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Background:. Distal radius fractures (DRFs) commonly require surgical fixation. Unscheduled healthcare contact (UHC) after surgery represents an area of quality improvement in surgical care. We hypothesize that UHC after outpatient surgical fixation of DRFs is more common in patients undergoing treatment at a safety-net hospital versus those treated at a university-affiliated facility. Methods:. An IRB-approved retrospective review studied patients who underwent outpatient surgical treatment of DRFs from January 2017 to May 2021. Surgery was performed either at a local safety-net hospital or at a university-affiliated hospital. UHC was defined as telephone calls, emergency room visits, and/or readmissions to the hospital within 30 days of surgery. Demographic factors, medical comorbidities, and injury and surgery details were analyzed. Results:. In total, 442 patients met inclusion criteria. An estimated 257 patients (58.1%) were treated at a university-affiliated facility, whereas 185 patients (41.9%) had surgery at the safety-net hospital. The overall rate of UHC within thirty-days of surgery was 14.0%, with the most common reason being uncontrolled pain. Rates of UHC were higher at the safety-net hospital compared with those at a university-affiliated facility (26.5% versus 5.1%, P < 0.05). Conclusions:. UHC was significantly greater for patients undergoing surgery in a safety-net hospital setting compared with those in a university setting. UHC after surgery is often related to inadequate postoperative pain control. Improved pain control and patient education may alleviate unnecessary healthcare contact.

Background:. Financial stress and lack of financial well-being are significant contributors to physician burnout. Many trainees believe little can contribute to developing financial freedom during their training years. However, residency is a pivotal moment in a young attending’s life; strategic financial steps taken during this time can lead to a path of financial freedom and well-being for years to come. Methods:. We introduce 12 effective financial steps physicians can take at the start of their careers. These essential steps were compiled both anecdotally and from published financial resources such as White Coat Investigator and the Millionaire Next Door. Steps include building your “why,” becoming financially educated, eliminating debt, attaining insurance, optimizing contracts, awareness of self-net worth, budgeting, maximizing investment strategies, smart investing, wise spending, K.I.S.S, and creating a personal financial plan. Results:. As an example, an IRA is a retirement account set up by you, and to take advantage of the tax benefits, you must have a modified adjusted gross income of less than $124,000 as a single tax filer for 2022. Most physicians are compensated at a rate higher than this; however, there is a legal loophole to take advantage of to allow earners to still contribute to a Roth IRA that is discussed. Conclusions:. Financial education is the first step toward a path to financial success in a young physician’s life. Implementation of these 12 financial steps early in a physician’s career will enrich one’s financial freedom and well-being.

Given the stance of education-based sport entities (i.e., NFHS) that sport participation leads to leadership development, this article aims to provide coaches and practitioners several strategies to teach leadership skills anchored in principles from skill acquisition literature. The principles explored include (1) identification of skill abilities, (2) demonstration, (3) verbal instruction, (4) specificity and (5) feedback. Following a continuum describing life skill acquisition (including structuring the sport context, facilitating a positive climate, discussing life skills, and practicing life skills), examples are provided of how to enhance leadership skill development.

Abstract Background Energy demands associated with pregnancy and lactation are significant forces in mammalian evolution. To mitigate increased energy costs associated with reproduction, female mammals have evolved behavioural and physiological responses. Some species alter activity to conserve energy during pregnancy and lactation, while others experience changes in metabolism and fat deposition. Restructuring of gut microbiota with shifting reproductive states may also help females increase the energy gained from foods, especially during pregnancy. The goal of this study was to examine the relationships among behaviour, gut microbiota composition, and reproductive state in a wild, non-human primate to better understand reproductive ecology. We combined life history data with > 13,000 behavioural scans and 298 fecal samples collected longitudinally across multiple years from 33 white-faced capuchin monkey (Cebus imitator) females. We sequenced the V4 region of the 16S rRNA gene and used the DADA2 pipeline to analyze microbial diversity. We used PICRUSt2 to assess putative functions. Results Reproductive state explained some variation in activity, but overall resting behaviours were relatively stable across pregnancy and lactation. Foraging was less frequent among females in the early stage of nursing compared to the cycling stage, though otherwise remained at comparable levels. Maximum temperature was a strong, significantly positive predictor of resting, while social dominance had a small but significantly negative effect on resting. Ecological variables such as available fruit biomass and rainfall had a small but significantly positive effects on measures of foraging time. Gut microbial community structure, including richness, alpha diversity, and beta diversity remained stable across the reproductive cycle. In pairwise comparisons, pregnant females exhibited increased relative abundances of multiple microbial ASVs, suggesting small changes in relation to reproductive state. Reproductive state was not linked to differential abundance of putative metabolic pathways. Conclusions Previous data suggest that activity budget and the gut microbiome shifts considerably during reproduction. The present study finds that both activity and gut microbial communities are less associated with reproduction compared to other predictors, including ecological contexts. This suggests that behavioural flexibility and gut microbial community plasticity is contrained by ecological factors in this population. These data contribute to a broader understanding of plasticity and stability in response to physiological shifts associated with mammalian reproduction.

We know little about the relative contributions of visual and olfactory senses for wild, frugivorous mammals. Here, the authors show that in capuchin monkeys, frequency of olfactory evaluation of fruits is higher when scent production increases with ripening, and among monkeys with red-green colorblindness.

Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide.Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events.Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen – Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020.Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional stressful events in the past month, and low resilience predicted more mental health problems for COVID-19 and other stressful events. Higher COVID-19 country impact was associated with increased mental health impact of both COVID-19 and other stressful events. Analysis of differences across geographic regions revealed that in Latin America more mental health symptoms were reported for COVID-19 related events versus other stressful events, while the opposite pattern was seen in North America.Conclusions: The mental health impact of COVID-19-related stressors covers a wide range of symptoms and is more severe than that of other stressful events. This difference was especially apparent in Latin America. The findings underscore the need for global screening for a wide range of mental health problems as part of a public health approach, allowing for targeted prevention and intervention programs.

Internet interventions face significant challenges in recruitment and attrition rates are typically high and problematic. Finding innovative yet scientifically valid avenues for attaining and retaining participants is therefore of considerable importance. The main goal of this study was to compare recruitment process and participants characteristics between two similar randomized control trials of mood management interventions. One of the trials (Bunge et al., 2016) was conducted with participants recruited from Amazon's Mechanical Turk (AMT), and the other trial recruited via Unpaid Internet Resources (UIR). Methods: The AMT sample (Bunge et al., 2016) consisted of 765 adults, and the UIR sample (recruited specifically for this study) consisted of 329 adult US residents. Participants' levels of depression, anxiety, confidence, motivation, and perceived usefulness of the intervention were assessed. The AMT sample was financially compensated whereas the UIR was not. Results: AMT yielded higher recruitment rates per month (p

Background: Most users of unsupported Internet interventions visit that site only once, therefore there is a need to create interventions that can be offered as a single brief interaction with the user. Objective: The main goal of this study was to compare the effect of a one-session unsupported Internet intervention on participants' clinical symptoms (depressive and anxiety symptoms) and related variables (mood, confidence and motivation). Method: A total of 765 adults residing in the United States took part in a randomized controlled trial. Participants were randomly assigned to one of five brief plain text interventions lasting 5–10 min. The interventions designed to address depressive symptoms were: thoughts (increasing helpful thoughts), activities (increasing activity level), sleep hygiene, assertiveness (increasing assertiveness awareness), Own Methods (utilizing methods that were previously successful). They were followed-up one week after consenting. Results: A main effect of time was observed for both depression (F(1, 563) = 234.70, p

BACKGROUND: Opioids are frequently prescribed for moderate to severe pain. A side effect of opioid usage is the inhibition of gastrointestinal (GI) motility, known as opioid-induced bowel dysfunction (OBD). OBD is typically treated prophylactically with laxatives and/or acid suppressants.