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To investigate the incidence of and identify risk factors associated with poor quality of recovery in dogs recovering from general anaesthesia. Case controlled study. All dogs undergoing general anaesthesia at the University of Liverpool Small Animal Teaching Hospital between January 2020 and January 2021 were eligible for recruitment. Signalment, anaesthetic case management and a recovery score were recorded. Univariable and multivariable logistic and ordinal logistic regression analysis were used to identify factors which impact incidence of poor quality of recovery. A total of 247 dogs undergoing general anaesthesia were included. Overall, 72 [29.1%; 95% confidence interval (CI) 23.8%–35.1%] dogs experienced a poor quality recovery. Of these, 40 (55.5%) required sedation to manage behaviours associated with poor recovery. Multivariable logistic regression revealed American Society of Anesthesiologists (ASA) physical status classification of III or higher was associated with a decreased incidence of poor quality recovery [odds ratio (OR) = 0.34, 95% CI 0.12–0.93, p = 0.037] and the use of multiple inhalational anaesthetics during one procedure was associated with an increased incidence of poor quality of recovery (OR = 42.5, 95% CI 3.0–598.3, p = 0.005). Poor quality recovery is common in dogs recovering from general anaesthesia and sedation is often required for resolution. It is more likely to occur in healthy veterinary patients (ASA I and II). The use of multiple inhalational anaesthetic agents during one procedure should be discouraged as this may increase the likelihood of poor quality of recovery. [ABSTRACT FROM AUTHOR]

The evolution of nursing education requires a combination of strong academic faculty and expert clinicians. Different professional growth and development pathways are necessary to build a robust faculty with clinical and research expertise. Some schools have implemented a formal clinical track (CT) to complement the traditional tenure track for the professional advancement of CT. The article presents a case example of how one institution maintains and advances a strong CT using the Kotter Change Model and discusses future directions. The school's infrastructure for promotion, which follows a similar structure and guidelines as Tenure Track (TT) Promotion and Tenure Guidelines, has led to an increase in the school's scholarly productivity among CT faculty across ranks. Increasing poster and podium presentations as well as publications to a national and international audience results in greater reach and improved reputation for the school, both nationally and internationally. While there is still work to be done to advance equity and inclusion for nursing CTs, developing and maintaining a CT with system-level structures holds significant value and provides a clear path to promotion, invests in clinical scholarship, and includes clinical faculty as full citizens in academia. • Clinical tracks (CTs) further teaching, practice, scholarship, and service missions • CT faculty achieving full citizenship in nursing academia promotes DEI • CT faculty scholarship boosts nursing institutions' academic reputation and ranking. • The strategies presented can build a more robust CT in nursing institutions. • CT faculty demonstrates multidimensional clinical skills, scholarship, and leadership. [ABSTRACT FROM AUTHOR]

To determine whether C-reactive protein (CRP) level is predictive of response to tumor necrosis factor-α blocker treatment in patients with ankylosing spondylitis (AS) and whether there is an optimal CRP range for treatment initiation. In this post hoc analysis, data on etanercept-treated patients with AS were pooled from four randomized trials. Week 12 responses (ASAS20, ASAS50, ASDAS-CRP < 1.3, and ASDAS-CRP ∆ ≤ 1.1) were evaluated in relationship to baseline CRP levels (normal, defined as ≤ upper limit of normal [≤ ULN]; elevated, > ULN; high, > ULN and ≤ 3xULN; and very high, > 3xULN), baseline levels of patient-reported outcomes (PROs), and CRP levels at weeks 2, 4, and 8, using univariate and stepwise predictor analyses. In addition, relationships between baseline CRP and other baseline predictors were analyzed using stepwise models of response. Among 867 patients, baseline CRP levels were normal in 371 (43%) patients, high in 299 (34%), and very high in 197 (23%). Very high baseline CRP was a significant predictor for all four week-12 outcomes, compared with normal CRP. Conversely, normal CRP at weeks 2, 4, and 8 was a stronger predictor of week 12 response than elevated CRP. PROs were less consistent predictors of response. In addition, there was a significant association between higher baseline CRP and lower age of disease onset (< 40 years) and between normal CRP and lower disease burden. In patients with AS, both baseline and post-baseline CRP levels can be predictive of response to treatment at week 12, more consistently than PROs. NCT00421915, NCT00247962, NCT00418548, NCT00356356 [ABSTRACT FROM AUTHOR]

• User focus group and stakeholder panel guide 360-video education innovation design. • Delivery feasible for a 360-video classroom innovation for advanced practice nurses. • High usability of a 360-video clinical scenarios for clinical skill development. Empathy of clinical providers is necessary for patient-centered care. Virtual reality, such as 360-videos, may enable empathy development with thoughtful design. We describe our process and outcomes developing an educational innovation for clinical providers to work with the challenges experienced by the deaf and hard-of-hearing population using 360-videos. A user-centered design-informed process was used to (a) empathize with our patient population using a focus group and stakeholder input, (b) design content for videos with iterative feedback from stakeholders, and (c) feasibility and usability test the innovation. We found multiple areas of concern of our patient population and subsequently created educational scripts for the videos to address these, with iterative refinement by stakeholders. Innovation delivery in the classroom setting with advanced practice nurse students was feasible and had good usability. While initial testing of this 360-video educational innovation was promising, further testing and dissemination strategies are needed. [ABSTRACT FROM AUTHOR]

Hyperhemolysis syndrome (HHS) is an uncommon transfusion reaction described in several hematologic disorders, including sickle cell disease (SCD). HHS is characterized by a decline in hemoglobin (Hb) values below pre-transfusion levels following transfusion of red blood cells (RBCs), coupled with laboratory markers consistent with hemolysis. The proposed pathophysiologic mechanisms underlying HHS include increased phosphatidylserine expression, macrophage activation, and complement dysregulation. Many pathophysiologic mechanisms thought to contribute to HHS have been similarly described in cases of severe COVID-19. A 28-year-old male with a history of HbSS presented with shortness of breath, right-sided chest pain, and a two-day history of fever. Polymerase chain reaction (PCR) detected SARS-CoV-2 infection with the omicron variant. The patient required an RBC transfusion (pre-transfusion hemoglobin [Hb]5.8 g/dL) with an immediate post-transfusion Hb of 6.3 g/dL. However, Hb rapidly declined to 1.7 g/dL, and lactate dehydrogenase (LDH) rose to 8701 u/L. The absolute reticulocyte count of 538 × 109/L correspondingly fell to 29 × 109/L. Despite additional RBC transfusions and initiation of immunosuppressive therapy, he expired on Day 9(D9). Given the similarities in their proposed pathophysiology, patients with SCD and concomitant SARS-CoV-2 infection may be predisposed to developing HHS. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. N/A. N/A. N/A. N/A. Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA. [ABSTRACT FROM AUTHOR]

Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided. • Girls, gender diverse youth, young children, and adolescents are underrepresented in the ADHD treatment literature. • Hispanic/Latine youth and youth from all racial groups other than White are underrepresented in the ADHD treatment literature. • Representation of minoritized and marginalized groups has been improving over time. • Findings underscore the need for researchers to design ADHD treatment studies with careful consideration of increasing representation and measurement of all groups. [ABSTRACT FROM AUTHOR]

Background: Screening facilitates the early identification of fetal alcohol spectrum disorder (FASD) and prevalence estimation of FASD for timely prevention, diagnostic, and management planning. However, little is known about FASD screening tools.Aims: The aims of this systematic review are to identify FASD screening tools and examine their performance characteristics.Methods: Four electronic databases were searched for eligible studies that examined individuals with FASD or prenatal alcohol exposure and reported the sensitivity and specificity of FASD screening tools. The quality of the studies was assessed using the Quality Assessment of Diagnostic Studies-2 tool.Results: Sixteen studies were identified, comprising five fetal alcohol syndrome (FAS) and seven FASD screening tools. They varied in screening approach and performance characteristics and were linked to four different diagnostic criteria. FAS screening tools performed well in the identification of individuals at risk of FAS while the performance of FASD screening tools varied in the identification of individuals at risk of FASD.Conclusion and Implications: Results highlight the vast differences in the screening approaches performance characteristics, and diagnostic criteria linked to FASD screening tools. More research is needed to identify biomarkers unique to FASD to guide the development of accurate FASD screening tools. [ABSTRACT FROM AUTHOR]

Oncolytic viral therapy utilizes a tumor-selective replicating virus which preferentially infects and destroys cancer cells and triggers antitumor immunity. The Western Reserve strain of vaccinia virus (VV) is the most virulent strain of VV in animal models and has been engineered for tumor selectivity through two targeted gene deletions (vvDD). We performed the first-in-human phase 1, intratumoral dose escalation clinical trial of vvDD in 16 patients with advanced solid tumors. In addition to safety, we evaluated signs of vvDD replication and spread to distant tumors, pharmacokinetics and pharmacodynamics, clinical and immune responses to vvDD. Dose escalation proceeded without dose-limiting toxicities to a maximum feasible dose of 3 × 109 pfu. vvDD replication in tumors was reproducible. vvDD genomes and/or infectious particles were recovered from injected (n = 5 patients) and noninjected (n = 2 patients) tumors. At the two highest doses, vvDD genomes were detected acutely in blood in all patients while delayed re-emergence of vvDD genomes in blood was detected in two patients. Fifteen of 16 patients exhibited late symptoms, consistent with ongoing vvDD replication. In summary, intratumoral injection of the oncolytic vaccinia vvDD was well-tolerated in patients and resulted in selective infection of injected and noninjected tumors and antitumor activity. [ABSTRACT FROM AUTHOR]

• A carbonate layer is an important global feature of the Cretaceous-Paleogene boundary. • Micrite is composed of diverse crystal morphologies suggesting a range of origins. • Crystals resemble precipitates from solution and carbonation of vaporized CaO. • Crystals associated with fossil organics resemble calcite precipitated by bacteria. • The layer likely represents global microbial blooms in supersaturated oceans. Microcrystalline calcite (micrite) dominates the sedimentary record of the aftermath of the Cretaceous–Paleogene (K–Pg) impact at 31 sites globally, with records ranging from the deep ocean to the Chicxulub impact crater, over intervals ranging from a few centimeters to more than seventeen meters. This micrite-rich layer provides important information about the chemistry and biology of the oceans after the impact. Detailed high-resolution scanning electron microscopy demonstrates that the layer contains abundant calcite crystals in the micron size range with a variety of forms. Crystals are often constructed of delicate, oriented agglomerates of sub-micrometer mesocrystals indicative of rapid precipitation. We compare the form of crystals with natural and experimental calcite to shed light on their origin. Close to the crater, a significant part of the micrite may derive from the initial backreaction of CaO vaporized during impact. In more distal sites, simple interlocking rhombohedral crystals resemble calcite precipitated from solution. Globally, we found unique calcite crystals associated with fossilized extracellular materials that strikingly resemble calcite precipitated by various types of bacteria in natural and laboratory settings. The micrite-rich layer contains abundant bacterial and eukaryotic algal biomarkers and most likely represents global microbial blooms initiated within millennia of the K–Pg mass extinction. Cyanobacteria and non-haptophyte microalgae likely proliferated as dominant primary producers in cold immediate post-impact environments. As surface-water saturation state rose over the following millennia due to the loss of eukaryotic carbonate producers and continuing river input of alkalinity, "whitings" induced by cyanobacteria replaced calcareous nannoplankton as major carbonate producers. We postulate that the blooms grew in supersaturated surface waters as evidenced by crystals that resemble calcite precipitates from solution. The microbial biomass may have served as a food source enabling survival of a portion of the marine biota, ultimately including life on the deep seafloor. Although the dominance of cyanobacterial and algal photosynthesis would have weakened the biological pump, it still would have removed sufficient nutrients from surface waters thus conditioning the ocean for the recovery of biota at higher trophic levels. [ABSTRACT FROM AUTHOR]