Documentation: The Order for the Burial of the Dead and Propers For A: Memorial Service with Holy Communion

The Order for the Burial of the Dead Propers For A: Memorial Service with Holy Communio

Alien Registration- De Kuzelewski, Adalbert R. (Bath, Sagadahoc County)

https://digitalmaine.com/alien_docs/9508/thumbnail.jp

A focus on the future of opioid prescribing: implementation of a virtual opioid and pain management module for medical students

Background: The United States opioid epidemic is a devastating public health crisis fueled in part by physician prescribing. While the next generation of prescribers is crucial to the trajectory of the epidemic, medical school curricula designated to prepare students for opioid prescribing (OP) and pain management is often underdeveloped. In response to this deficit, we aimed to investigate the impact of an online opioid and pain management (OPM) educational intervention on fourth-year medical student knowledge, attitudes, and perceived competence. Methods: Graduating students completing their final year of medical education at Sidney Kimmel Medical College of Thomas Jefferson University were sent an e-mail invitation to complete a virtual OPM module. The module consisted of eight interactive patient cases that introduced topics through a case-based learning system, challenging students to make decisions and answer knowledge questions about the patient care process. An identical pre- and posttest were built into the module to measure general and case-specific learning objectives, with responses subsequently analyzed using the Wilcoxon matched-pairs signed-rank test. Results: Forty-three students (19% response rate) completed the module. All median posttest responses ranked significantly higher than paired median pretest responses (p \u3c 0.05). Comparing the paired overall student baseline score to module completion, median posttest ranks (Mdn = 206, IQR = 25) were significantly higher than median pretest ranks (Mdn = 150, IQR = 24) (p \u3c 0.001). Regarding paired median Perceived Competence Scale metrics specifically, perceived student confidence, capability, and ability in opioid management increased from disagree (2) to agree (4) (p \u3c 0.001), and student ability to meet the challenge of opioid management increased from neither agree nor disagree (3) to agree (4) (p \u3c 0.001). Additionally, while 77% of students reported receiving OP training in medical school, 21% reported no history of prior training. Conclusion: Implementation of a virtual, interactive module with clinical context is an effective framework for improving the OPM knowledge, attitudes, and perceived competence of fourth-year medical students. This type of intervention may be an important method for standardizing and augmenting the education of future prescribers across multiple institutions

Adrenal ectopy and lipoma of an inguinal hernia sac: A case report & literature review.

INTRODUCTION & IMPORTANCE: Ectopic adrenocortical tissue is the presence of accessory adrenal cortex tissue located outside of the adrenal glands. It is a rare, incidental finding during inguinal hernia repair. This case report aims to discuss the anatomy and important patient implications related to this finding. CASE PRESENTATION: A 61-year-old male presented with a long-standing right direct inguinal hernia increasing in size and pain frequency. During open right anterior inguinal hernia repair, a lipoma was identified inside the hernia sac and removed. Further histopathological examination of the specimen revealed the presence of adrenocortical tissue inside the lipoma. No further interventions were performed. The postoperative and 2-year follow-up course were uneventful. CLINICAL DISCUSSION: Adrenocortical tissue can parallel the descent of the gonads during embryogenesis, arresting at any point along this path, including the inguinal region. Ectopic adrenocortical tissue is commonly found during inguinoscrotal procedures in infants, suggesting early involution. Its incidence in hernia sacs should be recognized to prevent misdiagnosis as neuroendocrine tumors or melanomas. If adrenocortical tissue is identified during hernia reduction, further surgical exploration is not recommended. In terms of prognosis, endocrine imbalances following surgical removal cannot be ruled out, promoting careful patient monitoring. The lipoma containing the adrenal tissue in our case is a common finding during hernia repair, identified in 22% of patients at operation. CONCLUSION: Ectopic adrenocortical tissue is a rare, incidental finding during inguinal hernia sac analysis in adults. This finding should be well-documented following removal and further studies are required to evaluate long-term outcomes

Overcrowded housing increases risk for COVID-19 mortality: an ecological study

Objectives: Overcrowded housing is a sociodemographic variable associated with increased infection and mortality rates from communicable diseases. It is not well understood if this association exists for COVID-19. Our objective was hence to determine the association between household overcrowding and risk of mortality from COVID-19, and this was done by performing bivariable and multivariable analyses using COVID-19 data from cities in Los Angeles County. Results: Bivariate regression revealed that overcrowded households were positively associated with COVID-19 deaths (standardized β = 0.863, p \u3c 0.001). COVID-19 case totals, people aged 60+, and the number of overcrowded households met conditions for inclusion in the backwards stepwise linear regression model. Analysis revealed all independent variables were positively associated with mortality rates, primarily for individuals 60 + (standardized β1 = 0.375, p = 0.001), followed by overcrowded households (standardized β2 = 0.346, p = 0.014), and total COVID-19 cases (standardized β3 = 0.311, p \u3c 0.001). Our findings highlight that residing in overcrowded households may be an important risk factor for COVID-19 mortality. Public health entities should consider this population when allocating resources for prevention and control of COVID-19 mortality and future disease outbreaks

Generalized iterated wreath products of symmetric groups and generalized rooted trees correspondence

Consider the generalized iterated wreath product $S_{r_1}\wr \ldots \wr S_{r_k}$ of symmetric groups. We give a complete description of the traversal for the generalized iterated wreath product. We also prove an existence of a bijection between the equivalence classes of ordinary irreducible representations of the generalized iterated wreath product and orbits of labels on certain rooted trees. We find a recursion for the number of these labels and the degrees of irreducible representations of the generalized iterated wreath product. Finally, we give rough upper bound estimates for fast Fourier transforms.Comment: 18 pages, to appear in Advances in the Mathematical Sciences. arXiv admin note: text overlap with arXiv:1409.060

The progressive nature of Wallerian degeneration in wild-type and slow Wallerian degeneration (Wld(S)) nerves

BACKGROUND: The progressive nature of Wallerian degeneration has long been controversial. Conflicting reports that distal stumps of injured axons degenerate anterogradely, retrogradely, or simultaneously are based on statistical observations at discontinuous locations within the nerve, without observing any single axon at two distant points. As axon degeneration is asynchronous, there are clear advantages to longitudinal studies of individual degenerating axons. We recently validated the study of Wallerian degeneration using yellow fluorescent protein (YFP) in a small, representative population of axons, which greatly improves longitudinal imaging. Here, we apply this method to study the progressive nature of Wallerian degeneration in both wild-type and slow Wallerian degeneration (Wld(S)) mutant mice. RESULTS: In wild-type nerves, we directly observed partially fragmented axons (average 5.3%) among a majority of fully intact or degenerated axons 37–42 h after transection and 40–44 h after crush injury. Axons exist in this state only transiently, probably for less than one hour. Surprisingly, axons degenerated anterogradely after transection but retrogradely after a crush, but in both cases a sharp boundary separated intact and fragmented regions of individual axons, indicating that Wallerian degeneration progresses as a wave sequentially affecting adjacent regions of the axon. In contrast, most or all Wld(S )axons were partially fragmented 15–25 days after nerve lesion, Wld(S )axons degenerated anterogradely independent of lesion type, and signs of degeneration increased gradually along the nerve instead of abruptly. Furthermore, the first signs of degeneration were short constrictions, not complete breaks. CONCLUSIONS: We conclude that Wallerian degeneration progresses rapidly along individual wild-type axons after a heterogeneous latent phase. The speed of progression and its ability to travel in either direction challenges earlier models in which clearance of trophic or regulatory factors by axonal transport triggers degeneration. Wld(S )axons, once they finally degenerate, do so by a fundamentally different mechanism, indicated by differences in the rate, direction and abruptness of progression, and by different early morphological signs of degeneration. These observations suggest that Wld(S )axons undergo a slow anterograde decay as axonal components are gradually depleted, and do not simply follow the degeneration pathway of wild-type axons at a slower rate

The Prescription Drug Monitoring Program in a Multifactorial Approach to the Opioid Crisis: PDMP Data, Pennsylvania, 2016–2020

Background: Prescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP\u27s role in a multifactorial approach to opioid harm reduction. Methods: State-level opioid prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. Data for oxycodone, hydrocodone, and morphine were analyzed by quarter for total prescription numbers and refills. Prescription lengths, pill quantities, and average morphine milliequivalents (MMEs) were analyzed by quarter for all 14 opioid prescription variants recorded by the PA PDMP. Linear regression was conducted for each group of variables to identify significant differences in prescribing trends. Results: For total prescriptions dispensed, the number of oxycodone, hydrocodone, and morphine prescriptions decreased by 34.4, 44.6, and 22.3% respectively (p \u3c 0.0001). Refills fluctuated less consistently with general peaks in Q3 of 2017 and Q3 of 2018 (p = 0.2878). The rate of prescribing for all opioid prescription lengths decreased, ranging in frequency from 22 to 30 days (47.5% of prescriptions) to 31+ days of opioids (0.8% of prescriptions) (p \u3c 0.0001). Similarly, decreased prescribing was observed for all prescription amounts, ranging in frequency from 22 to 60 pills (36.6% of prescriptions) to 60-90 pills (14.2% of prescriptions) (p \u3c 0.0001). Overall, the average MME per opioid prescription decreased by 18.9%. Conclusions: Per the PA PDMP database, opioid prescribing has decreased significantly in PA from 2016 to 2020. The PDMP database is an important tool for tracking opioid prescribing trends in PA, and PDMPs structured similarly in other states may enhance our ability to understand and influence the trajectory of the U.S. opioid crisis. Further research is needed to determine optimal PDMP policies and practices nationwide