The gut microbiomes of Channel Island foxes and island spotted skunks exhibit fine-scale differentiation across host species and island populations.

California's Channel Islands are home to two endemic mammalian carnivores: island foxes (Urocyon littoralis) and island spotted skunks (Spilogale gracilis amphiala). Although it is rare for two insular terrestrial carnivores to coexist, these known competitors persist on both Santa Cruz Island and Santa Rosa Island. We hypothesized that examination of their gut microbial communities would provide insight into the factors that enable this coexistence, as microbial symbionts often reflect host evolutionary history and contemporary ecology. Using rectal swabs collected from island foxes and island spotted skunks sampled across both islands, we generated 16S rRNA amplicon sequencing data to characterize their gut microbiomes. While island foxes and island spotted skunks both harbored the core mammalian microbiome, host species explained the largest proportion of variation in the dataset. We further identified intraspecific variation between island populations, with greater differentiation observed between more specialist island spotted skunk populations compared to more generalist island fox populations. This pattern may reflect differences in resource utilization following fine-scale niche differentiation. It may further reflect evolutionary differences regarding the timing of intraspecific separation. Considered together, this study contributes to the growing catalog of wildlife microbiome studies, with important implications for understanding how eco-evolutionary processes enable the coexistence of terrestrial carnivores-and their microbiomes-in island environments.

Outcomes of Therapy and Ulnar Nerve Transposition for Elbow Stiffness After Pediatric Medial Epicondyle Fractures.

Purpose: Following medial epicondyle fractures, a subset of pediatric patients has persistent limitations in elbow motion. This study soughted to understand the patient characteristics of this group and to assess the effectiveness of intensive therapy and ulnar nerve transposition in improving elbow range of motion and patient-reported outcomes. Methods: A cohort of 31 pediatric patients with stiffness after elbow trauma was narrowed to 8 pediatric patients (7 female) ranging in age from 9 to 14 years, who were diagnosed with medial epicondyle fractures and underwent intensive therapy and ulnar nerve transposition with or without elbow joint release. We collected demographic and objective data as well as subjective data including Patient-Reported Outcome Measurement Information System (PROMIS) scores before and after ulnar nerve transposition. Results: Following initial intensive therapy, elbow range of motion improved by an average of 56°, and 7 of the 8 patients reached a functional motion arc of 100°. Subsequently, following ulnar nerve surgery with or without elbow release, motion improved by an average of 22°, and 5 of the 8 patients demonstrated improvement from this intervention. Surgery led to improvements in subjective outcomes with an improvement in PROMIS mobility scores by an average of 9 points, pain interference by 6 points, and upper extremity scores by 3 points. Based on a previously determined minimally important difference of three points, these indicate significant clinical improvements. Conclusions: A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. However, not all patients were improved after ulnar nerve surgery, and the identification and treatment of ulnar nerve irritability may not fully resolve preoperative symptoms in all patients. Type of study/level of evidence: Therapeutic IV.

Does Current General Mental Health Status Relate to Current Smoking Status in Pregnant Women?

PURPOSE: Research shows that smoking during pregnancy is related to mental health diagnoses. The purpose of this study was to assess whether current general mental health status is related to current smoking status in pregnant women after controlling for other factors related to both mental health and tobacco use during pregnancy. METHODS: This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance Survey (BRFSS) data for 621 pregnant women aged 18-38 from Florida (N=136), Kansas (N=116), Minnesota (N=105), Nebraska (N=90), New York (N=78), and Utah (N=96). Multiple logistic regression analysis was used to assess the relationship between current mental health status and current tobacco use, while controlling for state, depression diagnosis, routine checkup, healthcare plan, age, marital status, ethnicity/race, education level, income level, and employment status. RESULTS: Overall, very few participants reported current smoking (6%) and about one-third reported low or moderate mental health status in the past 30 days. Adjusted results indicated that those who reported high mental health status were about 3 times less likely (OR=0.29, 95% CI=0.09, 0.88) to report current smoking status compared to those who reported low mental health status. CONCLUSIONS: Overall, current mental health status was highly related to current smoking status in pregnant women. Clinicians in obstetrics may expect a very low proportion of pregnant women to report smoking and up to one-third to report low or moderate current general mental health status. Given that current mental health issues and current tobacco use may harm both mother and child, be highly related in pregnant women, and change throughout the pregnancy, pregnant women should be screened automatically for both at each visit.

A custom bicycle handlebar adaptation for children with below elbow amputations.

As hand therapists, we are always using our creativity to help our patients participate in functional, desired activities. These authors share their expertise in adapting bicycles for children with below elbow amputations.

Pseudohyperkalemia without reported haemolysis in a patient with chronic lymphocytic leukaemia.

Hyperkalemia is a medical condition that requires immediate recognition and treatment to prevent the development of life-threatening arrhythmias. Pseudohyperkalemia is most commonly due to specimen haemolysis and is often recognised by laboratory scientists who subsequently report test results with cautionary warnings. The authors present a case of pseudohyperkalemia in a patient with chronic lymphocytic leukaemia that was the result of white blood cell lysis during phlebotomy. False elevations of potassium from this condition may not be reported with a warning from the laboratory. This places the patient at risk of unnecessary and potentially dangerous treatments. This phenomenon has not been published in the emergency medicine literature to date.

Consumer satisfaction to laboratory test interpretation by the ASCLS response team.

OBJECTIVE: To assess consumer satisfaction to responses to laboratory test interpretations as provided by the American Society for Clinical Laboratory Science (ASCLS) Consumer Response Team. Additional information studied included demographics, whether a response to the question was received, and the respective discipline related to the question. DESIGN: A computerized questionnaire was sent to 339 participants who had sent questions concerning laboratory test results to the ASCLS consumer website (www.ascls.org) in May 2007. A total of99 completed questionnaires (29.3%) provided usable data for analysis. SETTING: Participants answered the questionnaire via electronic mail and results were summarized in Zoomerang. PARTICIPANTS: Participants were national and international consumers who had sent a question regarding their laboratory results to the ASCLS website. Individuals were 18 years of age or older. Participation was voluntary and anonymous. MAIN OUTCOME MEASURES: Consumer satisfaction, measured by eleven satisfaction statements, with laboratory interpretations by the ASCLS Response Team averaged 4.0 on the five-point Likert scale: 1 = Strongly disagree to 5 = Strongly agree. Overall satisfaction of the website itself was 4.2 on the five-point Likert scale 1 = Poor to 5 = Excellent. RESULTS: The majority of respondents were female (71.1%) and ranged in age from 36-64 years (71.7%). Seventy-six percent of respondents reported they had received an answer to their laboratory test question. The most frequent disciplines for questions received were in chemistry, immunology, and hematology, respectively. CONCLUSIONS: This study indicates consumers of the ASCLS website were very satisfied with the clinical laboratory scientist volunteers' responses. The ASCLS Consumer Response Team model is contributing to the advancement of healthcare by providing this important service to the public.

The Partners in Information Access for the Public Health Workforce: a collaboration to improve and protect the public's health, 1995-2006.

OBJECTIVE: The paper provides a complete accounting of the Partners in Information Access for the Public Health Workforce (Partners) initiative since its inception in 1997, including antecedent activities since 1995. METHODS: A descriptive overview is provided that is based on a review of meeting summaries, published reports, Websites, project reports, databases, usage statistics, and personal experiences from offices in the National Library of Medicine (NLM), six organizations that collaborate formally with NLM on the Partners initiative, and one outside funding partner. RESULTS: With ten years of experience, the initiative is an effective and unique public-private collaboration that builds on the strengths and needs of the organizations that are involved and the constituencies that they serve. Partners-supported and sponsored projects include satellite broadcasts or Webcasts, training initiatives, Web resource development, a collection of historical literature, and strategies for workforce enumeration and expansion of public health systems research, which provide excellent examples of the benefits realized from collaboration between the public health community and health sciences libraries. CONCLUSIONS: With continued funding, existing and new Partners-sponsored projects will be able to fulfill many public health information needs. This collaboration provides excellent opportunities to strengthen the partnership between library science and public health in the use of health information and tools for purposes of improving and protecting the public's health.

Managing complex systems: performance management in public health.

The complexity of mobilizing and managing systems-wide public health responses has prompted Turning Point's Performance Management National Excellence Collaborative, funded by the Robert Wood Johnson Foundation, to develop a conceptual framework for performance management in public health. The framework has four integrated parts: (1) performance standards, (2) performance measures, (3) reporting of progress, and (4) a quality improvement process. The Collaborative based its framework on evidence gathered through a survey of current state performance management practices, a literature review, and its investigation of current practice models. This balanced and cohesive management model can be constructively used by public health programs, organizations, and community and state public health systems.