Search

Objective: In 2020, one study by Strait and colleagues raised awareness that the clinical images in rheumatology educational materials underrepresent people with skin of color (P‐SOC). Since then, publishers of rheumatology educational materials have focused on addressing this shortcoming. This study investigates the change in representation of P‐SOC following the review of Strait et al. Methods: We used the methods of the aforementioned study to collect images from commonly referenced rheumatology educational materials and categorized the skin tones within them as "light" or "dark." We calculated the proportional change in images depicting dark skin tones between 2020 and 2022 from the American College of Rheumatology (ACR) Image Library, the 10th edition of Kelley's Textbook of Rheumatology, and New England Journal of Medicine (NEJM) as well as between 2020 and 2024 from rheumatology articles within UpToDate. We compared results using one‐sided Z‐tests. Results: Overall, the proportion of images depicting dark skin tones increased 40.6% (P < 0.0001). The 10th edition of Kelley's Textbook of Rheumatology most significantly increased inclusion of P‐SOC (90.1%; P = 0.0039), with ACR Image Library, UpToDate, and NEJM also enhancing representation (41.9%, P < 0.0001; 31.0%, P = 0.0083; 28.2%, P = 0.3046, respectively). Conclusion: This study assesses the progress of rheumatology educational materials toward equitable representation of P‐SOC. It demonstrates that awareness coupled with focused efforts from educational publishers can enhance the proportion of images depicting dark skin tones, thereby enriching the quality of foundational knowledge relayed to rheumatology providers with the goal of improving health experiences and outcomes for P‐SOC with rheumatic diseases. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions To evaluate use and utility of the Fetal Alcohol Spectrum Disorder (FASD) Hub Australia website.Online REDCap user survey incorporating the Website Evaluation Questionnaire, open ended questions, Google metrics data and an accessibility audit.Seventy‐six participants: researchers (32%), health professionals (29%) and policymakers/advocates (16%) completed the survey. Most were from Australia (95%) and were likely or very likely to recommend the FASD Hub to colleagues (92%), friends (74%) and patients (72%). The mean Website Evaluation Questionnaire score was at least 3.45/5 for all dimensions (ease of use, hyperlinks, structure, relevance, comprehension, completeness, layout, search option); range 3.45 (search option) to 4.04 (relevance). Participants found the content trustworthy (92%) but wanted more information for, and to support, Aboriginal and Torres Strait Islander peoples, and improved search capacity. Google metrics identified 25,534 unique users over 6 months (82% new users); 83% aged 18–44 years, 72% female and 35% international.Users found the FASD Hub accessible, authoritative and useful and suggested improvements. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to compare early outcomes of de novo LCPT (once‐daily extended‐release tacrolimus) to IR TAC (twice‐daily immediate‐release tacrolimus) in a predominantly African American (AA) adult kidney transplant population. Methods: This is a single center, retrospective cohort study. Patients were divided into two cohorts: IR TAC (administered between January 1, 2017, and January 31, 2019) and LCPT (administered between February 1, 2019, and May 31, 2020). Primary endpoints were changes in tacrolimus trough levels (ng/mL) and estimated glomerular filtration rate up to 12 months post‐transplantation. Clinical endpoints included graft survival, delayed graft function, biopsy‐proven rejection, CMV viremia, and BK. A propensity score weighted generalized linear mixed effects model was used for analysis. Results: The rate of change in tacrolimus levels was significantly higher in the LCPT cohort compared to the IR TAC cohort at 14 days post‐discharge (.2455 ng/mL per day vs..1073 ng/mL, respectively; p <.001). Subsequently, the LCPT cohort had a slightly higher rate of decline (–.015 ng/mL per day vs. –.010 ng/mL with IR TAC; p =.0894) up to 12 months post‐discharge. Although eGFR was similar between the two cohorts at 12 months post‐transplant, the rate of increase was slower in the LCPT cohort (.1371 mL/min per day vs..1852 mL/min per day, p =.0314). No significant differences were found in graft survival, DGF, BPAR, CMV, or BK infection. Conclusion: This study demonstrates that despite higher early trough levels with immediate post‐transplant LCPT use, clinical outcomes are comparable to IR TAC at one‐year post‐transplant. Notably, LCPT use does not increase the incidence of DGF and that this formulation of CNI can be used as first line therapy post‐transplant. [ABSTRACT FROM AUTHOR]

Summary: An 18‐year‐old multiparous Thoroughbred mare with a 2‐month‐old foal at foot presented for investigation of colic. A right dorsal displacement of the large colon with a retroflexion of the pelvic flexure was corrected under general anaesthesia and interventional recovery using head and tail ropes was performed. The mare made multiple attempts to stand, using the ropes for support before achieving and maintaining a standing position. The following day, marked swelling around the perineal and vulval region was noted, combined with reduced tail tone. Urination, but not defaecation, had been observed following surgery. Transrectal ultrasonography indicated formation of a haematoma adjacent and ventral to the caudal sacral and first coccygeal vertebrae. Initial radiographic evaluation was suggestive of an oblique fracture of the caudal endplate of the first coccygeal vertebra, which was confirmed on repeat radiography 7 days later. Treatment included cold compresses to reduce swelling, multimodal analgesia, dietary modification to soften faecal consistency and regular manual evacuation of the rectum to avoid impaction. The mare was discharged after 19 days hospitalisation, gradually recovered the ability to defaecate and produced a viable foal the following year without assistance. [ABSTRACT FROM AUTHOR]

As healthcare delivery continues to evolve and expand, nurse educators must prepare advanced practice registered nursing (APRN) students to use telehealth technology safely, effectively, and confidently. The aims of this study were to describe APRN students' beliefs and confidence regarding the delivery of care via telehealth in their future practice. To evaluate these aims, a single group comparison study was conducted. APRN students received an intervention comprised of multimodal telehealth instruction, which involved the simulated application of telehealth with standardized patients. Students' beliefs regarding telehealth did not significantly change between the pre‐ and post‐intervention, in which all areas were rated high pre‐intervention. Students reported an increase in their perception and confidence post‐intervention. Integration of telehealth into the APRN curriculum is essential to instil knowledge and confidence as healthcare technology advances. [ABSTRACT FROM AUTHOR]

A 5‐year 7‐month‐old, entire, male Chow Chow presented with paraparesis and ataxia due to a previously diagnosed T11–T12 spinal diverticulum. Due to the progression of clinical signs, magnetic resonance imaging was indicated to reassess the lesion. Preoperative rectal temperature was unable to be assessed due to temperament; however, it was likely the patient would be hyperthermic as it had been hyperthermic (40.6°C) under general anaesthesia 4 months earlier. Consequently, measures were taken to attempt to reduce body temperature before general anaesthesia. While under general anaesthesia for imaging, the patient was confirmed to be markedly hyperthermic. This report details the management of a patient with hyperthermia under general anaesthesia. The patient was gradually cooled before recovery from anaesthesia. Once recovered from anaesthesia and normothermic, the patient was discharged home the same day. Follow‐up confirmed no adverse effects. [ABSTRACT FROM AUTHOR]

Objective: Lupus presents earlier and more severely among patients with skin of color (SOC), and this population experiences worse outcomes. Providers rely on medical education materials when developing skills to care for patients, yet these resources historically underrepresent patients with SOC and marginalize vulnerable populations. In this study, we investigated if this publication bias extends to images depicting patients with lupus. Methods: We reviewed published images of patients with lupus from rheumatology, dermatology, and internal medicine textbooks and medical journals, SOC atlases, online image libraries, UpToDate, and Google Images. We selected materials published from 2014 to 2019 that were available through our university's online medical library. We used the search terms "lupus" and "lupus rash" to identify images. We rated the skin color in each image using the New Immigrant Survey Skin Color Scale and categorized them as light, medium, or dark. We compared the frequencies of published skin tones with chi‐square and odds ratio analyses. Results: We assessed the skin tone of 1,417 images. The significant majority (56.4%) of the images represented light skin (χ2 = 490.14, P < 0.001). After SOC atlases, journals were the most inclusive of images depicting dark skin tones. The specialty of dermatology was most inclusive of medium and darker skin tones. Conclusion: Published images of lupus underrepresent patients with SOC, which may limit providers' ability to deliver care to the patients who are at greatest risk for complications. [ABSTRACT FROM AUTHOR]

Nearly half a century ago, two papers postulated the likelihood of lunar lava tube caves using mathematical models. Today, armed with an array of orbiting and fly‐by satellites and survey instrumentation, we have now acquired cave data across our solar system—including the identification of potential cave entrances on the Moon, Mars, and at least nine other planetary bodies. These discoveries gave rise to the study of planetary caves. To help advance this field, we leveraged the expertise of an interdisciplinary group to identify a strategy to explore caves beyond Earth. Focusing primarily on astrobiology, the cave environment, geology, robotics, instrumentation, and human exploration, our goal was to produce a framework to guide this subdiscipline through at least the next decade. To do this, we first assembled a list of 198 science and engineering questions. Then, through a series of social surveys, 114 scientists and engineers winnowed down the list to the top 53 highest priority questions. This exercise resulted in identifying emerging and crucial research areas that require robust development to ultimately support a robotic mission to a planetary cave—principally the Moon and/or Mars. With the necessary financial investment and institutional support, the research and technological development required to achieve these necessary advancements over the next decade are attainable. Subsequently, we will be positioned to robotically examine lunar caves and search for evidence of life within Martian caves; in turn, this will set the stage for human exploration and potential habitation of both the lunar and Martian subsurface. Plain Language Summary: We have now acquired cave data across our solar system—including the identification of potential cave entrances on the Moon, Mars, and at least nine other planetary bodies. These discoveries gave rise to the study of planetary caves. To help advance this field, we conducted an expert‐opinion based social survey to identify a strategy to explore caves beyond Earth. We focused primarily on astrobiology, the cave environment, geology, robotics, instrumentation, and human exploration. First, we assembled a list of 198 science and engineering questions. Then, through a series of social surveys, 114 scientists and engineers winnowed down the list to the top 53 highest priority questions. This exercise resulted in identifying emerging and crucial research areas that require robust development to ultimately support a robotic mission to a planetary cave—principally the Moon and/or Mars. With the necessary financial investment and institutional support, the research and technological development required to achieve these necessary advancements over the next decade are attainable. Subsequently, we will be positioned to robotically examine lunar caves and search for evidence of life within Martian caves; in turn, this will set the stage for human exploration and potential habitation of both the lunar and Martian subsurface. Key Points: Robotics and instrument advancements identified as linchpin focal areas for in situ study of planetary cavesResearch and technological development required for lunar and/or Martian cave exploration is achievable in next decade with proper investmentFirst application of systematic and statistically rigorous social survey to identify science and engineering requirements in planetary science [ABSTRACT FROM AUTHOR]

The Chicxulub impact caused a crash in productivity in the world's oceans which contributed to the extinction of ∼75% of marine species. In the immediate aftermath of the extinction, export productivity was locally highly variable, with some sites, including the Chicxulub crater, recording elevated export production. The long‐term transition back to more stable export productivity regimes has been poorly documented. Here, we present elemental abundances, foraminifer and calcareous nannoplankton assemblage counts, total organic carbon, and bulk carbonate carbon isotope data from the Chicxulub crater to reconstruct changes in export productivity during the first 3 Myr of the Paleocene. We show that export production was elevated for the first 320 kyr of the Paleocene, declined from 320 kyr to 1.2 Myr, and then remained low thereafter. A key interval in this long decline occurred 900 kyr to 1.2 Myr post impact, as calcareous nannoplankton assemblages began to diversify. This interval is associated with fluctuations in water column stratification and terrigenous flux, but these variables are uncorrelated to export productivity. Instead, we postulate that the turnover in the phytoplankton community from a post‐extinction assemblage dominated by picoplankton (which promoted nutrient recycling in the euphotic zone) to a Paleocene pelagic community dominated by relatively larger primary producers like calcareous nannoplankton (which more efficiently removed nutrients from surface waters, leading to oligotrophy) is responsible for the decline in export production in the southern Gulf of Mexico. Plain Language Summary: The end Cretaceous mass extinction was caused by the impact of an asteroid in what is now the Yucatán Peninsula, México. The impact ejected aerosols and dust into the air that reduced sunlight transmission, causing a severe decline in photosynthesis and the collapse of marine food webs. However, the change in the amount of organic matter created by photosynthesizing plankton that was delivered to the seafloor (export productivity) was variable across the oceans. At some places, including the Chicxulub crater, export productivity was actually high immediately after the impact. We produced a ∼3‐million ‐year record of export productivity in the crater to determine how long it remained elevated and why it eventually declined. Export production was very high for the first 320,000 years after the impact, declined from 320,000 to 1,200,000 years after the impact, and then remained low. We found that this production was not related to the input of nutrients nor the degree of stratification of the ocean, but instead was probably driven by the increase in the cell size of phytoplankton. Larger phytoplankton removed nutrients from the surface waters as they sank, prompting an increase in species which are better adapted to low‐nutrient waters. Key Points: Export productivity at Chicxulub was elevated for 1.2 Myr post K‐Pg; it was very high for the first 0.32 Myr and declined from 0.32–1.2 MyrThe final decline in export productivity ∼0.9–1.2 Myr is associated with the termination of calcareous nannoplankton disaster assemblagesExport productivity change is not correlated with stratification or terrigenous input and was likely driven by changes in the phytoplankton [ABSTRACT FROM AUTHOR]