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Background: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. Objective: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. Methods: A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged >= 50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Results: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. Conclusion: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy. Refereed/Peer-reviewed

High levels of IL1β can result in chronic inflammation, which in turn can promote tumor growth and metastasis. Inhibition of IL1β could therefore be a promising therapeutic option in the treatment of cancer. Here, the effects of IL1β blockade induced by the mAbs canakinumab and gevokizumab were evaluated alone or in combination with docetaxel, anti–programmed cell death protein 1 (anti–PD-1), anti-VEGFα, and anti-TGFβ treatment in syngeneic and humanized mouse models of cancers of different origin. Canakinumab and gevokizumab did not show notable efficacy as single-agent therapies; however, IL1β blockade enhanced the effectiveness of docetaxel and anti–PD-1. Accompanying these effects, blockade of IL1β alone or in combination induced significant remodeling of the tumor microenvironment (TME), with decreased numbers of immune suppressive cells and increased tumor infiltration by dendritic cells (DC) and effector T cells. Further investigation revealed that cancer-associated fibroblasts (CAF) were the cell type most affected by treatment with canakinumab or gevokizumab in terms of change in gene expression. IL1β inhibition drove phenotypic changes in CAF populations, particularly those with the ability to influence immune cell recruitment. These results suggest that the observed remodeling of the TME following IL1β blockade may stem from changes in CAF populations. Overall, the results presented here support the potential use of IL1β inhibition in cancer treatment. Further exploration in ongoing clinical studies will help identify the best combination partners for different cancer types, cancer stages, and lines of treatment.

Periprosthetic femoral fractures (PFF) in total hip arthroplasty (THA), especially those in contact with the diaphyseal stem, carry high morbidity. This study evaluated how stem design influences the risk of early Vancouver B PFF or other PFF requiring operative intervention after THA.A multi-center, retrospective study of 3,433 primary cementless THAs performed from 2014 to 2021 included 2,302 single-taper (micro M/L [n=1169]; M/L [n=1133]) and 1,131 double-taper (fit-and-fill [n=420]; compaction-collared [n=711]) stems. Mean follow-up was 2.2 years (range, 0.3 to 6.5). Primary outcomes were Vancouver B and surgically treated postoperative PFFs among differing femoral stems. Secondary outcomes included rates of intraoperative and postoperative Vancouver A and C PFFs.Forty-five postoperative PFFs (1.3%) occurred within 8.8 weeks (median), 25 of which were Vancouver B [0.7%] and 20 total PFFs that required operative intervention [0.6%]). Compaction-collared stems had a decreased risk of Vancouver B (HR 0.18, 95% CI: 0.03 - 0.97 p=0.044) and any surgically treated PFF (HR 0.10, 95% CI: 0.01 - 0.95; p=0.037). Intraoperative PFFs were most common with fit-and-fill stems (3.6%, p0.001) and Vancouver A with compaction-collared stems (1.8%, p0.001). The cohort with PFF had a higher Charlson comorbidity index (p=0.004), more women (p=0.001), more Dorr A or C femora (p=0.013), and more posterior or lateral surgical approaches compared to those without PFF (p≤0.001).After controlling for confounding variables, compaction-collared stems had a significantly lower risk of postoperative Vancouver B and PFF requiring operative treatment than single- and double-taper stems.

Background Phosphorylation is important in skeletal muscle development, growth, regeneration, and contractile function. Alterations in the skeletal muscle phosphoproteome due to aging have been reported in males; however, studies in females are lacking. We have demonstrated that estrogen deficiency decreases muscle force which correlates with decreased myosin regulatory light chain phosphorylation. Thus, we questioned whether the decline of estrogen in females that occurs with aging might alter the skeletal muscle phosphoproteome. Methods C57BL/6J female mice randomly assigned to a sham-operated (Sham) or ovariectomy (Ovx) group to investigate the effects of estrogen deficiency on skeletal muscle protein phosphorylation in a resting, non-contracting condition. After 16 weeks of estrogen deficiency, the tibialis anterior muscle was dissected and prepped for label-free nano-liquid chromatography tandem mass spectrometry phosphoproteomic analysis. Results We identified 4,780 phosphopeptides in tibialis anterior muscles of ovariectomized (Ovx) and Sham-operated (Sham) control mice. Further analysis revealed 647 differentially regulated phosphopeptides (Benjamini – Hochberg adjusted p-value

Alien insects represent one of the most species rich groups of organisms introduced to Europe, with some responsible for adverse social-economic, human-health, biodiversity and ecosystem impacts. The impacts of invasive alien species, especially on island ecosystems, have been a hot topic of research worldwide. Cyprus is a Mediterranean island at the biogeographic crossroads of Asia, Africa and Europe. This study presents the database of the alien insects of the island of Cyprus as a whole, created through an extensive review including grey literature and online sources. The Alien to Cyprus Entomofauna (ACE) triples the known number of alien insects and adds supplemental information to existing species. Data concerning a total of 349 alien insects are presented alongside an updated checklist and recommendations for informing management. The status of alien insects on the island, their origin, trophic guilds, establishment, pathways of introduction and impacts are discussed. Developing an alien species inventory for the island is challenging due to its geographic position and the increasing movement of people and goods leading to new species introductions. This publication constitutes an important first step towards providing information for effective actions to tackle invasive alien insects on Cyprus. The checklist and accompanying information can underpin understanding of the status and trends of alien species including providing information for risk assessments. ACE will continue to be maintained and updated as new records for Cyprus are made.

Purpose: To analyze the postoperative course, specifically postoperative complications, of pediatric patients who underwent cataract surgery by a single surgeon. The type of wound closure was compared to provide an evidence-based approach to surgical technique in pediatric cataract surgery. Methods: This retrospective study analyzed pediatric patients who underwent cataract extraction by a single surgeon from 2014 to 2020. Excluded from the study were patients with postoperative follow-up of less than 1 month. The primary outcome compared postoperative complications between patients with sutured and sutureless wound closure. Other outcomes analyzed included intraocular pressure, mean corrected distance visual acuity, and incidence of procedure needed to remove posterior capsule opacification. Results: The study comprised 116 eyes with sufficient follow-up; 86 had sutureless wound closure and 30 had sutured wound closure. An intraocular lens was placed in 52% of eyes in the sutureless group and in 80% of eyes in the sutured group. There was no statistically significant difference between preoperative and postoperative intraocular pressure between groups. The best corrected distance visual acuity was better in the sutured group at 6 months but not at the most recent follow-up visit. No cases of endophthalmitis were found in either group. There was no statistically significant difference between the incidence of retinal detachments and iris prolapse. Conclusions: The incidence of endophthalmitis, retinal detachment, and iris prolapse was similar between pediatric patients who underwent cataract removal with sutureless versus sutured wound closure. Therefore, it may be reasonable to avoid the suture after pediatric cataract surgery. [ J Pediatr Ophthalmol Strabismus . 2023;60(2):147–151.]

Fast-track and enhanced recovery after cardiac surgical procedures have shown reductions in intensive care unit (ICU) and hospital lengths of stay, with unchanged outcomes. However, cost reduction by an ultra-fast-track protocol after minimally invasive cardiac operations, without compromising clinical benefits, has yet to be demonstrated.A total of 215 consecutive patients underwent robotic-assisted coronary artery bypass grafting, with 156 preoperatively stratified into conventional ICU recovery vs 59 candidates for a defined ICU-bypass protocol involving recovery room and floor care. Of these, 40 candidates completed the protocol, and 19 had conversion-to-ICU recovery. Because of right-skewed distribution, inpatient cost was log-transformed, and linear regression models were constructed to estimate geometric mean ratios (GMRs) comparing inpatient cost for these groups (conventional ICU recovery, ICU-bypass, conversion-to-ICU recovery), adjusted for The Society of Thoracic Surgeons Predicted Risk of Mortality score.Compared with the conventional ICU group, the ICU-bypass group conferred a 15% reduction in total inpatient (GMR, 0.85; P = .0007) and a 14% reduction in total variable direct costs (GMR, 0.86; P = .003). Compared with the conventional ICU group, the ICU-bypass and conversion-to-ICU groups had similar net hospital stay reductions (1.6-1.7 days). Relative to the conventional ICU group, ICU and floor duration were shortened after conversion to ICU, with a trend to reduced costs. Cardiac arrest, 30-day mortality, and stroke were absent, and other key adverse events did not differ between groups.A selective, successful ultra-fast-track ICU-bypass protocol for robotic-assisted coronary artery bypass grafting reduces inpatient cost without affecting short-term outcomes. Conversion-to-ICU recovery also maintains outcomes and trends toward reduced costs.

Lung cancer is the second most common cancer in both men and women. Despite smoking cessation efforts and advances in lung cancer detection and treatment, long-term survival remains low. For early-stage primary lung carcinoma, surgical resection offers the best chance of long-term survival; however, only about one-third of patients are surgical candidates. For nonsurgical candidates, minimally invasive percutaneous thermal ablation therapies have become recognized as safe and effective treatment alternatives, including radiofrequency ablation, microwave ablation, and cryoablation. Lung ablation is also an acceptable treatment for limited oligometastatic and oligorecurrent diseases. This article discusses the technologies and techniques available for tumor ablation of thoracic malignancies, as well as new treatments on the horizon.

Breast implants whether used for cosmetic or reconstructive purposes can be placed in pockets either above or below the pectoralis major muscle, depending on clinical circumstances such as subcutaneous tissue volume, history of radiation, and patient preference. Likewise, cardiac implantable electronic devices (CIEDs) can be placed above or below the pectoralis major muscle. When a patient has both devices, knowledge of the pocket location is important for procedural planning and for durability of device placement and performance. Here, we report a patient who previously failed subcutaneous CIED placement due to incision manipulation with prior threatened device exposure requiring plane change to subpectoral pocket. Her course was complicated by submuscular migration of the CIED into her breast implant periprosthetic pocket. With subcutaneous plane change being inadvisable due to patient noncompliance, soft tissue support of subpectoral CIED placement with an acellular biologic matrix (ABM) was performed. Similar to soft tissue support used for breast implants, submuscular CIED neo-pocket creation with ABM was performed with durable CIED device positioning confirmed at 9 months postprocedure.

BackgroundNitrous oxide promotes absorption atelectasis in poorly ventilated lung segments at high inspired concentrations. The Evaluation of Nitrous oxide In the Gas Mixture for Anesthesia (ENIGMA) trial found a higher incidence of postoperative pulmonary complications and wound sepsis with nitrous oxide anesthesia in major surgery compared to a fraction of inspired oxygen of 0.8 without nitrous oxide. The larger ENIGMA II trial randomized patients to nitrous oxide or air at a fraction of inspired oxygen of 0.3 but found no effect on wound infection or sepsis. However, postoperative pulmonary complications were not measured. In the current study, post hoc data were collected to determine whether atelectasis and pneumonia incidences were higher with nitrous oxide in patients who were recruited to the Australian cohort of ENIGMA II.MethodsDigital health records of patients who participated in the trial at 10 Australian hospitals were examined blinded to trial treatment allocation. The primary endpoint was the incidence of atelectasis, defined as lung atelectasis or collapse reported on chest radiology. Pneumonia, as a secondary endpoint, required a diagnostic chest radiology report with fever, leukocytosis, or positive sputum culture. Comparison of the nitrous oxide and nitrous oxide–free groups was done according to intention to treat using chi-square tests.ResultsData from 2,328 randomized patients were included in the final data set. The two treatment groups were similar in surgical type and duration, risk factors, and perioperative management recorded for ENIGMA II. There was a 19.3% lower incidence of atelectasis with nitrous oxide (171 of 1,169 [14.6%] vs. 210 of 1,159 [18.1%]; odds ratio, 0.77; 95% CI, 0.62 to 0.97; P = 0.023). There was no difference in pneumonia incidence (60 of 1,169 [5.1%] vs. 52 of 1159 [4.5%]; odds ratio, 1.15; 95% CI, 0.77 to 1.72; P = 0.467) or combined pulmonary complications (odds ratio, 0.84; 95% CI, 0.69 to 1.03; P = 0.093).ConclusionsIn contrast to the earlier ENIGMA trial, nitrous oxide anesthesia in the ENIGMA II trial was associated with a lower incidence of lung atelectasis, but not pneumonia, after major surgery.Editor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is New

DNA glycosylase MutY plays a critical role in suppression of mutations resulted from oxidative damage, as highlighted by cancer-association of the human enzyme. MutY requires a highly conserved catalytic Asp residue for excision of adenines misinserted opposite 8-oxo-7,8-dihydroguanine (OG). A nearby Asn residue hydrogen bonds to the catalytic Asp in structures of MutY and its mutation to Ser is an inherited variant in human MUTYH associated with colorectal cancer. We captured structural snapshots of N146S Geobacillus stearothermophilus MutY bound to DNA containing a substrate, a transition state analog and enzyme-catalyzed abasic site products to provide insight into the base excision mechanism of MutY and the role of Asn. Surprisingly, despite the ability of N146S to excise adenine and purine (P) in vitro, albeit at slow rates, N146S-OG:P complex showed a calcium coordinated to the purine base altering its conformation to inhibit hydrolysis. We obtained crystal structures of N146S Gs MutY bound to its abasic site product by removing the calcium from crystals of N146S-OG:P complex to initiate catalysis in crystallo or by crystallization in the absence of calcium. The product structures of N146S feature enzyme-generated β-anomer abasic sites that support a retaining mechanism for MutY-catalyzed base excision.

The purpose of this study was to evaluate the Pitt Personal Wellness Program, three 1-hour workshops that were integrated into the first-semester curriculum of five health sciences graduate programs. The workshops were designed as a personalized education approach to promote self-care and well-being. One-hundred and fifty-six graduate students (n=156) participated in the Pitt Personal Wellness Program. Sixty-five percent (65%) of participants completed on-line questionnaires regarding stress and coping at three time points across a 14-week period, before the program, after workshop 2, and after workshop 3. Graduate students reported significant decreases in perceived stress and number of stressful situations across the three timepoints. Students who reported previous history of mental health counseling demonstrated steeper declines in perceived stress across time points 1 and 2 and reported significantly higher use of coping strategies across the three timepoints. Racially minoritized students and those reporting more financial struggles also reported significant declines in stress and number of stressors across time points 1 and 2. The Pitt Personal Wellness Program was acceptable to graduate students and a promising program for further dissemination and study.

The COVID-19 pandemic has disrupted access to, adherence to, and perceptions of routine vaccinations. We developed the Shift in Vaccine Confidence (SVC) survey tool to assess the impact of the pandemic on routine vaccinations, with a focus on the HBV vaccine, in Kinshasa, Democratic Republic of Congo (DRC). This study describes the content validation steps we conducted to ensure the survey tool is meaningful to measure changes in vaccine confidence to regular immunization (HBV vaccine) due to the pandemic. Three rounds of stakeholder feedback from a DRC-based study team, content and measurement experts, and study participants allowed us to produce a measure with improved readability and clarity.

Patients with mild traumatic brain injury (TBI) and intracranial hemorrhage often receive neurosurgical consultation. However, only a small proportion of patients require intervention. Our hypothesis is that low-risk minimal TBI patients managed without immediate neurosurgical consultation will have a reasonable safety and effectiveness outcome profile.A non-neurosurgical management protocol for adult minimal TBI was implemented at a level I trauma center as an interdisciplinary quality-improvement initiative in November 2018. Minimal TBI was defined as Glasgow Coma Scale (GCS) of 15 secondary to blunt mechanism, without anticoagulant or antiplatelet therapy, and isolated pneumocephalus and/or traumatic subarachnoid hemorrhage on head CT imaging. Safety was assessed by in-hospital mortality, neurosurgical interventions, and ED revisits within two weeks of discharge. Effectiveness was assessed by neurosurgical consult rate and length of stay. Outcomes were compared 8-months pre- and post-protocol implementation.A total of 97 patients were included, of which 49 were pre-protocol and 48 were post-protocol There was no difference in rates of in-hospital mortality [0 (0%) vs 0 (0%)], neurosurgical procedure [1 (2.1%) vs 0 (0%)], operations [0 (0%) vs 0 (0%)], and ED revisits [1 (2.0%) vs 2 (4.2%), p = 0.985] between the periods. There was a significant reduction in neurosurgical consults post-protocol implementation (92% vs 29%, p0.001).A protocol for minimal TBI patients effectively reduced neurosurgical consultation without changes in safety profile. Such an interdisciplinary management protocol for low-risk neurotrauma can effectively utilize the neurosurgery consult services by stratifying neurologically stable TBI patient.

Cellular mechanotransduction plays a central role in fibroblast activation during fibrotic disease progression, leading to increased tissue stiffness and reduced organ function. While the role of epigenetics in disease mechanotransduction has begun to be appreciated, there is little known about how substrate mechanics, particularly the timing of mechanical inputs, regulate epigenetic changes such as DNA methylation and chromatin reorganization during fibroblast activation. In this work, we engineered a hyaluronic acid hydrogel platform with independently tunable stiffness and viscoelasticity to model normal (storage modulus, G’ ∼ 0.5 kPa, loss modulus, G’’ ∼ 0.05 kPa) to increasingly fibrotic (G’ ∼ 3.5 and 8 kPa, G’’ ∼ 0.05 kPa) lung mechanics. Human lung fibroblasts exhibited increased spreading and nuclear localization of myocardin-related transcription factor A (MRTF-A) with increasing substrate stiffness within 1 day, with these trends holding steady for longer cultures. However, fibroblasts displayed time-dependent changes in global DNA methylation and chromatin organization. Fibroblasts initially displayed increased DNA methylation and chromatin decondensation on stiffer hydrogels, but both of these measures decreased with longer culture times. To investigate how culture time affected the responsiveness of fibroblast nuclear remodeling to mechanical signals, we engineered hydrogels amenable toin situsecondary crosslinking, enabling a transition from a compliant substrate mimicking normal tissue to a stiffer substrate resembling fibrotic tissue. When stiffening was initiated after only 1 day of culture, fibroblasts rapidly responded and displayed increased DNA methylation and chromatin decondensation, similar to fibroblasts on static stiffer hydrogels. Conversely, when fibroblasts experienced later stiffening at day 7, they showed no changes in DNA methylation and chromatin condensation, suggesting the induction of a persistent fibroblast phenotype. These results highlight the time-dependent nuclear changes associated with fibroblast activation in response to dynamic mechanical perturbations and may provide mechanisms to target for controlling fibroblast activation.

Background: Intra-articular hyaluronic acid (HA) injections in non-cancer patient populations have shown some positive outcomes in treating avascular necrosis, however outcomes in the oncology population are scarce. This pilot study describes 7 oncology patients who received ultrasound-guided HA injections and their associated outcomes. Case Report: This study included 4 female and 3 male patients with radiographic evidence of avascular necrosis. Six of the patients had avascular necrosis of the hip, while one patient had avascular necrosis of the shoulder. All patients underwent single or multiple ultrasound-guided injection(s) of hyaluronic acid to the affected joint. Outcomes were tracked using a combination of subjective pain and functional improvement and/or numeric pain scale. Five patients had improvement in their symptoms, while 2 patients did not. Conclusion: Intra-articular HA may be a viable alternative to the treatment of avascular necrosis in oncology patients. Key words: Avascular necrosis, cancer pain, case series, hyaluronic acid, joint pain

Purpose: The authors conducted a systematic review of single-case experimental designs that included individuals with autism spectrum disorder and/or intellectual disability who used speech-generating devices (SGDs) for communication. The purpose of this study was to review subjective and normative pre- and post-intervention social validity data, in addition to the cost, acceptability, and feasibility of the SGDs used in the studies. The authors also studied trends in the reporting of pre- and post-intervention data over time. Method: A systematic review of 7,327 articles resulted in 86 articles that met design quality criteria and included participants who used SGDs. A group of raters completed interrater reliability for all stages of the review. Results: Researchers reported more subjective than normative data. Few studies reported on the price of the SGD or the person who purchased the SGD. More researchers reported using an SGD with more than one use, but few solicited feedback about the SGD used during the intervention. Few researchers reported information about the portability of the device or the operation effort. Conclusions: Reporting on social validity represents a substantial limitation in experimental studies. Future work incorporating less biased/more objective measures is important for the creation of socially valid interventions.

The flavor of inhaled e-cigarette aerosols may be augmented using crushable flavor capsules added to e-cigarettes. For example, Puff Krush contains breakable flavor capsules in a sorbent material. The capsules are crushed, and then, aerosol passes through the saturated sorbent material before inhalation. Herein, we used NMR and GC-MS to identify the capsule medium chain triglyceride (MCT) solvent and flavorants in selected Puff Krush flavor capsules and then determined which molecules from the capsule transfer into aerosols. MCTs from the Puff Krush were not found in the aerosols, and ∼50% of Puff Krush flavorants transferred into the aerosol upon vaping.

Nurses at this Magnet®-recognized, National Cancer Institute-designated comprehensive cancer center restructured an existing clinical ladder program based on Benner's model and implemented an evidence-based progressive career development program for staff nurses. The revised program defines structured performance expectations and requirements for promotion and role maintenance, which encourage individual engagement and accountability. This article describes the creation and implementation of the clinical advancement program as well as outcomes of the 1st 10 years of the program.

To investigate the suitability of 6 rod- or cone-mediated dark adaptation (DA) parameters as outcome measures for clinical trials in age-related macular degeneration (AMD), including their retest reliability, association with age and disease severity, and measurable longitudinal change over time.Prospective, longitudinal study (Clinicaltrials.gov: NCT01352975).A total of 191 patients with AMD and older participants followed longitudinally over 5 years.Dark adaptation testing was performed using the AdaptDx dark adaptometer with a maximum test time of 40 minutes. A 2-part exponential-linear curve was fitted to obtain values for cone decay, cone plateau, time to rod-cone break, rod intercept time (RIT), rod adaptation rate (S2), and area under the curve. Intersession retest reliability was assessed in tests performed within 2 weeks using the Bland-Altman analysis. The relationship of DA parameters with age, AMD severity, and reticular pseudodrusen (RPD) presence was evaluated using linear mixed models.Retest reliability, association with disease severity, and longitudinal change of 6 DA parameters.A total of 1329 DA curves were analyzed. Rod intercept time was the parameter that showed the greatest reliability (intraclass correlation coefficient of 0.88) and greatest association with age, AMD severity, and RPD (marginal RAge-related macular degeneration severity and RPD presence are each associated with large differences in multiple DA curve parameters. In addition, substantial differences in some parameters occur with age, even accounting for AMD severity and RPD status. This supports the 2-hit hypothesis of age and disease status on DA (and perhaps AMD pathophysiology itself). Of the DA parameters, RIT has the highest retest reliability, closest correlation with AMD severity and RPD, and largest longitudinal changes. This underscores the suitability of RIT as an outcome measure in clinical trials. The cone plateau increases only in advanced stages of kinetic rod dysfunction, indicating rod dysfunction preceding cone dysfunction and degeneration in the temporal sequence of pathology in AMD.

A 6-year, male intact Coonhound, was presented for unilateral scrotal enlargement of roughly 3 months’ duration. His left side scrotum was markedly enlarged and edematous and both testes palpated normal. Rapid slide agglutination test (for brucellosis) and SNAP 4DX (IDEXX Laboratories, Inc., Westbrook, ME) test (for tick-borne disease) were negative. Initial scrotal ultrasonography revealed accumulation of anechoic fluid with hyperechoic flecks and swirling surrounding the left testis. On further ultrasonographic examination, omentum appeared extending through the left inguinal ring and into the scrotum. A case of scrotal hernia with secondary hydrocele was diagnosed. Hydrocele was resolved surgically and the dog returned to full athletic function.

Data assessing outcomes of patients with solid tumors demonstrating septic shock using the Third International Consensus Definitions for Sepsis and Septic Shock are scarce.What are the independent predictors of 28-day mortality in critically ill adults with solid tumors and septic shock?Cohort of solid tumor patients admitted to the ICU with septic shock. Demographic and clinical characteristics were gathered from the electronic health records. We developed a reduced multivariate logistics regression model to identify independent predictors of 28-day mortality and used Kaplan-Meier plots to assess survival.A total of 271 patients were included. The median age was 62 years (range, 19-94 years); 57.2% were men and 53.5% were White. The most common underlying malignancies were lung (19.2%), breast (7.7%), pancreatic (7.7%), and colorectal (7.4%) cancers. Most patients (84.5%) harbored metastatic disease. Twenty-eight days after ICU admission, 188 patients (69.4%) had died. Nonsurvivors showed a higher rate of advanced cancer, longer hospital stays before ICU admission, and higher Sequential Organ Failure Assessment scores at admission and throughout the ICU stay (P .001 for all). The multivariate analysis identified metastatic disease (OR, 3.17; 95% CI, 1.43-7.03), respiratory failure (OR, 2.34; 95% CI, 1.15-4.74), elevated lactate levels (OR, 3.19; 95% CI, 1.90-5.36), and Eastern Cooperative Oncology Group performance scores of 3 or 4 (OR, 2.72; 95% CI, 1.33-5.57) as independent predictors of 28-day mortality. Only 38 patients (14%) were discharged home without medical assistance.The 28-day mortality rate of patients with solid tumors and septic shock was considerably high. Factors associated with worse survival included advanced oncologic disease, poor performance status, high lactate level, and concomitant acute respiratory failure. Early goals-of-care discussions should be considered for frail patients with septic shock and advanced metastatic disease without denying access to the appropriate level of care.

Objectives This pilot project replicated a self-compassion program to support health-care professionals in palliative care settings. We anticipated that undertaking this program would enhance participants’ psychological well-being. Methods Participants were recruited by convenience sampling from palliative care services in an area of Melbourne, Australia. Because of the COVID-19 pandemic, the program was offered online and comprised six once-weekly gatherings. Three survey rounds with identical questions were conducted prior to, immediately after, and 3 months after the training. The surveys consisted of 6 scales: the Self-Compassion Scale, the Santa Clara Brief Compassion Scale, the Cognitive and Affective Mindfulness Scale, the Depression Anxiety Stress Scale, the Professional Quality of Life Scale, and the Interpersonal Reactivity Index Scale. Paired-sample t-test and repeated measures analysis of variance analyses were used to compare participant responses. Results Nine participants working in palliative care completed the training and 3 surveys and included qualitative responses. The experience was overwhelmingly positive. Self-compassion (F = 14.44; p F = 18.44; p Significance of results Participants all worked in a supportive environment, which encouraged self-care. Even against the pandemic difficulties, a short online program was effective, assisting participants to cultivate their inner resources in mindfulness and self-compassion. While a small sample size, expansion of the training may benefit the wider palliative care workforce.