Tourniquet Use in the Prehospital Setting.

PURPOSE: Tourniquets are a mainstay of life-saving hemorrhage control. The US military has documented the safety and effectiveness of tourniquet use in combat settings. In civilian settings, events such as the Boston Marathon bombing and mass shootings show that tourniquets are necessary and life-saving entities that must be used correctly and whenever indicated. Much less research has been done on tourniquet use in civilian settings compared to military settings. The purpose of this study is to describe the prehospital use of tourniquets in a regional EMS system served by a single trauma center. METHODS: All documented cases of prehospital tourniquet use from 2015 to 2020 were identified via a search of EMS, emergency department, and inpatient records, and reviewed by the lead investigator. The primary outcomes were duration of tourniquet placement, success of hemorrhage control, and complications; secondary outcomes included time of day (by EMS arrival time), transport interval, extremity involved, who placed/removed the tourniquet, and mechanism of injury. RESULTS: Of 182 patients with 185 tourniquets applied, duration of application was available for 52, with a median (IQR) of 43 (56) minutes. Hemorrhage control was achieved in all but two cases (96%). Three cases (5.8%) required more than one tourniquet. Complications included five cases of temporary paresthesia, one case of ecchymosis, two cases of fasciotomy, and two cases of compression nerve injury. The serious complication rate was 7.7% (4/52). Time of day was daytime (08:01-16:00) = 15 (31.9%), evening (16:01-00:00) = 27 (57.4%), and night (00:01- 08:00) = 5 (10.6%). The median transport interval was 22 (IQR 5] minutes. The limbs most often injured were the left and right upper extremities (15 each). EMS clinicians and police officers were most often the tourniquet placers. Common mechanisms of injury included gunshot wounds, motorcycle accidents, and glass injuries. CONCLUSION: Tourniquets used in the prehospital setting have a high rate of hemorrhage control and a low rate of complications.

Assessing healthcare provider knowledge of human trafficking.

BACKGROUND AND OBJECTIVES: Human trafficking is a significant problem in which healthcare workers are in a unique position to intervene. This study sought to determine the self-reported knowledge levels of healthcare providers most likely to come in direct contact with victims of human trafficking. METHODS: An anonymous survey assessing self-reported knowledge of human trafficking was developed and distributed online. Demographic information and questions pertaining to training and knowledge of trafficking in a healthcare setting were asked. The primary outcomes were descriptive statistics and secondary outcomes were comparisons among demographic groups. Qualitative methodology via content analysis was implemented on an open-ended question. RESULTS: The 6,603 respondents represented all regions of the country. Medical, nursing, and physician assistant students comprised 23% of the sample, while 40% were either physicians, fellows, or residents. Less than half the respondents (42%) have received formal training in human trafficking, while an overwhelming majority (93%) believe they would benefit by such training. Overall, respondents thought their level of knowledge of trafficking was average to below average (mean = 2.64 on a 5-point scale). There were significant differences in knowledge of trafficking by age group (p < .001), region (p < .001), and educational training level (p < .001). 949 respondents (14.4%) provided free-text comments that further described their opinions. CONCLUSION: Most respondents stated they have not received training but felt they would benefit from it. There were significant differences between demographic groups. Further innovation is needed to design a universally appropriate curriculum on human trafficking that is accessible to all healthcare providers as well as mandatory training programs for healthcare institutions.

Self-efficacy and confidence of medical students with prior scribing experience: A mixed methods study.

PURPOSE: Medical scribing is an increasingly common way for pre-medical students to gain clinical experience. Scribes are a valuable part of the healthcare team and have high rates of matriculation into health professional programs. Little is known about the effects of scribing on the success of the student. This manuscript aims to determine the effect of scribing experience on clinical self-efficacy during medical school. PARTICIPANTS AND METHODS: Perceived clinical self-efficacy was evaluated with validated survey questions using a 5-point Likert-type scale as well as free text responses. The survey was completed by 175 medical students at the Frank H. Netter, MD School of Medicine. Statistical analysis was conducted using SPSS. As part of the mixed methods study, free text responses were analyzed using thematic analysis. RESULTS: Quantitative results showed no statistical difference in perceived clinical self-efficacy between medical students with scribing experience and those without. Analysis of free text responses showed that medical students believed their scribing experience improved comfort in the clinical setting and increased familiarity with medical terminology. DISCUSSION AND CONCLUSIONS: Medical students with scribing experience did not demonstrate greater clinical self-efficacy than their peers without scribing experience. However, medical students with scribing experience have a perceived value of their pre-medical scribing experience on their success in medical school.

Within gut physicochemical variation does not correspond to distinct resident fungal and bacterial communities in the tree-killing xylophage, Anoplophora glabripennis.

Insect guts harbor diverse microbial assemblages that can be influenced by multiple factors, including gut physiology and interactions by the host with its environment. The Asian longhorned beetle (A. glabripennis; Cerambycidae: Lamiinae) is an invasive tree-killing insect that harbors a diverse consortium of fungal and bacterial gut associates that provision nutrients and facilitate lignocellulose digestion. The physicochemical conditions of the A. glabripennis gut and how these conditions may influence the microbial composition across gut regions are unknown. In this study, we used microsensors to measure in situ oxygen concentrations, pH, and redox potential along the length of the A. glabripennis larval gut from two North American populations. We then analyzed and compared bacterial and fungal gut communities of A. glabripennis within individual hosts along the length of the gut using 16S and ITS1 amplicon sequencing. The A. glabripennis midgut lumen was relatively anoxic (<0.01kPa) with a pH gradient from 5.5 to 9, moving anterior to posterior. Redox potential was higher in the anterior midgut relative to posterior regions. No differences in physicochemistry were measured between the two populations of the beetle, but the two populations harbored different communities of bacteria and fungi. However, microbial composition of the A. glabripennis gut microbiota did not differ among gut regions despite physicochemical differences. Unlike other insect systems that have distinct gut compartmentalization and corresponding microbial assemblages, the A. glabripennis gut lacks dramatic morphological modifications, which may explain why discrete microbial community structures were not found along the digestive system.

Escherichia coli K1 utilizes host macropinocytic pathways for invasion of brain microvascular endothelial cells.

Eukaryotic cells utilize multiple endocytic pathways for specific uptake of ligands or molecules, and these pathways are commonly hijacked by pathogens to enable host cell invasion. Escherichia coli K1, a pathogenic bacterium that causes neonatal meningitis, invades the endothelium of the blood-brain barrier, but the entry route remains unclear. Here, we demonstrate that the bacteria trigger an actin-mediated uptake route, stimulating fluid phase uptake, membrane ruffling and macropinocytosis. The route of uptake requires intact lipid rafts as shown by cholesterol depletion. Using a variety of perturbants we demonstrate that small Rho GTPases and their downstream effectors have a significant effect on bacterial invasion. Furthermore, clathrin-mediated endocytosis appears to play an indirect role in E. coli K1 uptake. The data suggest that the bacteria effect a complex interplay between the Rho GTPases to increase their chances of uptake by macropinocytosis into human brain microvascular endothelial cells.

Plant genotype and induced defenses affect the productivity of an insect-killing obligate viral pathogen.

Plant-mediated variations in the outcomes of host-pathogen interactions can strongly affect epizootics and the population dynamics of numerous species, including devastating agricultural pests such as the fall armyworm. Most studies of plant-mediated effects on insect pathogens focus on host mortality, but few have measured pathogen yield, which can affect whether or not an epizootic outbreak occurs. Insects challenged with baculoviruses on different plant species and parts can vary in levels of mortality and yield of infectious stages (occlusion bodies; OBs). We previously demonstrated that soybean genotypes and induced anti-herbivore defenses influence baculovirus infectivity. Here, we used a soybean genotype that strongly reduced baculovirus infectivity when virus was ingested on induced plants (Braxton) and another that did not reduce infectivity (Gasoy), to determine how soybean genotype and induced defenses influence OB yield and speed of kill. These are key fitness measures because baculoviruses are obligate-killing pathogens. We challenged fall armyworm, Spodoptera frugiperda, with the baculovirus S. frugiperda multi-nucleocapsid nucleopolyhedrovirus (SfMNPV) during short or long-term exposure to plant treatments (i.e., induced or non-induced genotypes). Caterpillars were either fed plant treatments only during virus ingestion (short-term exposure to foliage) or from the point of virus ingestion until death (long-term exposure). We found trade-offs of increasing OB yield with slower speed of kill and decreasing virus dose. OB yield increased more with longer time to death and decreased more with increasing virus dose after short-term feeding on Braxton compared with Gasoy. OB yield increased significantly more with time to death in larvae that fed until death on non-induced foliage than induced foliage. Moreover, fewer OBs per unit of host tissue were produced when larvae were fed induced foliage than non-induced foliage. These findings highlight the potential importance of plant effects, even at the individual plant level, on entomopathogen fitness, which may impact epizootic transmission events and host population dynamics.