Heterogeneity in managing rib fractures across non-trauma and level I, II, and III trauma centers.

BACKGROUND: We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients. METHODS: We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers. RESULTS: Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized. CONCLUSION: Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.

The Role of Association in Pre-schoolers' Solutions to "Spoon Tests" of Future Planning.

Imagining the future is a powerful tool for making plans and solving problems. It is thought to rely on the episodic system which also underpins remembering a specific past event [1-3]. However, the emergence of episodic future thinking over development and evolution is debated [4-9]. One key source of positive evidence in pre-schoolers and animals is the "spoon test" or item choice test [4, 10], in which participants encounter a problem in one context and then a choice of items in another context, one of which is the solution to the problem. A majority of studies report that most children choose the right item by age 4 [10-15, cf.16]. Apes and corvids have also been shown to pass versions of the test [17-19]. However, it has been suggested that a simpler mechanism could be driving choice: the participant simply chooses the item that has been assigned salience or value, without necessarily imagining the future event [16, 20-23]. We developed a new test in which two of the items offered to children were associated with positive outcomes, but only one was still useful. We found that older children (5-, 6-, and 7-year-olds) chose the correct item at above chance levels, but younger children (3- and 4-year-olds) did not. In further tests, 4-year-olds showed an intact memory for the encoding event. We conclude that positive association substantially impacts performance on item choice tests in 4-year-olds and that future planning may have a more protracted developmental trajectory than episodic memory.

Single-Cell RNA-Sequencing in Glioma.

PURPOSE OF REVIEW: In this review, we seek to summarize the literature concerning the use of single-cell RNA-sequencing for CNS gliomas. RECENT FINDINGS: Single-cell analysis has revealed complex tumor heterogeneity, subpopulations of proliferating stem-like cells and expanded our view of tumor microenvironment influence in the disease process. Although bulk RNA-sequencing has guided our initial understanding of glioma genetics, this method does not accurately define the heterogeneous subpopulations found within these tumors. Single-cell techniques have appealing applications in cancer research, as diverse cell types and the tumor microenvironment have important implications in therapy. High cost and difficult protocols prevent widespread use of single-cell RNA-sequencing; however, continued innovation will improve accessibility and expand our of knowledge gliomas.

Future Thinking: Children But Not Apes Consider Multiple Possibilities.

When anticipating the future, we draw on our past experience but must take uncertainty into account; for example, while preparing for a trip, we might pack a raincoat and sunglasses because of unpredictable weather. New research shows that the ability to plan for multiple future possibilities may be present in human children from as early as 3-4 years of age, but appears to be lacking in non-human apes.