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Hydrothermal explosions are significant potential hazards in Yellowstone National Park, Wyoming, USA. The northern Yellowstone Lake area hosts the three largest hydrothermal explosion craters known on Earth empowered by the highest heat flow values in Yellowstone and active seismicity and deformation. Geological and geochemical studies of eighteen sublacustrine cores provide the first detailed synthesis of the age, sedimentary facies, and origin of multiple hydrothermal explosion deposits. New tephrochronology and radiocarbon results provide a four-dimensional view of recent geologic activity since recession at ca. 15-14.5 ka of the >1-km-thick Pinedale ice sheet. The sedimentary record in Yellowstone Lake contains multiple hydrothermal explosion deposits ranging in age from ca. 13 ka to ~1860 CE. Hydrothermal explosions require a sudden drop in pressure resulting in rapid expansion of high-temperature fluids causing fragmentation, ejection, and crater formation; explosions may be initiated by seismicity, faulting, deformation, or rapid lake-level changes. Fallout and transport of ejecta produces distinct facies of subaqueous hydrothermal explosion deposits. Yellowstone hydrothermal systems are characterized by alkaline-Cl and/or vapor-dominated fluids that, respectively, produce alteration dominated by silica-smectite-chlorite or by kaolinite. Alkaline-Cl liquids flash to steam during hydrothermal explosions, producing much more energetic events than simple vapor expansion in vapor-dominated systems. Two enormous explosion events in Yellowstone Lake were triggered quite differently: Elliott's Crater explosion resulted from a major seismic event (8 ka) that ruptured an impervious hydrothermal dome, whereas the Mary Bay explosion (13 ka) was triggered by a sudden drop in lake level stimulated by a seismic event, tsunami, and outlet channel erosion. [ABSTRACT FROM AUTHOR]

Introduction: Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services., Methods: We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders., Results: The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. Discussion . There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Mihir Joshi et al.)

Hydrogels are excellent water-swollen polymeric materials for use in wearable, implantable, and disposable biosensors. Hydrogels have unique properties such as low cost, ease of preparation, transparency, rapid response to external conditions, biocompatibility and self-adhesion to the skin, flexibility, and strain sensitivity, making them ideal for use in biosensor platforms. This review provides a detailed overview of advanced applications of stimuli-responsive hydrogels in biosensor platforms, from hydrogel synthesis and functionalization for bioreceptor immobilization to several important diagnostic applications. Emphasis is placed on recent advances in the fabrication of ultrasensitive fluorescent and electrically conductive hydrogels and their applications in wearable, implantable, and disposable biosensors for quantitative measurements. Design, modification, and assembly techniques of fluorescent, ionically conductive, and electrically conductive hydrogels to improve performance will be addressed. The advantages and performance improvements of immobilizing bioreceptors (e.g., antibodies, enzymes, and aptamers), and incorporating fluorescent and electrically conductive nanomaterials are described, as are their limitations. Potential applications of hydrogels in implantable, wearable, disposable portable biosensors for quantitative detection of the various bioanalytes (ions, molecules, drugs, proteins, and biomarkers) are discussed. Finally, the global market for hydrogel-based biosensors and future challenges and prospects are discussed in detail., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Though awareness of health care structures that are racist and oppressive is increasing among health care professionals, there is a gap in continuing education curricula focused on antiracist anti-oppressive practices, and limited faculty and staff development to guide individuals towards action., Aim: To develop, implement, and evaluate a novel antiracist faculty and staff development program called the Tea House Series., Setting and Participants: A five-part continuing education series with an accompanying online community for faculty and staff at the divisions of Hospital Medicine in one institution in the western United States., Program Description: The four foundational pillars integral to the Tea House Series were as follows: educational framework based on the pedagogy of Paulo Freire, local disparities data, welcoming space to establish a community of practice and accountability. Each session contained participant dialogue in small group activities., Program Evaluation: Qualitative analysis of participant survey responses demonstrated transformation towards a hope to act with a sense of community. Quantitative analysis measured increased confidence for the program learning objectives., Discussion: The Tea House Series may be used as a model for continuing education to provide the tools and the community to confront systems of racism and oppression in any institution., (© 2022. The Author(s).)

Objectives: Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes., Methods: We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-19 who received lung POCUS with a 12-zone protocol. Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage., Results: N = 160 patients were included. Among critically ill patients, B-lines (94 vs 76%; P < .01) and consolidations (70 vs 46%; P < .01) were more common. For scans collected within 24 hours of admission (N = 101 patients), early B-lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71-14.30]; P < .01) or consolidations (OR 2.49 [95% CI: 1.35-4.86]; P < .01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01-4.70]; P = .047). Patients with a normal scan within 24 hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09-0.75]; P < .01) or supplemental oxygen (OR 0.26 [95% CI: 0.11-0.61]; P < .01). Ultrasound findings did not dynamically change over a 28-day scanning window after symptom onset., Conclusions: Lung POCUS findings detected within 24 hours of admission may provide expedient risk stratification for important COVID-19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24 hours of admission appears protective. POCUS findings appeared stable over a 28-day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications., (© 2021 American Institute of Ultrasound in Medicine.)

High resolution, rapid, and precise detection of biological analytes related to disease and infection is currently the focus of many researchers. Better biosensors could lead to earlier detection, more avenues of intervention, and higher efficacy of therapeutics, which would lead to better outcomes for all patients. One class of biosensors, single walled carbon nanotubes, is unique due to their nanoscale resolution, single molecule sensitivity, and reversibility for long term applications. While these biosensors have been successful in rodent models, to date, no study has shown successful sensor detection in a large animal. In this study, we show the first successful signal detection of single walled carbon nanotube-based sensors in a large mammal model. Using a relatively simple and cost-effective system, we were able to detect signals in nearly 70% of the sheep used in the study, marking an important steppingstone towards the use of SWNT-based sensors for clinical diagnostics., (Copyright © 2021 Elsevier Inc. All rights reserved.)