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Abstract Background The relationship between collapse and a diagnosis of hypoadrenocorticism is not well understood in dogs. Hypothesis To assess the prevalence of episodes of collapse in dogs screened for hypoadrenocorticism, and to assess the prevalence of confirmed hypoadrenocorticism in dogs presenting with reported collapse. Animals Seventy‐three client‐owned dogs with resting cortisol concentrations were measured and presented to a University teaching hospital for collapse. Methods Retrospective review of medical records of dogs at a single center. Results The prevalence of episodes of collapse in dogs that had a resting cortisol measurement was 73/856 (8.5%; 95% confidence interval [95% CI], 6.7%‐10.6%). Resting cortisol concentration was 2 μg/dL (>55 nmol/L). The most common diagnosis was vasovagal syncope (10/73), followed by sick sinus syndrome and third‐degree atrioventricular block (2/73). The final diagnosis was unknown in 24/73 dogs. Conclusions and Clinical Importance Hypoadrenocorticism was the final diagnosis in 1 of 73 dogs presented to a teaching hospital either in a collapsed state or with a previous history of episodes of collapse. No dog presenting as cardiovascularly stable for intermittent collapse was found to have hypoadrenocorticism.

Abstract When integrating AI tools in healthcare settings, complex interactions between technologies and primary users are not always fully understood or visible. This deficient and ambiguous understanding hampers attempts by healthcare organizations to adopt AI/ML, and it also creates new challenges for researchers to identify opportunities for simplifying adoption and developing best practices for the use of AI-based solutions. Our study fills this gap by documenting the process of designing, building, and maintaining an AI solution called SepsisWatch at Duke University Health System. We conducted 20 interviews with the team of engineers and scientists that led the multi-year effort to build the tool, integrate it into practice, and maintain the solution. This “Algorithm Journey Map” enumerates all social and technical activities throughout the AI solution’s procurement, development, integration, and full lifecycle management. In addition to mapping the “who?” and “what?” of the adoption of the AI tool, we also show several ‘lessons learned’ throughout the algorithm journey maps including modeling assumptions, stakeholder inclusion, and organizational structure. In doing so, we identify generalizable insights about how to recognize and navigate barriers to AI/ML adoption in healthcare settings. We expect that this effort will further the development of best practices for operationalizing and sustaining ethical principles—in algorithmic systems.

Abstract Using a combination of short- and long-reads sequencing, we were able to sequence the complete mitochondrial genome of the invasive ‘New Zealand flatworm’ Arthurdendyus triangulatus (Geoplanidae, Rhynchodeminae, Caenoplanini) and its two complete paralogous nuclear rRNA gene clusters. The mitogenome has a total length of 20,309 bp and contains repetitions that includes two types of tandem-repeats that could not be solved by short-reads sequencing. We also sequenced for the first time the mitogenomes of four species of Caenoplana (Caenoplanini). A maximum likelihood phylogeny associated A. triangulatus with the other Caenoplanini but Parakontikia ventrolineata and Australopacifica atrata were rejected from the Caenoplanini and associated instead with the Rhynchodemini, with Platydemus manokwari. It was found that the mitogenomes of all species of the subfamily Rhynchodeminae share several unusual structural features, including a very long cox2 gene. This is the first time that the complete paralogous rRNA clusters, which differ in length, sequence and seemingly number of copies, were obtained for a Geoplanidae.

IntroductionTrust is foundational to all social science domains, but to date, there is no unifying theory or consistent measurement basis spanning the social sciences. This research hypothesized that trust forms the basis of an ontology that could unify the social science domains. The proposed ontology comprises a Cartesian plane with axes self-trust and other-trust. Self-trust manifests in dominant behaviors, and other-trust manifests in cooperative behaviors. Both axes are divided into five discrete categories, creating a matrix of 25 cells. All words in the lexicon are allocated into one of these 25 cells.MethodsThis research started with an existing 14,000-word lexicon of dominance and affiliation. The lexicon was extended by manually identifying and including socially descriptive words with information regarding self-trust, other-trust, dominance, and cooperation. The taxonomy was optimized using the Gradient Descent machine learning algorithm and commercially curated synonyms and antonyms. The t-test was employed as the objective (or loss) function for Gradient Descent optimization. Word vectors were identified using groups of four words related as synonyms and antonyms.ResultsOver 30,000 words were identified and included in the lexicon. The optimization process yielded a t-score of over 1,000. Over 226,000 vectors were identified, such as malevolent-mean-gentle-benevolent. A new form of symmetry was identified between adjectives and verbs with a common root; for example, the words reject and rejected are horizontally reflected.DiscussionThe word vectors can create a metrologically compliant basis for psychometric testing. The symmetries provide insight into causes (verbs) and effects (adjectives) in social interactions. These vectors and symmetries offer the social sciences a basis of commonality with natural sciences, enabling unprecedented accuracy and precision in social science measurement.

IntroductionThe Consortium for Spinal Cord Medicine's inaugural Clinical Practice Guideline for Bone Health and Osteoporosis Management for Individuals with Spinal Cord Injury or Disease (CSCM-CPG) was published in 2022 for a clinician audience. The aim of this project was to develop a podcast series to ensure people with lived experience with Spinal Cord Injury or Disease (PLEX) understand the CSCM-CPG content and know how to act to reduce their fracture risk.MethodsThe “Bare Bones Podcast Series” consists of nine episodes; one related to each CSCM-CPG chapter. The podcast content and the questions asked in each podcast were co-developed by PLEX partners (PLEX-P) and the project team. Two PLEX-P acted as co-hosts for the series. The invited speaker(s) were CSCM-CPG expert panel members who participated in an informal dialogue with the hosts. Each podcast closes with a specific action a listener can do to advance their bone health. The related Educational Action Planning Tool (EAT) handouts contain text and infographic information specific to each podcast episode and include key concepts and a specific actionable take-home message. Local PLEX reviewers (PLEX-R) were invited to review podcast episodes and EATs and provide their feedback through focus group participation or one-on-one (1:1) interviews. The project team revised the podcast episodes and the EATs based on feedback from the PLEX-R prior to releasing them online.ResultsNine podcast episodes and related EATs were designed and created collaboratively with 3 PLEX-P, 22 PLEX-R, 11 CSCM-CPG expert panel members, and the project team. The episodes were titled: “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests—a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack”; and “Directions for Research”. The Bare Bones Podcast Series was shared through the project website.ConclusionsThe podcasts will aid PLEX and their family caregivers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality.

Contemporary attachment researchers claim that attachment-anxiety is associated with a hyperactivating defense strategy while attachment-avoidance is associated with a deactivating defense strategy. However, to date, no study has comprehensively examined the basic patterns of specific defense expression in the two dimensions of attachment insecurity (anxiety/avoidance). To address this research gap, the current study aimed to assess the character defenses associated with attachment-avoidance and attachment-anxiety, incorporating a broad spectrum of psychological defenses. The main objective was to understand what differentiates attachment-avoidance and attachment-anxiety in defensive functioning. In this study of online questionnaire design (N = 250), university undergraduates aged between 17 to 65 completed the Experiences in Close Relationship Scale (ECR) and the Defense Style Questionnaire (DSQ-60). The results show that the two dimensions of insecure attachment exhibit different defensive patterns. Regarding the main findings, attachment-avoidance uniquely predicted defensive isolation, and attachment-anxiety uniquely predicted the defenses splitting, projective identification, anticipation, acting out, passive-aggression, reaction formation, and undoing. Overall, the results indicate that attachment-anxiety is a significant predictor of global defensive functioning, over and above that of attachment-avoidance. One implication of this study is that the two-dimensional model of adult attachment may offer a promising framework for organizing psychological defenses. We discuss the significance of this concerning the future of the empirical study of psychological defenses. The discussion also considers the clinical application and relevance to attachment-based psychotherapy., Author(s): Emma Richardson [sup.1] , Alissa Beath [sup.1] , Simon Boag [sup.1] Author Affiliations: (1) https://ror.org/01sf06y89, grid.1004.5, 0000 0001 2158 5405, School of Psychological Sciences, Macquarie University, , Sydney, Australia [...]

Abstract Background Evidence indicating the optimal treatment protocol for dogs in adrenal crisis is lacking. Objectives Compare outcomes of dogs presented in adrenal crisis treated with either hydrocortisone (HC) continuous rate infusion (CRI) or intermittent dexamethasone (DEX) administration. Animals Thirty‐nine client‐owned dogs. Methods Multi‐institutional retrospective observational study (July 2016‐May 2022) including dogs diagnosed with adrenal crisis and with available sequential blood work during hospitalization. Dogs were excluded if already on treatment with exogenous corticosteroids. Outcomes assessed included duration of hospitalization, survival, number of repeat measurements of electrolyte concentrations, and time to normalization of electrolyte and acid‐base status. Results No significant difference was found between the groups for hospitalization time (P = .41; HC median [range] 48 h [19‐105 h]; DEX 57 h [17‐167 h]) nor case fatality rate 2/28 in the DEX group and 0/11 in the HC group (P = 1), nor in number of measurements of electrolyte concentrations (P = .90; HC 4 [2‐10]; DEX 4.5 [2‐15]). No significant differences were found between the 2 treatment groups in time to normalization of serum Na (P = .30; HC 33 h [7‐66 h]; DEX 16 h [1.5‐48 h]), K (P = .92; HC 17 h [4‐48 h]; DEX 16 h [1.25‐60 h]) or Na/K ratio (P = .08; HC 17 h [8‐48 h]; DEX 26 h [1.5‐60 h]). Conclusions This study detected no difference in outcomes for dogs in adrenal crisis treated with either DEX boluses or HC CRIs.

Introduction: The experiences and information needs for reproductive health counseling in women with chronic kidney disease (CKD) are poorly defined, despite the known importance of pregnancy planning in this higher-risk cohort. Methods: Australian adult women with CKD and their partners or family members completed a consumer codesigned survey about experiences of and preferences for pregnancy-related counseling, support, and education. Data were analyzed descriptively and with qualitative content analysis of free-text responses. Results: Responses were received from 102 women (CKD, n = 60; dialysis, n = 11; transplant, n = 26; unsure, n = 5 ) and 17 partners/family members. Pregnancy-related discussions were initiated mostly by women themselves (60.0%) compared to nephrologists (26.7%), and only after conception in 14.7%. Women found pregnancy-related discussions satisfactory (68.0%) and useful (50.7%) but also stressful (66.7%), with only 54.7% feeling in control of decision-making. Information deficits and quality, preformed decisions, clinician-patient disconnect, and burden of decision-making contributed to usefulness and outcomes of pregnancy-related counseling. Women received insufficient information about contraception (not provided in 35.2% of cases), medication safety (40.9%), fetal complications (33.8%) and emotional and psychological impact of pregnancy (73.2%). Women preferred counseling from nephrologists (86.4%), face-to-face settings (79.6%), websites (72.7%), handouts (61.4%), and online support groups (46.6%). High-quality, multiformat information by content experts, peer support, and psychological support were also strongly desired. Conclusion: This study highlights that preconception counseling and information needs of women with CKD are currently not being met. Frameworks and tools to assist patients and clinicians, particularly nephrologists, to initiate and conduct sensitive, useful, and informed shared decision-making (SDM) about pregnancy are urgently needed.

Conclusion: Perceived body fat was the only component of body perception that explained the association between weight status and psychological health. This finding suggests that research on psychological health in individuals with obesity or overweight needs to extend beyond mere perceived body weight and incorporate different components of body perception. Furthermore, interventions aimed at improving psychological health in individuals with obesity or overweight need to consider the potential effect of perceived body fat.

The minimum O2 needed to fuel the demand of aquatic animals is commonly observed to increase with temperature, driven by accelerating metabolism. However, recent measurements of critical O2 thresholds ("Pcrit") reveal more complex patterns, including those with a minimum at an intermediate thermal "optimum". To discern the prevalence, physiological drivers, and biogeographic manifestations of such curves, we analyze new experimental and biogeographic data using a general dynamic model of aquatic water breathers. The model simulates the transfer of oxygen from ambient water through a boundary layer and into animal tissues driven by temperature-dependent rates of metabolism, diffusive gas exchange, and ventilatory and circulatory systems with O2-protein binding. We find that a thermal optimum in Pcrit can arise even when all physiological rates increase steadily with temperature. This occurs when O2 supply at low temperatures is limited by a process that is more temperature sensitive than metabolism, but becomes limited by a less sensitive process at warmer temperatures. Analysis of published species respiratory traits suggests that this scenario is not uncommon in marine biota, with ventilation and circulation limiting supply under cold conditions and diffusion limiting supply at high temperatures. Using occurrence data, we show that species with these physiological traits inhabit lowest O2 waters near the optimal temperature for hypoxia tolerance and are restricted to higher O2 at temperatures above and below this optimum. Our results imply that hypoxia tolerance can decline under both cold and warm conditions and thus may influence both poleward and equatorward species range limits.

Abstract In an ocean that is rapidly warming and losing oxygen, accurate forecasting of species’ responses must consider how this environmental change affects fundamental aspects of their physiology. Here, we develop an absolute metabolic index (ΦA) that quantifies how ocean temperature, dissolved oxygen and organismal mass interact to constrain the total oxygen budget an organism can use to fuel sustainable levels of aerobic metabolism. We calibrate species-specific parameters of ΦA with physiological measurements for red abalone (Haliotis rufescens) and purple urchin (Strongylocentrotus purpuratus). ΦA models highlight that the temperature where oxygen supply is greatest shifts cooler when water loses oxygen or organisms grow larger, providing a mechanistic explanation for observed thermal preference patterns. Viable habitat forecasts are disproportionally deleterious for red abalone, revealing how species-specific physiologies modulate the intensity of a common climate signal, captured in the newly developed ΦA framework.

BackgroundClimate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice.MethodsA single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate “Green Theatre Checklist” was taken as an audit standard, focusing on “preparing for surgery” and “intraoperative equipment” subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration.ResultsDatasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively.ConclusionThis project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality.