Factors Influencing Physician Treatment Strategies in Crotaline Snake Envenomation

BACKGROUND: Crotaline snake envenomation is a potentially serious medical condition that affects thousands of Americans each year. There continues to be variation in treatment practices by physicians in the United States despite guidelines establishing the use of antivenom and supportive care as the mainstays for treating crotaline snake envenomation. METHODS: This study sought to determine associations between physician treatment strategies, snake identification (ID), venom effects, bite location and patient presentation. A cross-sectional review of electronic medical records (EMR) for patients diagnosed with venomous snake bites from July 1, 2014 to August 31, 2019 was completed. Data collected from the EMR included: patient demographics, transfer information, length of hospital and ICU stays, snake ID, bite site, progression of local tissue effects, additional clinical and lab results, patient comorbidities and complications, and provider treatment strategy. RESULTS: Of the 83 patients who met inclusion criteria, 68 patients (81.9%) received antivenom. None of the 15 patients who were under observation (no antivenom) for treatment went to the ICU. These patients experienced the shortest hospital stays (H(2)=16.76, p<0.001). Hospital stays were longest for patients envenomated by an identified rattlesnake or cottonmouth compared to patients envenomated by an unknown snake or copperhead (H(2)=14.32, p<0.05). Rattlesnake envenomations used more vials of antivenom than copperhead envenomations (H(2)=8.76, p=0.01). In a regression model of treatment strategy, progression of local tissue effects was the only statistically significant predictor of receiving antivenom while other independent variables including snake ID, patient age, hemotoxicity, systemic symptoms, site of the snakebite, and patient comorbidities were not significant predictors. Lastly, there was a statistically significant association between treatment strategy and opioid prescription, with 77.9% of patients who received antivenom also receiving an opioid for pain management vs. 33.3% of patients under observation (no antivenom) who received opioids (Fisher Exact Probability Test, p=0.001). CONCLUSION: Envenomated patients are likely to be treated with antivenom if there was progression of local tissue effects. For patients in this study who were bitten by copperheads and unknown snakes, close observation without antivenom administration had favorable outcomes including shorter hospital stays and likely decreased hospital costs.N

College students' knowledge of ticks in Oklahoma: Assessment and insights

Ticks (Arachnida: Acari) are common in Oklahoma and may transmit tick-borne diseases (TBDs) to people. Due to the difficulty in reducing tick populations, awareness of tick bite prevention, proper tick removal, and knowledge of when to seek medical treatment are critical. However, outreach and extension programs are hampered by a lack of knowledge of what community members know about ticks. To address this limitation, we surveyed college students enrolled in three nonmajor Entomology courses at Oklahoma State University in 2018. Of the 483 students invited to take a survey, 224 (46.4%) students took both surveys. Pre-survey responses indicated lower levels of knowledge of tick biology compared to post-survey responses. For both pre- and post-survey respondents, "ticks can jump" and "ticks reside up in trees" received the fewest correct responses. A majority of survey respondents considered Lyme disease to be the predominant TBD in Oklahoma, although it is not established in Oklahoma. Supplemental education overcame these knowledge gaps, with the exception of knowledge of Lyme disease which was still considered to be the predominant TBD in the post-survey. Our results can be used to develop assessment tools to improve extension programs and enhance protection from TBDs.Peer reviewedEntomology and Plant Patholog

Increased signal complexity is associated with increased mating success

The evolution of complex signals has often been explored by testing multiple functional hypotheses regarding how independent signal components provide selective benefits to offset the costs of their production. In the present study, we take a different approach by exploring the function of complexity per se. We test the hypothesis that increased vibratory signal complexity—based on both proportional and temporal patterning—provides selective benefits to courting male Schizocosa stridulans wolf spiders. In support of this hypothesis, all of our quantified metrics of vibratory signal complexity predicted the mating success of male S. stridulans. The rate of visual signalling, which is mechanistically tied to vibratory signal production, was also associated with mating success. We additionally found evidence that males can dynamically adjust the complexity of their vibratory signalling. Together, our results suggest that complexity per se may be a target of female choice

Increased signal complexity is associated with increased mating success

The evolution of complex signals has often been explored by testing multiple functional hypotheses regarding how independent signal components provide selective benefits to offset the costs of their production. In the present study, we take a different approach by exploring the function of complexity per se. We test the hypothesis that increased vibratory signal complexity—based on both proportional and temporal patterning—provides selective benefits to courting male Schizocosa stridulans wolf spiders. In support of this hypothesis, all of our quantified metrics of vibratory signal complexity predicted the mating success of male S. stridulans. The rate of visual signalling, which is mechanistically tied to vibratory signal production, was also associated with mating success. We additionally found evidence that males can dynamically adjust the complexity of their vibratory signalling. Together, our results suggest that complexity per se may be a target of female choice

Coherent J/psi photoproduction in ultra-peripheral PbPb collisions at root s(NN)=2.76 TeV with the CMS experiment

Peer reviewe

Measurements of the associated production of a Z boson and b jets in pp collisions at root s=8 TeV

Peer reviewe

Predictive Factors of Follow-Up in Early Lifestyle Intervention for Childhood Obesity

BACKGROUND: The Early Lifestyle Intervention (ELI) Clinic is an OU Physicians Pediatrics specialty clinic dedicated to helping children achieve healthier weights via behavioral modification through a multidisciplinary team approach. Children between 2–18 years of age from North Eastern Oklahoma are eligible for ELI referral if their BMI is at the 95th percentile or above. It is estimated that 30–40% of patients never make their ELI appointments after referral. This study explored predictive factors of patient follow-up to these appointments. METHODS: A retrospective chart review of 121 pediatric patients with ELI referrals made between January 2010 and March 2018 was conducted. Patients were grouped into three categories based on follow-up status for this intervention: immediate (attended first ELI appointment made at time of referral), late (did not attend first ELI appointment but eventually saw ELI provider), and never attended an ELI appointment. Demographic, medical, and social data were extracted from each patient’s medical record, including comorbid conditions such as musculoskeletal pain and past medical interventions such as obesity counseling. Reported comorbidities and conditions in family medical histories were documented for each patient according to the organ system affected. Associations between clinical and family factors and follow-up status were evaluated using the χ2 test, Fisher exact test, 1-way analysis of variance, and Kruskal-Wallis H test in SPSS. RESULTS: The majority of patients were Hispanic (n=73, 60.3%) and male (n=65, 53.7%), with an average age of 7.81 years (+ SD, 3.82 yrs). Frequency of obesity counseling from a healthcare provider and reported musculoskeletal pain differed significantly among groups. 31% of patients with timely follow-up experienced musculoskeletal pain compared to 3% of those with no follow-up and late follow-up. In addition, patients in the timely follow-up group had the highest frequencies of obesity counseling. The organ systems-based approach of conditions in family histories showed cardiovascular disease and endocrine disorders to be present in all patient groups with no significant difference across groups. CONCLUSION: The results suggest that providers who document counseling their patients about childhood obesity more frequently prior to ELI referral can improve their patients’ follow-up rates. Additionally, musculoskeletal pain was the only comorbidity significantly associated with attending ELI clinic. This suggests that most comorbid conditions associated with childhood obesity have a limited effect on motivating parent/patient behavior to seek longitudinal intervention.N