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Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Faecal glucocorticoid metabolite (fGCM) analysis provides a non-invasive, feedback-free approach for monitoring adrenocortical responses to natural and anthropogenic stressors. The use of enzyme-immunoassays (EIAs) to quantify immunoreactive fGCMs has gained popularity in recent years but requires species-specific validation prior to first use. We conducted a pharmacological challenge with adrenocorticotropic hormone (ACTH) to determine whether changes in circulating glucocorticoids are reflected in fGCM, concentrations and therefore to validate excreta as a matrix for monitoring endocrine status in a southern African passerine, the White-browed Sparrow-weaver (Plocepasser mahali) and a columbid, the Laughing Dove (Spilopelia capensis). We tested the suitability of four EIAs to quantify fGCMs in 10 individuals of each species. Two of the EIAs, tetrahydrocorticosterone and 11-Oxoetiocholanolone II, detected significant elevations and were therefore most suitable for quantifying fGCMs in the White-browed Sparrow-weavers. In contrast, the 5α-pregnane-3β, 11β, 21-triol-20-one EIA detected the highest elevations in fGCM concentrations in the Laughing Doves. The lag time between stressor initiation (ACTH injection) and the resulting peak fGCM concentrations was ~2 h in both species. The validations presented here open opportunities for monitoring physiological responses in free-ranging individuals and contribute to our knowledge of the EIAs suitable for non-invasive quantification of avian fGCM concentrations.

A fall after total hip arthroplasty (THA) that results in a periprosthetic femoral fracture (PPF) can have devastating functional and psychological consequences in older adults. There are few studies that have evaluated both functional and psychological outcomes of PPF post-THA in the same cohort.This is a retrospective study of 130 people who underwent revision THA between 2005 and 2019 due to PPF. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Harris Hip Score (HHS), and Short Form-12 (SF-12) assessed physical function, hip joint function, and psychological well-being, respectively. Descriptive statistics using means and standard deviation or frequencies and percentages were used to define the sample. The association between baseline demographic, clinical, and surgical factors on WOMAC, HHS, and SF-12 scores at 1-year post-PPF surgery was modelled using multivariable linear regression. The mean age (n = 130) was 80.6 ± 9.0 years, and 55.4% (n = 72) were female. The mortality rate was 15.4% (n = 20) at 1-year post-PPF surgery. One-year follow-up data were available for 35.4% (n = 46) of patients.The WOMAC (n = 37), HHS (n = 32), and SF-12 mental component summary (n = 46) scores at 1-year post-PPF surgery were 67.9 ± 20.3, 78.3 ± 15.0, and 52.7 ± 9.1, respectively. No significant association was found among age, gender, previous history of lower extremity surgery, Vancouver classification, and femoral bone grafting on WOMAC, HHS, and SF-12 scores.Our study found that patients with PPF have fair hip joint function, poor physical function and psychological well-being, and a high mortality rate at 1-year post-PPF surgery.

Background Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of this study was to describe medication classes and the number of medication classes prescribed to older adults prior to the fall-related injury. Methods This population-based descriptive study used secondary administrative health-care data in Ontario, Canada for 2010–2014. Descriptive statistics were reported for Anatomic Therapeutic Chemical 4th level medication classes. Frequency of medications prescribed to older adults was calculated on different sex, age groups, types of medications, and injures. Results Over five years (2010–2014), 288,251 older adults (63.2% females) were admitted to an emergency department for a fall-related injury (40.0% fractures, 12.1% brain injury). In the year before the injury, 48.5% were prescribed statins, 27.2% antidepressants, 25.0% opioids, and 16.6% anxiolytics. Females were prescribed more diuretics, antidepressants, and anxiolytics than males; and people aged 85 years and older had a higher percentage of diuretics, antidepressants, and antipsychotics. There were 36.4% of older adults prescribed 5–9 different medication classes and 41.2% were prescribed 10 or more medication classes. Discussion Older adults experiencing fall-related injuries were prescribed more opioids, benzodiazepines, and antidepressants than pre-viously reported for the general population of older adults in Ontario. Higher percentage of females and more 85+ older adults were prescribed with psychotropic drugs, and they were also found to be at higher risk of fall-related injuries. Further associations between medications and fall-related injuries need to be explored in well-defined cohort studies.

Using self-determination theory, we explored relationships between autonomous motivation (AM) and perceived competence (PC) with previously validated measures of motivation and adolescent-reported asthma medication adherence.Data were from adolescents (n = 260) enrolled in the School-Based Asthma Care for Teens study and taking preventive medication at baseline. Eligible adolescents (aged 12-16 years) had physician-diagnosed persistent asthma or poor control.Adolescents taking daily preventive medicine reported higher AM and PC for adherence, whereas adolescents likely to miss ≥1 dose in the next 2 weeks had lower AM and PC. Adolescents taking medicines as prescribed, with plans to continue, and those feeling able to follow provider care plans, had higher AM and PC. Findings remained significant in regressions with control variables.Many factors interfere with adolescent medication-taking. Clinicians' efforts to build AM and PC with patients and caregivers may be key to promoting adherence in this group.

We exploit the longitudinal Mexican Health and Aging Study to estimate the effects of health shocks in the short-run on the subsequent economic well-being of the aging population in Mexico. While there is substantial evidence indicating negative economic effects of such changes in industrialized countries, little is known about health impacts on the future economic position of older adults in low- and middle-income countries. This paper takes an important step towards filling this gap in knowledge. Our results are widely relevant, with a large percentage of the world's population residing in developing countries such as Mexico that are experiencing rapid aging. We find evidence of negative impacts of health shocks on subsequent economic well-being of older adults in Mexico, but the effect varies according to several dimensions. First, the impact is clearly on income, not wealth. Second, responses are heterogenous across sources of income, with evidence of an impact mainly on labor income. Third, we find clear differences by gender in the impact of a health shock, with a larger negative impact on men. Fourth, we conclude that the population groups most negatively affected are those with the greatest degree of vulnerability prior to the shock, as measured by education and access to health insurance. Even though Mexico has made important gains with anti-poverty programs such as the

Background Huntington disease (HD) is a neurodegenerative disease where a genetic mutation leads to excessive polyglutamine (Q) repeats in the huntingtin protein. The polyglutamine repeats create toxic plaques when the protein is cleaved, leading to neuron death. The glycolipid GM1 ganglioside (GM1) has been shown to be neuroprotective in HD models, as it prevents the cleavage of the mutant huntingtin protein by phosphorylation of serine 13 and 16. Previous studies have tested GM1 in both adult-onset and juvenile-onset HD models, but this study set out to investigate whether GM1 mediated cytoprotection is influenced by the length of polyglutamine repeats. Method and result This study utilized cell culture to analyze the effect of GM1 on cell viability, directly comparing the response between cells with adult-onset HD and juvenile-onset HD. HEK293 cells expressing either wild-type huntingtin (Htt) (19Q) exon 1, adult-onset HD mutant Htt exon 1 (55Q), or Juvenile HD mutant Htt exon 1 (94Q) were assessed for cell viability using the WST-1 assay. Our results suggested moderate doses of GM1 increased cell viability for all cell lines when compared to untreated cells. When comparing HEK293 55Q and 94Q cells, there was no difference in cell viability within each dose of GM1. Conclusion These data suggest cellular responses to GM1 are independent of polyglutamine repeats in HD cells and provide insight on GM1’s application as a therapeutic agent for HD and other diseases.

The United States Department of Labor's Occupational Safety and Health Administration (OSHA) defines workplace violence (WPV) as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. OSHA recognizes that WPV ranges from threats and verbal abuse to physical assaults and even homicide. There are no OSHA standards specifically related to WPV however the General Duty Clause, Section 5(a)(1) of the OSHA Act of 1970, requires employers to provide a workplace that is free of conditions that could cause death or serious harm to employees. The Joint Commission published standards in 2022 related to WPV. The standards require a proactive analysis of the organization relative to WPV. Monitoring of events and training of staff are also required. This article will explore one hospital's journey to understand the frequency and types of violence experienced by nurses in the facility; implement evidence-based strategies to mitigate violence in the hospital; maintain compliance with regulatory and accrediting bodies; and most importantly, to protect our staff from harm.

In people with dementia, provision of mobility aids is standard treatment for those with impaired gait. However, mobility aid use is independently associated with increased falls risk. In this short communication, gait velocity and stride time variability were recorded in eleven adults with Alzheimer’s disease dementia. Three conditions were tested: single-task (no aid), walking with a walker, and dual-task (walker use and counting backwards) under both a straight path and Figure-of-8 walking configuration. Gait velocity increased when using a walker compared to no aid in the Figure-of-8 walking configuration. Walker use improved gait in simple walking, but benefits diminished upon dual-task.

The global pandemic of coronavirus disease 2019 (COVID-19) affected many aspects of randomized controlled trials, including recruiting and screening participants. The purpose of this paper is to (a) describe adjustments to recruitment and screening due to COVID-19, (b) compare the proportional recruitment outcomes (not completed, ineligible, and eligible) at three screening stages (telephone, health assessment, and physical activity assessment) pre- and post-COVID-19 onset, and (c) compare baseline demographic characteristics pre- and post-COVID-19 onset in the Working Women Walking program. The design is a cross-sectional descriptive analysis of recruitment and screening data from a 52-week sequential multiple assignment randomized trial (SMART). Participants were women 18-70 years employed at a large urban medical center. Recruitment strategies shifted from in-person and electronic to electronic only post-COVID-19 onset. In-person eligibility screening for health and physical activity assessments continued post-COVID-19 onset with Centers for Disease Control and Prevention precautions. Of those who expressed interest in the study pre- and post-COVID-19 onset (n = 485n = 269 respectively), 40% (n = 194) met all eligibility criteria pre-COVID-19 onset, and 45.7% (n = 123) post-COVID-19 onset. Although there were differences in the proportions of participants who completed or were eligible for some of the screening stages, the final eligibility rates did not differ significantly pre-COVID-19 versus post-COVID-19 onset. Examination of differences in participant demographics between pre- and post-COVID-19 onset revealed a significant decrease in the percentage of Black women recruited into the study from pre- to post-COVID-19 onset. Studies recruiting participants into physical activity studies should explore the impact of historical factors on recruitment.

The aim of the present study is to investigate three different techniques for fitting the SLR data observed from the Changchun observatory in China which is characterized by its huge amount of data points and to examine which of the three techniques is more proper for fitting such kind of data. The first technique is the interpolation using the Chebyshev polynomial for fitting the total number of satellite laser ranging (SLR) data points. The second technique is the spline technique which is used for matching continuous intervals for fitting the SLR data. The third technique is the method, which is used at Changchun observatory, known as the Iterative 4th order polynomial fit. The three techniques are applied to 100 samples; 50 samples for the satellite LAGEOS I and the other 50 samples for the satellite Starlette that were observed during the first quarter of 2018. From the obtained results, it is found that the first two techniques, namely the Chebyshev polynomial and Spline techniques provide better standard deviation in comparison to the Iterative 4th order polynomial fit technique that is used at Changchun observatory, with merit to Spline technique over the Chebyshev polynomial.

Whether or not primates are behaviorally affected by the presence of visitors in a zoo setting is a question of great relevance to zoo animal well-being. The situation imposed by the COVID-19 pandemic provided an unusual opportunity to examine how the absence of visitors impacts behavior. We took advantage of this opportunity to study the behavior of a gorilla troop during periods of no-visitors compared to our long-term database on gorilla behavior during normal zoo operations. While there were notable individual differences in response to visitors, we found no significant relationship between presence of visitors and behavior. These results suggest that the presence of visitors does not have a significant impact on behavior and well-being of zoo-housed gorillas.

Bivalirudin is a direct thrombin inhibitor that is being increasingly used for anticoagulation in children after ventricular assist device (VAD) implantation. While the data on bivalirudin use in pulsatile flow VADs are growing, reports on its use in patients on continuous flow (CF) VAD as well as comparisons of associated outcomes with unfractionated heparin (UFH) remain limited.Retrospective cohort study.Single tertiary-quaternary referral center.All patients less than 21 years old on CF-VAD support who received bivalirudin or UFH for anticoagulation between the years 2016 and 2020.Not applicable.Clinical characteristics compared between the cohorts included time to target range of anticoagulation, markers of hemolysis, and prevalence of hemocompatibility-related adverse events such as major hemorrhagic complications, ischemic stroke, and pump thrombosis. In 42 unique patients (41 HeartWare HVAD [Medtronic, Minneapolis, MN], one HeartMate 3 LVAD [Abbott Laboratories, Abbott Park, IL]) during the study period, a total of 67 encounters of IV anticoagulation infusions (29 UFH and 38 bivalirudin) were retrospectively reviewed. In comparison with use of UFH, bivalirudin was associated with lesser odds of major bleeding complications (odds ratio [OR], 0.29; 95% CI, 0.09-0.97; p = 0.038). We failed to identify any difference in odds of major thrombotic complications (OR, 2.53; 95% CI, 0.47-13.59; p = 0.450). Eight of the patients (28%) on UFH were switched to bivalirudin due to hemorrhagic or thrombotic complications or inability to achieve therapeutic anticoagulation, while two of the patients (5%) on bivalirudin were switched to UFH due to hemorrhagic complications. Bivalirudin was used for a "washout" in eight cases with concern for pump thrombosis-six had resolution of the pump thrombosis, while two needed pump exchange.Use of bivalirudin for anticoagulation in patients on CF-VAD support was associated with lesser odds of hemorrhagic complications compared with use of UFH. Bivalirudin "washout" was successful in medical management of six of eight cases of possible pump thrombosis.

Cranial sutures are complex soft tissue structures whose mechanics are often studied due to their link with bone growth in the skull. Researchers will often use a cross-sectional two-dimensional slice to define suture geometry when studying morphometry and/or mechanical response to loading. However, using a single cross section neglects the full suture complexity and may introduce significant errors when defining their form. This study aims to determine trends in suture path variability through skull thickness in a swine model and the implications of using a 'representative' cross section on mechanical modeling. To explore these questions, a mixture of quantitative analysis of computed tomography images and finite element models was used. The linear interdigitation and width of coronal and sagittal sutures were analyzed on offset transverse planes through the skull thickness. It was found that sagittal suture width and interdigitation were largely consistent through the skull thickness, whereas the coronal suture showed significant variation in both. The finite element study found that average values of displacement and strain were similar between the two-dimensionally variable and three-dimensionally variable models. Larger ranges and more complex distributions of strain were found in the three-dimensionally variable model. Outcomes of this study indicate that the appropriateness of using a representative cross section to describe suture morphometry and predict mechanical response should depend on specific research questions and goals. Two-dimensional approximations can be sufficient for less-interdigitated sutures and when bulk site mechanics are of interest, while taking the true three-dimensional geometry into account is necessary when considering spatial variability and local mechanical response.

Environmental DNA (eDNA) quantification and sequencing are emerging techniques for assessing biodiversity in marine ecosystems. Environmental DNA can be transported by ocean currents and may remain at detectable concentrations far from its source depending on how long it persist. Thus, predicting the persistence time of eDNA is crucial to defining the spatial context of the information derived from it. To investigate the physicochemical controls of eDNA persistence, we performed degradation experiments at temperature, pH, and oxygen conditions relevant to the open ocean and the deep sea. The eDNA degradation process was best explained by a model with two phases with different decay rate constants. During the initial phase, eDNA degraded rapidly, and the rate was independent of physicochemical factors. During the second phase, eDNA degraded slowly, and the rate was strongly controlled by temperature, weakly controlled by pH, and not controlled by dissolved oxygen concentration. We demonstrate that marine eDNA can persist at quantifiable concentrations for over 2 weeks at low temperatures (≤10 °C) but for a week or less at ≥20 °C. The relationship between temperature and eDNA persistence is independent of the source species. We propose a general temperature-dependent model to predict the maximum persistence time of eDNA detectable through single-species eDNA quantification methods.

Teaching patients with cancer the skill of self-advocacy shifts the focus of their cancer care on what is important to them, leading to optimized patient-centered care. As oncology nurses, providing support to our patients as they self-advocate to get their needs met fosters a collaborative relationship, creating an environment in which patients feel comfortable verbalizing their needs and concerns. This article provides oncology nurses with background knowledge of self-advocacy; key ways in which they can support patients in self-advocating; and a case study to provide contextual understanding of how and why nurses can promote patient self-advocacy.

Educating medical students to be physicians involves many dimensions. But in an educational culture where science and technology dominate the curriculum, these subjects also too often dominate the academic value system as well. While a firm grasp of scientific knowledge and technical skill is essential, cultivating humanistic virtues is at the core of all good medical care and the full well-being of those within it. This article describes a formative educational process that points towards compassionate flourishing and unfolds through dialogue and reflection on the human aspects of patient care and the student experience, a process coequal in value to scientific development. This educational process has been successfully implemented at the Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook. When supported by a broader institutional culture through an ongoing reflective group process in residencies and other clinical settings, this process fosters professional flourishing, which leads to deeper meaning and compassionate care of patients.

Executive function (EF) develops throughout childhood and adolescence; however, little is known about whether and how early life factors are associated with EF during these two stages. This secondary analysis examined the associations between maternal psychological characteristics at 2 years after childbirth and offspring EF at 6 and 18 years.Data were from the 18-year New Mothers' Study in Memphis, TN. Women who self-identified as African-American were included (mother-child dyads: N = 414). Maternal psychological characteristics (e.g., depressive symptoms, self-esteem) were assessed using standardized questionnaires; offspring EF at 6 (i.e., working memory, response inhibition) and 18 years (e.g., working memory, sustained attention) were assessed using age-appropriate cognitive tasks. Statistical analyses included principal component analysis (PCA) and regression models.PCA reduced the correlated psychological characteristics to two factors: emotionality (depressive symptoms, emotional instability) and psychological resources (self-esteem, mastery, active coping). After controlling for maternal IQ, maternal emotionality was associated with worse working memory and response inhibition (marginally significant) at 6 years. Maternal psychological resources were marginally associated with better working memory at 6 years.Maternal psychological characteristics may be associated with later EF in offspring. Future studies are needed to replicate these findings and to explore potential mediators.African-American mothers' depressive symptoms and emotional instability at 2 years after childbirth were associated with offspring executive function at 6 and 18 years. African-American mothers' psychological resources at 2 years after childbirth were marginally associated with offspring working memory at 6 years. Maternal IQ attenuated all of the associations observed between maternal psychological status and offspring executive function.

OBJECTIVE: This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel ‘Facial Affect Sensitivity Training’ (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior. METHOD: We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits. RESULTS: In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST. CONCLUSIONS: We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.

Replication package for "Do Conditional Cash Transfers Improve Economic Outcomes in the Next Generation? Evidence from Mexico CCTs and the Next Generation"&nbsp

IntroductionA changing environment can select on life-history traits and trade-offs in a myriad of ways. For example, global warming may shift phenology and thus the availability of host-plants. This may alter selection on survival and fertility schedules in herbivorous insects. If selection on life-histories changes, this may in turn select for altered nutrient intake, because the blend of nutrients organisms consume helps determine the expression of life-history traits. However, we lack empirical work testing whether shifts in the timing of oviposition alter nutrient intake and life-history strategies.MethodsWe tested in the marula fruit fly, Ceratitis cosyra, how upward-selection on the age of female oviposition, in comparison with laboratory adapted control flies, affects the sex-specific relationship between protein and carbohydrate intake and life-history traits including lifespan, female lifetime egg production and daily egg production. We then determined the macronutrient ratio consumed when flies from each selection line and sex were allowed to self-regulate their intake.ResultsLifespan, lifetime egg production and daily egg production were optimised at similar protein to carbohydrate (P:C) ratios in flies from both selection lines. Likewise, females and males of both lines actively defended similar nutrient intake ratios (control =1:3.6 P:C; upward-selected = 1:3.2 P:C).DiscussionOur results are comparable to those in non-selected C. cosyra, where the optima for each trait and the self-selected protein to carbohydrate ratio observed were nearly identical. The nutrient blend that needs to be ingested for optimal expression of a given trait appeared to be well conserved across laboratory adapted and experimentally selected populations. These results suggest that in C. cosyra, nutritional requirements do not respond to a temporal change in oviposition substrate availability.

OBJECTIVE: The present study sought to measure and internally validate neural markers of facial emotion recognition (FER) in adolescents and young adults with ASD to inform targeted intervention. METHOD: We utilized fMRI to measure patterns of brain activity among individuals with ASD (N=21) and matched controls (CON; N=20) two seconds prior to judgements about the identity of six distinct facial emotions (happy, sad, angry, surprised, fearful, disgust). RESULTS: Predictive modeling of fMRI data (support vector classification; SVC) identified mechanistic roles for brain regions that forecasted correct and incorrect identification of facial emotion as well as sources of errors over these decisions. BOLD signal activation in bilateral insula, anterior cingulate (ACC) and right dorsolateral prefrontal cortex (dlPFC) preceded accurate FER in both controls and ASD. Predictive modeling utilizing SVC confirmed the utility of ACC in forecasting correct decisions in controls but not ASD, and further indicated that a region within the right dlPFC was the source of a type 1 error signal in ASD (i.e. neural marker reflecting an impending correct judgment followed by an incorrect behavioral response) approximately two seconds prior to emotion judgements during fMRI. CONCLUSIONS: ACC forecasted correct decisions only among control participants. Right dlPFC was the source of a false positive signal immediately prior to an error about the nature of a facial emotion in adolescents and young adults with ASD, potentially consistent with prior work indicating that dlPFC may play a role in attention to and regulation of emotional experience.

Leiomodin-2 (LMOD2) is an important regulator of the thin filament length, known to promote elongation of actin through polymerization at pointed ends. Mice with Lmod2 deficiency die around three weeks of age due to severe dilated cardiomyopathy, resulting from decreased heart contractility due to shorter thin filaments. To date, there have been three infants from two families reported with biallelic variants in LMOD2, presenting with perinatal onset dilated cardiomyopathy. Here, we describe a third family with a child harboring a previously described homozygous frameshift variant, c.1243_1244delCT (p.L415Vfs*108) with dilated cardiomyopathy, presenting later in infancy at nine months of age. Family history was relevant for a sibling who died suddenly at one year of age after being diagnosed with cardiomegaly. LMOD2-related cardiomyopathy is a rare form of inherited cardiomyopathy resulting from thin filament length dysregulation and should be considered in genetic evaluation of newborns and infants with suspected autosomal recessive inheritance or sporadic early onset cardiomyopathy.

More than 112,000 men, women, and children are awaiting solid organ transplant (SOT) as of March 2020, and more than 39,000 transplants were performed in the United States in 2019. Approximately 2,000 children undergo SOT every year in the United States, and the number of children awaiting SOT continues to increase. Immunosuppression is the mainstay of prevention and treatment of solid organ rejection, a significant source of morbidity and mortality after SOT. There are several different classes of immunosuppressive drugs, and the phases of immunosuppression after SOT can be divided into early, maintenance, and rescue therapies. The specific class and dose of drug will be determined by the type of organ transplant, time since transplant, phase of therapy, and other patient-specific considerations. The goal of the transplant team is to find the optimal balance between too little immunosuppression and too much immunosuppression. Too little immunosuppression can result in organ rejection, but too much immunosuppression can result in increased infections, increased malignancy, and adverse drug events such as nephrotoxicity. Although the specific drug choice and dosage will be managed by specialized transplant physicians, these immunosuppressive drugs have many drug interactions with commonly prescribed medications and require dose titration. To provide the best care to children who have received a SOT, pediatricians should be aware of these interactions and be able to distinguish routine pediatric concerns from transplant immunosuppression-related infections or complications. Current vaccine recommendations for children receiving immunosuppression after SOT are also discussed.

American football athletes are frequently hypohydrated before and during activity. Hypohydration increases the risk of exertional sickling in student-athletes with sickle cell trait (SCT). The authors examined weight charts from the 2010/2011 to 2018/2019 seasons at one Division I institution to determine if differences in percentage body mass losses (%BML) exist between those with and without SCT. Seventeen student-athletes with SCT and 17 matched-controls were included. A Bonferroni correction was applied to account for multiple comparisons (0.05/8), resulting in p p = .002) but not for the number of days %BML exceeded 2% (SCT: 0 ± 1 vs. control: 1 ± 1; p = .016). Implementation of proper hydration strategies minimized %BML in athletes with SCT, decreasing the risk of hypohydration and exertional sickling. The same strategies ensured all players remained below threshold to optimize performance and reduce heat illness risk.

Masticatory muscle features allow for an understanding of how dietary habits and masticatory functions have evolved across mammalian lineages. Herbivorous mammals were traditionally classified as pertaining to either ‘ungulate-grinding’ or ‘rodent-gnawing’ morphotypes, but those classes might not adequately encompass the diversity of past and present herbivores. We compiled data for 104 herbivorous (nine orders, including new data for 31 species) and ten non-herbivorous (five orders) extant species and for four extinct taxa, in order to construct a more comprehensive scheme of masticatory morphotypes. A myological phylomorphospace revealed 15 morphotypes, which were tested statistically and interpreted morphofunctionally. Extant herbivorous morphotypes diversified along two main pathways that did not reflect the traditional types. Additionally, some extinct herbivores adapted along alternative pathways to those of extant forms. Early mammaliaforms and mammals possessed muscle proportions almost identical to those of living carnivores. Several more plesiomorphic herbivorous morphotypes were recognized, with some of them retaining generalized myological proportions. The rodent disparity was remarkable and could not be encompassed by a single category or pathway. Features of some derived euungulates and diprotodonts resembled rodents, but only a few extinct euungulates and extant wombats converged closely with them. Criteria for selecting models for palaeobiological reconstructions are discussed.