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Actinomyces spp. has been shown to form biofilms when exposed to copper, possibly enhancing its degradation. Fragmentation and migration of the copper coil on an intrauterine device (IUD) is rare, but the concomitant presence of Actinomyces spp. may increase its incidence. We present the first case of a fragmented copper IUD within its lifespan of 10 years, with documented Actinomyces genitourinary tract colonization in a premenopausal woman. KEY POINTS: Actinomyces spp. are more prevalent in the urogenital tract of women with IUDs due to the local tissue injury from the device inside the uterus, which creates an anaerobic environment that allows this organism to flourish. Actinomyces spp. can form biofilms when exposed to copper, potentially enhancing its degradation, leading to fragmentation. Patients with a copper IUD and Actinomyces identified on routine or symptomatic cervical sampling should be counseled regarding potential enhanced copper degradation, fragmentation, and migration of the copper coil. [ABSTRACT FROM AUTHOR]

The COVID-19 global pandemic has raised many challenges in training family medicine residents. Family medicine is at the frontline for treating and managing patients with COVID-19. Attention is needed on the critical issue of the effect of the pandemic on resident training, the safety of those performing needed medical services, and the psychological well-being of trainees. We performed a cross-sectional, 25-question survey-based study to evaluate the perceived effect of the COVID-19 pandemic on family medicine residents' training and residents' well-being in the state of Texas. A total of 250 Texas-based family medicine residents were surveyed with a response rate of 12.8% (n = 32). After the pandemic began, all residents worried about exposing their loved ones to COVID-19, and 65% felt like the COVID-19 pandemic negatively impacted their training overall. Respondents indicated that changes occurred in their respective residency curricula that altered training such as canceling of scheduled lectures (84.3%) and more telemedicine visits (56.25%). There was a significant difference for postgraduate year level and the effect on rotation assignments, with more disruption to the first- and third-year residents (P = 0.03). The COVID-19 pandemic has had a notable impact on the perception of quality of training and mental health within family medicine. Our findings may guide programs in how to proactively target pandemic-related training challenges. [ABSTRACT FROM AUTHOR]

A significant public health burden exists related to firearm-related injuries in the United States. Primary care physicians (PCPs) find themselves on the frontline to address it. This study aimed to determine if PCPs feel prepared and responsible for providing firearm safety counseling. Data were gathered via a direct 23-question survey of family medicine, internal medicine, and pediatric physicians and residents in North and Central Texas between May 2019 and January 2020. The survey was delivered to 518 outpatient providers, with a 24% response rate. Associations were assessed by chi-square/Fisher's exact test. A total of 62% agreed that preventable firearm death is an important health issue and PCPs can have a positive effect; 10% felt their residency provided or provides opportunities to learn about firearm safety and how to counsel patients; 55% agreed that a standardized tool to question and counsel patients on firearm safety such as a template in the electronic health record would be useful; and 68% stated they would use a standardized template in their practice if proven to reduce firearm-related injuries. Physicians who had received training in residency felt their knowledge was adequate to be able to provide meaningful counseling to patients (P < 0.001). In conclusion, PCPs are pivotal in addressing firearm safety. A formal curriculum across primary care specialties' graduate education programs should be developed to improve physicians' competency in addressing firearm safety. Further investigation into standardized tools that could be implemented into an electronic health record may help bridge the gap from awareness to implementation of interventions. [ABSTRACT FROM AUTHOR]

Murine typhus is a rare condition caused by the gram-negative bacterium Rickettsiatyphi which classically presents with the triad of fever, rash, and headache. Herein we report a rare presentation of murine typhus in an adult who presented predominantly with fever and gastrointestinal symptoms. Initial imaging showed cardiomegaly and hepatosplenomegaly, which led to further workup revealing rickettsial disease. Although this illness is considered a rare diagnosis in the emergency department, every person with a pet that might have fleas is susceptible to it. [ABSTRACT FROM AUTHOR]

Abstract: In 1992, the Western Boreal Growth and Yield Association (WESBOGY) began a long-term study to evaluate the dynamics of regenerated aspen (Populus tremuloides Michx.)—white spruce (Picea glauca (Moench) Voss) mixedwood stands following manipulation of aspen to a range of densities. In this study six levels of aspen (0, 200, 500, 1500, 4000stemsha−1 and natural) and three levels of spruce (0, 500 and 1000stemsha−1) densities have been created. Data from four locations demonstrate substantial variation in initial aspen densities following clearcutting of aspen dominated stands. After 9 years densities begin to converge with the highest rates of mortality associated with high starting densities. A model was developed that shows a significant relationship between the proportion of trees surviving to the end of a year and the density at the beginning of the year. Size-density relationships based on quadratic mean root collar diameter, mean tree volume and mean tree height are presented. Three to four years following spacing of aspen to densities ranging from 200 to 4000stemsha−1 there were no significant effects of density on aspen size. In addition, spacing of the aspen had no significant effect on spruce height at year 9 (3–4 years after spacing), but spruce root collar diameter (RCD) was significantly smaller in the unspaced compared to the spaced plots. The ratio of height to root collar diameter (HDR) for white spruce showed a significant and clear response to aspen density and increased with increasing aspen density. [Copyright &y& Elsevier]

Focuses on the development of a maximum size-density relationship for constraining individual tree mortality functions. Steps taken to derive the maximum size-density relationship.

A large number of height-diameter functions were evaluated using felled tree data for white spruce (Picea glauca (Moench) Voss) grown in Alberta's boreal forests. The logistic-type function was found to produce the most satisfactory fits. Residual analyses were conducted to identify the error structure of the model. A weighting factor of w[sub i] = 1/Ĥ[sup 3/2, sub i] was found appropriate for satisfying the equal error variance assumption. Regional differences in the height-diameter models were examined and tested using the nonlinear extra sum of squares method. It was found that height-diameter models were different among different ecoregions. Incorrectly applying a height-diameter model fitted from one ecoregion to different ecoregions resulted in overestimations between 1.10% and 29.05%, or underestimations between 1.92% and 21.92%. [ABSTRACT FROM AUTHOR]

Investigates the development of an individual tree-height increment models for white spruce and aspen growing in the boreal mixed-species in Alberta. Selection of a base height-increment function; Incorporation of tree and stand level variables using the parameter prediction approach.