Mass Shootings in America: Consensus Recommendations for Healthcare Response.

BACKGROUND: In 2021, 702 people died in mass shooting incidents (MSIs) in the US. To define the best healthcare response to MSIs, the Uniformed Services University's National Center for Disaster Medicine and Public Health hosted a consensus conference of emergency medical services (EMS) clinicians, emergency medicine (EM) physicians, and surgeons who provided medical response to six of the nation's largest recent mass shootings. STUDY DESIGN: The study consisted of a 3-round modified Delphi process. A planning committee selected 6 MSI sites with the following criteria: the MSI occurred in 2016 or later, and must have resulted in at least 15 people killed and injured. The MSI sites were Orlando, FL, Las Vegas, NV, Sutherland Springs, TX, Parkland, FL, El Paso, TX, and Dayton, OH. Fifteen clinicians participated in the conference. All participants had EMS, EM, or surgery expertise and responded to 1 of the 6 MSIs. The first round consisted of a 2-part survey. The second and third rounds consisted of site-specific presentations followed by specialty-specific discussion groups to generate consensus recommendations. RESULTS: The 3 specialty-specific groups created 8 consensus recommendations in common. These 8 recommendations addressed readiness training, public education, triage, communication, patient tracking, medical records, family reunification, and mental health services for responders. There were an additional 11 recommendations created in common between 2 subgroups, either EMS and EM (2), EM and surgery (7), or EMS and surgery (2). CONCLUSIONS: There are multiple common recommendations identified by EMS, EM, and surgery clinicians who responded to recent MSIs. Clinicians, emergency planners, and others involved in preparing and executing a response to a future mass shooting event may benefit from considering these consensus lessons learned.

A 45-year-old Female with an Atypical Presentation of Pharyngitis.

INTRODUCTION: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses. CASE PRESENTATION: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative. DISCUSSION: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.

Isotopic evidence indicates saprotrophy in post-fire Morchella in Oregon and Alaska.

We assessed the nutritional strategy of true morels (genus Morchella) collected in 2003 and 2004 in Oregon and Alaska, 1 or 2 y after forest fires. We hypothesized that the patterns of stable isotopes (δ(13)C and δ(15)N) in the sporocarps would match those of saprotrophic fungi and that radiocarbon (Δ(14)C) analyses would indicate that Morchella was assimilating old carbon not current-year photosynthate. We compared radiocarbon and stable isotopes in Morchella with values from concurrently collected foliage, the ectomycorrhizal Geopyxis carbonaria (Alb. & Schwein.) Sacc., the saprotrophic Plicaria endocarpoides (Berk.) Rifai, and with literature to determine isotopic values for ectomycorrhizal or saprotrophic fungi. Geopyxis, Plicaria and Morchella, respectively, were 3‰, 5‰ and 6‰ higher in 13C than foliage and 5‰, 7‰ and 7‰ higher in (15)N. High (15)N enrichment in Morchella indicated that recent litter was not the primary source for Morchella nitrogen, and similar (13)C and (15)N enrichments to Plicaria suggest that Morchella assimilates its carbon and nitrogen from the same source pool as this saprotrophic fungus. From radiocarbon analyses Morchella averaged 11 ± 6 y old (n = 19), Plicaria averaged 17 ± 5 y old (n = 3), foliage averaged 1 ± 2 y old (n = 8) and Geopyxis (n = 1) resembled foliage in Δ(14)C. We conclude that morels fruiting in post-fire environments in our study assimilated old carbon and were saprotrophic.

"Schizomorphic" emulsion copolymerization particles.

Cryo-electron microscopy, atomic force microscopy, and light microscopy investigations provide experimental evidence that amphiphilic emulsion copolymerization particles change their morphology in dependence on concentration. The shape of the particles is spherical at solids content above 1%, but it changes to rod-like, ring-like, and web-like structures at lower concentrations. In addition, the shape and morphology of these particles at low concentrations are not fixed but very flexible and vary with time between spheres, flexible pearl-necklace structures, and stretched rods.

Phylogeny and historical biogeography of true morels (Morchella) reveals an early Cretaceous origin and high continental endemism and provincialism in the Holarctic.

True morels (Morchella, Ascomycota) are arguably the most highly-prized of the estimated 1.5 million fungi that inhabit our planet. Field guides treat these epicurean macrofungi as belonging to a few species with cosmopolitan distributions, but this hypothesis has not been tested. Prompted by the results of a growing number of molecular studies, which have shown many microbes exhibit strong biogeographic structure and cryptic speciation, we constructed a 4-gene dataset for 177 members of the Morchellaceae to elucidate their origin, evolutionary diversification and historical biogeography. Diversification time estimates place the origin of the Morchellaceae in the middle Triassic 243.63 (95% highest posterior density [HPD] interval: 169.35-319.89) million years ago (Mya) and the divergence of Morchella from its closest relatives in the early Cretaceous 129.61 (95% HPD interval: 90.26-173.16) Mya, both within western North America. Phylogenetic analyses identified three lineages within Morchella: a basal monotypic lineage represented by Morchella rufobrunnea, and two sister clades comprising the black morels (Elata Clade, 26 species) and yellow morels (Esculenta Clade, 16 species). Morchella possesses a Laurasian distribution with 37/41 species restricted to the Holarctic. All 33 Holarctic species represented by multiple collections exhibited continental endemism. Moreover, 16/18 North American and 13/15 Eurasian species appeared to exhibit provincialism. Although morel fruit bodies produce thousands of explosively discharged spores that are well suited to aerial dispersal, our results suggest that they are poorly adapted at invading novel niches. Morels also appear to have retained the ancestral fruit body plan, which has remained remarkably static since the Cretaceous.

Core-shell particle interconversion with di-stimuli-responsive diblock copolymers.

Core-shell reversible particle precipitation from aqueous di-stimuli-responsive diblocks is demonstrated as also is the interconversion from one core-shell combination to the other.

Mushrooms, trees, and money: value estimates of commercial mushrooms and timber in the pacific northwest.

Wild edible mushrooms are harvested in the forests of the Pacific Northwest, where both trees and mushrooms grow in the same landscape. Although there has been some discussion about the value of trees and mushrooms individually, little information exists about the joint production of, and value for, these two forest products. Through four case studies, the information needed to determine production and value for three wild mushroom species in different forests of the Pacific Northwest is described, and present values for several different forest management scenarios are presented. The values for timber and for mushrooms are site- and species-specific. On the Olympic Peninsula in Washington, timber is highly valued and chanterelles are a low-value product by weight; timber has a soil expectation value (SEV) 12 to 200 times higher than chanterelles. In south-central Oregon, timber and American matsutake mushrooms have the potential to have about the same SEV. In eastern Oregon, timber is worth 20 to 110 times as much as the morels that grow in the forest. Production economics is concerned with choices about how much and what to produce with what resources. The choices are influenced by changes in technical and economic circumstances. Through our description and analysis of the necessary definitions and assumptions to assess value in joint production of timber and wild mushrooms, we found that values are sensitive to assumptions about changes in forest management, yields for mushrooms and trees, and costs.