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IntroductionThere is unequivocal evidence that the emergency department (ED) is a challenging environment to deliver holistic care to older adults living with frailty; prolonged exposure predisposes older adults to a range of adverse outcomes. The Geriatric Emergency Medicine (GEM) Unit opened in University Hospital Limerick (UHL) in 2023 with the overall aim of improving the experience and outcomes of older adults aged ≥75 years that attend the ED. The GEM Unit is operational 24/7 and is staffed by an interdisciplinary team comprising Emergency Medicine, Nursing, and Health and Social Care Professions (HSCP). This service evaluation aims to profile 6-month disposition and process outcomes.MethodologyOur initiative was underpinned by a quality improvement methodology comprising tests of change. Descriptive statistics were used to profile the baseline and demographic characteristics and to summarize data related to process outcomes.ResultsA total of 845 older adults were assessed by the HSCP team in Q1 and Q2 2024; 58.2% (N=492) were discharged home following their index attendance with 41.8% (N=353) requiring admission. The overall GEM Unit conversion rate of 41.8% is 11.7% lower than the composite UHL 75+ conversion rate of 53.5% (HSE Planning and Performance Unit). Based on empirical evidence, this equates to cost savings of €606,672 year to date (YTD) and predicted annual savings of €1,213,344 based on a 5-day HSCP service (https://doi.org/10.1371/journal.pone.0298162). The 30-day unscheduled ED revisit continues to trend down year-on-year from 18.8% in 2019 to 13% YTD 2024.ConclusionThe interdisciplinary team espouse an integrated approach to care at the primary-secondary care interface and focus on a left-shift in reform and activity. This is achieved by exploring alternatives to hospital admission with older adults and active engagement with colleagues across the HSE Mid-West health region to ensure older adults are supported to return home.

The Sacramento City USD Safe Haven Resolution highlights a 2011 federal policy stating that Immigration and Customs Enforcement officers will not conduct raids at any sensitive location such as school sites. Online resources include email notifications, Know Your Rights cards, community pledge cards, local immigration legal panels, hotline numbers and professional support for staff. Jessie Ryan, first vice president of the Sacramento City USD Board of Education, works to increase college access and success for young people across the state.

Years active: I have been playing my original music live since 2008. Members: Jessie Ryan-Allen, electric guitar and vocals. How would you describe your sound: Alternative pop rock. Who would...

Winter storms in California's Sierra Nevada increase seasonal snowpack and provide critical water resources and hydropower for the state. Thus, the mechanisms influencing precipitation in this region have been the subject of research for decades. Previous studies suggest Asian dust enhances cloud ice and precipitation, whereas few studies consider biological aerosols as an important global source of ice nuclei (IN). Here, we show that dust and biological aerosols transported from as far as the Sahara were present in glaciated high-altitude clouds coincident with elevated IN concentrations and ice-induced precipitation. This study presents the first direct cloud and precipitation measurements showing that Saharan and Asian dust and biological aerosols probably serve as IN and play an important role in orographie precipitation processes over the western United States.

In nine patients with chronic lymphocytic leukemia that responded to the noncovalent BTK inhibitor pirtobrutinib and then developed resistance, analysis revealed a number of new mutations in the BTK kinase domain and occasional mutations in downstream PLCγ2. Despite the inactivity of BTK, alternative pathways of B-cell–receptor signaling were evident.

Abstract Background Obesity, sarcopenia, and myosteatosis in inflammatory bowel disease may confer negative outcomes, but their prevalence and impact among patients with Crohn’s disease (CD) have not been systematically studied. The aim of this study was to assess nutritional status and body composition among patients undergoing resectional surgery for CD and determine impact on operative outcomes. Methods Consecutive patients with CD undergoing resection from 2000 to 2018 were studied. Total, subcutaneous, and visceral fat areas and lean tissue area (LTA) and intramuscular adipose tissue (IMAT) were determined preoperatively by computed tomography at L3 using SliceOmatic (Tomovision, Canada). Univariable and multivariable linear, logistic, and Cox proportional hazards regression were performed. Results One hundred twenty-four consecutive patients were studied (ileocolonic disease 53%, n = 62, biologic therapy 34.4% n = 43). Mean fat mass was 22.7 kg, with visceral obesity evident in 23.9% (n = 27). Increased fat stores were associated with reduced risk of emergency presentation but increased corticosteroid use (β 9.09, standard error 3.49; P = .011). Mean LBM was 9.9 kg. Sarcopenia and myosteatosis were associated with impaired baseline nutritional markers. Myosteatosis markers IMAT (P = .002) and muscle attenuation (P = .0003) were associated with increased grade of complication. On multivariable analysis, IMAT was independently associated with increased postoperative morbidity (odds ratio [OR], 1.08; 95% confidence interval (CI), 1.01-1.16; P = .037) and comprehensive complications index (P = .029). Measures of adiposity were not associated with overall morbidity; however, increased visceral fat area independently predicted venous thromboembolism (OR, 1.02; 95% CI, 1.00-1.05; P = .028), and TFA was associated with increased wound infection (OR, 1.00; 95% CI, 1.00-1.01; P = .042) on multivariable analysis. Conclusion Myosteatosis is associated with nutritional impairment and predicts increased overall postoperative morbidity following resection for CD. Despite its association with specific increased postoperative risks, increased adiposity does not increase overall morbidity, reflecting preservation of nutritional status and relatively more quiescent disease phenotype. Impaired muscle mass and function represent an appealing target for patient optimization to improve outcomes in the surgical management of CD. Lay Summary Myosteatosis was predictive of postoperative morbidity following surgery for Crohn’s Disease. Increased adiposity does not increase overall morbidity, reflecting a more quiescent disease phenotype. Obesity, myosteatosis, and sarcopenia represent appealing targets for patient optimization to improve outcomes surgical outcomes in Crohn’s Disease.

BACKGROUND:This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California. METHODS:This study used data from the 2011–2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented). RESULTS:Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos. CONCLUSIONS:Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.

To create a comprehensive list of all openly available online trainings in scholarly peer review and to analyze their characteristics. A systematic review of online training material in scholarly peer review openly accessible between 2012 and 2022. Training characteristics were presented in evidence tables and summarized narratively. A risk of bias tool was purpose-built for this study to evaluate the included training material as evidence-based. Fourty-two training opportunities in manuscript peer review were identified, of which only twenty were openly accessible. Most were online modules (n = 12, 60%) with an estimated completion time of less than 1 hour (n = 13, 65%). Using our ad hoc risk of bias tool, four sources (20%) met our criteria of evidence-based. Our comprehensive search of the literature identified 20 openly accessible online training materials in manuscript peer review. For such a crucial step in the dissemination of literature, a lack of training could potentially explain disparities in the quality of scholarly publishing.