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Background The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS. Therefore, we hypothesized an increased incidence of HVI and mortality for OTPs vs younger trauma patients (YTPs) with abdominal SBS.Study Design This post hoc analysis of a multi-institutional, prospective, observational study (8/2020-10/2021) included patients >18 years old with an abdominal SBS who underwent abdominal computed tomography (CT) imaging. Older trauma patients were compared to YTPs (18-64 years old) with bivariate analyses.Results Of the 754 patients included in this study from nine level-1 trauma centers, there were 110 (14.6%) OTPs and 644 (85.4%) YTPs. Older trauma patients were older (mean 75.3 vs 35.8 years old, P< .01) and had a higher mean Injury Severity Score (10.8 vs 9.0, P= .02). However, YTPs had an increased abdominal abbreviated-injury scale score (2.01 vs 1.63, P= .02). On CT imaging, OTPs less commonly had intraabdominal free fluid (21.7% vs 11.9%, P= .02) despite a similar rate of abdominal soft tissue contusion (P> .05). Older trauma patients also had a statistically similar rate of HVI vs YTPs (5.5% vs 9.8%, P= .15). Despite this, OTPs had increased mortality (5.5% vs 1.1%, P< .01) and length of stay (LOS) (5.9 vs 4.9 days P< .01).Conclusion Despite a similar rate of HVI, OTPs with an abdominal SBS had an increased rate of mortality and LOS. This suggests the need for heightened vigilance when caring for OTPs with abdominal SBS.

Background Patients with peritoneal carcinomatosis (PC) can develop malignant bowel obstructions (MBOs) requiring inpatient admission and nasogastric tube decompression. Palliative decompressive gastrostomy tubes (G-tubes) may affect patient disposition, allowing for self-management and reduction in inpatient services. Therefore, we sought to assess disposition and inpatient readmission rates in patients admitted with PC and MBO following G-tube placement.Methods The Vizient® Clinical Data Base was queried for inpatient admissions from October 2018 to May 2022 utilizing ICD-10 codes to identify patients admitted with PC and bowel obstruction, with or without G-tube placement. Demographics and hospital outcomes were recorded. Descriptive statistics and multivariate logistic regression analysis were performed.Results From 750 patients, 59 (7.9%) had a G-tube placed. Compared to patients without G-tubes, those with G-tubes had lower rates of disposition to home (32.2% vs 70.0%, P< .001) and higher rates of disposition to hospice (home: 30.5% vs 7.8%, P< .001, facility: 10.2% vs 3.9%, P= .02). There was no significant difference in the rate (17.3% vs 22.3%, P= .40) or risk (OR = 1.44, 95% CI .69-3.01) of 30-day readmissions with G-tubes. However, palliative care consultation (OR 33.77, 95% CI 19.16-59.52) and G-tube placement (OR 5.82, 95% CI 2.56-13.25) were independent predictors for hospice.Discussion Placement of G-tubes in patients with PC and MBO was associated with higher rates of disposition to hospice but there is no difference in 30-day readmission rates compared to those without G-tubes. Further prospective studies are needed to understand the role of G-tube placement in patients with MBO in relation to outcomes and disposition.

IMPORTANCE: It has been well established that female physicians earn less than their male counterparts in all specialties and ranks despite controlling for confounding variables. OBJECTIVE: To investigate payments made from highest-grossing medical industry companies to female and male physicians and to assess compensation and engagement disparities based on gender. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cross-sectional study used data from the Open Payments database for the 5 female and 5 male physicians who received the most financial compensation from each of the 15 highest-grossing medical supply companies in the US from January 2013 to January 2019. MAIN OUTCOMES AND MEASURES: The primary outcome was total general payments received by female and male physicians from medical industry over time and across industries. The secondary outcome was trends in industry payment to female and male physicians from 2013 to 2019. RESULTS: Among the 1050 payments sampled, 1017 (96.9%) of the 5 highest earners were men and 33 (3.1%) were women. Female physicians were paid a mean (SD) of $41 320 ($88 695), and male physicians were paid a mean (SD) of $1 226 377 ($3 377 957) (P &lt; .001). On multivariate analysis, male gender was significantly associated with higher payment after adjusting for rank, h-index, and specialty (mean [SD], $1 025 413 [$162 578]; P &lt; .001). From 2013 to 2019, the payment gap between female and male physicians increased from $54 343 to $166 778 (P &lt; .001). CONCLUSIONS AND RELEVANCE: This study found that male physicians received significantly higher payments from the highest-grossing medical industry companies compared with female physicians. This disparity persisted across all medical specialties and academic ranks. The health care industry gender payment gap continued to increase from 2013 to 2019, with a wider compensation gap in 2019.

Background Hispanic individuals have a disproportionately higher incidence and mortality for stomach, cervix, and liver cancers compared to Non-Hispanic White people. Since disparities in cancer incidence are influenced by multiple factors including immigration, elucidating the effect of birthplace and exposure to risk factors on the prevalence of these cancers is crucial for identifying high-risk populations and target risk reduction interventions.Methods The National Institutes of Health All of Us Research Program is a prospective, multidimensional biomedical data resource of underrepresented, minoritized people. The Registered Tier Dataset v5 was utilized to evaluate the prevalence and risk of stomach, cervix, and liver cancers among United States (US) born and non-US born Hispanic participants.Results Of over 434 000 current participants, 60 540 are Hispanic; 30 803 (50.9%) reported being US born and 29 294 (48.4%) non-US born. Non-US born Hispanic participants had significantly higher prevalence (.39% vs .21%, P< .001) and associated risk (OR 1.84, 95% CI 1.29-2.64, P< .001) of liver cancer, and trend towards higher prevalence of stomach (.14% vs .09%, P= .076) and cervix cancers (.27% vs .20%, P= .083) compared to US born counterparts. US born Hispanic patients with these 3 cancers were significantly younger than non-US born cohort (mean age 56.8 vs 61.7 years, P< .001).Discussion This is the first report using All of Us data to show that non-US born Hispanic participants have a higher risk of liver cancer compared to US born participants. Further analyses, including genomic studies, are necessary to understand these differences and identify targets for risk reduction interventions.

Freshwater ecosystems are threatened by a wide range of anthropogenic infrastructure related to hydropower, irrigation, municipal withdrawals, and industrial cooling. Technology can be used to mitigate the loss of fish associated with such infrastructure by exploiting the sensory physiology of a species through stimuli designed to manipulate their natural behaviors (e.g., to attract or repel). Technologies used for behavioral guidance often incorporate light; however, previous studies investigating light devices have focused on mercury vapor bulbs and thus have been limited in their exploration of the broader light spectra. Innovations in light-emitting diode (LED) technology provide opportunities for manipulating light spectra (i.e., color) as well as light-pulse frequency. We tested the behavioral response of Largemouth Bass Micropterus salmoidesunder 16 different LED color and light-pulse frequency combinations as well as in a control in which no light was emitted. Red, orange, yellow, and green were considered with four light-pulse frequencies (0, 120, 300, and 600 pulses/min). Using a large shallow arena, lateral fish movement in response to the light treatments was examined. Regardless of color or light-pulse frequency, fish were repelled by the light source. In contrast, when there was no light emitted, fish were evenly distributed throughout the arena. This work suggests that colored light accompanied with light-pulse frequencies produced by LEDs can induce an avoidance response in Largemouth Bass. Received May 7, 2015; accepted January 5, 2016 Published online August 24, 2016

AbstractFreshwater ecosystems are threatened by a wide range of anthropogenic infrastructure related to hydropower, irrigation, municipal withdrawals, and industrial cooling. Technology can be used to mitigate the loss of fish associated with such infrastructure by exploiting the sensory physiology of a species through stimuli designed to manipulate their natural behaviors (e.g., to attract or repel). Technologies used for behavioral guidance often incorporate light; however, previous studies investigating light devices have focused on mercury vapor bulbs and thus have been limited in their exploration of the broader light spectra. Innovations in light-emitting diode (LED) technology provide opportunities for manipulating light spectra (i.e., color) as well as light-pulse frequency. We tested the behavioral response of Largemouth Bass Micropterus salmoidesunder 16 different LED color and light-pulse frequency combinations as well as in a control in which no light was emitted. Red, orange, yellow, and green were considered with four light-pulse frequencies (0, 120, 300, and 600 pulses/min). Using a large shallow arena, lateral fish movement in response to the light treatments was examined. Regardless of color or light-pulse frequency, fish were repelled by the light source. In contrast, when there was no light emitted, fish were evenly distributed throughout the arena. This work suggests that colored light accompanied with light-pulse frequencies produced by LEDs can induce an avoidance response in Largemouth Bass.Received May 7, 2015; accepted January 5, 2016 Published online August 24, 2016