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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]

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]

We report a 32-year-old male 14 years post-living-related kidney transplant presenting with new-onset hematuria and BK viremia. He was found to have BK virus-associated urothelial carcinoma originating in the renal allograft with locally advanced disease and metastases to multiple sites. He also developed acute T-cell-mediated rejection in the setting of immunosuppression reduction for BK viremia prior to undergoing transplant nephrectomy. Eight months following transplant nephrectomy and immunosuppression cessation, distant metastases persisted with partial response to chemotherapy and immunotherapy. Here, we discuss this unique presentation and compare it with other BK virus-associated allograft carcinomas reported in the literature, in addition to discussing evidence for the role of BK virus in oncogenesis. [ABSTRACT FROM AUTHOR]

Cretaceous/Paleogene (K/Pg) boundary is marked by one of the largest mass extinctions in Earth's history, with geological evidence for this event being expressed in hundreds of locations worldwide. An extensively studied section located near El Kef, northwestern Tunisia, is characterized by the classic iridium-rich K/Pg boundary layer, abundant and well-preserved microfossils, and apparently continuous sedimentation throughout the early Danian with no previously described structural complication. These features led to its designation in 1991 as the Global Stratigraphic Section and Point (GSSP) for the base of the Danian (i.e., the K/Pg boundary). However, the outcrop section has become weathered, and the "golden spike" marking the GSSP is difficult to locate. Therefore, the El Kef Coring Project aimed to provide a continuous record of unweathered sediments across the K/Pg transition in cores recovered from five rotary-drilled holes located close to the El Kef GSSP. Here, we present new, high-resolution lithologic, biostratigraphic, and geochemical data from these cores. The recovered stratigraphic successions of each hole (all drilled within ~75 m of one another) are unexpectedly different, and we identified a formerly unknown unconformity within planktic foraminiferal biozone P1b. Our results provide evidence that sedimentation at El Kef was not as continuous or free from structural complication as previously thought. Despite these challenges, we present a new composite section from the five El Kef holes and an age model correlated to the orbitally tuned record at Walvis Ridge, South Atlantic Ocean, which is critical in placing the paleoenvironmental and paleoecological records from El Kef in a global context. [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]

Digital rectal examination revealed frank blood and investigations revealed a coagulopathy with a prolonged prothrombin time of 115 sec, international normalized ratio of 14.7 and activated partial thromboplastin time of 222.5 sec with normal hemoglobin concentration (125 g/L) and platelet count (199 k/uL [199 × 10 SP 9 sp /L]). Her coagulation profile showed a prolonged thrombin time (>60 sec) and less prolonged prothrombin time (28.9 sec), international normalized ratio (2.9), and partial thromboplastin time (61.3 sec). Had the activated partial thromboplastin time and thrombin time been normal, management would have differed as the focus would have turned to non-anticoagulant etiologies of bleeding. [Extracted from the article]

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]

Anxious and depressive symptoms often co-occur and are associated with difficulties in academic, social, and emotional areas of functioning. The current study identified the factor structure and profiles of symptoms of anxiety and depression among 169 Black early adolescents in sixth through eighth grade (Mage = 12.6 years; 50% female) using confirmatory factor analyses (CFAs) and latent profile analyses (LPA), respectively. CFAs supported a six-factor model for depressive symptoms (i.e., dysphoria, social problems, externalizing, self-deprecation, biological dysregulation, and school problems) and a four-factor model for anxiety symptoms (i.e., social evaluation, worry, affective response, and physiological symptoms/sleep problems). These factors formed the profiles for the LPA analyses, and results supported a three-profile solution that included: (a) a low-severity group who reported few anxious or depressive symptoms, (b) a group who reported high levels of externalizing behaviors and moderate levels of school and social evaluation problems, and (c) a group who reported high levels of social evaluation problems and physiological/sleep anxiety. The three groups differed significantly in their ratings of anger regulation difficulties (i.e., anger emotion regulation coping, anger inhibition, and anger dysregulated expression) and their perceptions of the quality of school interpersonal relationships (i.e., student-teacher relationships and student-student relationships). These findings add to our knowledge about how patterns of depressive and anxious symptoms present for Black youth during adolescence and have important implications for the conceptualization, treatment, and prevention of anxiety and depression using culturally sensitive approaches. Highlights: The experience and presentation of depressive and anxious symptoms differed for Black youth. Factor structures of depression and anxiety measures were confirmed prior to running latent profile analyses. Three profiles of anxious and depressive symptom dimensions were identified. Profiles differed in youths' ratings of anger regulation difficulties and perceptions of the quality of school interpersonal relationships. [ABSTRACT FROM AUTHOR]

Underrepresentation of patients with non-white skin in rheumatology educational resources impairs practitioners' competence in caring for patients with skin of colour and reduces patients' confidence in the medical system. Medical publishers and educators should reconsider how to promote equal representation and care of patients with all skin types. [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]

Background: Patients with vitiligo experience reduced quality of life. Objective: To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods: A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results: Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations: Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions: The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration: PROSPERO (CRD42020162223). [ABSTRACT FROM AUTHOR]

Objectives The US health care payment system is complex and difficult to interpret. Although federal regulations require that more data, in the form of charges and negotiated rates, be made available, compliance remains variable. We review chargemaster and negotiated rate values for extracorporeal photopheresis (ECP) to assess this variability. We sought to determine the availability of chargemaster and negotiated rates for health care consumers and to assess compliance and pricing among institutions using ECP as a model for apheresis billing. Methods We obtained ECP chargemaster data and negotiated rates from 20 institutions. We analyzed the availability of ECP chargemaster data and compared values with a previously published historic cohort. We evaluated the availability of negotiated rates and determined relative reimbursement using charge to reimbursement ratios. We determined calculated fines for hospitals based on bed size. Results Chargemaster availability increased from 2019 to 2022, though only 65% (13/20) of hospitals had both chargemaster and negotiated rate data. Chargemaster prices increased significantly from 2019 to 2022 (range, $3,586.83-$34,043.00). We reviewed 1,191 negotiated rates, with institutions averaging 93.6 different rates (SD, 189.5). Negotiated rates were variable, ranging from $3,586.83 to $34,043.00 per procedure. Reimbursement was higher among private insurers compared with reported Centers for Medicare & Medicaid Services negotiated rates. Of the 35% (7/20) that lacked chargemaster and negotiated rates, institutions faced an average annual fine of $1,430,800. Conclusions Despite recent financial penalties, ECP pricing data are often unavailable or inadequate. Current available resources are unlikely to benefit the average health care consumer who requires ECP. [ABSTRACT FROM AUTHOR]

While the association of racial discrimination and internalizing symptoms in Black individuals is well established, we still have a limited understanding of mechanisms and contextual factors influencing this association, such as sleep and the family context. The present study examined sleep and fatigue as mediators underlying the relationship between racial discrimination and internalizing symptoms within Black adolescent-caregiver dyads. Using data from a larger survey study of risk and resilience in Black adolescents (Mage= 14.36, 49.5% female) and their caregivers (Mage= 39.25, 75.9% female), we used the Actor-Partner Interdependence Model extended Mediation (APIMeM) to test associations of racial discrimination, sleep factors, and internalizing symptoms among 179 dyads. Significant actor effects revealed that sleep disturbance and fatigue independently mediated the association of racial discrimination and internalizing symptoms among adolescents and caregivers. Additionally, partner effects were found, such that adolescents' experiences of discrimination were indirectly associated with their caregivers' internalizing symptoms via caregiver fatigue. No direct or indirect effects of caregiver experiences of discrimination on adolescent outcomes were found. The findings highlight the important role sleep and fatigue play in the link between racial discrimination and internalizing symptoms among Black adolescents and adults; and the role that the family context may play in this association. Mental health and sleep interventions for Black individuals should address the impact of racial discrimination on internalizing symptoms, with an emphasis on family-focused interventions. [ABSTRACT FROM AUTHOR]

Background: The United States has unacceptably high rates of maternal and infant mortality, especially among Black women and their infants. Prenatal and postpartum care help reduce maternal and infant morbidity and mortality; however, Black women are less likely to access and utilize peripartum care largely due to structural racism. Identifying factors that buffer against the systemic barriers disproportionately impacting this community is an important step in addressing racial health disparities. Using existing data from a randomized controlled trial (RCT) targeting maternal and infant health disparities, this study aims to (1) explore predictors of peripartum care attendance and (2) examine clinical trial sample representativeness. Methods: The analyses addressing the primary aim of the study included Black women at risk for low prenatal care (PNC) engagement who consented to RCT participation and had a documented live birth (n = 123). For the secondary study aim, comparisons between women who consented to the RCT (Consenters; n = 149) and those who did not (Non-consenters; n = 122) were made using chi-square and t-tests. Results: Hierarchical linear and logistic regression identified predictors of prenatal and postpartum care attendance, respectively. After controlling for multiple comparisons, no significant differences were identified between characteristics of Consenters and Non-consenters. Older age (p = 0.038), high-risk pregnancy (p < 0.001), and no past week substance use (p = 0.033) predicted better PNC attendance. PNC attendance predicted postpartum visit attendance (p < 0.001). Conclusions: This study provides benchmark data on predictors of peripartum care and sample representativeness in RCTs. Findings have important implications for health care system changes and development of culturally informed interventions. [ABSTRACT FROM AUTHOR]

To fully assess the resilience and recovery of life in response to the Cretaceous–Paleogene (K-Pg) boundary mass extinction ~ 66 million years ago, it is paramount to understand biodiversity prior to the Chicxulub impact event. The peak ring of the Chicxulub impact structure offshore the Yucatán Peninsula (México) was recently drilled and extracted a ~ 100 m thick impact-generated, melt-bearing, polymict breccia (crater suevite), which preserved carbonate clasts with common biogenic structures. We pieced this information to reproduce for the first time the macrobenthic tracemaker community and marine paleoenvironment prior to a large impact event at the crater area by combining paleoichnology with micropaleontology. A variable macrobenthic tracemaker community was present prior to the impact (Cenomanian–Maastrichtian), which included soft bodied organisms such as annelids, crustaceans and bivalves, mainly colonizing softgrounds in marine oxygenated, nutrient rich, conditions. Trace fossil assemblage from these upper Cretaceous core lithologies, with dominant Planolites and frequent Chondrites, corresponds well with that in the overlying post-impact Paleogene sediments. This reveals that the K-Pg impact event had no significant effects (i.e., extinction) on the composition of the macroinvertebrate tracemaker community in the Chicxulub region. [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]

Background: A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. Methods: Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. Results: Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. Conclusions: Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning. [ABSTRACT FROM AUTHOR]

In the current study, we examined how caregiver prompting of tobacco products (e.g., asking a child to empty an ashtray), caregiver monitoring, and caregiver-adolescent communication were associated with adolescents' tobacco use, intentions to use, and efficacy to refuse using tobacco. Caregiver-adolescent dyads were recruited from a southeastern city in the United States. Approximately 48% of the population in this city is Black. Participants included 101 Black caregivers who smoke and their adolescents (Mage = 14.4 years). Multiple regression analyses (R2 ranged from 0.10 to 0.44 across models) indicated that higher levels of adolescent-reported caregiver prompting were associated with a higher likelihood of adolescent-reported use and intentions to smoke tobacco products in their lifetime. Caregiver monitoring was associated with lower levels of adolescent tobacco use and intentions to use tobacco, and higher levels of tobacco refusal self-efficacy. General caregiver-adolescent communication was associated with greater tobacco refusal self-efficacy. Differences among caregiver prompting behavior by reporter highlight the importance of obtaining both adolescent and caregiver perceptions. These findings illustrate that caregivers may play a critical role in shaping their adolescents' tobacco-related outcomes through adolescent perceptions of their prompting of tobacco products, as well as their overall knowledge or monitoring of adolescent activities. Highlights: Black caregivers who smoke and their adolescent were both assessed. Prompting behavior from caregivers is associated with adolescent smoking. Caregivers that smoke tobacco products may shape their adolescents smoking behavior. [ABSTRACT FROM AUTHOR]

In August 2022, the Florida Department of Health notified CDC of a nurse who acquired monkeypox through an occupational exposure while providing care to a patient with monkeypox. To date, occupationally acquired Monkeypox virus (MPXV) infections in health care personnel (HCP) have been rarely reported during the 2022 multinational outbreak (1,2). This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP. [ABSTRACT FROM AUTHOR]

Simple Summary: There are many commonalities between children with cancer and other populations that experience early-life stress. Thus, it is important to review the existing research surrounding the stress response in the pediatric cancer population. In this review, we describe the psychoneuroimmunology behind stress regulation and the differences observed in stress regulatory pathways in childhood cancer patients. Our objective is to provide a clinically relevant summary of the stress pathways contributing to, and exacerbating, childhood illness and outline some potential interventions. Stress is a ubiquitous experience that can be adaptive or maladaptive. Physiological stress regulation, or allostasis, can be disrupted at any point along the regulatory pathway resulting in adverse effects for the individual. Children with cancer exhibit significant changes to these pathways in line with stress dysregulation and long-term effects similar to those observed in other early-life stress populations, which are thought to be, in part, a result of cytotoxic cancer treatments. Children with cancer may have disruption to several steps in the stress-regulatory pathway including cognitive-affective function, neurological disruption to stress regulatory brain regions, altered adrenal and endocrine function, and disrupted tissue integrity, as well as lower engagement in positive coping behaviours such as physical activity and pro-social habits. To date, there has been minimal study of stress reactivity patterns in childhood illness populations. Nor has the role of stress regulation in long-term health and function been elucidated. We conclude that consideration of stress regulation in childhood cancer may be crucial in understanding and treating the disease. [ABSTRACT FROM AUTHOR]