Evaluating the Feasibility and Effectiveness of an Interdisciplinary Verbal De-Escalation and Implicit Bias Check Training for Agitation Management in the Emergency Department.

Purpose: Recent scholarship has revealed racial disparities in emergency department (ED) physical restraint use in agitation management. We implemented an interdisciplinary educational program that integrates discussions about the role of bias in physical restraint use with workplace violence (WPV) prevention strategies to increase awareness of implicit bias and comfort with verbal de-escalation among ED staff.

Patients And Methods: In partnership with hospital security at a large urban academic medical center, we developed a 1-hour online WPV prerequisite course followed by a 2-hour multi-modal, in-person training consisting of 40 minutes each of didactics, an interactive defensive skills workshop, and case-based simulations with structured debriefings.

Novel Enhanced Recovery After Surgery Pathway Reduces Length of Stay and Postoperative Opioid Usage in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion.

Purpose: The goal of this study was to compare our institution's recently implemented enhanced recovery after surgery (ERAS) protocol to previous post-operative management for adolescent idiopathic scoliosis patients undergoing posterior spinal fusion, specifically assessing length of stay, opioid consumption, and pain scores.

Methods: This is a retrospective analysis that compares the length of stay, opioid consumption, and pain scores of patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Patients were analyzed prior to the implementation of our ERAS protocol, deemed the traditional pain pathway (TPP), to those who underwent the ERAS pathway.

Pliocene decoupling of equatorial Pacific temperature and pH gradients.

Ocean dynamics in the equatorial Pacific drive tropical climate patterns that affect marine and terrestrial ecosystems worldwide. How this region will respond to global warming has profound implications for global climate, economic stability and ecosystem health. As a result, numerous studies have investigated equatorial Pacific dynamics during the Pliocene (5.

Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population.

Background: Improved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1.

Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy: A retrospective observational cohort study.

Brachial plexus birth palsy (BPBP) is a neurologic injury that can result in mild to full paralysis of the affected upper extremity. In severe cases, nerve surgery is often performed before age 1 year. Several studies report gains in elbow flexion with onabotulinum toxin type A (OBTT-A) injections to the triceps; however, its use in infants is not widely reported.

The Relationship Between U.S. East Coast Sea Level and the Atlantic Meridional Overturning Circulation: A Review.

Scientific and societal interest in the relationship between the Atlantic Meridional Overturning Circulation (AMOC) and U.S. East Coast sea level has intensified over the past decade, largely due to (1) projected, and potentially ongoing, enhancement of sea level rise associated with AMOC weakening and (2) the potential for observations of U.

Constraints on Paleoproterozoic atmospheric oxygen levels.

The oxygenation of Earth's surface environment dramatically altered key biological and geochemical cycles and ultimately ushered in the rise of an ecologically diverse biosphere. However, atmospheric oxygen partial pressures (O) estimates for large swaths of the Precambrian remain intensely debated. Here we evaluate and explore the use of carbonate cerium (Ce) anomalies (Ce/Ce*) as a quantitative atmospheric O proxy and provide estimates of Proterozoic O using marine carbonates from a unique Precambrian carbonate succession-the Paleoproterozoic Pethei Group.

Regulation of peripheral B cell maturation.

Although it is clear that the final phases of B cell maturation occur after newly formed B cells exit the bone marrow, the mechanisms underpinning the maturation, selection, and long-term survival of immature peripheral B cells remain poorly understood. Here, we review recent advances in our understanding of how B cell receptor (BCR)-mediated signaling events integrate with additional environmental cues to promote the selection and differentiation of immature B cells into functionally distinct subpopulations of mature B cells. We pay particular attention to the role of the Baff cytokine family and the Notch receptor-ligand family and their unique roles in promoting B cell survival and differentiation into follicular and marginal zone B cells.

c-Myb is critical for B cell development and maintenance of follicular B cells.

The c-Myb transcription factor is crucial during definitive hematopoiesis. However, the embryonic lethality of Myb traditional null mutations has precluded analysis of c-Myb function in lymphocytes. Using tissue-specific inactivation at the Myb locus, we demonstrate that loss of Myb causes a partial block during B cell development at the pro-B to pre-B cell transition, resulting in greatly decreased output of new B cells from the bone marrow.