The panel proposed an overall estimated prevalence for chronic HBV infection in the US of 1.59 million persons (range 1.25-2.49 million). This review provides a summary of the workshop findings and conclusions, which may serve to inform future initiatives focused on HBV screening and prevention in the US.Background Ensuring students are both confident and competent for clinical practice will lead to improved patient outcomes. Early exposure to delivering safe and effective care using knowledge, skills, and abilities that are consonant with professional practice is essential. Problem Caring for an increasingly complex patient population is challenging. Entry-to-practice competencies must begin early in the student’s education and be developed throughout. Approach This educational initiative outlines an innovative and a collaborative evidence-based learning experience that prepares prelicensure nursing students to deliver safe and effective patient-centered care during their first clinical practice. Lecture and laboratory topics, clinical skills stations, and simulation scenarios were developed to promote critical thinking and clinical judgment in a complex health care environment. Outcomes More than 2300 first-year clinical students, instructors, and staff participated in this rigorous course-wide experience. Conclusion This 1-day immersion cultivates safe practice and may be incorporated throughout the curriculum as students encounter increasingly challenging clinical practice experiences.Background Oral feeding is one of the most complex maturational skills of infancy. Difficulties with feeding require specialized attention, and if not well managed, may prolong the newborn’s hospital length of stay. This is particularly true for prenatally opioid exposed (POE) infants. A paucity of literature exists characterizing feeding behaviors of POE infants, yet feeding problems are common. Purpose The purpose of this integrative review was to synthesize and critically analyze the evidence that characterizes feeding behaviors in full-term, POE infants. Methods/search strategy The electronic databases of CINAHL, PubMed, Scopus, and PsycINFO were used. Inclusion criteria were studies in English, conducted from 1970 to 2019, with participant samples consisting of infants with prenatal opioid exposure, born full-term, and between 38 and 40 weeks of gestation. Based on the inclusion criteria, our search yielded 557 articles. After further screening, only 4 studies met our full inclusion/exclusion criteria. These studies were analyzed for evidence of infant feeding behaviors, including characterization of problematic feeding behavior for POE infants. Findings/results Our findings revealed inconsistencies in characterization of feeding behaviors among POE infants. A synthesis of the most common evidence-based behaviors was constructed. Infant feeding behaviors were identified and grouped into 2 major behavior domains (1) typical feeding behavior and (2) problematic feeding behavior. Implications for practice and research Feeding behaviors related to sucking and behavioral states may be different in POE infants. Further examination of effective assessment methods and the categorization of infant feeding behaviors are warranted for use in the development of evidence-based, targeted intervention.Background Studies in anesthetized patients suggest that phenylephrine reduces regional cerebral oxygen saturation compared with ephedrine. The present study aimed to quantify the effects of phenylephrine and ephedrine on cerebral blood flow and cerebral metabolic rate of oxygen in brain tumor patients. The authors hypothesized that phenylephrine reduces cerebral metabolic rate of oxygen in selected brain regions compared with ephedrine. Methods In this double-blinded, randomized clinical trial, 24 anesthetized patients with brain tumors were randomly assigned to ephedrine or phenylephrine treatment. Positron emission tomography measurements of cerebral blood flow and cerebral metabolic rate of oxygen in peritumoral and normal contralateral regions were performed before and during vasopressor infusion. The primary endpoint was between-group difference in cerebral metabolic rate of oxygen. Secondary endpoints included changes in cerebral blood flow, oxygen extraction fraction, and regional cerebral oxygen satu3.6]% [P = 0.934]; contralateral hemisphere difference [95% CI], -0.1 [- 12.1 to 12.0]% [P = 0.989]) were comparable between groups. Conclusions The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine. WHAT WE ALREADY KNOW ABOUT THIS TOPIC Phenylepherine may reduce regional cerebral oxygen saturation in anesthetized patients without cerebral pathology when compared with ephedrine WHAT THIS ARTICLE TELLS US THAT IS NEW In adult patients with brain tumors, there were no differences in cerebral metabolic rate of oxygen in peritumoral regions or in the contralateral cerebral hemisphere after administration of ephedrine or phenylepherine.Background Clinical studies have shown that dexmedetomidine ameliorates cognitive decline in both the postoperative and critical care settings. This study determined the mechanism(s) for the benefit provided by dexmedetomidine in a medical illness in mice induced by lipopolysaccharide. Methods Cognitive decline, peripheral and hippocampal inflammation, blood-brain barrier permeability, and inflammation resolution were assessed in male mice. Dexmedetomidine was administered in the presence of lipopolysaccharide and in combination with blockers. Cultured macrophages (RAW 264.7; BV-2) were exposed to lipopolysaccharide ± dexmedetomidine ± yohimbine; tumor necrosis factor α release into the medium and monocyte NFκB activity was determined. Results In vivo, lipopolysaccharide-induced cognitive decline and inflammation (mean ± SD) were reversed by dexmedetomidine (freezing time, 55.68 ± 12.31 vs. 35.40 ± 17.66%, P = 0.0286, n = 14; plasma interleukin [IL]-1β 30.53 ± 9.53 vs. 75.68 ± 11.04 pg/ml, P less then 0.000cal studies suggest that the cognitive benefit provided by dexmedetomidine in mice administered lipopolysaccharide is mediated through α2 adrenoceptor-mediated anti-inflammatory pathways. WHAT WE ALREADY KNOW ABOUT THIS TOPIC Administration of lipopolysaccharide to young and middle-aged mice is associated with neuroinflammation and cognitive impairmentDexmedetomidine has been shown to decrease neuroinflammation in mice WHAT THIS ARTICLE TELLS US THAT IS NEW Administration of dexmedetomidine to mice treated with lipopolysaccharide decreased neuroinflammation and cognitive impairment in both young and aged miceThe effects of dexmedetomidine on neuroinflammation and cognitive impairment in mice treated with lipopolysaccharide are likely mediated by α2 adrenoceptor-mediated anti-inflammatory pathways.Purpose Valproic acid (VPA) is not only an antiepileptic drug but also a mood stabilizer for patients with bipolar disorder. Long-term VPA therapy can cause carnitine deficiency, which may result in an increase in the blood ammonia level, in patients with epilepsy. However, information about this effect in patients with bipolar disorder is limited. The aim of this study was to investigate the associations between the serum VPA level and the carnitine and ammonia levels in psychiatric adult patients with epilepsy. Methods The subjects were 182 consecutive Japanese adult patients (mean age 54.3 ± 19.5 years) diagnosed with bipolar disorder and treated with VPA. The serum VPA level, carnitine fraction, and plasma ammonia level were measured. Furthermore, the free carnitine and acylcarnitine fractions were measured using an enzyme cycling method. Results Sixty-nine patients (38%) had a low free carnitine level. There were significant differences in sex, height, VPA dose, serum VPA level, total carnitine level, acylcarnitine level, and acylcarnitine/free carnitine ratio between patients with a low free carnitine level and those with a normal range of free carnitine. The simple and multiple regression analyses revealed that the VPA dose and serum VPA level were inversely and significantly correlated with the free carnitine level. The plasma ammonia level was correlated with the VPA dose, serum VPA level, and acylcarnitine level but not with the free carnitine level. Conclusions These findings suggest that carnitine deficiency is associated with the VPA dose and the serum VPA level in patients with bipolar disorder. However, it is unlikely that carnitine deficiency is associated with hyperammonemia in patients with bipolar disorder.Background The role of high-field 3-Tesla intraoperative magnetic resonance imaging (I-MRI) during awake craniotomy (AC) has not been extensively studied. We report the feasibility and safety of AC during 3-Tesla I-MRI. Methods This retrospective descriptive report compared 3 groups AC with minimal sedation and I-MRI; I-MRI-guided craniotomy under general anesthesia (GA), and; AC without I-MRI. Perioperative factors, surgical, anesthetic and radiologic complications, and postoperative morbidity and mortality were recorded. Results Overall, 85 patients are included in this report. Five of 23 patients (22%) who underwent AC with I-MRI had anesthetic complications (nausea/vomiting and conversion to GA) compared with 3 of 40 (8%) who underwent I-MRI-guided craniotomy under GA (nausea/vomiting during extubation, and arrhythmia). Intraoperative surgical complications (seizures and speech deficits) occurred in 5 patients (22%) who underwent AC and I-MRI, excessive intraoperative bleeding occurred in 2 patients (5%) who had I-MRI-guided craniotomy under GA, and 4 of 22 (18%) patients who underwent AC without I-MRI experienced neurological complications (seizures, motor deficits, and transient loss of consciousness). Eight patients (20%) who had I-MRI with GA had postoperative complications, largely neurological. The duration of surgery and anesthesia were shortest in the group of patients receiving AC without I-MRI. Seventy-three percent of the patients in this group had residual tumor postoperatively compared with 44% and 38% in those having I-MRI with AC or GA, respectively. Patients who underwent I-MRI-guided craniotomy with GA had the highest morbidity (8%) at hospital discharge. Conclusions Our institutional experience suggests that AC under 3-Tesla I-MRI could be an option for glioma resection, although firm conclusions cannot be drawn given the limited and heterogenous nature of our data. Future multicenter trials comparing anesthetic and imaging modalities for glioma resection are recommended.Over recent months, coronavirus disease 2019 (COVID-19) has swept the world as a global pandemic, largely changing the practice of medicine as it was previously known. Physician trainees have not been immune to these changes – uncertainty during this time is undeniable for medical students at all levels of training. Of particular importance is the potential impact of COVID-19 on the upcoming residency application process for rising fourth year students; a further source of added complexity in light of the newly integrated allopathic and osteopathic match in the 2020-2021 cycle. Due to the impact COVID-19 could have on the residency match, insight regarding inevitable alterations to the application process and how medical students can adapt is in high demand. Further, it is very possible that programs will inquire about how applicants spent their time while not in the hospital due to COVID-19, and applicants should be prepared to provide a meaningful answer. While competitive at a basal level, the complexity of COVID-19 now presents an unforeseen, superimposed development in the quest to match.