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Abstract Background During the COVID-19 pandemic, patients with Alzheimer’s disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes. Methods Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors’ office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January–December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths — due to COVID and non-COVID causes — and changes in care use in the beneficiary’s state of residence. Results Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p

Knowledge translation and consumer testing aims to move research findings from scientists, professional journals, and conferences to the hands of end-users and organizations who use the information regularly. The purpose of this report is to outline the process by which the Burn Model System (BMS) has worked with the Model System Knowledge Translation Center (MSKTC) to develop and disseminate patient education materials to consumers. The National Institute on Disability, Independent Living, and Rehabilitation Research-funded BMS in collaboration with the MSKTC uses a multi-step process for developing and consumer-testing evidence-based/consensus-derived educational information prioritized by consumers. The final written products are made available in both English and Spanish at/below an 8th grade reading level. Products are disseminated through websites, clinical encounters, social media, and national/international engagement with clinicians and burn-related organizations. Written products are reviewed every five years to ensure they remain current and relevant. Number of online views for each product is a key measure of dissemination. Since 2011, the collaboration between the BMS and the MSKTC has produced or updated 22 educational factsheets, three videos, three infocomics, and one infographic. Collectively, these products have been viewed over two million times by people in 216 countries. Online views of all products have generally increased year-to-year. This process makes relevant health information accessible and understandable for consumers. As a result, Burn Model System informational products have been increasingly viewed by US and international consumers.

Introduction: Major burns and the intensive care required induce numerous physiologic changes and stress responses that impact recovery for months after hospital discharge. Little is known about sleep quantity and quality after index hospitalization discharge. We report on actigraphy and sleep outcome data from subjects enrolled in a prospective trial of home-based virtual rehabilitation (HBVR) after burn injury. Methods: We conducted a randomized controlled trial of a HBVR program over 12 weeks after index hospitalization. In both HBVR and control (usual care) groups, subjects were provided a wrist actigraphy accelerometer device (Garmin vívofit®) to wear. Sleep data were retrieved remotely and analyzed. Actigraphy data were defined a priori as complete if subjects had 5 out of 7 days of actigraphy wear in a week. Average weekly sleep was calculated and reported by group assignment. Sleep-relevant and fatigue outcomes were measured by PROMIS questionnaires at randomization (discharge + 0–30 days), 12-weeks, and 12-months. Descriptive statistics were used for comparisons and linear mixed effect model were used to evaluate trends in PROMIS T-scores between groups. Results: Fifty subjects were enrolled and 48 had complete sleep data. Mean age was 38 ± 14 years and mean burn size was 16 ± 13 % TBSA with a majority of subjects male (71 %). Average sleep duration was within general population norms, with little difference between subjects in the intervention and controls groups in the 12 weeks after study randomization (7.3 vs.7.2 h respectively, p = 0.25). Subjects in control group spent more time in light sleep (4.1 vs. 3.9 h, p

Abstract Faced with a growing opioid overdose crisis, emergency departments (EDs) are increasingly hiring peers—people with lived experiences of addiction and recovery—to work with patients in the ED who have opioid use disorders (OUDs) or who have experienced an opioid overdose. Despite a clear need for more support for patients with OUD and rapid expansion in grant funding for peer programs, there are limited data on how these programs affect clinical outcomes and how they are best implemented within the ED. In this narrative review, we synthesize the existing evidence on how to develop and implement peer programs for OUD in the ED setting. We describe the key activities peers can undertake in the ED, outline requirements of the peer role and best practices for peer supervision and hiring, detail how ED administrators have built financial and political support for peer programs, and summarize the limited evidence on clinical and care linkage outcomes of peer programs. We highlight key resources that ED clinicians and administrators can use to develop peer programs and key areas where additional research is needed.

Abstract Background Actigraphy is often used to measure sleep in pediatric populations, despite little confirmatory evidence of the accuracy of existing sleep/wake algorithms. The aim of this study was to determine the performance of 11 sleep algorithms in relation to overnight polysomnography in children and adolescents. Methods One hundred thirty-seven participants aged 8–16 years wore two Actigraph wGT3X-BT (wrist, waist) and three Axivity AX3 (wrist, back, thigh) accelerometers over 24-h. Gold standard measures of sleep were obtained using polysomnography (PSG; Embletta MPRPG, ST + Proxy and TX Proxy) in the home environment, overnight. Epoch by epoch comparisons of the Sadeh (two algorithms), Cole-Kripke (three algorithms), Tudor-Locke (four algorithms), Count-Scaled (CS), and HDCZA algorithms were undertaken. Mean differences from PSG values were calculated for various sleep outcomes. Results Overall, sensitivities were high (mean ± SD: 91.8%, ± 5.6%) and specificities moderate (63.8% ± 13.8%), with the HDCZA algorithm performing the best overall in terms of specificity (87.5% ± 1.3%) and accuracy (86.4% ± 0.9%). Sleep outcome measures were more accurately measured by devices worn at the wrist than the hip, thigh or lower back, with the exception of sleep efficiency where the reverse was true. The CS algorithm provided consistently accurate measures of sleep onset: the mean (95%CI) difference at the wrist with Axivity was 2 min (-6; -14,) and the offset was 10 min (5, -19). Several algorithms provided accurate measures of sleep quantity at the wrist, showing differences with PSG of just 1–18 min a night for sleep period time and 5–22 min for total sleep time. Accuracy was generally higher for sleep efficiency than for frequency of night wakings or wake after sleep onset. The CS algorithm was more accurate at assessing sleep period time, with narrower 95% limits of agreement compared to the HDCZA (CS:-165 to 172 min; HDCZA: -212 to 250 min). Conclusion Although the performance of existing count-based sleep algorithms varies markedly, wrist-worn devices provide more accurate measures of most sleep measures compared to other sites. Overall, the HDZCA algorithm showed the greatest accuracy, although the most appropriate algorithm depends on the sleep measure of focus.

Abstract The formation and evolution of the South Pole‐Aitken (SPA) basin is critical to relating large impact basin formation and modification to lunar geophysical evolution. Most prior models of the SPA impact were conducted in 2D, making it difficult to compare model output to the 3D crustal structure and ejecta distribution. In order to better constrain the parameters of the SPA impactor and the expected post impact distribution of crust and ejecta, we conducted numerical simulations of the SPA impact in 3D. We tested a wide range of impact parameters and constrained model results with recent geophysical data. We found the crustal structure of the SPA basin is best fit by an oblique impact (30–45°) of a 350–400 km diameter projectile impacting at 12–16 km/s. The impact excavated material from as deep as 80–120 km, and ejecta was deposited in a butterfly pattern with a forbidden region uprange of the impact.

Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.

Abstract Background Injuries are a leading cause of death and disability for Alaska Native (AN) people. Alaska Native Tribal Health Consortium (ANTHC) is supporting the development of a burn care system that includes a partnership between Alaska Native Medical Center (ANMC) in Anchorage, AK and UW Medicine Regional Burn Center at Harborview Medical Center (HMC) in Seattle, WA. We aimed to better understand the experiences of AN people with burn injuries across the care continuum to aid development of culturally appropriate care regionalization. Methods We performed focus groups with twelve AN people with burn injury and their caregivers. A multidisciplinary team of burn care providers, qualitative research experts, AN care coordinator, and AN cultural liaison led focus groups to elicit experiences across the burn care continuum. Transcripts were analyzed using a phenomenological approach and inductive coding to understand how AN people and families navigated the medical and community systems for burn care and areas for improvement. Results Three themes were identified: 1-Challenges with local burn care in remote communities including limited first aid, triage, pain management, and wound care, as well as long-distance transport to definitive care; 2-Divergence between cultural values and medical practices that generated mistrust in the medical system, isolation from their support systems, and recovery goals that were not aligned with their needs; 3-Difficulty accessing emotional health support and a survivor community that could empower their resilience. Conclusion Participants reported modifiable barriers to culturally competent treatment for burn injuries among AN people. The findings can inform initiatives that leverage existing resources, including expansion of the Extension for Community Healthcare Outcomes (ECHO) telementoring program, promulgation of the Phoenix Society Survivors Offering Assistance in Recovery (SOAR) to AK, coordination of regionalized care to reduce time away from AK and provide more comfortable community reintegration, and define rehabilitation goals in terms that align with personal goals and subsistence lifestyle skills. Long-distance transport times are non-modifiable, but better pre-hospital care could be achieved by harnessing existing telehealth services and adapting principles of prolonged field care to allow for triage, initial care, and resuscitation in remote environments.

Objective: Serous tubal intraepithelial carcinoma (STIC) are precursors for high grade serous carcinomas (HGSC) of tubo-ovarian origin. It is a rare entity, most commonly described in patients with a BRCA pathogenic variant (PV) undergoing risk-reducing surgery. Little is known about the risk of subsequent HGSC in patients found to have an isolated STIC without a genetic PV. The objective of this study is to report the outcomes of STIC diagnosed in patients with negative genetic testing (“average risk”). Methods: Retrospective population-based cohort study from British Columbia, Canada. Chart review of patients diagnosed with an isolated STIC from January 2012 to May 2022. Average risk patients are defined as individuals with known negative genetic testing results. Treatment and outcomes are described in the “average risk”, BRCA PV, and total cohorts. Results: Twenty-nine patients with isolated STIC were identified. Ten patients had a BRCA PV, four had other variants identified (BRIP1, MLH1, BRIP1 VUS, BRCA 2 VUS), nine had no PV identified (“average risk”), and six were unknown (no genetic testing). Of the nine “average risk” patients, eight (89%) underwent surgical staging. Three (33.3%) had subsequent HGSC diagnosed 29, 70 and 86 months after STIC diagnosis. Conclusions: STIC identified in patients with negative genetic testing are at risk of subsequent HGSC. Patients developed primary peritoneal HGSC despite surgical staging. These patients should also be included in future meta-analysis to determine outcomes and optimal treatment.

Abstract Introduction Hepatitis E virus (HEV) is the most common cause of acute hepatitis. While symptoms are generally mild and resolve within weeks, some populations (e.g., pregnant women, immunocompromised adults) are at high-risk of severe HEV-related morbidity and mortality. There has not been a recent comprehensive review of contemporary HEV outbreaks, which limits the validity of current disease burden estimates. Therefore, we aimed to characterize global HEV outbreaks and describe data gaps to inform HEV outbreak prevention and response initiatives. Methods We performed a systematic review of peer-reviewed (PubMed, Embase) and gray literature (ProMED) to identify reports of outbreaks published between 2011 and 2022. We included (1) reports with ≥ 5 cases of HEV, and/or (2) reports with 1.5 times the baseline incidence of HEV in a specific population, and (3) all reports with suspected (e.g., clinical case definition) or confirmed (e.g., ELISA or PCR test) cases if they met criterium 1 and/or 2. We describe key outbreak epidemiological, prevention and response characteristics and major data gaps. Results We identified 907 records from PubMed, 468 from Embase, and 247 from ProMED. We screened 1,362 potentially relevant records after deduplication. Seventy-one reports were synthesized, representing 44 HEV outbreaks in 19 countries. The populations at risk, case fatalities, and outbreak durations were not reported in 66% of outbreak reports. No reports described using HEV vaccines. Reported intervention efforts included improving sanitation and hygiene, contact tracing/case surveillance, chlorinating boreholes, and advising residents to boil water. Commonly missing data elements included specific case definitions used, testing strategy and methods, seroprevalence, impacts of interventions, and outbreak response costs. Approximately 20% of HEV outbreaks we found were not published in the peer-reviewed literature. Conclusion HEV represents a significant public health problem. Unfortunately, extensive data shortages and a lack of standardized reporting make it difficult to estimate the HEV disease burden accurately and to implement effective prevention and response activities. Our study has identified major gaps to guide future studies and outbreak reporting systems. Our results support the development of standardized reporting procedures/platforms for HEV outbreaks to ensure accurate and timely data distribution, including active and passive coordinated surveillance systems, particularly among high-risk populations.

IntroductionPulsed field ablation is an emerging modality for catheter-based cardiac ablation. The main mechanism of action is irreversible electroporation (IRE), a threshold-based phenomenon in which cells die after exposure to intense pulsed electric fields. Lethal electric field threshold for IRE is a tissue property that determines treatment feasibility and enables the development of new devices and therapeutic applications, but it is greatly dependent on the number of pulses and their duration.MethodsIn the study, lesions were generated by applying IRE in porcine and human left ventricles using a pair of parallel needle electrodes at different voltages (500–1500 V) and two different pulse waveforms: a proprietary biphasic waveform (Medtronic) and monophasic 48 × 100 μs pulses. The lethal electric field threshold, anisotropy ratio, and conductivity increase by electroporation were determined by numerical modeling, comparing the model outputs with segmented lesion images.ResultsThe median threshold was 535 V/cm in porcine ((N = 51 lesions in n = 6 hearts) and 416 V/cm in the human donor hearts ((N = 21 lesions in n = 3 hearts) for the biphasic waveform. The median threshold value was 368 V/cm in porcine hearts ((N = 35 lesions in n = 9 hearts) cm for 48 × 100 μs pulses.DiscussionThe values obtained are compared with an extensive literature review of published lethal electric field thresholds in other tissues and were found to be lower than most other tissues, except for skeletal muscle. These findings, albeit preliminary, from a limited number of hearts suggest that treatments in humans with parameters optimized in pigs should result in equal or greater lesions.

Intro: Campylobacter is the most common bacterial cause of foodborne gastroenteritis in Australia, however outbreaks caused by the pathogen are relatively uncommon. On 4 March 2022, the Victorian Department of Health was notified of a gastrointestinal illness in 20 guests following attendance at a wedding reception on 12 February 2022. Four individuals were notified with laboratory confirmed campylobacteriosis, and an investigation was undertaken to determine the full extent of the outbreak and prevent further illness. Methods: A nested case-control study was conducted to determine the likely source of infection. Cases were defined as attendees of the wedding reception, with onset of diarrhoea and/or abdominal pain 1-10 days after attending the function. Controls were randomly selected from the remaining non-ill guests. Cases and controls were interviewed using a standardised menu-based questionnaire, and odds ratios (ORs) calculated of consumed foods. Food preparation processes were documented, and food samples collected. Findings: A total of 29 wedding guests met the case definition, with onset of illness between 2-5 days and major symptoms including diarrhoea (90%), abdominal pain (100%), headache (79%), and fever (62%). Two cases were hospitalised, one with ongoing neurological sequelae. Illness was found to be significantly associated with consumption of a duck breast brioche canape containing duck liver parfait following univariate analysis and stratification by other implicated foods (OR=2.85, 95% CI [1.03-7.86]). Cases aged 10-29 years were 13.2 times more likely to have eaten duck than controls in that age group. Discussion: The investigation found the duck canape was the likely vehicle of infection in this outbreak. Consistent with the literature on Campylobacter transmission, it is likely that inadequate cooking of the duck liver for the parfait was the contributing factor that led to illness. Conclusion: This outbreak investigation highlights the risks posed by poultry dishes if undercooked, and that education of food handlers remains a priority.

Abstract Super-Earths and sub-Neptunes are the most common planet types in our galaxy. A subset of these planets is predicted to be water worlds, bodies that are rich in water and poor in hydrogen gas. The interior structures of water worlds have been assumed to consist of water surrounding a rocky mantle and iron core. In small planets, water and rock form distinct layers with limited incorporation of water into silicate phases, but these materials may interact differently during the growth and evolution of water worlds due to greater interior pressures and temperatures. Here, we use density functional molecular dynamics (DFT-MD) simulations to study the miscibility and interactions of enstatite (MgSiO3), a major end-member silicate phase, and water (H2O) at extreme conditions in water world interiors. We explore pressures ranging from 30 to 120 GPa and temperatures from 500 to 8000 K. Our results demonstrate that enstatite and water are miscible in all proportions if the temperature exceeds the melting point of MgSiO3. Furthermore, we performed smoothed particle hydrodynamics simulations to demonstrate that the conditions necessary for rock-water miscibility are reached during giant impacts between water-rich bodies of 0.7–4.7 Earth masses. Our simulations lead to water worlds that include a mixed layer of rock and water.

Earth likely acquired much of its inventory of volatile elements during the main stage of its formation. Some of Earth’s proto-atmosphere must therefore have survived the giant impacts, collisions between planet-sized bodies, that dominate the latter phases of accretion. Here, we use a suite of 1D hydrodynamic simulations and impedance-match calculations to quantify the effect that preimpact surface conditions (such as atmospheric pressure and the presence of an ocean) have on the efficiency of atmospheric and ocean loss from protoplanets during giant impacts. We find that—in the absence of an ocean—lighter, hotter, and lower-pressure atmospheres are more easily lost. The presence of an ocean can significantly increase the efficiency of atmospheric loss compared to the no-ocean case, with a rapid transition between low- and high-loss regimes as the mass ratio of atmosphere to ocean decreases. However, contrary to previous thinking, the presence of an ocean can also reduce atmospheric loss if the ocean is not sufficiently massive, typically less than a few times the atmospheric mass. Volatile loss due to giant impacts is thus highly sensitive to the surface conditions on the colliding bodies. To allow our results to be combined with 3D impact simulations, we have developed scaling laws that relate loss to the ground velocity and surface conditions. Our results demonstrate that the final volatile budgets of planets are critically dependent on the exact timing and sequence of impacts experienced by their precursor planetary embryos, making atmospheric properties a highly stochastic outcome of accretion.

We captured 235 Gray Hawks ( Buteo plagiatus ) in the Lower Rio Grande Valley (Hidalgo, Willacy, and Cameron counties) of Texas from 6 February 2003 to 8 April 2023. We identified birds in five molt cycles: 115 birds in their first cycle, 16 in their second cycle, 73 in at least their second cycle, 19 in at least their third cycle, and 12 in at least their fourth cycle. Of these, we documented 15 instances of preformative molt, six instances where birds had an incomplete second prebasic molt, resulting in one to three retained juvenile rump feathers and/or wing coverts, and 18 instances where incomplete prebasic molts resulted in birds with multiple generations of flight feathers. We also present morphometric data from 144 Gray Hawks (nestlings and first-cycle birds captured prior to 1 October excluded). These results from the Lower Rio Grande Valley, on both molting strategies and measurements, differed in some respects from other sources based on the entire Gray Hawk population, most notably that birds from this northern and non-migratory population may show lower incidence of Stafflemauser molting patterns, and that they are heavier, which supports Bergmann’s rule.

The mid-summer drought, veranillo or canícula, is a phenomenon experienced in many areas, including Mexico, Central America, and the Caribbean. It generally is experienced as reduced rainfall in July–August, in the middle of the typical rainy season (May–September). Many past studies have attempted to quantify changes in mid-summer drought characteristics during the recent past or for future climate projections. To do this, objective definitions of a mid-summer drought's occurrence, strength, and duration have been developed by many researchers. In this effort we adopt a recent set of definitions and examine the impact of varying these on the characterization of mid-summer droughts and the detected changes over the past 4 decades. We find the selection of a minimum intensity threshold has a dramatic effect on the results of both the area considered as experiencing a mid-summer drought and the changes detected in the recent historical record. The intensity chosen can affect both the magnitude and direction of changes reported in the recent observed record. Further, we find that the typical mid-summer drought pattern may not be occurring during the time it has historically; whether examining past or future changes or developing improved seasonal forecasts, the non-stationarity of its timing should be accommodated.

Echinococcus spp. tapeworms can cause serious diseases in mammals, including humans. Within the E. granulosus species complex, metacestodes produce unilocular cysts that are responsible for cystic echinococcosis in animal intermediate hosts. Canids are definitive hosts, harbouring adult cestodes in their intestines. Adult E. canadensis were recovered from the small intestine of 1 of 262 coyotes (Canis latrans) from Nova Scotia, Canada. Subsequently, we found unilocular cysts in lungs and livers of 4 of 8 sympatric moose (Alces alces) from Cape Breton Island. DNA was extracted from three cysts using the Qiagen DNeasy Blood and Tissue kit and assayed by polymerase chain reaction (PCR) with primers (cest4 and cest5) for a 117-bp region of the small subunit of ribosomal RNA of E. granulosus sensu lato, and further validated as E. canadensis G8 using primers targeting nicotinamide adenosine dinucleotide dehydrogenase subunit 1 (ND1) and cytochrome c oxidase subunit 1 (CO1) mitochondrial genes. These are the first records of E. canadensis in any of the three Maritime provinces, which include Nova Scotia, New Brunswick, and Prince Edward Island. The parasite was thought to be absent in this region due to extirpation of wolves (Canis spp.) in the 1800s. These findings suggest that further wildlife surveillance and risk assessment is warranted.

Background: Mortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. Methods: Using a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. Results: We identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. Conclusions: State regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

Introduction: Ghana implemented a National Health Insurance Scheme (NHIS) in 2003 as a step toward universal health coverage. We aimed to determine the effect of the NHIS on timeliness of care, mortality, and catastrophic health expenditure (CHE) among children with serious injuries at a trauma center in Ghana. Methods: We performed a retrospective cohort study of injured children aged 0.10). Uninsured children were more likely to have a delay in care for financial reasons (17.3 vs 6.4%, p

BackgroundBurn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment.MethodsWe performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021.ResultsThere were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0–18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1–5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as “limited” for 23% of pediatric patients.ConclusionsChildren represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.

The aim was to predict the post-pubertal mandibular length and Y axis of growth in males by using various machine learning (ML) techniques. Cephalometric data obtained from 163 males with Class I Angle malocclusion, were used to train various ML algorithms. Analysis of variances (ANOVA) was used to compare the differences between predicted and actual measurements among methods and between time points. All the algorithms revealed an accuracy range from 95.80% to 97.64% while predicting post-pubertal mandibular length. When predicting the Y axis of growth, accuracies ranged from 96.60% to 98.34%. There was no significant interaction between methods and time points used for predicting the mandibular length (p = 0.235) and Y axis of growth (p = 0.549). All tested ML algorithms accurately predicted the post-pubertal mandibular length and Y axis of growth. The best predictors for the mandibular length were mandibular and maxillary lengths, and lower face height, while they were Y axis of growth, lower face height, and mandibular plane angle for the post-pubertal Y axis of growth. No significant difference was found among the accuracies of the techniques, except the least squares method had a significantly larger error than all others in predicting the Y axis of growth.

ObjectiveThe primary aim of the study was to determine levels of literacy in both oral health and orthodontics in an adult population. The secondary study aim was to investigate differences in literacy between males and females.MethodsParticipants included individuals 18 years or older seeking dental treatment at the East Carolina University (ECU) School of Dental Medicine. To determine levels of oral health literacy (OHL) and orthodontic literacy (OrthoL), validated instruments were administered, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry, the Oral Health Literacy Instrument and its separate scales, and a questionnaire on orthodontic literacy. Summary statistics were computed, and statistical significance was set at 0.05.ResultsOne hundred seventy-two individuals participated in the study and had a mean age of 55.03 (range:18-88). Greater than 70% of the sampled population exhibited inadequate or marginal oral health knowledge. Additionally, greater than 70% of the sample possessed no more than an 8th grade reading level, with regard to basic medical and dental terms. Higher education was weakly associated with higher OrthoL and OHL. Higher age was also weakly associated with lower OrthoL and OHL. Males on average exhibited significantly higher OHL (p < .05) but there were no OrthoL differences between males and females. Dental visit frequency was not associated with OrthoL or OHL.ConclusionLow levels of OrthoL and OHL were observed in the study. While males demonstrated a higher level of OHL than females, neither age nor the occurrence of dental appointments significantly influenced levels of literacy.

We identify a new mechanism that can lead to the destruction of small, close-in planetary satellites. If a small moon close to the planet has a sizable eccentricity and inclination, its ejecta that escape to the planetocentric orbit would often reimpact with much higher velocity due to the satellite’s and fragment’s orbits precessing out of alignment. If the impacts of returning ejecta result in net erosion, a runaway process can occur that may end in disruption of the satellite, and we term this process “sesquinary catastrophe.” We expect the moon to reaccrete, but on an orbit with significantly lower eccentricity and inclination. We find that the large majority of small close-in moons in the solar system have orbits that are immune to sesquinary catastrophe. The exceptions include a number of resonant moonlets of Saturn for which resonances may affect the velocities of reimpact of their own debris. Additionally, we find that Neptune’s moon Naiad (and to a lesser degree, Jupiter’s Thebe) must have substantial internal strength, in line with prior estimates based on Roche limit stability. We also find that sesquinary instability puts important constraints on the plausible past orbits of Phobos and Deimos or their progenitors.