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Background: Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes.Methods: Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI).Results: Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD.Conclusion: At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers. [ABSTRACT FROM AUTHOR]

Background: Mentorship has been recognized as a strategy to develop leadership competencies in clinical leaders and has been integrated into leadership programs. However, there are few published frameworks to guide mentor conversations with mentees training to assume nursing leadership roles., Objective: This study explores mentors' perceptions of 6-month mentorship, a component of the Strengths-Based Nursing Leadership program, the effectiveness of the Facilitated Engagement Approach, a pedagogical strategy developed to facilitate conversation between the mentor and mentee, and the impact of mentorship on leadership practice of mentees., Methods: A mixed method qualitative and quantitative approach was used with semi-structured interviews and bi-weekly survey among mentors. Data were thematically analyzed., Results: Mentors described the use of the Facilitated Engagement Approach to guide their mentorship conversations and found it to be effective in mentoring program participants. Mentors described techniques used and the process of deepening a reflective mentorship conversation. The Spiraling Process (58 %) and the Story Sharing Process (74 %) were integral aspects of the Facilitated Engagement Approach used. Mentorship was found to be impactful in that mentors reported a change in their mentee., Conclusions: The Facilitated Engagement Approach was an effective tool for mentees and mentors to develop leadership capacities., 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 Elsevier Ltd. All rights reserved.)

Background: Development of nursing leadership is necessary to ensure that nurse leaders of the future are well-equipped to tackle the challenges of a burdened healthcare system. In this context, the Strengths-Based Nursing and Healthcare Leadership program was delivered to 121 participants from 5 organizations in Canada in 2021 and 2022. To date, no study used a qualitative approach to explore nursing leaders' perceptions of a leadership Strengths-Based Nursing and Healthcare Leadership program three months post training., Objective: To describe nursing leaders' perceptions of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training., Methods: Qualitative descriptive design was used with individual semi-structured interviews. A convenient sample of nurse leaders ( n = 20) who had participated in the leadership program were recruited for an individual interview three months post training. The data generated by interviews were analyzed using a method of thematic content analysis., Results: Three themes emerged from the qualitative data analysis related to the leadership program that stayed with participants three months post training: 1) mentorship: a lasting relationship , 2) human connections through Story-sharing , and 3) focus on strengths . Two other themes emerged related to the changes that they have made since attending the program: 1) seeking out different perspectives to work better as a team and 2) create a positive work environment and to show appreciation for their staff., Conclusion: The present study offers evidence of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training., Implication: This study reinforces the importance of training using a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership., Competing Interests: 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., (© 2024 The Authors.)

Background: Targeted interventions have been found effective for developing leadership practices in nurses. However, to date, no leadership training program based on the Strengths-Based Nursing and Healthcare Leadership approach exists., Objectives: Demonstrate the effectiveness of a Strengths-Based Nursing and Healthcare Leadership 6-month program designed for nurse and healthcare leaders on leadership capacity and psychological outcomes., Design: Concurrent mixed-methods with nurse and healthcare leaders from five healthcare organisations in Quebec and Ontario (Canada)., Settings: Participants were recruited from five Canadian health care organizations: two in Toronto (Ontario) and three in Montreal (Quebec)., Participants: A total of 50 nurse leaders and healthcare leaders were included in the quantitative component, and 22 (20 nurse leaders and two healthcare leaders) participated in the qualitative individual interviews., Methods: Quantitative and qualitative (interviews) methods were used. Quantitative data (pre-post surveys) were collected from the participants before their participation in the program (Time 0), as well as after the completion of the program (Time 1). Qualitative data (individual interviews) were collected from participants at the end of the program (Time 1). Analysis was conducted using descriptive statistics, paired-sample t -tests, and thematic analysis., Results: Quantitative results suggest a significant improvement in terms of leadership capabilities, work satisfaction, and reduction in perceived stress among participants. Three themes emerged from the qualitative data analysis: 1) focus on people's strengths, 2) structure and language based on Strengths-Based Nursing and Healthcare values, and 3) building support networks., Conclusions: The Strengths-Based Nursing and Healthcare Leadership program developed to build the leadership capabilities of nurse and healthcare leaders was found to be effective. The positive impact of the 6-month program was demonstrated. It was also shown that the leadership program can help improve the leadership competencies, well-being, and work satisfaction of participating nurses and healthcare leaders., Implication: This study reinforces the importance of working with educational, research, and healthcare organizations to establish leadership development programs and mentorship opportunities. Future leadership training should use a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership and stress in the workplace., Competing Interests: 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., (© 2024 The Authors. Published by Elsevier Ltd.)

Objective: The aim of the study is to establish consensus recommendations on features used to determine the route of antibiotic administration and disposition for children with uncomplicated cellulitis., Methods: Modified Delphi methodology was performed with 2 rounds of confidential surveys of Emergency medicine and hospital medicine (HM) providers at Lurie Children's Hospital to assess cellulitis management in children (ages 6 months-18 years) without signs of sepsis or abscess formation. Using a 9-point Likert scale, emergency medicine providers ranked features by perceived level of importance when deciding initial antibiotic route and HM providers ranked features on importance when transitioning to oral antibiotics. Responses were grouped as not important (1-3), neutral (4-6), and important (7-9) and re-evaluated in the second round to reach consensus, defined as ≥70% agreement., Results: Emergency medicine providers (n = 17) reached consensus on 15 of 16 features (93.8%), 10 deemed important. Participants reached greatest consensus (100%) on fevers/chills, lymphangitis, and functional impairment as considerations for initiating intravenous antibiotics. HM providers (n = 15) reached consensus on 9 of 11 factors (81.8%), with 7 considered important when deciding on readiness for oral antibiotics. Providers indicated that stability, rather than reduction, of erythematous margins is sufficient to consider transition and de-escalation of therapy at less than 24 hours if all other clinical improvement criteria are met., Conclusions: This study achieved consensus on important features for treatment and disposition of children with uncomplicated cellulitis in both emergency and inpatient contexts. These features have the potential to aid in decision making and improve standardization of clinical practice., Competing Interests: Disclosure: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Triple negative breast cancer (TNBC) is the most aggressive and hard-to-treat subtype of breast cancer, affecting 10-20% of all women diagnosed with breast cancer. Surgery, chemotherapy and hormone/Her2 targeted therapies are the cornerstones of treatment for breast cancer, but women with TNBC do not benefit from these treatments. Although the prognosis is dismal, immunotherapies hold significant promise in TNBC, even in wide spread disease because TNBC is infiltrated with more immune cells. This preclinical study is proposing to optimize an oncolytic virus-infected cell vaccine (ICV) based on a prime-boost vaccination strategy to address this unmet clinical need., Methods: We used various classes of immunomodulators to improve the immunogenicity of whole tumor cells in the prime vaccine, followed by their infection with oncolytic Vesicular Stomatitis Virus (VSVd51) to deliver the boost vaccine. For in vivo studies, we compared the efficacy of a homologous prime-boost vaccination regimen to a heterologous strategy by treating 4T1 tumor bearing BALB/c mice and further by conducting re-challenge studies to evaluate immune memory responses in surviving mice. Due to the aggressive nature of 4T1 tumor spread (akin to stage IV TNBC in human patients), we also compared early surgical resection of primary tumors versus later surgical resection combined with vaccination., Results: In vitro results demonstrated that immunogenic cell death (ICD) markers and pro-inflammatory cytokines were released at the highest levels following treatment of mouse 4T1 TNBC cells with oxaliplatin chemotherapy and influenza vaccine. These ICD inducers also contributed towards higher dendritic cell recruitment and activation. With the top ICD inducers at hand, we observed that treatment of TNBC-bearing mice with the influenza virus-modified prime vaccine followed by VSVd51 infected boost vaccine resulted in the best survival. Furthermore, higher frequencies of both effector and central memory T cells along with a complete absence of recurrent tumors were observed in re-challenged mice. Importantly, early surgical resection combined with prime-boost vaccination led to improved overall survival in mice., Conclusion: Taken together, this novel cancer vaccination strategy following early surgical resection could be a promising therapeutic avenue for TNBC patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Niavarani, St-Cyr, Daniel, Lawson, Giguère, Alkayyal and Tai.)

MiRNAs (miRNA, miR) play important functions in the tumor microenvironment (TME) by silencing gene expression through RNA interference. They are involved in regulating both tumor progression and tumor suppression. The pathways involved in miRNA processing and the miRNAs themselves are dysregulated in cancer. Consequently, they have become attractive therapeutic targets as underscored by the plethora of miRNA-based therapies currently in pre-clinical and clinical studies. It has been shown that miRNAs can be used to improve oncolytic viruses (OVs) and enable superior viral oncolysis, tumor suppression and immune modulation. In these cases, miRNAs are empirically selected to improve viral oncolysis, which translates into decreased tumor growth in multiple murine models. While this infectious process is critical to OV therapy, optimal immunomodulation is crucial for the establishment of a targeted and durable effect, resulting in cancer eradication. Through numerous mechanisms, OVs elicit a strong antitumor immune response that can also be further improved by miRNAs. They are known to regulate components of the immune TME and promote effector functions, antigen presentation, phenotypical polarization, and varying levels of immunosuppression. Reciprocally, OVs have the power to overcome the limitations encountered in canonical miRNA-based therapies. They deliver therapeutic payloads directly into the TME and facilitate their amplification through selective tumoral tropism and abundant viral replication. This way, off-target effects can be minimized. This review will explore the ways in which miRNAs can synergistically enhance OV immunotherapy to provide the basis for future therapeutics based on this versatile combination platform., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 St-Cyr, Penarroya, Daniel, Giguère, Alkayyal and Tai.)

Background: The COVID-19 crisis in long-term care (LTC) homes was devastating for residents and front-line workers. Recent reports have detailed what went wrong in LTC facilities, including equipment shortages, lack of preparedness, underestimation of COVID-19's virulence and bans on caregiver visits. Less is known about what went well in some facilities., Purpose: To describe nurses' and other staff members' experiences and lessons learned in two LTC facilities in Quebec that reported no COVID-19 outbreaks during the first wave of the pandemic., Methods: Methods: A case study design guided by appreciative inquiry was conducted, in which a case was defined as a LTC facility without COVID-19 outbreaks; two cases were included. Twenty-three healthcare team members from the two sites were recruited and interviewed between October and November, 2020., Results: Several common themes were identified: being informed and respecting outbreak protocols; the presence of key outbreak protocols, which allowed for stable teams; a clear action plan; and access to materials and resources. Key management themes included team support and reward, ongoing communication and providing compassionate care to residents., Conclusion: This study highlights several lessons learned that have the potential to strengthen the LTC health system., (Copyright © 2022 Longwoods Publishing.)

Background: The diagnosis of complex post-traumatic stress disorder (CPTSD) was recently included into the 11th edition of the International Classification of Diseases (ICD-11). Recognizing the need for a brief and specific measure CPTSD symptoms as defined by the ICD-11, Cloitre and her team (2018) developed the original English version of the International Trauma Questionnaire (ITQ). The ITQ is composed of two scales-'post-traumatic stress disorder (PTSD)' and 'disturbances in self-organization' (DSO), respectively subdivided into three subscales. It was found to be psychometrically valid but has yet to be available in French., Objective: The purpose of this study was to provide a French version of the ITQ and to examine its factorial validity, internal consistency, and convergent validity in a French-speaking Canadian sample., Participants: The sample included 335 French-Canadian adults from the community., Methods: The ITQ was translated in French, back translated into English, and deemed equivalent by the original ITQ's author. Participants answered the French version of the ITQ, as well as measures of convergent validity, via phone interview., Results: Confirmatory factorial analyses revealed that the French ITQ presented the same factor structure as the original ITQ. Composite reliability scores revealed good internal consistency for both scales, and all but one subscale. Pearson's correlation and Steiger's Z test revealed good convergent validity., Conclusion: This study supports the factorial validity, internal consistency, and convergent validity of the French version of the ITQ, suggesting that it is a psychometrically sound measure of CPTSD., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the ICD-11 in 2018. Debates are still ongoing in the scientific community regarding the conceptual distinction between CPTSD symptoms and those of comorbid PTSD and borderline personality disorder (BPD). The present study aimed to determine whether (a) patterns of symptoms reported by women in a community sample would reveal a CPTSD profile distinct from PTSD and BPD profiles and (b) the resulting profiles could be compared on measures of cumulative childhood trauma exposure, dissociation, and life satisfaction. Women who reported at least one potentially traumatic experience (N = 438) completed questionnaires assessing PTSD, CPTSD, and BPD symptoms. We performed latent profile analyses testing seven models, with the five-profile model emerging as the most appropriate solution. The profiles were characterized as "high PTSD symptoms" (12.0%), "high CPTSD symptoms" (7.6%), "high BPD symptoms" (9.9%), "high CPTSD and BPD symptoms" (3.8%), and "low symptoms" (66.7%). Group comparisons revealed that the profiles characterized by high CPTSD symptoms, high BPD symptoms, and high CPTSD and BPD symptoms tended to include participants with higher levels of cumulative childhood trauma exposure and symptoms of dissociation and lower ratings of life satisfaction compared to the profiles characterized by high PTSD symptoms and low symptoms, ds = 0.55-1.06. These findings support the distinction between ICD-11 CPTSD symptoms and those of PTSD and BPD, promoting an integrative approach to understanding trauma sequelae, diagnosis, and treatment., (© 2021 International Society for Traumatic Stress Studies.)

Aim: This study describes the impact of a university-based mentorship programme that is designed to prepare nursing students for the transition to practice during their last year of classes., Background: Research shows that mentorship is an effective strategy for facilitating the transition to clinical practice. However, there is a lack of programmes that provide mentorship prior to the students' graduation from nursing school., Methods: A mixed qualitative and quantitative approach was chosen to describe nursing students' perceptions. Mentees and mentors were invited to complete a survey or participate in an interview (September-November 2018)., Results: Nine participants were interviewed and 22 completed the survey. Four themes were found. Students were as follows: Feeling unsure and looking for answers from clinicians and wanted to Learn about practical real-life situations. Their experiences allowed them to Normalize the entry to practice and become more prepared and capable to address pragmatic issues., Conclusions: By bridging the academic and clinical environments, this mentorship programme helped mentees address their concerns and facilitated an easier transition to the workplace after graduation., Implications for Nursing Management: Nurse managers can advocate for mentorship programmes by partnering with educational institutions. This support can also be continued as new graduates transition into their careers., (© 2020 John Wiley & Sons Ltd.)

Nonsyndromic craniosynostosis results in premature fusion of cranial sutures and is rarely found in the context of other craniofacial abnormalities. Here the authors present the case of a 3-month-old male infant with a rare presentation of sagittal craniosynostosis and concomitant calcified cephalohematoma repaired by endoscopic-assisted sagittal strip craniectomy with good cosmetic and functional outcomes. The authors discuss the advantages of endoscopic repair of craniosynostosis when found in the presence of a cephalohematoma and the need for further research to investigate a possible causal relationship between these 2 pathologies.

Objectives: Cumulative childhood trauma (CCT) survivors are at a higher risk of suffering from interpersonal problems including couple dissatisfaction. Dispositional mindfulness is increasingly proposed as a potential explanatory mechanism of post-traumatic symptomatology and has been documented as a predictor of couple satisfaction. Most authors operationalize mindfulness as a multidimensional disposition comprised of five facets (i.e., Describing, Observing, Non-judgment of inner experiences, Non-reactivity, and Acting with awareness), but the role of these facets in the link between CCT and couple satisfaction has yet to be understood. This study aimed to assess mindfulness as a potential mediator in the relationship between CCT and couple satisfaction and to examine the distinctive contributions of mindfulness facets in this mediation., Methods: A sample of 330 participants from the community completed measures of couple satisfaction, mindfulness, and exposure to eight types of childhood maltreatment experiences., Results: Path analysis results revealed that mindfulness mediated the relationship between CCT and couple satisfaction. More precisely, two mindfulness facets acted as specific mediators, namely, Describing and Non-judgment of inner experiences. The final integrative model explained 14% ( p  < .001) of the variance in couple satisfaction., Conclusions: Findings suggest that mindfulness may be a meaningful mechanism in the link between CCT and couple satisfaction. They also highlight that description of inner experiences and a non-judgmental attitude of these experiences may act as key components to understand the influence of CCT on adults' lower couple satisfaction., Competing Interests: Conflict of InterestThe authors declared that they have no conflict of interest., (© The Author(s) 2020.)

Magnetic resonance imaging may detect central nervous system involvement even when cerebrospinal fluid is normal and tests to detect Mycobacterium tuberculosis are negative. We describe 2 cases of miliary tuberculosis in young children with clinically unexpected central nervous system involvement. Magnetic resonance imaging of the brain should be considered part of the initial diagnostic workup for miliary tuberculosis in very young children.

Background: The safety and efficacy of low-molecular-weight heparin in the prevention of extracorporeal dialysis circuit clotting among in-center extended duration nocturnal hemodialysis (INHD) patients are unknown. The aim of this study was to determine the safety and efficacy of 2 doses of tinzaparin, among INHD patients receiving 6-8 h hemodialysis, 3 times per week., Methods: We conducted a retrospective cohort study to examine antifactor Xa levels at time 0, 2 h, 4 h mid-hemodialysis (mid-HD), 6 h, and at end of each INHD session for 4 weeks and to determine extracorporeal dialysis circuit clotting and bleeding events after switching from unfractionated heparin to tinzaparin, using a standard protocol of tinzaparin delivery at the initiation and midpoint of HD., Results: All 16 patients in The Ottawa Hospital INHD program were converted to tinzaparin and followed for 177 INHD sessions. Mean antifactor Xa level at 2 h of HD was 0.41 ± 0.21 (SD) IU/mL, at 4 h (mid-HD) 0.19 ± 0.17 IU/mL, at 6 h 0.44 ± 0.21 IU/mL, and at dialysis end 0.26 ± 0.14 IU/mL. Antifactor Xa levels were undetectable at the start of INHD, suggesting no tinzaparin accumulation. Five patients required an increase in tinzaparin due to extracorporeal dialysis circuit clotting. There were no bleeding events. One patient required a switch to fondaparinux due to an adverse reaction., Conclusion: Tinzaparin was safe and efficacious for most INHD patients without accumulation or bleeding. The conversion from unfractionated heparin to tinzaparin required an increased tinzaparin dose for 31% of INHD patients., (© 2019 S. Karger AG, Basel.)

Objectives: Survivors of early interpersonal trauma may experience relational problems, anger, impulsive and self-destructive behaviors, identity disturbance, and other difficulties that are associated with borderline personality disorder. Insecure attachment also has been documented in survivors and may be related to borderline personality-related symptoms (BPRS). The goal of the current study was to examine an integrative model of maternal and paternal childhood maltreatment and insecure attachment as they predict BPRS., Method: The sample was composed of 954 participants who completed self-report measures of parental maltreatment during childhood, attachment security, and trauma-related symptoms., Results: Structural equation modeling suggested differential impacts of maternal and paternal maltreatment on male and female participants. Both maternal and paternal maltreatment were directly associated with BPRS in women, whereas in men, only paternal maltreatment was directly related to BPRS. In women, paternal maltreatment was indirectly associated with BPRS through attachment anxiety but not through attachment avoidance. In men, maternal maltreatment was indirectly associated with BPRS through attachment anxiety but not through attachment avoidance., Conclusion: These findings have implications for the understanding of gender-specific etiologies of borderline personality symptoms and underscore attachment security as an important intervention target. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Boreal forests subject to low fire activity are complex ecosystems in terms of structure and dynamics. They have a high ecological value as they contain important proportions of old forests that play a crucial role in preserving biodiversity and ecological functions. They also sequester important amounts of carbon at the landscape level. However, the role of time since fire in controlling the different processes and attributes of those forests is still poorly understood. The Romaine River area experiences a fire regime characterized by very rare but large fires and has recently been opened to economic development for energy and timber production. In this study, we aimed to characterize this region in terms of live aboveground biomass, merchantable volume, stand structure and composition, and to establish relations between these attributes and the time since the last fire. Mean live aboveground biomass and merchantable volume showed values similar to those of commercial boreal coniferous forests. They were both found to increase up to around 150 years after a fire before declining. However, no significant relation was found between time since fire and stand structure and composition. Instead, they seemed to mostly depend on stand productivity and non-fire disturbances. At the landscape level, this region contains large amounts of biomass and carbon stored resulting from the long fire cycles it experiences. Although in terms of merchantable volume these forests seemed profitable for the forest industry, a large proportion were old forests or presented structures of old forests. Therefore, if forest management was to be undertaken in this region, particular attention should be given to these old forests in order to protect biodiversity and ecological functions. Partial cutting with variable levels of retention would be an appropriate management strategy as it reproduces the structural complexity of old forests., (Copyright © 2018. Published by Elsevier Ltd.)

Self-reported impulsivity has been found to predict the perpetration of sexual coercion in both sexual offenders and male college students. Impulsivity can be conceptualized as a generalized lack of self-control (i.e., general perspective) or as a multifaceted construct that can vary from one context to the other (i.e., domain-specific perspective). Delay discounting, the tendency to prefer sooner smaller rewards over larger delayed rewards, is a measure of impulsive decision making. Recent sexual adaptations of delay discounting tasks can be used to test domain-specific assumptions. The present study used the UPPS-P impulsivity questionnaire, a standard money discounting task, and a sexual discounting task to predict past use of sexual coercion in a sample of 98 male college students. Results indicated that higher negative urgency scores, less impulsive money discounting, and more impulsive sexual discounting all predicted sexual coercion. Consistent with previous studies, sexuality was discounted more steeply than money by both perpetrators and non-perpetrators of sexual coercion, but this difference was twice as large in perpetrators compared to non-perpetrators. Our study identified three different predictors of sexual coercion in male college students: a broad tendency to act rashly under negative emotions, a specific difficulty to postpone sexual gratification, and a pattern of optimal non-sexual decision making. Results highlight the importance of using multiple measures, including sexuality-specific measures, to get a clear portrait of the links between impulsivity and sexual coercion.