Encounter Rates Research Articles

Rural disparities in emergency department utilization for migraine care.

To evaluate differences in emergency department (ED) utilization and quality of care for migraine in patients with rural and nonrural residences. Migraine is a significant problem in the United States with direct health-care utilization cost amounting to US $4.2 billion annually. A considerable portion of this cost is attributed to more than 4 million annual ED visits for migraine and headache. Previous research has documented health disparities among rural populations in other disease states, which can be influenced by factors such as socioeconomic status and health-care access. Given these associations, it was hypothesized that patients with rural residence in a national sample would have increased ED utilization for migraine compared to patients with nonrural residence. This was a cross-sectional epidemiologic study to evaluate rural disparities in ED utilization and quality of care for migraine in the United States in 2019. ED encounter data were collected from the Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) and Kentucky State Emergency Department Database (KY-SEDD). The primary outcome was crude and age-adjusted rates of ED encounters for migraine per 10,000 population. ED encounters were included if they had a primary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code of G43.xx. ED encounters lacking sufficient data to classify into a geographic group were excluded. Secondary outcomes examined differences in quality of care, including mean ED charges and the proportion of encounters with medication administration, imaging, and nerve block service codes between groups. One hundred eighty-three thousand two hundred eleven national ED discharges were classified as rural patient encounters and 627,176 were classified as nonrural. The rural group had significantly higher crude and age-adjusted rates of ED utilization for migraine (crude: rural 39.8, 95% confidence interval [CI] 36.9-42.7; nonrural 22.2, 95% CI 21-23.5 and age-adjusted: rural 41.8, 95% CI 38.8-44.8; nonrural 23.4, 95% CI 22.1-24.7). Opioid utilization was higher in rural encounters (rural n = 26,764, 14.6%; nonrural n = 50,367, 8%; p < 0.001). A Kentucky sub-analysis found 5210 ED discharges were classified as Appalachian and 12,551 as non-Appalachian. The Appalachian group had significantly higher ED utilization rates for migraine compared to the non-Appalachian and national rural groups (crude: Appalachian 44.9, 95% CI 43.7-46.2; age-adjusted: Appalachian 47.4, 95% CI 46.1-48.8). The Kentucky Appalachian group also demonstrated significantly higher opioid analgesia use compared to the national rural group (Appalachian n = 1031, 19.8%; p < 0.001). This study suggests rural populations, particularly in Appalachia, may experience significantly higher ED utilization for migraine compared to nonrural patients. Moreover, rural populations were more likely to receive suboptimal migraine management with opioid analgesia. Multimodal health-care interventions should be developed to improve access to outpatient migraine care and further investigate potential risk factors in the rural population. With high ED utilization, the Appalachian population may benefit most from such an intervention.

Trait‐based analyses reveal global patterns in diverse diets of albacore tuna (Thunnus alalunga)

AbstractSimplifying complex species interactions can facilitate tracking and predicting functional responses to ecological stressors. This is important for highly migratory pelagic predators, exploiting diverse prey fields as they respond to dynamic environments. We reconstructed the historical resource use of albacore tuna (Thunnus alalunga) globally from the 1900s to 2015 and confirmed highly biodiverse diets with 308 prey species, and an additional 238 taxa at coarser taxonomic resolution. We synthesised prey diversity into seven functional trait guilds using hierarchical divisive clustering algorithms as a function of four traits that describe habitat use and influence predator–prey encounter rates – prey habitat association vertically in the water column, horizontally along the coastal to pelagic gradient, seasonal and diel vertical migratory behaviour. We explored variability in historical composition of albacore diets across geographies based on species identity, individual trait information and functional trait guilds using a multi‐matrix modelling framework. Taxonomic information remains important for trophic ecology, however, species‐based diet composition in albacore tuna was highly variable across geographies and years sampled, making interpretation of these patterns difficult. By simplifying species identity into habitat‐based traits, we highlight changes in prey resources consumed, such as the historical importance of near‐surface epipelagic prey resources from coastal to oceanic habitats, and seasonally migrating continental shelf prey, with less frequent pulses of deeper water and demersal taxa. Trait information and trait guilds serve as useful classification frameworks for identifying functionally redundant food web linkages across biodiverse prey, and will prove useful in tracking predators' foraging responses to changing resource availability.

The African Manatee (Trichechus Senegalensis, link 1795) in the Ramsar site of Setté Cama: Case at Lake Cachimba

The West African manatee (Trichechus senegalensis) is classified as vulnerable on the IUCN red list and is highly protected in Gabon. Gabon could be home to one of the highest densities of manatees remaining in Africa. Many people agree on the presence of manatee populations in several lakes and lagoons in Gabon. The aim of this study is to investigate the distribution and abundance of manatees by monitoring. The study was carried out in the catchment area of Lake Cachimba at the Setté Cama Ramsar site. We used three data collection methods: secondary data collection, boat surveys and surveys of markets and landing sites. Data analysis was based on descriptive statistics, manatee encounter rates and carcass encounter rates (number of carcasses/km of river). The chi-square (χ2) goodness-of-fit test was used to determine whether there were significant differences in the abundance of manatee encounter rates between Lake Cachimba and the Mbissi River. The results showed that manatee hotspots in Lake Cachimba are located near the mouth of the DuebiRiver, along the shore of the village of Cachimba. In addition, fishing activities are a potential threat to the African manatee.

Discovery and Timing of Millisecond Pulsars in the Globular Cluster M5 with FAST and Arecibo

We report on a comprehensive multiwavelength study of the pulsars in the globular cluster (GC) M5, including the discovery of M5G, a new compact noneclipsing “black widow” pulsar. Thanks to the analysis of 34 yr of radio data taken with the Five-hundred-meter Aperture Spherical radio Telescope and Arecibo telescopes, we obtained new phase-connected timing solutions for four pulsars and improved those of the other three. These have resulted in, among other things, (a) much improved proper motions for five pulsars, with transverse velocities (relative to the cluster) that are smaller than their respective escape velocities; (b) 3σ and 1.5σ detections of Shapiro delays in M5F and M5D, respectively; and (c) greatly improved measurement of the periastron advance in M5B, whose value of implies that M5B is still likely to be a heavy () neutron star. The binary pulsars M5D, M5E, and M5F are confirmed to be in low-eccentricity binary systems, the low-mass companions of which are newly identified to be He white dwarfs using Hubble Space Telescope data. Four pulsars are also found to be associated with X-ray sources. Similarly to the eclipsing pulsar M5C, M5G shows little or no nonthermal X-ray emission, indicative of weak synchrotron radiation produced by intrabinary shocks. All seven pulsars known in M5 have short spin periods (<8 ms), and five are in binary systems with low orbital eccentricities. These characteristics differ from the overall GC pulsar population but confirm the expectations for the pulsar population in a cluster with a small rate of stellar encounters per binary system.

Single-atom catalysis in space: Computational exploration of Fischer–Tropsch reactions in astrophysical environments

Context. Gas-phase chemistry at extreme conditions (low densities and temperatures) is difficult, so the presence of interstellar grains is especially important for the synthesis of molecules that cannot form in the gas phase. Interstellar grains are advocated to enhance the encounter rate of the reactive species on their surfaces and to dissipate the energy excess of largely exothermic reactions, but less is known of their role as chemical catalysts that provide low activation energy pathways with enhanced reaction rates. Different materials with catalytic properties are present in interstellar environments, like refractory grains containing space-abundant d-block transition metals. Aims. In this work we report for first time mechanistic insights on the Fischer–Tropsch methanol (CH3OH) synthesis under astrophysical conditions using single-atom Fe-containing silica surfaces as interstellar heterogeneous catalysts. Methods. Quantum chemical calculations considering extended periodic surfaces were carried out in order to search for the stationary points and transitions states to finally construct the reaction potential energy surfaces. Binding energy and kinetic calculations based on the Rice–Ramsperger–Kassel–Marcus (RRKM) scheme were also performed to evaluate the catalytical capacity of the grain and to allocate those reaction processes within the astrochemical framework. Results. Our mechanistic studies demonstrate that astrocatalysis is feasible in astrophysical environments. Thermodynamically the proposed process is largely exergonic, but kinetically it shows energy barriers that would need from an energy input in order to go through. Kinetic calculations also demonstrate the strong temperature dependency of the reaction process as tunnelling is not relevant in the involved energetic barriers. The present results can explain the presence of CH3OH in diverse regions where current models fail to reproduce its observational quantity. Conclusions. The evidence of astrocatalysis opens a completely new spectrum of synthetic routes triggering chemical evolution in space. From the mechanistic point of view the formation of methanol catalysed by a single atom of Fe0 is feasible; however, its dependency on the temperature makes the energetics a key issue in this scenario.

Testing presence of directionality information in female spider silk trails through male trail-following behavior

Mate search is challenging for solitary species. Trails represent a particularly potent, target-oriented means for finding mates, as trail-following increases encounter rates between individuals compared to random search. Embedding directionality information into the trail allows individuals to follow trails correctly to the source. Yet, directionality remains poorly understood. Spiders deposit trails during locomotion consisting of silk lines and substrate-borne chemicals. We conducted multiple experiments to test whether female silk trails convey directionality information, whether directionality is chemically or structurally encoded and depends on female phenotype. We also examined whether males interact with silk in a way that suggests information gathering. We exposed males of the cursorial spider Pisaura mirabilis to female trails deposited unidirectionally and scored their trail-following direction (i.e., same as or opposite to the females’). Tests were repeated after washing trails with a solvent to remove putative chemicals and by sourcing silk from females of different feeding regimes. While we found little evidence for male directional trail-following, we did find that unwashed trails were more likely to be followed than washed trails. Similarly, trails of relatively larger females were more likely to be followed correctly than those of smaller females. Males extensively probed and pulled on silk lines with their appendages, suggesting the gathering of chemical and tactile information. Taken together, results suggest that directional trail-following is selected only under specific contexts in this species. Chemical attributes of trails may convey information on female quality, with directional trail-following reflecting male mate choice in a system characterized by costly male nuptial gifts.Significance statementIn the context of male mate search, following conspecific trails increases the chances of encountering a mating partner, especially if trails provide information about the direction the conspecific went. Yet, trail directionality remains poorly understood. Female spiders deposit silk trails as they walk. We overall show that males follow trails directionally only under a specific context. Males were more likely to follow correctly when trails were unmanipulated (compared to being washed with solvents to remove chemicals) and when they were deposited by relatively larger females (compared to smaller ones). Chemical attributes of trails may potentially indicate directionality, while decoding movement direction from trails of larger females may reflect male preferences for females of higher reproductive value.

The Impact ofthe COVID-19 Pandemic onthe Military Health System's Care ofMilitary Sexual Assault.

Sexual assault remains a high priority challenge for leaders in the U.S. military. The COVID-19 pandemic further complicated the issue by disrupting work and lifestyles, potentially affecting reporting and care-seeking by victims. To date, there are no studies addressing the impact of changes in access to health services and reporting of sexual assault by active duty service members to inform medical and public health interventions in a post-COVID-19 era and during future public health emergencies. Using the Military Health System Data Repository (MDR), we identified a retrospective open cohort of active duty servicemembers receiving care in the Military Health System (MHS) from fiscal years 2018 to 2021. Through the use of ICD-10 diagnostic codes, all corresponding sexual assault care was identified for the cohort before (October 1, 2017-February 28, 2020; pre-pandemic period) and after (March 1, 2020-September 30, 2021; pandemic period) the institution of COVID-19 pandemic protective measures. Pre-pandemic and pandemic period rates of sexual assault associated encounters per 10,000 total health encounters were calculated by geographic location and compared using Wilcoxon's sign rank test. Multivariate log binomial regression models were performed to estimate associated risk of sexual assault among active duty servicemembers and compared across both periods. The study identified 47,067,073 encounters for servicemembers in the pre-pandemic period, of which 7,813 (0.016%) were associated with sexual assault. During the pandemic period, 4,377 (0.015%) of 28,926,480 encounters were associated with sexual assault, indicating a 44% reduction in total encounters and a 9% reduction in the proportion of encounters associated with sexual assault. Eighteen installations within the MHS had statistically significant increases in rates of encounters. Most sexual assault encounters occurred in the 20-24 year age, Female, White, Junior Enlisted, Army, and Unmarried categories. During both time-frames, younger age and being female were associated with an increased risk of sexual assault encounters. Race, service branch, and marital status were also associated with the risk of encounters. Contrary to reports indicating a modest increase in the number of sexual assaults reported within the DoD, we found a reduction in the frequency of healthcare encounters associated with sexual assault during the pandemic which may be related to reduced access to care. Men comprised approximately 22% of sexual assault encounters delivered through the MHS although the racial distribution of encounters approximates the estimates of the DoD-published demographic statistics. This study illustrates that COVID-19 measures appear to have reduced access to care for sexual assault within the MHS but did not demonstrably alter the demographics of servicemembers seeking care. These findings suggest that the MHS may require contingency plans for future disruptions to care and public health emergencies.

In the Lyme light: individual trait determinants of Borrelia burgdorferi infection in Peromyscus mice

Abstract Disease ecologists commonly use abiotic factors (e.g. temperature and moisture) or measures of biodiversity (e.g. species richness) to predict Lyme disease transmission patterns, but variance in infection probability among individuals within a population is poorly understood. Most studies assume intraspecific consistency, but recent evidence suggests that individual traits, such as animal personality, may drive differences in encounter rates with infected vectors and pathogen transmission probabilities through differential space use and microhabitat selection, leading to intraspecific variation in infection probability. In addition, because vectors and hosts are nonrandomly distributed across a landscape, land-use changes that modify key habitat features—such as forest management practices—may substantially alter associations between individual traits and infection probability. To address these gaps in our knowledge, we used a large-scale capture–mark–recapture study targeting Peromyscus mice in Maine, United States, to test whether personality drives probability of Borrelia burgdorferi infection in hosts within managed forest compartments with different silvicultural treatments. Specifically, we tested effects of individual phenotypic traits (physical and behavioral) and environmental traits (microhabitat and forest type) on infection probability within 2 species: P. leucopus and P. maniculatus. We found evidence that boldness negatively influences infection probability in P. maniculatus, and that body mass positively influences infection probability in both species. We found no effect of mouse density, microhabitat, or forest type in our analyses. These results suggest that personalities vary in their functional contributions to the natural cycle of B. burgdorferi, and that broader integration of behavioral diversity in disease ecology studies may aid in identifying key transmission zones for this rapidly expanding vector-borne zoonosis.

Post-Exposure Prophylaxis for Varicella-Zoster Virus Exposure in High-Risk Children.

Post-exposure prophylaxis (PEP) with varicella immunoglobulin is recommended to minimize risk of varicella complications for high-risk children. However, providers frequently use alternatives like acyclovir or intravenous immunoglobulin. A retrospective cohort study was conducted of PEP for varicella in children from January 2009 to December 2019. Data were provided by 47 children's hospitals who participate in the Pediatric Health Information Systems database. Patients with clinical encounters for varicella exposure were reviewed. Choice of varicella PEP regimens, including differences by underlying condition and institution, and incidence of varicella disease were determined. A total of 1704 patients with first clinical encounters for varicella met inclusion criteria. Of these patients, 509 (29.9%) were prescribed PEP after varicella exposure, and 65 (3.8%) ultimately had a subsequent encounter for varicella disease. Of 509 patients who received PEP, acyclovir was most frequently prescribed (n = 195, 38.3%), followed by varicella immunoglobulin (n = 146, 28.7%), IVIG (n = 115, 22.6%), and combination therapy (n = 53, 10.4%). The highest proportion of varicella immunoglobulin use (10/20, 50%) was amongst children with diagnoses of rheumatological/gastrointestinal conditions. The highest proportion of acyclovir use (29/684, 4.2%) was amongst children with diagnoses of oncology/stem cell transplant conditions. The proportion of patients who subsequently had clinical encounters for varicella disease was highest for Acyclovir (30/195, 15.4%) followed by varicella immunoglobulin (5/146, 3.4%), combination therapy (2/53, 3.8%), and intravenous immunoglobulin alone (0/115) (P < .0001). Varicella PEP in high-risk children was highly varied among children's hospitals. In our dataset, use of acyclovir was associated with a higher rate of subsequent encounters for Varicella disease.

Abundance and factors affecting the appearance of Siamese fireback and Red junglefowl in the lowland forest of Thailand

Abstract. Sukmasuang R, Chaisomboon P, Paansri P, Trisurat Y, Kanka P, Khiowsree N, Kaewdee B, Siripattanukul K, Chankhao A. 2023. Abundance and factors affecting the appearance of Siamese fireback and Red junglefowl in the lowland forest of Thailand. Biodiversitas 24: 5718-5730. Pheasants are indeed important species in various ecosystems. Studies of the abundance and factors influencing the presence of pheasant species have been conducted in the lowland areas of the Khao Ang Rue Nai Wildlife Sanctuary, Thailand, using camera trapping and species distribution models. A total of 23 factors, 2 bio-physiological, 2 geophysical, and 19 climate factors, were used to analyze in this study. The study revealed the presence of only two species of pheasants in the surveyed area, namely the Siamese fireback (Lophura diardi) and the Red junglefowl (Gallus gallus). The encounter rates were calculated as 1.74 photos per 100 trap nights for the Siamese fireback and 2.28 photos per 100 trap nights for the Red junglefowl. The factors influencing the presence of both Siamese fireback and the Red junglefowl were climate factors followed by biophysical and topography factors, respectively. The study's results highlight the importance of climate factors to the appearance of the pheasants, even in lowland areas. The results showed that the both pheasants responded more positively to the secondary forests, the grassland followed by dry dipterocarp forest than to other forest types. Therefore, conservation efforts to protect the areas inside are crucial for conserving the species' population.

Gauging the threat: exposure and attraction of sooty albatrosses and white-chinned petrels to fisheries activities in the Southern Indian Ocean

Abstract Bycatch risk assessments typically rely on spatial overlaps between seabirds and fishing vessels but should also consider seabirds’ position in the attraction spectrum. Investigating seabird-fishery interactions in relation to habitat use is vital for species-specific risk assessments. To address this, we studied interactions between sooty albatrosses (SA) and white-chinned petrels (WCP) with fisheries. GPS data from 20 SA and 18 WCP individuals from Marion Island were analysed alongside Automatic Identification System-derived boat locations over two breeding seasons. We calculated encounter and attraction rates and correlated them with marine habitat characteristics. SA interactions occurred in deeper, warmer waters compared to their foraging habitat when vessels were absent, with 20% of individuals encountering and only 5% being attracted to boats. In contrast, WCP interactions occurred in shallow, warm South African shelf waters, consistent with their typical foraging habitats, with 72% encountering and 56% attracted to boats. These results highlight the need for continued reinforcement of mitigation measures for WCP. Despite the low attraction rates for SA, ongoing vigilance is required due to their smaller population size, which heightens the potential impact of illegal fisheries. The comparison of species along an attraction spectrum contributes to refining risk assessments and informs species-specific conservation strategies.

Technological issues in shale oil development using horizontal wells in Ordos Basin, China

The PetroChina Changqing Oilfield Company has successfully achieved large-scale economical development of continental low-pressure freshwater lake interlayer shale oil in the Ordos Basin, China, targeting the gravity-flow sandstone thin interlayers in the organically rich mud shale formation of the seventh member of Yanchang Formation (Chang 7 Member) of Triassic,. Their significant discovery of the 1-billion-ton-level Qingcheng shale oil field, with a proven reserve of 1.052 × 109 t, has marked the establishment of China's first million-ton shale oil development zone. However, the extensive growth in production and construction has brought attention to notable challenges, including geological variances, low initial production, rapid decline, low recovery rates, and high development costs. Based on extensive field experience, this paper identifies several technological issues in shale oil development and offers comprehensive recommendations through systematic analysis. The encounter rate of horizontal shale oil wells, crucial for enhancing individual well productivity, can be improved both vertically and horizontally by prioritizing the extension direction of high-quality reservoirs during the deployment of horizontal wells. The contribution of fracturing fluid elasticity to the recovery rate is relatively low. Reservoir modification should not overemphasize large sand volume, fluid volume, or discharge. Additionally, optimizing parameters such as well spacing, vertical interlayer distribution, and fracture development is essential for maximizing the efficiency of fracturing scale, operation discharge, and other parameters. Variability in hydrocarbon source rock quality and the strength of diagenesis significantly impact oil saturation in sand bodies, affecting the selection of favorable areas and the distribution of high-quality reservoirs. Furthermore, the utilization of pre-fracturing with CO2 proves to be an effective approach in reducing viscosity and increasing the ultimate recovery rate. To ensure the efficient development of shale oil in the Changqing Oilfield, this paper emphasizes the necessity of deepening integrated geological studies, clarifying the main controlling factors of shale oil heterogeneous accumulation, and meticulously depicting three-dimensional sweet spots while exploring more effective development methodologies.

Dynamical aspects of Galactic habitability in N-body simulations

Abstract Recent studies of Galactic evolution revealed that the dynamics of the stellar component might be one of the key factors when considering galactic habitability. We run an N-body simulation model of the Milky Way, which we evolve for 10 Gyr, to study the secular evolution of stellar orbits and the resulting galactic habitability-related properties, i.e., the density of the stellar component and close stellar encounters. The results indicate that radial migrations are not negligible, even in a simple axisymmetric model with mild levels of dynamical heating, and that the net outward diffusion of the stellar component can populate galactic outskirts with habitable systems. Habitable environment is also likely even at sub-Solar galactocentric radii, because the rate of close encounters should not significantly degrade habitability. Stars that evolve from non-circular to stable nearly-circular orbits typically migrate outwards, settling down in a broad Solar neighborhood. The region between R ≈ 3 kpc and R ≈ 12 kpc represents the zone of radial mixing, which can blur the boundaries of the Galactic Habitable Zone, as it has been conventionally understood. The present-day stable population of the stars in the Solar neighborhood originates from this radial mixing zone, with most of the stars coming from the inner regions. The Solar system can be considered as a typical Milky Way habitable system because it migrated outwards from the metal-rich inner regions of the Disk and has a circular orbit in the present epoch. We conclude that the boundaries of the Galactic Habitable Zone cannot be sharply confined for a given epoch because of the mixing caused by the stellar migrations and secular evolution of stellar orbits.

Hereditary Hemorrhagic Telangiectasia May be the Most Clinically Significant and Morbid Inherited Bleeding Disorder of Women

Background Hereditary hemorrhagic telangiectasia (HHT) is the second most common inherited bleeding disorder (1 in 5000 people) behind von Willebrand disease (VWD) and has no FDA- or EMA-approved therapies. HHT causes serious bleeding resulting in severe iron deficiency anemia, major psychosocial complications, and visceral arteriovenous malformations in brain, lung, and liver that can cause life-threatening hemorrhage, stroke, and other morbid complications. While HHT prevalence is equal in men and women, manifestations may be worse in women (as evidenced by a female predominance in HHT clinical trials). Due to the focus on hemophilia (an X-linked disease nearly exclusive to men) in the hemostasis research community, no study has examined the relative morbidity of the most common inherited bleeding disorders in women: HHT and VWD. Methods We performed an observational cohort study of women with HHT or VWD cared for at our institutional Comprehensive Hemophilia and Von Willebrand Disease Treatment Center or HHT Center of Excellence. Using an electronic patient data registry, a representative sample of 100 randomly selected women with HHT were age-matched to 100 randomly selected women with VWD for analysis. All data was extracted and confirmed using manual chart review; we quantified and compared bleeding and healthcare utilization outcomes. Results Patient Population. The mean (range) age in both groups was 49 (14-87) years. Mean BMI was 27 in both groups, and racial/ethnic breakdown was similar in both groups. Mean follow-up durations were 9.07 years (HHT) and 14.83 years (VWD) per patient. The VWD group included 86 patients with type 1 VWD and 14 with type 2 VWD. Bleeding Outcomes. Bleeding outcomes are detailed in TABLE 1. In women with HHT compared with VWD, recurrent epistaxis and GI bleeding were more likely (odds ratio [OR] [95% CI] = 32.73 [13.81-71.80], P&amp;lt;0.0001 and 5.69 [2.59-12.89], P&amp;lt;0.0001, respectively), and heavy menstrual bleeding was less likely (OR 0.32 [0.18-0.57], P&amp;lt;0.0001). Iron deficiency anemia was significantly more likely, and lowest hemoglobin significantly lower, in HHT versus VWD. Requirements for IV iron and RBC transfusion were significantly more likely in HHT versus VWD. Women with HHT had 17-fold higher odds of iron infusion dependence and 8-fold higher odds of requiring hemostatic surgical procedures than women with VWD. Healthcare Utilization for HHT or VWD Management. Healthcare utilization is detailed in TABLE 2. In women with HHT compared with VWD, emergency department (ED) visits and hospital admissions specifically to manage disease complications were significantly more likely (OR [95% CI] = 3.83 [1.67-8.48], P=0.001 and 7.33 [3.57-14.73], P&amp;lt;0.0001, respectively). Rates of ED visitation, admission, and outpatient encounters specifically for HHT or VWD management were significantly higher in women with HHT vs. women with VWD: ED visits, 10.3 per 100 patient-years (pt-yrs) vs. 0.74 per 100 pt-yrs, P=0.001; admissions, 14.4 per 100 pt-yrs vs. 1.0 per 100 pt-yrs, P&amp;lt;0.0001; outpatient encounters, 386.5 per 100 pt-yrs vs. 43.7 per 100 pt-yrs, P&amp;lt;0.0001. Adjusting these rates for the prevalence of HHT (1 in 5000) and VWD (1 in 1000) at the population level, all rates were still higher in the HHT group. Infusion visits, radiology encounters, and nearly all subspecialty provider visit types were much higher in women with HHT ( TABLE 2). Conclusions Analyzing matched populations of women at a health system that serves as a tertiary referral center for both diseases, HHT, a historically neglected bleeding disorder, was responsible for much higher morbidity and healthcare utilization in women than VWD, certainly at the individual patient level and possibly at the population level (prevalence-adjusted). Overall incidence of disease complications in each group was consistent with the published literature for both HHT and VWD, supporting the generalizability of our findings. These findings are critically important in achieving gender equity in the hemostasis field, given that both government and industry funding for VWD research is many times greater than for HHT research and such funding for hemophilia research, a disease of men, is at least 10-fold greater than for HHT research. Continued neglect of funding for clinical care and research of HHT within the hemostasis academic community and industry will only sustain and exacerbate gender inequities in hematology.

Is the M81 Fast Radio Burst Host Globular Cluster Special?

We use multiband archival Hubble Space Telescope (HST) observations to measure the photometric and structural parameters of the M81 globular cluster (GC) that hosts the fast radio burst FRB 20200120E. Our best-fitting King model has an effective radius r h = 3.06 pc with a moderate King model concentration of c = 53, and an inferred core radius of 0.81 pc. We revisit the exact astrometric location of the FRB within the cluster, and find that FRB 20200120E is located 1.92 pc from the center, but within the projected half-light radius. We estimate the relative encounter rate of the FRB host, along with the corresponding rates of 210 other GCs in M81, and compare these values with the encounter rates of Galactic GCs. The FRB resides in a GC with an encounter rate that is moderately higher than the median stellar encounter rate in our two comparison samples. While the estimated encounter rate of the FRB host cluster (e.g., ∼50% of a cluster like 47 Tuc) is sufficient to allow the possibility that the FRB formed dynamically, our results do not place strong constraints on this scenario due to the limitations of the available HST data and the possible systematic uncertainties and selection effects in the comparison data.

Effectiveness of a dedicated therapist on improving prospective identification and pre-operative rehabilitation (PREHAB) to reduce post-operative treatment encounters for breast cancer-related lymphedema (BCRL) in a rural and underserved population.

399 Background: The rural and underserved have unique challenges and barriers to receiving evaluation and treatment for BCRL. Prospective identification and PREHAB for those at high risk including mastectomy over age 60, axillary node dissection, and radiation reduces the risk of BCRL and post-operative treatment encounters. In a rural Virginia breast program in 2021, 71% (40/56) of breast cancer (BC) patients were identified as high-risk for BCRL. Only fifteen percent (6/40) of high-risk patients received PREHAB with fifty-two percent (29/56) of total BC patients required post-operative encounters for treatment of BCRL. A quality improvement project to improve these numbers was implemented. Methods: We sought to increase the number of PREHAB encounters for patients at high-risk for developing BCRL and to decrease the total number of BC patients requiring post-operative BCRL treatment encounters. A Certified Lymphedema Therapist (CLT) prospectively identified patients at high-risk for development of BRCL during multidisciplinary breast cancer conference (MBCC). High-risk patients were offered PREHAB appointments, and the rates of PREHAB and post-operative intervention encounters were recorded. Results: In 2022, 76% (51/67) of BC patients were identified as high-risk for developing BCRL. Thirty-seven percent (19/51) received PREHAB, a 22% increase from 2021. The average number of visits was 7.7 visits for patients who received PREHAB and 19.2 visits for patients who did not. Forty-two percent (28/67) of total BC patients required post-operative encounters for treatment of BCRL, a 10% decrease from 2021. Barriers/Challenges: Both providers and patients showed limited engagement in the PREHAB model at the start of the program. Patient barriers to treatment included transportation and time limitations. Conclusions: A dedicated focus including high-risk screening, PREHAB, and a CLT at MBCC, can improve outcomes for BCRL in a rural and underserved population. Future investigation will include measuring BCRL rates over time.

Hunting behavior and feeding ecology of Mojave rattlesnakes (Crotalus scutulatus), prairie rattlesnakes (Crotalus viridis), and their hybrids in southwestern New Mexico.

Predators must contend with numerous challenges to successfully find and subjugate prey. Complex traits related to hunting are partially controlled by a large number of co-evolved genes, which may be disrupted in hybrids. Accordingly, research on the feeding ecology of animals in hybrid zones has shown that hybrids sometimes exhibit transgressive or novel behaviors, yet for many taxa, empirical studies of predation and diet across hybrid zones are lacking. We undertook the first such field study for a hybrid zone between two snake species, the Mojave rattlesnake (Crotalus scutulatus) and the prairie rattlesnake (Crotalus viridis). Specifically, we leveraged established field methods to quantify the hunting behaviors of animals, their prey communities, and the diet of individuals across the hybrid zone in southwestern New Mexico, USA. We found that, even though hybrids had significantly lower body condition indices than snakes from either parental group, hybrids were generally similar to non-hybrids in hunting behavior, prey encounter rates, and predatory attack and success. We also found that, compared to C. scutulatus, C. viridis was significantly more active while hunting at night and abandoned ambush sites earlier in the morning, and hybrids tended to be more viridis-like in this respect. Prey availability was similar across the study sites, including within the hybrid zone, with kangaroo rats (Dipodomys spp.) as the most common small mammal, both in habitat surveys and the frequency of encounters with hunting rattlesnakes. Analysis of prey remains in stomachs and feces also showed broad similarity in diets, with all snakes preying primarily on small mammals and secondarily on lizards. Taken together, our results suggest that the significantly lower body condition of hybrids does not appear to be driven by differences in their hunting behavior or diet and may instead relate to metabolic efficiency or other physiological traits we have not yet identified.

Can the annual bycatch per unit effort of common dolphins (Delphinus delphis) be used to index the species' relative abundance in the East Sea of Korea?

AbstractVisual line‐transect surveys are widely used to estimate the abundance of cetacean populations; however, this method can be prohibitively expensive. Thus, a less expensive alternative method was investigated in the present study, i.e., whether temporal changes in the bycatch per unit effort (BPUE) of cetaceans could be used to index the changes in their abundance. Specifically, the relationship between the annual BPUE of two main bycatch fisheries and the relative abundance of common dolphins (Delphinus delphis) was examined in 2012, 2013, 2015, and 2017 when vessel‐based line‐transect surveys were conducted in the coastal region of the East Sea of Korea. The encounter rate (individuals/km) by study year was significantly correlated with the annual BPUE of set nets. An increase in the density (individuals/km2) of common dolphins, estimated according to a hazard‐rate key function by study year, was associated with an increase in the BPUE of set nets. These results suggest that the annual BPUE of common dolphins could be used to index the species' relative abundance. The BPUE of set nets, which are fixed in coastal regions, reflect the densities of common dolphins in the coastal regions better than that of gill nets used in coastal and offshore regions.

Diet of the sylvatic triatomine Mepraia spinolai: Association with Trypanosoma cruzi infection near human settlements

The proximity between infectious disease vector populations and human settlements, and the infection prevalence of vector populations can determine the rate of encounters between vectors and humans and hence infection risk. The diet of sylvatic triatomine vectors (kissing bugs) provides evidence about the host species involved in the maintenance of the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. Here, we characterized the diet of the Chilean endemic triatomine Mepraia spinolai using Next Generation Sequencing (NGS), and evaluated the relation between T. cruzi infection status and proximity to human settlements, with the proportion of human and human-associated (domestic and synanthropic) vertebrates in the diet. We sampled 28 M. spinolai populations, covering a latitudinal range of ∼800 km in Chile. For each population, genomic DNA was obtained from M. spinolai intestinal content. We assessed T. cruzi infection individually, and sequenced vertebrate cytochrome b to characterize the diet from infected and uninfected pooled samples. Human and human-associated animals were present in the diet of both T. cruzi-infected (13.50 %) and uninfected (10.43 %) kissing bugs. The proportion of human and human-associated vertebrates in the diet of infected M. spinolai was negatively associated with the distance from surrounding human settlements, but no relationship was detected for uninfected kissing bugs. This pattern could be related to alterations of kissing bug feeding behavior when infected by the protozoan. Our results highlight the relevance of developing a deeper knowledge of the wild transmission cycle of T. cruzi, thus advancing in the surveillance of vectors present in the natural environment near human settlements.

Detection of Borrelia burgdorferi sensu lato species in host-seeking Ixodes species ticks in the United States

Lyme disease is the most commonly reported vector-borne disease in the United States and is transmitted by Ixodes scapularis in the eastern US and I. pacificus in the west. The causative agents, Borrelia burgdorferi sensu stricto (Bbss) and B. mayonii belong to the B. burgdorferi sensu lato (Bbsl) species complex. An additional eight species of Bbsl have been identified in Ixodes species ticks in the US, but their geographic distribution, vector associations, human encounter rates and pathogenicity in humans are poorly defined. To better understand the geographic distribution and vector associations of Bbsl spirochetes in frequent and infrequent human-biting Ixodes species ticks in the US, we previously screened 29,517 host-seeking I. scapularis or I. pacificus ticks and 692 ticks belonging to eight other Ixodes species for Borrelia spirochetes using a previously described tick testing algorithm that utilizes a combination of real-time PCR and Sanger sequencing for Borrelia species identification. The assay was designed to detect known human pathogens spread by Ixodes species ticks, but it was not optimized to detect Bbsl co-infections. To determine if such co-infections were overlooked particularly in ticks infected with Bbss, we retested and analyzed a subsample of 845 Borrelia infected ticks using a next generation sequencing multiplex PCR amplicon sequencing (MPAS) assay that can identify Borrelia species and Bbsl co-infections. The assay also includes targets that can molecularly confirm identifications of Ixodes species ticks to better inform pathogen-vector associations. We show that Bbss is the most prevalent species in I. scapularis and I. pacificus; other Bbsl species were rarely detected in I. scapularis and the only Bbsl co-infections identified in I. scapularis were with Bbss and B. mayonii. We detected B. andersonii in I. dentatus in the Mid-Atlantic and Upper Midwest regions, B. kurtenbachii in I. scapularis in the Upper Midwest, B. bissettiae in I. pacificus and I. spinipalpis in the Northwest, and B. carolinensis in I. affinis in the Mid-Atlantic and Southeast, and B. lanei in I. spinipalpis in the Northwest. Twelve of 62 (19.4%) Borrelia-infected I. affinis from the Mid-Atlantic region were co-infected with Bbss and B. carolinensis. Our data support the notion that Bbsl species are maintained in largely independent enzootic cycles, with occasional spill-over resulting in multiple Bbsl species detected in Ixodes species ticks.