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Background: High-consequence infectious diseases (HCIDs) include contact-transmissible viral haemorrhagic fevers and airborne-transmissible infections such as Middle Eastern Respiratory Syndrome. Assessing suspected HCID cases requires specialized infection control measures including patient isolation, personal protective equipment (PPE), and decontamination. There is need for an accessible course for NHS staff to improve confidence and competence in using HCID PPE outside specialist HCID centres., Aim: To produce and evaluate a training course for National Health Service (NHS) staff on recognition and assessment of patients with suspected HCID infection., Methods: We developed a multi-disciplinary course blending online learning with in-person, high-fidelity simulation using a manikin which employs fluorescent tracers to simulate airborne, contact, and fomite transmission. This facilitates visualization of contamination pre- and post-PPE removal and supports team-based debrief of performance. Training culminated in competency-based assessment. Educational effectiveness was evaluated through curriculum-linked pre- and post-course tests, and self-rated confidence using Likert scales., Findings: Between December 2022 and April 2024 180 nurses, specialty registrars and consultants were trained. Educational effectiveness was evaluated in 60 consecutive participants between December 2022 and April 2023. Pre- and post-course assessments revealed significant improvements in knowledge (mean score 61% vs 83%, P<0.0001). Pre-course, 36% of learners reported feeling confident in HCID PPE donning and doffing, rising to 97% post-course. Participants unanimously rated the learning experience as high- or very-high quality., Conclusion: This course, incorporating ultraviolet markers for contamination visualization, represents a novel approach outside military settings. The results demonstrate its effectiveness as an educational intervention, improving staff confidence and competence in PPE use., Competing Interests: Conflict of interest statement There are no competing interests for any of the authors., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A female entire dog with a history of travel from Eastern Europe, coprophagia, and absent prophylactic treatment against parasites, developed excessive haemorrhage during elective ovariohysterectomy, resulting in abandonment of the procedure. Physical examination and abdominal ultrasound were unremarkable. Routine blood analysis was unremarkable and there was no support for angiostrongylosis or the presence of common travel-associated infectious agents. Viscoelastic testing demonstrated hyperfibrinolysis and Baermann's faecal analysis documented Strongyloides stercoralis infection. They were treated with ivermectin, with a resolution of hyperfibrinolysis. This is the first description of transient hyperfibrinolysis associated with strongyloidiasis in the dog, although hyperfibrinolysis has been described in association with other helminth infections in the dog and in other host species. Strongyloidiasis should be considered as an uncommon cause of acquired clinical hyperfibrinolysis, particularly in dogs where common differentials have been excluded., (© 2024 British Small Animal Veterinary Association.)

Southern flounder skin pigmentation is a critical phenotypic characteristic for this species' survival in the natural environment. Normal pigmentation allows rapid changes of color for concealment to capture prey and UV light protection. In contrast, highly visible hypopigmented pseudo-albinos exhibit a compromised immune system and are vulnerable to predation, sensitive to UV exposure, and likely have poor survival in the wild. Skin and brain tissue samples from normally pigmented and hypopigmented individuals were analyzed with next-generation RNA sequencing. A total of 1,589,613 transcripts were used to identify 952,825 genes to assemble a de novo transcriptome, with 99.43% of genes mapped to the assembly. Differential gene expression and gene enrichment analysis of contrasting tissues and phenotypes revealed that pseudo-albino individuals appeared more susceptible to environmental stress, UV light exposure, hypoxia, and osmotic stress. The pseudo-albinos' restricted immune response showed upregulated genes linked to cancer development, signaling and response, skin tissue formation, regeneration, and healing. The data indicate that a modified skin collagen structure likely affects melanocyte differentiation and distribution, generating the pseudo-albino phenotype. In addition, the comparison of the brain transcriptome revealed changes in myelination and melanocyte stem cell activity, which may indicate modified brain function, reduced melanocyte migration, and impaired vision.

Study Objective: To determine the optimal sedative dose of intranasal dexmedetomidine for children undergoing laceration repair., Methods: This dose-ranging study employing the Bayesian Continual Reassessment Method enrolled children aged 0 to 10 years with a single laceration (<5 cm), requiring single-layer closure, who received topical anesthetic. Children were administered 1, 2, 3, or 4 mcg/kg intranasal dexmedetomidine. The primary outcome was the proportion with adequate sedation (Pediatric Sedation State Scale score of 2 or 3 for ≥90% of the time from sterile preparation to tying of the last suture). Secondary outcomes included the Observational Scale of Behavior Distress-Revised (range: 0 [no distress] to 23.5 [maximal distress]), postprocedure length of stay, and adverse events., Results: We enrolled 55 children (35/55 [64%] males; median [interquartile range {IQR}] age 4 [2, 6] years). At 1, 2, 3, and 4 mcg/kg intranasal dexmedetomidine, respectively, the proportion of participants "adequately" sedated was 1/3 (33%), 2/9 (22%), 13/21 (62%), and 12/21 (57%); the posterior mean (95% equitailed credible intervals) for the probability of adequate sedation was 0.38 (0.04, 0.82), 0.25 (0.05, 0.54), 0.61 (0.41, 0.80), and 0.57 (0.36, 0.76); the median (IQR) Observational Scale of Behavior Distress-Revised scores during suturing was 2.7 (0.3, 3), 0 (0, 3.8), 0.6 (0, 5), and 0 (0, 3.7); the median (IQR) postprocedure length of stay was 67 (60, 78), 76 (60, 100), 89 (76, 109), and 113 (76, 150) minutes. There was 1 adverse event, a decrease in oxygen saturation at 4 mcg/kg, which resolved with head repositioning., Conclusion: Despite limitations, such as our limited sample size and subjectivity in Pediatric Sedation State Scale scoring, sedation efficacy for 3 and 4 mcg/kg were similarly based on equitailed credible intervals suggesting either could be considered optimal., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Objectives: Pain is the most common reason for prehospital transport. As emergency wait times increase, timely pain management is essential. In children, there is abundant evidence that prehospital pharmacologic analgesia is suboptimal, but little is known about non-pharmacologic therapies. We sought to characterize documentation by paramedics of non-pharmacologic (immobilization and ice) and pharmacologic analgesia in children with musculoskeletal injuries., Methods: We reviewed all ambulance call reports for children 0-17 years transported to Southwestern Ontario regional hospitals from January 1, 2017, to December 31, 2019, with a musculoskeletal injury (Ontario Ministry of Health and Long-Term Care problem codes 66 and 67). Primary and secondary outcomes were documented immobilization or ice and pharmacologic analgesia, respectively. In a multivariable analysis, we explored the relationship between immobilization or ice and the following a priori covariates: age, sex, visible deformity, crew type, pain severity, and analgesia., Results: Of 40,692 ambulance call reports reviewed, 4445 met inclusion criteria. There were 2584/4441 (58.2%) males, with a median (IQR) age of 14 (10, 16) years. In ambulance call reports with documented pain scores, 2106/3048 (69.1%) ambulance call reports reported "moderate or severe" pain. Immobilization or ice were documented in 1605/4445 (36.1%) and 385/4445 (8.7%) of ambulance call reports. Pharmacologic analgesia was documented in 275/1983 (13.9%) and 125/991 (12.6%) of ambulance call reports for primary care paramedics and advanced care paramedics, respectively. An increased odds of documented immobilization or ice was associated with moderate or severe pain [OR: 2.4; 95% CI 1.84-3.17; p < 0.01] and visible deformity [OR: 2.5; 95% CI 1.97-3.12; p < 0.01]., Conclusions: Documented immobilization and ice and pharmacologic analgesia to children by paramedics is suboptimal. Our findings underscore an important need for enhanced education surrounding the benefits of non-pharmacologic options for children with musculoskeletal injuries., (© 2022. The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).)