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Julie Simard,1 Christine Shea,1 Veronica Cho,2 Laure Perrier,1 Melissa Prokopy,1,2 Emitis Moshirzadeh,2 Sundeep Sodhi,1,2 Alia Karsan,2 Tyrone A Perreira1,2 1Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 2Ontario Hospital Association, Toronto, Ontario, CanadaCorrespondence: Tyrone A Perreira, Ontario Hospital Association, 200 Front St West, Suite 2800, Toronto, Ontario, M5V 3L1, Canada, Email Tperreira@oha.comBackground: Physicians are essential in health-care delivery. Physician engagement, defined as active participation in administrative and leadership activities in their organization, is a useful metric for hospital leaders to evaluate as they develop and implement strategy. The purpose of this study was to gain insight into the perspectives of senior hospital physician leaders on factors impacting physician engagement.Methods: Semi-structured interviews were conducted virtually. A purposive sample was used. Hospital physician senior leaders were recruited from Ontario public hospitals in Canada. The interviews were recorded, transcribed verbatim, and analyzed.Results: Ten participants in senior hospital physician leadership positions were interviewed. Seven themes were identified as impacting physician engagement: being seen and being heard, accountability, trust, leadership engagement, intercommunication, organizational stability, and discord within the organization. Saturation of themes was achieved.Conclusion: Two-way communication is essential to physician engagement. Physician input in decision-making processes is a vital way to improve engagement. For this to work, leadership must also be engaged. Trust and accountability are critical attributes for senior hospital physician leaders, especially during times of organizational instability. For physicians whose remuneration model is fee-for-service, new compensation models are required for them to actively participate in hospital decision-making.Keywords: physician engagement, hospitals, leadership, interviews as a topic, qualitative research

The current growth of the geriatric population and increased burden on trauma services throughout the United States (US) has created a need for systems that can improve patient care and reduce hospital costs. We hypothesize that the multidisciplinary services provided through the Geriatric Injury Institute (GII) can reduce hospital costs, improve patient triage throughput, and decrease hospital length of stay (LOS). Methods and Material: We performed a single-center, retrospective chart review of our Level II trauma center registry and electronic medical records of patients ages 65 and older who satisfied trauma activation/code criteria between July 1, 2014, to June 30, 2016 (N = 663). Patients presenting from July 1, 2014, to June 30, 2015, were grouped as Pre-GII, while those presenting from July 1, 2015, to June 30, 2016, were grouped as Post-GII. Primary outcomes were emergency department (ED) triage time, overall LOS, and hospital costs. Secondary outcomes included patient disposition, mortality, and health assessments. Statistical comparisons were made using a one-way analysis of variance and Mann-Whitney U test. Results: Pre-GII vs. Post-GII average ages and the Injury Severity Score (ISS) were not statistically different (p>0.05). The average LOS was similar between the Pre-GII and Post-GII groups (4.64 ± 4.42 days vs. 4.26 ± 5.58 days, p = 0.48). More patients were discharged earlier (≤ 4 days; 64% vs. 73%) as well as discharged to home (37% vs. 45%) in the Post-GII group. The total cost savings were $53,000 with a median savings of $1061 per patient ($8808 vs. $7747, p = 0.04). Savings were highest during the first two days of admission (p = 0.03). The reduction in ED triage time was not significant (310.7 minutes vs 219. 8 minutes, p > 0.05). Conclusion: With the increase in geriatric trauma, innovative models of care are needed. Our study suggests that the GII multidisciplinary approach to trauma services can lower overall hospital costs.

Abstract Background Reverse genetic strategies, such as virus-induced gene silencing, are powerful techniques to study gene function. Currently, there are few tools to study the spatial dependence of the consequences of gene silencing at the cellular level. Results We report the use of multimodal Raman and mass spectrometry imaging to study the cellular-level biochemical changes that occur from silencing the phytoene desaturase (pds) gene using a Foxtail mosaic virus (FoMV) vector in maize leaves. The multimodal imaging method allows the localized carotenoid distribution to be measured and reveals differences lost in the spatial average when analyzing a carotenoid extraction of the whole leaf. The nature of the Raman and mass spectrometry signals are complementary: silencing pds reduces the downstream carotenoid Raman signal and increases the phytoene mass spectrometry signal. Conclusions Both Raman and mass spectrometry imaging show that the biochemical changes from FoMV-pds silencing occur with a mosaic spatial pattern at the cellular level, and the Raman images show carotenoid expression was reduced at discrete locations but not eliminated. The data indicate the multimodal imaging method has great utility to study the biochemical changes that result from gene silencing at the cellular spatial level of expression in many plant tissues including the stem and leaf. Our demonstrated method is the first to spatially characterize the biochemical changes as a result of VIGS at the cellular level using commonly available instrumentation.

Background: Suicide by means of self-inflicted stab wounds is relatively uncommon and little is known about this population and their management. Materials and Methods: Retrospective review of adult trauma patients admitted to our Level-1 trauma center between January 2005 and October 2009 for management of non-fatal, self-inflicted stab wounds. Results: Fifty-eight patients were evaluated with self-inflicted stab wounds. Four patients died due to their injuries (mortality, 7%). Of the non-fatal stab wounds, 78% were male ranging in age from 19-82 (mean: 45 years). The most common injury sites were the abdomen (46%), neck (33%), and chest (20%). In terms of operative interventions, 56% of abdominal operations were therapeutic, whereas 100% of neck and chest operations were therapeutic. When assessing for suicidal ideation, 44 patients (81%) admitted to suicidal intentions whereas 10 patients (19%) described "accidental" circumstances. Following psychiatric evaluation, 8 of the 10 patients with "accidental injuries" were found to be suicidal. Overall, 54 patients (98%) met criteria for a formal psychiatric diagnosis with 48 patients (89%) necessitating inpatient or outpatient psychiatric assistance at discharge. Conclusions: Compared to previous reports of stab wounds among trauma patients, patients with self- inflicted stab wounds may have a higher incidence of operative interventions and significant injuries depending on the stab location. When circumstances surrounding a self-inflicted stabbing are suspicious, additional interviews by psychiatric care providers may uncover a suicidal basis to the event. Given the increased incidence of psychiatric illness in this population, it is imperative to approach the suicidal patient in a multidisciplinary fashion.

Abstract Libraries of inherent optical properties (IOPs) of microplastics are sparse, yet they are essential for the development of optical techniques to detect and quantify microplastics in the ocean. In this study, we describe our results and technique for the measurement of the IOPs of microplastic suspensions generated from commonly utilized plastics. The measurements included angle‐resolved polarized light scattering, and spectral absorption and beam attenuation coefficients. We also performed ancillary characterization of particle properties, including size distribution, shape, and mass concentration of suspended matter. We observed several unique optical characteristics regarding absorption, scattering, and polarization properties compared with typical marine particle assemblages. We show that these results are useful for radiative transfer simulations as well as the potential development of novel plastic detection techniques from above‐ or in‐water optical measurements.

Abstract As natural landscapes are modified and converted into simplified agricultural landscapes, the community composition and interactions of organisms persisting in these modified landscapes are altered. While many studies examine the consequences of these changing interactions for crops, few have evaluated the effects on wild plants. Here, we examine how pollinator and herbivore interactions affect reproductive success for wild resident and phytometer plants at sites along a landscape gradient ranging from natural to highly simplified. We tested the direct and indirect effects of landscape composition on plant traits and reproduction mediated by insect interactions. For phytometer plants exposed to herbivores, we found that greater landscape complexity corresponded with elevated herbivore damage, which reduced total flower production but increased individual flower size. Though larger flowers increased pollination, the reduction in flowers ultimately reduced plant reproductive success. Herbivory was also higher in complex landscapes for resident plants, but overall damage was low and therefore did not have a cascading effect on floral display and reproduction. This work highlights that landscape composition directly affects patterns of herbivory with cascading effects on pollination and wild plant reproduction. Further, the absence of an effect on reproduction for resident plants suggests that they may be adapted to their local insect community.

The recent closure of the Uluru climb marked a pivotal moment in Australia's tourism history. Uluru in the Northern Territory has long been a contested symbolic tourist site subject to competing narratives of its significance as a tourist icon and Aboriginal cultural landscape. This study examines tourist responses to the climb closure through a netnographic analysis of TripAdvsior content. The findings uncover enduring tensions in tourist perceptions and behaviours in relation to the climb closure. This research highlights the dynamic nature of the tourist gaze upon contested sites, such as Uluru. We conclude that despite ongoing contestation, the climb closure signifies broader societal shift towards respecting Aboriginal perspectives in tourism decision-making.

The Fantasy of Reunion: Anglicans, Catholics, and Ecumenism, 1833-1882. By Mark D. Chapman. (New York: Oxford University Press. 2014. Pp. x, 329. $99.00. ISBN 978-0-19-968806-7.) Mark Chapman's new book casts [...]