Digital Commons Network^™

Estate Planning: Significant Recent Developments Concerning Estate Planning, Byrle M. Abbin

Tax Adviser

No abstract provided.

Private Foundations And Tax Reform: Mandatory Income And Corpus Distributions, William J. Lehrfeld

Tax Adviser

No abstract provided.

Impact Of The Tax Reform Act Of 1969 On Trust And Estate Planning, Abraham J. Briloff

Tax Adviser

No abstract provided.

Simplifying The Operation Of Sec. 367, Robert T. Cole

Tax Adviser

No abstract provided.

The Tax Adviser, Volume 2, Number 3, March 1971, American Institute Of Certified Public Accountants

Tax Adviser

No abstract provided.

Index: Subject Index—12 Months Ended February 1971; Author Index—12 Months Ended February 1971, American Institute Of Certified Public Accountants

Tax Adviser

No abstract provided.

Tax Trends, Harry Z. Garian

Tax Adviser

No abstract provided.

Rock Outcropping, Kaliakra Peninsula, Black Sea, Bulgaria, Barbara L. Gracious

HCA Healthcare Journal of Medicine

This photo, taken in June 2024 at the Northern Bulgarian Black Sea Coast, captures our fleeting time against that of ocean and rocks.

Cape Kaliakra (“Beautiful Headland”) has been fought over by various tribes and groups across centuries. Succession included the Dacians, Greeks, Ottoman Turks, the Russian Navy, and in the last century, the communist government of Bulgaria. Now a nature reserve, dolphins play off the coast and cormorants seek its updrafts.

Cape Kaliakra sits on the Via Pontica, an ancient Greek road and major bird migration route from Africa into Eastern and Northern Europe.

Its beauty and its importance …

Is It Retaliation Or Remediation? Educating Our Learners On The Difference, France M. Leandre, Almari Ginory

HCA Healthcare Journal of Medicine

The goal of this article is to discuss 1 of the questions in the Accreditation Council for Graduate Medical Education Resident/Fellow Survey, which assesses the fear of retaliation in a program. To better understand the needs of residents and facilitate the reporting of concerns, programs must evaluate and educate residents on the difference between remediation and retaliation.

The Mahec Research Certificate Program: A Brief And Introductory Exposure To Key Research Topics For Diverse Learners, Grace E. Flinchum, Emily S. Mazure, Chelsea C. Atkins, Wendy Nuzzo, C Micha Belden, Edward C. Jauch, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background

Research is a core component of health profession training programs, but few efficient training resources exist that provide introductory research training that is brief, freely accessible, and supportive of learners with varying levels of research experience.

Methods

We set out to create the Mountain Area Health Education Center (MAHEC) Research Certificate program to support Graduate Medical Education (GME) residents and other learners. We initially explored existing curricula used to instruct medical and doctor of pharmacy students in order to identify foundational research topics to include in our introductory research program. We were guided by stakeholders to create a curriculum …

Nonglomerular Hypocomplementemic Interstitial Nephritis, Tyler Hemphill, Yogesh Sanghvi

HCA Healthcare Journal of Medicine

Background

Acute interstitial nephritis (AIN) is the most common cause of acute kidney injury (AKI) with subsequent renal impairment and is often underdiagnosed. Acute interstitial nephritis presents with a decline in kidney function and is characterized by an inflammatory infiltrate in the kidney interstitium. It is most often induced by drug therapy and is sometimes followed by infections with unknown causes. In a typical presentation of AIN, there is no evidence of hypocomplementemia; low complement is associated most commonly with autoimmune etiologies. Renal biopsy serves as the most definitive test for both the diagnosis and prognosis of AIN.

Case Presentation …

Spontaneous Pneumomediastinum Following Ingestion Of Bleach, Dish Soap, And Laundry Detergent And Inhalation Of Methamphetamines, Marshall Johnson, Matthew Boss, Alayna S. Buzzetta, Barbara L. Gracious

HCA Healthcare Journal of Medicine

Introduction

Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in patients without an observable traumatic cause. Pneumomediastinum is a somewhat rare condition that occurs 1 in every 25 000 individuals, aged 5 to 34 years old, with 76% occurring in men. Pneumomediastinum can further be divided into 2 categories: SPM and traumatic pneumomediastinum. Traumatic pneumomediastinum is most commonly seen with blunt force trauma or any iatrogenic procedures to the chest wall. Spontaneous pneumomediastinum frequently occurs due to air leaking through small alveolar sacs, which rupture within the surrounding bronchovascular sheath. Spontaneous pneumomediastinum …

Use Of Topical Hemostatic Agents In A Gynecologic Patient With Coagulopathy, Alexis O'Connell, Syeda Zainab Shah

HCA Healthcare Journal of Medicine

Introduction

The use of topical hemostatic agents has become common during surgical interventions. There is a wide variety of substances available to augment clotting, ranging from physical agents to topical thrombin combinations. Application of these agents in gynecologic surgery in patients with existing coagulopathies has not been studied.

Case Presentation

A 62-year-old woman with an inferior vena cava filter and a history of multiple deep vein thromboses presented to the clinic with pelvic pain, stress urinary incontinence, and uterovaginal prolapse. She underwent a total vaginal hysterectomy, sacral colpopexy, tension-free vaginal tape sling, and cystourethroscopy. Warfarin was cross titrated to enoxaparin …

Utilizing Femoral Metaphyseal Sleeves In Primary Total Knee Arthroplasty For Post-Traumatic Osteoarthritis: A Case Report, Zachary Sukin, Adam Dentinger, Jeremiah Earl

HCA Healthcare Journal of Medicine

Background

Total knee arthroplasty in younger patients presents a heightened risk of postoperative complications and implant failures compared to older populations, particularly in those with posttraumatic arthritis. These challenges necessitate careful consideration and specialized approaches to optimize the outcomes in this patient demographic.

Case Presentation

A 43-year-old man presented with left knee pain resulting from a traumatic lawn mower injury, causing an intraarticular distal femur, at the age of 6. The injury led to a limb-length discrepancy for which he underwent 2 limb-lengthening procedures in his early 20s. Radiographs demonstrated advanced posttraumatic osteoarthritis, and the patient elected to proceed with …

Upper Respiratory Tract Infection Leading To A New Diagnosis Of Sweet Syndrome And Monoclonal Gammopathy Of Unknown Significance, Nidhi Rawat, Meron Gebrehiwot, Jason Raw, Jeyaprakash Ramachandran

HCA Healthcare Journal of Medicine

Background

We present a rare case of Sweet syndrome with underlying monoclonal gammopathy of unknown significance (MGUS) which initially presented as upper respiratory tract infection.

Case Presentation

A 52-year-old woman presented with a complaint of sore throat for 6 days, productive cough and fever for 5 days, and red, pruritic, circular, tender rashes on face, arms and trunk for 2 days. There was a past history of similar self-limiting rashes presenting intermittently for 1.5 years. She also reported to be taking tablet ibuprofen, as required for the past 1-2 years, for cervical spondylosis. On integumentary examination, widespread, red, tender, annular …

Capacity Over Cognition: A Case Of High-Risk Disease And Homelessness, Mikalah E. Maury, Avery M. Duncan, Rebecca A. Taylor, Mary Ann Beil, Maulikkumar A. Patel

HCA Healthcare Journal of Medicine

Background

Medical decision-making in indigent patients with baseline cognitive deficits and lack of supportive resources is a difficult problem that reveals many ethical issues. Performing high-level medical procedures (eg, invasive surgery, chemotherapy, radiation therapy) on these patients without supportive resources brings into question the efficacy and necessity of treatment if it places the patient at higher risk of additional complications and mortality.

Case Presentation

In this article, we present a case of a 62-year-old indigent man with a long history of encephalopathy secondary to alcohol abuse, presenting with an aggressive head and neck cancer impacting his quality of life.

Conclusion …

Rapid Percutaneous Nephrostomy Stent Encrustation In Pregnancy: Navigating Your Stone Challenge, Victor M. Feldbaum, Roberto Morales, Shawn R. Ramsey, Michael L. Douso

HCA Healthcare Journal of Medicine

Background

Surgical management of kidney stones in pregnancy can be a serious problem for both mother and fetus.

Case Presentation

A 20-year-old woman with a second trimester pregnancy presented to the emergency room with renal calculi. She required surgical intervention and a left nephrostomy tube after consultation with urology. Five weeks later, her tube was solidified in place unbeknownst to her care team. She required several surgeries, dealt with encrustation remnants, infections, radiation exposure, persistent infection requiring antibiotic management, and, ultimately, an early delivery at 37 weeks.

Conclusion

At the time of writing, this was the first case to describe …

Rectal Fidaxomicin As Salvage Therapy In Fulminant Clostridioides Difficile Infection After Total Colectomy: A Case Report, Akankcha Alok, Mohamed Ismail, Stephanie Pino Fabara, Mohammed Al Said, Vidya Sagar Kollu

HCA Healthcare Journal of Medicine

Introduction

Clostridioides difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea and colitis, ranging from mild to severe and potentially life-threatening conditions, like fulminant colitis with toxic megacolon and bowel perforation. The 2021 guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend vancomycin and metronidazole for fulminant CDI (FCDI), with consideration of rectal vancomycin for cases with ileus. Fidaxomicin, though preferred for initial and recurrent CDI treatment, is not the first line for FCDI due to limited evidence. Fidaxomicin has a narrow spectrum of activity only targeting C difficile and …

Clinical Images Of Cutaneous Horns In Patients Presenting To A Family Medicine Residency Practice, Julia Fashner, Tillie Schumann

HCA Healthcare Journal of Medicine

We detail 2 cases of cutaneous horn, also referred to as cornu cutaneum, which is a hard-compacted linear outgrowth of keratin that projects above the skin. We present these images to increase awareness for all medical specialties who may see a patient with this skin lesion.

Clinical Characteristics Associated With Hospital Mortality And Length Of Stay Among Older Adults Admitted With Delirium: Retrospective Analysis, Se Won Lee, Jeff J. Kim, Cole Kretchmar, Napatkamon Ayutyanont, Mooyeon Oh-Park

HCA Healthcare Journal of Medicine

Background

Limited information exists on the characteristics of older adults admitted with delirium at risk of poor hospital outcomes. This study aims to identify risk factors present on admission that are associated with hospital mortality and length of stay (LOS) among older adults admitted with delirium.

Methods

This is a retrospective study of 5598 patients 65 years of age or older who were admitted to acute care units at 8 community hospitals with an International Statistical Classification of Diseases, Tenth Revision code of delirium.

Results

Multivariate regression analyses revealed that in-hospital mortality increase was associated with increased age, Asian race, …

Can The Combination Of White Blood Cell Count And C-Reactive Protein Rule Out Pediatric Appendicitis, A Retrospective Analysis?, Scott Gutovitz, Samantha Stoner, Jarrett Koper, Sarah Kleist

HCA Healthcare Journal of Medicine

Background

Pediatric appendicitis (PA) is the most frequent cause of pediatric emergency surgery. Standard PA scoring systems incorporate inflammatory biomarkers (white blood cell count [WBC] or C-reactive protein [CRP]); however, the individual biomarker sensitivities have not been reported beyond single-center sites. We aimed to measure the individual and combined sensitivities of WBC and CRP to rule out PA in a large multicenter hospital system.

Methods

We did a retrospective study of pediatric emergency department patients (age <18) with abdominal pain, using a deidentified electronic health database from a 175-hospital system in the United States, comparing PA versus non-PA patients. Pediatric appendicitis patients were identified by ICD-10 diagnosis codes and had advanced imaging, whereas non-PA patients had advanced imaging and were discharged home with the ICD-10 code for abdominal pain. Using matched propensity matching, we calculated receiver operator characteristics and Youden’s index to find the optimal cutpoints. Sensitivity was calculated at the optimal and traditional cutpoints for each biomarker, also combined in parallel fashion.

Results

We identified 7414 subjects (3707 PA matched to 3707 controls). The WBC in PA patients was 14.99 ± 5.00 k/mm³ versus 9.63 …

Beyond The Norm: Decoding Spontaneous Coronary Artery Dissection As An Unusual Cause Of Acute Coronary Syndrome, Holden Zimmerman, Himanshi Banker, Inder P. Kaur, Jaskaran Munjal, Vasu Gupta, Ayushi Garg, Nikita Garg, Meet Patel, Rohit Jain

HCA Healthcare Journal of Medicine

Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of myocardial infarction among young women, particularly during pregnancy. As the name suggests, SCAD is caused by the spontaneous formation of the false lumen within the coronary artery wall, thus compromising the blood flow to the myocardium. Unlike atherosclerotic acute coronary syndromes, SCAD is not directly associated with diabetes or hypertension; moreover, underlying connective tissue defects and inflammation are considered more contributory towards its etiology. Although its pathophysiology is not well understood, multiple theories have been proposed. Clinically, SCAD has a similar presentation to acute coronary syndromes, including substernal chest …

Response: Letter To The Editor, Exercise Is A Vital Sign, Megan Dannemiller, Anthony Shadiack, Marvin Sineath Jr, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G. Flynn

HCA Healthcare Journal of Medicine

This letter is submitted in response to the letter to the editor regarding the authors’ article “Exercise Is a Vital Sign.”

Exercise Promotes Health But Is Not A Vital Sign, Jacob Draves, Halil Tekiner, Steven H. Yale, Eileen S. Yale

HCA Healthcare Journal of Medicine

The term “vital sign” has been attached to at least 83 conditions, symptoms, or phenomena in the literature to highlight their role and importance in overall health and well-being. This has created considerable confusion and overlapping terms in the medical literature. The 4 time-honored vital signs include temperature, pulse, blood pressure, and respiration. Two other measurements, blood oxygen saturation, and capnography (end-tidal CO2) are considered the fifth and sixth vital signs, respectively. The authors argue that exercise should be named a vital sign, and several authors have designated it as the fifth vital sign. However, not all symptoms or phenomena, …

Three Good Things And Family Process, Julia Prouty

Journal of Undergraduate Research at Minnesota State University, Mankato

There is a need for adaptive and affordable prevention/intervention strategies to promote happiness, health, and well-being in families. Three Good Things (3GT) is a free exercise from the field of positive psychology meant to shift an individual’s focus and perceptions towards gratitude. 3GT promotes focusing on gratitude by reflecting on what an individual is grateful for from the past day/week. Persons are encouraged to write down and share their 3GT with another individual. A mindset of gratitude is closely associated with improved happiness, health, and well-being. The exercise of reflecting on 3GT is adaptive to most individuals/families. To date, most …

A Case Study On The Use Of Cultural Violence And Its Contribution To The Third Reich's 'Euthanasia' Program, Grace Larsen

Journal of Undergraduate Research at Minnesota State University, Mankato

The genocidal actions taken by the Third Reich during the mid-20th century were horrific and dehumanizing. While the Holocaust often focuses on the tragic genocide that occurred against the Jewish people carried out by the Third Reich, the genocide that they carried out against the disabled community is often overlooked. With the deaths of tens of thousands of disabled people occurring through this genocide, it is important to understand how this genocide occurred, without any worldwide protest. Nazi Leaders including Alfred Rosenberg, Adolf Hitler, and Ernest Rüdin used widespread cultural indoctrination to dehumanize the disabled community and horrifically justify their …

Exploring Cultural Perspectives On Autism Spectrum Disorder: A Literature Review, Carly A N Kuhlman

Journal of Undergraduate Research at Minnesota State University, Mankato

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impairments in personal, social, academic, or occupational functioning. Despite its universal recognition, perceptions and responses to autism vary widely across different cultural contexts. This paper explores the impact of cultural perspectives on the diagnosis, intervention, and support for individuals with autism. It highlights how cultural beliefs, values, and societal norms shape the understanding and management of ASD, revealing significant differences in diagnostic practices and support systems around the world. The paper discusses how cultural factors influence the interpretation of autism, using case studies from diverse settings, including Africa, Southeast Asia, …

What We Watch On Social Media Makes An Impact, Gracie G. Johnson

Journal of Undergraduate Research at Minnesota State University, Mankato

Prior research has demonstrated that certain social media content consumed can create unrealistic expectations of themselves; however, some hypothesize that social media provides empowering and supportive spaces. Unfortunately, many studies rely on cross-sectional data, limiting the ability to infer causality. This study looked at one of the most-used social media platforms by teens in the United States, TikTok. For this study, it was predicted that viewing “body check” videos would negatively affect body image. If significant, we could try and restrict those videos from being posted. The findings supported the hypothesis, but not significantly. However, there were quite a few …

From "Pata Pata" To Come Back, Africa: Miriam Makeba And Her Fight Against Apartheid, 1953-1990, Maddie Heiser

Journal of Undergraduate Research at Minnesota State University, Mankato

Perhaps one of the most notorious periods in African history was that of Apartheid – a system of racial, political, social, and economic discrimination placed upon the non-white majority of South Africa. Beginning in 1948 and lasting until the early 1990s, Apartheid marked a significant transformation in not only African liberation movements but also those happening across the globe, including the Civil Rights Movement in the United States. While the efforts to overcome Apartheid and empower the overall messages of African liberation and solidarity are well-documented, there are several methods of achieving these goals that have been unfortunately overlooked. Figures …

The Art Of Movement, Payton Hedderman

Journal of Undergraduate Research at Minnesota State University, Mankato

I wanted to do this project for my Interdisciplinary Studies Capstone to showcase some of my skills and to articulate what I want to do with my degree. I want to go into Medical Illustration, and I want to make science easier for people to learn. To do this I want to take complicated subjects and remake them into simpler terms. For my capstone, I decided to take anatomy of the arm, leg, and abdominal organs and draw them on professional women athletes. I thought that expressing this anatomy in less of a clinical way is one strategy to make …