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Purpose: Many children who face natural disasters experience significant mental health consequences. Parents play a prominent role in the likelihood of child mental health outcomes after a weather-related disaster. This study aimed to examine the relationship between parent risk factors and children's psychological well-being post Hurricane Harvey., Methods: Parents (n = 140) completed a survey that measured hurricane exposure, parental depression and anxiety, parenting behaviors, and assistance given and received during or after Hurricane Harvey. Additionally, parents were asked to complete questionnaires assessing one of their children's post-disaster psychosocial functioning and distress., Results: Results indicated that heightened parent anxiety was significantly associated with an increased risk for emotional symptoms, conduct problems, and hyperactivity-inattention symptoms in children. Additionally, inconsistency in parental discipline was significantly associated with an increased risk of child conduct problems. Further, higher numbers of assistance types received by parents-a proxy indicator of resource loss-was associated with higher child emotional distress scores., Conclusions: Broader systems-level interventions that address parents' physical and emotional needs may help mitigate maladaptive reactions in children and facilitate greater post-disaster psychosocial adjustment., Competing Interests: Conflict of interestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Up to 70% of older adults have experienced a psychologically traumatic event in their life. Traumatic events can have lifelong effects on functioning and emotion regulation and can affect behavior and experiences in care settings. Common healthcare practices and environments can be re-traumatizing for trauma survivors. These features may trigger behavior change (e.g., aggression and agitation) particularly after the onset of dementia. However, very little research exists to understand how the effects of traumatic events manifest in aged care settings. Trauma-informed care is a framework in which the potential impact of trauma is acknowledged, and practices and procedures are adapted to maximize feelings of control and safety for the patient. Trauma-informed care is an innovative approach with little published evidence in acute geriatric settings., Methods: We present a series of cases to demonstrate how psychological trauma can affect the experience of inpatient care for older people. The cases detail the patients' relevant background, triggers and behaviors followed by the steps taken by staff to support the patient and respond to their trauma-related needs. These cases describe how the principles of trauma-informed care can be applied to recognize when past psychologically traumatic events are impacting the older adult in hospital. The outcomes of these interventions are reported on in terms of their impact on challenging behavior, patient experiences and satisfaction with care, and/or staff confidence and skill., Findings: A range of past events negatively impacted the patients during their time in hospital, including childhood abuse, military service, and domestic violence. Staff implemented strategies to accommodate trauma-related needs while providing care that improved safety and reduced patient distress. Principles of trauma-informed care were applied where able, including providing choices and enabling autonomy. However, organizational and environmental features of inpatient wards continued to pose risks for re-traumatisation., Conclusions: Trauma-informed care is an under-utilized yet potentially beneficial approach to care for older adults in the hospital setting. The cases detailed here demonstrated that the impact of psychological trauma requires an individualized response from staff which when effectively implemented can promote staff and patient safety, reduce the risk of re-traumatisation, and minimize adverse events., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Couzner, Spence, Fausto, Huo, Vale, Elkins, Saltis and Cations.)

Background Standardized letters of recommendation (SLOR) have become common features of the medical school to residency transition. Research has shown many advantages over the narrative letter of recommendation including improved letter-writing efficiency, ease of interpretation, and improved reliability as performance predictors. Currently, at least four specialties require fellowship SLORs. Internal medicine adopted its SLOR in 2017. Previous research showed fellowship program directors' satisfaction with the 2017 guidelines. Little is known about residency program directors' acceptance and adherence to the guidelines. Objectives The study sought to assess the adoption rate of each component, barriers to adoption, time commitment, and alignment with intended goals of the guidelines. Methods Anonymous survey links were posted to an internal medicine discussion forum prior to the guidelines in spring 2017 and twice following the guidelines in fall 2018 and winter 2019. Two-sample tests of proportions were used to compare respondent characteristics with known survey population data. Pre- and post-survey comparisons were assessed for statistical significance with Pearson chi-squared statistic. Results The response rate varied from 30% to 35% for each survey period. Medical knowledge, patient care, interpersonal and communication skills, professionalism, and scholarly activity were reported frequently (>96%) at baseline. Inclusion of residency program characteristics, systems-based practice, practice-based learning and improvement, and skills sought to master increased over the study period. Conclusions The new guidelines improved uniform reporting of all core competency data. Overall, the gains were modest, as many pre-survey respondents reported high rates of including components within the guidelines., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.)

The mammalian cochlea possesses unique acoustic sensitivity due to a mechanoelectrical 'amplifier', which requires the metabolic support of the cochlear lateral wall. Loud sound exposure sufficient to induce permanent hearing damage causes cochlear blood flow reduction, which may contribute to hearing loss. However, sensory epithelium involvement in the cochlear blood flow regulation pathway is not fully described. We hypothesize that genetic manipulation of the mechanoelectrical transducer complex will abolish sound induced cochlear blood flow regulation. We used salsa mice, a Chd23 mutant with no mechanoelectrical transduction, and deafness before p56. Using optical coherence tomography angiography, we measured the cochlear blood flow of salsa and wild-type mice in response to loud sound (120 dB SPL, 30 minutes low-pass filtered noise). An expected sound induced decrease in cochlear blood flow occurred in CBA/CaJ mice, but surprisingly the same sound protocol induced cochlear blood flow increases in salsa mice. Blood flow did not change in the contralateral ear. Disruption of the sympathetic nervous system partially abolished the observed wild-type blood flow decrease but not the salsa increase. Therefore sympathetic activation contributes to sound induced reduction of cochlear blood flow. Additionally a local, non-sensory pathway, potentially therapeutically targetable, must exist for cochlear blood flow regulation.

Auditory brainstem responses (ABRs) require averaging responses to hundreds or thousands of repetitions of a stimulus (e.g., tone pip) to obtain a measurable evoked response at the scalp. Fast repetition rates lead to changes in ABR amplitude and latency due to adaptation. To minimize the effect of adaptation, stimulus rates are sometimes as low as 10 to 13.3 stimuli per second, requiring long acquisition times. The trade-off between reducing acquisition time and minimizing the effect of adaptation on ABRs is an especially important consideration for studies of cochlear synaptopathy, which use the amplitude of short latency responses (wave 1) to assess auditory nerve survival. It has been proposed that adaptation during ABR acquisition can be reduced by interleaving tones at different frequencies, rather than testing each frequency serially. With careful ordering of frequencies and levels in the stimulus train, adaptation in the auditory nerve can be minimized, thereby permitting an increase in the rate at which tone bursts are presented. However, widespread adoption of this stimulus design has been hindered by lack of available software. Here, we develop and validate an interleaved stimulus design to optimize the rate of ABR measurement while minimizing adaptation. We implement this method in an open-source data acquisition software tool that permits either serial or interleaved ABR measurements. The open-source software library, psiexperiment, is compatible with widely used ABR hardware. Consistent with previous studies, careful design of an interleaved stimulus train can reduce ABR acquisition time by more than half, with minimal effect on ABR thresholds and wave 1 latency, while improving measures of wave 1 amplitude.

The last imported case of yellow fever seen in this country was in 1924. We report a case of yellow fever acquired by an American tourist who visited the jungles of Brazil along the Rio Negro and Amazon Rivers. The patient died 6 days after hospital admission and 10 days after his first symptoms appeared. Yellow fever virus was recovered from clinical specimens, and the isolate was genetically similar to the E genotype IIB of South American yellow fever viruses. This patient's illness represents a case of vaccine-preventable death since he failed to be immunized with a recommended preexposure yellow fever vaccine.