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Background: The emergency medicine (EM) landscape has evolved due to the increasing number of programs paired with fewer applicants. This study analyzed the characteristics of EM residency programs associated with unfilled positions during the 2024 Match and compared them with data from the 2023 Match to identify persistent and emerging trends influencing these outcomes. Methods: In this cross-sectional, observational study, we investigated factors associated with unfilled EM residency positions in the 2024 Match. We used publicly accessible data from the National Resident Matching Program. To identify program-level predictors of unfilled positions, we constructed a Bayesian hierarchical logistic regression model, incorporating data from the 2023 Match season. Results: In 2024, 54 out of 281 (19.2%) residency programs remained unfilled. Our Bayesian analysis reaffirmed that smaller program size, geographical location, prior osteopathic accreditation, and corporate ownership continue to be significant factors. Programs with vacancies in the previous year were also more likely to remain unfilled. Thus, several factors identified in 2023 remained associated with this year's Match outcomes, with the impact of previous unfilled positions being particularly pronounced. Conclusions: This study identified several factors associated with a greater likelihood of having unfilled EM residency positions, with previous unfilled positions emerging as the most significant predictor. These findings offer critical insights for residency programs and governing bodies, providing a basis for enhancing recruitment strategies, addressing the cyclical nature of unfilled positions, and tackling workforce challenges in EM.

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The large, directional stimuli-response of aligned liquid crystalline elastomers (LCEs) could enable functional utility in robotics, medicine, consumer goods, and photonics. The alignment of LCEs has historically been realized via mechanical alignment of a two-stage reaction. Recent reports widely utilize chain extension reactions of liquid crystal monomers (LCM) to form LCEs that are subject to either surface-enforced or mechanical alignment. Here, we prepare LCEs that contain intra-mesogenic supramolecular bonds synthesized via direct free-radical chain transfer photopolymerization processible by a distinctive mechanical alignment mechanism. The LCEs were prepared by the polymerization of a benzoic acid monomer (11OBA), which dimerized to form a liquid crystal monomer, with a diacrylate LCM (C6M). The incorporation of the intra-mesogenic hydrogen bonds increases the achievable nematic order from mechanical programming. Accordingly, LCEs prepared with larger 11OBA concentration exhibit higher magnitude thermomechanical strain values when compared to a LCE containing only covalent bonds. These LCEs can be reprogrammed with heat to return the aligned film to the polydomain state. The LCE can then be subsequently programmed to orient in a different direction. The facile preparation of (re)programmable LCEs with supramolecular bonds opens new avenues for the implementation of these materials as shape deployable elements.

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OBJECTIVE: Primary sacral tumors pose unique challenges because of their complex radiographic appearances, diverse pathologic entities, and dramatically different treatment paradigms based on tumor type. Magnetic resonance imaging and computed tomography (CT) can provide valuable information; however, sacral lesions can possess unique radiographic features and pose diagnostic dilemmas. CT-guided percutaneous needle biopsy is a critical component of the diagnostic workup. However, limited data are available on its efficacy for primary sacral tumors. METHODS: The data from patients with newly diagnosed primary sacral lesions during a 12-year period at our hospital were analyzed. The preoperative magnetic resonance imaging findings, biopsy results, and pathological data for patients who required surgery were analyzed. Unique cases in which the final pathologic result was unexpected from the preoperative imaging findings have been highlighted. RESULTS: Of 38 patients who underwent percutaneous needle biopsy, diagnostic tissue was obtained on the first attempt for 31 (82%). Five of the remaining 7 obtained diagnostic tissue on the second attempt, yielding 95% diagnosis, with only two requiring open biopsies. In 2 patients with diagnostic tissue on CT-guided biopsy, an open biopsy was still recommended because of the clinical scenario. In both patients, the open biopsy results matched those of the CT-guided biopsy. For the 18 patients who required surgery, we found 100% correlation between the percutaneous needle biopsy findings and the final pathological diagnosis. No biopsy-induced complications or extraspinal tumor seeding occurred. CONCLUSIONS: CT-guided biopsy is a safe and effective technique. It represents a critical component of the diagnostic algorithm, given the diverse pathological findings of primary sacral lesions and dramatic differences in treatment.

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OBJECTIVE: To determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness. METHODS: This was a multicenter retrospective cohort study of consecutive adult patients admitted to the hospital from the ED with infectious disease-related illnesses. We recorded qSOFA criteria and initial lactate levels in the first 6 h of ED stay. Our primary outcome was a composite of hospital death, vasopressor use, and intensive care unit stay ≤72 h of presentation. Diagnostic test characteristics were determined for: 1) lactate levels ≥2 and ≥4; 2) qSOFA scores ≥1, ≥2, and =3; and 3) combinations of these. RESULTS: Of 3743 patients, 2584 had a lactate drawn ≤6 h of ED stay and 18% met the primary outcome. The qSOFA scores were ≥1, ≥2, and =3 in 59.2%, 22.0%, and 5.3% of patients, respectively, and 34.4% had a lactate level ≥2 and 7.9% had a lactate level ≥4. The combination of qSOFA ≥1 OR Lactate ≥2 had the highest sensitivity, 94.0% (95% CI: 91.3-95.9). CONCLUSIONS: The combination of qSOFA ≥1 OR Lactate ≥2 provides substantially improved sensitivity for the screening of critical illness compared to isolated lactate and qSOFA thresholds.

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OBJECTIVE: To characterize the extent of mucosal injury on the upper gastrointestinal tract following oral administration of 3% hydrogen peroxide (H2 O2 ) to induce emesis in normal dogs. DESIGN: Prospective clinical study. SETTING: Specialty referral hospital. ANIMALS: Seven staff-owned, healthy, adult dogs. INTERVENTIONS: Six dogs were assigned to the H2 O2 group and 1 dog was assigned as the apomorphine control. Dogs were anesthetized for gastroduodenoscopy with gross inspection and gastroduodenal biopsies at time 0 and 4 hours, 24 hours, 1 week, and 2 weeks following administration of oral 3% H2 O2 or subconjunctival apomorphine. Gross esophageal, gastric, and duodenal mucosal lesion scoring was performed by 2 blinded, experienced scorers. Biopsy samples were evaluated histologically by a veterinary pathologist. MEASUREMENTS AND MAIN RESULTS: Grade I esophagitis was noted in 2 dogs at 4 hours and in 1 dog at 2 weeks, while grade III esophagitis was observed in 1 dog 1 week following H2 O2 administration. At 4 hours, gastric mucosal lesions were visualized in all dogs, and lesions worsened by 24 hours. Mild to moderate duodenal mucosal lesions were visualized up to 24 hours after administration. Histopathology identified the most severe gastric lesions at 4 hours as hemorrhage; at 24 hours as degeneration, necrosis, and mucosal edema; and at 1 week as inflammation. By 2 weeks, most visual and histopathologic lesions were resolved. No histopathologic lesions were identified at any time point in the dog administered apomorphine. CONCLUSIONS: Significant visual and histopathologic gastric lesions occurred following administration of 3% H2 O2 in all dogs. Less severe visual duodenal lesions were identified. As compared to H2 O2 dogs, minimal gross gastroduodenal lesions and normal histopathology were identified in the apomorphine control.

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To evaluate the relationship between aircraft noise exposure and the quality of national park visitor experience, more than 4600 visitor surveys were collected at seven backcountry sites in four U.S. national parks simultaneously with calibrated sound level measurements. Multilevel logistic regression was used to estimate parameters describing the relationship among visitor responses, aircraft noise dose metrics, and mediator variables. For the regression models, survey responses were converted to three dichotomous variables, representing visitors who did or did not experience slightly or more, moderately or more, or very or more annoyance or interference with natural quiet from aircraft noise. Models with the most predictive power included noise dose metrics of sound exposure level, percent time aircraft were audible, and percentage energy due to helicopters and fixed-wing propeller aircraft. These models also included mediator variables: visitor ratings of the "importance of calmness, peace and tranquility," visitor group composition (adults or both adults and children), first visit to the site, previously taken an air tour, and participation in bird-watching or interpretive talks. The results complement and extend previous research conducted in frontcountry areas and will inform evaluations of air tour noise effects on visitors to national parks and remote wilderness sites.

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OBJECTIVE: To describe the clinical course and successful management of a febrile dog with polyarthritis, splenic vasculitis, thrombosis, and infarction that was infected with Bartonella henselae. CASE SUMMARY: An 8-year-old female spayed Labrador Retriever was referred to The Ohio State University Veterinary Medical Center Emergency Service for evaluation of limping, fever, vomiting, and malaise of 4 days' duration. Physical examination abnormalities included generalized weakness, diminished conscious proprioception, bilateral temporalis muscle atrophy, and diarrhea. Peripheral lymph nodes were normal, and there were no signs of abdominal organomegaly, joint effusion, or spinal pain. Abdominal ultrasound identified a nonocclusive splenic vein thrombus. Fine-needle aspirates of the spleen revealed pyogranulomatous inflammation, mild reactive lymphoid hyperplasia, and mild extramedullary hematopoiesis. Splenic histopathology found marked, multifocal to coalescing acute coagulation necrosis (splenic infarctions) and fibrinoid necrotizing vasculitis. Bartonella henselae DNA was amplified by polymerase chain reaction and sequenced from the splenic tissue. The dog responded favorably to antimicrobials and was healthy at the time of follow-up evaluation. NEW AND UNIQUE INFORMATION PROVIDED: Bartonella henselae is an incompletely characterized emerging canine pathogen. This case report establishes a potential role for this bacterium as a cause of vasculitis and thromboembolism, which have not been previously reported in association with B. henselae infection in dogs.

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Cytauxzoon felis is a hemoprotozoan parasite of cats. While many infected cats die of acute illness, some enter a chronic carrier state. To date, no treatment has been documented to clear the chronic carrier state, leaving recovered cats to act as a potential indirect source of infection via a tick vector. Diminazene diaceturate is an anti-protozoal therapy that has been suggested for use in the treatment of acute cytauxzoonosis, but which failed to clear the carrier state at the dose used in acute illness. We hypothesized that a dose-intensified regimen of diminazene could reduce or eliminate parasitemia from five domestic cats naturally infected with C felis. Cats were administered 4 mg/kg of diminazene diaceturate intramuscularly for 5 consecutive days. Clearance of the organism was assessed via semi-quantitative polymerase chain reaction and light microscopy 1, 3, 6 and 10 weeks after starting treatment. Additionally, cats were monitored for adverse drug reactions by daily observation and examination. Complete blood count, biochemical profile and urinalysis were performed at 1, 3 and 10 weeks. Adverse events were common and included profuse salivation and nausea at the time of injection, monoparesis in the injected leg, proteinuria and potential hepatotoxicity. Severity of parasitemia was not reduced. Diminazene diaceturate cannot be recommended for elimination of the carrier state of C felis infection.

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BACKGROUND: Written and video approaches to donor education have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific coping suggestions for donation-related concerns. This study extends this work by comparing Web-based approaches to donor preparation among donors and nondonors. STUDY DESIGN AND METHODS: Young adults (62% female; mean [±SD] age, 19.3 [±1.5] years; mean [range] number of prior blood donations, 1.1 [0-26]; 60% nondonors) were randomly assigned to view 1) a study Web site designed to address common blood donor concerns and suggest specific coping strategies (n = 238), 2) a standard blood center Web site (n = 233), or 3) a control Web site where participants viewed videos of their choice (n = 202). Measures of donation attitude, anxiety, confidence, intention, anticipated regret, and moral norm were completed before and after the intervention. RESULTS: Among nondonors, the study Web site produced greater changes in donation attitude, confidence, intention, and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for moral norm and anxiety. Among donors, the study Web site produced greater changes in donation confidence and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for donation attitude, anxiety, intention, and moral norm. CONCLUSION: Web-based donor preparation materials may provide a cost-effective way to enhance donation intentions and encourage donation behavior.

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OBJECTIVE: To determine whether apparently healthy captive-born wild felids that were not native to North America and were housed in an area endemic for Cytauxzoon felis harbored the pathogen. DESIGN: Prospective observational case series. ANIMALS: 11 captive-born wild felids that were (1 bobcat [Lynx rufus] and 1 cougar [Puma concolor]) or were not (1 lion [Panthera leo] and 8 tigers [Panthera tigris]) native to North America and 6 domestic cats (5 pets and 1 feral). PROCEDURES: Blood was collected, and a PCR assay for C felis was performed. The C felis 18S rRNA gene sequence was characterized in samples that tested positive. Blood smears were evaluated microscopically for intraerythrocytic organisms consistent with C felis. Blood smears from an additional 6 feral domestic cats found dead on the study premises were also evaluated. RESULTS: 4 tigers and 6 domestic cats without clinical signs of disease tested positive for C felis infection via PCR assay; intraerythrocytic organisms consistent with C felis were identified in smears from 1 C felis-infected tiger (which also had azotemia) and in smears from 11 of 12 domestic cats. Possible erythrocytic inclusions were identified in 1 tiger that tested negative for C felis. Sequences of C felis 18S rRNA amplicons from all infected tigers shared > 99.8% identity with reported C felis sequences from North American domestic cats and were identical to amplicons from domestic cats on the premises. CONCLUSIONS AND CLINICAL RELEVANCE: Captive tigers without clinical signs of disease tested positive for C felis. The PCR assay for C felis appeared to be more reliable than cytologic detection of piroplasms in tigers.

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Cytauxzoon felis is a hemoprotozoan parasite of cats capable of causing severe, often fatal disease during acute infection, but cats that survive the acute stage of disease become chronic carriers. These otherwise healthy carriers are capable of transmitting the infection to other cats via the bite of a vector tick. A variety of other hematoprotozoan parasites are capable of vertical transmission from mother to offspring. If this were possible for C. felis, it could be an important part of the explanation for the apparent emergence of this disease with an increased incidence in an expanding geographic area. We investigated the possibility of perinatal transmission of C. felis from chronically infected cats to their offspring. Two queens produced a total of 14 healthy kittens in three litters. All kittens tested negative for C. felis by microscopic slide review and PCR until they were adopted to private homes at approximately 12 weeks of age. While this does not rule out the possibility of perinatal transmission, it is unlikely to be a common phenomenon.

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Two-dimensional electronic spectroscopy (2DES) has emerged as a powerful method for elucidating the structure-function relationship in photosynthetic systems. In this Perspective, we discuss features of two-dimensional spectroscopy that make it highly suited to address questions about the underlying electronic structure that guides energy- and charge-transfer processes in light-harvesting materials. We briefly describe a pulse-shaping-based implementation of two-dimensional spectroscopy that is making the method widely accessible to problems spanning frequency regimes from the ultraviolet to the mid-infrared. We illustrate the utility of 2DES in the context of our recent studies of the primary energy-transfer and charge separation events in the photosystem II reaction center, discussing remaining challenges and speculating about exciting future directions for the field of multidimensional spectroscopy.

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Growth mixture modeling (GMM) identified latent groups based on treatment outcome trajectories of headache disability measures in patients in headache subspecialty treatment clinics. Using a longitudinal design, 219 patients in headache subspecialty clinics in 4 large cities throughout Ohio provided data on their headache disability at pretreatment and 3 follow-up assessments. GMM identified 3 treatment outcome trajectory groups: (1) patients who initiated treatment with elevated disability levels and who reported statistically significant reductions in headache disability (high-disability improvers; 11%); (2) patients who initiated treatment with elevated disability but who reported no reductions in disability (high-disability nonimprovers; 34%); and (3) patients who initiated treatment with moderate disability and who reported statistically significant reductions in headache disability (moderate-disability improvers; 55%). Based on the final multinomial logistic regression model, a dichotomized treatment appointment attendance variable was a statistically significant predictor for differentiating high-disability improvers from high-disability nonimprovers. Three-fourths of patients who initiated treatment with elevated disability levels did not report reductions in disability after 5 months of treatment with new preventive pharmacotherapies. Preventive headache agents may be most efficacious for patients with moderate levels of disability and for patients with high disability levels who attend all treatment appointments.

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We examine the effect that pulse chirp has on the shape of two- dimensional electronic spectra through calculations and experiments. For the calculations we use a model two electronic level system with a solvent interaction represented by a simple Gaussian correlation function and compare the resulting spectra to experiments carried out on an organic dye molecule (Rhodamine 800). Both calculations and experiments show that distortions due to chirp are most significant when the pulses used in the experiment have different amounts of chirp, introducing peak shape asymmetry that could be interpreted as spectrally dependent relaxation. When all pulses have similar chirp the distortions are reduced but still affect the anti-diagonal symmetry of the peak shapes and introduce negative features that could be interpreted as excited state absorption.

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The feline infectious peritonitis virus (FIPV) is a mutated form of the feline enteric coronavirus (FeCV) that can present with a variety of clinical signs. The purpose of this retrospective study was to analyze abdominal ultrasonographic findings associated with cats with confirmed FIPV infection. Sixteen cases were included in the study from a review of medical records at two academic institutions; inclusion was based either on necropsy lesions (n=13) or a combination of histopathological, cytological, and clinicopathological findings highly suggestive of FIPV infection (n=3). The liver was judged to be normal in echogenicity in 11 (69%) cats, diffusely hypoechoic in three cats, focally hyperechoic in one cat, and focally hypoechoic in one cat. Five cats had a hypoechoic subcapsular rim in one (n=3) or both (n=2) kidneys. Free fluid was present in the peritoneal cavity in seven cats and in the retroperitoneal space in one cat. Abdominal lymphadenopathy was noted in nine cats. The spleen was normal in echogenicity in 14 cats and was hypoechoic in two. One cat had bilateral orchitis with loss of normal testicular architecture. Although none of these ultrasonographic findings are specific for FIPV infection, a combination of these findings should increase the index of suspicion for FIPV infection when considered along with appropriate clinical signs.

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We report 2D Fourier transform electronic spectroscopy obtained in the pump-probe geometry using a continuum probe. An acousto-optic pulse shaper placed in the pump arm of a standard pump-continuum probe experiment permits 2D spectroscopy that probes a broad spectral range. We demonstrate the method on a simple dye system exhibiting vibrational wavepacket dynamics that modulate the peak shapes of the 2D spectra. The broad spectral range of the continuum probe allows us to observe vibronic cross peaks in the 2D spectra.

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We report two-color two-dimensional Fourier transform electronic spectroscopy obtained using an acousto-optic pulse-shaper in a pump-probe geometry. The two-color setup will facilitate the study of energy transfer between electronic transitions that are widely separated in energy. We demonstrate the method at visible wavelengths on the laser dye LDS750 in acetonitrile. We discuss phase-cycling and polarization schemes to optimize the signal-to-noise ratio in the pump-probe geometry. We also demonstrate that phase-cycling can be used to separate rephasing and nonrephasing signal components.

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Pectin methyl esterases (PMEs) and their endogenous inhibitors are involved in the regulation of many processes in plant physiology, ranging from tissue growth and fruit ripening to parasitic plant haustorial formation and host invasion. Thus, control of PME activity is critical for enhancing our understanding of plant physiological processes and regulation. Here, we report on the identification of epigallocatechin gallate (EGCG), a green tea component, as a natural inhibitor for pectin methyl esterases. In a gel assay for PME activity, EGCG blocked esterase activity of pure PME as well as PME extracts from citrus and from parasitic plants. Fluorometric tests were used to determine the IC50 for a synthetic substrate. Molecular docking analysis of PME and EGCG suggests close interaction of EGCG with the catalytic cleft of PME. Inhibition of PME by the green tea compound, EGCG, provides the means to study the diverse roles of PMEs in cell wall metabolism and plant development. In addition, this study introduces the use of EGCG as natural product to be used in the food industry and agriculture.

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We investigated geographic patterns of herbivory and resource allocation to defense, growth, and reproduction in an invasive biennial, Alliaria petiolata, to test the hypothesis that escape from herbivory in invasive species permits enhanced growth and lower production of defensive chemicals. We quantified herbivore damage, concentrations of sinigrin, and growth and reproduction inside and outside herbivore exclusion treatments, in field populations in the native and invasive ranges. As predicted, unmanipulated plants in the native range (Hungary, Europe) experienced greater herbivore damage than plants in the introduced range (Massachusetts and Connecticut, USA), providing evidence for enemy release, particularly in the first year of growth. Nevertheless, European populations had consistently larger individuals than US populations (rosettes were, for example, eightfold larger) and also had greater reproductive output, but US plants produced larger seeds at a given plant height. Moreover, flowering plants showed significant differences in concentrations of sinigrin in the invasive versus native range, although the direction of the difference was variable, suggesting the influence of environmental effects. Overall, we observed less herbivory, but not increased growth or decreased defense in the invasive range. Geographical differences in performance and leaf chemistry appear to be due to variation in the environment, which could have masked evolved differences in allocation.

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Host plant-associated fitness trade-offs are central to models of sympatric speciation proposed for certain phytophagous insects. But empirical evidence for such trade-offs is scant, which has called into question the likelihood of nonallopatric speciation. Here, we report on the second in a series of studies testing for host-related selection on pupal life-history characteristics of apple- (Malus pumila L.) and hawthorn- (Crataegus mollis L. spp.) infesting races of the Tephritid fruit fly, Rhagoletis pomonella (Walsh). In particular, we examine the effects of winter length on the genetics of these flies. We have previously found that the earlier fruiting phenology of apple trees exposes apple-fly pupae to longer periods of warm weather preceding winter than hawthorn-fly pupae. Because R. pomonella has a facultative diapause, we hypothesized that this selects for pupae with more recalcitrant pupal diapauses (or slower metabolic/development rates) in the apple-fly race. A study in which we experimentally manipulated the length of the prewintering period for hawthorn-origin pupae supported this prediction. If the period preceding winter is important for apple- and hawthorn-fly pupae, then so too should be the length (duration) of winter; the rationale for this prediction is that "fast developing" pupae that break diapause too early will deplete their energy reserves and disproportionately die during long winters. To test this possibility, we chilled apple- and hawthorn-origin pupae collected from a field site near Grant, Michigan, in a refrigerator at 4°C for time periods ranging from one week to two years. Our a priori expectation was that longer periods of cold storage would select against allozyme markers that were associated with faster rates of development in our earlier study. Since these electromorphs are typically found at higher frequencies in hawthorn flies, extending the overwintering period should favor "apple-fly alleles" in both races. The results from this "overwinter" experiment supported the diapause hypothesis. The anticipated genetic response was observed in both apple and hawthorn races, as allele frequencies became significantly more "apple-fly-like" in eclosing adults surviving longer chilling periods. This indicates that it is the combination of environmental conditions before and during winter that selects on the host races. Many tests for trade-offs fail to adequately consider the interplay between insect development, host plant phenology, and local climatic conditions. Our findings suggest that such oversight may help to explain the paucity of reported fitness trade-offs.