Search

In the United States, melioidosis is an emerging infectious disease caused by Burkholderia pseudomallei (1,2). In melioidosis-endemic areas, the bacterium causes pneumonia and fatal bacteremia with diverse mortality rates that [...]

Introduction: The emergence of artificial intelligence (AI)-based support system endoscopy, including cystoscopy, has shown promising results by training deep learning algorithms with large datasets of images and videos. This AI-aided cystoscopy has the potential to significantly transform the urological practice by assisting the urologists in identifying malignant areas, especially considering the diverse appearance of these lesions. Methods: Four databases, the PubMed, ProQuest, EBSCOHost, and ScienceDirect were searched, along with a manual hand search. Prospective and retrospective studies, experimental studies, cross-sectional studies, and case-control studies assessing the utilization of AI for the detection of bladder cancer through cystoscopy and comparing with the histopathology results as the reference standard were included. The following terms and their variants were used: 'artificial intelligence,' 'cystoscopy,' and 'bladder cancer.' The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A random effects model was used to calculate the pooled sensitivity and specificity. The Moses-Littenberg model was used to derive the Summary Receiver Operating Characteristics (SROC) curve. Results: Five studies were selected for the analysis. Pooled sensitivity and specificity were 0.953 (95 confidence interval [CI]: 0.908-0.976) and 0.957 (95 CI: 0.923-0.977), respectively. Pooled diagnostic odd ratio was 449.79 (95 CI: 12.42-887.17). SROC curve (area under the curve: 0.988, 95 CI: 0.982-0.994) indicated a strong discriminating power of AI-aided cystoscopy in differentiation normal or benign bladder lesions from the malignant ones. Conclusions: Although the utilization of AI for aiding in the detection of bladder cancer through cystoscopy remains questionable, it has shown encouraging potential for enhancing the detection rates. Future studies should concentrate on identification of the patients groups which could derive maximum benefit from accurate identification of the bladder cancer, such as those with intermediate or high-risk invasive tumors., Author(s): Antoninus Hengky (corresponding author) [1,2]; Stevan Kristian Lionardi [3]; Christopher Kusumajaya [4] INTRODUCTION As science and technology continues to advance, the increase in the volume of data, along with [...]

Objective: We reviewed our institutional experience of radical prostatectomy with and without preoperative multiparametric magnetic resonance imaging (mpMRI) to assess the impact of preoperative prostate mpMRI on surgical outcomes of radical prostatectomy. Methods: We identified patients at our institution who underwent radical prostatectomy for prostate cancer (PCa) between January 2012 and December 2017 (n = 1044). Using propensity scoring analysis, patients who underwent preoperative mpMRI (n = 285) were matched 1:1 to patients who did not receive preoperative mpMRI (n = 285). Multivariable regression analysis was performed to identify factors predictive of operative time, estimated blood loss (EBL), lymph node yield, rates of complications within 30 days, and positive surgical margin (PSM). Results: There were no significant differences in operative time, EBL, PSM, lymph node yield, or complication rates between the two cohorts. Multivariable analysis demonstrated that preoperative mpMRI was not predictive of the measured perioperative outcomes. Significant comorbidity (Charlson Comorbidity Index ≥3) was the sole predictor of perioperative complications (P = 0.015). Increasing biopsy Gleason score predicted increased lymph node yield (P < 0.001). The probability of PSM was associated with increasing preoperative prostate-specific antigen (odds ratio 1.036, P = 0.009). Body mass index was a predictor of operative time (P = 0.016) and EBL (P = 0.001). Conclusions: Although preoperative mpMRI has an important role in the diagnosis and staging of PCa, it does not impact perioperative radical prostatectomy outcomes. Our findings do not support the routine use of preoperative mpMRI for surgical planning in patients already diagnosed with clinically localized PCa., Author(s): Christopher K. Bozorgmehr [1]; Johnny Wang [1]; James T. Gross [1]; Nicholas A. Pickersgill (corresponding author) [1,2]; Joel M. Vetter [1]; Joseph E. Ippolito [3]; Eric H. Kim [4,5] [...]

Background: The status of the regional lymph node basin is of prognostic importance in patients with melanoma, making the performance of sentinel lymph node biopsies (SLNBs) a key component of patient care management, particularly with the advent of immunotherapy for adjuvant treatment. The primary goal of our study was to assess the false-negative rate of SLNBs among patients with melanoma. Methods: We conducted a retrospective review of patients with melanoma undergoing SLNB by a single surgeon between Jan. 1, 2005, and Dec. 31, 2020. We extracted and cross-referenced patient demographic and pathologic information. Results: During the study period, 501 patients underwent an SLNB. Of these, 97 (19.4%) patients had pathologically positive sentinel lymph nodes and 404 (80.6%) patients had negative results. The latter were subject to further review; 84 (20.8%) patients subsequently developed recurrence, with 25 (6.2%) recurrences within the primary nodal basin. Isolated regional recurrence occurred in 11 (2.7%) patients and conjunction with a false-negative rate was 10.2%. Unadjusted recurrence rates were similar across each lymph node basin, including the axilla (2.7%), groin (3.6%), and neck (1.4%). Conclusion: The false-negative SLNB rate was 10.2% for isolated regional recurrences. These findings need to be considered in the era of using adjuvant systemic therapy for patients with melanoma. Contexte: L&apos; tat du bassin ganglionnaire r gional rev t une importance pronostique chez les personnes atteintes de m lanome, ce qui rend les biopsies des ganglions sentinelles (BGS) essentielles la prise en charge de la maladie, particuli rement depuis l&apos;av nement de l&apos;immunoth rapie en traitement adjuvant. Le principal objectif de notre tude tait d&apos; valuer le taux de r sultats faussement n gatifs des BGS dans les cas de m lanome. M thodes: Nous avons proc d une revue r trospective des cas de m lanome soumis des BGS effectu es par 1 seul membre de l&apos; quipe de chirurgie entre le 1 (er) janvier 2005 et le 31 d cembre 2020. Nous avons extrait et recoup les donn es d mographiques et anatomopathologiques. R sultats: Pendant la dur e de l&apos; tude, 501 personnes ont subi des BGS. Parmi elles, 97 (19,4%) pr sentaient des ganglions sentinelles positifs la biopsie et 404 (80,6%) avaient des r sultats n gatifs. Ce dernier groupe a t soumis un examen plus approfondi; 84 (20,8%) ont par la suite pr sent des r cidives, dont 25 (6,2%) l&apos;int rieur du bassin ganglionnaire primitif. Des r cidives r gionales isol es sont survenues chez 11 (2,7%) personnes et le recoupement avec le taux de r sultats faussement n gatifs a t de 10,2%. Les taux de r cidives non ajust s ont t similaires peu importe les bassins ganglionnaires, y compris axillaires (2,7%), inguinaux (3,6%) et cervicaux (1,4%). Conclusion: Le taux de r sultats faussement n gatifs des BGS a t de 10,2% dans le cas des r cidives r gionales isol es. Il faut interpr ter ces r sultats en tenant compte du fait qu&apos;ils ont t recueillis une poque o les malades atteints de m lanome taient trait s par chimioth rapie adjuvante., The status of the regional lymph node basin is of prognostic significance in patients with melanoma, making sentinel lymph node biopsy (SLNB) a key component of patient care management. Although [...]

* Context.-Artificial intelligence algorithms hold the potential to fundamentally change many aspects of society. Application of these tools, including the publicly available ChatGPT, has demonstrated impressive domain-specific knowledge in many areas, including medicine. Objectives.-To understand the level of pathology domain-specific knowledge for ChatGPT using different underlying large language models, GPT-3.5 and the updated GPT-4. Design.-An international group of pathologists (n = 15) was recruited to generate pathology-specific questions at a similar level to those that could be seen on licensing (board) examinations. The questions (n = 15) were answered by GPT-3.5, GPT-4, and a staff pathologist who recently passed their Canadian pathology licensing exams. Participants were instructed to score answers on a 5-point scale and to predict which answer was written by ChatGPT. Results.-GPT-3.5 performed at a similar level to the staff pathologist, while GPT-4 outperformed both. The overall score for both GPT-3.5 and GPT-4 was within the range of meeting expectations for a trainee writing licensing examinations. In all but one question, the reviewers were able to correctly identify the answers generated by GPT-3.5. Conclusions.-By demonstrating the ability of ChatGPT to answer pathology-specific questions at a level similar to (GPT-3.5) or exceeding (GPT-4) a trained pathologist, this study highlights the potential of large language models to be transformative in this space. In the future, more advanced iterations of these algorithms with increased domain-specific knowledge may have the potential to assist pathologists and enhance pathology resident training. (Arch Pathol Lab Med. 2024;148:1152-1158; doi: 10.5858/arpa.2023-0296-OA), Rapid technological advancements in molecular pathology and a continuously growing body of knowledge have resulted in an unprecedented increase in diagnostic complexity for pathologists. (1) This presents a challenge for [...]

Native and invasive tick species pose serious public health concerns in the United States, particularly in northeastern states. Recent and rapid expansion of the lone star tick (Amblyomma americanum) into [...]

The spot (Leistomus xanthurus) is among the most abundant demersal fish species in the estuaries of the Atlantic and Gulf coasts of the United States and in the coastal ocean. [...]

The draft dodgers and other political émigrés always seemed American to me in their very rejection of American life and attitudes. They, after all, knew what they were repudiating far better than the people among whom they made a new life. Even if they learned to speak with a Canadian accent, their own preoccupation with the nation they had left was quite different from that of Canadian friends ..., W HEN support for the Vietnam War was collapsing among young Americans in the late 1960s, and thousands of draft-age men were seeking refuge north of the border, a satirical [...]

In this essay, we argue that liberal egalitarians cannot maintain their commitment to liberalism alongside a commitment to distributive egalitarianism--that is, the view that justice requires the state to bring [...]

Certificate-of-Need (CON) laws restrict entry and/or expansion of healthcare facilities in 35 states. These laws require hospitals, nursing homes, ambulatory surgical centers (ASCs), and other healthcare providers to obtain regulatory [...]

Woodstars arc a clade of small hummingbirds with poorly known life history. One reason why they are insufficiently characterized is they tend to be little represented in museum collections. The Cornell Lab of Ornithology's Macaulay Library, an online database of user-uploaded photographs, is a complementary source of phenological information. Here, stimulated by our own field observations, we analyzed up to 200 photos per species from the Macaulay Library to investigate whether adult male Slender-tailed Woodstar (Chaetocercus [Microstilbon] burmeisteri), Amethyst Woodstar (Calliphlox amethystina), Chilean Woodstar (Eulidia yarrellii), Peruvian Sheartail (Thaumastura cord), and Purple-collared Woodstar (Thaumastura [Myrtis] fanny) molt into a drab-throated, nonbreeding plumage distinct from the better known iridescent-throated breeding plumage. We investigated these 5 species because adult males have elongated, dimorphic tails, meaning that we could distinguish adult males from immature males by their tail morphology alone. The photos show that, post-breeding, entire populations of Slendertailed Woodstar and Peruvian Sheartail males replace their iridescent throat feathers with non-iridescent feathers, then molt back into their breeding plumage a few months later. The holotype of Microstilbon insperalus Todd 1913, type species of the genus Microstilbon, is an adult male of Slender-tailed Woodstar in the nonbreeding plumage that we describe here. Our data also suggest that male Amethyst, Chilean, and Purple-collared woodstars have a second distinct nonbreeding plumage. In these 3 species, photos showing the apparent drab-throated male plumage were tare, suggesting these species might have complex breeding phenology with some individuals molting into the nonbreeding plumage at the same time that others were breeding in iridescentthroated plumage. The rapidly growing number of photographs available in the Macaulay Library makes this resource valuable for documenting phenology, including for rare species such as woodstars. Received 11 August 2023. Accepted 17 June 2024. Key words: alternate plumage, citizen science, eclipse plumage, Macaulay Library. (Spanish)--Las estrellitas son un ciado de pequenos colibries con historias de vida poco conocidas. Una de las razones por las que no estan adecuadamente caracterizadas es que tienden a estar poco representadas en colecciones de museo. La Macaulay Library del Laboratorio de Ornitologia de Cornell, una base de datos en linea de fotografias cargadas por usuarios, es una fuente complementaria de informacion fenologica. Aqui, estimulados por nuestras propias observaciones de campo, analizamos hasta 200 fotografias por especie de la Macaulay Library para investigar si los machos adultos de picaflor enano (Chaetocercus [Microstilbon] burmeisteri), picaflor amatista (iCalliphlox amethystina), picaflor de Arica (Eulidia yarrellii), picaflor de cora (Thaumastura cora) y la estrellita de collar purpura (Thaumastura [Myrtis] fanny) mudan a un plumaje no-reproductivo de garganta desvaida, distinto del mas conocido plumaje reproductivo de garganta iridiscente. Investigamos estas 5 especies porque los machos adultos tienen colas elongadas y dimorficas, por lo cual podemos distinguir a los machos adultos de los machos inmaduros por la morfologia de su cola. Las fotografias muestran que, despues de la reproduccion, poblaciones enteras de machos de C. burmeisteri y T. cora reemplazan las plumas iridiscentes de su garganta con plumas no iridiscentes y luego mudan nuevamente a su plumaje nupcial unos meses despues. El holotipo de Microstilbon insperatus Todd 1913, especie tipo del genero Microstilbon, es un macho adulto de C. burmeisteri en el plumaje no-reproductivo que aqui describimos. Nuestros datos tambien sugieren que los machos de C. amethystina, E. yarrellii y T. fanny tambien tienen este segundo plumaje no- reproductivo distintivo. En estas 3 especies, las fotografias mostrando el aparente plumaje masculino de garganta desvaida fueron escasas, lo que sugiere que estas especies podrian tener una fenologia reproductiva compleja, con algunos individuos mudando al plumaje no-reproductivo al mismo tiempo que otros se reproducen en plumaje de garganta iridiscente. El numero cada vez mayor de fotografias disponibles en la Macaulay Library hace que este recurso sea valioso para documentar la fenologia, incluso para especies raras como las estrellitas. Palabras clave: ciencia ciudadana, plumaje alterno, plumaje eclipse, Macaulay Library., The Cornell Lab of Ornithology's Macaulay Library (https://www.macaulaylibrary.org/) is an online repository where users have uploaded millions of images of wild birds. These images potentially reveal information about species with [...]

Mortality from entanglement and hanging in fishing line or baling twine is known for many species of birds. In this note, we add to the list multiple deaths of Cliff Swallows (Petrochelidon pyrrhonota). We found 4 hanging or entanglement events of this species from 3 counties in western Kansas. In Ellis County we found 2 locations under bridges: 3 birds hung together at the nest opening with fishing line and a single bird hung from a nest from an unknown source. In Gove County a single bird was hung with baling twine that was embedded into the base of a mud nest attached to a natural rock formation. At the last location in Hamilton County, an entanglement death of a bird at a bridge was due to an unknown cause, but multiple nests had baling twine incorporated into their formation. Proper disposal of fishing line and baling twine could reduce mortality from these and other sources in the future. Received 26 July 2023. Accepted 27 June 2024. Key words: baling twine, death, fishing line, hanging, mud nest. (Spanish)--La mortandad por enredamiento y ahorcamiento en lineas de pesca o hilo de empacar es conocida para muchas especies de aves. En esta nota, anadimos a la lista varias muertes de golondrinas Petrochelidon pyrrhonota. Encontramos 4 eventos de ahorcamiento o enredamiento de esta especie en tres condados en el oeste de Kansas. En Ellis County encontramos 2 localidades debajo de puentes: 3 aves se ahorcaron juntas en la abertura del nido con linea de pescar y un ave solitaria se ahorco de un nido con una fuente desconocida. En Gove County un ave solitaria se ahorco con hilo de empacar que estaba incrustado en la base de un nido de barro unido a una formacion natural rocosa. En la ultima localidad en Hamilton County, una muerte por enredamiento de un ave en un puente se debio a causas desconocidas, pero varios nidos tertian hilo de empacar incorporados en su elaboracion. Descartar adecuadamente las lineas de pescar y los hilos de empacar podrian reducir la mortandad por estas y otras fuentes en el futuro. Palabras clave: ahorcamiento, hilo de empacar, lineas de pesca, muerte, nido de barro, There are a variety of natural sources of avian mortality (Winkler 2016, Loss and O'Connell 2018); there are also many human-related reasons for death in birds (Banks 1979, Calvert et [...]

Difficulty in using observations to isolate the impacts of aerosols from meteorology on deep convection often stems from the inability to resolve the spatiotemporal variations in the environment serving as the storm's inflow region. During the U.S. Department of Energy (DOE) Tracking Aerosol Convection interactions Experiment (TRACER) in June-September 2022, a Texas A&M University (TAMU) team conducted a mobile field campaign to characterize the meteorological and aerosol variability in air masses that serve as inflow to convection across the ubiquitous mesoscale boundaries associated with the sea and bay breezes in the Houston, Texas, region. These boundaries propagate inland over the fixed DOE Atmospheric Radiation Measurement (ARM) sites. However, convection occurs on either or both the continental or maritime sides or along the boundary. The maritime and continental air masses serving as convection inflow may be quite distinct, with different meteorological and aerosol characteristics that fixed- site measurements cannot simultaneously sample. Thus, a primary objective of TAMU TRACER was to provide mobile measurements similar to those at the fixed sites, but in the opposite air mass across these moving mesoscale boundaries. TAMU TRACER collected radiosonde, lidar, aerosol, cloud condensation nuclei (CCN), and ice nucleating particle (INP) measurements on 29 enhanced operations days covering a variety of maritime, continental, outflow, and prefrontal air masses. This paper summarizes the TAMU TRACER deployment and measurement strategy, instruments, and available datasets and provides sample cases highlighting differences between these mobile measurements and those made at the ARM sites. We also highlight the exceptional TAMU TRACER undergraduate student participation in high-impact learning activities through forecasting and field deployment opportunities. SIGNIFICANCE STATEMENT: The environment influencing storms often varies across scales that are not always adequately captured by measurements collected at fixed locations. This paper describes our strategy for collecting mobile measurements of the aerosols and meteorology that influenced convection initiated by the sea breeze across the Houston, Texas, region. We show several examples of the local variations in aerosols and meteorology influencing storms that were captured by our mobile platform that were different from those sampled at fixed observation sites. We also highlight potential future studies and science questions that could be addressed using our dataset. KEYWORDS: Deep convection; Sea breezes; Aerosols; Cloud microphysics; Soundings; Aerosol-cloud interaction, 1. Motivation and goals Deep convective systems play a significant role in a number of critical components of the climate system through their large contribution to the hydrological cycle, feedback [...]

Medscape CME Activity In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited with commendation [...]

Polyaryletherketone (PAEK) thermoplastic composite materials have received increasing attention for the manufacturing of composite structures. One manufacturing process of great interest for PAEK composite structures is automated fiber placement, which can increase the throughput of complex part fabrication and reduce the use of autoclaves for assembly of composite parts. Understanding the thermal effects of the material allows the control and adjustment of manufacturing variables to assure the integrity of the composite structure. PAEK resins and carbon fiber reinforced composites have been analyzed using differential scanning calorimetry to study crystallization kinetics. Isothermal and non-isothermal tests were conducted, and the time-dependent crystallization kinetics were modeled using the Velisaris and Seferis model for isothermal processes and the Gaussian process regression method for non- isothermal processes. The results show the influence of the thermal conditions and the chemical structures considering the ketone content, and the effects of the presence of the carbon fibers on crystallization kinetics. The models utilized describe with high accuracy the time-dependent crystallization kinetics of PAEK composite materials. An artificial neural network application was also implemented using the non-isothermal PAEK composite models for further prediction of relative volume crystallinity and crystallization rate. Highlights * Polyaryletherketone (PAEK) materials crystallize differently depending on the crystallization conditions. * Carbon fibers influence the crystallization response in PAEK polymers. * Machine learning was used to characterize crystallization kinetics. * Activation energies were obtained for different thermal treatments. * Artificial neural network tool was developed for PAEK composites in non- isothermal regimes. KEYWORDS crystallization, machine learning, polyaryletherketone, thermoplastics, 1 | INTRODUCTION Polyaryletherketone (PAEK) composites are used for rapid manufacturing of structural components owing to their mechanical properties, chemical resistance, high temperature stability, and ease of material handling relative [...]

Human respiratory syncytial virus (HRSV) is a leading cause of acute lower respiratory tract infection in children, elderly, and immunocompromised persons. In 2023, the US Food and Drug Administration and [...]

PURPOSE Relationship continuity of care has declined across English primary health care, with cross-sectional and longitudinal variations between general practices predicted by population and service factors. We aimed to describe cross-sectional and longitudinal variations across the COVID-19 pandemic and determine whether practice factors predicted the variations. METHODS We conducted a longitudinal, ecological study of English general practices during 2018-2022 with continuity data, excluding practices with fewer than 750 patients or National Health Service (NHS) payments exceeding 500 [pounds sterling] per patient. Variables were derived from published data. The continuity measure was the product of weighted responses to 2 General Practice Patient Survey questions. In a multilevel mixed-effects model, the fixed effects were 11 variables&apos; interactions with time: baseline continuity, NHS region, deprivation, location, percentage White ethnicity, list size, general practitioner and nurse numbers, contract type, NHS payments per patient, and percentage of patients seen on the same day as booking. The random effects were practices. RESULTS Main analyses were based on 6,010 practices (out of 7,190 active practices). During 2018-2022, mean continuity in these practices declined (from 29.3% to 19.0%) and the coefficient of variation across practices increased (from 48.1% to 63.6%). Both slopes were steepest between 2021 and 2022. Practices having more general practitioners and higher percentages of patients seen the same day had slower declines. Practices having higher baseline continuity, located in certain non-London regions, and having higher percentages of White patients had faster declines. The remaining variables were not predictors. CONCLUSIONS Variables potentially associated with greater appointment availability predicted slower declines in continuity, with worsening declines and relative variability immediately after the COVID-19 lockdown, possibly reflecting surges in demand. To achieve better levels of continuity for those seeking it, practices can increase appointment availability within appointment systems that prioritize continuity. Key words: primary health care; continuity of patient care; physician-patient relationship; health workforce; delivery of health care; office visits; COVID-19; allied health personnel; telemedicine; organizational change https://doi.org/10.1370/afm.3128 Annals Early Access article, INTRODUCTION Continuity in primary (community-based) health care can be understood in different ways. (13) We aimed to study therapeutic longitudinal (relationship) continuity of care (LCoC), defined as the repeated contact [...]

PURPOSE Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists. Key words: child abuse; health inequities; racism; implicit bias; qualitative research https://doi.org/10.1370/afm.3139, INTRODUCTION The United States Child Abuse and Prevention Treatment Act requires states to enact policies to identify newborns affected by substance use disorders or prenatal substance exposure (PSE) during pregnancy. [...]

Over the last decade, supercell simulations and observations with ever-increasing resolution have provided new insights into the vortex-scale processes of tornado formation. This article incorporates these and other recent findings into the existing three-step model by adding an additional fourth stage. The goal is to provide an updated and clear picture of the physical processes occurring during tornadogenesis. Specifically, we emphasize the importance of the low-level wind shear and mesocyclone for tornado potential, the organization and interaction of relatively small-scale pretornadic vertical vorticity maxima, and the transition to a tornado-characteristic flow. Based on these insights, guiding research questions are formulated for the decade ahead. SIGNIFICANCE STATEMENT: This article provides a nontechnical overview of how tornadoes form. Sequentially, the most important processes include the initial creation of rotating updrafts, the development of disorganized patches of rotation at the surface, the organization of these patches into a more defined, symmetric vortex, and the final transition into a fully developed tornado in which air turns abruptly upward very near the surface. Based on this proposed conceptual model, guiding research questions are formulated for the decade ahead. KEYWORDS: Tornadogenesis; Severe storms; Tornadoes; Radars/Radar observations; Supercells, 1. How does a tornado form? This is perhaps one of the most elementary yet enduring questions in meteorology. Even though severe-storm research has focused on this problem for over [...]

Introduction Research has shown that exposure to traffic-related air pollution (TRAP) can damage the respiratory mucosa by decreasing epithelial barrier function, exaggerating inflammatory responses at the mucosal surface, and impairing [...]

* Context.--Laboratories face the challenge of providing quality patient care while managing costs and turnaround times (TATs). To this end, we brought the heparin-induced thrombocytopenia (HIT) antibody test in-house with the goal of reducing costs and the time to diagnosis. Objectives.--To determine the cost-effectiveness and return on investment of our in-house HIT antibody test by comparing it to send-out assays with TATs of 2, 3, or 4 days. Design.--We performed a retrospective chart review of all patients with a HIT antibody assay and analysis of laboratory financial records. Analysis included the percentage of patients receiving alternative treatment, cost of treatment, startup costs of bringing the test in-house, and average TAT of the in-house test. Results.--We found significant reductions in the cost of treatment for patients and the overall cost to the health care system. The in-house assay became cost-effective at between 8 and 20 tests, with a return on investment of up to 298%. Conclusions.--Bringing the HIT antibody assay in-house becomes cost-effective at a very low test volume with excellent return on investment. This novel analysis can provide a framework for other laboratory medicine professionals to analyze the benefits of bringing this and other assays in-house. doi: 10.5858/arpa.2023-0141-OA), Modern clinical laboratories aim to provide excellent quality by producing accurate and cutting-edge results with the least turnaround time (TAT) possible while simultaneously balancing health care costs. To achieve this, [...]

Rocky Mountain spotted fever (RMSF), a tickbome disease caused by Rickettsia rickettsii, is the leading cause of death from rickettsial infections in the Western Hemisphere (1). The disease can progress [...]

Spotted fever rickettsiosis in solid organ transplant recipients is rarely described, and all reports document disease acquired months to years after the transplant, after recognized tick bites or exposures to [...]

Globally, the COVID-19 pandemic resulted in >650 million infections and 6.5 million deaths during March 2020-December 2022 (2,2). Uganda recorded its first case of SARS-CoV-2 infection on March 21, 2020; [...]

I. INTRODUCTION 95 II. CY PRES AND CHARITABLE TRUSTS 99 A. The Origins of Cy Pres 99 B. Cy Pres in America 101 C. Religious Purpose Trusts in America 106 [...], Author&apos;s Synopsis: In the law of charitable trusts, courts wield exceptional power with respect to two equitable remedies: cy pres and the closely related doctrine of deviation. Courts can grant these equitable remedies for trusts that have purposes or terms rendered ineffectual, and either doctrine allows the court to prolong the trust&apos;s life, perhaps forever. Historically, the invocation of these remedies was anathema to American courts. But increasingly, they have contemplated the possibility of extending the life of charitable trusts through application of these doctrines. In many ways, the evolution of these doctrines is owing to the jurisprudence involving trusts created for the benefit of a religious congregation or charity. Yet, this connection and the implications of judicial decisions regarding the right to these remedies has not garnered much attention until now. In this study, I analyze the extent to which courts have applied these equitable remedies to religious purpose charitable trusts via an econometric analysis of a universe of cases with a published opinion from an American court from the nation&apos;s founding through 2019. This study provides a novel analysis of these equitable remedies and the history of religious purpose charitable trusts along a considerable timeline in American history. First, it explores how the equitable remedies of cy pres and deviation were shaped by and shaped the caselaw around religious purpose charitable trusts, revealing simultaneously that each is a valid remedy and trust. Second, it examines the possible bias of the courts in awarding these remedies to certain religious groups but not others, ultimately finding that trusts created for the benefit of Catholic churches and charities were deemed less worthy of these remedies by the courts, all else equal. These findings have implications not only for understanding the application of these equitable remedies more deeply but also for uncovering the implicit and overt bias of the courts in cases where it has no actual basis.

During the first half of the twentieth century, millions of American workers and farmers wanted to socialize banking. In a nation where socialist principles supposedly lacked appeal, grassroots support for public banks revealed the prevalence and popularity of economic ideas that intersected and overlapped with socialism. Banking politics also presents a potential source of working-class political mobilization today., As a lonely critic who dared to challenge Federal Reserve Board chairman Alan Greenspan during the stock market mania of the late 1990s, then congressman Bernie Sanders received recognition from [...]

Living Together: Inventing Moral Science By David Schmidtz New York: Oxford University Press, 2023. Pp. xv, 274. $35 hardcover. The two-part title of David Schmidtz's new book, Living Together: Inventing [...]

High-quality data from surveillance of vaccine-preventable disease (VPD) are critical for timely detection of and response to outbreaks. In 2019, the World Health Organization (WHO) Regional Office for Africa (AFRO) began a change from Epi Info, a statistical software package developed by the US Centers for Disease Control and Prevention (CDC), with limited capability to integrate with other information systems, affecting reporting timeliness and data use, to the District Health Information Software 2 (DHIS2), a free, open-source software platform for electronic aggregate Integrated Disease Surveillance and Response (IDSR) and case-based surveillance reporting. A national reporting system was introduced to allow countries to adopt this system. Regionally, the Epi Info database will be replaced by a DHIS2 regional data platform. This report describes phased implementation from 2019 to the present. Phase 1 (2019-2021) involved developing IDSR aggregate and case-based surveillance packages and pilot studies in Mali, Rwanda and Togo. Phase 2 (2022) included extending national implementation to 27 countries and establishing the WHO AFRO DHIS2 regional data platform. Phase 3 (from 2023 onwards) comprised building local capacity and support for national reporting to the regional platform. By February 2024, 8 of 47 AFRO countries had adopted both the aggregate IDSR and case-based surveillance packages, and 2 had successfully transferred VPD surveillance data to the AFRO regional platform. The challenges included limited human and financial resources, establishment of data-sharing and governance agreements, technical support for data transfer, and building local capacity to report to the regional platform. Transition to DHIS2 will ensure efficient data transmission to strengthen detection and response of VPD and public health emergencies through greater system integration and interoperability. Il est essentiel de disposer de donnees de surveillance de qualite sur les maladies a prevention vaccinale (MPV) pour detecter rapidement les flambees epidemiques et y riposter. En 2019, le Bureau regional de l'Organisation mondiale de la Sante (OMS) pour l'Afrique a commence a remplacer Epi Info, un progiciel statistique developpe par les Centers for Disease Control and Prevention (CDC) des Etats-Unis, s'adaptant difficilement a d'autres systemes d'information et ne permettant pas de bien tenir les delais ou de partager les donnees de maniere optimale, par le logiciel d'information sanitaire de district DHIS2 (District Health Information Software 2), une plateforme logicielle libre et gratuite pour les donnees de surveillance integree des maladies et la riposte et les donnees de surveillance basee sur l'identification des cas. Un systeme de notification au niveau national a ete mis en place, offrant aux pays la possibilite d'adopter ce nouveau systeme. Au niveau regional, la base de donnees Epi Info sera remplacee par une plateforme de donnees DHIS2 regionale. Le present rapport decrit la mise en oeuvre progressive de cette plateforme de 2019 a aujourd'hui. La phase 1 (2019-2021) a consiste a elaborer des modules pour les donnees agregees de surveillance integree des maladies et la riposte et de surveillance basee sur les cas; des essais pilotes ont ete menes au Mali, au Rwanda et au Togo. La phase 2 (2022) a vu l'extension de la mise en oeuvre au niveau national a 27 pays et la mise en place de la plateforme de donnees regionale DHIS2 du Bureau regional de l'OMS pour l'Afrique. Les activites de la phase 3 (a partir de 2023) ont porte sur le renforcement des capacites locales et l'appui aux pays pour la transmission des donnees nationales a la plateforme regionale. Les difficultes recensees concernaient le manque de ressources humaines et financieres, la necessite d'etablir des accords de partage et de gouvernance des donnees, l'appui technique pour le transfert des donnees et le renforcement des capacites locales pour la transmission des donnees a la plateforme regionale. En fevrier 2024, 8 pays parmi les 47 pays de la Region africaine de l'OMS avaient adopte les modules pour la surveillance integree des maladies et la riposte et pour la surveillance basee sur les cas, et 2 avaient transfere avec succes leurs donnees de surveillance sur les MPV vers la plateforme regionale. La transition vers la plateforme DHIS2 favorisera une transmission efficace des donnees pour renforcer la detection des MPV et des urgences de sante publique et la riposte a ces evenements grace a une meilleure integration et interoperabilite des systemes., Introduction VPD surveillance is critical to public health, as it provides data for timely detection of and response to VPD cases and outbreaks. High-quality, timely data are necessary to guide [...]

North American Black Terns (Chlidonias niger) breed primarily in the Prairie Pothole region of southern Canada and the northern United States, winter in Central and South American waters, and often migrate through the northern Gulf of Mexico (nGoM). This species has exhibited long-term population declines and is exposed to a myriad of anthropogenic threats in the nGoM, including oil spills, with an estimated 800-1,000 injured during the Deepwater Horizon oil spill, yet historical studies of Black Terns' use of the nGoM are sparse, with inconsistent spatial and temporal coverage. Using vessel-based observations collected from 2017 to 2019, we characterize Black Tern spatial and temporal occurrence in marine waters of the nGoM. We develop 2 separate habitat models: one describing spatial and temporal aspects of Black Terns occurrence and the other describing the relative density when present. In 10 months of survey effort, January-October, we observed Black Terns in 7 (Mar-May and Jul-Oct), predominantly on the continental shelf at Key words: habitat models, migration, nonbreeding, seasonality, vessel-based observations. (French)--Les guifettes noires d'Amerique du Nord (Chlidonias niger) se reproduisent principalement dans la region des Prairies Pothole du sud du Canada et du nord des Etats-Unis, hivernent dans les eaux d'Amerique centrale et du Sud et migrent souvent a travers le nord du golfe du Mexique (nGoM). Cette espece a montre des declins de population a long terme et est exposee a une myriade de menaces anthropiques dans le nGoM, y compris les marees noires, avec environ 800 a 1 000 individus blesses lors de la maree noire de Deepwater Horizon, mais des etudes historiques sur l'utilisation du nGoM par les guifettes noires sont rares, avec une couverture spatiale et temporelle incoherente. A l'aide d'observations basees sur des navires recueillies de 2017 a 2019, nous caracterisons l'occurrence spatiale et temporelle de la guifette noire dans les eaux marines du nGoM. Nous developpames deux modeles d'habitat distincts: l'un decrivant les aspects spatiaux et temporels de l'occurrence des guifettes noires et l'autre decrivant la densite relative lorsqu'elles sont presentes. Au coure des 10 mois d'enquetes, de janvier a octobre, nous observames des guifettes noires en sept mois (de mars a mai et de juillet a octobre), principalement sur le plateau continental a Mots-cles: migration, modeles d'habitat, non-reproduction, observations basees sur des navires, saisonnalite., The North American Black Terns (Chlidonias niger) are the only obligate wetland-breeding terns in the New World. Black Terns breed primarily in the Prairie Pothole Region with small populations distributed [...]

The mosaic landscape of small-scale cropping, agroforests, and secondary forests common to steep-sloped, volcanic islands in the Caribbean provide habitats and food sources for many terrestrial bird species. Information on the diets of species living in these agroecosystems can inform conservation management and land-use decisions, and reveal the ecosystem services performed by these unique island bird communities. We obtained fecal samples from 356 individuals of 14 bird species, including 3 Lesser Antilles endemics, that occur in various agroforests, pasture, and cropping habitats on the island of Grenada, May-September 2018 and January-March 2019, and determined diet items using DNA meta-barcoding analysis. Identified food items included 14 orders and 259 genera of arthropods, and 25 orders and 98 genera of plants. We found a wide mix of arthropod and plant genera across an annual cycle in every bird species studied, including those believed to be nominally nectarivorous, frugivorous, or granivorous, supporting predictions that small-island bird populations exhibit generalist foraging. Similarly, diet composition varied among species within each study site to a similar degree that diets varied among study sites within each species further indicating opportunistic/generalist foraging. In addition, we found 26 arthropod genera and 34 plant genera that were frequently shared by 3 or more bird species, suggesting the importance of specific food resources for sustaining bird communities in these heterogeneous agricultural landscapes. We also found 4 known invertebrate crop pathogens amongst 5 bird species. Together, this study reveals the various roles that these generalist species play in agroforest habitats (e.g., crop-plant pest control, pollination, seed dispersal), and the results can be used to further explore land-use practices that best provide food resources to support this unique island bird community and the ecosystem functions they carry out. Received 8 August 2023. Accepted 10 January 2024. Key words: agroecosystems, DNA meta-barcoding, Grenada, small islands, tropical birds. (Spanish)--El paisaje de mosaico de cultivos a pequena escala, agroforestales y bosques secundarios comunes a las islas volcanicas y con fuertes pendientes en el Caribe proporcionan habitats y fuentes de recursos para muchas especies de aves terrestres. Informacion de la dieta de las especies que viven en estos agroecosistemas pueden ayudar al manejo de la conservacion y decisiones de uso de suelo y mostrar los servicios ecosistemicos realizados por las comunidades unicas de aves de islas. Obtuvimos muestras fecales de 356 individuos de 14 especies de aves, incluyendo 3 especies endemicas de las Antillas Menores, que estan presentes en varios sistemas agroforestales, pastizales y habitats de cultivo en las isla de Granada, de mayo a septiembre 2018 y de enero y marzo 2019, y determinado componentes de su dieta usando meta-analisis de codigo de barras de ADN. Alimentos identificados incluyeron 14 ordenes y 259 generos de artropodos, asi como 25 ordenes y 98 generos de plantas. Encontramos una amplia mezcla de generos de plantas y artropodos a traves de un ciclo anual en cada especie de ave estudiada, incluyendo las especies que se creian que eran exclusivamente nectarivoras, frugivoras o granivoras, lo que apoya la prediccion que en poblaciones de aves de islas pequenas exhiben un forrajeo generalista. De igual modo, la composicion de la dieta vario entre especies dentro de cada sitio de estudio en un grado similar a la variacion de las dietas entre sitios de estudio dentro de cada especie, indicando aun mas forrajeo oportunista/generalista. Ademas, encontramos 4 invertebrados plagas de cultivos entre 5 especies de aves. Con toda esta evidencia, este estudio revela los varios papeles que juegan estas especies generalistas en habitats agroforestales (es decir, control de plagas de cultivos, polinizacion, dispersion de semillas) y los resultados pueden ser usados para explorar mas las practicas de uso de suelo que mejor proveen recursos alimentarios para apoyar esta comunidad de aves de islas unica y las funciones ecosistemicas que realizan. Palabras clave: agroecosistemas, aves tropicales, Granada, islas pequenas, meta-analisis de codigo de barras de ADN., The sustainable management of natural resources on small, tropical islands is critical for ensuring the long-term well-being of the people and natural environments living on them (Pantin 1999, Hay 2013, [...]

Interrupting transmission and infection caused by multidrug-resistant organisms (MDROs) in healthcare settings can help mitigate the global antimicrobial resistance (AMR) crisis, reduce illness and death, increase patient safety, and extend [...]

* Context.--The College of American Pathologists (CAP) surveys provide national benchmarks of pathology practice. Objective.--To investigate pancreaticobiliary cytology practice in domestic and international laboratories in 2021. Design.--We analyzed data from the CAP Pancreaticobiliary Cytology Practice Supplemental Questionnaire that was distributed to laboratories participating in the 2021 CAP Nongynecologic Cytopathology Education Program. Results.--Ninety-three percent (567 of 612) of respondent laboratories routinely evaluated pancreaticobiliary cytology specimens. Biliary brushing (85%) was the most common pancreaticobiliary cytology specimen evaluated, followed by pancreatic fine-needle aspiration (79%). The most used sampling methods reported by 235 laboratories were 22-gauge needle for fine-needle aspiration (62%) and SharkCore needle for fine-needle biopsy (27%). Cell block was the most used slide preparation method (76%), followed by liquid-based cytology (59%) for pancreatic cystic lesions. Up to 95% (303 of 320) of laboratories performed rapid on-site evaluation (ROSE) on pancreatic solid lesions, while 56% (180 of 320) performed ROSE for cystic lesions. Thirty-six percent (193 of 530) of laboratories used the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology in 2021. Among all institution types, significant differences in specimen volume, specimen type, ROSE practice, and case sign-out were identified. Additionally, significant differences in specimen type, slide preparation, and ROSE practice were found. Conclusions.--This is the first survey from the CAP to investigate pancreaticobiliary cytology practice. The findings reveal significant differences among institution types and between domestic and international laboratories. These data provide a baseline for future studies in a variety of practice settings. (Arch Pathol Lab Med. 2024;148:677-685; doi: 10.5858/arpa.2023-0167-CP), Cytology has proven to be a minimally invasive and cost-effective modality for accurately diagnosing pancreaticobiliary lesions, and in some patients, the only modality to diagnose lesions in this anatomic region. [...]

Earlier this year, I wrote an MPO column about the large number of available vulnerability scoring rubrics and the issues with all of them (Jan/Feb 2024 issue). (1) This month, [...]

Verruciform xanthomas are rare lesions affecting 0.025-0.5 of the population. They present as an asymptomatic, slow growing solitary lesion on the oral mucosa. Commonly misdiagnose as squamous cell carcinoma, verruca vulgaris, leukoplakia, and lichen planus. Presented is a 22 year old male with a painful verruciform xanthoma on the posterior ear lobe in a prior ear piercing. Keywords: Keloid, trauma-induced, verruciform xanthoma, Author(s): Hannah E. Myers (corresponding author) [1]; Subhapradha Rangarajan [2]; Michael Roberts [3,4]; Christopher Buckley [3,4]; Josh Hammel [3,4] Introduction Verruciform xanthomas are rare lesions affecting 0.025-0.5 of the population.[sup.[1]] [...]