The authors offer reflections and lessons learned in a single pediatric tertiary center’s experience during a pediatric mass casualty incident (MCI). The MCI occurred at a holiday parade and the patients were brought to multiple community emergency departments for initial resuscitation prior to transfer to the Pediatric level 1 trauma center. In total, 18 children presented with severe blunt force trauma after a motor vehicle entered the parade route. Following initial triage in emergency departments, 10 of 18 children injured during the incident were admitted to the Pediatric Intensive Care Unit, collectively representing a system-wide stressor of emergency medicine, critical care, and surgical services. Institutional characteristics, activation of personnel and supplies, and psychosocial support for families during an MCI are important to consider in children’s hospitals’ disaster preparedness planning.

Subglacial lake water-volume changes produce ice-elevation anomalies that provide clues about water flow beneath glaciers and ice sheets. Significant challenges remain in the quantitative interpretation of these elevation-change anomalies because the surface expression of subglacial lake activity depends on basal conditions, rate of water-volume change, and ice rheology. To address these challenges, we introduce an inverse method that reconstructs subglacial lake activity from altimetry data while accounting for the effects of viscous ice flow. We use a linearized approximation of a Stokes ice-flow model under the assumption that subglacial lake activity only induces small perturbations relative to a reference ice-flow state. We validate this assumption by accurately reconstructing lake activity from synthetic data that are produced with a fully nonlinear model. We then apply the method to estimate the water-volume changes of several active subglacial lakes in Antarctica by inverting data from NASA's Ice, Cloud, and land Elevation Satellite 2 (ICESat-2) laser altimetry mission. The results show that there can be substantial discrepancies (20% or more) between the inversion and traditional estimation methods due to the effects of viscous ice flow. The inverse method will help refine estimates of subglacial water transport and further constrain the role of subglacial hydrology in ice-sheet evolution.

We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.

People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.

From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.

Nonnative plant invasions can have devastating effects on native plant communities; conversely, management efforts can have nontarget and deleterious impacts on desirable plants. In the arid sagebrush steppe rangelands of the western United States, nonnative winter annual species affect forage production and biodiversity. One method proposed to control these species is to suppress the soil seedbank using the preemergent herbicide indaziflam. Our goal was to evaluate the efficacy of indaziflam to control nonnative annual mustards (Alyssum spp.) and to understand potential nontarget effects of management on the diverse mountain sagebrush steppe plant communities within Yellowstone National Park. Six sites were established along an elevation gradient (1,615 to 2,437 m), each with high and low Alyssum spp. infestations. We applied 63g ai ha−1 of indaziflam in late summer of 2018 and evaluated plant community cover in situ for 2 yr after treatment and emergence of forb species from the soil seedbank ex situ. Indaziflam was highly effective at controlling emergence of Alyssum spp. for 2 yr. Richness and Shannon’s diversity of the nontarget plant community were significantly lower in sprayed plots than in the control, and both decreased along the elevation gradient. These reductions were due to a decrease in perennial forbs and native annual forbs in the sprayed plots; perennial graminoids were not affected. Overall, the aboveground and seedbank community composition was negatively impacted by indaziflam, and these effects were strongest for the native annual forbs that rely on annual regeneration from the seedbank. The effects of this herbicide to the nontarget community should be evaluated beyond the length of our study time; however, we conclude that indaziflam should likely be reserved for use in areas that are severely invaded and have seedbanks that are composed of nondesirable species rather than diverse, native mountain sagebrush communities.

Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.

In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.

This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.