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Objectives . Facing risk of contracting COVID-19, adopting individual health and safety behaviors to prevent infection was critical for first responders to ensure personal and public safety. This study assessed direct and indirect relationships between safety leadership, safety behaviors and the effect of risk perceptions on these relationships among aircraft rescue and firefighting (ARFF) personnel during the COVID-19 pandemic. Method . A total of 127 ARFF frontline personnel participated in an online survey. COVID-19-specific constructs of safety leadership, safety behaviors and risk perceptions were assessed using a structural model with moderation and serial mediation analysis using the mixed-model method. Results . Safety leadership had significant direct effects on safety compliance and indirect effects on safety participation and mask use. ARFF personnel's perceived severity of the virus had significant direct effects on mask use and indirect effects on safety compliance and participation behaviors. The interaction of safety leadership and perceived susceptibility to the virus had significant direct effects on safety compliance behaviors and indirect effects on safety participation and mask use. Conclusion . There are practical implications to strengthen safety compliance behaviors through leadership. This study contributes to the literature on leadership and safety behaviors among ARFF personnel during exceptional circumstances and times of crisis.

Domestic dogs (Canis familiaris) are descended from gray wolf (Canis lupus) populations that inhabited Western Europe and Siberia. The specific timing of dog domestication is debated, but archeological and genetic evidence suggest that it was a multi-phase process that began at least 15,000 years ago. There are many morphological differences between dogs and wolves, including marked divergence in facial muscle morphology, but we know little about the comparative physiology of these muscles. A better understanding of comparative facial muscle physiology between domestic dogs and gray wolves would improve our conceptual framework for the processual mechanisms in dog domestication. To address these issues, we assessed the myosin profiles (type I and type II) from the zygomaticus and orbicularis oris muscles of 6 domestic dogs and 4 gray wolves. Due to small sample sizes, statistical analyses were not done. Results reveal that sampled domestic dogs have almost 100% fast-twitch (type II) muscle fibers while gray wolves have less than 50%, meaning that dog faces can contract fast while wolf faces are able to sustain facial muscle contraction. Sample sizes are limited but the present study indicates that dog domestication is associated with not only a change in facial muscle morphology but a concomitant change in how these muscles function physiologically. Selective pressures in the development of communication between dogs and humans using facial expression may have influenced this evolutionary divergence, but the paedomorphic retention of barking in adult dogs may have also played a role., (© 2024 The Author(s). The Anatomical Record published by Wiley Periodicals LLC on behalf of American Association for Anatomy.)

Hyperostosis frontalis interna (HFI) is a human skeletal lesion characterized by nodules of hyperplastic bone and thickening of the frontal bone's inner surface. Despite its prevalence in the general population and its long history of observation-it is one of the most frequently observed pathologies in gross anatomy laboratories-HFI's etiology and pathogenesis remain poorly understood. This is largely due to the lack of a thorough survey of its histology across the various stages of its development. Our study has three major aims: (1) assess HFI histology from incipient to advanced lesions; (2) elucidate lamellar and trabecular structure in HFI; and (3) clarify impacts/roles of the dura mater in HFI. Sections of nondecalcified bone provide evidence for two different categories of lesions: (1) stratum lesions, characterized by lamellar-based overall thickening of the internal table, and (2) eruptive lesions, characterized by nodular formations of initially lamellar bone that appear to form the bulk of bone mass in advanced stages. Sections of nondecalcified bone also suggest that for both lesion types, HFI growths begin as deposits of lamellar bone, which are later remodeled into woven bone deposits; our data do not support the hypothesis that lesions begin as a "diploization" of cortical bone as suggested by prior studies. Trichrome-stained sections provide evidence that growing lesions erode through and engulf the dura mater, effectively destroying this tissue layer as they grow laterally and inwardly. Our results indicate possible avenues of research to better understand the root causes of this disorder., (© 2024 American Association for Anatomy.)

Introduction: Despite the growing use of temporary mechanical circulatory support (tMCS), little data exists to inform management and weaning of these devices., Methods: We performed an online survey among cardiac intensive care unit directors in North America to examine current practices in the management of patients treated with intraaortic balloon pump and Impella., Results: We received responses from 84% of surveyed centers (n=37). Our survey focused on three key aspects of daily management: 1. Hemodynamic monitoring; 2. Hemocompatibility; and 3. Weaning and removal. We found substantial variability surrounding all three areas of care., Conclusion: Our findings highlight the need for consensus around practices associated with improved outcomes in patients treated with tMCS., Competing Interests: Declaration of Competing Interest Christopher Barnett receives research funding from Merck and is a consultant for Abiomed, Zoll, and Abbott. Michael Kontos is a consultant for Beckman Coulter. Barbara Pisani has self-funded personal investments in Abbott, Amgen, GlaxoSmithKline, Bristol Myers Squibb. Andrea Thompson is supported by NIH-NHLBI [K08HL163328]. The remaining authors have no conflicts of interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Hereditary angioedema (HAE) is a rare genetic condition causing unpredictable and severe episodes of angioedema that are debilitating and life-threatening. Moreover, HAE can be classified into HAE due to C1-esterase inhibitor deficiency (HAE-C1INH) or HAE with normal C1INH. Moreover, HAE-C1INH is subcategorized as types I and II based on deficient or dysfunctional circulating C1INH protein resulting from inherited or spontaneous mutations in the SERPING1 gene leading to uncontrolled factor XII/plasma kallikrein activation and excessive bradykinin production. Bradykinin-2 receptor activation leads to vasodilation, increased vascular permeability, and smooth muscle contractions, resulting in subcutaneous or submucosal fluid extravasation that can affect the face, extremities, airway, and gastrointestinal and genitourinary systems. Furthermore, HAE with normal C1INH is caused by either a known or unknown genetic mutation, and the mechanisms are less well-established but most forms are thought to be related to bradykinin signaling with a similar presentation as HAE-C1INH despite normal levels of C1INH protein and function. Current HAE management strategies include on-demand and prophylactic treatments which replace C1INH, reduce kallikrein activity, or block bradykinin binding to the bradykinin B2 receptor. With the advent of additional small molecule inhibitors, monoclonal antibodies, RNA-targeted therapies, gene therapies, and gene modification approaches, preclinical studies and human clinical trials are underway to further expand therapeutic options in HAE. This review article will briefly summarize current HAE treatments and provide an overview of potential future therapies for HAE., Competing Interests: Disclosures Dr Riedl has received research support from BioCryst, BioMarin, CSL Behring, Ionis Pharmaceuticals, KalVista, Pharvaris, and Takeda and consultancy fees from Astria, BioCryst, BioMarin, CSL Behring, Cycle Pharma, Grifols, Intellia, KalVista, Ono Pharma, Pfizer, Pharming, Pharvaris, Sanofi-Regeneron, and Takeda. Dr Smith has no conflicts of interest to report., (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Introduction: Firefighter injuries and fatalities have been attributed to improper or ineffective use of personal protective equipment (PPE). Although studies have examined predictors of PPE to include situational, leadership, stressors and other psychosocial factors, research has not thoroughly examined the relationships between effective safety training administration, knowledge creation, and the influence of those factors on PPE use among firefighters., Method: This study aimed to assess those relationships by using structural equation modeling analysis., Results: The model fit was good, and findings confirmed the hypothesized model and relationships, which included a positive, significant relationship between effective safety training and safety knowledge and positive, significant relationships between safety knowledge and PPE-related safety behavior outcomes, including the effective use of PASS devices, the correct use of SCBA and PPE during overhaul operations, and the correct use and inspection of PPE among firefighters in general., Practical Applications: Findings support the importance of safety training in the fire service to bolster knowledge and correct PPE use., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The effect of lengthened incubation periods on embryonic development, especially vestigial structures, is poorly understood. An example of which is the avesuchian vomeronasal organ (VNO), a nasal chemosensory organ found in many tetrapods but absent in adult avesuchians (crocodilians and birds) in whom it is presumed to be a transitory fetal structure. The Laysan Albatross (Phoebastria immutabilis) has an incubation period of their eggs of about 65 days. This incubation period is twice that of domestic fowl, wherein a putative VNO has been documented as an epithelial thickening. The purpose of this study is to document the development of a putative VNO in the albatross. Serial histological sections of nine albatross embryonic heads, across 6 stages (representing days 19 to 32: stages 31-39), were examined. A paired putative VNO was present as a short, tubular structure in the anterodorsal aspect on either side of the nasal septum from stage 32 onwards, getting steadily longer in later specimens. At the earliest stages, the epithelial walls of the tube resemble a neuroepithelium, but then becomes thinner and simpler in morphology. Based on our available age range, it is unclear whether it persists as a rudimentary structure (like that of the human) or if it is a transitory structure (like in chickens) in these mid embryonic stages. Though future studies must determine the fate of the Laysan albatross VNO (e.g., is it retained postnatally?), the role of incubation period length on embryonic development is a bigger question to be explored., (© 2024 American Association for Anatomy.)

Recently, Yohe and Krell (The Anatomical Record, vol. 306:2765-2780) lamented the incongruence between genetics and morphology in the vomeronasal system of bats. Here, we studied 105 bat species from 19 families using histology, iodine-enhanced computed tomography (CT), and/or micro-CT. We focused on structural elements that support a functional peripheral vomeronasal receptor organ (vomeronasal organ [VNO]), together comprising the "vomeronasal complex." Our results support prior studies that describe a functional VNO in most phyllostomid bats, miniopterids, and some mormoopids (most known Pteronotus spp.). All of these species (or congeners, at least) have vomeronasal nerves connecting the VNO with the brain and some intact genes related to a functional VNO. However, some bats have VNOs that lack a neuroepithelium and yet still possess elements that aid VNO function, such as a "capsular" morphology of the vomeronasal cartilages (VNCs), and even large venous sinuses, which together facilitate a vasomotor pump mechanism that can draw fluid into the VNO. We also show that ostensibly functionless VNOs of some bats are developmentally associated with ganglionic masses, perhaps involved in endocrine pathways. Finally, we demonstrate that the capsular VNC articulates with the premaxilla or maxilla, and that these bones bear visible grooves denoting the location of the VNC. Since these paraseptal grooves are absent in bats that have simpler (bar-shaped or curved) VNCs, this trait could be useful in fossil studies. Variable retention of some but not all "functional" elements of the vomeronasal complex suggests diverse mechanisms of VNO loss among some bat lineages., (© 2024 American Association for Anatomy.)

Systems of the body develop in a modular manner. For example, neural development in primates is generally rapid, whereas dental development varies much more. In the present study, we examined development of the skull, teeth, and postcrania in a highly specialized leaping primate, Galago moholi. Eighteen specimens ranging from birth to adult were studied. Bones, teeth, and the cranial cavity (i.e., endocast) were reconstructed with Amira software based on microCT cross-referenced to histology. Amira was also used to compute endocast volume (as a proxy for brain size). Reconstructions of the wrist and ankle show that ossification is complete at 1 month postnatally, consistent with the onset of leaping locomotion in this species. Endocranial volume is less than 50% of adult volume at birth, ~80% by 1 month, and has reached adult volume by 2 months postnatal age. Full deciduous dentition eruption occurs by 2 weeks, and the young are known to begin capturing and consuming arthropods on their own by 4 weeks, contemporaneous with the timing of bone and ankle ossification that accompanies successful hunting. The modular pattern of development of body systems in Galago moholi provides an interesting view of a "race" to adult morphology for some joints that are critical for specialized leaping and clinging, rapid crown mineralization to begin a transitional diet, but perhaps more prolonged reliance on nursing to support brain growth., (© 2024 Wiley Periodicals LLC.)

Background: This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach., Methods: A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables., Results: The outpatient group had a mean hospital stay of 13 hours, whereas the inpatient group had a mean of 58 hours (p<0.001). Three outpatients and four inpatients experienced post-op complications. Three inpatients and one outpatient visited the ER within 8 weeks of surgery. No difference in pre-operative hemoglobin (p = 0.210), or surgical blood loss (p = 0.550) was found between study groups. There was no difference found between groups regarding Oxford-12 Hip Score improvement, nor satisfaction at six months, one and two years (p>0.125)., Conclusion: This study demonstrates that outpatient THA using the posterolateral approach is as safe and effective as inpatient THA for overall healthy and carefully screened patients, based on the low rate of AEs observed and similar patient outcomes reported. Significantly reduced time in hospital demonstrates the reduced healthcare resources associated with outpatient THA., Competing Interests: Some of the authors received institutional support for unrelated studies from Smith&Nephew, DePuy Synthes, Zimmer, and/or Hip Innovation Technologies. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Motor vehicle incidents or apparatus crashes are a leading cause of firefighter fatalities in the United States. Nonuse of seat belts has been linked to some of these fatalities. This research seeks to understand the relationship between safety climate and seat belt use among firefighters, as findings will provide insights into factors that may bolster seat belt use and protect firefighters., Methods: Data were collected from 208 career firefighters working for a city fire department in the southeastern United States. Structural equation modeling was used to test a hypothesized model and to assess the relationships between organizational safety climate, work group safety climate and seat belt use., Results: It was determined that positive perceptions of workgroup safety climate, as a higher order factor, comprised of supervisor support, horizontal cohesion, and vertical cohesion, was positively associated with seat belt use within a sample of firefighters. Organizational level safety climate did not have a significant relationship with seat belt use but did positively influence workgroup safety climate perceptions., Conclusions: Safety climate has been associated with safety compliance and participation behaviors, but more research was needed to specifically examine the impact of safety climate on seat belt use in firefighters. The findings point to the importance of safety climate as a leading indicator and predictor of seat belt use. Bolstering safety climate through safety programs, commitment to safety, effective communication, supportive supervisors and cohesion should ultimately aid in bolstering seat belt use among firefighters, which is important to curtailing firefighter injuries and fatalities.

Background: Aircraft rescue and firefighting (ARFF) personnel are first responders located at airports in the United States who provide emergency response, mitigation, evacuation, and rescue of passengers and crew of aircraft at airports. The nature of their work puts ARFF personnel in close contact with travelers on a regular basis and at elevated risk for COVID-19 exposure., Objective: In this study, we focused on safety behavior, perceived risk, and workplace resources to understand COVID-19 outcomes in the early pandemic among the overlooked worker population of ARFF personnel. The goal of this study was to examine how a self-reported positive COVID test were associated with safety behavior, perceived risk, and workplace resources., Methods: Cross-sectional survey data were collected among ARFF personnel a year into the COVID-19 pandemic., Results: Regression results showed that each additional unit increase in perceived susceptibility to COVID-19 was associated with a 133% increase in the odds of testing positive for COVID-19 (OR = 2.33, p <  0.05), and with each additional unit increase in perceived severity level, the odds of getting COVID-19 decreased by 47% (OR = 0.53, p <  0.05)., Conclusions: Infection control among first responders may be improved by providing relevant information physical and emotional resources, and support that help shape perceptions of risk and adoption of prevention behaviors.

Paranasal sinuses of living apes and humans grow with positive allometry, suggesting a novel mechanism for bone enlargement. Here, we examine the paranasal sinuses of the owl monkey (Aotus spp.) and a tamarin (Saguinus midas) across postnatal development. The prediction that paranasal sinuses grow disproportionately faster than the main nasal chamber is tested. We used diffusible iodine-based contrast-enhanced computed tomography and histology to study sinuses in eight Aotus and three tamarins ranging from newborn to adult ages. Sinuses were segmented at the mucosa-air cavity interface and measured in volume. All sinuses were lined by a ciliated respiratory epithelium, except for the ethmoid air cells in Aotus, which are lined in part by olfactory epithelium. An age comparison indicates that only the maxillary sinus and ethmoid air cells are present in newborns, and two additional sinuses (invading the orbitosphenoid and the frontal bone), do not appear until late infancy or later. Comparing newborns and adults, the main nasal airway is 10 times larger in the adult Aotus and ~ 6.5 times larger in adult Saguinus. In contrast, the maxillary sinus far exceeds this magnitude of difference: 24 times larger in the adult Aotus and 46 times larger in adult Saguinus. The frontal sinuses add significantly to total paranasal space volume in both species, but this growth is likely delayed until juvenile age. Results suggest ethmoid air cells expand the least. These results support our prediction that most paranasal sinuses have a distinctly higher growth rate compared to the main nasal chamber., (© 2023 American Association for Anatomy.)

Macrophages hold vital roles in immune defense, wound healing, and tissue homeostasis, and have the exquisite ability to sense and respond to dynamically changing cues in their microenvironment. Much of our understanding of their behavior has been derived from studies performed using in vitro culture systems, in which the cell environment can be precisely controlled. Recent advances in miniaturized culture platforms also offer the ability to recapitulate some features of the in vivo environment and analyze cellular responses at the single-cell level. Since macrophages are sensitive to their surrounding environments, the specific conditions in both macro- and micro-scale cultures likely contribute to observed responses. In this study, we investigate how the presence of neighboring cells influence macrophage activation following proinflammatory stimulation in both bulk and micro-scale culture. We found that in bulk cultures, higher seeding density negatively regulated the average TNF-α secretion from individual macrophages in response to inflammatory agonists, and this effect was partially caused by the reduced cell-to-media volume ratio. In contrast, studies conducted using microwells to isolate single cells and groups of cells revealed that increasing numbers of cells positively influences their inflammatory activation, suggesting that the absolute cell numbers in the system may be important. In addition, a single inflammatory cell enhanced the inflammatory state of a small group of cells. Overall, this work helps to better understand how variations of macroscopic and microscopic culture environments influence studies in macrophage biology and provides insight into how the presence of neighboring cells and the soluble environment influences macrophage activation., (© 2023 Wiley Periodicals LLC.)

Comparative studies are a common way to address large-scale questions in sensory biology. For studies that investigate olfactory abilities, the most commonly used metric is olfactory bulb size. However, recent work has called into question the broad-scale use of olfactory bulb size. In this paper, we use three neuroanatomical measures with a more mechanistic link to olfactory function (number of olfactory sensory neurons (OSNs), number of mitral cells (MCs), and number of glomeruli) to ask how species with different diets may differ with respect to olfactory ability. We use phyllostomid bats as our study system because behavioral and physiological work has shown that fruit- and nectar-feeding phyllostomids rely on odors for detecting, localizing, and assessing potential foods, while insect-eating species do not. Therefore, we predicted that fruit- and nectar-feeding bats would have larger numbers of these three neuroanatomical measures than insect-eating species. In general, our results supported the predictions. We found that fruit-eaters had greater numbers of OSNs and glomeruli than insect-eaters, but we found no difference between groups in number of MCs. We also examined the allometric relationship between the three neuroanatomical variables and olfactory bulb volume, and we found isometry in all cases. These findings lend support to the notion that neuroanatomical measures can offer valuable insights into comparative olfactory abilities, and suggest that the size of the olfactory bulb may be an informative parameter to use at the whole-organism level., (© 2023 American Association for Anatomy.)

This special issue of The Anatomical Record is inspired by and dedicated to Professor Kunwar P. Bhatnagar, whose lifelong interests in biology, and long career studying bats, inspired many and advanced our knowledge of the world's only flying mammals. The 15 articles included here represent a broad range of investigators, treading topics familiar to Prof. Bhatnagar, who was interested in seemingly every aspect of bat biology. Key topics include broad themes of bat development, sensory systems, and specializations related to flight and diet. These articles paint a complex picture of the fascinating adaptations of bats, such as rapid fore limb development, ear morphologies relating to echolocation, and other enhanced senses that allow bats to exploit niches in virtually every part of the world. In this introduction, we integrate and contextualize these articles within the broader story of bat ecomorphology, providing an overview of each of the key themes noted above. This special issue will serve as a springboard for future studies both in bat biology and in the broader world of mammalian comparative anatomy and ecomorphology., (© 2023 American Association for Anatomy.)

Herein, we compared the developmental maturity of the cranium, limbs, and feeding apparatus in a perinatal common vampire bat relative to its mother. In addition, we introduce a method for combining two computed tomographic imaging techniques to three-dimensionally reconstruct endocasts in poorly ossified crania. The Desmodus specimens were scanned using microcomputed tomography (microCT) and diffusible iodine-based contrast-enhanced CT to image bone and soft tissues. Muscles of the jaw and limbs, and the endocranial cavity were segmented using imaging software. Endocranial volume (ECV) of the perinatal Desmodus is 74% of adult ECV. The facial skeletal is less developed (e.g., palatal length 60% of adult length), but volumes for alveolar crypts/sockets of permanent teeth are nearly identical. The forelimb skeleton is uniformly less ossified than the distal hind limb, with no secondary centers ossified and an entirely cartilaginous carpus. All epiphyseal growth zones are active in the brachium and antebrachium, with the distal radius exhibiting the greatest number of proliferating chondrocytes arranged in columns. The hind limb skeleton is precociously ossified from the knee distally. The musculature of the fore limb, temporalis, and masseter muscles appear weakly developed (6-11% of the adult volume). In contrast, the leg and foot musculature is better developed (23-25% of adult volume), possibly enhancing the newborn's capability to grip the mother's fur. Desmodus is born relatively large, and our results suggest they are born neurally and dentally precocious, with generally underdeveloped limbs, especially the fore limb., (© 2023 American Association for Anatomy.)

Competing Interests: Declaration of Competing Interest Dr. Basir is a consultant/speaker for Abbott Vascular, Abiomed, Boston Scientific, Cardiovascular Systems, Chiesi, Saranas, and Zoll and receives funding from Abiomed, Chiesi, Saranas, Shockwave Medical, and Zoll. Dr. Kearney reports is consultant for Abbott Vascular, Abiomed, Boston Scientific, Cardiovascular Systems, Medtronic, Teleflex, and Shockwave Medical and receives research funding from Teleflex. Dr. Kaki reports is consultant/speaker for Abiomed, Abbott Vascular, Cardiovascular Systems, and Shockwave Medical. Dr. Lichaa is a consultant for Abiomed, Abbott Vascular, Philips, and Cordis. Dr. Smith is a consultant/speaker for Abiomed, Boston Scientific, and Maquet. Dr. Truesdell is a consultant/speaker for Abiomed and Shockwave Medical. Dr. Vallabhajosyula receives intramural funding from Wake Forest University. The remaining authors have no competing interests to declare.

Aims: Invasive haemodynamic assessment with a pulmonary artery catheter is often used to guide the management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting haemodynamic parameters in CS., Methods and Results: The Critical Care Cardiology Trials Network is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018-2022) who underwent invasive haemodynamic assessment within 24 h of CICU admission were included. Associations of haemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score. Among the 3603 admissions with CS, 1473 had haemodynamic data collected within 24 h of CICU admission. The median cardiac index was 1.9 (25th-75th percentile, 1.6-2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66-86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for the intensity of background pharmacologic and mechanical haemodynamic support. These parameters were also associated with higher presenting serum lactate., Conclusion: In a contemporary CS population, presenting haemodynamic parameters reflecting decreased systemic arterial tone and right ventricular dysfunction are associated with adverse outcomes and systemic hypoperfusion., Competing Interests: Conflict of interest: D.D.B., E.A.B., V.M.B-Z., J.G., S.M.P., and D.A.M. are members of the TIMI Study Group, which has received institutional research grant support through Brigham and Women’s Hospital from Abbott, Abiomed, Amgen, Anthos Therapeutics, ARCA Biopharma, Inc., AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc., Daiichi-Sankyo, Eisai, Intarcia, Ionis Pharmaceuticals, Inc., Janssen Research and Development, LLC, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Roche, Siemens Healthcare Diagnostics, Inc., Softcell Medical Limited, The Medicines Company, Zora Biosciences. M.A.S. receives research support from the National Institutes of Health Clinical Center intramural research funds. A.D.T. is supported by NIH-NHLBI (K08HL163328)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: This study evaluated interconnected pathways of the use of safety management systems (SMS), environmental management systems (EMS), Lean, participatory programs, and integrated systems and their effect on safety management and other organizational outcomes from the perspective of safety professionals working within complex work systems., Method: Data were collected from 136 safety professionals. A structural path analysis assessed direct and indirect effects within the model and a confirmatory factor analysis evaluated high impact risk management practices and safety incidents as a model to assess safety management outcomes., Results: SMS implementation had significant direct effects on safety climate and high impact risk management practices. EMS implementation had significant direct effects on environmental management outcomes. Integration of SMS and EMS with Lean had significant direct effects on safety climate and safety professional engagement. Participatory programs had significant direct effects on high impact risk management practices and safety incidents. Safety professional engagement and safety climate had significant mediating effects on safety and organizational outcomes as did the use of high impact risk management practices., Conclusion: Results of this study present a case for the use of high impact risk management practices and safety incidents as a measurement of safety management outcomes and the use of participatory programs, SMS, and integrated systems, driven by highly engaged individuals to influence safety and organizational outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 National Safety Council and Elsevier Ltd. All rights reserved.)

Objectives: We sought to study the association of renal impairment (RI) with mortality in ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock and/or cardiac arrest (CS/CA)., Methods: Patients with RI (estimated glomerular filtration rate <60 mL/min/1.73 m 2 ) were identified from the Midwest STEMI consortium, a prospective registry of four large regional programs comprising consecutive patients over 17 years. Primary outcome was in-hospital and 1-year mortality stratified by RI status and presence of CS/CA among patients with STEMI referred for coronary angiography., Results: In a cohort of 13,463 STEMI patients, 13% (n = 1754) had CS/CA, 30% (n = 4085) had RI. Overall, in-hospital mortality was 5% (12% RI vs. 2% no-RI, p < 0.001) and 1-year mortality 9% (21% RI vs. 4% no-RI, p < 0.001). Among uncomplicated STEMI, in-hospital mortality was 2% (4% RI vs. 1% no-RI, p < 0.001) and 1-year mortality 6% (13% RI vs. 3% no-RI, p < 0.001). In STEMI with CS/CA, in-hospital mortality was 29% (43% RI vs. 15% no-RI, p < 0.001) and 1-year mortality 33% (50% RI vs. 16% no-RI, p < 0.001). Using Cox proportional hazards, RI was an independent predictor of in-hospital mortality in STEMI with CS/CA (odds ratio [OR]: 3.86; confidence interval [CI]: 2.6, 5.8)., Conclusions: The association of RI with in-hospital and 1-year mortality is disproportionately greater in those with CS/CA compared to uncomplicated STEMI presentations. Factors predisposing RI patients to higher risk STEMI presentations and pathways to promote earlier recognition in the chain of survival need further investigation., (© 2023 Wiley Periodicals LLC.)

Advances in next generation sequencing technologies, as well as their expanded accessibility and clinical use over the past 2 decades, have led to an exponential increase in the number of identified single gene disorders. Among these are primary atopic disorders-inborn errors of immunity resulting in severe allergic phenotypes as a primary presenting feature. Two cardinal aspects of type I immediate hypersensitivity allergic reactions are hives and angioedema. Mast cells (MCs) are frequent primary drivers of these symptoms, but other cells have also been implicated. Even where MC degranulation is believed to be the cause, mediator-induced symptoms may greatly vary among individuals. Angioedema-particularly in the absence of hives-may also be caused by hereditary angioedema conditions resulting from aberrant regulation of contact system activation and excessive bradykinin generation or impairment of vascular integrity. In these patients, swelling can affect unpredictable locations and fail to respond to MC-directed therapies. Genetic variants have helped delineate key pathways in the etiology of urticaria and nonatopic angioedema and led to the development of targeted therapies. Herein, we describe the currently known inherited and acquired genetic causes for these conditions, highlight specific features in their clinical presentations, and discuss the benefits and limitations of biomarkers that can help distinguish them., (Published by Elsevier Inc.)

Background: Despite workplaces having policies on fire evacuation, many employees still fail to evacuate when there is a fire alarm. The Reasoned Action Approach is designed to reveal the beliefs underlying people's behavioral decisions and thus suggests causal determinants to be addressed with interventions designed to facilitate behavior. This study is a uses a Reasoned Action Approach salient belief elicitation to identify university employees' perceived advantages/disadvantages, approvers/disapprovers, and facilitators/barriers toward them leaving the office building immediately the next time they hear a fire alarm at work., Methods: Employees at a large public United States Midwestern university completed an online cross-sectional survey. A descriptive analysis of the demographic and background variables was completed, and a six-step inductive content analysis of the open-ended responses was conducted to identify beliefs about leaving during a fire alarm., Results: Regarding consequence, participants perceived that immediately leaving during a fire alarm at work had more disadvantages than advantages, such as low risk perception. Regarding referents, supervisors and coworkers were significant approvers with intention to leave immediately. None of the perceived advantages were significant with intention. Participants listed access and risk perception as significant circumstances with the intention to evacuate immediately., Conclusion: Norms and risk perceptions are key determinants that may influence employees to evacuate immediately during a fire alarm at work. Normative-based and attitude-based interventions may prove effective in increasing the fire safety practices of employees., Competing Interests: The authors declare no conflict of interest., (© 2023 Occupational Safety and Health Research Institute.)

In an era of rapid identification of inborn errors of immunity, Sharma et al. 1 report novel heterozygous gain-of-function variants in the signal transducer and activator of transcription 6 (STAT6) gene in individuals with severe and early onset multi-systemic allergic disease., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population., Competing Interests: Disclosure All authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Individuals with hereditary angioedema (HAE) experience stress-related sequelae, including enhanced disease morbidity and reduced quality of life. The pervasive societal strain that surround the coronavirus disease 2019 (COVID-19) pandemic may theoretically pose a disproportionate risk for patients with HAE. Objective: To dissect the interrelationship(s) among the COVID-19 pandemic, stress, and HAE disease-related morbidity and overall well-being. Methods: Subjects with HAE (either due to C1-inhibitor deficiency or with normal C1 inhibitor) as well as non-HAE household members (normal controls) completed online questionnaires that covered the impact of the COVID-19 pandemic on attack frequency, observed effectiveness of HAE medications, stress, and perceived quality of life and/or well-being. The subjects scored each of the questions to reflect their current status as well as their status before being aware of the pandemic. Results: Disease morbidity and psychologic stress outcomes were significantly worse in patients with HAE during the pandemic compared with before they were aware of the pandemic. A COVID-19 infection further increased attack frequency. Control subjects also experienced deterioration of well-being and optimism. A comorbid diagnosis of anxiety, depression, or posttraumatic stress disorder (PTSD) was generally associated with worse outcomes. Women consistently showed greater decrements in wellness during the pandemic compared with men. Women also reported higher levels of comorbid anxiety, depression, or PTSD than men and experienced a higher rate of job loss during the pandemic. Conclusion: The results implicated a deleterious impact of stress in the aftermath of COVID-19 awareness on HAE morbidity. The female subjects were universally more severely affected then were the male subjects. Overall well-being and/or quality of life, and optimism for the future deteriorated after awareness of the COVID-19 pandemic for the subjects with HAE and non-HAE household controls.

The nasal capsule, as the most rostral part of the chondrocranium, is a critical point of connection with the facial skeleton. Its fate may influence facial form, and the varied fates of cartilage may be a vehicle contributing to morphological diversity. Here, we review ontogenetic changes in the cartilaginous nasal capsule of mammals, and make new observations on perinatal specimens of two chiropteran species of different suborders. Our observations reveal some commonalities between Rousettus leschenaultii and Desmodus rotundus, such as perinatal ossification of the first ethmoturbinal. However, in Rousettus, ossification of turbinals is demonstrated as either perichondrial or endochondral. In Desmodus, perichondrial and endochondral ossification of the posterior nasal cupula is observed at birth, a part of the nasal capsule previously shown to persist as cartilage into infancy in Rousettus. Combined with prior findings on cranial cartilages we identify several diverse transformational mechanisms by which cartilage as a tissue type may contribute to morphological diversity of the cranium. First, cartilage differentiates in an iterative fashion to increase nasal complexity, but still retains the capacity for later elaboration via de novo bone emanating outward before or after cartilage ossifies. Second, cartilage acts as a driver of growth at growth centers, or via interstitial growth (e.g., septal cartilage). Finally, cartilage as a tissue may influence the timing of ossification and union of the facial and basicranial skeleton. In particular, cartilage at certain points of ontogeny may "model" via selective resorption, showing some similarity to bone., (© 2023 American Association for Anatomy.)

Rationale & Objective: Risk prediction tools for assisting acute kidney injury (AKI) management have focused on AKI onset but have infrequently addressed kidney recovery. We developed clinical models for risk stratification of mortality and major adverse kidney events (MAKE) in critically ill patients with incident AKI., Study Design: Multicenter cohort study., Setting & Participants: 9,587 adult patients admitted to heterogeneous intensive care units (ICUs; March 2009 to February 2017) who experienced AKI within the first 3 days of their ICU stays., Predictors: Multimodal clinical data consisting of 71 features collected in the first 3 days of ICU stay., Outcomes: (1) Hospital mortality and (2) MAKE, defined as the composite of death during hospitalization or within 120 days of discharge, receipt of kidney replacement therapy in the last 48 hours of hospital stay, initiation of maintenance kidney replacement therapy within 120 days, or a ≥50% decrease in estimated glomerular filtration rate from baseline to 120 days from hospital discharge., Analytical Approach: Four machine-learning algorithms (logistic regression, random forest, support vector machine, and extreme gradient boosting) and the SHAP (Shapley Additive Explanations) framework were used for feature selection and interpretation. Model performance was evaluated by 10-fold cross-validation and external validation., Results: One developed model including 15 features outperformed the SOFA (Sequential Organ Failure Assessment) score for the prediction of hospital mortality, with areas under the curve of 0.79 (95% CI, 0.79-0.80) and 0.71 (95% CI, 0.71-0.71) in the development cohort and 0.74 (95% CI, 0.73-0.74) and 0.71 (95% CI, 0.71-0.71) in the validation cohort (P < 0.001 for both). A second developed model including 14 features outperformed KDIGO (Kidney Disease: Improving Global Outcomes) AKI severity staging for the prediction of MAKE: 0.78 (95% CI, 0.78-0.78) versus 0.66 (95% CI, 0.66-0.66) in the development cohort and 0.73 (95% CI, 0.72-0.74) versus 0.67 (95% CI, 0.67-0.67) in the validation cohort (P < 0.001 for both)., Limitations: The models are applicable only to critically ill adult patients with incident AKI within the first 3 days of an ICU stay., Conclusions: The reported clinical models exhibited better performance for mortality and kidney recovery prediction than standard scoring tools commonly used in critically ill patients with AKI in the ICU. Additional validation is needed to support the utility and implementation of these models., Plain-Language Summary: Acute kidney injury (AKI) occurs commonly in critically ill patients admitted to the intensive care unit (ICU) and is associated with high morbidity and mortality rates. Prediction of mortality and recovery after an episode of AKI may assist bedside decision making. In this report, we describe the development and validation of a clinical model using data from the first 3 days of an ICU stay to predict hospital mortality and major adverse kidney events occurring as long as 120 days after hospital discharge among critically ill adult patients who experienced AKI within the first 3 days of an ICU stay. The proposed clinical models exhibited good performance for outcome prediction and, if further validated, could enable risk stratification for timely interventions that promote kidney recovery., (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Musculoskeletal disorders (MSDs) and associated musculoskeletal symptoms (MSS) are problematic in stone, sand, and gravel mining. Research is needed to explore relationships between job demands, work-related hazards and MSS., Objective: An exploratory study was conducted in Indiana during 2019-2020 to examine associations between job demands, work-related hazards and MSS., Methods: Through convenience sampling, cross-sectional survey data from 459 workers were collected and analyzed using logistic multiple and binary logistic regression methods. Outcome variables were MSS to the low back, neck/shoulder, and wrist/hand. Predictor variables and MSS measures are based on the Dutch Musculoskeletal Questionnaire., Results: Increased odds of low back MSS were related to dynamic loads (OR = 2.14), pushing/pulling heavy loads (OR = 1.56), torso bending or twisting (OR = 2.36), bent, stooped, or twisted posture (OR = 2.04), uncomfortable postures (OR = 2.07), repetition (OR = 1.67) and vibrating tools (OR = 1.81). Increased odds of neck/shoulder MSS were related to dynamic loads (OR = 1.83), static loads (OR = 1.24), heavy lifting (OR = 1.50), pushing/pulling heavy loads (OR = 1.68), bending or twisting of the neck (OR = 1.82), twisted neck posture (OR = 1.77) and uncomfortable postures (OR = 1.81). Increased odds of wrist/hand MSS were related to dynamic loads (OR = 2.06), static loads (OR = 1.45), bending or twisting of the wrists/hands (OR = 10.52), extended reaching (OR = 3.05), repetition (OR = 5.25), awkward postures (OR = 4.47), working above shoulder level (OR = 2.47), and vibrating tools (OR = 1.78)., Conclusion: Hazards that increased the likelihood of MSS were identified. These hazards should be abated or controlled to prevent MSDs in stone, sand, and gravel mining. More applied research, including ergonomic assessments to further identify hazards that can be controlled or abated, is warranted.

Aims: The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness., Methods and Results: The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year. More than 20 000 unique CICU admissions are now included in the CCCTN Registry. To date, scientific observations from the CCCTN Registry include description of variations in care, the epidemiology and outcomes of all CICU patients, as well as subsets of patients with specific disease states, such as shock, heart failure, renal dysfunction, and respiratory failure. The CCCTN has also characterised utilization patterns, including use of mechanical circulatory support in response to changes in the heart transplantation allocation system, and the use and impact of multidisciplinary shock teams. Over years of multicentre collaboration, the CCCTN has established a robust research network to facilitate multicentre registry-based randomised trials in patients with cardiac critical illness., Conclusion: The CCCTN is a large, prospective registry dedicated to describing processes-of-care and expanding clinical knowledge in cardiac critical illness. The CCCTN will serve as an investigational platform from which to conduct randomised controlled trials in this important patient population., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Intravascular lithotripsy (IVL) uses acoustic shock waves in a balloon-based delivery system to modify severely calcified atherosclerotic coronary vascular lesions in preparation for stent implantation. IVL results in circumferential and longitudinal calcium fracture, which improves transmural vessel compliance and facilitates subsequent stent expansion without requiring high-pressure balloon dilation. Clinical trials have demonstrated IVL to be safe (low rates of major adverse cardiac events in hospital and to 1 year; low rates of severe angiographic complications), effective (high rates of procedural success), and easy to use (little or no learning curve) when applied in the treatment of severely calcified coronary arteries., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study compared levels of concern, spending, and use of external support by working status among older adults in the U.S. during the COVID-19 pandemic. It assessed whether work influences these variables related to wellness. Data from 2489 older adults from the 2020 U.S. Health and Retirement Study were analyzed using multiple linear and logistic regression. Older adults who worked had lower concerns about the pandemic (β = -0.28, p = 0.048), were less likely to increase their spending (OR = 0.74, p = 0.041), and were less likely to use external support (OR = 0.50, p < 0.001). Use of external support increased with age (OR = 1.04, p < 0.001) and increased spending (OR = 1.32, p = 0.019). Married older adults were less likely to increase spending (OR = 0.75, p = 0.007) and had lower concerns toward COVID-19 (β = -0.28, p = 0.011). Higher levels of concern were reported among women (β = 0.31, p = 0.005) and participants who had friends or family members diagnosed with COVID-19 (β = 0.51, p < 0.001). Women were more likely to use support (OR = 1.80, p < 0.001). Work appears to bolster older adult wellness outcomes.

Our knowledge of nasal cavity anatomy has grown considerably with the advent of micro-computed tomography (CT). More recently, a technique called diffusible iodine-based contrast-enhanced CT (diceCT) has rendered it possible to study nasal soft tissues. Using diceCT and histology, we aim to (a) explore the utility of these techniques for inferring the presence of venous sinuses that typify respiratory mucosa and (b) inquire whether distribution of vascular mucosa may relate to specialization for derived functions of the nasal cavity (i.e., nasal-emission of echolocation sounds) in bats. Matching histology and diceCT data indicate that diceCT can detect venous sinuses as either darkened, "empty" spaces, or radio-opaque islands when blood cells are present. Thus, we show that diceCT provides reliable information on vascular distribution in the mucosa of the nasal airways. Among the bats studied, a nonecholocating pteropodid (Cynopterus sphinx) and an oral-emitter of echolocation sounds (Eptesicus fuscus) possess venous sinus networks that drain into the sphenopalatine vein rostral to the nasopharynx. In contrast, nasopharyngeal passageways of nasal-emitting hipposiderids are notably packed with venous sinuses. The mucosae of the nasopharyngeal passageways are far less vascular in nasal-emitting phyllostomids, in which vascular mucosae are more widely distributed in the nasal cavity, and in some nectar-feeding species, a particularly large venous sinus is adjacent to the vomeronasal organ. Therefore, we do not find a common pattern of venous sinus distribution associated with nasal emission of sounds in phyllostomids and hipposiderids. Instead, vascular mucosa is more likely critical for air-conditioning and sometimes vomeronasal function in all bats., (© 2021 American Association for Anatomy.)

Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population., Competing Interests: Disclosure All authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Research has shown that long work hours and overtime are associated with health impairment, including stress, burnout, and overall health. However, this has not been thoroughly assessed among stone, sand, and gravel mine workers. As such, this study examined whether significant differences in stress, burnout, and overall health existed among workers that worked different hours each week. Methods: ANOVA analyses were completed for the outcome variables (stress, burnout, and health status). Each analysis included three categorical independent variables: age, sex, and work hours. Age and sex were control variables. BMI was added to the health status analysis as an additional control variable. Results: There were significant differences between work hour groups for all three outcomes. Post hoc analyses determined that workers working >60 h/week had more stress, more burnout, and lower health. Differences were not found between age or sex. There were no differences in health status for different BMI groups, but the interaction of BMI and work hours was significant. Conclusions: Working more than 60 h per week was problematic. Mine and safety administrators should enact programs to protect and promote worker health, particularly among those working long hours, especially if more than 60 h per week.

Background: Nonresidential fires and resultant injuries and deaths have been on the rise the last decade in the United States. Although evacuation is a primary prevention method, people in the workplace still fail to evacuate when they hear a fire alarm. The current formative study applied the Reasoned Action Approach (RAA) to identify belief factors associated with university employees' intention evacuate., Methods: Data were collected from employees at a large public university ( N = 490) through an online survey. Multiple linear regression quantified the relative contribution of six RAA constructs that represent belief factors underlying employees' intention to leave the office building immediately the next time they hear a fire alarm., Findings: Nearly 60% of the variation in employees' intention to leave was predicted from the belief factors, adjusted R 2 = 0.598, F (17, 472) = 43.80, p < .001. Controlling for demographic characteristics, five of the six RAA global constructs showed statistically significant independent associations with intention: instrumental attitude ( B = .272, SE = .026, p < .001), experiential attitude ( B = -.073, SE = .026, p = .024), injunctive norm ( B = .210, SE = .075, p < .001), descriptive norm ( B = .347, SE = .070, p < .001), and capacity ( B = .178, SE = .077, p < .001)., Conclusions/applications to Practice: These findings show the RAA can be successfully applied to provide employees' perspective on safety decisions like evacuation. The belief factors' relative contributions can help safety professionals prioritize interventions to facilitate leaving immediately. Here the high weights for the two normative factors suggest addressing employees' descriptive beliefs that others like them leave and their injunctive beliefs that significant others, like supervisors and safety personnel, approve of their leaving.

Background: Musculoskeletal disorders (MSD) are problematic in many industries, including stone, sand, and gravel mining (SSGM). This research aimed to delineate MSD risk factors and to identify protective safety resources that reduce MSD within these operations., Methods: A deductive content analysis of recorded transcripts from a focus group, which included professionals working in SSGM organizations, was completed., Findings: Results suggested demographic and personal factors associated with MSD included age, lack of experience, low levels of physical fitness, and attitudes toward risks. Work factors and job demands included excessive lifting, performing additional job duties, production-focused operations, lack of resources, and work related to maintenance and equipment operation. Suggested safety resources included a focus on worker fitness, resource adequacy, pay and benefits, the SLAM (Stop, Look, Analyze, and Manage) process and positive safety culture., Conclusion: This qualitative research project utilized mine experts to identify demographic, personal, work, and job demand factors they perceive or know to be associated with MSD. Safety programs suggested by these same experts to reduce MSD were also presented., Application to Practice: Occupational health and safety practitioners and mine administrators should focus on the identified factors in their work to prevent MSD within SSGM operations. Safety efforts need to include integrated programs that promote health and fitness as well. These efforts should be implemented along with recommended programs such as SLAM and the provision of appropriate safety resources to minimize risks. These efforts should promote the importance of safety and will help with bolstering a positive safety culture.

Background: The long-term outcomes of diabetic patients presenting with ST-segment elevation myocardial infarction (STEMI) in contemporary practice have received limited study., Methods: We evaluated the clinical characteristics and outcomes of STEMI patients with and without diabetes in a large regional STEMI program designed to facilitate timely primary percutaneous coronary intervention (PCI) (Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN). The primary and secondary outcome measures were in-hospital mortality, 1-year major adverse cardiovascular events (MACE) (stroke, myocardial infarction, unplanned PCI or coronary artery bypass graft [CABG] surgery, and all-cause mortality), and 5-year mortality., Results: Of the 6292 patients included, 1158 (18.4%) had Diabetes Mellitus (DM) (95.3% Type II, 4.7% Type I). Patients with DM were older (mean age 66 vs. 62.8 years, p < 0.01), had more co-morbidities and were more likely to receive medical therapy without reperfusion (13% vs. 10%, p = 0.003). Patients with DM had higher in-hospital (8% vs. 5%, p = 0.001), 1-year (8% vs. 4%, p < 0.001) and 5-year mortality (16% vs. 9%, p < 0.001) compared to non-diabetics. On Cox proportional hazards analysis, DM was independently associated with worse mortality (hazard ratio: 1.70, 95% confidence interval (CI): 1.32-2.19, p < 0.001) and MACE [HR: 1.63 (95% (CI)): 1.28-2.08, p < 0.001]., Conclusions: Despite advancements in medical therapy and revascularization strategies for STEMI, DM remains independently associated with higher short- and long-term morbidity and mortality in contemporary practice., Competing Interests: Declaration of competing interest Santiago Garcia: consultant for Edwards Lifesciences and Abbott Vascular. Institutional Grant support from Edwards Lifesciences, BSCI, and Abbott vascular. Proctor: Edwards Lifesciences. Emmanouil Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures. Other authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Axillary artery access has become increasingly widespread as an alternative to the femoral route for large-bore transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and mechanical circulatory support (MCS) procedures. Advantages of percutaneous access include avoidance of a surgical incision, general anesthesia, and conduit graft infection. This statement aims to review the anatomic considerations and risks for percutaneous axillary artery access, suggest best practices for access techniques, hemostasis/closure strategies, and complication management, and recommend options for training and privileging., (© 2022 The Author(s).)

The occupational stress inherent in firefighting poses both physiological and psychological risks to firefighters that have been found to possess a reciprocal nature. That is, the nature of these relationships in terms of indicator and impact are elusive, especially as it relates to sleep health (e.g., quality, quantity, hygiene, etc.) as a specific physiological risk and burnout as a specific psychological risk. A series of mediation models were assessed to examine the reciprocal relationships between occupational stress, burnout, and sleep health in a sample of 161 career firefighters. The mediation models confirmed reciprocity among the variables in so much that relationships were best described by the underlying mechanism at work. Comprehensive assessments of both subjective and objective markers of sleep health should be incorporated into firefighter research to supplement behavioral health assessments and interventions, especially related to burnout and occupational stress.

Unplanned repeat coronary angiography (CAG) after balloon angioplasty for ST-elevation myocardial infarction (STEMI) was common before the advent of coronary stenting. Limited data are available regarding the role of unplanned repeat CAG in contemporary percutaneous coronary intervention (PCI) for STEMI. Therefore, we analyzed a large, 2-center prospective STEMI registry (January 2011 to June 2020) stratified by the presence or absence of unplanned repeat CAG during index hospitalization. Patients with planned CAG for staged PCI or experimental drug administration were excluded. Among 3,637 patients with STEMI, 130 underwent unplanned repeat CAG (3.6%) during index hospitalization. These patients were more likely to have cardiogenic shock (16% vs 9.8%, p = 0.021), left anterior descending culprit (44% vs 31%, p <0.001), lower left ventricular ejection fraction (45% vs 52%, p <0.001), and higher peak troponin levels (22 vs 8 ng/ml, p <0.001) than those without repeat CAG. At repeat CAG, 80 patients had a patent stent (62%) including 65 requiring no further intervention (50%) and 15 who underwent intervention on a nonculprit lesion (12%). Only 32 patients had stent thrombosis (25%). Repeat CAG was associated with a higher incidence of recurrent MI (19% vs 0%, p <0.001) and major bleeding (12% vs 4.5%, p <0.001), yet similar in-hospital mortality (7% vs 6.4%, p = 0.93) than those without repeat CAG. In conclusion, in the era of contemporary PCI for STEMI, unplanned repeat CAG during index hospitalization was infrequent and more commonly observed in patients with left anterior descending culprit in the presence of significant left ventricular dysfunction or shock and was associated with higher in-hospital recurrent myocardial infarction and major bleeding complications., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021. Published by Elsevier Inc.)

Background: Certified Hand Therapy is a subset of occupational/physical therapy that is relatively unknown to the common individual. Certified Hand Therapists (CHTs) help those with upper extremity injuries, whether it be those with workplace injuries, those who suffered a traumatic injury or those recovering from major surgery to reach the point where they are able to be independent and back to doing daily life activities., Objective: This study aimed to discern the roles that Certified Hand Therapists have in rehabilitating individuals with upper extremity injuries, to assess their participation in work-related injury prevention, to examine with whom CHTs interact during the rehabilitation process, and to gain insight into how the relationships between CHTs and occupational safety professionals can be improved., Methods: Structured interviews were conducted with eight occupational therapists who are Certified Hand Therapists or are in the process of being certified. Interviews were recorded, transcribed and analyzed to determine themes relative to the study objectives., Results: Content analyses determined trends in job roles, interactions with occupational safety professionals, the importance of patient education in prevention and rehabilitation and barriers to effective treatment of work-related injuries., Conclusion: CHTs shared similar thoughts regarding their profession. CHTs revealed common themes in the eight interviews conducted. Specifically, many CHTs believe education is a vital part of the profession in terms of improving the profession and in the rehabilitation process. In addition, patient compliance and the current workers' compensation system were seen as challenges when rehabilitating patients.

Background Contemporary real-world data on stroke in patients presenting with ST-segment-elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long-term impact of stroke on 5-year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5-year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P -trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4-72 hours), which led to a small minority (3%) receiving endovascular treatment and high in-hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10-1.58; P -value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03-3.78; P =0.032)) were associated with a higher risk of in-hospital stroke. In-hospital stroke was independently associated with increased risk of 5-year mortality (hazard ratio, 2.01; 95% CI, 1.13-3.57; P =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in-hospital (18%) and long-term mortality (35% at 5 years). Stroke was associated with double the risk of 5-year death.

Diffusible iodine-based contrast-enhanced computed tomography (diceCT) has emerged as a viable tool for discriminating soft tissues in serial CT slices, which can then be used for three-dimensional analysis. This technique has some potential to supplant histology as a tool for identification of body tissues. Here, we studied the head of an adult fruit bat ( Cynopterus sphinx ) and a late fetal vampire bat ( Desmodus rotundus ) using diceCT and µCT. Subsequently, we decalcified, serially sectioned and stained the same heads. The two CT volumes were rotated so that the sectional plane of the slice series closely matched that of histological sections, yielding the ideal opportunity to relate CT observations to corresponding histology. Olfactory epithelium is typically thicker, on average, than respiratory epithelium in both bats. Thus, one investigator (SK), blind to the histological sections, examined the diceCT slice series for both bats and annotated changes in thickness of epithelium on the first ethmoturbinal (ET I), the roof of the nasal fossa, and the nasal septum. A second trial was conducted with an added criterion: radioopacity of the lamina propria as an indicator of Bowman's glands. Then, a second investigator (TS) annotated images of matching histological sections based on microscopic observation of epithelial type, and transferred these annotations to matching CT slices. Measurements of slices annotated according to changes in epithelial thickness alone closely track measurements of slices based on histologically-informed annotations; matching histological sections confirm blind annotations were effective based on epithelial thickness alone, except for a patch of unusually thick non-OE, mistaken for OE in one of the specimens. When characteristics of the lamina propria were added in the second trial, the blind annotations excluded the thick non-OE. Moreover, in the fetal bat the use of evidence for Bowman's glands improved detection of olfactory mucosa, perhaps because the epithelium itself was thin enough at its margins to escape detection. We conclude that diceCT can by itself be highly effective in identifying distribution of OE, especially where observations are confirmed by histology from at least one specimen of the species. Our findings also establish that iodine staining, followed by stain removal, does not interfere with subsequent histological staining of the same specimen., Competing Interests: The authors declare that they have no competing interests., (© 2021 Smith et al.)

Background: Patients with hereditary angioedema (HAE) have been postulated to be at increased risk for coronavirus disease 2019 (COVID-19) infection due to inherent dysregulation of the plasma kallikrein-kinin system. Only limited data have been available to explore this hypothesis. Objective: To assess the interrelationship(s) between COVID-19 and HAE. Methods: Self-reported COVID-19 infection, complications, morbidity, and mortality were surveyed by using an online questionnaire. The participants included subjects with HAE with C1 inhibitor (C1INH) deficiency (HAE-C1INH) and subjects with HAE with normal C1-inhibitor (HAE-nl-C1INH), and household controls (normal controls). The impact of HAE medications was examined. Results: A total of 1162 participants who completed the survey were analyzed, including: 695 subjects with HAE-C1INH, 175 subjects with HAE-nl-C1INH, and 292 normal controls. The incidence of reported COVID-19 was not significantly different between the normal controls (9%) and the subjects with HAE-C1INH (11%) but was greater in the subjects with HAE-nl-C1INH (19%; p = 0.006). Obesity was positively correlated with COVID-19 across the overall population (p = 0.012), with a similar but nonsignificant trend in the subjects with HAE-C1INH. Comorbid autoimmune disease was a risk factor for COVID-19 in the subjects with HAE-C1INH (p = 0.047). COVID-19 severity and complications were similar in all the groups. Reported COVID-19 was reduced in the subjects with HAE-C1INH who received prophylactic subcutaneous C1INH (5.6%; p = 0.0371) or on-demand icatibant (7.8%; p = 0.0016). The subjects with HAE-C1INH and not on any HAE medications had an increased risk of COVID-19 compared with the normal controls (24.5%; p = 0.006). Conclusion: The subjects with HAE-C1INH who were not taking HAE medications had a significantly higher rate of reported COVID-19 infection. Subcutaneous C1INH and icatibant use were associated with a significantly reduced rate of reported COVID-19. The results implicated potential roles for the complement cascade and tissue kallikrein-kinin pathways in the pathogenesis of COVID-19 in patients with HAE-C1INH.