Providing gender affirming and inclusive care to transgender men experiencing pregnancy.

OBJECTIVES AND DESIGN: Information about providing professional and appropriate perinatal care to transgender men in the perinatal setting is scarce, and healthcare providers often have insufficient knowledge or skills to provide this care. In response, a quality improvement educational program for nursing staff was developed and implemented, with the goal of evaluating the impact of this intervention on nurses' knowledge, skills, and attitudes when caring for pregnant transgender men. SETTING AND PARTICIPANTS: The training was offered to nursing staff of a 24-bed inpatient perinatal unit at a large, private academic medical center in a major East Coast city during the unit's quarterly staff meeting in March 2020. INTERVENTION: The training covered the provision of affirming and inclusive perinatal care for transgender men. The content of the training was based on recommendations in the literature and reviewed by content experts. MEASUREMENTS: Pre-test (N = 55) and post-test (N = 23) online self-administered surveys assessed nursing staff's knowledge of, comfort, and interest in providing gender affirming care for transgender men. Mann-Whitney U and Fischer's exact tests were used to determine significant changes in knowledge and attitudes over time. FINDINGS: Findings suggest the training improved nursing staff's self-reported knowledge and skills in providing gender affirming care to pregnant transgender men over time, with participants demonstrating improved knowledge about communication around pronouns, gender identity, reproductive systems, and obstetric history. Awareness of resources for both professional development and to refer transgender patients also improved. However, persistent deficits in other knowledge, skills, and attitudes remained, suggesting that nurses would likely benefit from further support and training in transgender-specific health issues. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings support the utility of unit-based training in improving affirming and inclusive care in the perinatal setting. This highlights opportunities for supporting nurses' professional practice of caring for transgender patients experiencing pregnancy and may be adapted for use in other specialty units.

Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review.

Purpose of Review: We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality. Recent Findings: Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults' intersectional identities. Summary: Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.

Survival of western Gulf Coast Mottled Ducks (Anas fulvigula) in the path of a Category 4 hurricane.

Tropical cyclones are the most powerful storms on earth, causing catastrophic damage to human lives and infrastructure. Hurricanes also cause wildlife mortality when they make landfall, but the severity of these effects is difficult to quantify because data collection is either logistically impossible or deprioritized in the wake of human tragedy. On August 27, 2020, Hurricane Laura made landfall in southwestern Louisiana with maximum sustained winds of 241 kph (150 mph), making it one of the most powerful storms to strike the mainland United States. Hurricane Laura passed directly over the core breeding range of the western Gulf Coast population of Mottled Duck (Anas fulvigula), during a time when many adult birds were undergoing a simultaneous wing feather molt and were flightless. We used GPS-GSM telemetry data to evaluate survival rates of adult female Mottled Ducks in late summer 2020 (bracketing August 27 by one month on either side) relative to the same period in 2018 and 2019. Mortality was lower in 2018 (12 out of 29; 41%) and 2019 (8 out of 28; 29%) than in 2020 (12 out of 18; 67%), and 7 out of 12 mortalities documented in 2020 occurred when Hurricane Laura made landfall. Survival analyses in program MARK confirmed lower survival probability in 2020, but there was overlap in 85% confidence intervals in all years. This single storm resulted in the death of ~40% of all marked birds in our sample, suggesting that hurricanes have the potential to influence population demographics. In addition, Hurricane Laura resulted in widespread habitat loss and degradation that has reduced available nesting habitat in 2021, and possibly for years to come. The acute and chronic effects of hurricanes may exacerbate Mottled Duck population declines, which may worsen in the face of increasingly frequent and more severe tropical storms.

Compelling Voices of Diversity, Equity, and Inclusion in Prelicensure Nursing Students: Application of the Cultural Humility Framework.

BACKGROUND: Diversity, equity, and inclusion are increasingly recognized as core values for guiding nursing education, practice, and research. The conceptual framework of cultural humility has been adapted in a variety of health care settings, fostering a culture of diversity, equity, and inclusion through openness, supportive interaction, self-awareness, self-reflection, and critique. PROBLEM: Nurse educators have the opportunity, but may find it challenging, to teach students about the changing landscape of health care and the populations we serve. APPROACH: This article describes the integration of the cultural humility framework into nursing curricula to teach principles of diversity, equity, and inclusivity. We provide a practical example of a diversity panel, with student and panelist reflections, exploring the intersectionality of experiences in health care and integration of personal accounts and perspectives. CONCLUSION: Dialogue about diversity, equity, and inclusion is essential for preparing future nurses to deliver culturally competent care and promote health equity.

Polyphenols Extracted from Chinese Hickory (Carya cathayensis) Promote Apoptosis and Inhibit Proliferation through the p53-Dependent Intrinsic and HIF-1α-VEGF Pathways in Ovarian Cancer Cells.

Ovarian cancer is the second most common gynecologic cancer with an estimated 13,940 mortalities across the United States in 2020. Natural polyphenols have been shown to double the survival time of some cancer patients due to their anticancer properties. Therefore, the effect of polyphenols extracted from Chinese hickory seed skin Carya cathayensis (CHSP) on ovarian cancer was investigated in the present study. Cell viability results showed that CHSP is more effective in inhibiting ovarian cancer cells than normal ovarian cells, with the IC50 value for inhibition of cell proliferation of Ovarian cancer cells (OVCAR-3) being 10.33 ± 0.166 µg/mL for a 24 h treatment. Flow cytometry results showed that the apoptosis rate was significantly increased to 44.21% after 24 h treatment with 20 µg/mL of CHSP. Western blot analysis showed that CHSP induced apoptosis of ovarian cancer cells through a p53-dependent intrinsic pathway. Compared with control values, levels of VEGF excreted by OVCAR-3 cancer cells were reduced to 7.87% with a 40 µg/mL CHSP treatment. Consistent with our previous reports, CHSP inhibits vascular endothelial growth factor (VEGF) secretion by regulating the HIF-1α-VEGF pathway. In addition, we also found that the inhibitory effect of CHSP on ovarian cancer is related to the up-regulation of Phosphatase and tension homolog (PTEN) and down-regulation of nuclear factor kappa-B (NF-kappa B). These findings provide some evidence of the anti-ovarian cancer properties of CHSP and support the polyphenols as potential candidates for ovarian cancer adjuvant therapy.

Impact of molt-disrupting BDE-47 on epidermal ecdysteroid signaling in the blue crab, Callinectes sapidus, in vitro.

Polybrominated diphenyl ethers (PBDEs) are environmentally pervasive flame retardants that have been linked with endocrine disruption in a variety of organisms. BDE-47, one of the most prevalent congeners found in aquatic environments, has recently been shown to inhibit crustacean molting, but little is known about the specific mechanism through which molt-inhibition occurs. This study examined whether the inhibitory effect on molting arises from the disruption of hormone signaling in the epidermis using the blue crab, Callinectes sapidus, as the model crustacean. First, we partially sequenced cDNA of N-acetyl-ß-glucosaminidase (NAG) from the epidermis, a terminal enzyme in the molting hormone-signaling cascades that is commonly used as the biomarker for ecdysteroid signaling. This partial cDNA sequence was then used to create primers for quantification of NAG gene expression. Then, a new tissue culture technique was developed and dubbed the epidermis-with-exoskeleton (EWE) method, wherein epidermal tissue, along with the overlying exoskeleton, is immersed in a medium of physiologically relevant osmolarity. Using this EWE tissue culture method, we assessed the inducibility of NAG mRNA by 20-hydroxyecdysone (20-HE) in vitro. Exposures to 1µM 20-HE were found to induce NAG mRNA at a significantly higher level than the control. Using NAG expression as a biomarker for ecdysteroid signaling, the effects of BDE-47 were measured. BDE-47 alone at 100nM and a combination of 1µM BDE-47 and 1µM 20-HE were found to significantly increase NAG mRNA. A trend of increasing NAG gene expression in the binary BDE-47 exposure as compared to 1µM BDE-47 and 1µM 20-HE alone is suggestive of a synergistic effect of these two chemicals on ecdysteroid signaling in the cultured epidermis. Discussion on the mechanism for inhibition of crustacean molting by BDE-47 is presented.

Early, but not late visual distractors affect movement synchronization to a temporal-spatial visual cue.

The ease of synchronizing movements to a rhythmic cue is dependent on the modality of the cue presentation: timing accuracy is much higher when synchronizing with discrete auditory rhythms than an equivalent visual stimulus presented through flashes. However, timing accuracy is improved if the visual cue presents spatial as well as temporal information (e.g., a dot following an oscillatory trajectory). Similarly, when synchronizing with an auditory target metronome in the presence of a second visual distracting metronome, the distraction is stronger when the visual cue contains spatial-temporal information rather than temporal only. The present study investigates individuals' ability to synchronize movements to a temporal-spatial visual cue in the presence of same-modality temporal-spatial distractors. Moreover, we investigated how increasing the number of distractor stimuli impacted on maintaining synchrony with the target cue. Participants made oscillatory vertical arm movements in time with a vertically oscillating white target dot centered on a large projection screen. The target dot was surrounded by 2, 8, or 14 distractor dots, which had an identical trajectory to the target but at a phase lead or lag of 0, 100, or 200 ms. We found participants' timing performance was only affected in the phase-lead conditions and when there were large numbers of distractors present (8 and 14). This asymmetry suggests participants still rely on salient events in the stimulus trajectory to synchronize movements. Subsequently, distractions occurring in the window of attention surrounding those events have the maximum impact on timing performance.

Fatal retroperitoneal hematoma after enoxaparin administration in a patient with paroxysmal atrial flutter.

PURPOSE: A case of fatal retroperitoneal hematoma that developed after enoxaparin administration in a woman with paroxysmal atrial flutter and chest pain is reported. SUMMARY: A 63-year-old, 74-kg, African-American woman arrived at the emergency department with a 24-hour history of severe, nonexertional, substernal chest pain that radiated down her left arm. An electrocardiograph with continuous telemetry showed new-onset paroxysmal atrial flutter without ST-segment elevation. She was treated with aspirin 325 mg, metoprolol 25 mg, and subcutaneous enoxaparin 80 mg (0.93 mg/kg) every 12 hours. On hospital day 2, she was given warfarin 5 mg daily and continued on enoxaparin. Approximately 36 hours after admission, she became acutely hypotensive and developed tachycardia. She was transferred to the medical intensive care unit and intubated for respiratory arrest. Soon after, she was found to be in asystole and, despite multiple rounds of standard advanced cardiac life support and infusion of blood products, the patient expired 3 hours after the initial emergency resuscitation code was called. A postmortem examination revealed a large, noncommunicating, retroperitoneal hematoma located posterior to the right kidney as the cause of death. CONCLUSION: A 63-year-old African-American woman with a 24-hour history of severe, nonexertional chest pain and new-onset paroxysmal atrial flutter without ST-segment elevation was treated with enoxaparin and subsequently died of a fatal spontaneous retroperitoneal hematoma.

Comparison of Hispanic children with and without limited English proficiency on the Naglieri Nonverbal Ability Test.

Hispanic children with (n=148) and without (n=148) limited English proficiency were given the Naglieri Nonverbal Ability Test (NNAT; J. A. Naglieri. 1997a) and the Stanford Achievement Test-9th edition (SAT-9: 1995). The groups were selected from the NNAT standardization sample (N=22.620) and matched on geographic region, gender, socioeconomic status, urbanicity. and ethnicity. There was a very small difference (d ratio=0.1) between the NNAT standard scores for the children with limited English proficiency (M - 98.0) and those without limited English proficiency (M=96.7). The NNAT correlated moderately and similarly with achievement for the 2 groups. The sample of children with limited English proficiency earned considerably lower scores on SAT-9 Reading and Verbal subtests. Results suggest that the NNAT may be useful for the assessment of Hispanic children with and without limited English proficiency.