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The purpose of this study was to obtain a broad view of the knowledge, attitudes, beliefs, and lived experiences of emergency nurses regarding implicit and explicit bias.An exploratory, descriptive, sequential mixed-methods approach using online surveys and focus groups to generate study data. Two validated instruments were incorporated into the survey to evaluate experiences of microaggression in the workplace and ethnocultural empathy. Focus group data were collected using Zoom meetings.The final sample comprised 1140 participants in the survey arm and 23 focus group participants. Significant differences were found in reported experiences of institutional, structural, and personal microaggressions for non-White vs White participants. Respondents who identified Christianity as their religious group had lower mean scores on items representing empathetic awareness. Respondents who identified as nonheterosexual had significantly higher mean total Scale of Ethnocultural Empathy scores, empathetic awareness subscale scores, and empathetic feeling and expression subscale scores. Thematic categories that arose from the focus group data included witnessed bias, experienced bias, responses to bias, impact of bias on care, and solutions.In both our survey and focus group data, we see evidence that racism and other forms of bias are threats to safe patient care. We challenge all emergency nurses and institutions to reflect on the implicit and explicit biases they hold and to engage in purposeful learning about the effects of individual and structural bias on patients and colleagues. We suggest an approach that favors structural analysis, intervention, and accountability.

Charge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.An explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.Participants reported minimal training for the CN role, with divergent understandings of role, required education and experience, the need for situational awareness, and the acceptability of the CN taking on other duties.The ED CN is critical to the safety of both nursing environment and patient care. Nurses in this pivotal role do not receive adequate leadership orientation or formal training in the key areas of nurse patient assignment, communication, and situational awareness. Formal training in nurse-patient assignment, communication, and situational awareness are critical to appropriate patient care and maintenance of interprofessional trust necessary for successful execution of the CN role. ED nurse managers should advocate for this training.

PDF file - 401K, Supplementary Figure S1. Parental and 2nd generation anti-androgen resistant cell line proliferation. Supplementary Figure S2. AR levels in parental and 2nd generation anti-androgen resistant cell lines. Supplementary Figure S3. AR levels in transfection assays. Supplementary Figure S4. Transcriptional reporter assay of AR mutants. Supplementary Figure S5. Ligand binding domain of the AR bound to DHT (1T7T;(1)). Supplementary Figure S6. Competitive binding assay of wild-type AR vs. F876L AR. Supplementary Figure S7. AR levels in AR overexpressing cell lines. Supplementary Figure S8. LNCaP/AR(cs), LNCaP/SRF876L and LNCaP/pCDNAF876L cell proliferation. Supplementary Figure S9. Transcriptional activity of ARN-509 and enzalutamide in LNCaP/pCDNAF876L cells. Supplementary Figure S10. AR ChIP analysis of AR target genes. Supplementary Figure S11. PSA response for 3 patients with detectable AR F876L mutation.

PDF file - 183K, Supplementary Table S1. 1st and 2nd generation AR antagonist activity on F876L-AR. Supplementary Table S2. LNCaP/SRF876L Xenograft Pharmacokinetics Supplementary Table S3. AR nucleotide changes monitored by BEAMing assay Supplementary Table S4. Primary F876L BEAMing of ARN-509-001 Patients Supplementary Table S5. Transcriptional Real-time PCR Oligonucleotide Sequence Supplementary Table S6. ChIP Real-time PCR Oligonucleotide Sequence

The general problem of constructing regions that have a guaranteed coverage probability for an arbitrary parameter of interest $$\psi \in \Psi $$ ψ ∈ Ψ is considered. The regions developed are Bayesian in nature and the coverage probabilities can be considered as Bayesian confidences with respect to the model obtained by integrating out the nuisance parameters using the conditional prior given $$\psi .$$ ψ . Both the prior coverage probability and the prior probability of covering a false value (the accuracy) can be controlled by setting the sample size. These coverage probabilities are considered as a priori figures of merit concerning the reliability of a study while the inferences quoted are Bayesian. Several problems are considered where obtaining confidence regions with desirable properties have proven difficult to obtain. For example, it is shown that the approach discussed never leads to improper regions which has proven to be an issue for some confidence regions.

On March 11, 2020, the World Health Organization declared that COVID-19 was a pandemic.1 At that time, only 118,000 cases had been reported globally, 90% of which had occurred in 4 countries.1 Since then, the world landscape has changed dramatically. As of March 31, 2020, there are now nearly 800,000 cases, with truly global involvement.2 Countries that were previously unaffected are currently experiencing mounting rates of the novel coronavirus infection with associated increases in COVID-19–related deaths. At present, Canada has more than 8000 cases of COVID-19, with considerable variation in rates of infection among provinces and territories.3 Amid concerns over growing resource constraints, cardiac surgeons from across Canada have been forced to make drastic changes to their clinical practices. From prioritizing and delaying elective cases to altering therapeutic strategies in high-risk patients, cardiac surgeons, along with their heart teams, are having to reconsider how best to manage their patients. It is with this in mind that the Canadian Society of Cardiac Surgeons (CSCS) and its Board of Directors have come together to formulate a series of guiding statements. With strong representation from across the country and the support of the Canadian Cardiovascular Society, the authors have attempted to provide guidance to their colleagues on the subjects of leadership roles that cardiac surgeons may assume during this pandemic: patient assessment and triage, risk reduction, and real-time sharing of expertise and experiences. A visual abstract of the main principles underlying our recommended approach is provided in Figure 1.

Significance: Time-domain functional near-infrared spectroscopy (TD-fNIRS) has been considered as the gold standard of noninvasive optical brain imaging devices. However, due to the high cost, complexity, and large form factor, it has not been as widely adopted as continuous wave NIRS systems. Aim: Kernel Flow is a TD-fNIRS system that has been designed to break through these limitations by maintaining the performance of a research grade TD-fNIRS system while integrating all of the components into a small modular device. Approach: The Kernel Flow modules are built around miniaturized laser drivers, custom integrated circuits, and specialized detectors. The modules can be assembled into a system with dense channel coverage over the entire head. Results: We show performance similar to benchtop systems with our miniaturized device as characterized by standardized tissue and optical phantom protocols for TD-fNIRS and human neuroscience results. Conclusions: The miniaturized design of the Kernel Flow system allows for broader applications of TD-fNIRS.

The spectrum on how to manage aortic valve disease continues to widen. The purpose of this study is to add further clarification to the role of rapid deployment valves (RDVs) by comparing their outcomes with traditional sutured valves (TSVs) in the reoperative aortic valve replacement (AVR) setting.This study was a retrospective review of all patients undergoing a second surgical reoperation for aortic valve disease. Patients were categorized into 2 groups: RDV and TSV. Cox proportional hazards regression models were used to determine the association between exposures of interest and the primary and secondary outcomes, after adjusting for all the baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) within 3 years, which was the composite of all-cause death, readmission for myocardial infarct, readmission for stroke, and readmission for heart failure.A total of 307 patients made up the study population from 2010 to 2019. Of those, 254 patients received TSV, and 53 patients received RDV. RDV patients were significantly older than TSV patients by 10 years, on average. Shorter cardiopulmonary bypass (CPB) times were found with the RDV group. There was no significant difference in the primary outcome of MACE within 3 years.This single-centre large cohort study of patients with reoperative AVR found that RDVs facilitate smoother operations by saving 1 hour of cross-clamp time and CPB time. Furthermore, RDVs have comparable outcomes with TSVs, despite the significantly older patient population.Les nouvelles méthodes pour la prise en charge de la maladie de la valve aortique continuent de se multiplier. Cette étude vise à apporter d’autres précisions sur le rôle des valves à déploiement rapide (VDR) en comparant leurs résultats avec ceux des valves suturées traditionnelles (VST) dans le cadre d’un remplacement valvulaire aortique (RVA) réopératoire.Cette étude était une analyse rétrospective de tous les patients subissant une deuxième réopération chirurgicale pour la maladie valvulaire aortique. Les patients ont été classés en deux groupes : VDR et VST. Des modèles de régression des hasards proportionnels de Cox ont été utilisés pour déterminer l’association entre les expositions d’intérêt et les critères d’évaluation principal et secondaires, après ajustement pour toutes les caractéristiques initiales. Le paramètre principal était les événements cardiovasculaires indésirables majeurs (ECIM) dans les trois ans, soit un critère composite incluant le décès toutes causes confondues, la réadmission pour un infarctus du myocarde, la réadmission pour un accident vasculaire cérébral et la réadmission pour une insuffisance cardiaque.Au total, 307 patients faisaient partie de la population de l’étude de 2010 à 2019. Parmi ceux-ci, 254 patients ont reçu une VST, et 53 patients ont reçu une VDR. Les patients porteurs d’une VDR étaient significativement plus âgés que ceux porteurs d’une VST, soit de 10 ans en moyenne. Des temps plus courts sous circulation extracorporelle (CEC) ont été constatés dans le groupe VDR. Aucune différence significative n’a été observée en ce qui concerne le critère d’évaluation principal des ECIM dans les trois ans.Cette importante étude de cohortes menée à un seul centre auprès de patients subissant un RVA réopératoire a permis de constater que les VDR facilitaient les interventions en réduisant d’une heure le temps de clampage et le temps de CEC. De plus, les VDR ont procuré des résultats comparables à ceux obtenus avec les VST, malgré une population de patients significativement plus âgée.

EKS : This is a dream I had a couple of years ago. I was shopping for clothes for myself at a store that was nominally Bloomingdale's. I was dubious about whether they would have any clothes that would be big enough for me, but a saleswoman said they did, adding that rather than being marked by size numbers, each size-group of clothes was gathered under a graphic symbol: over here, she said, were the clothes that would fit me. "Over here" referred to a cluster of luscious-looking clothes, hung on a rack between two curtained dressing-rooms. The graphic symbol that surmounted them was a pink triangle. I woke up extremely cheerful. MM : My love of opera as a proto-gay child growing up in rural Oklahoma in the fifties had at least as much to do with the

The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This "flattening of the curve" has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.