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Creating summative assessments that accurately test students' breadth of knowledge and critical thinking can be a difficult task. Instructors often rely upon overly complex quick response questions or constructed response exams. However, students often have negative perceptions of the latter. The authors implemented an approach for administering constructed response exams called "Essay Roulette" in which students were given essay prompts a week prior to the exam, and the actual exam questions were chosen by the roll of a die. Students reported increased motivation, a reduction in stress, and saw improvement on their essay performance.

The ability to clearly disseminate scientific knowledge is a skill that is necessary for any undergraduate student within the sciences. Traditionally, this is accomplished through the instruction of scientific presentation or writing with a focus on peer-to-peer communication at the expense of teaching communication aimed at a nonscientific audience. One of the ramifications of focusing on peer-to-peer communication has presented itself as an apprehension toward scientific knowledge within the general populace. This apprehension can be seen in a variety of venues, including the traditional media, popular culture, and education, which generally paint scientists as aloof and with an inability to discuss scientific issues to anyone other than other scientists. This paper describes a curriculum designed to teach Introduction to Anatomy and Physiology students the tools necessary for communicating complex concepts that were covered during the semester using approachable language. Students were assessed on their word usage in associated writing activities, the student's ability to reduce complexity of their statements, and performance in an informal scientific presentation to a lay audience. Results showed that this pedagogical approach has increased students' ability to reduce the complexity of their language in both a written and oral format. This, in turn, led to evaluators reporting greater levels of understanding of the topic presented following the presentation.

Research confirms the positive effect of collaborative learning environments when students are considered as one homogeneous group. Little has been done to provide a detailed view of the performance of subgroups of students within collaborative settings. This quantitative and longitudinal study uses survey responses to explore differences in the variables of social self-efficacy (SSE) and leadership relative to each other, different academic performance levels, and across two academic years in a cohort of undergraduate students. Analysis showed no relationship between either sex or race and academic performance. However, results confirm that there is a positive relationship between SSE and grades, and that leaders have a higher SSE than followers. Results also show that SSE improves for leaders, but no evidence for such improvement for followers. We conclude that in collaborative learning environments, high SSE and leadership are important components in student achievement and should be considered when designing curricula.

The environmental tenacity of influenza A viruses (IAVs) in the environment likely plays a role in their transmission; IAVs are able to remain infectious in aquatic habitats and may have the capacity to seed outbreaks when susceptible wild bird hosts utilize these same environments months or even seasons later. Here, we aimed to assess the persistence of low-pathogenicity IAVs from naturally infected ducks in Northwestern Minnesota through a field experiment. Viral infectivity was measured using replicate samples maintained in distilled water in a laboratory setting as well as in filtered water from four natural water bodies maintained in steel perforated drums (hereafter, mesocosms) within the field from autumn 2020 to spring 2021. There was limited evidence for the extended persistence of IAVs held in mesocosms; from 65 initial IAV-positive samples, only six IAVs persisted to at least 202 days in the mesocosms compared to 17 viruses persisting at least this long when held under temperature-controlled laboratory settings in distilled water. When accounting for the initial titer of samples, viruses detected at a higher concentration at the initiation of the experiment persisted longer than those with a lower starting titer. A parallel experimental laboratory model was used to further explore the effects of water type on viral persistence, and the results supported the finding of reduced tenacity of IAVs held in mesocosms compared to distilled water. The results of this investigation provide evidence that many factors, including temperature and physicochemical properties, impact the duration of viral infectivity in natural settings, further extending our understanding of the potential and limitations of environmental-based methodologies to recover infectious IAVs. [ABSTRACT FROM AUTHOR]

Background: Healthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores. Methods: A Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified. Results: Listening sessions produced three major themes, with recommended actions for primary care clinics. #1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity. #2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion. #3: Funding Based on Current Quality Measures Perpetuates Health Inequities. Conclusion: Community leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke.Methods: Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence.Results: The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p < 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey.Conclusions: Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study.Implications: Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers.Trial Registration: ClinicalTrial.gov: NCT03379142. [ABSTRACT FROM AUTHOR]

Background: Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness.Methods: Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer).Results: Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes.Conclusions: During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study. [ABSTRACT FROM AUTHOR]

In this investigation, we used a combination of field- and laboratory-based approaches to assess if influenza A viruses (IAVs) shed by ducks could remain viable for extended periods in surface water within three wetland complexes of North America. In a field experiment, replicate filtered surface water samples inoculated with duck swabs were tested for IAVs upon collection and again after an overwintering period of approximately 6–7 months. Numerous IAVs were molecularly detected and isolated from these samples, including replicates maintained at wetland field sites in Alaska and Minnesota for 181–229 days. In a parallel laboratory experiment, we attempted to culture IAVs from filtered surface water samples inoculated with duck swabs from Minnesota each month during September 2018–April 2019 and found monthly declines in viral viability. In an experimental challenge study, we found that IAVs maintained in filtered surface water within wetlands of Alaska and Minnesota for 214 and 226 days, respectively, were infectious in a mallard model. Collectively, our results support surface waters of northern wetlands as a biologically important medium in which IAVs may be both transmitted and maintained, potentially serving as an environmental reservoir for infectious IAVs during the overwintering period of migratory birds. [ABSTRACT FROM AUTHOR]

The Chesterian (Mississippian) Hartselle Sandstone is a tar sand exposed in the Black Warrior Basin and southern Appalachian fold belt in northern Mississippi and Alabama. Previous studies disagree about the delivery direction and relative contributions of sediment from the cratonic interior, the Appalachians, and the Ouachitas. The goal of this research is to investigate lateral trends in sedimentary and geochemical properties to provide new details about the provenance of the Hartselle. Samples were collected along a west-to-east transect and analyzed using petrography, X-ray fluorescence (XRF) geochemistry, and U-Pb detrital zircon (DZ) geochronology. Point counting indicated a major cratonic interior source with a minor recycled orogen signal. Sillimanite in the easternmost sample narrows down the potential Appalachian sources to areas of high-grade metamorphism. Petrographic observations suggest both western and eastern sources. The XRF results showed high concentrations of Ti and Mo in the westernmost sample, suggestive of a nearby terrigenous source. All of the samples had similar U-Pb DZ age distributions except for the easternmost sample, which had statistically higher proportions of Paleozoic- and Archean-aged grains (Kolmogorov-Smirnov test: p <.02). For the first time, Eoarchean and Paleoarchean grains were found in the Hartselle, indicating a likely sediment source from the Minnesota River Valley gneisses of the Superior Craton prior to Grenvillian overprinting. Based on integration of all data, we conclude that a large fluvial system draining the continental interior provided a substantial volume of sediment from the northwest. At the same time, a more dispersed drainage basin associated with the Appalachian front contributed recycled orogenic material from the northeast. [ABSTRACT FROM AUTHOR]

Objective Provider profiling of outcome performance has become increasingly common in pay-for-performance programs. For chronic conditions, a substantial proportion of patients eligible for outcome measures may be lost to follow-up, potentially compromising outcome profiling. In the context of primary care depression treatment, we assess the implications of missing data for the accuracy of alternative approaches to provider outcome profiling. Data We used data from the Improving Mood-Promoting Access to Collaborative Treatment trial and the Depression Improvement across Minnesota, Offering a New Direction initiative to generate parameters for a Monte Carlo simulation experiment. Study Design The patient outcome of interest is the rate of remission of depressive symptoms at 6 months among a panel of patients with major depression at baseline. We considered two alternative approaches to profiling this outcome: (1) a relative, or tournament style threshold, set at the 80th percentile of remission rate among all providers, and (2) an absolute threshold, evaluating whether providers exceed a specified remission rate (30 percent). We performed a Monte Carlo simulation experiment to evaluate the total error rate (proportion of providers who were incorrectly classified) under each profiling approach. The total error rate was partitioned into error from random sampling variability and error resulting from missing data. We then evaluated the accuracy of alternative profiling approaches under different assumptions about the relationship between missing data and depression remission. Principal Findings Over a range of scenarios, relative profiling approaches had total error rates that were approximately 20 percent lower than absolute profiling approaches, and error due to missing data was approximately 50 percent lower for relative profiling. Most of the profiling error in the simulations was a result of random sampling variability, not missing data: between 11 and 21 percent of total error was attributable to missing data for relative profiling, while between 16 and 33 percent of total error was attributable to missing data for absolute profiling. Finally, compared with relative profiling, absolute profiling was much more sensitive to missing data that was correlated with the remission outcome. Conclusions Relative profiling approaches for pay-for-performance were more accurate and more robust to missing data than absolute profiling approaches. [ABSTRACT FROM AUTHOR]

In 1998, after 160 y without documented nesting, Double-crested Cormorants (Phalacrocorax auritus) recolonized Leech Lake, Minnesota. Competition for nesting space with the state threatened Common Tern (Sterna hirundo), and concern regarding potential walleye (Sander vitreus) and yellow perch (Perca flavescens) population declines prompted culling of cormorants and research into their diet. Stomach contents of adult and subadult cormorants were collected in 2004, 2005, and 2006 (186, 356 and 348, respectively) and from cormorant chick regurgitants in 2005 and 2006 (151 and 114, respectively). Perca flavescens (>70% composition and biomass) and shiner species (Notropis sp.) (>4% composition and biomass) were the main components of subadult and adult cormorant diets in 2004 and 2005 and the diet of chicks in 2005. However in 2006, whitefish species (Coregonus sp.) was the majority of percent biomass consumed by subadults and adults (43.4%) and a large proportion of percent biomass consumed by chicks (17.8%). In 2006 percent biomass of Corengonus sp. was different from other years for adults and subadults (P < 0.001) and chicks (P < 0.01) and may have been a product of a warming event die-off in late summer. All eight of the select common prey species varied (P < 0.01) in percent biomass between at least one of the ten delineated periods within 2004, 2005, or 2006. Differential prey selection by adults for self-feeding and provisioning for chicks was detected in Coregonus sp. (P < 0.01). While the diet of Leech Lake cormorants mainly consists of small abundant fish (P. flavescens and Notropis sp.), cormorant diet can vary within and among years. This study represents the first description of the diet of cormorants from a midwestern location other than the Great Lakes and reinforces the importance of site specific diet assessment, as the particular abundant prey species differs between locations. [ABSTRACT FROM AUTHOR]

lloglossidium fonti sp. nov. is described based on specimens from black bullheads ( Ameiurus melas) collected from several localities in northwestern Minnesota. The new species is morphologically closest to A. corti and A. geminum. These two species were also found in the same region as A. fonti sp. nov. and sometimes in the same individual fish. Examination of numerous genetically marked specimens has demonstrated that the most reliable distinguishing feature among the three species is the position of anterior margin of the vitelline fields. In the new species they are situated at the level of anterior margin of ventral sucker while in A. corti it is at the level of intestinal bifurcation or even further anteriorly, and in A. geminum it is at the level of posterior margin of ventral sucker or further posteriorly. The new species has a relatively smaller cirrus sac than A. geminum. Despite rather minor, albeit stable morphological differences, the molecular data strongly supported the status of A. fonti sp. nov. as a new species. Moreover, molecular data and morphological examination of new material suggested that A. kenti, earlier synonymized with A. corti, is a valid species that is resurrected here. Comparison of 2420 base long sequences of nuclear rDNA (partial 18S, complete ITS region, and partial 28S) obtained from multiple specimens of all 4 species collected in Minnesota, North Dakota, Nebraska and Mississippi, showed essentially no intraspecific variability (except for 1 base difference in the ITS2 region of A. fonti sp. nov.), but has demonstrated pronounced interspecific differences. The new species was not found in the four examined catfish species from the Red River of the North (on the border between North Dakota and Minnesota) and neighbouring North Dakota. [ABSTRACT FROM AUTHOR]

Painted turtles (Chrysemys picta) are commercially harvested in large numbers in Minnesota for sale to biological supply companies and the pet trade. We investigated the possible effects of this harvest by comparing size, demography, and catch rates of painted turtles in 12 harvested and 10 nonharvested painted turtle populations in 2001 and 2002. We correlated turtle catch rates to harvest status, and harvested lakes had a lower catch-per-unit-effort than nonharvested lakes. Harvest had minimal effect on the size of turtles captured, and we found no significant differences in the count of male:female:juvenile turtles among lakes of different harvest status. We suggest that painted turtle populations likely have been impacted by harvester activities, but it was unclear whether the current harvest is sustainable. Further work is needed to determine whether there are any long-term effects on painted turtle populations. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effect, if any, of a teacher education seminar stressing economic concepts and methodology on the level of understanding in economics held by the students of the participants. The Economic Education Institute at Auburn University hosted two 2-week seminars during three summer sessions. Each was offered to secondary level teachers of social studies, business education, and home economics for five quarter hours of graduate credit. The Beginning Institute primarily stressed microeconomics, while the Advanced Institute stressed macroeconomic concepts. Upon completion of the Institute programs, a randomly chosen intact class of students of participants and selected matching teachers were administered two economics tests. The scores indicate that students of participants have a significantly higher level of understanding in economics than students of nonparticipating teachers. [ABSTRACT FROM AUTHOR]

The issue of sudden death in young athletes and consideration for the most practical and optimal strategy to identify those genetic and/or congenital heart diseases responsible for these tragic events continues to be debated. However, proponents of broad-based and mandatory national preparticipation screening, including with 12-lead electrocardiograms have confined the focus to a relatively small segment of the youthful population who choose to engage in competitive athletic programs at the high school, college, and elite-professional level. Therefore, lost in this discussion of preparticipation screening of athletes is that the larger population of young people not involved in competitive sports (and, therefore, a priori are excluded from systematic screening) who nevertheless may die suddenly of the same cardiovascular diseases as athletes. To substantiate this hypothesis, we accessed the forensic Hennepin County, Minnesota registry in which cardiovascular sudden deaths were 8-fold more common in nonathletes (n = 24) than athletes (n = 3) and threefold more frequent in terms of incidence. The most common diseases responsible for sudden death were hypertrophic cardiomyopathy (n = 6) and arrhythmogenic right ventricular cardiomyopathy (n = 4). These data raise ethical considerations inherent in limiting systematic screening for unsuspected genetic and/or congenital heart disease to competitive athletes. [ABSTRACT FROM AUTHOR]

Introduction: Residential and wilderness excursion summer camps are safe, but outdoor activities can lead to injuries. The frequency of various illnesses and injuries at summer camps has been incompletely described. The treatments provided and the need for escalation to higher levels of care are variable., Methods: A retrospective cohort analysis was conducted for all visits to a camp infirmary over 3 seasons at a residential summer camp in Minnesota. Seventeen descriptive categories of chief complaints and 13 categories of treatment disposition were created for all 695 eligible infirmary visits. The frequency and illness type for which escalation to a higher level of care beyond the camp infirmary was needed were reviewed., Results: Four hundred one campers sought medical care 695 times over 3 seasons. The most common chief complaints were related to skin (35%), musculoskeletal injury (17%), and upper-respiratory symptoms (15%). The most common treatment and dispositions were over-the-counter medications (43%) and simple bandage or dressing (19%). Escalation of care to a clinic or emergency room was uncommon, with 35 (5%) infirmary visits requiring escalation. Musculoskeletal injuries were the most common reason for escalations of care. While overall less common than musculoskeletal injury, dental injury almost always resulted in escalation of care., Conclusions: An analysis of 3 y of visits to a summer camp infirmary was used by camp medical staff to update protocols and obtain new supplies for diagnosis and treatments. A more complete understanding of the prevalence of injuries and illnesses has the potential to allow better preparation for camp medical staff., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the association between total body irradiation (TBI) and subsequent breast cancer in women treated with blood or marrow transplantation (BMT) for hematologic malignancies., Patients and Methods: Participants were drawn from the BMT Survivor Study (BMTSS), a retrospective cohort study that included patients who underwent transplantation between 1974 and 2014 and survived for ≥ 2 years after BMT. Patients with pre-BMT chest radiation or a history of breast cancer were excluded. Participants completed the BMTSS survey, which included details regarding breast cancer diagnosis. Subsequent breast cancer was confirmed by pathology report review or physician notes. Cox proportional hazards models assessed the association between TBI and subsequent breast cancer. Standardized incidence ratios were calculated to determine the excess risk of subsequent breast cancer compared with that in the general population., Results: A total of 1,464 female BMT survivors (allogeneic: n = 788; autologous: n = 676) participated, with a median follow-up of 9.3 years from BMT. TBI was used in 660 patients (46%). Thirty-seven women developed subsequent breast cancer (allogeneic: n = 19; autologous: n = 18). Multivariable analysis revealed that exposure to TBI was associated with an increased risk of subsequent breast cancer among allogeneic BMT survivors (hazard ratio [HR], 3.7 [95% CI, 1.2 to 11.8]; P = .03) and autologous BMT survivors (HR, 2.6 [95% CI, 1.0 to 6.8]; P = .048). Pre-BMT exposure to alkylating agents was associated with an increased risk of subsequent breast cancer among autologous BMT survivors (HR, 3.3 [95% CI, 1.0 to 9.0]; P = .05). Compared with that in the general population, exposure to TBI at age < 30 years was associated with a 4.4-fold higher risk of subsequent breast cancer in allogeneic BMT survivors and a 4.6-fold higher risk in autologous BMT survivors., Conclusion: The association between TBI and subsequent breast cancer, especially among those exposed at a young age, as well as pre-BMT exposure to alkylating agents, should inform breast cancer screening for early detection.

Background and Objectives: Precepting methods have significant impact on the financial viability of family medicine residency programs. Following an adverse event, four University of Minnesota Family Medicine residency clinics moved from using Medicare's Primary Care Exception (PCE) and licensure precepting (LP) to a "universal precepting" method in which preceptors see every patient face to face. Variation in the implementation of universal precepting created a natural experiment of its financial impact., Methods: Universal precepting was implemented in October 2013 across four residency programs. Billing codes were measured 1 year before and 2.5 years after implementation by clinic and residency year., Results: There were significant financial differences between clinics based on original precepting method and implementation quality of universal precepting. The clinic moving from PCE to universal precepting with excellent implementation increased higher-level billing (99214) by 8%-10%. Clinics moving from LP demonstrated wide variation ranging from an 18% increase to a 13% decrease, consistent with the implementation quality., Conclusions: Clinics transitioning from PCE to universal precepting can see a significant increase in 99214 billing. Clinics transitioning from LP to universal precepting are at significant financial risk if poorly implemented, but may see increased 99214 billing with effective implementation. This suggests that both implementation quality and original precepting method impact 99214 billing rates when transitioning to universal precepting.

Objective: To develop and test an automated surveillance algorithm (sepsis "sniffer") for the detection of severe sepsis and monitoring failure to recognize and treat severe sepsis in a timely manner., Patients and Methods: We conducted an observational diagnostic performance study using independent derivation and validation cohorts from an electronic medical record database of the medical intensive care unit (ICU) of a tertiary referral center. All patients aged 18 years and older who were admitted to the medical ICU from January 1 through March 31, 2013 (N=587), were included. The criterion standard for severe sepsis/septic shock was manual review by 2 trained reviewers with a third superreviewer for cases of interobserver disagreement. Critical appraisal of false-positive and false-negative alerts, along with recursive data partitioning, was performed for algorithm optimization., Results: An algorithm based on criteria for suspicion of infection, systemic inflammatory response syndrome, organ hypoperfusion and dysfunction, and shock had a sensitivity of 80% and a specificity of 96% when applied to the validation cohort. In order, low systolic blood pressure, systemic inflammatory response syndrome positivity, and suspicion of infection were determined through recursive data partitioning to be of greatest predictive value. Lastly, 117 alert-positive patients (68% of the 171 patients with severe sepsis) had a delay in recognition and treatment, defined as no lactate and central venous pressure measurement within 2 hours of the alert., Conclusion: The optimized sniffer accurately identified patients with severe sepsis that bedside clinicians failed to recognize and treat in a timely manner., (Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Introductions of H7 influenza A virus (IAV) from wild birds into poultry have been documented worldwide, resulting in varying degrees of morbidity and mortality. H7 IAV infection in domestic poultry has served as a source of human infection and disease. We report the detection of H7N9 subtype IAVs in Minnesota (MN) turkey farms during 2009 and 2011. The full genome was sequenced from eight isolates as well as the haemagglutinin (HA) and neuraminidase (NA) gene segments of H7 and N9 virus subtypes for 108 isolates from North American wild birds between 1986 and 2012. Through maximum-likelihood and coalescent phylogenetic analyses, we identified the recent H7 and N9 IAV ancestors of the turkey-origin H7N9 IAVs, estimated the time and geographical origin of the ancestral viruses, and determined the relatedness between the 2009 and 2011 turkey-origin H7N9 IAVs. Analyses supported that the 2009 and 2011 viruses were distantly related genetically, suggesting that the two outbreaks arose from independent introduction events from wild birds. Our findings further supported that the 2011 MN turkey-origin H7N9 virus was closely related to H7N9 IAVs isolated in poultry in Nebraska during the same year. Although the precise origin of the wild-bird donor of the turkey-origin H7N9 IAVs could not be determined, our findings suggested that, for both the NA and HA gene segments, the MN turkey-origin H7N9 viruses were related to viruses circulating in wild birds between 2006 and 2011 in the Mississippi Flyway., (© 2015 The Authors.)

Objectives: To compare the outcomes of restorations placed by restorative function auxiliaries (RFAs) with those placed by dentists., Methods: Between July 1, 2007, and June 30, 2008, we matched 455 restorations placed by RFAs working at HealthPartners Dental Group with the same number placed by dentists. Restorations were matched by tooth number, American Dental Association procedure code, and patient age-group., Results: Of 910 restorations, 17 (1.9 percent) had problems potentially related to the filling or crown placement during the first year. Problem rates were not significantly different (p = 0.33) for restorations placed by RFAs (1.3 percent, 6 of 455) and those placed by dentists (2.4 percent, 11 of 455)., Conclusions: There was no significant difference in problem rates for restorations placed by RFAs versus those placed by dentists. This finding may free dentists to handle more difficult cases, alleviating some of the pressures of daily practice and meeting the need for improved access., (© 2012 American Association of Public Health Dentistry.)

The purpose of this study was to compare blood fentanyl concentrations in fentanyl-related deaths with fentanyl concentrations found incidentally at autopsy, as well as with fentanyl concentrations found in hospitalized patients receiving fentanyl. Between the years 1997 to 2005, 23 fentanyl-positive postmortem cases were identified. Nineteen of 23 (82.6%) cases were deemed to be drug overdoses. Fentanyl alone was responsible for 8 of the 19 (42.1%) overdose deaths. Mean and median fentanyl concentrations were 36 (SD 38) microg/L and 22 microg/L, respectively, range 5-120 microg/L. Seven of the cases were accidental, one undetermined. The remaining 11 of the 19 (57.9%) cases were mixed drug overdoses. Fentanyl concentrations in these cases were 31 (SD 46) microg/L, range 5-152 microg/L. All of the mixed drug overdoses were determined to be accidental. Four cases where fentanyl was considered an incidental postmortem finding were determined to be natural deaths. In hospitalized inpatients (n = 11) receiving fentanyl 2 of the patients receiving fentanyl for chronic pain for more than 3 months had concentrations of 8.5 microg/L and 9.9 microg/L. The other nine inpatient concentrations were less than 4 microg/L. In conclusion, blood fentanyl concentrations found in cases where fentanyl alone was determined to be the cause of death were similar to cases where fentanyl was part of a mixed drug overdose. There was also considerable overlap between fentanyl concentrations in fentanyl-related overdose deaths compared to hospitalized patients being treated for chronic pain. Fentanyl concentrations in postmortem cases must be interpreted in the context of the deceased's past medical history and autopsy findings.