Red blood cell distribution width (RDW) has been reported as a meaningful prognostic factor in various diseases. Our study compared patients’ RDW levels and prognosis at admission and discharge time. A total of 128 patients 77 patients who suffered brain death (subject group), and 51 patients who were discharged from the hospital (control group) with GCS ≤ 6 were recruited from 60 hospitals for this study. Demographical data and RDW measurements in these patients at admission time and brain death/discharge time were extracted into two groups. 46 (35.9%) patients were females and 82 patients (64.1%) were males with a median age of 36 years old. A significant difference in baseline characteristics of GCS (P < 0.001), RDW at admission time (P < 0.001), and RDW at discharge or brain death time (P < 0.001) were noted between the two groups. In the overall population, RDW at admission time had a median value of 13.75% and was positively correlated with gender (P < 0.04, rs = 0.582) and age (P < 0.023, rs = − 0.201). Initially, there were no significant differences in RDW upon admission. However, upon discharge, although the RDW in the control group was not significant (P < 0. 1), the RDW level at the time of brain death was notably 0.45 fold higher (P = 0.001) compared to the time of admission. The standardized residuals at the two-time points showed an approximately normal distribution. The most effective RDW cut-off in Brain death was determined as 14.55. Based on the findings, using RDW as a prognostic factor has a sensitivity of 0.468 and a specificity of 0.137 in diagnosing brain death. RDW biomarker is a simple and inexpensive laboratory test that may be seen as a valuable perspective for initial patient evaluation. RDW is a powerful marker for the prognosis of brain death in patients with a GCS ≤ 6 at admission time, in order to identify a subset of patients who may require more aggressive management in the trauma center.

Studies of mentorship in emergency medicine show that mentored residents are twice as likely to describe their career preparation as excellent as compared to nonmentored peers. There has been significant interest in the mentor-mentee relationship in medicine; however, there is minimal guidance and published literature specific to emergency medicine residents. In this narrative review, we described the emergency medicine mentor-mentee relationship, discussed alternatives to the traditional dyadic model, and highlighted current barriers to effective mentorship. We conducted a structured literature review to identify relevant published articles regarding the mentoring of emergency medicine residents. Additional studies from general mentoring literature were included based on relevancy. We identified 39 studies in emergency medicine literature based on our search criteria. Additional studies from general medicine literature were included based on relevancy to this review. Based on the limited available literature, we recommend maximizing the resident mentoring relationship by developing formal mentoring programs, supporting the advancement of women and underrepresented minority mentors, and moving toward team mentoring, including peer, near-peer, and collaborative mentorship. The development of a mentoring network is a logical strategy for residents to work with a diverse group of individuals to maximize benefits in multiple areas. Alternative approaches to the traditional and hierarchal dyadic mentoring style (eg, team mentoring) are effective methods that residencies may promote to increase effective mentoring. Future efforts in mentoring emergency medicine residents emphasize these strategies, which are increasingly beneficial given the constraints and use of technology highlighted by the COVID-19 pandemic.

AbstractBiodiversity monitoring in conservation projects is essential to understand environmental health, complexity, and recovery. However, traditional field surveys can be expensive, time‐consuming, biased toward visual detection, and/or only measure a limited set of taxa. Environmental DNA (eDNA) methods provide a new approach to biodiversity monitoring that has the potential to sample a taxonomically broader set of organisms with a similar effort, but many of these approaches are still in the early stages of development and testing. Here, we used multi‐locus eDNA metabarcoding to understand how the removal of invasive red swamp crayfish using cypermethrin pesticide impacts local biodiversity of a desert oasis ecosystem, as well as to detect crayfish both directly and indirectly. We tracked crayfish DNA signatures, microbial DNA associated with crayfish, and biodiversity of plant, fungal, animal, and bacterial communities through time. We were unsuccessful in detecting crayfish directly in either control tanks or oases using targeted metabarcoding primers for invertebrates and eukaryotes, similar to previous studies which have shown variable levels of success in detecting crayfish from environmental samples. However, we were successful in discerning a suite of 90 crayfish‐associated taxa to serve as candidate bioindicators of invasive presence using 16S and fungal ITS2 metabarcoding. Ranking these 90 taxa by their geographic distribution in eDNA surveys and by evidence of crayfish associations in the literature, we support nine taxa to be high ranking, and suggest they be prioritized in future biomonitoring. Biodiversity analyses from five metabarcode loci including plants, animals, and both prokaryotic and eukaryotic microbes showed that communities differed but that species richness remained relatively similar between oases through time. Our results reveal that, while there are limitations of eDNA approaches to detect crayfish and other invasive species, microbial bioindicators offer a largely untapped biomonitoring opportunity for invasive species management, adding a valuable resource to a conservation manager's toolkit.

Background: In 2022, the smartphone application and pump software for the t:slim X2 with Control-IQ technology updated to allow bolus insulin programming from a user’s personal smartphone (mobile bolus, MB) in the United States. The aim of this study was to determine if MB increased bolus frequency in users who bolus &amp;lt;3 times/day. Methods: De-identified data from users with low bolus frequency and &amp;gt;21 days with 70% CGM pre-and post MB were analyzed for changes in bolusing behavior and Time in Range (TIR) before and after MB. Results: A total of 4,470 users bolused &amp;lt;3 times/day and upgraded to MB. After MB start, these users increased the number of boluses per day from 2.2 to 2.7 (+0.5 per day, p&amp;lt;0.001, table). After MB upgrade, approximately 1 bolus/day (36% of boluses) were delivered on the smartphone app instead of the insulin pump. TIR improved discreetly, with children &amp;lt;12 years old experiencing 34 more minutes in target range each day (p&amp;lt;0.01). Of all, 87% of users were very satisfied or satisfied with the MB feature. Conclusions: For users with low bolus frequency, the MB feature meaningfully increased the number of boluses given each day, and can be leveraged as a way to increase daily bolusing behaviors. Disclosure L.H.Messer: Advisory Panel; Lilly, Consultant; Dexcom, Inc., Capillary Biomedical, Inc., Employee; Tandem Diabetes Care, Inc., Research Support; Beta Bionics, Inc., Medtronic, Insulet Corporation. L.Mueller: Employee; Tandem Diabetes Care, Inc., Stock/Shareholder; Tandem Diabetes Care, Inc. E.W.D'souza: None. S.Habif: Employee; Tandem Diabetes Care, Inc. J.E.Pinsker: Employee; Tandem Diabetes Care, Inc. Funding Tandem Diabetes Care, Inc.

Introduction: Facial Onset Sensory and Motor Neuronopathy (FOSMN) typically presents with paresthesias in the trigeminal nerve distribution and weakness that progresses rostro-caudally.&#x0D; Objective: To present two new cases of FOSMN, summarize the current literature, and address areas for future study.&#x0D; Methods: Observational data was collected from two patients with FOSMN from our institution. A literature review of FOSMN was completed using PubMed.&#x0D; Results: We identified 100 cases of FOSMN, including our two new cases. 93% presented with facial paresthesias. 97% had bulbar symptoms. Five had family history of ALS. Abnormal Blink reflex was most common on EMG/NCS. CSF was typically normal, but a rare severe case showed elevated protein. Mutations included: TARDBP, OPMD, D90A-SOD1, CHCHD10, VCP, and SQSTM1. Neuropathological studies showed neurodegenerative changes without inflammation. Some cases have reported transient stabilization or improvement to immunomodulatory therapy.&#x0D; Case Reports: A 72-year-old man presented with right-sided trigeminal paresthesias that progressed in a rostro-caudal fashion, dysphagia, and hand weakness. He died 4-5 years after symptom onset. A 69-year-old man presented with left-sided jaw paresthesias, dysphagia and dysarthria. He was trialed on IVIG for 1.5 years without improvement and died 2.6 years after symptom onset.&#x0D; Conclusion: FOSMN is a rare disorder with a unique clinical and electrophysiological phenotype. The pathophysiology has been associated with neurodegeneration and multiple gene mutations have correlated to FOSMN. Some reports suggest transient response to immunomodulatory therapy, though prospective studies are lacking. CSF protein elevation may be seen in severe disease. Future studies will help further elucidate the approach to diagnosis, treatment, and prognostic counseling (biomarkers).&#x0D;

Clinical TransplantationVolume 37, Issue 6 e15002 LETTER TO THE EDITOR Issues related to organ donation in Iran This article relates to: Transplantation in Iran Behrouz Broumand, Mahmoudreza Moein, Reza F. Saidi, Volume 37Issue 6Clinical Transplantation First Published online: April 28, 2023 This article relates to: Transplantation in Iran Behrouz Broumand, Mahmoudreza Moein, Reza F. Saidi, Volume 37Issue 6Clinical Transplantation First Published online: April 28, 2023 Shadnoush Mahdi, Shadnoush Mahdi Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IranSearch for more papers by this authorlatifi Marzieh, latifi Marzieh Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranSearch for more papers by this authorRahban Habib, Rahban Habib Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, California, USASearch for more papers by this authorPourhosein Elahe, Pourhosein Elahe Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranSearch for more papers by this authorDehghani Sanaz, Corresponding Author Dehghani Sanaz [email protected] orcid.org/0000-0001-5946-2611 Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran Correspondence Dehghani Sanaz, Sina University Hospital, Hassan-abad Sq. Emam Khomeini St. Tehran, Iran. Email: [email protected]Search for more papers by this author Shadnoush Mahdi, Shadnoush Mahdi Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, IranSearch for more papers by this authorlatifi Marzieh, latifi Marzieh Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranSearch for more papers by this authorRahban Habib, Rahban Habib Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, California, USASearch for more papers by this authorPourhosein Elahe, Pourhosein Elahe Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranSearch for more papers by this authorDehghani Sanaz, Corresponding Author Dehghani Sanaz [email protected] orcid.org/0000-0001-5946-2611 Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran Correspondence Dehghani Sanaz, Sina University Hospital, Hassan-abad Sq. Emam Khomeini St. Tehran, Iran. Email: [email protected]Search for more papers by this author First published: 04 May 2023 https://doi.org/10.1111/ctr.15002Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1Shadnoush M, Latifi M, Rahban H, et al. Trends in organ donation and transplantation over the past eighteen years in Iran. Clin Transplant. 2022; 37:e14889. 2Pourhosein E, Bagherpour F, Latifi M, et al. The influence of socioeconomic factors on deceased organ donation in Iran. Korean J Transplant. 2022; 36(1): 54- 60. https://doi.org/10.4285/kjt.21.0034 3Mahdi S, Marzieh L, Habib R, Elahe P, Sanaz D. The role of healthcare professionals to improve organ donation and transplantation outcome: a national study. Cell Tissue Bank. 2023; 24: 1- 7. 4Radi E, Ghanavati M, Khoundabi B, et al. The effect of the Iranian family approach-specific course (IrFASC) on obtaining consent from deceased organ donors’ families. Korean J Transplant. 2022; 36(4): 237- 244. 10.4285/kjt.22.0041 5Shakerian B, Dehghani S, Ashraf H, et al. The outcomes of marginal donor hearts compared with ideal donors: a single-center experience in Iran. Korean J Transplant. 2022; 36(2): 136- 142. Volume37, Issue6June 2023e15002 ReferencesRelatedInformation