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Although soft tissues of coleoid cephalopods record key evolutionary adaptations, they are rarely preserved in the fossil record. This prevents meaningful comparative analyses between extant and fossil forms, as well as the development of a relative timescale for morphological innovations. However, unique 3-D soft tissue preservation of Vampyronassa rhodanica (Vampyromorpha) from the Jurassic Lagerstätte of La Voulte-sur-Rhône (Ardèche, France) provides unparalleled opportunities for the observation of these tissues in the oldest likely relative of extant Vampyroteuthis infernalis . Synchrotron X-ray microtomography and reconstruction of V. rhodanica allowed, for the first time, a high-resolution re-examination of external and internal morphology, and comparison with other fossil and extant species, including V. infernalis . The new data obtained demonstrate that some key V. infernalis characters, such as its unique type of sucker attachment, were already present in Jurassic taxa. Nonetheless, compared with the extant form, which is considered to be an opportunistic detritivore and zooplanktivore, many characters in V. rhodanica indicate a pelagic predatory lifestyle. The contrast in trophic niches between the two taxa is consistent with the hypothesis that these forms diversified in continental shelf environments prior to the appearance of adaptations in the Oligocene leading to their modern deep-sea mode of life.

The fossil record of gladius-bearing coleoids is scarce and based only on a few localities with geological horizons particularly favourable to their preservation (the so-called Konservat-Lagerstätten), which naturally leads to strongly limited data on geographical distributions. This emphasizes the importance of every new locality providing gladius-bearing coleoids. Here, we assess for the first time the gladius-bearing coleoid taxonomic diversity within the lower Toarcian “Schistes Cartons” of the Causses Basin (southeastern France). The material includes two fragmentary gladii, identified as Paraplesioteuthis sagittata and ? Loligosepi a sp. indet. Just with these two specimens, two (Prototeuthina and Loligosepiina) of the three (Prototeuthina, Loligosepiina and Teudopseina) suborders of Mesozoic gladius-bearing coleoids are represented. Thus, our results hint at a rich early Toarcian gladius-bearing coleoid diversity in the Causses Basin and point out the need for further field investigations in the lower Toarcian “Schistes Cartons” in this area. This new record of Paraplesioteuthis sagittata is only the second one in Europe and the third in the world (western Canada, Germany and now France). Based on these occurrences, we tentatively suggest that P . sagittata originated in the Mediterranean domain and moved to the Arctic realm through the Viking Corridor to eventually move even farther to North America.

IntroductionPeople experiencing severe and multiple disadvantage (SMD: homelessness, substance use and criminal offending) have multiple intersecting unmet health and social care needs and high mortality rates, often due to street-drug overdose. Pilot randomised controlled trials (RCTs) suggest an integrated, holistic, collaborative outreach intervention (Pharmacy Homeless Outreach Engagement Non-medical Independent Prescribing Rx (PHOENIx)) involving generalist-trained pharmacists, nurses or General Practitioners accompanied by staff from third sector homeless organisations may improve outcomes, including reducing overdose.MethodsMulticentre, parallel group, prospective RCT with parallel economic and process evaluation. Set in six areas of Scotland, UK, 378 adults with SMD will be recruited and randomised (stratified by setting and previous non-fatal overdoses) to PHOENIx intervention in addition to usual care (UC) or UC. Aiming to meet participants weekly for 9–15 months, PHOENIx teams assess and address health and social care needs while referring onwards as necessary, co-ordinating care with wider health and third sector teams. During a person-centred consultation, in the participants’ choice of venue, and taking account of the participant’s priorities, the NHS clinician may prescribe, de-prescribe and treat, for example, wound care, and refer to other health services as necessary. The third sector worker may help with welfare benefit applications, social prescribing or advocacy, for example, securing stable housing. Pairings of clinicians and third sector workers support the same participants. The primary outcome is time to first fatal/non-fatal street-drug overdose at nine months. Secondary endpoints include health-related quality of life, healthcare use and criminal justice encounters. A health economic evaluation will assess cost per quality adjusted life year of PHOENIx relative to standard care. A parallel qualitative process evaluation will explore the perceptions and experiences of PHOENIx, by participants, stakeholders and PHOENIx staff.AnalysisThe primary and other time-to-event secondary outcomes will be analysed by Cox proportional hazards regression.Ethics and disseminationIRAS number 345246, approved 23/10/2024 by North of Scotland Research Ethics Service. Results will be shared with participants, third sector homelessness organisations, health and social care partnerships, then peer-reviewed journals and conferences worldwide, from the first quarter of 2027.Trial registration numberISRCTN12234059 registered on 20/2/2025 (ISRCTN).

Emergency departments have an important role in screening for human immunodeficiency virus infection and reducing the morbidity, mortality, and transmission of the human immunodeficiency virus. There are debates about human immunodeficiency virus screening, including opt-in, opt-out, and active choice models. Previous studies have shown that multiple factors affect the patient rate of acceptance, including where, when, and by whom the screening is offered. The purpose of this quality improvement project was to test a team-based triage intervention to improve the amount of HIV testing done in our emergency department. The design was a single site quality improvement intervention with post-intervention monthly rates compared to historic monthly rate controls. The intervention focused on the introduction of a Licensed Practical Nurse in addition to the current triage process and personnel. The percentage of patients receiving human immunodeficiency virus testing and the number of tests sent per month before and after the implementation of the intervention were measured. Our results show that 0.6% (SD < 0.01) and 2.5% (SD 2.2) of patients received human immunodeficiency virus testing before and after implementation of the intervention, respectively (χ2 = 501.76, P < 0.05). A mean of 37.4 (SD = 12.91) and 151.3 (SD = 33.34) human immunodeficiency virus tests were sent per month before and after implementation of the intervention, respectively (t = 8.53, P < 0.001). This process intervention, in which licensed practical nurses offered human immunodeficiency virus screening tests during team triage, resulted in a 3-fold increase in the percentage of patients being tested for human immunodeficiency virus.

Cold methane seeps were common in the Late Cretaceous Western Interior Seaway of North America. They provided a habitat for a diverse array of fauna including ammonites. Recent research has demonstrated that ammonites lived at these sites. However, it is still unknown if they hatched at the seeps or only arrived there later in ontogeny. To answer this question, we documented the abundance and size distribution of small specimens of Baculites and Hoploscaphites at eight seep sites in the Pierre Shale of South Dakota. The specimens of Hoploscaphites range from 0.8 to 8.1 mm in shell diameter, with most of them falling between 1 and 1.5 mm. The specimens of Baculites range from 0.7 to 19.2 mm in length, with most specimens falling between 6 and 8 mm. The small size and morphology of these specimens indicate that they are neanoconchs, that is, newly hatched individuals that lived for a short time after hatching. We also analyzed the isotope composition (δ13C and δ18O) of 12 small specimens of Baculites and one specimen of Hoploscaphites with excellent shell preservation from one seep deposit. The values of δ13C and δ18O range from -16.3 to -2.5‰ and -3.0 to -0.9‰, respectively. The values of δ 18O translate into temperatures of 19–28°C, which are comparable to previous estimates of the temperatures of the Western Interior Seaway. The low values of δ13C suggest that the tiny animals incorporated carbon derived from anaerobic oxidation of 12C-enriched methane into their shells. Evidently, they must have lived in close proximity to seep fluids emerging at the sediment-water interface and the associated microbial food web. However, this may have contributed to their demise if they were exposed to elevated concentrations of H2S derived from the anaerobic oxidation of methane.

Numerous crisis intervention programs have been developed to train and improve health care providers' responses to aggressive patient behaviour. Nevertheless, research regarding the efficacy of staff crisis intervention training within the hemodialysis setting is limited. To bridge the knowledge gap, this study explored the effectiveness of training using the Live Model within the crisis prevention intervention (CPI) framework. The Live Model used the re-enactments of crisis scenarios from true patient-provider interactions and highlighted various patient and staff safety concerns at an in-centre hemodialysis unit. The training, also integrated with Crisis Development Theory, aimed to improve staff ability and confidence to manage patients presenting in crisis. In total, 103 multidisciplinary hemodialysis staff from a single centre participated in the standardized 30-minute training sessions. After viewing the pre-filmed re-enacted typical aggressive scenarios that frequently occurred in the hemodialysis unit, the facilitators analyzed the stages of crisis in each scenario, provided various de-escalation strategies, and facilitated interactive discussions of the material. Preand post-questionnaires were administered to measure knowledge, attitude, and comfort level in utilizing de-escalation techniques. Most crisis management indicators showed statistically significant improvements between pre-training and post-training surveys, indicating that our Live Model improved staff knowledge and confidence in de-escalation techniques. The survey showed a high satisfaction with the Live Model in training dialysis professionals. However, the differences in agreement were no longer statistically significant in the three-month post-training follow-up, suggesting sustainability challenges after initial success.

Background There is a Registered Nurse (RN) shortage across the United States that is predicted to intensify in the upcoming years. RNs are an integral part of Emergency Departments (EDs) and perform many vital tasks, including IV placement, blood draws, medication administration, acute assessments, and patient hand-offs. Thus, RN staffing is a crucial part of ED operations, and ED initiatives should account for RN workforce shortages. Given the increase in ED visits and crowding, throughput initiatives that can expedite patient care are integral to the functioning of an ED. Team Triage is a throughput initiative that has been shown to improve ED time to provider, length of stay, and left without being seen rates. In our institution, we created a Team Triage model where advanced practice providers (APPs) perform a patient's initial evaluation in triage and place orders for labs, intravenous (IV) catheters, and imaging. Given the RN staffing shortage, we incorporated Licensed Practical Nurses (LPNs) in Team Triage to place IV catheters and draw blood work for laboratory tests. The objective of this investigation was to describe a Team Triage model that incorporated LPNs and to report the patient safety and productivity of this model. Methods This was a single-site retrospective study at a large, academic, tertiary care center with over 100,000 annual visits. Adult patients who self-presented to the ED and went through Team Triage (11 am-11 pm) between Jan 1, 2020, and Jan 31, 2020, were included in this study. LPNs staffed the Team Triage, along with APPs. LPNs placed IV catheters and drew blood specimens for the Team Triage patients. The primary outcomes studied were the proportion of specimens mislabeled by LPNs, the proportion of patients receiving IV catheters, the proportion of patients receiving blood work, blood tubes drawn per hour, and IVs inserted per hour in Team Triage. Results During the study period, 1355 patients went through Team Triage. Of these patients, 1075 (79%) were ordered for blood work, and 1017 (75%) were ordered for an IV catheter. All Team Triage blood work and IV catheter placements were completed by LPNs, who staffed 372 hours of Team Triage. A total of 2558 blood tubes were collected by LPNs. The LPNs cared for 2.9 patients per hour, collected 6.9 blood tubes per hour, inserted 2.7 IV catheters per hour, and collected 2.4 blood tubes per patient. The LPNs had a 0% specimen mislabeling rate. Conclusion Due to the significant RN workforce shortage impacting Emergency Medicine coupled with increased ED crowding, there is a significant need to evaluate the integration of LPNs into Team Triage to place IV catheters and perform blood draws. This study shows that incorporating LPNs in Team Triage is a productive and safe way to address nursing shortages in Emergency Medicine.

Polioviruses are single stranded RNA viruses and members of the picornavirus family. They have an unusually long non coding region at the 5’ end which has elaborate secondary structure predicted to be made up of seven domains. Part of the secondary structure constitutes an internal ribosome entry site (IRES) which allows the virus to utilise cap-independent initiation of translation whilst disabling the host cell’s cap-dependent translation. Translation inefficiencies originally caused by disruptions of the secondary structure of domain V could be compensated for in monkey kidney cells in vitro by coding changes in the protease 2A. These coding changes were found throughout the protease which is otherwise quite highly conserved in polioviruses. They appear to have no effect on monkey neurovirulence and their activity was found to be cell specific, having little or no compensatory effect in a mouse cell line. Using this cell line to investigate the effects of mutations in functionally significant secondary structure of domain V on virus growth highlighted unpaired loops as being important. Shortening one loop was detrimental to the virus whereas the sequence of the loop was much less important. In addition, flexibility at another position between two stems appeared to be critical and mutations that could potentially alter the folding in this area rendered the virus temperature sensitive.