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Background Readmission after surgery is an established surrogate indicator of quality of care. We aimed to compare short-term readmission rates and patient outcomes between open, video-assisted thoracoscopic (VATS), and robotic lobectomies in the Nationwide Readmissions Database (NRD). Methods Adults who underwent open, VATS, or robotic lobectomy for lung cancer from 2010 to 2014 were evaluated. Propensity-matched analysis was used to assess differences in readmission characteristics, GDP-adjusted cost, and mortality. Results Of the 129,539 lobectomies for lung cancer, 74,493 (57.5%) were open, 48,185 (37.2%) VATS, and 6861 (5.3%) robotic. Open surgery was associated with significantly higher readmission rate (10.5 vs 9.3%, p  < 0.001), mortality (2 vs 1.2%, p  < 0.001), index hospitalization cost [$21,846 (16,158–31,034) vs $20,779 (15,619–27,920), p  < 0.001], and length of stay [6 (5–9) vs 4 (3–7) days, p  < 0.001] compared to minimally invasive surgery. The robotic approach had similar mortality, readmission rate, and length of stay compared to VATS, but higher index cost [$23,870 (18,372–31,300) vs $20,279 (15,275–27,375), p  < 0.001] and incidence of pulmonary complication (35.9 vs 31.6%, p  < 0.001). The robotic approach was associated with greater direct discharges to home. Conclusions Analysis of the NRD revealed significantly reduced readmission rates, better clinical outcomes, and lower cost in the minimally invasive approach compared to open surgery. Although VATS and robotic surgery had similar readmission and mortality rates, VATS is associated with significantly reduced risk of short-term complications and lower cost.

Objectives Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire. Methods Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings. Results The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health ( n  = 14), mental health ( n  = 16), and inflammation and oxidative stress ( n  = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue. Conclusions While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.

The Family and Medical Leave Act (\"FMLA\") recognizes an employee's right to take leave to care for a qualifying family member. In light of the Act's remedial nature, the intended scope of the care provision is broad, but its definitional details are sparse. As a result of the attendant interpretive discretion afforded to courts, the Seventh Circuit announced its rejection of the requirement—first articulated by the Ninth Circuit—that care provided during travel be related to continuing medical treatment. A facial analysis of the resulting circuit split fails to appreciate the fundamental difference between the Seventh and Ninth Circuits' considerations: the distinction between physical and psychological care. Whereas physical care is readily measurable, psychological care is less defined and, consequently, ripe to facilitate FMLA abuse. Efforts to combat this potential lead courts to impose judicially devised limitations on psychological care, but judicial discretion still infuses some uncertainty into proceedings. For employers, the best remedy lies in the FMLA's optional certification provision, which requires medical validation of an employee's need for leave. In requiring certification, employers should distinguish between physical and psychological care, maximize the FMLA's informational requirements, and implement complete and consistent request and approval procedures.

Confl ict is an unavoidable part of public health work--especially in the wake of the COVID-19 pandemic, which brought a surge in harassment and threats toward public health officials. These challenges have led to staff turnover and weakened public health systems across the U.S.

ObjectivesThe increase in global wildland fire activity has accelerated the urgency to understand health risks associated with wildland fire suppression. The aim of this project was to identify occupational health research priorities for wildland firefighters and related personnel.DesignIn order to identify, rank and rate health research priorities, we followed a modified Delphi approach. Data collection involved a two-stage online survey followed by semi-structured interviews.SettingBritish Columbia, Canada.ParticipantsParticipants included any current or past wildland firefighter or individuals engaged in related roles. There were 132 respondents to the first survey. Responses to the first survey were analysed to produce 10 research topics which were ranked by 75 participants in the second survey (response rate: 84%).Primary and secondary outcome measuresThe primary outcome was the identification, ranking and level of agreement of research priorities through a two-round online survey. We contextualised these findings through deductive and inductive qualitative content analysis of semi-structured interviews.ResultsThe most important research priorities identified were (% consensus): effects of smoke inhalation on respiratory health (89%), fatigue and sleep (80%), mental health (78%), stress (76%) and long-term risk of disease (67%). Interviews were completed with 14 individuals. Two main themes were developed from an inductive content analysis of interview transcripts: (1) understanding the dynamic risk environment; and (2) organisational fit of mitigation strategies.ConclusionsParticipants expressed a general concern with the unknown mental and physical health impacts of their jobs, including the long-term risk of morbidity and mortality. Future research must address knowledge gaps in our understanding of the health impacts of wildland fire and work to develop appropriate mitigation strategies while considering the needs of workers and unpredictable workplace environment.Trial registration numberOpen Science Framework, https://osf.io/ugz4s/

Beginning in the mid-1980s, the Laurentian Great Lakes underwent successive invasions by Ponto-Caspian species. We quantified major changes in the diversity and relative abundance of pre-invasion benthic macroinvertebrates at the same study site in southwestern Lake Ontario from 1983–2014. The zebra mussel Dreissena polymorpha Pallas arrived at the study site before 1991, the quagga mussel Dreissena rostriformis bugensis Andrusov and the amphipod Echinogammarus ischnus Stebbing arrived before 1999, and the Round Goby Neogobius melanostomus Pallas arrived about 2004. The macroinvertebrate community in 2014 was very different from 3 earlier communities in 1983, 1991, and 1999. In 2014, pulmonate and prosobranch snails and sphaeriid bivalves were absent, D. r. bugensis replaced D. polymorpha, E. ischnus replaced Gammarus fasciatus Say as the dominant amphipod, and a previously diverse community of benthic fish was replaced by abundant N. melanostomus. From 1983 to 1999, the relative abundance of prosobranchs and pulmonates declined 10-fold and rose 2-fold, respectively. From 1991 to 2014, the relative abundance of oligochaetes and chironomids increased 32- and 78-fold, respectively. The shifts we report probably are attributable to nutrient enrichment of the nearshore of Lake Ontario during the 1990s leading to a thick carpet of macroalgae, a change in the base of the benthic food web from dressenid feces and pseudofeces to macroalgal detritus, and predation by N. melanostomus on snails.