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ABSTRACTIntroductionMilitary-civilian transition (MCT) refers broadly to the process of leaving military employment and becoming re-established in the civilian world. The cultural differences between military and civilian spheres can create challenges for veterans as they make this transition.ObjectivesTo explore the time use and experiences of Canadian Armed Forces members as they progressed through their release from the military.MethodsSemi-structured interviews were conducted at two time points with the same participant group (T1 – within 6 months of release date and T2 – 6 to 12 months after the release date) as part of a larger qualitative MCT study. For this study, a secondary analysis of previously coded time use data was conducted using the software program MAXQDA to support our process. We framed our analysis using three theoretical lenses related to time use and MCT: occupational disruption, occupational transition, and occupational balance.ResultsData from 75 English-speaking participants at T1 and 68 at T2 were included. Many participants demonstrated experiences of occupational disruption due to health limitations, occupational transition through changes in time use after leaving a highly structured career and seeking occupational balance, including meaningful time use with those who were important to them. There were diverse experiences across the participant group.ConclusionsThis study is the first to explore the time use experiences of Canadian military members and veterans during MCT. It identified challenges in filling time after leaving a highly structured career, with health limitations impacting time use options. Participants worked to balance demands of home and family, while valuing having discretionary time and spending it in meaningful occupations.

Surfactants provide detergency, foaming, and texture in personal care formulations, yet the micellization of typical industrial primary and cosurfactants is not well understood, particularly in light of the polydisperse nature of commercial surfactants. Synergistic interactions are hypothesized to drive the formation of elongated wormlike self-assemblies in these mixed surfactant systems. Small-angle neutron scattering, rheology, and pendant drop tensiometry are used to examine surface adsorption, viscoelasticity, and self-assembly structure for wormlike micellar formulations comprising cocoamidopropyl betaine, and its two major components laurylamidopropyl betaine and oleylamidopropyl betaine, with sodium alkyl ethoxy sulfates. The tail length of sodium alkyl ethoxy sulfates was related to their ability to form wormlike micelles in electrolyte solutions, indicating that a tail length greater than 10 carbons is required to form wormlike micelles in NaCl solutions, with the decyl homologue unable to form elongated micelles and maintaining a low viscosity even at 20 wt % surfactant loading with 4 wt % NaCl present. For these systems, the incorporation of a disperse ethoxylate linker does not enable shorter chain surfactants to elongate into wormlike micelles for single-component systems; however, it could increase the interactions between surfactants in mixed surfactant systems. For synergy in surfactant mixing, the nonideal regular solution theory is used to study the sulfate/betaine mixtures. Tail mismatch appears to drive lower critical micelle concentrations, although tail matching improves synergy with larger relative reductions in critical micelle concentrations and greater micelle elongation, as seen by both tensiometric and scattering measurements.

Purpose: Recovery within and between rounds is crucial to combat sports performance. We sought to determine whether sprint interval training (SIT) improves recovery dynamics and aerobic performance. Methods: Eleven male kickboxing athletes (26 ± 5 years; body mass index 25 ± 3 kg/m2) were recruited. Participants were tested three times for VO2peak/time to exhaustion and critical power; baseline, 3 weeks control, 3 weeks of SIT (8 × 10 s lower body sprints followed by a maximum of 10 min recovery before completing 8 × 10 s upper body sprints). During SIT session 1 and 9 continuous gas analysis was performed. Results: There was a significant reduction in recovery time between lower and upper body sprints with training (session 1: 441 ± 150 s; session 9: 268 ± 10 s; P< 0.01; d= 2.77) and change in oxygen off-kinetics amplitude (session1: 3.0 ± 0.7 L/min, session 9: 3.6 ± 1.0 L/min; P< 0.05; d= − 1.77), VO2end (session 1: 0.59 ± 0.19 L/min, session 9: 0.81 ± 0.21 L/min; P< 0.05, d= − 0.90), time constant (session 1: 81 ± 21 s; session 9: 60 ± 11 s; P< 0.05; d= 1.03). Following training there was a significant improvement in critical power (P< 0.05; η2p= 0.72) time to exhaustion (P< 0.05; η2p= 0.30) but not VO2peak(P> 0.05). Conclusion: SIT improves recovery time associated and aerobic performance associated with improved oxygen off-kinetics. Therefore, training needs to focus on improving oxygen off-kinetics to enhance combat performance.

Introduction Studies have demonstrated that trauma patients with early-ventilator associated pneumonia (early-VAP, < 7 days) have decreased risk of methicillin-resistant Staphylococcus aureus(MRSA) and Pseudomonas aeruginosainfections. We hypothesize that routinely using broad-spectrum antibiotics is unnecessary to treat trauma patients with the diagnosis of early-VAP.Methods This retrospective cohort study included adult trauma patients with the diagnosis of VAP. The primary outcome was the presence of MRSA and/or P. aeruginosain patients with early- and late-VAP. Secondary outcomes included the bacterial susceptibility of pathogens to methicillin, ampicillin/sulbactam, ceftriaxone, piperacillin/tazobactam, and cefepime. Intensive care unit (ICU) and hospital length of stay (LOS), ventilator-free days, and in-hospital mortality were also collected.Results 164 patients met inclusion criteria, and 208 organisms (n = 90 early vs n = 118 late) were identified by respiratory culture. The incidence of MRSA and P. aeruginosain early-VAP was 7.7% (7/90) and 5.6% (5/90), respectively. The susceptibility of bacteria causing early-VAP to ampicillin/sulbactam and ceftriaxone was 73.3% (66/90) and 83.3% (75/90), respectively. Ventilator-free days at 30 days was similar between groups (P= .649). Patients with late-VAP spent more time in the ICU (P= .040); however, in-hospital mortality was higher in the early-VAP group (P= .012).Conclusions Ampicillin/sulbactam or ceftriaxone monotherapy did not provide reliable broad-spectrum coverage for early-VAP in our cohort. These findings highlight the importance of each institution performing a similar analysis to ensure adequate initial treatment of VAP.

How many high school students do you know who are going to college when they graduate? All of them, of course! Now ask them which college, what course of study, [...]

Background Roughly 5% of patients with blunt abdominal trauma (BAT) have a blunt bowel and/or mesenteric injury (BBMI). Determining the need for operative management in these patients can be challenging when hemodynamically stable. Single center studies have proposed scoring systems based on CT findings to guide management. Our study aimed to determine the predictability of abdominopelvic CT scan (CT A/P) findings in conjunction with clinical exam to determine the necessity of operative intervention for BBMI.Methods Patients presenting from 2017 to 2022 to the University of South Alabama Level 1 Trauma Center after motor vehicle collision were retrospectively reviewed. Patients with CT findings suggestive of BBMI were further analyzed, noting CT findings, Glasgow coma scale (GCS), shock index, abdominal exam, operative or nonoperative management, and intraoperative intervention.Results 1098 patients with BAT underwent CT A/P. 139 patients had ≥1 finding suggestive of BBMI. 38 patients underwent surgical exploration and 30 had surgically confirmed BBMI. 27 patients required intervention for BBMI. Univariate analysis indicated that pneumoperitoneum (p< 0.0001), active extravasation of contrast (p= 0.0001), hemoperitoneum without solid organ injury (SOI) (p< 0.0001), peritonitis (p< 0.0001), and mesenteric stranding(p< 0.05) were significantly associated with intervention.Conclusion In total, 30 patients had surgically confirmed BBMI. Active extravasation, pneumoperitoneum, hemoperitoneum without SOI, mesenteric stranding, and peritonitis were significant indicators of BBMI requiring intervention. CT and clinical findings cannot reliably predict the need for surgical intervention without ≥1 of these findings. Initial nonoperative management with serial clinical exams should be strongly considered to reduce incidence of nontherapeutic laparotomies.

Crystalline silicotitanate (CST) ion exchange media is currently utilized in the tank side cesium removal (TSCR) system on the Hanford site to remove Cs-137 from the tank waste supernate. As the main dose contributor to the liquid supernate in Hanford tank waste, it is necessary to remove the Cs-137 to expedite low activity waste processing and immobilization. Ongoing batch contact experiments with CST have been done to tease out the impact of group II metals, anions, potassium, and temperature on Cs removal to better understand bounding conditions for operations as well as aid in development of a wholesome isotherm model to predict Cs behavior in the tank waste. This paper discusses the impact of Na concentration on Cs exchange and provides insight into the challenges associated with activity coefficient estimations for modeling Cs distribution in tank waste matrices.

In this study, we evaluated the effects of the pandemic on our trauma population. We performed a retrospective review of the trauma registry in the 2 years prior, and then 2 years during the pandemic. We evaluated age, race, gender, injury severity score (ISS), mechanism of trauma, rate of self-inflicted injury, rate of gunshot wounds (GSW), presence of EtOH, drug screen results, mortality, rate of burn traumas, and zip code of residence. Our query captured 5 054 patients before, and 5 731 during the pandemic. We found no statistical difference in age, gender, mechanism of trauma, rate of self-inflicted injuries, and mortality during the pandemic when compared to before. There were statistically significant differences in race, ISS, rate of GSWs, EtOH use, drug screen results, and burn traumas. Geospatial mapping found a rise in GSWs for zip code 36606. Gun violence and substance use rose in our trauma population during COVID-19.

Portal venous thrombosis (PVT) is an uncommon disease associated with highly morbid conditions such as intestinal ischemia and portal hypertension. Patients at higher risk of developing PVT include those with cirrhosis, malignancy, or prothrombotic states. The mainstay of treatment is early initiation of anticoagulation. The first case is a 49-year-old female diagnosed with a cecal mass and PVT. She was started on anticoagulation and underwent a right hemicolectomy with several small bowel resections. She developed portal hypertension that required TIPS and mechanical thrombectomy. The second patient is a 65-year-old female found to have PVT. She was anticoagulated with heparin and given systemic TPA. She developed intestinal ischemia and portal hypertension requiring small bowel resection, TIPS, and mechanical thrombectomy. These cases give insight into the impact of a multidisciplinary team approach to PVT. The role and timing of endovascular treatment is not well established and needs to be further investigated.

Academic libraries experience a profound shift in atmosphere when transitioning from daytime to nighttime hours. Previously employed during nighttime hours, the authors examine issues that arose during late night hours and recommend measures to remedy these situations. A study was conducted to determine hourly library usage based on gate counts. Researchers found that entry numbers for late night patrons are only slightly less than entry numbers for daytime patrons despite the majority of staff resources allocated to traditional working hours. Research recommendations include increased security measures, cross training for all employees, and additional reference training for Access Services nighttime staff. [ABSTRACT FROM AUTHOR]

Public policy advocacy is crucial to ensure equitable access for all those seeking applied behavior analysis (ABA) services. Based on their experiences engaging in state-level public policy advocacy, the authors created a Public Policy Advocacy Actions Checklist that summarizes specific strategies they found to be successful with a variety of public policy issues relevant to ABA. Although this article focuses on advocacy efforts related to Medicaid reimbursement rates and Medicaid policies for ABA service provision, the strategies presented have also been used to advocate for coverage of telehealth ABA services, licensure for behavior analysts, and mandates for commercial insurance to cover ABA and/or autism intervention. The State of Wisconsin is used to illustrate implementation of the Public Policy Advocacy Actions Checklist, and the states of Arizona and Massachusetts are presented as additional examples of successful advocacy efforts using these strategies. This article walks behavior analysts through the process of identifying the local challenges and opportunities, developing advocacy goals, implementing an action plan, collecting data, recruiting support from the community, and influencing policy makers to implement favorable policy changes. The authors present additional resources to support new behavior analyst advocates including links to free advocacy toolkits, tips on selecting a lobbyist, recommendations for meetings with policy makers, a sample budget request, and two examples of “call to action” communications encouraging members of the community to contact their representatives regarding a specific issue. Finally, the successful advocacy outcomes and remaining opportunities for advocacy in each of these three states are discussed.

Theories suggest that people with schizophrenia (SZ) have problems generating predictions based on past experiences. The dorsolateral prefrontal cortex (DLPFC) and hippocampus participate in memory-based prediction. We used functional magnetic resonance imaging to investigate DLPFC and hippocampal function in healthy control (HC) subjects and people with SZ during memory-based prediction.

Abstract

Problem-solving strategies, such as visual imagining and self-questioning, may assist children with autism spectrum disorder (ASD) in recalling past events. In the current study, at the start of each session, a 7-year-old boy with ASD engaged in a novel activity with a behavior therapist who took pictures of the activity. Ninety minutes later, a different therapist asked the participant to describe the prior activity. The intervention consisted of showing the participant pictures of the activity, telling him to close his eyes and imagine the activity, modeling asking and answering seven questions (e.g., “Who was there?” “What was one thing that happened?”), prompt fading, and reinforcement. Following the intervention, recall statements increased.

Blunt cerebrovascular injury (BCVI) results from blunt trauma causing injury to the carotid and/or vertebral arteries. Its most severe manifestation is stroke. The purpose of this study was to evaluate the incidence, management, and outcomes of BCVI at a level one trauma/stroke center. Data on patients diagnosed with BCVI from 2016 to 2021 were extracted from the USA Health trauma registry with associated intervention performed and patient outcomes. Of the 97 patients identified, 16.5% presented with stroke-like symptoms (SS). Medical management was employed for 75%. Intravascular stent alone was utilized for 18.8%. The mean age of symptomatic BCVI patients was 37.6 with a mean injury severity score (ISS) of 38.2. Within the asymptomatic population, 58% received medical management and 3.7% underwent combination therapy. The mean age of asymptomatic BCVI patients was 46.9 with a mean ISS of 20.3. There were 6 mortalities, only one BCVI related.

Traumatic aortic injuries in children and adolescents are rare, and even more rare are blunt traumatic injury to the abdominal aorta in this population. Therefore, there are few reports discussing the presentation and repair of such injuries, especially within the pediatric population. We report the successful repair of traumatic abdominal aortic transection in a 10-year-old female after a high speed MVC. She arrived in extremis with a seatbelt sign and was taken emergently for damage control laparotomy with subsequent postoperative CT findings of aortic transection/dissection at L3 with active extravasation. She immediately underwent open thrombectomy of the bilateral iliac arteries, and repair of her aortic injury with a 12 × 7 mm Hemashield interposition graft extending just distal to the IMA and 1 cm proximal to the aortic bifurcation. There are little data regarding long-term outcomes of pediatric patients undergoing different aortic repair techniques, and further research is needed.

Trauma patients are especially vulnerable to inadvertent medication reconciliation discrepancies. We conducted a prospective study to evaluate the USA Health University Hospital’s incidence and type of inadvertent medication reconciliation discrepancies among trauma patients. Patients were interviewed for accuracy of their admission medication reconciliation (AMR). Eighty-nine patients were included in this study. Twenty-six patients (29%) never received an AMR. There were 107 inadvertent medication reconciliation errors identified from 30 separate patients (48%), for a rate of 3.6 errors per patient with any error. There was a significant difference in the frequency of inadvertent medication reconciliation discrepancies for patients with >5 medication compared to those with fewer (P= .00029). In conclusion, trauma centers must be adequately staffed to provide timely, accurate, and available medication lists so that patients can be appropriately cared for.

As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).

Diabetes is a major determinate for mortality in trauma patients. Many diabetics are undiagnosed or poorly controlled. Trauma patients disproportionately come from lower socioeconomic status, making missed diagnoses more likely. We aimed to quantify the incidence of undiagnosed or poorly controlled diabetics assessed at a Level 1 Trauma Center. We did a retrospective chart review of admitted trauma patients over a one-month period. Past Medical History, home medication lists, and Hemoglobin A1c on admission were recorded for each patient. We determined that 30 of 173 trauma patients qualifying for the study were diabetic. Furthermore, 30% of these diabetics were undiagnosed or had poorly controlled diabetes. Undiagnosed pre-diabetics made up 20% of the entire study group. Our data show that 26% of trauma patients would benefit from an intervention for improved glucose control. Trauma centers should consider creating routine clinical practice guidelines to identify at-risk patients and provide intervention for long-term management.

Objective: Few studies have examined the impact of coronavirus disease 2019 (COVID-19) on the primarily Latinx community along the U.S.-Mexico border. This study explores the socioeconomic impacts which contribute to strong predictors of severe COVID-19 complications such as intensive care unit (ICU) hospitalization in a primarily Latinx/Hispanic U.S.-Mexico border hospital. Methods: A retrospective, observational study of 156 patients (≥ 18 years) Latinx/Hispanic patients who were admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at a U.S.-Mexico border hospital from April 10, 2020, to May 30, 2020. Descriptive statistics of sex, age, body mass index (BMI), and comorbidities (coronary artery disease, hypertension, diabetes, cancer/lymphoma, current use of immunosuppressive drug therapy, chronic kidney disease/dialysis, or chronic respiratory disease). Multivariate regression models were produced from the most significant variables and factors for ICU admission. Results: Of the 156 hospitalized Latinx patients, 63.5% were male, 84.6% had respiratory failure, and 45% were admitted to the ICU. The average age was 67.2 (± 12.2). Those with body mass index (BMI) ≥ 25 had a higher frequency of ICU admission. Males had a 4.4 (95% CI 1.58, 12.308) odds of ICU admission (p= 0.0047). Those who developed acute kidney injury (AKI) and BMI 25–29.9 were strong predictors of ICU admission (p&lt; 0.001 and p= 0.0020, respectively). Those with at least one reported comorbidity had 1.98 increased odds (95% CI 1.313, 2.99) of an ICU admission. Conclusion: Findings show that age, AKI, and male sex were the strongest predictors of COVID-19 ICU admissions in the primarily Latinx population at the U.S.-Mexico border. These predictors are also likely driven by socioeconomic inequalities which are most apparent in border hospitals.

Objective Anterior cruciate ligament reconstruction (ACLR) has not been shown to decrease the risk for development of post-traumatic osteoarthritis. Magnetic resonance imaging (MRI) T2 mapping can be used to assess cartilage compositional changes. This study tests whether (1) worse cartilage arthroscopic status at ACLR is reflected by higher cartilage T2 values in matched study regions 6 weeks and 1 year after ACLR, and (2) increasing cartilage T2 values between 6 weeks and 1 year after ACLR are associated with worsening patient-reported outcomes.Design Twenty-two participants with ACLR and 26 controls underwent 3T MRI. T2 values in medial and lateral femoral and tibial cartilage were measured at 6 weeks and 1 year after ACLR and compared with arthroscopic grades, Knee injury and Osteoarthritis Outcome Scores (KOOS), and control T2 values.Results Most (59%-86%) cartilage study regions examined by arthroscopy demonstrated intact articular surfaces. Average T2 value increased in 3 of 4 study regions between 6 weeks and 1 year after ACLR (P= .001-.011). T2 value increased (P< .013) even for participants whose cartilage had intact articular surfaces at ACLR. Participants with ACLR who showed greater increases in cartilage T2 values had less improvement to KOOS Quality of Life (P= .009, ρ = −0.62).Discussion Cartilage status assessed arthroscopically at ACLR and by MRI T2 maps 6 weeks later was healthier than cartilage status assessed by MRI T2 maps at 1-year follow-up. Progressive T2 elevations were observed over the first year after ACLR even in patients with arthroscopically intact cartilage at the time of surgery and were associated with reduced improvement in knee quality of life suggesting preosteoarthritis.

Introduction: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL).Methods: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic.Results: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly.Conclusion: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.