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This study aimed to understand how the personal and professional resilience of Registered Practical Nurses working in long-term care (LTC) homes in Ontario were impacted during the Coronavirus 2019 pandemic.Registered Practical Nurses are primary regulated healthcare providers that have worked in Ontario LTC homes during the COVID-19 pandemic. As frontline workers, they have experienced increased stress secondary to lockdowns, changing Ministry of Health recommendations, social isolation and limited resources. LTC homes experienced almost a third of all COVID-19-related deaths in Ontario. Understanding registered practical nurses' (RPNs) resilience in this context is vital in developing the programs and supports necessary to help nurses become and stay resilient in LTC and across a range of settings.Purposive sampling was used to recruit 40 Registered Practical Nurses working in LTC homes across Ontario for interviews. Charmaz's Grounded theory guided in-depth one-on-one interviews and analyses completed between April to September 2021.Registered Practical Nurse participants represented 15 (37.5%) private, and 25 (62.5%) public LTC homes across Ontario Local Health Integration Networks. Findings informed two distinct perspectives on resilience, one where nurses were able to maintain resilience and another where they were not. Sustaining and fraying resilience, presented as bimodal processes, was observed in four themes: 'Dynamic Role of the Nurse', 'Preserving Self', 'Banding Together' and 'Sense of Leadership Support'.Resilience was largely drawn from themselves as individuals. Resources to support self-care and work-life balance are needed. Additionally, workplace supports to build capacity for team-based care practices, collegial support in problem-solving and opportunities for 'connecting' with LTC nursing colleagues would be beneficial. Our findings suggest a role for professional development resources in the workplace that could help rebuild this workforce and support RPNs in providing quality care for older adults living in LTC.Our research team included two members of the Registered Practical Nurses Association of Ontario, and these team members contributed to the discussion and design of the study methodology, recruitment, analysis and interpretation. Further, RPNs working in long-term care during the COVID-19 pandemic were the participants in this study and, therefore, contributed to the data. They did not contribute to data analysis or interpretation.

To explore the use of Indigenous philosophies and ways of knowing as a means to critique, understand and improve the care of Indigenous infants and families in the neonatal intensive care unit (NICU).The ability of health professionals to provide culturally safe and equitable care to Indigenous infants and their families can affect infant development and long-term health outcomes. Research suggests that family involvement in care benefits both the infant and their family, but there is limited research that addresses the experience of Indigenous families in the NICU and advances understanding of how nurses involve Indigenous families in their infants' care.A discursive, critical review will be presented to outline the assumptions of Indigenous philosophies and to explore how the consideration and implementation of Indigenous ways of knowing can improve the nursing care of Indigenous infants and their families in the NICU.First, our subjective positioning as Indigenous nurses and as health researchers is described. Second, our understanding of Indigenous philosophical frameworks and how these approaches fit in the context of the philosophy of science is defined. Third, the key elements of an Indigenous philosophical paradigm are described. Fourth, an application of Indigenous paradigms to supporting the care of Indigenous infants and families in the NICU context is made.An Indigenous philosophical approach to nursing is ideal for understanding and improving the experiences of Indigenous infants and families in the NICU. This approach allows nurses to critically analyse the history and legacy of colonialism and its impact on the health and wellbeing of Indigenous peoples. By prioritising the voices and concerns of Indigenous families in the clinical setting and in nursing research, nurses can better understand the experiences of these families in the NICU and use strengths-based approaches to facilitate family involvement in care.The application of Indigenous philosophies in the nursing context can be used to inform the care of Indigenous infants and families in the NICU. Potential benefits include improved therapeutic relationships between nurses and Indigenous families, and increased uptake of parent-led interventions in nursing practice, which may lead to improved health outcomes for Indigenous infants in the NICU and throughout their subsequent development.

10 pages, 6 figures, supporting information https://doi.org/10.1002/ece3.10012.--- Data Availability Statement: Quantitative estimates for reproductive effort (fecundity), total host cells (18S rDNA), and symbiont cells (16S rDNA) are provided in the Appendix S1, The transmission of microbes from mother to offspring is an ancient, advantageous, and widespread feature of metazoan life history. Despite this, little is known about the quantitative strategies taken to maintain symbioses across generations. The quantity of maternal microbes that is provided to each offspring through vertical transmission could theoretically be stochastic (no trend), consistent (an optimal range is allocated), or provisioned (a trade-off with fecundity). Examples currently come from animals that release free-living eggs (oviparous) and suggest that offspring are provided a consistent quantity of symbionts. The quantity of maternal microbes that is vertically transmitted in other major reproductive strategies has yet to be assessed. We used the brooding (viviparous) sponge Halichondria panicea to test whether offspring receive quantitatively similar numbers of maternal microbes. We observed that H. panicea has a maternal pool of the obligate symbiont Candidatus Halichondribacter symbioticus and that this maternal pool is provisioned proportionally to reproductive output and allometrically by offspring size. This pattern was not observed for the total bacterial community. Experimental perturbation by antibiotics could not reduce the abundance of Ca. H. symbioticus in larvae, while the total bacterial community could be reduced without affecting the ability of larvae to undergo metamorphosis. A trade-off between offspring size and number is, by definition, maternal provisioning and parallel differences in Ca. H. symbioticus abundance would suggest that this obligate symbiont is also provisioned, T.J.C. was supported by a post-doctoral fellowship from the Alexander von Humboldt Foundation, the Deutsche Forschungsgemeinschaft (CRC 1182 “Origin and Function of Metaorganisms”; Project ID: 261376515), and the GEOMAR Helmholtz Center for Ocean Research; L.S. was supported by the Max Planck Institute for Evolutionary Biology; L.P. and S.J. were supported by the GEOMAR Helmholtz Center for Ocean Research; and U.H. was supported by the Deutsche Forschungsgemeinschaft (CRC 1182 “Origin and Function of Metaorganisms”; Project ID: 261376515), the Gordon and Betty Moore Foundation (GBMF9352), and the GEOMAR Helmholtz Center for Ocean Research. Open Access funding enabled and organized by Projekt DEAL, With the institutional support of the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S)

Genetic cardiomyopathies are disorders of the cardiac muscle, most often explained by pathogenic mutations in genes encoding sarcomere, cytoskeleton, or ion channel proteins. Clinical phenotypes such as heart failure and arrhythmia are classically treated with generic drugs, but aetiology-specific and targeted treatments are lacking. As a result, cardiomyopathies still present a major burden to society, and affect many young and older patients. The Translational Committee of the Heart Failure Association (HFA) and the Working Group of Myocardial Function of the European Society of Cardiology (ESC) organized a workshop to discuss recent advances in molecular and physiological studies of various forms of cardiomyopathies. The study of cardiomyopathies has intensified after several new study setups became available, such as induced pluripotent stem cells, three-dimensional printing of cells, use of scaffolds and engineered heart tissue, with convincing human validation studies. Furthermore, our knowledge on the consequences of mutated proteins has deepened, with relevance for cellular homeostasis, protein quality control and toxicity, often specific to particular cardiomyopathies, with precise effects explaining the aberrations. This has opened up new avenues to treat cardiomyopathies, using contemporary techniques from the molecular toolbox, such as gene editing and repair using CRISPR-Cas9 techniques, antisense therapies, novel designer drugs, and RNA therapies. In this article, we discuss the connection between biology and diverse clinical presentation, as well as promising new medications and therapeutic avenues, which may be instrumental to come to precision medicine of genetic cardiomyopathies. ispartof: EUROPEAN JOURNAL OF HEART FAILURE vol:24 issue:3 pages:406-420 ispartof: location:England status: published

Iohexol clearance has been proposed to estimate the glomerular filtration rate (GFR). A population pharmacokinetics (popPK) model was developed from heterogeneous patients. A Bayesian estimator (MAP-BE) based on a limited sampling strategy (LSS) was derived and evaluated in external patients.Full pharmacokinetic data (7-12 samples) from 172 patients receiving iohexol for measurement of their GFR (unstable and stable ICU patients, liver failure patients and kidney transplant patients) were split into development (n = 136) and validation (n = 36) datasets. A PopPK model was developed in Monolix and was used to develop MAP-BE based on LSS. Its performance for GFR estimation was evaluated in the validation set.A two-compartment model with first-order elimination best described the data. The final model included the type of patients on volume of distribution (Vd), clearance and intercompartmental constants, serum creatinine on clearance and body weight on Vd. The best LSS included samples at 0.1-1-9 h exhibiting a relative mean prediction error (MPE) (RMSE) = -3.7% (14.3%) and better performance than the Bröchner-Mortensen formula (-3.0%/17%). Split by type of patients, the highest interindividual variability and imprecision was observed in unstable ICU patients (MPE (RMSE) = 3.7% (18.8%)) while the best performances were obtained for renal transplant patients (MPE (RMSE) = 1.0% (5.8%)). All LSS that included samples before 9 hours for the third sample were associated with an increased imprecision.A single MAP-BE of iohexol based on a three-sample LSS for four heterogeneous populations was developed and allowed accurate estimation of GFR in kidney transplant patients, slightly biased in stable ICU patients and slightly imprecise in unstable ICU patients.

Aim The objective of this scoping review of reviews will be to synthesize the existing literature to identify key elements, conceptualizations and interventions of cultural safety to improve healthcare for Indigenous Peoples. Design Eligible studies will include reviews (e.g. scoping reviews, systematic reviews and narrative reviews) focused on Indigenous cultural safety in healthcare. Methods Guided by Weber-Pillwax's Indigenous principles of relationality and Arksey and O'Malley's scoping review framework, a review of reviews will be conducted by searching peer-reviewed literature published between January 2010 and December 2020. The database search will include CINAHL, PubMed, Scopus, Web of Science, and Google Scholar. This scoping review protocol was registered with the Joanna Briggs Institute on January 28, 2021. Discussion There is a paucity of knowledge on existing interventions and implementation strategies to support Indigenous cultural safety within the healthcare system. Improving Indigenous cultural safety in healthcare requires a comprehensive understanding of its core components and the specific interventions. Impact This review will help guide future research and enhance cultural safety interventions for Indigenous Peoples, including Indigenous Peoples with diverse genders and sexualities. The findings from this review will provide critical insight and knowledge to inform cultural safety policies, programs and practices to support healthcare for Indigenous populations.

Environmental stressors have profound implications for species, communities, and ecosystems by altering fundamental processes. With increasing human impacts on aquatic ecosystems, two main scenarios have been reported: (1) the spatiotemporal superposition of multiple stressors, leading to interactions among them and (2) intensifying environmental gradients, leading to threshold responses. However, studies designed to assess the effects of multiple stressors (e.g., pulse stressors) along environmental gradients (e.g., press stressors) are uncommon, and interactions between pulse and press stressors may cause abrupt changes in biological responses. We conducted a laboratory experiment to investigate the effects of osmotic stress along a nutrient enrichment gradient on a freshwater community composed of periphyton, microorganisms, and zebra mus- sels (Dreissena polymorpha). Our objectives were to (1) quantify the individual and combined effects of stressors, (2) delineate thresholds along the nutrient gradient (press) in the absence and presence of osmotic stress (pulse), and (3) test for interactions between the two stressors. We evaluated effects on metabolic rates inD. polymorphaand on microbial activity, as well as phototrophic periphyton biomass and physiological sta- tus. We observed interactions between the two stressors for metabolic rates inD. polymorphaand periphytic phaeopigments. In contrast, we found an individual effect of osmotic stress on microbial activity and chloro- phyllacontent. Thresholds were only identified in the presence of osmotic stress for metabolic rates inD. polymorpha. Our work highlights the importance of combining multiple stressors with environmental gra- dients and the need to consider multiple biological compartments when evaluating the impacts of stressors on ecosystems.

Objective Where people with systemic sclerosis (SSc) (or scleroderma) obtain diet and nutrition information to manage their disease is not known. Objectives were to identify 1) resources used by people with SSc for nutrition and diet information and 2) perceived advantages and disadvantages of resources. Methods We conducted nominal group technique (NGT) sessions in which people with SSc reported nutrition and diet information resources they have used and perceived advantages and disadvantages of accessing and using resources. Participants indicated whether they had tried each resource. They rated helpfulness and importance of possible advantages and disadvantages. Items elicited across sessions were merged to eliminate overlap. Results We conducted four NGT sessions (three English language, one French language; 15 total participants) and identified 33 unique information resources, 147 resource‐specific advantages, and 118 resource‐specific disadvantages. Resource categories included health care providers, alternative and complementary practitioners, websites and other media platforms, events, and print materials. The most common themes for advantages and disadvantages included quality and individualization of information and accessibility of resources in terms of cost, location, and comprehensibility. Information provided by medical professionals was regarded as most credible and can be obtained through books, articles, and websites if individual consultation is not easily accessible. Web‐based information was considered highly accessible, although of variable credibility. In‐person events may be an important source of health information for people with SSc. Conclusion People with SSc obtain nutrition and diet information from multiple resources. They seek credible and accessible resources that provide SSc‐specific and individualized information.

History of venous thromboembolism (VTE) is prevalent among patients undergoing hematopoietic cell transplantation (HCT). Management of anticoagulation is particularly challenging as most patients will have chemotherapy-induced thrombocytopenia while awaiting engraftment post-HCT. We conducted a retrospective study of autologous and allogeneic HCT recipients with prior VTE from 2006-2015 to 1) compare anticoagulant strategies on short-term VTE recurrence and bleeding and 2) assess predictors for VTE recurrence beyond 30 days. After inverse probability of weighting, patients with VTE were allocated to two cohorts based on anticoagulant strategy at thrombocytopenia onset to assess primary outcomes of VTE recurrence and bleeding within 30 days post-HCT. Multivariable logistic regression model was designed to assess the association of 100-day VTE recurrence by the HIGH-2-LOW VTE risk assessment score and whether patients resumed anticoagulation at platelet recovery. Thirteen percent of recipients had VTE prior to HCT; of those meeting inclusion criteria, 227 continued anticoagulation and 113 temporarily discontinued. Anticoagulant strategy was not significantly associated with decreased risk of VTE recurrence within 30 days (3% vs 4%, p=0.61); however, risk of overall bleeding was non-significantly higher in those who continued vs. discontinued anticoagulation (41% vs 31%, p=0.08). Among 250 allogeneic HCT patients, every 1-point increase of HIGH-2-LOW score was significantly associated with VTE recurrence at 100 days (OR 1.57 [95% CI 1.10-2.23]), while anticoagulation resumption upon platelet engraftment was associated with lower recurrent risk (OR 0.48 [0.20-1.14]). Temporarily withholding anticoagulation during thrombocytopenia may optimize risk-benefit tradeoffs, though additional strategies are essential to prevent VTE recurrence after hematopoietic recovery. This article is protected by copyright. All rights reserved.