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Abstract Background Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention—an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. Methods This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. Conclusion The results will inform the protocol for larger trials addressing needle distress in HD patients. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .

The article aims to update the evidence and to diversify the research agenda on leadership roles of women senior-managers. This research work draws attention to the essential gap in the research of women as senior-managers and organizational leaders. In the first place, it notices that while the conceptualization of leadership has expanded to define leadership from interpersonal to organizational influence, the research on women leadership has not updated accordingly. The article claims that research agenda on women in organizations overlooks examination of women as senior-managers and respectively overlooks understanding of the leadership roles that women perform to organizations. Second, the article aims to examine and update the evidence as per the interplay of gender and women senior-managers’ leadership roles in organizational context. Namely, the research examines how women senior-managers perceive their leadership mandate, and whether organizations enable or constrain it. Results of the 21 indepth semi-standardized interviews identified three distinct leadership roles that women senior-managers perceive as requisite for the roles of senior-manager. That is followed by a discussion of implications for organizational leadership theory and organizational routines. Key words: women senior-managers, gender, organizational behavior, leadership roles.

Understanding green turtle habitat use during the nesting season is important for informing management decisions relating to green turtles and ecosystems that support them. Despite patterns such as migration being described, few studies investigate behaviour during the inter-nesting period. This research aims to describe and quantify the spatial distribution patterns of green turtles during 2 nesting seasons on Raine Island in the northern Great Barrier Reef. Satellite telemetry data were used to analyse the inter-nesting movements and patterns of green turtles in 2017 (n = 19) and 2018 (n = 20). The inter-nesting period ranged from 51 to 100 d (76.33 ± 15.98 d) across both seasons. The average inter-nesting area of individual turtles did not differ between nesting seasons (2017: 12.31 ± 13.22 km2, 2018: 12.01 ± 21.92 km2). In addition, it was established that 39 individuals are a sufficient sample size to describe the spatial distribution. Approximately half of the tracked individuals remained at the same reef for their entire inter-nesting season (n = 19), and half used habitat on nearby reefs (n = 20). Most turtles showed fidelity to Raine Island as a nesting site (n = 37), laying all their clutches on the island. However, 2 individuals travelled 479 and 337 km during the inter-nesting period. This study thus highlights where the habitats used by green turtles during the inter-nesting season are and how they are used. Therefore, management strategies and conservation decisions can be informed to maintain the viability of these essential habitats.

Abstract Background In current care, patients’ personal and self-reported family histories are primarily used to determine whether genetic testing for hereditary endocrine tumor syndromes (ETS) is indicated. Population genomic screening for other conditions has increased ascertainment of individuals with pathogenic/likely pathogenic (P/LP) variants, leading to improved management and earlier diagnoses. It is unknown whether such benefits occur when screening broader populations for P/LP ETS variants. This manuscript assesses clinical utility outcomes of a large, unselected, healthcare-based genomic screening program by describing personal and family history of syndrome-related features, risk management behaviors after result disclosure, and rates of relevant post-disclosure diagnoses in patient-participants with P/LP ETS variants. Methods Observational study of individuals informed of a P/LP variant in MEN1, RET, SDHAF2, SDHB, SDHC, SDHD, or VHL through Geisinger’s MyCode Community Health Initiative between June 2016 and October 2019. Electronic health records (EHRs) of participants were evaluated for a report of pre-disclosure personal and self-reported family histories and post-disclosure risk management and diagnoses. Results P/LP variants in genes of interest were identified in 199 of 130,490 (1 in 656) adult Geisinger MyCode patient-participants, 80 of which were disclosed during the study period. Eighty-one percent (n = 65) did not have prior evidence of the result in their EHR and, because they were identified via MyCode, were included in further analyses. Five participants identified via MyCode (8%) had a personal history of syndrome-related features; 16 (25%) had a positive self-reported family history. Time from result disclosure to EHR review was a median of 0.7 years. Post-disclosure, 36 (55.4%) completed a recommended risk management behavior; 11 (17%) were diagnosed with a syndrome-related neoplasm after completing a risk management intervention. Conclusions Broader screening for pathogenic/likely pathogenic variants associated with endocrine tumor syndromes enables detection of at-risk individuals, leads to the uptake of risk management, and facilitates relevant diagnoses. Further research will be necessary to continue to determine the clinical utility of screening diverse, unselected populations for such variants.

Abstract Background Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD. Methods We identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC 0.05). Conclusions The prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality.

Abstract Background Shoulder arthroscopy is a safe and effective procedure with a low complication rate. Although rare, there are potentially life-threatening risks such as fluid extravasation causing airway compromise. Case presentation We report the case of a 65-year-old female treated with an arthroscopic rotator cuff repair who had significant extravasation of arthroscopic fluid causing severe facial and neck swelling. Overnight intubation was required for respiratory monitoring until the edema had resolved enough to allow safe extubation. Conclusion This case highlights the risk factors and clinical course of a patient with airway compromise caused by extravasation of fluid during shoulder arthroscopy. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment.

Summary: The development of new treatments for heart failure lack animal models that encompass the increasingly heterogeneous disease profile of this patient population. This report provides evidence supporting the hypothesis that Western Diet−fed, aortic-banded Ossabaw swine display an integrated physiological, morphological, and genetic phenotype evocative of cardio-metabolic heart failure. This new preclinical animal model displays a distinctive constellation of findings that are conceivably useful to extending the understanding of how pre-existing cardio-metabolic syndrome can contribute to developing HF. Key Words: cardio-metabolic disease, heart failure, integrative pathophysiology, preclinical model of cardiovascular disease