Addressing Worker Safety and Health Through the Lens of Strategic Enforcement-Part One.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces that present a dizzying array of hazards, is daunting. Every day, workers are maimed or die from workplace injuries or occupational illnesses. Hence, government agencies must use all available means to ensure the laws intended to keep workers safe and healthy in their workplaces are maximally effective in accomplishing that purpose. This paper addresses this challenge through the lens of strategic enforcement. It examines how federal and state authority are designed to interact to ensure worker protection in this space, and focuses on what tools for deterring violations - many unrecognized or underutilized by worker safety agencies - are available to leverage the limited resources that inevitably constrain the agencies' reach. The forthcoming Part II will, among other things, showcase a number of noteworthy state and local initiatives that exceed the federal standard.

Stop Asking How Much Information Your Patient Wants Before Discussing Serious News.

Discussing serious news is a fundamental communication skill, and many clinicians have been taught to ask their patients how much detail they want to hear before sharing difficult information. Over the past decade, we have taught hundreds of medical students how to discuss serious news and reviewed hundreds of their recorded conversations. We've found that asking how much detail a patient wants to hear often results in confusion and is not an effective way to understand their communication preferences. Instead of asking how much detail your patient wants to hear, we propose an alternative way to tailor information to their needs when discussing serious news. By asking permission to share, presenting the news in a succinct, jargon-free headline, and providing emotional support and expert guidance at the right times, you can give the correct amount of detail while avoiding unnecessary confusion resulting in high-quality, patient centered communication every time you discuss serious news.

The impact of an adapted SPIKES protocol vs routine care in the delivery of bad news to IVF patients: an exploratory pilot multicenter randomized controlled trial.

PURPOSE: Determine if the SPIKES method was associated with less distress and more compassion than current modes of delivering negative pregnancy test results to patients undergoing in vitro fertilization. METHODS: Twenty-seven nurses from two centers were randomized to use the modified SPIKES script or continue their standard of care; 136 patients with a negative hCG following embryo transfer were included. SPIKES nurses received 1 h of training by a study psychologist; nurses in the control group were instructed to deliver the news as done previously. Patients who underwent embryo transfer and received a call by a participating nurse with a negative test result received an email invitation on the following day. RESULTS: Control patients reported significantly less distress than SPIKES patients; 33% of SPIKES patients reported that they had felt "extremely sad," compared to 15.2% of the control patients (p = 0.01). Perceived compassion did not differ between the groups (all p ≥ 0.22). CONCLUSION: Patients who received a negative pregnancy test result from the nurses who received a brief training and a script on how to deliver bad news via the modified SPIKES protocol reported significantly more distress than patients receiving negative results from nurses utilizing their standard of care. It is unclear whether a modified SPIKES method to deliver negative pregnancy test results will benefit patients undergoing in vitro fertilization. TRIAL REGISTRATION: Clinical trials.gov NCT04917445.

Bad beauty: Aesthetic judgments are influenced by references to morally contentious content in photographs.

Affective responses can influence evaluative judgments, but how are subjective beauty ratings affected by references to morally contentious elements in aesthetic stimuli? In an online experiment (N = 460), we investigated the relationship between two types of descriptive texts (Neutral vs. Negative) and the beauty ratings of 25 photographs that depict sources of environmental pollution. For each photograph, the neutral descriptive text contained general information, whereas the negative descriptive text addressed the pollution source. Further, we explored whether this relationship is mediated by changes in positive and negative affect, and how it interacts with the biospheric values of participants. Our results showed that (1) participants in the Negative Condition rated the photographs as less beautiful than in the Neutral Condition, (2) this relationship was partially mediated by changes in negative affect, and (3) in the Negative Condition, participants with higher levels of biospheric values rated the photographs as less beautiful. Our results indicate that individual values, as well as affective responses induced by aesthetic stimuli, directly influence subjective beauty. This aligns with current theoretical frameworks and fills a gap in experimental research. Finally, we discuss limitations and directions for future studies. PSYCHINFO CLASSIFICATION CODE: 2340.

Assessing expert reliability in determining intracranial EEG channel quality and introducing the automated bad channel detection algorithm.

Objective.To evaluate the inter- and intra-rater reliability for the identification of bad channels among neurologists, EEG Technologists, and naïve research personnel, and to compare their performance with the automated bad channel detection (ABCD) algorithm for detecting bad channels.Approach.Six Neurologists, ten EEG Technologists, and six naïve research personnel (22 raters in total) were asked to rate 1440 real intracranial EEG channels as good or bad. Intra- and interrater kappa statistics were calculated for each group. We then compared each group to the ABCD algorithm which uses spectral and temporal domain features to classify channels as good or bad.Main results.Analysis of channel ratings from our participants revealed variable intra-rater reliability within each group, with no significant differences across groups. Inter-rater reliability was moderate among neurologists and EEG Technologists but minimal among naïve participants. Neurologists demonstrated a slightly higher consistency in ratings than EEG Technologists. Both groups occasionally misclassified flat channels as good, and participants generally focused on low-frequency content for their assessments. The ABCD algorithm, in contrast, relied more on high-frequency content. A logistic regression model showed a linear relationship between the algorithm's ratings and user responses for predominantly good channels, but less so for channels rated as bad. Sensitivity and specificity analyses further highlighted differences in rating patterns among the groups, with neurologists showing higher sensitivity and naïve personnel higher specificity.Significance.Our study reveals the bias in human assessments of intracranial electroencephalography (iEEG) data quality and the tendency of even experienced professionals to overlook certain bad channels, highlighting the need for standardized, unbiased methods. The ABCD algorithm, outperforming human raters, suggests the potential of automated solutions for more reliable iEEG interpretation and seizure characterization, offering a reliable approach free from human biases.

Post-cooling sperm processing can rescue sperm quality of cooled-stored stallion semen.

Poor sperm quality in cooled-shipped semen has been related to subpar fertility in horses. Therefore, this study aimed to evaluate the ability of post-cooling sperm processing to improve sperm parameters of cooled-stored stallion semen for artificial insemination. For all experiments, ejaculates were collected, processed, and diluted in skimmed milk-based (SM) medium and stored at 5 °C/24h. In all experiments an aliquot of unprocessed cooled semen was used as a control. In the first experiment (Exp 1.), cooled-stored semen from 16 stallions (n = 32) was processed by SpermFilter or centrifugation (600×g/10min) and resuspended in an egg yolk-based freezing medium containing permeating cryoprotectants (EY-C) for cryopreservation. Sperm recovery and motility parameters were immediately assessed after sperm resuspension in both groups and compared with unprocessed (Unp) samples. In Exp 2., cooled semen samples from six stallions (n = 18) were processed using SpermFilter and resuspended in SM or EY-C. Motility parameters and plasma membrane integrity were assessed in all groups (Unp, SM, and EY-C). In Exp 3, cooled semen from four stallions (n = 20) was processed by SpermFilter, resuspended in SM, EY-C, or egg yolk-based medium without cryoprotectants (EY-nC); and submitted to a thermoresistance test (37 °C/3h). Motility parameters, plasma membrane integrity and stability, mitochondrial membrane potential, mitochondrial superoxide generation, and DNA fragmentation index were evaluated in all groups. Finally, in Exp 4, 39 estrous cycles of 11 mares were inseminated with unprocessed (n = 6) cooled-stored semen or semen cooled at 5 °C/24h and then processed by SpermFilter and resuspended in SM (n = 5), EY-C (n = 11), EY-nC (n = 11), or centrifuged and resuspended in EY-C (n = 6). Overall, semen processing and resuspension in EY mediums (EY-C and EY-nC) improved sperm parameters compared with those of unprocessed semen (P < 0.05). Centrifugation (91 ± 5 %) recovered more sperm than SpermFilter (84 ± 9 %; P < 0.05). Sperm resuspended in EY-nC maintained better sperm parameters throughout the thermoresistance test than those in the other groups (P < 0.05). The fertility rates were similar between all groups (P > 0.05). In conclusion, processing and resuspension in EY medium can improve sperm parameters in post-cooled-stored stallion semen.

Pressure to not feel bad among (different-sex) romantic partners: prevalence, and correlates.

Western society generally highly values happiness. As a result, people sometimes experience pressure not to feel negative emotions. In this study, we comprehensively investigated this pressure, and how it manifests itself, in adult romantic relationships. Specifically, we first examined when, how often and how intensely people experience pressure not to feel bad from their romantic partners (94 different-sex couples). Additionally, we investigated (both between- and within-person) how this pressure is related to context (presence of, contact and or conflict with a partner), emotional processes (i.e. experienced sadness and anxiety, emotion suppression, and how their partner perceived their affect), and relationship well-being. Using experience sampling methodology data (6/14 reports per day over one week) we found that although participants generally did not experience strong pressure from their partner, they experienced some feelings of pressure about 50% of the time. Furthermore, within-person predictors associated with negative processes/emotions (i.e. negative emotions, conflict, emotion suppression) were related to the momentary frequency (odds) and/or intensity of perceived pressure not to feel bad. At the between-person level, individuals who experience more sadness, anxiety and reported suppressing their emotions more often tended to experience more and/or stronger pressure. Only weak associations with relationship well-being were found.

Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses.

BACKGROUND: Nurses accompany patients throughout the breaking bad news process. AIM: The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization. STUDY DESIGN: A cross-sectional comparative study. RESULTS: Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%). CONCLUSIONS: Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented. RELEVANCE TO CLINICAL PRACTICE: The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.

Expression and Purification of Human U1-70K (snRNP70) and its BAD Domains Using an E. coli Expression System.

U1-70K (snRNP70) serves as an indispensable protein component within the U1 complex, assuming a pivotal role in both constitutive and alternative RNA splicing processes. Notably, U1-70K engages in interactions with SR proteins, instigating the assembly of the spliceosome. This protein undergoes regulation through phosphorylation at multiple sites. Of significant interest, U1-70K has been implicated in Alzheimer's disease, in which it tends to form detergent-insoluble aggregates. Even though it was identified more than three decades ago, our understanding of U1-70K remains notably constrained, primarily due to challenges such as low levels of recombinant expression, susceptibility to protein degradation, and insolubility. In endeavoring to address these limitations, we devised a multifaceted approach encompassing codon optimization, strategic purification, and a solubilization protocol. This methodology has enabled us to achieve a high yield of full-length, soluble U1-70K, paving the way for its comprehensive biophysical and biochemical characterization. Furthermore, we provide a detailed protocol for the preparation of phosphorylated U1-70K. This set of protocols promises to be a valuable resource for scientists exploring the intricate web of U1-70K-related mechanisms in the context of RNA splicing and its implications in neurodegenerative disorders and other disorders and biological processes. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Expression and purification of full-length U1-70K from E. coli Support Protocol 1: Making chemically competent BL21 Star pRARE/pBB535 cells Basic Protocol 2: Phosphorylation of full-length U1-70K using SRPK1 Support Protocol 2: Purification of SRPK1 Basic Protocol 3: Expression and purification of U1-70K BAD1 from E. coli Basic Protocol 4: Phosphorylation of U1-70K BAD1 using SRPK1 Basic Protocol 5: Expression and purification of U1-70K BAD2 from E. coli.

Binary classification of dead detector elements in flat panel detectors using convolutional neural networks.

Objective.Medical physicists routinely perform quality assurance on digital detection systems, part of which involves the testing of flat panel detectors. Flat panels may degrade over time as an increasing number of individual detector elements begin to malfunction. The pixels that correspond to these elements are corrected for using information elsewhere in the detector system, however these corrected elements still constitute a loss in image quality for the system as a whole. These correction methods, as well as the location and number of dead detector elements, are often only available to the vendor of the digital detection system, but not to the medical physicist responsible for the quality assurance of the system.Approach.We greatly expand upon a previous work by providing a novel technique for classifying dead detector elements at single pixel resolution. We also demonstrate that this technique can be trained on one detector, and then tested and validated on another with moderate success, which demonstrates some ability to generalize to different detectors. The technique requires 3 flat field, or 'noise', images to be taken to predict the dead detector element maps for the system.Main results.Models using only for-processing pixel data were unable to successfully generalize from one detector to the other. Models preprocessed using the standard deviation across three for-processing images were able to classify dead detector element maps with an F1score ranging from 0.4527 to 0.8107 and recall ranging from 0.5420 to 0.9303 with better performance, on average, observed using the low exposure data set.Significance. Many physicists do not have access to the dead detector maps for their diagnostic digital radiography systems. CNNs are capable of predicting the dead detector maps of flat panel detectors with single pixel resolution. Physicists can implement this tool by acquiring three flat field images and then inputting them into the model. Model performance saw a marginal increase when trained on the low exposure set data, as opposed to the high exposure set data, indicating high exposure, low relative noise images may not be necessary for optimal performance. Model performance across detectors manufactured by different vendors requires further investigation.

Oral cancer diagnosis communication: Impact of an educational intervention using the SPIKES protocol.

OBJECTIVE: This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses. METHODS: A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube. RESULTS: Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased. CONCLUSION: A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative. CLINICAL RELEVANCE: Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.

The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke.

PURPOSE: After stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients' experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback. MATERIALS AND METHODS: This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback. RESULTS: The analysis revealed the clinician's interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician's misjudged response to the patient's aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit. CONCLUSIONS: Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation.IMPLICATIONS FOR REHABILITATIONAfter stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning.Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news.The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received.Greater awareness is needed of how feedback following assessment might impact patients' psychological wellbeing and engagement in rehabilitation.

Wellness Strategies Among Bad Outcomes and Complications.

Surgery of the chest is high stakes, and adverse events are common. Given the frequency and severity of such complications, cardiothoracic surgeons are at particularly high risk of becoming second victims. Even though our primary commitment as doctors is to take care of our patients, surgeons may fall into the emotional and intellectual trap of taking on the whole responsibility of a patient's poor outcome. This viewpoint may lead the physician to develop a heightened self-doubt, greater insecurity, and imposter syndrome, further affecting their ability to prevent complications and tackle difficult cases in the future.

The experiences of Indonesian parents receiving bad news about their children's diseases: A qualitative descriptive study.

PURPOSE: Breaking bad news about children's chronic diseases is challenging and is often not performed according to the needs of parents. The aim of the study was to explore the experiences of Indonesian parents receiving bad news about their chronically ill child. DESIGN AND METHOD: This is a qualitative descriptive study that used semi-structured interviews. Twenty one parents who met the inclusion criteria were face-to-face interviewed between August 2021 and September 2022. Interviews were audio-recorded and transcribed. The data were analyzed using content analysis. The trustworthiness of the study was established through member checking, triangulation, and detailed transcriptions. The COREQ checklist was followed in this study. FINDINGS: Findings revealed four categories: 1) reactions when receiving bad news; 2) expectations while receiving bad news; 3) conflicting feelings and situations; and 4) perceived roles of nurses in delivering the news. CONCLUSION: Parents reacted in different ways when receiving bad news about their children's disease, mostly experiencing negative thoughts and being unable to bear the news. Despite those reactions, parents highlighted their right to receive the news with an understandable explanation through the roles of nurses as educators, advocates, and empathizers. PRACTICE IMPLICATION: Nurses are encouraged to strengthen their roles in breaking bad news. Nurses and healthcare professionals are also suggested to use understandable language and explain medical terms that are used in delivering the information to parents.

Picornavirus VP3 protein induces autophagy through the TP53-BAD-BAX axis to promote viral replication.

Macroautophagy/autophagy and apoptosis are pivotal interconnected host cell responses to viral infection, including picornaviruses. Here, the VP3 proteins of picornaviruses were determined to trigger autophagy, with the autophagic flux being triggered by the TP53-BAD-BAX axis. Using foot-and-mouth disease virus (FMDV) as a model system, we unraveled a novel mechanism of how picornavirus hijacks autophagy to bolster viral replication and enhance pathogenesis. FMDV infection induced both autophagy and apoptosis in vivo and in vitro. FMDV VP3 protein facilitated the phosphorylation and translocation of TP53 from the nucleus into the mitochondria, resulting in BAD-mediated apoptosis and BECN1-mediated autophagy. The amino acid Gly129 in VP3 is essential for its interaction with TP53, and crucial for induction of autophagy and apoptosis. VP3-induced autophagy and apoptosis are both essential for FMDV replication, while, autophagy plays a more important role in VP3-mediated pathogenesis. Mutation of Gly129 to Ala129 in VP3 abrogated the autophagic regulatory function of VP3, which significantly decreased the viral replication and pathogenesis of FMDV. This suggested that VP3-induced autophagy benefits viral replication and pathogenesis. Importantly, this Gly is conserved and showed a common function in various picornaviruses. This study provides insight for developing broad-spectrum antivirals and genetic engineering attenuated vaccines against picornaviruses.Abbreviations: 3-MA, 3-methyladenine; ATG, autophagy related; BAD, BCL2 associated agonist of cell death; BAK1, BCL2 antagonist/killer 1; BAX, BCL2 associated X, apoptosis regulator; BBC3/PUMA, BCL2 binding component 3; BCL2, BCL2 apoptosis regulator; BID, BH3 interacting domain death agonist; BIP-V5, BAX inhibitor peptide V5; CFLAR/FLIP, CASP8 and FADD like apoptosis regulator; CPE, cytopathic effects; CQ, chloroquine; CV, coxsackievirus; DAPK, death associated protein kinase; DRAM, DNA damage regulated autophagy modulator; EV71, enterovirus 71; FMDV, foot-and-mouth disease virus; HAV, hepatitis A virus; KD, knockdown; MAP1LC3/LC3, microtubule associated protein 1 light chain 3; MOI, multiplicity of infection; MTOR, mechanistic target of rapamycin kinase; PML, promyelocytic leukemia; PV, poliovirus; SVA, Seneca Valley virus; TCID50, 50% tissue culture infectious doses; TOR, target of rapamycin. TP53/p53, tumor protein p53; WCL, whole-cell lysate.

The association between halitosis and periodontitis: a systematic review and meta-analysis.

OBJECTIVES: The purpose of this systemic review and meta-analysis was to explore the association between halitosis and periodontitis in observational studies. MATERIALS AND METHODS: A systematic search covered PubMed, Web of Science, Embase, Scopus, and Cochrane Library until August 18, 2023. Nine observational studies (585 cases, 1591 controls) were analyzed using Stata 17, with odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses considered halitosis assessment methods. RESULTS: The review found a positive association between halitosis and periodontitis. Significant differences were observed with organoleptic test (OR = 4.05, 95% CI: 1.76, 9.30, p < 0.01) and volatile sulfur compound readings (OR = 4.52, 95% CI: 1.89, 10.83, p < 0.01). CONCLUSIONS: A positive association was observed between halitosis and periodontitis, supported by significant differences in both organoleptic and volatile sulfur compound readings. However, conclusive findings are limited by statistical heterogeneity, emphasizing the need for additional research. CLINICAL RELEVANCE: Understanding the halitosis and periodontitis association is clinically significant, informing potential interventions for improved oral health. Further research is vital to refine understanding and guide effective clinical strategies, acknowledging the limitations in current findings.

Chlorogenic Acid and its Isomers Attenuate NAFLD by Mitigating Lipid Accumulation in Oleic Acid-Induced HepG2 Cells and High-Fat Diet- Fed Zebrafish.

Chlorogenic acid (Chl), isochlorogenic acid A (Isochl A), and isochlorogenic acid B (Isochl B) are naturally occurring phenolic compounds, which have been shown to exert a regulatory effect on lipid metabolism. However, the mechanism underlying this effect remains unclear. Herein, we investigated the inhibitory effects and underlying mechanisms of these three phenolic compounds on oleic acid (OA)-induced HepG2 cells and high-fat diet (HFD)-fed zebrafish. Lipid accumulation and triacylglycerol levels increased in OA-induced cells, which was attenuated by Chl, Isochl A, and Isochl B. Moreover, the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) decreased, while superoxide dismutase (SOD) levels increased by Chl, Isochl A and Isochl B treatment. Western blot analysis demonstrated that Chl, Isochl A and Isochl B reduced the expression of lipogenesis-related protein, including fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC) and peroxisome proliferator-activated receptor gamma (PPARγ). Moreover, peroxisome proliferator-activated receptor alpha gamma (PPARα) was increased by Chl, Isochl A, and Isochl B treatment. In addition, our results indicated that Chl, Isochl A and Isochl B decreased lipid profiles and lipid accumulation in HFD-fed zebrafish. Thus, these findings highlight the potential of Chl, Isochl A, and Isochl B as effective agents for treating or/and ameliorating non-alcoholic fatty liver disease (NAFLD).

Breaking bad news: A mix methods study reporting the need for improving communication skills among doctors in Pakistan.

BACKGROUND: Effective skills and training for physicians are essential for communicating difficult or distressing information, also known as breaking bad news (BBN). This study aimed to assess both the capacity and the practices of clinicians in Pakistan regarding BBN. METHODS: A cross-sectional study was conducted involving 151 clinicians. Quantitative component used a structured questionnaire, while qualitative data were obtained through in-depth interviews with 13 medical educationists. The responses were analyzed using descriptive statistics and thematic analysis. RESULTS: While most clinicians acknowledged their responsibility of delivering difficult news, only a small percentage had received formal training in BBN. Areas for improvement include time and interruption management, rapport building, and understanding the patients' point of view. Prognosis and treatment options were not consistently discussed. Limited importance is given to BBN in medical education. DISCUSSION: Training in BBN will lead to improved patient and attendants' satisfaction, and empathetic support during difficult times.

Post-cooling semen processing and sperm re-suspension as an alternative method to circumvent poor semen cooling in stallions.

BACKGROUND: Artificial insemination with cooled-shipped semen is the primary method used in the equine breeding industry; yet, sperm quality and fertility can be suboptimal for some stallions when standard techniques are used. Therefore, there is a critical need to develop alternative approaches for these stallions. OBJECTIVE: To assess sperm quality parameters and fertility of cooled-stored stallion semen processed by SpermFilter® or centrifugation and resuspended in three extenders. STUDY DESIGN: Controlled and field study. METHODS: In Experiment 1, semen was collected from 21 stallions classified as having good ('Good-coolers', n = 8) or poor ('Bad-coolers', n = 13) semen cooling. The semen was extended at 30 million spermatozoa/mL in a skimmed milk-based (SM) diluent, and refrigerated for 24 h. Then, the cooled-stored semen was processed through SpermFilter® or centrifugation, and the resulting sperm pellets were resuspended in SM, SM containing pentoxifylline (SM-P), or an egg yolk-based (EY) extender. Unprocessed cooled-stored semen served as control. Sperm motility parameters, plasma membrane integrity (PMI), and mitochondrial membrane potential (HMMP) were assessed in cooled-semen pre- and post-processing. Experiment 2, cooled semen from 9 stallions classified as Bad-coolers was used to inseminate 18 embryo donor mares at 66 cycles (Unprocessed, n = 22; SpermFilter®/SM-P, n = 16; or SpermFilter®/EY, n = 28). Data were analysed with a mixed model and Tukey's as posthoc, and logistic regression. RESULTS: Processed semen resuspended in EY had superior sperm motility compared to unprocessed, SM and SM-P (p < 0.0001). Semen processed by SpermFilter® resuspended in SM-P was similar to EY (p > 0.05). Pellet resuspension with EY and SM-P improved the HMMP of Bad-cooler stallions (p = 0.0010). Semen processed by SpermFilter® had superior PMI to centrifuged semen (p < 0.0001). Mares inseminated with SpermFilter®/SM-P (50%, 8/16) or SpermFilter®/-EY (68%, 9/28) had higher pregnancy rates than mares bred with unprocessed semen (14%, 3/22) (p < 0.001). MAIN LIMITATIONS: Low number of mares in the fertility trial. CONCLUSION: Sperm quality and fertility of Bad-cooler stallions can be enhanced by SpermFilter® and pellet resuspension with either EY or SM-P.

Interdisciplinary Simulation Courses to Train Residents on Communication of Unexpected Complications from Perioperative Care: A Randomized Comparison of Within-Event (Microdebriefing) and Postscenario Debriefing.

INTRODUCTION: Training to disclose bad news in a pluridisciplinary format facilitates communication and improves learning. There are many different debriefing methods described in the literature. The aim of this study was to compare and evaluate the value of final debriefing and microdebriefing with interruptions of the scenario in a simulation program about communication in unexpected complications from perioperative care. METHODS: We conducted a prospective, randomized, single center study between October 2018 and July 2019 in a simulation center. Three scenarios were related to patient or family disclosure of complications which had occurred during gynecologic surgery by a dyad involving 2 residents (a gynecology and an anesthesia resident). All sessions involved 6 residents (3 gynecologist and 3 anesthesiologist). The main outcome measure was the immediate residents' self-assessment of the impact of the course on their medical practice immediately after the session. RESULTS: We performed 15 simulation sessions including 80 residents. Thirty-nine residents were included in final debriefing group and 41 in micro-debriefing group. There was no significant difference on the impact for medical practice between groups (9.3/10 in the micro-debriefing group versus 9.2 in the final debriefing group (p = 0.53)). The overall satisfaction was high in the 2 group (9.1/10 in the 2 groups). CONCLUSION: This study is the first one to compare two debriefing methods in case of breaking bad news simulation. No difference between the 2 techniques was found concerning the students' feelings and short and long-term improvement of their communication skills.