Caecal diverticulitis presenting as acute appendicitis: a case report

Solitary caecal diverticulum is an uncommon entity and therefore difficult to diagnose except at surgery. Caecal diverticulitis is an infrequent cause of acute abdomen and usually presents in a manner similar to acute appendicitis. It is extremely difficult to differentiate it preoperative from acute appendicitis and such distinction is usually made in the operating room. The optimal management of this clinical condition is still controversial, ranging from conservative treatment with antibiotics to aggressive surgical resections

Coordinating Community Healthcare Needs to Local Services in Paraiso, Dominican Republic Through Strategic Assessment Strategies

Background: The availability of healthcare services is limited in Paraiso, Dominican Republic with the nearest full-service hospital located 34.1 km away. A local, underutilized clinic was unaware of the needs of this disadvantaged community. Method: Researchers adapted a World Health Organization assessment survey with the goals of determining residents’ priority needs and an appraisal of the current clinic capabilities and gaps in services in order to provide the community with relevant healthcare. 106 families were randomly selected in seven separate geographic areas of Paraiso to participate in the self-report assessment. Researchers, along with a community volunteer, conducted interviews utilizing the 63 question instrument. 105 families agreed to participate representing 504 individuals

Impact of Abamectin on Anagrus Nilaparvatae, an Egg Parasitoid of Nilaparvata Lugens

Anagrus nilaparvatae (Hymenoptera: Mymaridae) is an egg parasitoid potential for controlling the major pests on rice, the brown planthopper (Nilaparvata lugens [Hemiptera: Delphacidae]).Abamectin is one of insecticides registered for N. lugens. The research was aimed to investigate the impact of contact application of abamectin on the parasitism level of A. nilaparvatae under laboratory conditions. Adults of A. nilaparvatae and the first instars as well as adults of N. lugens were exposed to the residue of abamection inside the test tube. A. nilaparvatae was much more susceptible to abamectin compared to N. lugens. Application of abamectin at the recommended concentration (22.78 ppm) for 30 min caused 100% mortality, and it reduced to 85% when the concentration was decreased to 0.36 ppm. In contrast, the mortality for the first instar of N. lugens was only 15% at 22.78 and no mortality at 0.36 ppm. No N. lugens adults died even when they were exposed to 22.78 ppm. Furthermore, the parasitism test was conducted using 38 days after planting of IR-64 rice variety. Those plants were infested with 50 females of N. lugens for 2 days. A. nilaparvatae were exposed by contact to 0.02, 0.23, and 2.28 ppm of abamectin. The survivors were released to the rice plant containing eggs of N. lugens. Contact application of abamectin reduced parasitism level of A. nilaparvatae as much as 86.34, 70.01, and 28.43% with concentrations of 2.28 ppm, 0.23 and 0.02 ppm, respectively. In addition, the number of parasitoids emerged decreased with increasing concentration of abamectin. These results suggest that abamectin could be detrimental to A. nilaparvatae due to direct mortality, reduced the parasitism level, and decreased the number of progeny produced. IntisariAnagrus nilaparvatae (Hymenoptera: Mymaridae) merupakan salah satu parasitoid telur yang berpotensi untuk mengendalikan hama utama tanaman padi, wereng batang padi cokelat (Nilaparvata lugens [Hemiptera: Delphacidae]). Abamektin adalah salah satu insektisida yang terdaftar untuk pengendalian N. lugens. Penelitian ini bertujuan untuk mengetahui dampak aplikasi kontak abamektin terhadap suseptibilitas dan tingkat parasitasi A. nilaparvatae terhadap telur N. lugens pada kondisi laboratorium. Imago A. nilaparvatae serta instar satu dan imago N. lugens dipapar dengan residu abamektin di dalam tabung reaksi. A. nilaparvatae lebih peka terhadap abamektin dibandingkan N. lugens. Aplikasi abamektin pada konsentrasi anjuran (22,78 ppm) selama 30 menit menyebabkan mortalitas A. nilaparvatae 100%, dan mengurangi sampai dengan 85% pada konsentrasi yang lebih rendah 0,36 ppm. Sebaliknya, mortalitas instar satu N. lugens hanya sebesar 15% pada 22,78 ppm dan tidak menimbulkan kematian pada 0,36 ppm. Konsentrasi 22,78 ppm tidak menimbulkan kematian imago N. lugens. Selanjutnya, uji parasitasi dilakukan menggunakan media tanaman padi varietas IR-64 umur 38 hari setelah tanam. Tanaman diinfestasi dengan 50 ekor betina N. lugens selama dua hari. A. nilaparvatae dipapar abamektin dengan metode kontak pada konsentrasi 0.02, 0,23, dan 2,28 ppm. Parasitoid yang mampu bertahan hidup dilepaskan pada tanaman padi yang telah diinfestasi telur N. lugens. Aplikasi kontak abamektin mengurangi tingkat parasitasi A. nilaparvatae sebesar 86,34, 70.01, dan 28,43% pada konsentrasi 2,28; 0,23; dan 0,02 ppm. Selain itu, jumlah parasitoid yang muncul semakin menurun dengan peningkatan konsentrasi abamektin. Hasil ini menunjukkan bahwa abamektin dapat merugikan secara langsung terhadap mortalitas serta mengurangi tingkat parasitasi dan jumlah keturunan A. nilaparvatae

A Conceptual Model for Navigating a Career Path in Medical School Leadership

There is a paucity of literature providing guidance to physicians hoping to attain a position as a medical school dean. Realizing this gap, the Society for Academic Emergency Medicine (SAEM) Faculty Development Committee organized an educational session focused on offering faculty guidance for obtaining a position in medical school leadership. The session involved panelists who are nationally known leaders in medical school administration and was successfully presented at the SAEM 2018 annual meeting in Indianapolis, Indiana. Knowledge and perspective gained both during this session and through literature review was analyzed using a conceptual thinking skills framework. This process offered insights that promoted the development of a conceptual model informed by current evidence and expert insight and rooted in educational, economic, and cognitive theory. This model provides a step‐by‐step guide detailing a process that physicians can use to create a plan for professional development that is informed, thoughtful, and individualized to their own needs to optimize their future chances of advancing to a career in medical school leadership.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146843/1/aet210212.pd

A Theoryâ based Didactic Offering Physicians a Method for Learning and Teaching Others About Human Trafficking

Emergency clinicians are on the frontlines of identifying and caring for trafficked persons. However, most emergency providers have never received training on trafficking, and studies report a significant knowledge gap involving this important topic. Workshops often employ a â trainâ theâ trainerâ model to address cliniciansâ knowledge gaps involving various topics (including trafficking). By offering participants knowledge and skills needed to both understand relevant content and teach this content to future learners, this model aims at promoting widespread dissemination of essential information. However, current trainâ theâ trainer workshops typically involve full or multiday sessions and employ multimodal instructional techniques, making them time and resource intensive for both participants and facilitators.To address these challenges, we created a 50â minute trainâ theâ trainer workshop to teach emergency clinicians the knowledge and skills needed to recognize and care for trafficked patients while providing instructional techniques to teach learners this content in the clinical environment. Learning theory and principles informed the choice of instructional methods and were employed when designing the paperâ based learning guides that functioned as this intervention’s primary instructional resource. Guides contained detailed scripts used to perform roleâ playing exercises. These â scripted guidesâ were designed for participants to learn important content while simultaneously practicing techniques to teach this content to one another. They provided the scaffolding necessary to independently direct learning during the workshop (with minimal facilitator intervention), while also being carefully formatted and organized to create an accessible tool for future use during clinical teaching.The session was implemented at the 2018 Society for Academic Emergency Medicine Annual Meeting in Indianapolis, Indiana. Based on participantsâ selfâ assessment using a retrospective preâ post test, the workshop was successful in creating a trainâ theâ trainer model that is brief, requiring minimal facilitator resources and offers instruction on both content knowledge and instructional methods to disseminate this knowledge to future learners.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147170/1/aet210206_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147170/2/aet210206.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147170/3/aet210206-sup-0001-DataS1.pd

Consumer Decision Making and Aging: Current Knowledge and Future Directions

We review existing knowledge about older consumers and decision making. We develop a conceptual framework that incorporates the notion of fit between individual characteristics, task demands and the contextual environment. When the fit is high, older consumers use their considerable knowledge and experience to compensate for the impact of any age‐related changes in abilities and resources. When the fit is relatively low, older consumers feel increased need to adapt their decision making processes. We discuss these consumer adaptations and propose a number of research questions related to the processes underlying them in order to contribute to a better understanding of how they can lead to more effective consumer decision making for older adults. We further consider some pragmatic implications of the adaptations for marketing management and public policy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141554/1/jcpy2.pd

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing. CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing

Draft genomes of 12 Bifidobacterium isolates from human IBD fecal samples

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IDOL regulates systemic energy balance through control of neuronal VLDLR expression.

Liver X receptors limit cellular lipid uptake by stimulating the transcription of Inducible Degrader of the LDL Receptor (IDOL), an E3 ubiquitin ligase that targets lipoprotein receptors for degradation. The function of IDOL in systemic metabolism is incompletely understood. Here we show that loss of IDOL in mice protects against the development of diet-induced obesity and metabolic dysfunction by altering food intake and thermogenesis. Unexpectedly, analysis of tissue-specific knockout mice revealed that IDOL affects energy balance, not through its actions in peripheral metabolic tissues (liver, adipose, endothelium, intestine, skeletal muscle), but by controlling lipoprotein receptor abundance in neurons. Single-cell RNA sequencing of the hypothalamus demonstrated that IDOL deletion altered gene expression linked to control of metabolism. Finally, we identify VLDLR rather than LDLR as the primary mediator of IDOL effects on energy balance. These studies identify a role for the neuronal IDOL-VLDLR pathway in metabolic homeostasis and diet-induced obesity