore more plausibly interpreted as causal. Using this control group we estimate that the probability of employment falls by 11 percentage points in the year of disability onset. The equivalent estimate using the control group drawn from those not experiencing onset is about fifty percent larger. The employment effects of disability onset are also shown to be larger for those with lower qualification levels, consistent with weaker attachment to the labour market.

Dual-mycorrhizal plants: their ecology and relevance.

Dual-mycorrhizal plants are capable of associating with fungi that form characteristic arbuscular mycorrhizal (AM) and ectomycorrhizal (EM) structures. Here, we address the following questions: (1) How many dual-mycorrhizal plant species are there? (2) What are the advantages for a plant to host two, rather than one, mycorrhizal types? (3) Which factors can provoke shifts in mycorrhizal dominance (i.e. mycorrhizal switching)? We identify a large number (89 genera within 32 families) of confirmed dual-mycorrhizal plants based on observing arbuscules or coils for AM status and Hartig net or similar structures for EM status within the same plant species. We then review the possible nutritional benefits and discuss the possible mechanisms leading to net costs and benefits. Cost and benefits of dual-mycorrhizal status appear to be context dependent, particularly with respect to the life stage of the host plant. Mycorrhizal switching occurs under a wide range of abiotic and biotic factors, including soil moisture and nutrient status. The relevance of dual-mycorrhizal plants in the ecological restoration of adverse sites where plants are not carbon limited is discussed. We conclude that dual-mycorrhizal plants are underutilized in ecophysiological-based experiments, yet are powerful model plant-fungal systems to better understand mycorrhizal symbioses without confounding host effects.