Almost one in five emergency department presentations are by mental health clients: a secondary data analysis.

Aim: Mental health-related emergency department (ED) presentations are steadily increasing, including presentations for both mental health and non-mental health concerns by existing clients of mental health services. The study aim was to examine and compare mental health clients and non-clients' ED presentations, identify data and clinical gaps and make recommendations for improvement.

Method: De-identified 2017/2018 ED data were used to describe presentations for current and recent (within last 5 years) clients of specialist public mental health and addiction services, compared to presentations of non-mental health clients.

'An accident waiting to happen' - experiences of police officers, paramedics, and mental health clinicians involved in 911-mental health crises: a cross-sectional survey.

What Is Known On The Subject: Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under-prepared. The single frontline service approach is time-intensive and risks a coercive pathway to care. The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal.

Do Not Ignore Those Raccoon Eyes; They May Indicate Lethal AL Amyloidosis.

Light chain (AL) amyloidosis is a lethal form of systemic amyloidosis that arises from the clonal expansion of CD38+ plasma cells. Organ damage occurs when these plasma cells produce misfolded immunoglobulin light chains, which form amyloid fibrils and deposit in tissues. A minority of patients with AL amyloidosis show "raccoon eyes" caused by increased vascular fragility from accumulation of amyloid fibrils.

Incorporation of Student Pharmacists into a Proton Pump Inhibitor Deprescribing Telehealth Program for Rural Veterans.

: Proton pump inhibitors (PPIs) are among the most widely prescribed class of medications in the United States. Although effective in the treatment of acid related disease, inappropriate PPI use is prevalent, and long-term PPI use has been associated with adverse effects. This evaluation explores the novelty of a student-pharmacist directed PPI deprescribing telehealth program with the goals of (1) determining whether PPIs are appropriately prescribed in Veterans via remote student-led chart reviews, (2) identifying if a gap exists between urban and rural Veterans prescribed a PPI, and (3) assessing the feasibility of integrating student pharmacists into the PPI deprescribing process utilizing telehealth visits through a pilot study.

Missed presentations, missed opportunities: A cross-sectional study of mental health presentation undercounting in the emergency department.

Objectives: The burden of mental illness is increasing across developed countries. EDs are often used as access points by people experiencing mental health crises, with such rising demand in Australasia. Accurate data is critical to track and address this need, but research suggests that current data collection methods undercount mental health presentations to the EDs.

Using entrustable professional activities to better prepare students for their postgraduate medical training: A medical student's perspective.

The Problem: Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, a medical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes.

A Solution: The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work.

Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes.

Background: Diabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans.

Improving Youth COVID-19 Knowledge, Attitudes, and Practices Through a Novel Medical Student Driven Curriculum.

Despite widespread media coverage and public health messaging, many high school students lacked formal education about COVID-19 during the pandemic. Providing this education, particularly to underserved communities, may reduce health disparities and encourage youth to engage in the sciences. Twenty-five medical students at Emory University School of Medicine created a virtual, synchronous, COVID-19 curriculum.

Anthropogenic impact on the organic carbon sources, transport and distribution in a subtropical semi-enclosed bay.

Suspended particulate organic carbon (POC) and sedimentary total organic carbon (TOC) in coastal areas play critical roles in the global carbon cycle, yet sources and dynamics of coastal POC and TOC have been affected by various anthropogenic activities such as aquaculture, sewage discharge, dam construction and land reclamation. To better understand the anthropogenic impacts on coastal organic carbon, this study was carried out in a representative semi-enclosed bay, Dongshan Bay, Southeast China. Through analyses of stable isotopic compositions of both POC (δC and δN) and TOC (δC and δN), the ratio of total organic carbon vs.

Internal medicine resident perspectives on scoring USMLE as pass/fail.

Background: The scoring rubric on the USMLE Step 1 examination will be changing to pass/fail in January 2022. This study elicits internal medicine resident perspectives on USMLE pass/fail scoring at the national level.

Objective: To assess internal medicine resident opinions regarding USMLE pass/fail scoring and examine how variables such as gender, scores on USMLE 1 and 2, PGY status and type of medical school are associated with these results.

Androgens predispose males to monocyte-mediated immunopathology by inducing the expression of leukocyte recruitment factor CXCL1.

Hepatic amebiasis, predominantly occurring in men, is a focal destruction of the liver due to the invading protozoan Entamoeba histolytica. Classical monocytes as well as testosterone are identified to have important functions for the development of hepatic amebiasis in mice, but a link between testosterone and monocytes has not been identified. Here we show that testosterone treatment induces proinflammatory responses in human and mouse classical monocytes.

Amazon Sediment Transport and Accumulation Along the Continuum of Mixed Fluvial and Marine Processes.

Sediment transfer from land to ocean begins in coastal settings and, for large rivers such as the Amazon, has dramatic impacts over thousands of kilometers covering diverse environmental conditions. In the relatively natural Amazon tidal river, combinations of fluvial and marine processes transition toward the ocean, affecting the transport and accumulation of sediment in floodplains and tributary mouths. The enormous discharge of Amazon fresh water causes estuarine processes to occur on the continental shelf, where much sediment accumulation creates a large clinoform structure and where additional sediment accumulates along its shoreward boundary in tidal flats and mangrove forests.

Features of Blood Clotting on Thromboelastography in Hospitalized Patients With Cirrhosis.

Introduction: Thromboelastography (TEG) provides a global assessment of hemostasis and may have value for patients with cirrhosis who have multiple hemostatic defects. We sought to examine the characteristics of TEG in hospitalized patients with cirrhosis and its relationship with outcomes.

Methods: We performed a cohort study of all adults with cirrhosis hospitalized at Indiana University Hospital between November 2015 and October 2018 with a TEG.

Static computer-aided implant surgery (s-CAIS) analysing patient-reported outcome measures (PROMs), economics and surgical complications: A systematic review.

Objective: To systematically evaluate the scientific literature for patient-reported outcome measures (PROMs) in static computer-aided implant surgery (s-CAIS).

Methods: A PICO strategy was executed using an electronic (MEDLINE, EMBASE, CENTRAL), plus manual search up to 15-06-2017 focusing on clinical studies investigating s-CAIS with regard to patients' pain & discomfort, economics and/or intra-operative complications. Search strategy was assembled from multiple conjunctions of MeSH Terms and unspecific free-text words.

Dual role of USP30 in controlling basal pexophagy and mitophagy.

USP30 is an integral protein of the outer mitochondrial membrane that counteracts PINK1 and Parkin-dependent mitophagy following acute mitochondrial depolarisation. Here, we use two distinct mitophagy reporter systems to reveal tonic suppression by USP30, of a PINK1-dependent component of basal mitophagy in cells lacking detectable Parkin. We propose that USP30 acts upstream of PINK1 through modulation of PINK1-substrate availability and thereby determines the potential for mitophagy initiation.

Shape Stability of Octahedral PtNi Nanocatalysts for Electrochemical Oxygen Reduction Reaction Studied by in situ Transmission Electron Microscopy.

Octahedral faceted nanoparticles are highly attractive fuel cell catalysts as a result of their activity for the oxygen reduction reaction (ORR). However, their surface compositional and morphological stability currently limits their long-term performance in real membrane electrode assemblies. Here, we perform in situ heating of compositionally segregated PtNi octahedral nanoparticles inside a transmission electron microscope, in order to study their compositional and morphological changes.

Electrochemical processes on solid shaped nanoparticles with defined facets.

This 2007 Chemistry Nobel prize update covers scientific advances of the past decade in our understanding of electrocatalytic processes on surfaces of nanoscale shape-controlled polyhedral solids. It is argued that the field of chemical reaction processes on solid surfaces has recently been paying increasing attention to the fundamental understanding of electrified solid-liquid interfaces and toward the operando study of the minute fraction of catalytically active, structurally dynamic non-equilibrium Taylor-type surface sites. Meanwhile, despite mounting evidence of acting as structural proxies in some cases, the concept of catalytic structure sensitivity of well-defined nanoscale solid surfaces continues to be a key organizing principle for the science of shape-controlled nanocrystals and, hence, constitutes a central recurring theme in this review.

Internal Medicine Program Directors' Perceptions of the "All In" Match Rule: A Cross-Sectional Survey.

Background: Since 2013, the National Resident Matching Program (NRMP) has asked all programs to declare themselves to be "all in" or "all out" for the NRMP. Before this rule was enacted, program directors who were surveyed expressed concerns about what they anticipated with the change, including resources for increased applications and potential delays with residency start times.

Objective: This study investigated the positive and negative effects of the rule change on recruiting seen from the perspective of internal medicine (IM) program directors.

GFPuv-Expressing Recombinant Rickettsia typhi: a Useful Tool for the Study of Pathogenesis and CD8 T Cell Immunology in R. typhi Infection.

is the causative agent of endemic typhus, a disease with increasing incidence worldwide that can be fatal. Because of its obligate intracellular life style, genetic manipulation of the pathogen is difficult. Nonetheless, in recent years, genetic manipulation tools have been successfully applied to rickettsiae.

Cytotoxic effector functions of T cells are not required for protective immunity against fatal Rickettsia typhi infection in a murine model of infection: Role of TH1 and TH17 cytokines in protection and pathology.

Endemic typhus caused by Rickettsia (R.) typhi is an emerging febrile disease that can be fatal due to multiple organ pathology. Here we analyzed the requirements for protection against R.

CD4+ T Cells Are as Protective as CD8+ T Cells against Rickettsia typhi Infection by Activating Macrophage Bactericidal Activity.

Rickettsia typhi is an intracellular bacterium that causes endemic typhus, a febrile disease that can be fatal due to complications including pneumonia, hepatitis and meningoencephalitis, the latter being a regular outcome in T and B cell-deficient C57BL/6 RAG1-/- mice upon Rickettsia typhi infection. Here, we show that CD4+ TH1 cells that are generated in C57BL/6 mice upon R. typhi infection are as protective as cytotoxic CD8+ T cells.

Financial impact of a targeted reduction in cardiac enzyme testing at a community hospital.

Objectives: Nearly one-third of healthcare costs are potentially avoidable and would not compromise medical care if eliminated. Therefore, we sought to evaluate the financial impact of reduction in use of creatinine kinase (CK)-MB and myoglobin tests after removing them from the cardiac enzyme order set at a community hospital.

Methods: Grand rounds were held, and an email notification was sent to de-emphasize the use of CK, CK-MB, myoglobin, SGOT (glutamic-oxaloacetic transaminase), and SGPT (serum glutamic-pyruvic transaminase) in acute coronary syndrome (ACS) work up.

Comparative evaluation of two Rickettsia typhi-specific quantitative real-time PCRs for research and diagnostic purposes.

Rickettsioses are caused by intracellular bacteria of the family of Rickettsiaceae. Rickettsia (R.) typhi is the causative agent of endemic typhus.