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Health promotion among the elderly has been shown to produce positive outcomes despite widespread belief that the elderly will not benefit. Helping the elderly to quit smoking has immediate and significant health and economic benefits. This epidemiological study examined the tobacco use status of elderly living in rural areas primarily because of their reduced accessibility to group cessation programs and their relative isolation. The authors found that although a large proportion of rural elderly visited their primary care provider at least once during the previous year and had received advice to quit smoking, only about half of those receiving this advice had actually made a serious attempt to quit for at least one day. Persons living in this rural mid-south state also have higher point prevalence rates of smoking for both men and women as compared to national data. Use of spit tobacco, cigars and pipes is also practiced on an occasional basis by some of the men in the sample. Future research should be focused on improving the cessation counseling methods used with the rural elderly tobacco user and on assisting them in their maintenance efforts. [ABSTRACT FROM AUTHOR]

Background and Objectives: Physicians have long been considered valued members of a solid US health care system. Significant changes in medical education, health care, and society at-large suggest that current medical students may face a different future. To help guide educators and policy makers, we set out to understand medical students' perceptions of the future of health care and their place in it., Methods: In year one of a longitudinal study, we conducted in-depth interviews of Case Western Reserve University medical students. A multidisciplinary team performed iterative thematic analyses and sampling until reaching saturation on major themes., Results: Eleven medical student participants described social and health care issues as major influences on their professional futures. Concerns included health care system failings, unsustainable costs, climate change, demographic shifts, disinformation, and public distrust in health care. Students looked forward to team practice and using technology, data, and artificial intelligence in care delivery. They hoped for greater access and equity in health care, with a focus on prevention and social, behavioral, and environmental drivers of health. Most students expected to be employed rather than in private practice and sought time/flexibility for professional and personal interests. Paying off medical school debt and advocating for patients and change were priorities. Many saw primary care as important, but fewer envisioned it as their career path of choice., Conclusions: Medical students envision a future shaped by health care systems and social issues. These findings can inform those helping students prepare for uncertainty and rapid change in their careers, their lives, and the lives of their patients.

Three adult black howler monkeys ( Alouatta pigra ) were vasectomized for the purpose of population control. Two different surgical approaches (inguinal and pelvic) were used to vasectomize the animals under general anesthesia. One monkey was vasectomized with a pelvic approach, and the other two monkeys were vasectomized with an inguinal approach. The inguinal approach was minimally invasive and proved to be an effective field procedure, utilizing minimal surgical equipment with a mean operative time of 35 min. The inguinal approach allowed for better visualization of the spermatic cord, which prompted easier ligation and transection of the ductus deferens. Identification of the ductus deferens was successfully performed intraoperatively using a tuberculin syringe to aseptically aspirate cord contents, as histopathology was not available. All howler monkeys fully recovered without complication. The social hierarchy of the troop and mating behavior has not been affected. There have been no new pregnancies reported in the troop since the vasectomies were performed. The inguinal approach is preferred as it is minimally invasive and can be performed confidently in a field setting.

Clonazepam causes sedation and psychomotor impairment in people. Due to similarities between people and swine in response to benzodiazepines, clonazepam may represent a viable option to produce mild-to-moderate tranquillization in pigs. The objective of this study was to determine the pharmacokinetic profile of a single oral dose (0.5 mg/kg) of clonazepam in eight healthy, growing commercial cross pigs. Serial plasma samples were collected at baseline and up to 96 h after administration. Plasma concentrations were quantified using reverse-phase high-performance liquid chromatography, and compartment models were fit to time-concentration data. A one-compartment first-order model best fits the data. Maximum plasma concentration was 99.5 ng/mL, and time to maximum concentration was 3.4 h. Elimination half-life was 7.3 h, mean residence time 7.4 h, and apparent volume of distribution 5.7 L/kg. Achieved plasma concentrations exceeded those associated with psychomotor impairment in people although pharmacodynamic effects have not been investigated in pigs. A simulated oral regimen consisting of 0.35 mg/kg administered every 8 h to pigs would achieve plasma concentrations above 32 ng/mL which are shown to produce psychomotor impairment in people. Further studies to test the clinical efficacy of these dosages in commercial and miniature pigs are warranted., (© 2024 John Wiley & Sons Ltd.)

Objectives: The main objective of this study was to compare the postoperative analgesic effects of grapiprant with those of robenacoxib in cats undergoing ovariohysterectomy (OVH)., Methods: In total, 37 female cats (age range 4 months-10 years, weighing ⩾2.5 kg) were enrolled in a prospective, randomized, masked, non-inferiority (NI) clinical trial. Cats received oral robenacoxib (1 mg/kg) or grapiprant (2 mg/kg) 2 h before OVH. Analgesia was assessed via the Feline Grimace Scale (FGS), the Glasgow Composite Measure Pain Scale-Feline (CMPS-F), von Frey monofilaments (vFFs) and pressure algometry (ALG) 2 h before treatment administration, at extubation, and 2, 4, 6, 8, 18 and 24 hours after extubation. Hydromorphone (<8 h postoperatively) or buprenorphine (>18 h postoperatively) were administered to cats with scores of ⩾5/20 on CMPS-F and/or ⩾4/10 on FGS. NI margins for CMPS-F and vFFs were set at 3 and -0.2, respectively. A mixed-effect ANOVA was used for FGS scores ( P  <0.05). Data are reported as mean ± SEM., Results: The data from 33 cats were analyzed. The upper limit of the 95% confidence interval (CI) (0.35) was less than the NI margin of 3 for CMPS-F, and the lower limit of the 95% CI (0.055) was greater than the NI margin of -0.2 for vFFs, indicating NI of grapiprant. The FGS scores were greater than baseline at extubation for both treatments (1.65 ± 0.63; P  = 0.001); however, there was no difference between treatments. There was no difference between treatments, nor treatment by time interaction, for vFFs ( P  <0.001). The CMPS-F scores for both treatments were higher at extubation but returned to baseline after 4 h ( P  <0.001). For ALG, there was no difference in treatment or treatment by time interaction. The robenacoxib group had lower pressure readings at extubation and 6 h compared with baseline., Conclusions and Relevance: These results indicate that grapiprant was non-inferior to robenacoxib for mitigating postsurgical pain in cats after OVH performed via ventral celiotomy. The impact of grapiprant for analgesia in OVH via the flank is unknown., Competing Interests: Conflict of interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The aim of this retrospective cohort study was to provide a single-center clinical audit of complications for single chamber permanent pacemaker implantation (PPI) techniques and determine if the clinical parameters, PPI technique or complications were associated with outcome. The electronic medical records were searched for dogs treated for bradyarrhythmia with PPI. Data related to presenting complaint, signalment of the dog, ECG diagnosis, echocardiographic findings, PPI technique, and programing of the pacemaker were recorded. Survival length (days) was recorded as the last veterinary visit; if the dog was dead the reason was documented. Cumulative survival of each pacemaker was examined by a Kaplan-Meier survival curve and the two techniques compared with a logrank test. Chi-square was used to determine the association between major complications and death. A total of 66 dogs with 52 transvenous and 30 epicardial PPIs were included. All epicardial pacemakers were implanted via transdiaphragmatic approach. A total of 31 life-threatening complications were reported. There were nine deaths related to major complications (13.6% of the study sample). The median follow-up period was 366 days, with a median survival of 255 days, and a significant difference in cumulative survival of each pacemaker (P = 0.01) between epicardial (93 days, range 0-1882 days) and transvenous (334 days, range 0-2745) PPIs but no significant difference in cumulative survival between the two techniques when only the first pacemaker was considered (p = 0.07). The presence of a major complications had a significant association with death due to pacemaker complications (P<0.001). The decision to perform epicardial PPI in failed transvenous PPI patients may have skewed the cumulative survival as was evident in the lack of significant difference in survival when only first PPI were examined. Major complication rates between the two techniques were similar and the authors consider both techniques equally reliable to manage symptomatic bradycardia in dogs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Köster et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pigs are at risk of vomiting from medical conditions as well as the emetic side effects of drugs administered for peri-operative manipulations, but there is a lack of pharmacokinetic data for potential anti-emetic therapies, such as maropitant, in this species. The main objective of this study was to estimate plasma pharmacokinetic parameters for maropitant in pigs after a single intramuscular (IM) administration dosed at 1.0 mg/kg. A secondary objective was to estimate pilot pharmacokinetic parameters in pigs after oral (PO) administration at 2.0 mg/kg. Maropitant was administered to six commercial pigs at a dose of 1.0 mg/kg IM. Plasma samples were collected over 72 h. After a 7-day washout period, two pigs were administered maropitant at a dose of 2.0 mg/kg PO. Maropitant concentrations were measured via liquid chromatography/mass spectrometry (LC-MS/MS). A non-compartmental analysis was used to derive pharmacokinetics parameters. No adverse events were noted in any of the study pigs after administration. Following single IM administration, maximum plasma concentration was estimated at 412.7 ± 132.0 ng/mL and time to maximum concentration ranged from 0.083 to 1.0 h. Elimination half-life was estimated at 6.7 ± 1.28 h, and mean residence time was 6.1 ± 1.2 h. Volume of distribution after IM administration was 15.9 L/kg. Area under the curve was 1336 ± 132.0 h*ng/mL. The relative bioavailability of PO administration was noted to be 15.5% and 27.2% in the two pilot pigs. The maximum systemic concentration observed in the study pigs after IM administration was higher than what was observed after subcutaneous administration in dogs, cats, or rabbits. The achieved maximum concentration exceeded the concentrations for anti-emetic purposes in dogs and cats; however, a specific anti-emetic concentration is currently not known for pigs. Further research is needed into the pharmacodynamics of maropitant in pigs to determine specific therapeutic strategies for this drug., (© 2023 John Wiley & Sons Ltd.)

Objective: To report and characterize cases of acute hyperkalemia of unknown origin in dogs under anesthesia., Study Design: Multicentric retrospective clinical study., Animals: Medical records of 19 client-owned dogs that developed acute hyperkalemia during anesthesia., Methods: Anesthetic records of dogs developing acute hyperkalemia from January 2015 to December 2022 were evaluated. Data collected included demographics, duration of anesthesia until the episode, electrolytes and blood gas measurements, electrocardiogram (ECG) abnormalities, drugs used as part of the anesthetic protocol, hyperkalemia treatment and outcome., Results: A total of 13 cases met the inclusion criteria with documented acute hyperkalemia with no apparent underlying cause during anesthesia. Dogs were [mean ± standard deviation (range)] 6.5 ± 5.0 (3-10) years old and weighed 18.0 ± 14.3 (5.1-40.0) kg. All dogs were administered dexmedetomidine and an opioid as part of the premedication. All dogs had inhalation anesthesia of >60 minutes' duration. The first clinical sign was bradycardia that was minimally responsive to anticholinergic administration and was often accompanied by moderate/severe hypotension. These signs were rapidly followed by ECG changes compatible with hyperkalemia and/or cardiac arrest. Rapid identification and treatment for hyperkalemia, with or without dexmedetomidine reversal, resulted in survival of 12 dogs and one fatality., Conclusions and Clinical Relevance: Unknown origin hyperkalemia is a life-threatening complication that can occur during general anesthesia. In healthy dogs, preanesthetic administration of dexmedetomidine in association with an opioid and followed by inhalation anesthesia of more than 1 hour duration may predispose to this complication. A sudden decrease in heart rate >90 minutes after dexmedetomidine administration, or ECG changes, may warrant measurement of blood potassium concentrations., (Copyright © 2022 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.)

Limited data are available on the effects of pregnancy on the maternal metabolome. Therefore, the objective of this study was to use metabolomics analysis to determine pathways impacted by pregnancy followed by targeted confirmatory analysis to provide more powerful conclusions about metabolic alterations during pregnancy. Forty-seven pregnant women, 18-50 years of age were included in this study, with each subject serving as their own control. Plasma samples were collected between 25 and 28 weeks gestation and again ≥3 months postpartum for metabolomics analysis utilizing an HILIC/UHPLC/MS/MS assay with confirmatory targeted specific concentration analysis for 10 of the significantly altered amino acids utilizing an LC/MS assay. Principle component analysis (PCA) on metabolomics data clearly separated pregnant and postpartum groups and identified outliers in a preliminary assessment. Of the 980 metabolites recorded, 706 were determined to be significantly different between pregnancy and postpartum. Pathway analysis revealed three significantly impacted pathways, arginine biosynthesis ( p = 2 × 10 -5 and FDR = 1 × 10 -3 ), valine, leucine, and isoleucine metabolism ( p = 2 × 10 -5 and FDR = 2 × 10 -3 ), and xanthine metabolism ( p = 4 × 10 -5 and FDR = 4 × 10 -3 ). Of these we focused analysis on arginine biosynthesis and branched-chain amino acid (BCAA) metabolism due to their clinical importance and interconnected roles in amino acid metabolism. In the confirmational analysis, 7 of 10 metabolites were confirmed as significant and all 10 confirmed the direction of change of concentrations observed in the metabolomics analysis. The data support an alteration in urea nitrogen disposition and amino acid metabolism during pregnancy. These changes could also impact endogenous nitric oxide production and contribute to diseases of pregnancy. This study provides evidence for changes in both the ammonia-urea nitrogen and the BCAA metabolism taking place during pregnancy.

Background: Workers of color experience a disproportionate share of work-related injuries and illnesses (WRII), however, most workers' compensation systems do not collect race and ethnicity information, making it difficult to monitor trends over time, or to investigate specific policies and procedures that maintain or could eliminate the unequal burden of WRII for workers of color. The purpose of this study is to apply a Bayesian method to Washington workers' compensation claims data to identify racial and ethnic disparities of WRII by industry and occupation, improving upon existing surveillance limitations. Measuring differences in risk for WRII will better inform prevention efforts and target prevention to those at increased risk., Methods: To estimate WRII by race/ethnicity, we applied the Bayesian Improved Surname Geocode (BISG) method to surname and residential address data among all Washington workers' compensation claims filed for injuries in 2013-2017. We then compare worker and injury characteristics by imputed race/ethnicity, and estimate rates of WRII by imputed race/ethnicity within industry and occupation., Results: Black/African Americans had the highest rates of WRII claims across all industry and occupational sectors. Hispanic/Latino WRII claimants also had higher rates than Whites and Asian/Pacific Islanders in almost all industry and occupational sectors. For accepted claims with both medical and non-medical compensation, Bodily reaction/overexertion injuries accounted for almost half of the claims during this reporting period., Discussion: The high rates of injury we report by racial/ethnic categories is a cause for major concern. Nearly all industry and occupation-specific rates of workers' compensation claims are higher for Black/African American and Hispanic/Latino workers compared to Whites. More work is needed to identify work-related, systemic, and individual characteristics., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Noninvasive blood pressure measurement is commonly performed with oscillometry; however, this technique provides clinically helpful information only if it is representative of the gold standard. Agreement between direct and oscillometric blood pressure measurements were performed in 14 anesthetized, captive tigers ( Panthera tigris ). A cuff, placed around the tail base and connected to a multiparameter monitor, was used to measure arterial blood pressure oscillometrically and provided systolic, mean, and diastolic pressures. At the same time, direct blood pressures were obtained from a dorsal pedal arterial catheter, and the oscillometric and direct readings were considered paired data points. Agreement between the two methods was evaluated by Bland-Altman plots. All animals completed the study and provided 196 paired data points. The bias (mm Hg) for systolic, mean, and diastolic arterial pressures was -3.7, -0.8, and -1.6, respectively. Limits of agreement (mm Hg) for systolic, mean, and diastolic arterial pressures were -31 to 24, -29 to 27, and -29 to 26, respectively. Oscillometry provided an acceptable amount of readings within 10 and 20 mm Hg of the gold standard. The oscillometric technique provided reasonable agreement with direct measurements. Therefore, in the conditions used in this study, oscillometric blood pressure measured via the ventral coccygeal artery provided reasonable estimates of invasive blood pressure in anesthetized tigers.

Objective: To evaluate and compare postoperative analgesic effects of grapiprant and carprofen in dogs undergoing ovariohysterectomy., Animals: 42 sexually intact female healthy dogs (< 35 kg and 0.5 to 7 years old) were enrolled., Procedures: In a masked, randomized, noninferiority clinical trial, dogs received either 2 mg/kg of grapiprant or 4.4 mg/kg of carprofen orally 2 hours prior to ovariohysterectomy. Postoperative pain was assessed using the Glasgow Composite Pain Scale-Short Form (GCPS-SF) at extubation and 2, 4, 6, 8, 18, and 24 hours postextubation and compared to baseline. After each pain scoring, mechanical nociceptive testing with von Frey monofilaments (vF) was performed to assess hyperalgesia. Hydromorphone (0.05 mg/kg, IM) was administered to any dog with a GCPS-SF of ≥ 5/24. The noninferiority limit (NI) for the GCPS-SF was Δ = 3. The NI for vF was Δ = -0.2. Following noninferiority, a mixed-effect ANOVA and post hoc comparisons were made with the Tukey correction method (P < .05)., Results: 3 dogs required rescue analgesia and were excluded from statistical analysis. Of the remaining 39 dogs, the upper CI for GCPS-SF was below the NI of 3 and the lower CI for vF was greater than the NI of -0.2, indicating noninferiority of grapiprant as compared to carprofen. There was no difference between treatment (P = .89) nor treatment by time (P = .62) for GCPS-SF. There was no difference between groups at any time point or over time when vF were used., Clinical Relevance: Our study results support the use of grapiprant as an analgesic alternative to carprofen in dogs undergoing ovariohysterectomy.

Workers performing cleaning duties experience higher injury rates, especially in the form of musculoskeletal disorders (MSDs), than other industries. It is essential to understand the inherent risks associated with the nature of this occupation. Based on the Balance Theory (Smith & Carayon-Sainfort, 1989), this review surveys the current literature, especially those published since the previous review paper (Kumar & Kumar, 2008), and identifies which elements contributing to MSD risks were examined: task, technology, organization, environment, individual, and their interactions. Thirty-nine research papers published between 2005 and 2021 are identified and summarized. Among these papers, task and individual elements received the most attention, at 42 and 34 occurrences, respectively. The interaction elements of technology-organization, technology-environment, and organization-environment received less than three mentions. The goal of this literature review is to update the knowledge base and identify current trends for the cleaning occupation. Possible interventions for risk reduction and future research directions are suggested., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Activation of T cell responses is essential for effective tumor clearance; however, inducing targeted, potent antigen presentation to stimulate T cell responses remains challenging. We generated Activating Antigen Carriers (AACs) by engineering red blood cells (RBCs) to encapsulate relevant tumor antigens and the adjuvant polyinosinic-polycytidylic acid (poly I:C), for use as a tumor-specific cancer vaccine. The processing method and conditions used to create the AACs promote phosphatidylserine exposure on RBCs and thus harness the natural process of aged RBC clearance to enable targeting of the AACs to endogenous professional antigen presenting cells (APCs) without the use of chemicals or viral vectors. AAC uptake, antigen processing, and presentation by APCs drive antigen-specific activation of T cells, both in mouse in vivo and human in vitro systems, promoting polyfunctionality of CD8+ T cells and, in a tumor model, driving high levels of antigen-specific CD8+ T cell infiltration and tumor killing. The efficacy of AAC therapy was further enhanced by combination with the chemotherapeutic agent Cisplatin. In summary, these findings support AACs as a potential vector-free immunotherapy strategy to enable potent antigen presentation and T cell stimulation by endogenous APCs with broad therapeutic potential., Competing Interests: All listed authors are current or former SQZ Biotechnologies Company employees., (Copyright © 2022 Blagovic, Smith, Ramakrishnan, Moore, Soto, Thompson, Stockmann, Kruszelnicki, Thakkar, Murray, Torres, Wondimagegnhu, Yi, Dadgar, Paracha, Page, Clear, Chaudhry, Myint, Bridgen, Gilbert, Seidl, Sharei, Loughhead, Bernstein and Yarar.)

Objective: To determine the effects of intravenous (IV) premedication with acepromazine, butorphanol or their combination, on the propofol anesthetic induction dosage in dogs., Study Design: Prospective, blinded, Latin square design., Animals: A total of three male and three female, healthy Beagle dogs, aged 3.79 ± 0.02 years, weighing 10.6 ± 1.1 kg, mean ± standard deviation., Methods: Each dog was assigned to one of six IV treatments weekly: 0.9% saline (treatment SAL), low-dose acepromazine (0.02 mg kg -1 ; treatment LDA), high-dose acepromazine (0.04 mg kg -1 ; treatment HDA), low-dose butorphanol (0.2 mg kg -1 ; treatment LDB), high-dose butorphanol (0.4 mg kg -1 ; treatment HDB); and a combination of acepromazine (0.02 mg kg -1 ) with butorphanol (0.2 mg kg -1 ; treatment ABC). Physiologic variables and sedation scores were collected at baseline and 10 minutes after premedication. Then propofol was administered at 1 mg kg -1 IV over 15 seconds, followed by boluses (0.5 mg kg -1 over 5 seconds) every 15 seconds until intubation. Propofol dose, physiologic variables, recovery time, recovery score and adverse effects were monitored and recorded. Data were analyzed using mixed-effects anova (p < 0.05)., Results: Propofol dosage was lower in all treatments than in treatment SAL (4.4 ± 0.5 mg kg -1 ); the largest decrease was recorded in treatment ABC (1.7 ± 0.3 mg kg -1 ). Post induction mean arterial pressures (MAPs) were lower than baseline values of treatments LDA, HDA and ABC. Apnea and hypotension (MAP < 60 mmHg) developed in some dogs in all treatments with the greatest incidence of hypotension in treatment ABC (4/6 dogs)., Conclusions and Clinical Relevance: Although the largest decrease in propofol dosage required for intubation was after IV premedication with acepromazine and butorphanol, hypotension and apnea still occurred., (Copyright © 2022. Published by Elsevier Ltd.)

Vitamin A is vital to maternal-fetal health and pregnancy outcomes. However, little is known about pregnancy associated changes in maternal vitamin A homeostasis and concentrations of circulating retinol metabolites. The goal of this study was to characterize retinoid concentrations in healthy women ( n = 23) during two stages of pregnancy (25-28 weeks gestation and 28-32 weeks gestation) as compared to ≥3 months postpartum. It was hypothesized that plasma retinol, retinol binding protein 4 (RBP4), transthyretin and albumin concentrations would decline during pregnancy and return to baseline by 3 months postpartum. At 25-28 weeks gestation, plasma retinol (-27%), 4-oxo-13- cis -retinoic acid (-34%), and albumin (-22%) concentrations were significantly lower, and all-trans -retinoic acid (+48%) concentrations were significantly higher compared to ≥3 months postpartum in healthy women. In addition, at 28-32 weeks gestation, plasma retinol (-41%), retinol binding protein 4 (RBP4; -17%), transthyretin (TTR; -21%), albumin (-26%), 13- cis -retinoic acid (-23%) and 4-oxo-13- cis -retinoic acid (-48%) concentrations were significantly lower, whereas plasma all-trans -retinoic acid concentrations (+30%) were significantly higher than ≥3 months postpartum. Collectively, the data demonstrates that in healthy pregnancies, retinol plasma concentrations are lower, but all-trans -retinoic acid concentrations are higher than postpartum.

Background: Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness., Methods: Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages., Results: There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims., Conclusions: Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors., (© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.)

Melanoma causes most skin cancer-related deaths, yet melanoma mortality rates can be decreased by life-long reduction of ultraviolet radiation exposure and early detection. The disease is readily detectable through skin examinations by trained medical providers; however, the U.S. Preventive Services Task Force cites insufficient evidence to recommend "visual skin examination by a clinician to screen for skin cancer" in asymptomatic adults in the United States. As a coastal state with much outdoor occupational and recreational exposure to ultraviolet light, Rhode Island has developed a coordinated statewide partnership of stakeholders who provide valuable resources and expertise that maximize the reach and efficacy of targeted skin cancer prevention and screening programs. These programs include public skin cancer screening events, shade planning efforts, distribution of sunscreen at state parks and beaches, and educational programming.

In canine and feline patients presenting in a state of hemodynamic collapse, obtaining vascular access can be challenging. Delays in achieving vascular access interfere with delivery of patient care. In human medicine, definitions of difficult vascular access are variable and include the need for multiple placement attempts or involvement of specialized teams and equipment. Incidence and risk factors for difficult vascular access have not been well studied in veterinary patients, which limits understanding of how best to address this issue. Alternatives to percutaneous peripheral or central intravenous catheterization in dogs and cats include venous cutdowns, umbilical access in newborns, corpus cavernosum access in males, ultrasound-guided catheterization, and intraosseous catheterization. In recent years, advances in ultrasonography and intraosseous access techniques have made these more accessible to veterinary practitioners. These vascular access techniques are reviewed here, along with advantages, limitations, and areas for future study of each technique., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lee, Guieu, Bussières and Smith.)

Objective: To evaluate the level of agreement (LOA) between direct and oscillometric blood pressure (BP) measurements and the ability of oscillometric measurements to accurately detect hypotension in anesthetized chimpanzees (Pan troglodytes)., Animals: 8 captive, adult chimpanzees., Procedures: During prescheduled annual examinations, each chimpanzee underwent general anesthesia and patient monitoring for their examination, echocardiography for a concurrent study, and measurement of direct BP with the use of tibial artery catheterization and oscillometry with the use of a cuff placed around a brachium and a cuff placed around the second digit of the contralateral forelimb for the present study. Bland-Altman plots were generated to compare results for direct and oscillometric BP measurements. Mean bias and 95% LOAs were calculated for oscillometric measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) for each cuff site. Sensitivity and specificity in detecting hypotension were also determined for each cuff site., Results: There were 74 paired direct and brachial oscillometric measurements of each, SAP, MAP, and DAP and 66 paired direct and digit oscillometric measurements of each, SAP, MAP, and DAP. Only brachial oscillometric measurements of MAP had adequate sensitivity (78%) and specificity (95%) to accurately detect hypotension, and this technique also had the least mean bias (0.8 mm Hg; 95% LOA, -29 to 31 mm Hg)., Conclusions and Clinical Relevance: Results indicated that brachial oscillometric measurement of MAP provided reasonable agreement with tibial arterial direct MAP measurement and performed well in diagnosing hypotension in anesthetized chimpanzees.

Introduction: In recent decades, adolescents' interactions with peers have increasingly transitioned online. While socially interactive technologies provide multiple avenues for positive communication between peers, adolescents may experience harmful online peer interactions, with such interactions negatively impacting their well-being. A paucity of work exists investigating how adolescents' characteristics are related to their communicative choices on social media and if such choices can be influenced by cues to consider a recipient. Addressing this gap, this work examines experimental manipulations of perspective-taking and individual differences in socio-cognitive skills as they relate to adolescents' communicative choices online., Method: Within individual sessions, 12- to 15-year-old Canadian participants (N = 72, 36 girls) viewed pictures of other adolescents on a simulated social media app similar to Snapchat and chose between pre-written aggressive or prosocial comments to send to a recipient under three conditions: a perspective-taking cue, a time-delay, no delay. Participants also completed self-report questionnaires assessing emotion regulation and empathy., Results: Following perspective-taking cues, participants chose more prosocial comments to send compared to when participants were permitted to choose a comment immediately after viewing another adolescent's picture, while controlling for a brief time-delay. Adolescents' individual characteristics (i.e., Social Media Use, State Mood, Affective Empathy, Gender) were associated with their communicative choices online., Conclusions: Findings from this work provide new insight into the ways adolescents navigate their complex and increasingly online peer interactions. Further, the results suggest that adolescents' social media communication is malleable with a brief perspective-taking cue to consider a recipient., (Copyright © 2021 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)