Enacting a diversity, equity, inclusion, and justice emphasis in graduate and professional leadership education.

This article explores leadership education, leadership scholarship, and leadership practices with a focus on the continued growth in thought, paradigm development, research and practices that address societal problems in relation to human existence. We respond to the question "how can the integration of counter narratives into leadership education - all while integrating diverse perspectives into our leadership education conversation so the complexity we now understand to be true can be revealed?" The exploration creates opportunities to deepen the diversity, equity, and inclusion discourse incorporated into graduate leadership education programs.

Pulse Oximetry and Race in Critically Ill Adults.

Unlabelled: For critically ill adults, oxygen saturation is continuously monitored using pulse oximetry (Spo) as a surrogate for arterial oxygen saturation (Sao). Skin pigmentation may affect accuracy of Spo by introducing error from statistical bias, variance, or both. We evaluated relationships between race, Spo, Sao, and hypoxemia (Sao < 88%) or hyperoxemia (Pao > 150 mm Hg) among adults receiving mechanical ventilation in a medical ICU.

Advances in Sepsis Care.

This review article summarizes current scientific evidence regarding the treatment of sepsis. We highlight recent advances in sepsis management with a focus on antibiotics, fluids, vasopressors, and adjunctive therapies such as corticosteroids and renal replacement therapy.

"Don't let anybody ever put you down culturally…. it's not good…": Creating spaces for Blak women's healing.

Research has highlighted the importance of Indigenous knowledge and cultural practice in healing from ongoing histories of trauma, dispossession, and displacement for Indigenous peoples in Australia and elsewhere. Connection with culture, Country, and kinship has been identified as protective factors for Aboriginal social and emotional well-being and as facilitating cultural healing. This paper draws on stories mediated through cultural practice specifically, Wayapa and bush-dyeing workshops, to explore how women resignified experiences and engaged in "healing work.

NGLY1 Deficiency Zebrafish Model Manifests Abnormalities of the Nervous and Musculoskeletal Systems.

NGLY1 is an enigmatic enzyme with multiple functions across a wide range of species. In humans, pathogenic genetic variants in are linked to a variable phenotype of global neurological dysfunction, abnormal tear production, and liver disease presenting the rare autosomal recessive disorder N-glycanase deficiency. We have ascertained four NGLY1 deficiency patients who were found to carry a homozygous nonsense variant (c.

Creating Comics to Address Well-Being and Resilience During the COVID-19 Pandemic.

In this descriptive case series, we detail the theoretical basis, methodology, and impact of a small-scale pilot implementation of graphic medicine workshops as an innovative approach to well-being and resilience in the age of COVID-19 and increasing awareness of racial injustice. The data provided in this article are anecdotal and based on participation in the workshops. Images created during the workshops are also shared as examples of the types of reflection that graphic medicine can enable.

Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial.

Importance: For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain.

Objective: To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.

Linear Association Between Hypoalbuminemia and Increased Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults.

Unlabelled: We hypothesized that low serum albumin would contribute to pulmonary edema formation, thereby independently increasing the risk of developing acute respiratory distress syndrome in critically ill patients.

Design: Retrospective analysis of prospective cohort.

Setting: Medical, surgical, and cardiovascular ICUs at Vanderbilt University Medical Center.

Design, synthesis, and preliminary evaluation of a potential synthetic opioid rescue agent.

Background: One of the most prominent opioid analgesics in the United States is the high potency agonist fentanyl. It is used in the treatment of acute and chronic pain and as an anesthetic adjuvant. When used inappropriately, however, ingestion of just a few milligrams of fentanyl or other synthetic opioid can cause opioid-induced respiratory depression (OIRD), often leading to death.

Feline Idiopathic Cystitis: Pathogenesis, Histopathology and Comparative Potential.

Bladder pain syndrome (BPS) is a debilitating disease in humans, particularly women, with patients experiencing chronic, intractable, lower urinary and pelvic pain. Although rodent models have been used, feline idiopathic cystitis (FIC) is a naturally occurring bladder disease of cats that is frequently considered to be the preferred model for BPS. Histologically, FIC is most similar to the non-Hunner BPS subtype.

Protocolized Postextubation Respiratory Support to Prevent Reintubation: A Randomized Clinical Trial.

Respiratory support (noninvasive ventilation or high-flow nasal cannula) applied at the time of extubation has been reported to reduce reintubation rates, but concerns regarding effectiveness have limited uptake into practice. To determine if providing postextubation respiratory support to all patients undergoing extubation in a medical ICU would decrease the incidence of reintubation. We conducted a pragmatic, two-armed, cluster-crossover trial of adults undergoing extubation from invasive mechanical ventilation between October 1, 2017, and March 31, 2019, in the medical ICU of an academic medical center.

Sisters Network, Inc.: the Importance of African American Survivor Advocates in Addressing Breast Cancer Disparities.

Purpose Of Review: To explain the role of African American survivor advocates in addressing breast cancer disparities.

Recent Findings: The Sisters Network, Inc. is a national African American survivor advocates organization, founded in Houston Texas in 1994 and active today via affiliate chapters throughout the United States as well as its national headquarters.

Effect of balanced crystalloids versus saline on urinary biomarkers of acute kidney injury in critically ill adults.

Background: Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown.

Methods: From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU.

Clinical implications of using adrenocorticotropic hormone diagnostic cutoffs or reference intervals to diagnose pituitary pars intermedia dysfunction in mature horses.

Background: Diagnosis of pituitary pars intermedia dysfunction (PPID) is problematic because of large variations in ACTH concentrations.

Hypothesis/objectives: Compare the test characteristics of baseline and post-thyrotropin-releasing hormone (TRH) stimulation plasma ACTH concentrations in horses using diagnostic cutoff values (DCOVs) and reference intervals (RIs) and determine the clinical consequences of using each method.

Animals: One hundred six mature horses: 72 control cases and 34 PPID cases.

Predicting Diagnosis of Australian Canine and Feline Urinary Bladder Disease Based on Histologic Features.

Anatomic pathology is a vital component of veterinary medicine but as a primarily subjective qualitative or semiquantitative discipline, it is at risk of cognitive biases. Logistic regression is a statistical technique used to explain relationships between data categories and outcomes and is increasingly being applied in medicine for predicting disease probability based on medical and patient variables. Our aims were to evaluate histologic features of canine and feline bladder diseases and explore the utility of logistic regression modeling in identifying associations in veterinary histopathology, then formulate a predictive disease model using urinary bladder as a pilot tissue.

Effect of Early Balanced Crystalloids Before ICU Admission on Sepsis Outcomes.

Background: Studies suggest that using balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) rather than saline (0.9% sodium chloride) may improve outcomes for patients with sepsis in the ED and ICU.

Research Question: What is the relative impact on sepsis outcomes of fluid composition during early resuscitation in the ED vs after ICU admission?

Study Design And Methods: We performed a secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) data set, examining medical ICU patients with a diagnosis of sepsis (n = 1,641).

Comparative Plasma Pharmacokinetics of Ceftriaxone and Ertapenem in Normoalbuminemia, Hypoalbuminemia, and Albumin Replacement in a Sheep Model.

Optimal concentrations of unbound antimicrobials are essential for a maximum microbiological effect. Although hypoalbuminemia and albumin fluid resuscitation are common in critical care, the effects of different albumin concentrations on the unbound concentrations of highly protein-bound antimicrobials are not known. The aim of this study was to compare the effects of different albumin states on total and unbound concentrations of ertapenem and ceftriaxone using an ovine model.

Evaluation of the inflammatory response to two intra-articular hyaluronic acid formulations in normal equine joints.

Intra-articular (IA) hyaluronic acid (HA) is commonly used to treat equine arthritis. Inflammatory response or "joint flare" is a recognized potential side effect. However, the incidence and severity of inflammation following IA HA injection in horses is not well documented.

Cytokine Expression in Canine Lymphoma, Osteosarcoma, Mammary Gland Tumour and Melanoma: Comparative Aspects.

Cytokines released in the tumour microenvironment play a major role in cancer pathogenesis. In human cancers and corresponding animal models, cytokine expression contributes to tumour growth and progression, as well as regulation of the host anti-tumour response. The elucidation of the function and importance of cytokines in canine cancers is still in an early stage, although relevant data have been obtained in classical examples of comparative models of human cancers, such as osteosarcoma, melanoma, mammary tumour and lymphoma.

Advances in Rotorcraft Crashworthiness - Trends Leading to Improved Survivability.

This paper documents progress in rotorcraft crashworthiness research and development that has been realized during the past forty years. Trends are presented in several categories including: facilities and equipment for conducting crash testing, updated crash certification requirements, the application of crash modeling and simulation techniques, and rotorcraft structural design for improved crash performance focusing on the application of advanced composite materials. Likely one of the most important advances is the ability to rapidly simulate crash impacts and to see the effects of design changes on the impact response.

Barriers and facilitators of Canadian quality and safety teams: a mixed-methods study exploring the views of health care leaders.

Background: Health care organizations are utilizing quality and safety (QS) teams as a mechanism to optimize care. However, there is a lack of evidence-informed best practices for creating and sustaining successful QS teams. This study aimed to understand what health care leaders viewed as barriers and facilitators to establishing/implementing and measuring the impact of Canadian acute care QS teams.

Using the transformative paradigm to conduct a mixed methods needs assessment of a marginalized community: Methodological lessons and implications.

We explore opportunities as well as challenges associated with conducting a mixed methods needs assessment using a transformative paradigm. The transformative paradigm is a research framework that centers the experiences of marginalized communities, includes analysis of power differentials that have led to marginalization, and links research findings to actions intended to mitigate disparities. We argue that a community needs assessment is a natural fit for the use of a transformative framework, serving as an entry-point for the development of responsive programmatic and funding decisions.