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This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.

Mass casualty events particularly those requiring multiple simultaneous operating rooms are of increasing concern. Existing literature predominantly focuses on mass casualty care in the emergency department. Hospital disaster plans should include a component focused on preparing for multiple simultaneous operations. When developing this plan, representatives from all segments of the perioperative team should be included. The plan needs to address activation, communication, physical space, staffing, equipment, blood and medications, disposition offloading, special populations, and rehearsal.

OBJECTIVE: US trauma centers (TCs) must remain prepared for mass casualty incidents (MCIs). However, trauma surgeons may lack formal MCI training. The recent COVID-19 pandemic drove multiple patient surges, overloaded Emergency Medical Services (EMS) agencies, and stressed TCs. This survey assessed trauma surgeons MCI training, experience, and system and personal preparedness before the pandemic compared with the pandemics third year. METHODS: Survey invitations were emailed to all 1544 members of the American Association for the Surgery of Trauma in 2019, and then resent in 2022 to 1575 members with additional questions regarding the pandemic. Questions assessed practice type, TC characteristics, training, experience, beliefs about personal and hospital preparedness, likelihood of MCI scenarios, interventions desired from membership organizations, and pandemic experiences. RESULTS: The response rate was 16.7% in 2019 and 12% in 2022. In 2022, surgeons felt better prepared than their hospitals for pandemic care, mass shootings, and active shooters, but remained feeling less well prepared for cyberattack and hazardous material events, compared with 2019. Only 35% of the respondents had unintentional MCI response experience in 2019 or 2022, and even fewer had experience with intentional MCI. 78% had completed a Stop the Bleed (STB) course and 63% own an STB kit. 57% had engaged in family preparedness activities; less than 40% had a family action plan if they could not come home during an MCI. 100% of the respondents witnessed pandemic-related adverse events, including colleague and coworker illness, patient surges, and resource limitations, and 17% faced colleague or coworker death. CONCLUSIONS: Trauma surgeons thought that they became better at pandemic care and rated themselves as better prepared than their hospitals for MCI care, which is an opportunity for them to take greater leadership roles. Opportunities remain to improve surgeons family and personal MCI preparedness. Surgeons most desired professional organization interventions include advocacy, national standards for TC preparedness, and online training. LEVEL OF EVIDENCE: VII, survey of expert opinion.

Recently it has been proposed that impairments related to autism spectrum disorder (ASD) may reflect a more fundamental disruption in time perception. Here, we examined whether in utero exposure to valproic acid (VPA) can generate specific behavioral deficits related to ASD and time perception. Pups from control and VPA groups were tested using fixed-interval (FI) temporal bisection, peak interval, and intertemporal choice tasks. In addition, the rats were assessed on motor function, perseverative and exploratory behavior, anxiety, and memory. The VPA group displayed a leftward shift in timing functions. VPA rats displayed no deficits on the motor and memory tasks, but were significantly different from controls on measures of perseveration and anxiety.

Rodent models are commonly used in behavioral research because they offer increased experimental control and findings often generalizable to humans. However, one possible dilemma is that rodents are primarily nocturnal and research tasks often dismpt their light, rest phase. The present study used a within-subjects design to investigate possible effects of light-dark phase on delay discounting, motor coordination, open field, and elevated-plus maze behavior in Wistar rats. Rats spent significantly more time in the closed arms of the elevated plus maze when tested during the light, rest phase compared to the dark, active phase. There were no differences in motor coordination or delay discounting during the two phases. These results suggest possible important differences in certain behavioral tasks when testing in the light, rest versus dark, active phase for rats--researchers should be aware of these possible differences when planning and conducting experiments and when comparing research findings across laboratories. Keywords Light-dark cycle phase * Anxiety-like behavior * Motor coordination * Delay discounting * Impulsivity * Rats, Circadian rhythms are 'internal clocks' that determine sleep-wake cycles in humans and nonhumans by combining neurophysiological signals with environmental signals to either be awake or asleep (Aschoff, 1965). Interruptions or [...]

Plain language summary Comprehensive biomarker testing is a crucial requirement for the optimal treatment of advanced‐stage non–small cell lung cancer (NSCLC), with emerging relevance in the adjuvant treatment setting. To advance its goal of ensuring optimal therapy for persons diagnosed with lung cancer, the American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) held The Summit on Optimizing Lung Cancer Biomarkers in Practice in September 2020 to align its partners toward the goal of ensuring comprehensive biomarker testing for all eligible patients with NSCLC. The ACS NLCRT's Strategic Plan for Advancing Comprehensive Biomarker Testing in NSCLC, a product of the summit, comprises actions to promote comprehensive biomarker testing for all eligible patients. The approach is multifaceted, including policy‐level advocacy and the development and dissemination of targeted educational materials, clinical decision tools, and guides to patients, physicians, and payers aimed at ameliorating barriers to testing experienced by each of these groups. The ACS NLCRT works to improve care for patients with lung cancer. The ACS NLCRT supports comprehensive biomarker testing as essential to determine treatment options for all eligible patients with non–small cell lung cancer. Many factors lead to some patients not receiving optimal biomarker testing. The ACS NLCRT held a collaborative summit and developed a strategic plan to achieve and promote comprehensive biomarker testing for all patients. These plans include developing educational materials and physician tools and advocating for national policies in support of biomarker testing. The ACS NLCRT works to improve care for patients with lung cancer.The ACS NLCRT supports comprehensive biomarker testing as essential to determine treatment options for all eligible patients with non–small cell lung cancer.Many factors lead to some patients not receiving optimal biomarker testing.The ACS NLCRT held a collaborative summit and developed a strategic plan to achieve and promote comprehensive biomarker testing for all patients.These plans include developing educational materials and physician tools and advocating for national policies in support of biomarker testing. [ABSTRACT FROM AUTHOR]

BACKGROUND & AIMS: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis. METHODS: A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences. RESULTS: Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement. CONCLUSIONS: EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm2) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.

The Gulf sturgeon (Acipenser oxyrinchus desotoi) is a large-bodied, anadromous fish found in drainages of the Gulf coast of the United States from Louisiana to Florida. Like most members of [...]

Objective: The objective of this study was to estimate the population size and annual recruitment of Shortnose Sturgeon Accipenser brevirostrum in the Altamaha River estuary in Georgia, United States, during an 11‐year period. The Shortnose Sturgeon is an endangered fish species that occupies rivers on the east coast of North America. Previous studies have suggested that the Altamaha River supports the largest population of Shortnose Sturgeon in the southern United States; however, the status of the population has not been assessed in 11 years. Methods: We used entanglement gears to capture Shortnose Sturgeon in the Altamaha River estuary, marked them, and used an established statistical method (closed‐population capture–mark–recapture models) to annually estimate total population size and age‐1 recruitment from 2012 to 2022. Result: We were able to estimate the size of age‐1 cohorts in 7 of the 11 years of data collection. Point estimates of annual age‐1 recruitment varied between 113 and 1021 individuals, and total population size varied between 452 (95% confidence interval [CI]: 116–2277) and 5054 individuals (95% CI: 2155–13,267). Conclusion: Recruitment of age‐1 juveniles was variable, suggesting that reproduction success is inconsistent between years in the Altamaha River. The results of this study, in combination with previous work, do not show any clear trends in Altamaha River Shortnose Sturgeon population abundance or recruitment. The population seems to be stable, but in the absence of historical population numbers, it is unclear whether the population should be considered recovered or is stagnated in its recovery. Impact statementEleven years of data indicate that the Altamaha River population of Shortnose Sturgeon appears stable but reproduction is not successful every year. In the absence of historical data, it is unclear whether the population is recovered or stagnated in its recovery. [ABSTRACT FROM AUTHOR]

The shortnose sturgeon (Acipenser brevirostrum) is an imperiled species that is widely distributed along the Atlantic seaboard of the United States (Vladykov and Greeley, 1963; Birstein, 1993; Kynard, 1997; NMFS, [...]

Models of interval timing typically include a response threshold to account for temporal production.  The present study sought to evaluate the dependent concurrent fixed-interval fixed-interval schedule of reinforcement as a tool for selectively isolating the response threshold in rats, pigeons, and humans.  In this task, reinforcement is available either at one location after a short delay or at another location at a longer delay. Because the reinforced location is not signaled, subjects normally respond on the first location and, if reinforcement is not delivered, then switch to the second location.  The latency to switch between locations served as the primary dependent measure.  After training rats, pigeons, and humans with equal reinforcement magnitudes in the short and long delays, the magnitude of reinforcement was increased threefold on the long-delay location. Consistent with model predictions, this biasing procedure decreased estimates of the response threshold of rats and pigeons, but also reduced temporal control in these species and increased response-threshold estimates in humans.  Human and pigeon performance also suggested a magnitude-induced increase in the speed of the internal clock.  Collectively, these results suggest that differences in reinforcement magnitude between response alternatives appear to modulate the response threshold, but not selectively, and may provide guidance for better isolating response-threshold effects in humans.

Recent research has indicated high economic and environmental costs of human paper usage. Technologies have been developed to reduce consumers' paper use behavior, including mechanical dispensers that institute a delay between opportunities to obtain each consecutive unit. However, there is no empirical evidence that these dispensers or delays reduce paper use. In Experiment 1, implementing a delay between paper-unit deliveries using mechanical dispensers in a university cafe resulted in a significant decrease in units per person, material per person, and cost per person, compared to free-access dispensers. In Experiment 2, a relatively long delay was more effective than a short delay in reducing paper consumption in a laboratory experiment using mechanical dispensers. These results indicate that delays could be used to decrease paper use in many contexts on a larger scale. More research is necessary to determine the underlying behavioral mechanisms responsible for the observed reduction and the cost-benefit relationship under different circumstances. Keywords Reinforcement delays * Paper dispensers * Sustainability * Climate change * Behavioral nudges, Sustainability is rooted in human behavior, which is controlled by variables that can be manipulated (Baum, 2005; Skinner, 1953; Ylek & Steg, 2007). Verbal strategies (e.g., requests, education, information) to [...]

Background: Anaphylaxis is a sudden multisystem allergic reaction which may result in a fatal outcome if not treated promptly. Guidelines worldwide suggest intramuscular adrenaline as the first‐line treatment for anaphylaxis outside a perioperative reaction. Adrenaline autoinjectors (AAIs) are widely used self‐administrable devices, especially in community settings. Different commercial AAIs have been authorized to be marketed in Europe. For an AAI to be efficacious, a rapid adrenaline delivery in patients, including those who are overweight or obese, resulting in an optimal cardiovascular (CV) response, is a key feature. AAIs are designed to achieve this requirement, which is reflected in their differing functional properties such as primary container selection, drug delivery mechanism (cartridge‐or syringe‐based), needle length, needle gauge, and adrenaline dose (150 μg, 300 μg, or 500 μg). However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices. The purpose of this review: Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin‐to‐muscle distances of the participants. [ABSTRACT FROM AUTHOR]

Abstract--The Atlantic sturgeon CAcipenser oxyrinchus oxyrinchus) is an anadromous species that historically occurred in the Atlantic Ocean along the North American coast from maritime Canada to the St. Johns River, [...]

The Atlantic sturgeon (Acipenser oxyrinchus oxyrinchus) is a anadromous fish found along the east coast of North America and is listed under the Endangered Species Act of the United States. Decades of overfishing and habitat degradation have caused range-wide population declines, and the population status of this species in many rivers is unclear. Quantifying annual recruitment is one way to assess the status of sturgeon populations, but such assessments are few. The objective of this study was to quantify recruitment of juvenile Atlantic sturgeon in the Savannah, Ogeechee, and Satilla Rivers in Georgia. Because we used identical methods in 3 rivers simultaneously, we were able to directly compare recruitment among these populations with that of other populations observed in contemporaneous studies in other rivers. We conducted mark-recapture sampling during 2014-2017 and used Huggins closed population models to estimate annual recruitment. Because there are no historical data for comparison, we evaluated the 3 populations in terms of recruit abundance, variation, and consistency. The Savannah River annually had relatively large numbers of recruits (639-937 individuals). Fewer recruits were produced in the Ogeechee (27-57 individuals) and Satilla (51-134 individuals) Rivers; recruitment occurred in only some years in those rivers. Populations that produce few recruits or do not have regular recruitment may be experiencing bottlenecks preventing recovery. [ABSTRACT FROM AUTHOR]

Advances in biomarker‐driven therapies for patients with nonsmall cell lung cancer (NSCLC) both provide opportunities to improve the treatment (and thus outcomes) for patients and pose new challenges for equitable care delivery. Over the last decade, the continuing development of new biomarker‐driven therapies and evolving indications for their use have intensified the importance of interdisciplinary communication and coordination for patients with or suspected to have lung cancer. Multidisciplinary teams are challenged with completing comprehensive and timely biomarker testing and navigating the constantly evolving evidence base for a complex and time‐sensitive disease. This guide provides context for the current state of comprehensive biomarker testing for NSCLC, reviews how biomarker testing integrates within the diagnostic continuum for patients, and illustrates best practices and common pitfalls that influence the success and timeliness of biomarker testing using a series of case scenarios. [ABSTRACT FROM AUTHOR]