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Introduction: Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications.Case Report: A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient self-navigated to addiction treatment.Conclusion: Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services.

This article presents a framework that considers how relationships, representation, and respect can be prioritized, presented, and nurtured in early learning environments to support and foster equity and inclusion. This simultaneously supports an enhanced sense of belonging and creates an environment where students feel valued and respected. As an encompassing approach, the components of the framework should be considered in both curricular and pedagogical decisions and practices, where teachers reflect upon: (1) what they are teaching; (2) how students interpret and receive what is being taught; and (3) how the learning experience interacts with and enhances students' experiences and understanding.

Se realizó un estudio relacional, transversal y de fuente retrospectiva de la información, cuyo objetivo fue determinar la relación entre el nivel del antígeno prostático específico y hallazgos gammagráficos en el cáncer de próstata, Instituto de Oncología Dr. Heriberto Pieter. El universo estuvo conformado por 262 pacientes diagnosticados con cáncer de próstata y la muestra por 216 pacientes, representando un 82,4 %. Para la recolección de los datos se utilizó un formulario con ocho preguntas a partir de las variables de estudio. Los resultados mostraron que 69,4 % de los pacientes evidenciaron una relación entre el nivel de antígeno prostático específico y la gammagrafía ósea. El grupo etario más afectado con cáncer de próstata fue mayor de 75 años. 46,5 % de los pacientes con metástasis ósea mostraron un nivel de PSA mayor o igual a 100 ng/mL. Los principales focos metastásicos fueron columna lumbosacra y la pelvis con 24,3 y 20,7 % de metástasis, respectivamente. La escala de Gleason más frecuente en pacientes metastásico fue siete, mientras que en los no metastásico fue menor o igual a seis con 53,8 %

Multicultural and culturally sustaining approaches to education help educators act on two essential concepts: that each student is unique and that uniqueness is central to the academic and social development of every student. Language is a key aspect of this uniqueness, and because language is integral to culture and identity, understanding language variation and diversity is critical to education equity. All educators need knowledge and tools to honor and value students' (and their families' and communities') language differences and variations, to understand and address any language-related challenges students may face, and to support students' academic, social, and emotional development. Efforts to help all students achieve their highest potential are incomplete without an understanding that linguistic discrimination, inseparable from racial discrimination, has historically limited African Americans' access to opportunities afforded other citizens. This article focuses on linguistic variations specific to African American English and ways educators can actively and creatively support Black students.

Academic institutions are now expected to engage in developing and assessing learning outcomes; however, responsibility outcomes, such as respect for human dignity (RFHD), can be particularly challenging. As part of our Biopsychology course and Sensation and Perception course over the past decade, we applied the scientist-educator model of learning and drew from the literature on prejudice reduction to develop our RFHD interventions, which involved face-to-face interactions with others who had sensory deficits or brain/spinal cord injuries. We iteratively created two pre-post measures to assess development of different aspects of RFHD: a Behavioral Tendencies Questionnaire and a 4-Factor RFHD Model Questionnaire. Recently, we modified the intervention and the assessments for adoption in our Class, Race, and Ethnicity in Society course. This paper reports findings from these three courses and a control course in engineering (n = 153). Findings support our two sets of hypotheses, regarding 1) the efficacy of the assessments to capture different likelihoods for interacting with others targeted by the interventions and changes over time in these factors, and 2) positive effects of the face-to-face intervention activities. This study demonstrates RFHD can be developed and assessed in a college course and provides new assessments for RFHD that are easily modified for a variety of types of others (e.g., individuals who are homeless versus blind or of a particular race).

Introduction: The application of structural competency and structural vulnerability to emergency medicine (EM) research has not been previously described despite EM researchers routinely engaging structurally vulnerable populations. The purpose of this study was to conduct a scoping review and consensus-building process to develop a structurally competent research approach and operational framework relevant to EM research.Methods: We conducted a scoping review focused on structural competency and structural vulnerability. Results of the review informed the development of a structural competency research framework that was presented throughout a multi-step consensus process culminating in the 2021 Society for Academic Emergency Medicine Consensus Conference. Feedback to the framework was incorporated throughout the conference.Results: The scoping review produced 291 articles with 123 articles relevant to EM research. All 123 articles underwent full-text review and data extraction following a standardized data extraction form. Most of the articles acknowledged or described structures that lead to inequities with a variety of methodological approaches used to operationalize structural competency and/or structural vulnerability. The framework developed aligned with components of the research process, drawing upon methodologies from studies included in the scoping review. Conclusion: The framework developed provides a starting point for EM researchers seeking to understand, acknowledge, and incorporate structural competency into EM research. By incorporating components of the framework, researchers may enhance their ability to address social, historical, political, and economic forces that lead to health inequities, reframing drivers of inequities away from individual factors and focusing on structural factors.

The Santa Barbara Basin is an extraordinary archive of environmental and ecological change, where varved sediments preserve microfossils that provide an annual to decadal record of the dynamics of surrounding ecosystems. Of the microfossils preserved in these sediments, benthic foraminifera are the most abundant seafloor-dwelling organisms. While they have been extensively utilized for geochemical and paleoceanographic work, studies of their morphology are lacking. Here we use a high-throughput imaging method (AutoMorph) designed to extract 2D data from photographic images of fossils to produce a large image and 2D shape dataset of recent benthic foraminifera from two core records sampled from the center of the Santa Barbara Basin that span an ~800-year-long interval during the Common Era (1249-2008 CE). Information on more than 36,000 objects is included, of which more than 22,000 are complete or partially-damaged benthic foraminifera. The dataset also includes other biogenic microfossils including ostracods, pteropods, diatoms, radiolarians, fish teeth, and shark dermal denticles. We describe our sample preparation, imaging, and identification techniques, and outline potential data uses.

BackgroundMany long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.ObjectiveThe purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.DesignThis study was a descriptive, cross-sectional survey using targeted sampling.ParticipantsA total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.MethodsThis study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.ResultsThe mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).ConclusionSince the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.Clinical relevanceOur study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Despite a sound policy framework, the right of learners with disabilities in South Africa to inclusive and equitable quality education is not being met. A key reason hindering the realisation of this right is that there are very few teacher education programs focused on supporting learners with disabilities. Acknowledging the urgency of teacher education, in this paper we draw on qualitative data from 109 teacher participants and 39 course facilitators of a series of disability inclusion-focused teacher education short courses in the Western Cape province of South Africa. Based on their experience of the courses, we consider how teachers can be empowered to meet the diverse needs of their learners within an inclusive framework. Findings highlight that professional and personal growth facilitated a more empathic understanding of learners and the opportunity to collaborate with others, enabling teachers to find creative ways of solving problems faced in their workplaces. To support teachers in meeting the needs of their learners, teacher training should facilitate active reflection on the role they play in shaping the lives of their learners, and prepare teachers to respond to challenges strategically, taking advantage of the resources available to them within and beyond their school environment.

Abstract Myopia is a common ocular condition characterized by biomechanical weakening revealed by increasing creep rate, cyclic softening scleral thinning, change of collagen fibril crimping, and excessive elongation of the posterior sclera resulting in blurred vision. Animal studies support scleral crosslinking as a potential treatment for myopia control by strengthening the weakened sclera and slowing scleral expansion. While multiple studies investigated aspects of the biomechanical weakening and strengthening effects in myopia and after scleral crosslinking, a comprehensive analysis of the underlying mechanical changes including the effect of vehicle injections is still missing. The purpose of this study was to provide a comprehensive analysis of biomechanical changes by scleral inflation testing in experimental myopia, after retrobulbar vehicle injections and scleral crosslinking using genipin in tree shrews. Our results suggest that biomechanical weakening in myopia involves an increased creep rate and higher strain levels at which collagen fibers uncrimp. Both weakening effects were reduced after scleral crosslinking using genipin at doses that were effective in slowing myopia progression. Vehicle injections increased mechanical hysteresis and had a small but significant effect on slowing myopia progression. Also, our results support scleral crosslinking as a potential treatment modality that can prevent or counteract scleral weakening effects in myopia. Furthermore, vehicle solutions may cause independent biomechanical effects, which should be considered when developing and evaluating scleral crosslinking procedures.

This systematic review provides investigation into the evolution of Supply Chain Management (SCM) practices from Industry 4.0 to Industry 5.0 in South African enterprises, with a specific focus on the integration of Blue Ocean Strategy. Industry 5.0 marks a significant shift towards more personalised, sustainable, and human- centric industrial practices, leveraging advanced technologies to improve operational efficiency and address environmental concerns. The research aims to investigate how SCM practices in South African firms are transforming under the influence of Industry 5.0 paradigms and to assess how the Blue Ocean Strategy can bolster competitiveness, operational efficiency, and sustainable growth. Adopting a comprehensive methodology, this study systematically reviewed peer-reviewed articles from 2019 to 2023. Employing the PRISMA framework for structured literature review, and thematic analysis using Atlas-ti 24 software, the research scrutinised the evolution of SCM practices, focusing on technological adoption, strategic innovation, and sustainability integration. The findings reveal that South African firms are progressively adopting Industry 5.0 technologies, integrating them within SCM to improve flexibility, responsiveness, and sustainability. The application of Blue Ocean Strategy is identified as a catalyst for creating uncontested market spaces and driving innovation, which not only improves the firms’ market position but also aligns with sustainable business practices. However, challenges such as technological integration complexity, high transition costs, and the need for skilled human resources are notable impediments. This research significantly contributes to academic literature by providing a nuanced understanding of the SCM evolution in the context of Industry 5.0 within emerging markets, particularly focusing on South African enterprises. It also offers practical insights for industry practitioners on leveraging Blue Ocean Strategy alongside Industry 5.0 technologies to achieve competitive advantage and sustainable growth. The study underlines the need for policy interventions to support technological adaptation and capacity building in the SCM sector, suggesting avenues for future research on overcoming the barriers to Industry 5.0 adoption.

The integration of Artificial Intelligence (AI) within supply chain management (SCM) has precipitated a significant transformation in business processes, particularly in emerging economies like South Africa. This systematic literature review explores the extent of AI’s influence on SCM practices across various industries within the South African context, underpinning the potential of AI to improve operational efficiency, strategic decision-making, and innovation. This review thoroughly followed the PRISMA guidelines. The findings reveal that AI significantly contributes to the advancement of SCM by improving accuracy in demand forecasting, optimising resource allocation, and facilitating real-time decision-making. This review synthesizes current research, offering a comprehensive overview of AI’s transformative potential in SCM within South Africa. It also suggests areas for future research, particularly in addressing the challenges of AI implementation and exploring its impact on sustainable SCM practices. The implications for both practitioners and policymakers include prioritising digital infrastructure development, ethical AI integration, and encouraging public-private partnerships to support AI-driven innovations in supply chain networks. Future research should prioritise the development of practical methods that specifically target the demands and obstacles of incorporating AI into supply chains in South Africa, with the aim of promoting fair and sustainable growth.

This study evaluates the disruptions in South African pharmaceutical supply chains, focusing on resilience mechanisms and risk factors essential for maintaining continuity and efficiency amidst various disruptions. It leverages a comprehensive literature review and qualitative insights from interviews with 25 local experts, employing a phenomenological approach to explore the strategic experiences and adaptations to supply chain challenges. Findings highlight the significance of diversified sourcing, strategic adaptability, and local production enhancement in ensuring supply chain robustness and pharmaceutical availability. The research underscores the importance of robust risk management, strategic foresight, and local capability investment, offering practical insights for stakeholders to enhance supply chain resilience. Contributing valuable perspectives to supply chain management discourse, it enriches the understanding of resilience and risk mitigation in the pharmaceutical sector, providing a basis for informed strategic planning and policymaking to safeguard against future disruptions.

Abstract Rare genetic diseases are typically studied in referral populations, resulting in underdiagnosis and biased assessment of penetrance and phenotype. To address this, we develop a generalizable method of genotype inference based on distant relatedness and deploy this to identify undiagnosed Type 5 Long QT Syndrome (LQT5) rare variant carriers in a non-referral population. We identify 9 LQT5 families referred to a single specialty clinic, each carrying p.Asp76Asn, the most common LQT5 variant. We uncover recent common ancestry and a single shared haplotype among probands. Application to a non-referral population of 69,819 BioVU biobank subjects identifies 22 additional subjects sharing this haplotype, which we confirm to carry p.Asp76Asn. Referral and non-referral carriers have prolonged QT interval corrected for heart rate (QTc) compared to controls, and, among carriers, the QTc polygenic score is independently associated with QTc prolongation. Thus, our innovative analysis of shared chromosomal segments identifies undiagnosed cases of genetic disease and refines the understanding of LQT5 penetrance and phenotype.

Introduction: Medical and nonmedical ketamine use is increasing in the United States. This will likely lead to an increase in emergency department (ED) visits in individuals experiencing associated side effects. Physicians will need to be able to effectively recognize and manage ketamine-related complications. Case Report: A 31-year-old male with a three-year history of inhalational, intramuscular, and intravenous nonmedical ketamine use presented to the ED twice within a week with symptoms of severe atraumatic back pain, abdominal pain, and dyspepsia. A comprehensive workup, including advanced imaging, was unrevealing for identifiable causes, and the patient was discharged with instructions for primary care follow-up for further evaluation. The patient used information shared on Reddit, an online forum and social network, to identify that the cause of his pain was related to chronic ketamine use. Subsequently, upon discontinuation of ketamine, the pain improved in 24 hours. The patient self-navigated to addiction treatment. Conclusion: Emergency physicians should consider sequelae of chronic ketamine use as a possible cause for gastrointestinal and urologic symptoms in the ED. In addition to thorough examination and assessment for other acute medical problems, patients should be offered education, symptomatic treatment, and linkage to harm reduction and substance use disorder treatment services.

Abstract Background The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date. Case presentation A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient’s pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient’s dyspnea resolved; one month later, leg edema and abdominal bloating were relieved. Conclusions Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.

Reading fluency (RF) involves the automaticity of many distinct reading skills (e.g., pacing, word recognition, phonological awareness) and allows cognitive resources to be allocated to higher-order reading skills (e.g., comprehension, synthesis). Early identification of students at-risk for RF deficits is critical, but many screeners require a level of basic proficiency with foundational reading skills. This review examines the longitudinal relationships between neurocognitive precursors of RF with special consideration of cognitive processing demands of measurement tasks. Eighteen articles yielded 80 unique correlations between 6 neurocognitive constructs (phonological processing, rapid automatic naming, working memory, nonverbal reasoning, orthographic processing, and visual-spatial processing) measured through 35 unique subtests/tasks and 2 primary RF outcomes (word RF and text RF) measured through 11 unique subtests/tasks. Phonological processing was the most frequently assessed neurocognitive predictor (41.3% of total correlations), followed by rapid automatic naming (32.5%). Nearly all correlation coefficients were significant (83.75%); 28.75% of correlations suggested a strong predictive relationship between a neurocognitive predictor and an RF outcome. The strength of correlation largely varied as a function of the task demands as evidenced through the supplemental process analyses, suggesting future consideration should be given to the specificity of task selection to improve ecologically valid conclusions. Evidence from this review supports the need to consider specific neurocognitive functions, specifically rapid automatic naming and orthographic processing, as critical components of dynamic and comprehensive assessments of reading to help identify students at-risk for future RF challenges.