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Breaking down language barriers in paediatric care is pivotal for effective communication and positive health outcomes, particularly for vulnerable groups such as refugees, asylum seekers, the deaf and neurodivergent patients. This paper highlights the importance of culturally competent care. The specific needs of children with deafness and neurodiverse conditions are also considered. [ABSTRACT FROM AUTHOR]

For dosimetry of radiopharmaceutical therapies, it is essential to determine the volume of relevant structures exposed to therapeutic radiation. For many radiopharmaceuticals, the kidneys represent an important organ-at-risk. To reduce the time required for kidney segmentation, which is often still performed manually, numerous approaches have been presented in recent years to apply deep learning-based methods for CT-based automated segmentation. While the automatic segmentation methods presented so far have been based solely on CT information, the aim of this work is to examine the added value of incorporating PSMA-PET data in the automatic kidney segmentation. A total of 108 PET/CT examinations (53 [68Ga]Ga-PSMA-I&T and 55 [18F]F-PSMA-1007 examinations) were grouped to create a reference data set of manual segmentations of the kidney. These segmentations were performed by a human examiner. For each subject, two segmentations were carried out: one CT-based (detailed) segmentation and one PET-based (coarser) segmentation. Five different u-net based approaches were applied to the data set to perform an automated segmentation of the kidney: CT images only, PET images only (coarse segmentation), a combination of CT and PET images, a combination of CT images and a PET-based coarse mask, and a CT image, which had been pre-segmented using a PET-based coarse mask. A quantitative assessment of these approaches was performed based on a test data set of 20 patients, including Dice score, volume deviation and average Hausdorff distance between automated and manual segmentations. Additionally, a visual evaluation of automated segmentations for 100 additional (i.e., exclusively automatically segmented) patients was performed by a nuclear physician. Out of all approaches, the best results were achieved by using CT images which had been pre-segmented using a PET-based coarse mask as input. In addition, this method performed significantly better than the segmentation based solely on CT, which was supported by the visual examination of the additional segmentations. In 80% of the cases, the segmentations created by exploiting the PET-based pre-segmentation were preferred by the nuclear physician. This study shows that deep-learning based kidney segmentation can be significantly improved through the addition of a PET-based pre-segmentation. The presented method was shown to be especially beneficial for kidneys with cysts or kidneys that are closely adjacent to other organs such as the spleen, liver or pancreas. In the future, this could lead to a considerable reduction in the time required for dosimetry calculations as well as an improvement in the results. [ABSTRACT FROM AUTHOR]

Prostate-specific membrane antigen (PSMA) PET/CT has been widely integrated into the management of prostate cancer (PCa) patients with biochemical recurrence, is increasingly used for initial staging in high-risk patients prior to surgery or to identify candidates for PSMA-targeted radioligand therapy (RLT). To date, monitoring response in PCa patients in prospective studies remains the domain of conventional imaging, such as magnetic resonance/CT or bone scintigraphy. With the increasing use of PSMA-targeted PET/CT in PCa, however, varying criteria based on molecular imaging have been established to define progressive disease, including "PSMA PET Progression Criteria," "Response evaluation criteria in PSMA PET/CT (RECIP 1.0)" or consensus statements of respective societies. In the present review, we will discuss the current status of PSMA PET/CT for response monitoring, focusing on PSMA RLT with [177Lu]Lu-labeled PSMA ligands, along with a head-to-head comparison of recently published response criteria. [ABSTRACT FROM AUTHOR]

Antenatal administration of magnesium sulfate (MgSO 4) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO 4 exposure with neonatal respiratory outcomes. Very low birth weight (VLBW) infants exposed to antenatal MgSO 4 were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO 4 therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO 4 cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors. Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p < 0.01) and lower birth weight (786 vs. 1115 g (g), p < 0.01), there were no significant differences between groups in regard to MgSO 4 cumulative dose (24 vs. 27 g, p = 0.29), infusion time (14.6 vs. 18 h, p = 0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p = 0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: −0.03, p = 0.66; and 0.02, p = 0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: −0.04 to −0.07, p = 0.21–0.51). In addition, there was no relationship between MgSO 4 dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH. Regardless of dose or duration of infusion, antenatal MgSO 4 exposure is not associated with increased intubation or mechanical ventilation early in life. [ABSTRACT FROM AUTHOR]

Renal scintigraphy is a centerpiece of nuclear medicine and is also commonly applied for (peri-)acute care. In this regard, referrals by the treating physician include: I.) acute obstructions caused by gradual and infiltrative tumor growth or renal off-target effects under anti-tumor treatment, II.) functional issues in infants, for example, structural abnormalities such as duplex kidneys or uroliths in adults, which can also trigger III.) Infections of renal parenchyma. Renal radionuclide imaging is also requested due to IV.) acute trauma to the abdomen, for example, to assess renal scarring or upon further follow-up after reconstructive surgery. We will discuss clinical applications of (peri-)acute renal scintigraphy, along with future prospects on the use of more advanced nuclear imaging techniques such as renal positron emission tomography. [ABSTRACT FROM AUTHOR]

De novo designed peptides that self-assemble into cross-β rich fibrillar biomaterials have been pursued as an innovative platform for the development of adjuvant- and inflammation-free vaccines. However, they share structural and morphological properties similar to amyloid species implicated in neurodegenerative diseases, which has been a long-standing concern for their successful translation. Here, we comprehensively characterize the amyloidogenic character of the amphipathic self-assembling cross-β peptide KFE 8 , compared to pathological amyloid and amyloid-like proteins α-synuclein (α-syn) and TDP-43. Further, we developed plasmid-based DNA vaccines with the KFE 8 backbone serving as a scaffold for delivery of a GFP model antigen. We find that expression of tandem repeats of KFE 8 is non-toxic and efficiently cleared by autophagy. We also demonstrate that preformed KFE 8 fibrils do not cross-seed amyloid formation of α-syn in mammalian cells compared to α-syn preformed fibrils. In mice, vaccination with plasmids encoding the KFE 32 -GFP fusion protein elicited robust immune responses, inducing production of significantly higher levels of anti-GFP antibodies compared to soluble GFP. Antigen-specific CD8+T cells were also detected in the spleens of vaccinated mice and cytokine profiles from antigen recall assays indicate a balanced Th1/Th2 response. These findings illustrate that cross-β-rich peptide nanofibers have distinct physicochemical properties from those of pathological amyloidogenic proteins, and are an attractive platform for the development of DNA vaccines with self-adjuvanting properties and improved safety profiles. Biomaterials comprised of self-assembling peptides hold great promise for the development of new vaccines that do not require use of adjuvants. However, these materials have safety concerns, as they self-assemble into cross-β rich fibrils that are structurally similar to amyloid species implicated in disease. Here, we comprehensively study the properties of these biomaterials. We demonstrate that they have distinct properties from pathological proteins. They are non-toxic and do not trigger amyloidogenesis. Vaccination of these materials in mice elicited a robust immune response. Most excitingly, our work suggests that this platform could be used to develop DNA-based vaccines, which have few storage requirements. Further, due to their genetic encoding, longer sequences can be generated and the vaccines will be amenable to modification. [Display omitted] [ABSTRACT FROM AUTHOR]

Preeclampsia is a multisystemic disorder of pregnancy that affects 250,000 pregnant individuals in the United States and approximately 10 million worldwide per annum. Preeclampsia is associated with substantial immediate morbidity and mortality but also long-term morbidity for both mother and offspring. It is now clearly established that a low dose of aspirin given daily, beginning early in pregnancy modestly reduces the occurrence of preeclampsia. Low-dose aspirin seems safe, but because there is a paucity of information about long-term effects on the infant, it is not recommended for all pregnant individuals. Thus, several expert groups have identified clinical factors that indicate sufficient risk to recommend low-dose aspirin preventive therapy. These risk factors may be complemented by biochemical and/or biophysical tests that either indicate increased probability of preeclampsia in individuals with clinical risk factors, or more importantly, identify increased likelihood in those without other evident risk. In addition, the opportunity exists to provide this population with additional care that may prevent or mitigate the short- and long-term effects of preeclampsia. Patient and provider education, increased surveillance, behavioral modification, and other approaches to improve outcomes in these individuals can improve the chance of a healthy outcome. We assembled a group with diverse, relevant expertise (clinicians, investigators, advocates, and public and private stakeholders) to develop a care plan in which providers and pregnant individuals at risk can work together to reduce the risk of preeclampsia and associated morbidities. The plan is for care of individuals at moderate to high risk for developing preeclampsia, sufficient to receive low-dose aspirin therapy, as identified by clinical and/or laboratory findings. The recommendations are presented using the GRADE methodology with the quality of evidence upon which each is based. In addition, printable appendices with concise summaries of the care plan's recommendations for patients and healthcare providers are provided. We believe that this shared approach to care will facilitate prevention of preeclampsia and its attendant short- and long-term morbidity in patients identified as at risk for development of this disorder. [ABSTRACT FROM AUTHOR]

• Need hospital-to-home interventions to support both older adult and caregiver needs. • Must target underrepresented and marginalized groups of caregivers. • Community-based services, social networks, and professional services are key. The objective of this scoping review is to examine current evidence regarding unpaid/family caregivers' experiences during older adults' hospital-to-home transitions to identify gaps and opportunities to involve caregivers in transitional care improvement efforts. Eligible articles focused on caregiver experience, outcomes, or interventions during older adults' hospital-to-home transitions. Our review identified several descriptive studies focused on exploring the caregiver experience of older adult hospital-to-home transitions and caregiver outcomes (such as preparedness, strain, burden, health, and well-being). Qualitative studies revealed challenges at multiple levels, including individual, interpersonal, and systemic. Few interventions have targeted or included caregivers to improve discharge education and address support needs during the transition. Future work should target underrepresented and marginalized groups of caregivers, and caregivers' collaboration with community-based services, social networks, or professional services. Work remains in developing and implementing interventions to support both older adult and caregiver needs. [ABSTRACT FROM AUTHOR]

Background: The prevalence of deaths involving synthetic opioids has historically been lower in Texas than most U.S. states but more than quadrupled from January 2020 to January 2022. This paper explores the emergence of fentanyl in a drug supply where black tar heroin predominates, a factor considered protective against fentanyl adulteration, through the perspectives of people who use drugs (PWUD). Objectives: We describe experiences of unintentional exposure to fentanyl, illustrate how some people identify fentanyl in their supply, and present harm reduction strategies that PWUD use to avoid overdose. Methods: Thirty rapid assessment interviews were conducted in July 2021 at 2 mobile outreach sites of a harm reduction organization in Austin, Texas. The brief semistructured interviews were designed to assess participant fentanyl exposure experiences. Results: Participants were clients who reported using heroin or fentanyl in the past week and had lived in Texas for at least 6 months. Seventeen participants identified as male, 10 as female, and 3 as nonbinary. Half identified as white; other participants were Latinx (6), black (2), American Indian (1), and mixed race (6). Two-thirds were unhoused or in transitional housing. The drug supply in Texas has evolved; most participants reported that the heroin and other drugs they obtained contain fentanyl. Participants detected differences by observing changes in the physical characteristics of the drug, experiencing unexpected effects, and using fentanyl test strips. Many had been unintentionally exposed to fentanyl and expressed concerns about fentanyl’s presence. The presence of fentanyl had negative unintended consequences for participants, including adverse effects and developing a dependence on opioids. Conclusion: PWUD in Austin, Texas, report increasing prevalence of unintentional fentanyl exposure, despite the predominance of black tar heroin. Pharmacists can provide crucial supplies and education to safeguard the health of this vulnerable population. [ABSTRACT FROM AUTHOR]

Global digitalization and electrification require economical and environmentally sustainable battery cell factories on a gigawatt scale. Upscaling the production of solid-state batteries poses new challenges for factory planning. As compared to conventional lithium ion batteries (LIB), solid-state batteries require additional production processes under defined environment (e.g. dry rooms with controlled due point) to fulfill product requirements. The efficient provision of these production environments results in significant capital and energy costs, and influences the design and planning of giga factories for solid-state batteries. The design of these production environments is primarily determined by the interactions between the employees, the processes, and the battery materials used. To account for these interactions, the planning of solid-state battery factories requires a holistic, simulation-based factory design. In this research, a modular factory simulation framework for the assessment of scalable solid-state battery cell production (from pilot to industry scale) is introduced. Parameterizable machine and production environments enable a step-by-step design of the specific process chains, for which the technical, economic and environmental aspects can be assessed. The functionality of the simulation is presented based on a comparison of two models for the anode procurement (internally made or externally purchased) whereby key figures are determined and discussed. [ABSTRACT FROM AUTHOR]

• Introduction to special issue with six case studies of climate delay (mitigation deterrence) arising from CDR. • Mitigation deterrence operates through three processes in which CDR is envisioned, rendered knowable, and used for offsetting. • The introduction also identifies gaps for future work, including studies of mitigation deterrence in the Global South. [ABSTRACT FROM AUTHOR]

Two major sociopolitical challenges loom over the development of carbon removal. One is mitigation deterrence: that research and deployment of carbon removal could delay mitigation efforts. The other is environmental and climate justice — in particular that carbon removal will be developed in ways that further environmental racism, e.g. for the benefit of interests and groups in the global North while harming overburdened communities of color. A variety of policy measures have been proposed to deal with these challenges, from developing separate targets for emissions and removals to social safeguarding principles and standards. Here, we suggest that such measures in and of themselves are unlikely to be sufficient. Policy recommendations and scholarship on mitigation deterrence need to become more attentive to how racial capitalism helps form the conditions for mitigation deterrence. We describe how racial capitalism sets up mitigation deterrence, and how mitigation deterrence in turn goes on to perpetuate racial capitalism. We conclude by suggesting a few ways in which incorporating understandings of racial capitalism can help policymakers, carbon removal developers and investors make decisions that limit the risks of mitigation deterrence and racial injustice. • Racial capitalism is an important concept to understand for people thinking about carbon removal. • Racial capitalism enables mitigation deterrence from carbon removal through erasures in modelling and racialized labor formations. • Mitigation deterrence in turn goes on to perpetuate racial capitalism. • Environmental justice advocates have put forward ideas on addressing some mitigation deterrence risks from carbon removal. [ABSTRACT FROM AUTHOR]

• Planning for aging and frailty is a comprehensive approach that assesses adults readiness to plan for aging and frailty across their aging trajectory, while encompassing social determinants of health. • Over 50% of older participants were in the no action (precontemplation/contemplation/preparation) stage, except for the financial domain, representing the lack of planning along their aging trajectory. • Older age, marital status, and living situation are factors most indicative of planning for aging and frailty. • Participants had higher levels of experience with others across all domains of planning. Many older adults want to age in place but do not make plans. Understanding how and under what conditions adults prepare/plan ahead is vital given population aging and increasing frailty. This study examines the stages of change and experiences (personal/others) related to readiness to plan for aging and frailty. Descriptive cross-sectional. Setting : Community-dwelling. Participants : Adults aged 50–80(N = 252). Data collection: demographics, other characteristics, stages of change, experiences (personal/others) was assessed with survey questions. Data analysis: frequencies/percentages, McNemar test, Chi-square. Among domains, participants' percentages in action/maintenance stages ranged from 28.2% (cognitive) to 68.7% (financial). Participants had increased experience with others across domains rather than self. Older participants (≥ 70) vs. younger (50–69) reported statistically significant greater planning in action/maintenance stages for all domains (p <.05) with the exception of cognitive. Examining the concept of planning for aging and frailty provides a foundation for future work to develop/test interventions aimed at increasing readiness for aging. [ABSTRACT FROM AUTHOR]

• Informal caregivers have a substantial role in direct care for individuals living with heart failure, but their contributions are under-reported. • Understanding the nature of patient-caregiver dyads can elicit a more holistic understanding of dyads' ability to manage heart failure in the community. • Resilience can be a useful construct for evaluating heart failure management at the dyadic level. Individuals living with heart failure often require informal caregiving assistance for optimal self-care maintenance. The influence of caregiver burden and resilience on dyadic congruence is not well understood. To compare how dyadic congruence is influenced by level of burden and resilience expressed by caregivers of patients with heart failure. Mixed-methods analysis of individuals with heart failure and their caregivers, focusing on measures of caregiver burden (Zarit Burden Interview) and resilience (Brief Resilience Scale). Data were integrated using the Heart Failure Care Dyadic Typology. Twelve dyads (n=24 participants) were classified as Type II (n=7) and Type III (n=5) dyads. Among Type II dyads, average caregiver burden was 19.43 (± 13.89) and resilience was 3.16 (± 1.04). For Type III dyads, average caregiver burden was 3.80 (± 4.27) and resilience 4.07 (± 1.36), respectively. Two key themes were derived: 1) caregivers' tendency to take the lead, and 2) the usefulness of cognitive reframing. Data integration elucidated that theme 1 was more common among Type II dyads and those with higher burden, and theme 2 was more prevalent among Type III dyads and those with higher resilience. Findings highlight important variances in how dyads collectively manage heart failure. Future inquiry should involve tailored intervention development to bolster informal caregivers' quality of life and ability to better support patients throughout their heart failure trajectory. [ABSTRACT FROM AUTHOR]

While literature on psychological consequences among frontline healthcare workers (HCWs) flourishes, understanding the psychological burden on this group is particularly crucial, as their exposure to COVID-19 makes them especially at high risk. We explored what is known about psychological effects of the COVID-19 pandemic on emergency HCWs. We used a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The search identified 5432 articles, from which a total of 21 were included in the final review. Anxiety, burnout, depression, inadequate sleep, post-traumatic stress disorder (PTSD) symptoms, distress/stress and secondary trauma, were all reportedly experienced by emergency HCWs. Anxiety, burnout, depression and stress levels were higher among physicians and nurses compared to others. Post-traumatic stress disorder symptoms were higher among reserve medics, while Red Cross volunteers developed similar reactions of psychological stress and secondary trauma to other healthcare workers. Male HCWs reported more post-traumatic stress disorder symptoms than females, while stress was higher among females than male HCWs. Emergency HCWs providing care during the COVID-19 pandemic are at risk from specific psychological impacts, including anxiety, burnout, depression, inadequate sleep, PTSD symptoms, psychological distress/stress and secondary trauma, and stress Emergency healthcare workers are at direct risk of psychological impacts from the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this study was to show the non-inferiority of [18F]FDG-PET/CT compared with panendoscopy with regards to secondary malignancies of the UADT, and to evaluate the diagnostic performance of PET/CT for detecting synchronous malignancies. Patients with newly diagnosed OSCC and both panendoscopy and [18F]FDG-PET/CT at primary staging were enrolled in this retrospective study. The accuracy in detecting synchronous malignancies was assessed for both modalities, and their diagnostic measures for the detection of malignancies within the UADT were compared. Histopathological analysis and clinical follow-up served as reference standards. In total, 182 patients were enrolled in this study. Eighteen patients (9.9%) had in total 22 synchronous malignancies, of which eight were located within the UADT. [18F]FDG-PET/CT detected all malignancies within the whole body (sensitivity: 100%) and yielded false-positive results in four cases (specificity: 97.6%). Sensitivity ([18F]FDG-PET/CT: 100% vs panendoscopy: 87.5%), specificity (99.4% vs 100%), negative predictive value (100% vs 99.4%), and positive predictive value (88.9% vs 100%) for detecting secondary UADT malignancies did not differ between modalities (all p = 0.32). Within the limitations of the study it seems that [18F]FDG-PET/CT detects synchronous malignancies of the UADT with an accuracy comparable to panendoscopy, and enables highly sensitive whole-body tumor screening in patients with newly diagnosed OSCC. This could be a relevant factor for therapeutic decision making in clinical routine. [ABSTRACT FROM AUTHOR]

Diuretic scintigraphy includes single-photon emitting radiotracers for planar and single photon emission computed tomography (SPECT) imaging as well as agents for positron emission tomography (PET). These radiotracers provide split-renal functional parameters, including glomerular filtration rate, effective renal plasma flow, tubular function, and/or renal blood flow. Beyond measuring kidney function, the tracer principle also allows for the assessment of various pathophysiological processes in the renal parenchyma, for example ongoing inflammation, activation of angiotensin II type 1 receptor in patients with renovascular hypertension, deterioration of mitochondrial complex I following acute or chronic kidney injury, or characterization of indeterminate renal masses. Providing a whole-body read-out, PET also enables the assessment of kidney-organ interactions, for example cardiorenal crosstalk after primary cardiac injury. This manuscript provides an overview of established clinical applications for single-photon-emitting and PET radiotracers for renal radionuclide imaging. Future perspectives in the field will also be highlighted, such as introduction of PET-guided strategies for drug dose optimization and the recent introduction of radiotracers targeting fibroblast activation protein inhibition, which may allow differentiation between acute inflammatory vs chronic fibrosis in the kidneys. [ABSTRACT FROM AUTHOR]

The risk of Post-COVID-19 condition (PCC) under hybrid immunity remains unclear. Using data from the German National Cohort (NAKO Gesundheitsstudie), we investigated risk factors for self-reported post-infection symptoms (any PCC is defined as having at least one symptom, and high symptom burden PCC as having nine or more symptoms). Sixty percent of 109,707 participants reported at least one previous SARS-CoV-2 infection; 35% reported having had any symptoms 4–12 months after infection; among them 23% reported nine or more symptoms. Individuals, who did not develop PCC after their first infection, had a strongly reduced risk for PCC after their second infection (50%) and a temporary risk reduction, which waned over 9 months after the preceding infection. The risk of developing PCC strongly depended on the virus variant. Within variants, there was no effect of the number of preceding vaccinations, apart from a strong protection by the fourth vaccination compared to three vaccinations for the Omicron variant (odds ratio = 0.52; 95% confidence interval 0.45–0.61). Previous infections without PCC and a fourth vaccination were associated with a lower risk of PCC after a new infection, indicating diminished risk under hybrid immunity. The two components of risk reduction after a preceding infection suggest different immunological mechanisms. • Individuals exhibited a lower Post-COVID-19 risk after a second infection. • The risk of developing Post-COVID-19 strongly depended on the virus variant. • A fourth vaccination offers a strong protection against Post-COVID-19 condition. [ABSTRACT FROM AUTHOR]

This study investigated a colloidal microgel for angiogenic and odontogenic differentiation of cells in the presence of cell-derived extracellular matrix (ECM) proteins using a 3-dimensional culture model. Viscoelastic properties of human dental pulp were determined to understand the native ECM environment. ECM proteins were extracted from dental pulp stem cell (DPSC) cultures, and MaxGel (Millipore Sigma, Burlington, MA) was used as a commercially available ECM protein. DPSCs were incubated in colloidal microgels in the presence of ECM proteins or gelatin methacryloyl (GelMA) as a bulk hydrogel (n = 9/group). The viability and odontogenic differentiation of DPSCs within hydrogels was determined using viability assays, mineralization staining, calcium and alkaline phosphatase assays, and quantitative polymerase chain reaction for odontogenic gene expression. Angiogenic properties of endothelial cells were determined using tubule formation assays and quantitative polymerase chain reaction to detect angiogenic gene expression. Dental pulp had a higher elastic modulus than the viscous modulus, showing a solidlike response similar to hydrogels. DPSC-derived ECM showed higher collagen and GAG than MaxGel (P <.05). The viability of DPSCs was similar in colloidal microgels, whereas higher cell viability, calcium deposition, and alkaline phosphatase activity were observed in GelMA (P <.05). Colloidal microgels allowed tubule-like structures by endothelial cells, whereas no tubular formation was observed in GelMA. DPSC-derived ECM in colloidal microgel up-regulated odontogenic gene expression, whereas MaxGel up-regulated angiogenic gene expression (P <.05). Colloidal microgels allowed cellular organization that can improve penetration and nutritional supply in a full-length root canal system. The bioactivity of cell-derived ECM proteins can be modified depending on the external stimulus. [ABSTRACT FROM AUTHOR]

Pandemic-related restrictions increased the risk of delayed emergency response of bystanders to sudden cardiac arrest among youth athletes. Education and SCA emergency preparedness, implemented by nurse leaders and adapted to environmental changes, can greatly reduce the risks associated with an SCA episode. A nurse-led, quality improvement pilot project was implemented in a recreational youth soccer league. The project included the implementation of an emergency action plan (EAP; with or without the pandemic and social-distancing restrictions) for bystanders responding to SCA. Participants showed significant improvement in knowledge and perceptions of SCA and emergency response (p <.001). Willingness to initiate cardiopulmonary resuscitation (CPR) improved (p =.127), and fear to engage in EAP decreased (p =.119) following an educational intervention on SCA. Nurse-led SCA education and implementation of youth league EAP successfully demonstrated safety in SCA preparedness and best practice recommendations for youth sports from the Interassociation Task Force. [ABSTRACT FROM AUTHOR]

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. [ABSTRACT FROM AUTHOR]

Improved emergency care of children with acute illness or injuries is needed for countries in Africa to continue to reduce childhood mortality rates. Quality improvement efforts will depend on robust baseline data, but little has been published on the breadth and severity of paediatric illness seen in Mozambique. This was a retrospective review of routinely collected provider shift summary data from the Paediatric Emergency Department (PED) at Hospital Central de Maputo (HCM), the principal academic and referral hospital in the country. All children 0–14 years of age seen in the 12-month period from August 2018–July 2019 were included. Descriptive statistical analyses were performed. Data from 346 days and 64,966 patient encounters were analyzed. The large majority of patients (96.4%) presented directly to the PED without referral from a lower level facility. An average of 188 patients was seen per day, with significant seasonal variation peaking in March (292 patients/day). The most common diagnoses were upper respiratory infections (URI), gastroenteritis, asthma, and dermatologic problems. The highest acuity diagnoses were neurologic problems (59%), asthma (57%), and neonatal diagnoses (50%). Diagnoses with the largest proportion of admissions included neurologic problems, malaria, and neonatal diagnoses. Rapid malaria antigen tests were the most commonly ordered laboratory test across all diagnostic categories; full blood count (FBC) and chemistries were also commonly ordered. Urinalysis and HIV testing were rarely done in the PED. This epidemiologic profile of illness seen in the HCM PED will allow for improved resource utilisation. We identified opportunities for evidence-based care algorithms for common diagnoses such as respiratory illness to improve patient care and flow. The PED may also be able to optimize laboratory and radiology evaluation for patients and develop standardized admission criteria by diagnosis. [ABSTRACT FROM AUTHOR]

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. [ABSTRACT FROM AUTHOR]

Background: Sympathetic activation in ischemic heart disease can cause lethal arrhythmias. These often are preceded by premature ventricular complexes (PVCs), which at the cellular level could result from delayed afterdepolarizations.Objective: The purpose of this study was to identify and map vulnerable areas for arrhythmia initiation after myocardial infarction (MI) and to explore the link between PVCs and cellular events.Methods: Anterior-septal wall MI was induced by 120 minutes of coronary occlusion followed by reperfusion (27 MI and 16 sham pigs). After 4 weeks, EnSite™ electroanatomic mapping combined with imaging was performed to precisely locate PVC sites of origin and subsequently record monophasic action potentials. Cardiomyocytes were isolated from different regions to study regional cellular remodeling. Isoproterenol was used as a surrogate for adrenergic stimulation both in vivo and in cardiomyocytes.Results: PVCs originated from the MI border zone (BZ) and occurred at discrete areas with clusters of PVCs within the BZ. At these sites, frequent delayed afterdepolarizations and occasional associated spontaneous action potentials translating to a PVC were present. Cardiomyocytes isolated from the MI BZ exhibited more spontaneous action potentials than cardiomyocytes from remote regions. Sensitivity to adrenergic stimulation was increased in MI, in vivo and in cardiomyocytes. In awake, freely moving MI animals, frequent PVCs, ventricular arrhythmia, and sudden cardiac death occurred spontaneously at moderately elevated heart rates.Conclusion: Post-MI, arrhythmias initiate from discrete vulnerable areas within the BZ, where delayed afterdepolarizations, related to increased adrenergic response of BZ cardiomyocytes, can generate PVCs. [ABSTRACT FROM AUTHOR]

• Students retained more knowledge of newborn assessment when participating in virtual simulation compared to traditional lab-based activities. Future use of virtual simulation could improve consistency in content delivery and students' knowledge acquisition. • The results from the Student Satisfaction and Self-Confidence in Learning scale indicated that students' satisfaction and self-confidence were greater with the opportunity to participate in in-person lab activities compared to the virtual simulation. These finding suggest that student's satisfaction does not always reflect knowledge gained from virtual simulation experiences. • The findings suggest that the virtual simulation format, which allows for repetition and more control over the content delivery, supports students' knowledge attainment. Yet, knowledge alone is inadequate to prepare for nursing practice. Virtual simulation offers learning opportunities in specialty nursing environments that may be otherwise limited. A quasi-experimental design was used to compare students who learned newborn assessment using a virtual simulation to those in a traditional lab-based setting. Students' knowledge, skill, satisfaction, self-confidence, and clinical judgment were evaluated. Findings from this study revealed that students' knowledge acquisition of newborn assessment was greater when the content and demonstration were delivered by the virtual simulation, however students' satisfaction and self-confidence were greater with the opportunity to engage in in-person lab activities. These research findings illuminate the potential for virtual simulation to enhance knowledge and competencies in the student nurse and expand on traditional pedagogical approaches. [ABSTRACT FROM AUTHOR]

• Emotional competence is important for health professionals in end-of-life care. • Simulated patients improve health professionals' emotional competence. • Addressing learners' emotions during debriefing is vital for emotional competence. • Theory-based simulation and debriefing can enhance end-of-life care training. A simulation-based learning experience (SBLE) is known to improve emotional skills. Arksey and O'Malley's (2005) framework and the preferred reporting items for scoping reviews were used. Databases included PubMed, PsycINFO, and Scopus for randomized controlled trials examining the impact of utilizing SBLE to promote emotional competence among healthcare professionals and students in the context of end-of-life (EOL) care. Eleven studies which included EOL care simulation interventions and outcomes for promoting emotional competence were identified. Gaps concerning effectiveness of post-simulation debriefing and using theoretical models were discussed. SBLE promoting emotional competence could address the psychological needs of learners at EOL care. [ABSTRACT FROM AUTHOR]

Testicular salvage rates for torsion are time-dependent 1. Door to detorsion time has been identified as an independent testicular survival factor 2. We describe an initiative to reduce door to incision (DTI) time for pediatric testicular torsion. An institutional multidisciplinary quality improvement initiative with a primary outcome of reducing DTI time for pediatric testicular torsion was developed with multidisciplinary stakeholders. Several process and balancing measures were used as secondary outcomes to help interpret and verify the observed change in DTI time. Interventions were implemented in cycles. Initial interventions standardized assessment of suspected torsion by Emergency Medicine utilizing a validated scoring system. A threshold Testicular Workup for Ischemia and Suspected Torsion (TWIST) score led to parallel notification of essential services for rapid assessment and case prioritization 3. Subsequently, bedside ultrasound in the Emergency Department was implemented. Progress was tracked in a live dashboard and analyzed with X-mR process control charts and Nelson rules. These tools are used in quality improvement and process control to demonstrate the significance of changes as they are being implemented, prior to when traditional hypothesis testing would be able to do so. We aimed to increase the proportion of cases with DTI times under 4 h from 64% to >90% within one year. We observed 22 torsion cases prior to and 62 following initial implementation. The percentage of cases with DTI times under 4 h improved from 64% to 95%. At week 29, a shift identified a significant change on the X chart, with reduction in mean DTI time from 221 to 147 min. At the same time, a shift on the mR chart identified reduction in patient-to-patient variation. Mean time from arrival to Urology evaluation decreased from 140 to 56 min, mean time from arrival to scrotal ultrasound decreased from 70 to 36 min, and mean time from scrotal ultrasound to surgical incision decreased from 128 to 80 min. These improvements highlight the two key successes of our project: application of the TWIST score and bedside ultrasound for rapid assessment of suspected testicular torsions, and parallel processing of the evaluation and management. Implementation of a protocol for pediatric testicular torsion increased the proportion of cases with DTI time <4 h to 95%, decreased mean DTI time, and decreased variation. Our protocol provides a model to improve timeliness of care in treating pediatric testicular torsion. [Display omitted] [ABSTRACT FROM AUTHOR]

• IV Iron monotherapy may not reduce the number of patients transfused. • Iron monotherapy may not reduce the number of red blood cell (RBC) units transfused. • It is unclear if IV and oral iron monotherapy differentially impact RBC utilization. • Oral iron + ESAs probably reduce the number of patients and RBC units transfused. • IV Iron + ESAs may reduce the number of patients transfused. Patient Blood Management (PBM) is an evidence-based, multidisciplinary, patient-centred approach to optimizing the care of patients who might need a blood transfusion. This systematic review aimed to collect the best available evidence on the effectiveness of preoperative iron supplementation with or without erythropoiesis-stimulating agents (ESAs) on red blood cell (RBC) utilization in all-cause anaemic patients scheduled for elective surgery. Five databases and two trial registries were screened. Primary outcomes were the number of patients and the number of RBC units transfused. Effect estimates were synthesized by conducting meta-analyses. GRADE (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the certainty of evidence. We identified 29 randomized controlled trials (RCTs) and 2 non-RCTs comparing the effectiveness of preoperative iron monotherapy, or iron + ESAs, to control (no treatment, usual care, placebo). We found that: (1) IV and/or oral iron monotherapy may not result in a reduced number of units transfused and IV iron may not reduce the number of patients transfused (low-certainty evidence); (2) uncertainty exists whether the administration route of iron therapy (IV vs oral) differentially affects RBC utilization (very low-certainty evidence); (3) IV ferric carboxymaltose monotherapy may not result in a different number of patients transfused compared to IV iron sucrose monotherapy (low-certainty evidence); (4) oral iron + ESAs probably results in a reduced number of patients transfused and number of units transfused (moderate-certainty evidence); (5) IV iron + ESAs may result in a reduced number of patients transfused (low-certainty evidence); (6) oral and/or IV iron + ESAs probably results in a reduced number of RBC units transfused in transfused patients (moderate-certainty evidence); (7) uncertainty exists about the effect of oral and/or IV iron + ESAs on the number of patients requiring transfusion of multiple units (very low-certainty evidence). Effect estimates of different haematological parameters and length of stay were synthesized as secondary outcomes. In conclusion, in patients with anaemia of any cause scheduled for elective surgery, the preoperative administration of iron monotherapy may not result in a reduced number of patients or units transfused (low-certainty evidence). Iron supplementation in addition to ESAs probably results in a reduced RBC utilization (moderate-certainty evidence). [ABSTRACT FROM AUTHOR]

In a parameter study, we systematically varied parameter values, and quantified the resulting traffic flow in each individual lane. We modeled two-, three-, and four-lane freeway sections with the microscopic traffic flow simulation tool PTV Vissim. We compared the results with findings from literature. Simulations using car following model Wiedemann 99 fit better to empirical studies than those using Wiedemann 74. Empirically determinable parameters, that have a relevant influence on lane flow distribution are desired speed distributions (mean for heavy-duty vehicles and standard deviation for cars), heavy-duty vehicle share, and the gradient of the section. Additionally, the driving behavior parameters CC1 (headway time), CC3 (threshold for entering following), and safety distance reduction factor have an influence. As CC1 is one of the most relevant parameters for calibrating capacity, CC3 and the safety distance reduction factor remain for lane flow adjustment. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) and completion advance care directives (ACDs) is recommended for patients with cancer. Documentation needs to be available at the point of care. To describe the prevalence of ACDs in health records and the self-reported awareness of and engagement in ACP as reported by older Australians with cancer, and to examine the concordance between self-reported completion of and presence of documentation in participants' health records. Prospective multi-center audit of health records, and a self-report survey of eligible participants in 51 Australian health and residential aged care services. The audit included 458 people aged ≥65 years with cancer. 30% had ≥ ACD located in their record. 218 people were eligible for survey completion; 97 (44% response rate) completed it. Of these, 81% had a preference to limit some/all treatments, 10% wanted to defer decision-making to someone else, and 9% wanted all treatments. Fifty-eight percent of survey completers reported having completed an ACP document. Concordance between documentation in the participant's record and self-report of completion was 61% (k = 0.269), which is only fair agreement. Whilst 30% of participants had at least one ACD in their record, 58% self-reported document completion, and concordance between self-reported completion and presence in records was only fair. This is significant given most people had a preference for some/all limitation of treatment. Further ACP implementation strategies are required. These include a systematic approach to embedding ACP into routine care, workforce education, increasing community awareness, and looking at e-health solutions to improve accessibility at the point of care. [ABSTRACT FROM AUTHOR]

• The Caregiver Contribution to Heart Failure Self-Care was adapted to Brazil. • The content of the adapted version was validated by professionals and caregivers. • Further psychometric evaluation for the Brazilian version is warranted. The Caregiver Contribution to Heart Failure Self-Care (CACHS) is a Canadian instrument that assesses caregivers' (CGs) contributions to heart failure (HF) patients' self‐care, but a Brazilian version was lacking. To adapt CACHS into Brazilian Portuguese and to estimate the content validity of the adapted version. A psychometric study of cross-cultural adaptation and content validation was conducted. Linguistic equivalence was assessed by eight professional experts. Content validity was assessed by an expert professional panel (n=8; for clarity, theoretical relevance and practical relevance) and a CG panel (n=46; for cognitive debriefing of the adapted instrument). In the cultural adaptation, the items were considered equivalent if experts reached an agreement ≥80%. In the content validation, the items were considered acceptable if content validity coefficients (CVC) were ≥0.70. The translated version was considered consistent with the original CACHS by the authors. In the second round of linguistic equivalence assessment, all items achieved 100% agreement, except for one item, which presented 75% agreement in conceptual equivalence. The CVC in the first and second rounds of content validity assessment by experts was 0.80 to 0.90. During cognitive testing, the CGs requested explanations on three items, which were reformulated. All CGs then understood the Brazilian version of CACHS, named CACHS – Versão Brasileira (CACHS-Br). CACHS-Br is equivalent to the original version and provided satisfactory evidence of content validity. Further psychometric testing of this version should allow for the measurement of the CG contributions to HF self-care in Brazil. [ABSTRACT FROM AUTHOR]

Rates of postoperative Crohn's disease recurrence remain high, although the ability to predict this risk of recurrence remains limited. As such, we aimed to determine the association of histologic features at the time of resection with postoperative recurrence. Electronic databases were searched through February 2020 for studies that reported risk of clinical, endoscopic, or surgical postoperative recurrence in patients with positive resection margins, plexitis, or granulomas in the index specimen. Pooled risk ratios (RRs) with 95% CIs were calculated for this risk in patients with and without these histologic features. Twenty-one studies (2481 patients) assessed positive resection margins, 10 studies (808 patients) assessed plexitis, and 19 studies (1777 patients) assessed granulomas. Positive resection margins increased the risk of clinical (RR, 1.26; 95% CI, 1.06–1.49; I2 = 41%) and surgical (RR, 1.87; 95% CI, 1.14–3.08; I2 = 71%) recurrence, with a trend toward endoscopic recurrence (RR, 1.56; 95% CI, 0.79–3.05; I2 = 85%). Granulomas increased the risk of clinical (RR, 1.31; 95% CI, 1.05–1.64; I2 = 36%) and endoscopic (RR, 1.37; 95% CI, 1.00–1.87; I2 = 49%) recurrence, with a trend toward surgical recurrence (RR, 1.58; 95% CI, 0.89–2.80; I2 = 75%). Plexitis increased the risk of endoscopic recurrence (RR, 1.31; 95% CI, 1.00–1.72; I2 = 20%), with a trend toward clinical recurrence (RR, 1.34; 95% CI, 0.95–1.91; I2 = 46%). Positive resection margins, granulomas, and plexitis are predictive of postoperative Crohn's disease recurrence and should be recorded at the time of index resection. [ABSTRACT FROM AUTHOR]

• Investigate machinability of stone-plastic composite during diamond milling. • Mathematical models of cutting force and temperature developed using response surface method. • Optimal conditions for efficient cutting of stone-plastic composite. With the aim of providing scientific guidance for the application of diamond cutting tools to the machining of stone-plastic composite, this work presents results on the influence of tool geometry and cutting parameters on cutting forces and temperature during helical milling of stone–plastic composite with diamond cutters. Four factors—helical angle, spindle speed, feed rate, and cutting depth—were assessed using a response surface method. Mathematical models were developed and identified by verification testing to accurately predict changes in cutting forces and temperature during composite helical milling. Then, the significant contributions of each factor and of two-factor interactions were determined by analysis of variance, and the trends of cutting forces and temperature were studied using response surface methodology. The optimal conditions in terms of low cutting forces and temperature were determined to be a helical angle of 70°, cutting speed of 51.3 m/s, feed per tooth of 0.24 mm, and cutting depth of 0.5 mm. These parameters are proposed for use in the industrial production of stone–plastic composite material to improve machining efficiency. [ABSTRACT FROM AUTHOR]

Study Objective: Prior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.Design: Cross-sectional study among women with no prior diagnosis of endometriosis.Setting: Fourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.Patients: A total of 495 women (of which 473 were analyzed), aged 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.Interventions: Gynecologic laparoscopy/laparotomy regardless of clinical indication.Measurements and Main Results: Participants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I-IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.Conclusion: Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates. [ABSTRACT FROM AUTHOR]

Considerable uncertainty remains regarding the veracity of measuring myokine irisin more than seven years after its original description. Unresolved issues include the nature of transcription of the irisin precursor fibronectin type III domain containing 5 (FNDC5) gene across species, the reliability of irisin levels measured with commercial enzyme-linked immunosorbent assays (ELISAs), and the overall validity of the recently published reference values for human serum measured with quantitative mass spectrometry. We utilized multiple species and measures to evaluate the robustness of commonly used reagents and methods for reporting irisin. Amplification of cDNA was used to assess the FNDC5 transcript patterns in humans and mice. The specificity and sensitivity of different irisin antibodies were examined via western blotting. Quantification of circulating native irisin was conducted with mass spectrometry using an absolute quantification peptide for irisin. We show that there is a greater transcript diversity of human FNDC5 than currently annotated, but no indication of the expression of transcripts leading to a truncated form of irisin. Available irisin antibodies still bind to patterns of unspecific serum proteins, which compromise reliable measurements of irisin with ELISAs. Absolute quantification of irisin with labeled peptides by mass spectrometry is an advanced method but requires a multi-step sample preparation introducing uncontrollable variations in the measurement. Our data represent an explicit warning against measuring circulating irisin using available methods. Measuring irisin is akin to chasing shadows. • Transcription pattern of the host FNDC5 gene is not conserved from mouse to human. • Irisin antibodies detect neither circulating irisin nor FNDC5 in humans and mice. • Sample preparation impairs exact quantification of irisin by mass spectrometry. • Results on irisin levels in humans and mice are still unreliable. [ABSTRACT FROM AUTHOR]