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The objective of this study was to examine the payer mix and the economic impact of acute firearm injuries at a Level I Trauma Center in New Orleans.Acute firearm injury economic data were obtained from the trauma registry database of the University Medical Center in New Orleans, Louisiana for 2016 through 2019. Patients were identified by the ICD-10-CM external causes of morbidity codes found in their electronic medical records. All patients with codes for initial encounters for gunshot wounds were included. Abstracted data included total charges and payments. Using the hospital cost-to-charge ratio, the estimated costs and losses were tabulated. Data analysis for this study occurred from 2020 to 2021.A total of 2,094 patients with acute firearm injuries were identified over the 4-year period. These patients incurred charges of $122,440.642, whereas $17,293,655 was collected as payment. The estimated cost associated with the encounters was $37,602,667, resulting in a net loss of $20,309,012 from 2016 to 2019 for the hospital.Firearm injuries continue to plague the U.S. as a serious public health problem, causing preventable death, illness, and disability. They also continue to result in a major economic burden.

Water temperature is an important abiotic component in farmed and wild crayfish habitats as it influences individual and population characteristics including growth, metabolic activity, and overall population vigor. Thermal limits, however, have not been established for the two commercially important crayfishes in Louisiana, the red swamp crayfish Procambarus clarkii (Girard, 1852) and the southern white river crayfish P. zonangulus (Hobbs & Hobbs, 1990). We aimed to determine the thermal stress responses for the two species. Thermal stress was examined by the critical thermal maxima (CTmax) for crayfish acclimated to 24, 27, or 30 °C for two weeks prior to experimentation. Water temperature in all acclimation trials was increased 1 °C h–1 and the end-point temperature for an individual was determined by the failure of righting response within 30 seconds. CTmax values (±SD) for P. clarkii acclimated at 24, 27, and 30 °C were 39.5 ± 0.5, 39.1 ± 0.3, and 39.4 ± 0.7 °C respectively, and 39.8 ± 0.8, 38.8 ± 0.8, and 39.0 ± 0.6 °C for P. zonangulus. CTmax did not differ significantly between species in any of the acclimation treatments. Thermal stress was also examined by measuring P. clarkii and P. zonangulus hemolymph glucose concentration every two hours for crayfish acclimated at 26 °C for two weeks and water temperature increased 1 °C h–1. Hemolymph glucose concentration began to increase at 36 °C in P. zonangulus and 38 °C in P. clarkii. Large increases in mean hemolymph glucose concentration (±SE) were observed in both P. clarkii (67.19 mg–dl ± 24.55) and P. zonangulus (74.11 mg–dl ± 18.04) at 40 °C.

Water quality and river connectivity influence fisheries, but their role is not understood in wild crayfish harvest, or how water quality and river connectivity are incorporated into crayfish harvest strategies. In Louisiana, wild harvesting practices were evaluated with field observations and interviews with individual harvesters. Field observations included trap locations, water quality, water stable isotopes (2016) and habitat components over two seasons (2015 and 2016). Traps were set in less turbid water (NTU 40% respondents; a surrogate for turbidity and connectivity) in harvesting initiation and trap locations. Harvesters appeared to follow lateral water movements onto and within the floodplain, likely based on local environmental knowledge.

Peripheral venous pressure (PVP) waveform analysis is a novel, minimally invasive, and inexpensive method of measuring intravascular volume changes. A porcine cohort was studied to determine how venous and arterial pressure waveforms change due to inhaled and infused anesthetics and acute hemorrhage.Venous and arterial pressure waveforms were continuously collected, while each pig was under general anesthesia, by inserting Millar catheters into a neighboring peripheral artery and vein. The anesthetic was varied from inhaled to infused, then the pig underwent a controlled hemorrhage. Pearson correlation coefficients between the power of the venous and arterial pressure waveforms at each pig's heart rate frequency were calculated for each variation in the anesthetic, as well as before and after hemorrhage. An analysis of variance (ANOVA) test was computed to determine the significance in changes of the venous pressure waveform means caused by each variation.The Pearson correlation coefficients between venous and arterial waveforms decreased as anesthetic dosage increased. In an opposing fashion, the correlation coefficients increased as hemorrhage occurred.Anesthetics and hemorrhage alter venous pressure waveforms in distinctly different ways, making it critical for researchers and clinicians to consider these confounding variables when utilizing pressure waveforms. Further work needs to be done to determine how best to integrate PVP waveforms into clinical decision-making.

The majority of Louisiana’s wild crayfish landings are harvested from the Atchafalaya River Basin (ARB) during floodplain inundation from the annual flood pulse. Spatial and temporal heterogeneity in ARB physicochemical characteristics are associated with flood pulse characteristics and floodplain inundation, and extensive areas of the ARB experience environmental hypoxia (dissolved oxygen [DO] < 2.0 mg·L-1) for several weeks to months during the annual flood pulse. The purpose of this research was to evaluate the effects of flood pulse characteristics and physicochemistry on harvested crayfish populations at 14 sites in the ARB that were sampled biweekly during the 2016 and 2017 crayfish seasons. Despite dissimilar 2016 and 2017 flood pulse characteristics, red swamp crawfish Procambarus clarkii and southern white river crawfish P. zonangulus carapace length and CPUE were similar between sample years. Comparisons of P. clarkii populations among physicochemical location groupings indicated that DO concentration, particularly chronically hypoxic water, is the principal abiotic variable influencing P. clarkii population characteristics. Although not significant, normoxic locations produced larger crayfish and yielded higher CPUE values for the majority of both crayfish seasons. Furthermore, hemolymph protein concentrations in P. clarkii from normoxic areas were significantly and consistently higher than individuals from chronically hypoxic locations.

This study was carried out in the context of the reform of the Common Agricultural Policy (CAP) for the period 2021-2027: one of the key elements of this reform is the shift towards an obligation of results for some subsidies. Supported by specific cases, we first show that the distinction between the obligation of means and the obligation of results is overly simplistic. The pure obligation of results in the environmental field never truly exists, and practical examples fall on a continuum of estimates of results with varying degrees of accuracy. An estimation of the costs of six instruments found on this continuum (Green Payments (GPs), Agri-Environment- Climate Measures (AECMs), organic conversion support, High Environmental Value certification (HEV), and two carbon certification systems) enables us to draw several conclusions. First, the obligation of results is not necessarily more costly than the obligation of means: AECMs for example, which are generally considered as obligations of means, are more expensive to administer than carbon certification systems, which are typically considered as obligations of results. The genericity of the instrument plays a key role, making it possible to spread the design and monitoring costs across a large number of farmers. Next, as regards the effectiveness of the instrument in terms of environmental impact, working towards an obligation of results does not appear to be decisive per se. Two factors are, however: the ambition of the instrument and the level of additionality required, for example by making subsidies conditional upon demonstrating an improvement over an initial state. Finally, the specific advantage of shifting towards an obligation of results seems to be that it facilitates the environmental assessment of the CAP, which would make it possible to redirect support where necessary according to this impact data, which is currently unavailable. The reform of the CAP opens up the possibility of introducing new types of payment in the context of the eco-schemes under the first pillar, and especially the carbon certification systems. Indeed, these systems give a good deal of attention to the issue of additionality. Since they are neither more costly to implement nor less effective than an AECM type instrument, they could begin to emerge within the CAP. Moreover, the example of support for organic agricultureshows that basing CAP subsidies on external labels is not without precedent.

Study Design Retrospective Review Objective The aim of this study was to evaluate the incidence and magnitude of pedicle asymmetry as well as spinous process deviation in the healthy lumbar spine. Summary of Background Data Minimally invasive spine surgery relies on fluoroscopic imaging as bony landmarks used for instrumentation are not exposed. The precision of techniques used to determine vertebral body rotation intraoperatively may be confounded by anatomic variation or pathology. Here, we investigate the physiologic variation in different anatomic structures of the lumbar spine used for percutaneous pedicle screw placement. Methods 100 normal lumbar CT scans, without evidence of acute deformity, significant spondylosis, scoliosis, or spondylolisthesis were reviewed to assess for pedicle height, width and spinous process angle (SPA) to compare symmetry between right and left sided pedicles for each vertebral body. Spinous process deviation of ≥5° in the axial plane was considered a relevant finding and the magnitude of offset from midline was calculated using the deviation angle and spinous process length. Results Analysis of CT scans found that 17.5% of lumbar spinous processes had an average angular variation ≥5°. This calculates to a clinically significant 3.53 mm average offset of spinous processes from midline in 17.5% of lumbar vertebrae. Pedicle height and width measurements did not show statistically or clinically significant variation when comparing right to left lumbar pedicles. Conclusion These results suggest that using the spinous process as a fluoroscopic landmark during intraoperative imaging to determine neutral rotation of lumbar vertebrae can be an unreliable technique. Rotational alignment can be determined more reliably by comparing left to right pedicle symmetry. These findings should be considered when selecting an operative technique to assess neutral vertebral alignment during percutaneous pedicle screw instrumentation.