Wilson Community College

Direct and indirect consequences of climate change pose significant challenges to people with cancer and the healthcare systems that support them. Healthcare providers are increasingly observing the ramifications of climate change across the cancer care continuum. Climate-related health challenges faced by people with cancer are expected to intensify without substantial intervention. This study aimed to assess the awareness, concerns, motivations, and behaviors of oncology nurses regarding climate change and its impact on health. This cross-sectional, exploratory study used convenience sampling and an open-access, anonymous online survey. Data were captured through the Climate and Health Tool. Among the 135 participants, most were aware that climate change is caused by human activity, but fewer were aware of the healthcare sector's contribution. Most were concerned about the effects of climate change on health and were motivated to respond but need additional knowledge and skills to act.

Background: Primary cardiac lymphoma (PCL) is an extremely rare malignancy, accounting for approximately 1–2% of primary cardiac tumors and about 0.5% of extranodal lymphomas. It primarily affects immunocompetent adults, with a median age of 55–65 years, and male predominance (65–85%). Case Presentation: A 44-year-old male with well-controlled HIV on Rilpivirine presented with a 2-week history of progressive shortness of breath, facial edema, and exertional peripheral cyanosis. His physical exam confirmed facial and upper extremities edema and jugular venous distension suggestive of superior vena cava syndrome. Contrast computed tomography (CT) of the chest identified a large 12 × 6.2 × 7.5 cm lytic rib lesion invading the pleura and chest wall, accompanied by left supraclavicular, axillary, mediastinal, and upper abdominal lymphadenopathy. CT also showed a large (8.3 × 5.8 × 6.0 cm) right atrial mass causing near-complete occlusion of the superior and inferior vena cava (Fig 1A). A transthoracic echocardiogram with contrast-enhanced imaging confirmed a large right atrial mass extending into the IVC (Fig 1B). Cardiac magnetic resonance imaging (MRI) further detailed an 8.3 × 6.5 × 6.4 cm mass nearly filling the right atrium, infiltrating the interatrial septum with mass effect on left atrium and encroaching on the right superior and inferior pulmonary veins (Fig 2A). Biopsy of the rib lesion confirmed high-grade B-cell lymphoma with 11q aberration. The patient was started on Rituximab combined with E-POCH chemotherapy on day 7 of admission. A follow-up PET-CT scan after the first cycle showed significant regression of the intracardiac mass (Fig 2B.) Discussion: PCL is an uncommon extranodal lymphoma, most often presenting as diffuse large B-cell lymphoma (DLBCL). High-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a distinct entity characterized by a unique 11q gain/loss cytogenetic pattern, typically lacking MYC rearrangement and frequently showing Burkitt-like morphology. Standard treatment for primary cardiac DLBCL involves immunochemotherapy, most commonly R-CHOP unless contraindicated. Curative regimens yield 5-year survival rates of 70–80% in selected cohorts; however, prognosis worsens with advanced or extracardiac disease.

Frequency analysis of train passby noise and vibration is usually limited to one-third octave analysis for analyzing assessment criteria for human comfort and instrument sensitivity. However narrowband frequency analysis is essential for certain purposes such as identifying pure tones, periodic signals, highly resonant oscillation, and identifying sources. Acquiring meaningful narrowband frequency information from train passby measurements is challenging due to the transient nature of the excitation and non-stationary behavior. Spectrogram plots can be used to visualize how the frequency spectrum varies with time. The spectrogram is usually generated by Fourier analysis and/or one-third octave analysis. These analyses, although fast and computationally cost-effective, do not provide a full representation of the signal in the frequency and time domains. The Wavelet Transform provides more detailed frequency and time domain representations of transient non-stationary data than Fourier or third octave analyses. In this paper, The Wavelet Transform is used to analyze field data of short events within a distributed transient vibration signature. The main goal is obtaining more detailed information contained in the measured data and characterizing the spectrum of the vibration to identify maintenance and state of good repair issues such as out-of-round (OOR) wheels and various track defects.

Nurses in all specialties have been called upon to take action to address global climate change, climate justice, and health. The American Nurses Association (2023) has specifically tasked nursing professional organizations to (a) educate members on climate change-related illnesses and negative impacts on treatment, (b) collaborate with grassroots organizations for environmental justice efforts, (c) support policies that promote climate mitigation and adaptation, (d) maintain familiarity with climate justice frameworks, and (e) collectively amplify the voice of nursing to strengthen its impact on climate policy. The purpose of this white paper is to enlighten members of the Oncology Nursing Society and oncology nurses at large on the increasing impact of climate change across the cancer control continuum and the pivotal role of the oncology nurse in education, research, clinical practice, and advocacy. Climate change refers to long-term shifts in temperature and weather patterns that are occurring because of global warming (United Nations, n.d.). Climate change is an often-overlooked social determinant of (or contributor to) health that exacerbates poor health, increases healthcare costs, disproportionately affects some communities, and has a synergistic effect with other social determinants of health (Ragavan et al., 2020). Climate change affects all aspects of the cancer control continuum and impacts some populations disproportionately. Events such as wildfires and floods, exacerbated by climate change, can heighten individuals' exposure to cancer-causing substances, thereby increasing their susceptibility to the disease; reducing such exposure can reduce risks for cancer and positively impact the environment. Air pollution, extended droughts, heat waves, ultraviolet radiation, extreme weather events, and food supply disruptions also impact cancer etiology. Extreme weather events disrupt preventive care, cancer detection, and screening efforts, and create workforce shortages that can lead to suboptimal care. Disruptions in the supply chain and scheduled healthcare visits impact patient care continuity. Additionally, climate-related extreme weather events have an impact on overall survival and disrupt end-of-life care, underscoring the pervasive impact of climate change on cancer care across the continuum. Oncology nurses are strategically positioned to contribute to multifaceted solutions, including obtaining and offering education to fellow healthcare providers, students, patients, community members, and policymakers. Oncology nurse scientists are equipped to spearhead the generation of pertinent new knowledge, and nurses in clinical care can play a crucial role in assisting their healthcare system to become carbon net neutral. Oncology nurses must answer the call to actively engage in climate and health advocacy efforts within their own healthcare systems and in the communities where they live, work, and play. Several resources for education and action are shared.

To determine the effects of swarming motility (SM) and multi-locus sequence types (MLST) on the main effect of virulence genotype of Escherichia coli through an embryos lethality assay between the 12th and 18th days of incubation. We collected 58 E. coli isolates from asymptomatic commercial hens (n=42) and lesions of colibacillosis cases (n=16), then classified their virulence genotype as avirulent, moderately virulent, virulent-healthy, and virulent-colibacillosis categories by the presence of five virulence-associated genes (iroN, ompT, hlyF, iutA, and iss). These isolates were further classified as non-motile, motile, or hyper-motile by SM assay. From the 58 isolates, we selected 29 for ELA and determined their MLST. Each isolate was inoculated into 15 embryonated eggs through the allantoic cavity. We found the avirulent isolates reduced the relative embryo weight compared to virulent-colibacillosis and moderately virulent isolates (37.49vs. 41.51 and 40.34%, P=0.03). Among the moderately virulent and virulent-colibacillosis categories, embryo lethality was lower when isolates were non-motile. Yolk retention was unaffected by virulence categories, motility, or MLST. Interaction between virulence genotype and SM substantially influenced the embryo lethality assay of E. coli isolates.

Introduction: Presentation with shockable rhythm markedly improves survival from out-of-hospital sudden cardiac arrest (SCA). Shockable rhythms (ventricular fibrillation/tachycardia; VF/VT) are known to deteriorate to asystole or pulseless electrical activity (PEA) over time, but little population-based data is available regarding this phenomenon. Also, bystander CPR (BCPR) improves survival from SCA but its association with maintenance of shockable rhythms is unclear. Hypothesis: With longer EMS response time, the proportion of EMS-assessed shockable initial rhythms will decrease. BCPR may influence this association. Methods: We analyzed EMS-assessed initial rhythm of SCA cases from the Oregon SUDS study in the Portland, OR metro area (pop ~1 million). For this analysis, we included bystander-witnessed SCA cases (2002-2018) aged ≥18 with resuscitation attempted by EMS. SCA was defined as a sudden, unexpected pulseless condition of likely cardiac origin. We assessed initial rhythm proportions across EMS response times using Cochran-Armitage trend tests. Results: Among 3,309 SCA cases, 1,748 (53%) were bystander-witnessed, and of these, 706 (40%) received BCPR. Response time was 7.3 ± 3.4 minutes for cases with BCPR and 6.8 ± 3.1 minutes without BCPR (p=0.01). In the group receiving BCPR, the proportion with shockable rhythm remained near 60% across response times from <3 to ≥12 minutes (Figure, solid line; p=0.88), and proportions of PEA and asystole remained stable. In the group without BCPR, shockable rhythm declined from 70% at <3 minutes to 44% at ≥12 minutes response time (Figure, dashed line; p<0.001), while non-shockable rhythms increased. Conclusions: Among community-based SCA cases who received bystander CPR, there was no significant decrease in shockable rhythm as response time increased. In contrast, among SCA cases without bystander CPR, longer response times were associated with a lower proportion of shockable rhythms.

Ultrasonography can be used for canine pregnancy diagnosis, determination of gestational age, assessing foetal maturation and readiness for birth, monitoring high-risk pregnancies, assessing foetal distress, evaluating bitches in dystocia and foetal gender determination. As the quality and resolution of ultrasound machines have improved, the clinician's abilities to utilize ultrasound as an integral part of reproductive evaluation of all aspects of pregnancy have exponentially increased. This paper reviews the use of ultrasonography throughout pregnancy and the advances made in the interpretation of captured images.

Introduction: Pre-pregnancy hypertension (HTN), hypertensive disorders of pregnancy (HDP), and diabetes are linked to increased risk of post-pregnancy coronary heart disease (CHD) and all-cause mortality, but the cumulative impact of pre-pregnancy HTN, HDP, and diabetes has yet to be fully investigated. We aimed to examine associations between HDP and diabetes with CHD and mortality ≤5 years of delivery stratified by race/ethnicity. Methods: This retrospective cohort study included women aged 12-49 with ≥1 singleton, live birth in South Carolina (2004-2016). After exclusions, 431,839 women remained: non-Hispanic White [NHW; 58.8%], non-Hispanic Black [NHB; 31.7%], and Hispanic [9.5%]. Birth certificates defined pre-pregnancy HTN, HDP (preeclampsia, eclampsia, gestational hypertension), and diabetes (pre-pregnancy, gestational); hospitalization/ED visit data also defined pre-pregnancy HTN and HDP. Hospitalization/ED visit data and death certificates defined incident CHD and all-cause mortality. Cox proportional hazard models adjusted for covariates assessed associations by condition and race/ethnicity. Results: Incident CHD risk was increased ≤5 years of delivery for women with diabetes (HR=1.79, CI: 1.40-2.29), HDP (HR=2.91, CI: 1.98-2.65), diabetes and HDP (HR=3.95 CI:3.09-5.05), pre-pregnancy HTN and HDP (HR=3.94, CI: 3.11-5.00), and all three conditions (HR=5.78, CI: 4.41-8.06) compared to none. All-cause mortality risk was increased for HDP (HR=1.31, CI: 1.08-1.58), diabetes and HDP (HR=1.93, CI: 1.30-2.87), pre-pregnancy HTN and HDP (HR=2.20, CI: 1.54-3.15), and all three conditions (HR=2.88, CI: 1.61-5.16), but not with diabetes. The table shows overall and race/ethnic-specific event rates and model results. Discussion: Women with HDP (regardless of pre-pregnancy HTN) and/or diabetes experienced higher incident CHD and all-cause mortality risk ≤5 years of delivery. Event rates were highest for women with two or three conditions, with all event rates higher for NHB than NHW women.

Introduction: The Safety and efficacy of DOACs is unknown in patients with left ventricular thrombus as these patients were excluded from DOAC trials. Hypothesis: The safety and efficacy of DOACs is comparable to vitamin K antagonists Methods: Databases including Medline, Scopus and Cochrane Central Registration of Controlled Trials were queried from inception to March 30 th 2022. Studies reporting efficacy and safety outcomes were selected for the analysis. Results: We included 11 studies comprising 1920 patients with left ventricular thrombus. The mean age in the DOAC group was 57.5 years (SD 12.8) and 58.6 years (SD 13.0) in the VKA group; 26.8% were females. Pooled results showed no difference in mortality (RR, 0.64 [95% CI, 0.16-2.52]) embolic events (RR, 0.94 [95% CI, 0.59-1.50]) or major bleeding (RR, 0.95[95% CI, 0.66-1.36]) in the DOACs compared to VKA groups. Event rate for DOAC group compared to VKA group was 12.7 vs 17.5 per 100 patient-years (mean follow up of 4.0 months) for mortality, 19.5 vs 26.5 per 100 patient-years (mean follow up of 8.9 months) for embolic events and 8.0 vs 10.0 per 100 patient-years (mean follow up of 9.5 months) for major bleeding. Conclusions: These data, from observational and randomized studies, demonstrate promising safety and efficacy of DOACs for treatment of left ventricular thrombus. Elevated embolic and mortality rates regardless of anticoagulant choice emphasize the need for further research to improve outcomes for patients with this complication.