Pulmonary Imaging of Dairy Calves with Naturally Acquired Respiratory Disease

Bovine respiratory disease complex (BRD) is an infection of both the upper and lower respiratory tract and includes components of rhinitis, otitis, tracheitis, and pneumonia. Bovine respiratory disease (BRD) is one of the most common causes of morbidity and mortality of calves in the United States and world-wide. Besides the financial and animal losses, BRD has negative implications for animal welfare. Clinical diagnosis of pulmonary disease in calves with BRD is challenging as clinical respiratory scoring systems, thoracic auscultation, and bronchoalveolar lavage are only moderately sensitive and specific for pulmonary disease detection. Thus, alternative diagnostic testing methods (i.e., thoracic radiography, ultrasonography, and computed tomography) are needed for early detection and treatment of BRD.Thoracic radiography is the most commonly utilized technique to evaluate the thorax for the presence of pulmonary disease. However, in large animal patients including calves, pulmonary ultrasound is currently more frequently performed due to its ease of use, real time imaging, ability to monitor disease, and availability in field conditions. In human patients, computed tomography (CT) is considered either the gold standard or method of choice to evaluate for pulmonary disease. This is likely similar in veterinary patients but has not been established yet.In the first study, the objective was to evaluate if thoracic radiography provides accurate information about the severity and extent of lung disease compared to CT in calves with naturally occurring respiratory disease. The goal of the study was to assess if thoracic radiography could be used as a potential on-farm diagnostic tool for pulmonary disease detection in calves with naturally occurring respiratory disease. As CT is considered the method of choice to for detecting pulmonary disease, it was used as a reference standard. Additionally, we were interested if current clinical respiratory scoring techniques allow for detection of pulmonary disease in acute and chronic pulmonary diseased calves to a similar degree as thoracic computed radiography (CR) and CT.First, a CT protocol was established utilizing an intravenously injected sedation protocol using xylazine, butorphanol, and ketamine. The feasibility and safety of performing contrast-enhanced thoracic multidetector computed tomography (CT) examinations in sedated calves was evaluated. Finally, radiographic pulmonary disease detection rates were compared with those of thoracic CR and the Wisconsin respiratory scoring system.Lateral thoracic CR was performed on fifteen awake, standing Jersey calves with acute or chronic respiratory disease as diagnosed on-farm with the Wisconsin respiratory scoring system. Once calves were sedate, thoracic CT was performed pre- and post- intravenous iodinated contrast medium administration using a 64-multidetector CT.We observed that thoracic CT was superior to CR for pneumonia detection in acute and chronic respiratory diseased calves due to the lack of summation in all areas of the lungs. However, a diagnosis of pneumonia was made with equal rate on both thoracic CR and CT. The intravenous sedation protocol enabled acquisition of CT images of diagnostic quality, without the need for re-scanning. Although mild differences in classification of lung pattern and extent of lung disease were seen when comparing an experienced and a less experienced evaluator, the overall differences were not statistically significant. The best intra- and inter-observer agreement was noted when evaluating the cranioventral aspects of the lungs in either modality. Wisconsin Calf Respiratory Scoring was not able to diagnose chronic pneumonia in calves.Lung ultrasonography (US) has been used to diagnose and monitor pulmonary disease in large animal veterinary species as well as in humans. In the second study, the objective was to evaluate US as a potential on-farm diagnostic tool for pulmonary disease detection in calves. To accomplish our objective, US lung lesion detection rates of 16 Jersey calves with and 6 Jersey calves without clinical sigs of respiratory disease were compared to those with digital radiography (DR), CT, histopathology, and Wisconsin Calf Respiratory Scoring. In the second study, we observed that lung US was successfully performed in all calves without sedation and in standing position. Clinically healthy calves with low respiratory scores (<2) were diagnosed with pulmonary parenchymal changes on all imaging modalities and histopathologically, but the observed changes were smaller and less severe than in calves with clinical respiratory disease. Accurate assessments of severity and distribution of pneumonia, and differentiation of lung pattern types could bemade with US and correlated well with DR, CT and histopathology. Pulmonary US is an easy to perform, feasible and accurate technique diagnosing pulmonary disease in calves and allows differentiation between clinically healthy and respiratory diseased calves. However, US does not allow identification of intraparenchymal bullae or abscesses.In this study, thoracic DR, pulmonary US, and thoracic CT performed similarly well for pneumonia detection by each evaluator, and a more experienced evaluator had a better overall sensitivity for pneumonia detection with all imaging modalities. This supports the use of US as a potential diagnostic tool for pneumonia detection in calves.Keywords: Imaging, Ultrasound, Calves, Computed Tomography, Pneumonia, Radiograph

Reducing Disparities in the Burden of Cancer: The Role of Patient Navigators

Many racial and ethnic minority patients with cancer face barriers related to access to health care and information. Patient navigators, say the authors, could help to overcome these barriers

Supporting caregivers of veterans with Alzheimer’s disease and traumatic brain injury: study protocol for a randomized controlled trial

Background: Patients with Alzheimer's disease and related dementias (ADRD) and traumatic brain injury (TBI) and their caregivers require cognitive and behavioral symptom management, interdisciplinary care, support for caregivers, and seamless care coordination between providers. Caring for someone with ADRD or TBI is associated with higher rates of psychological morbidity and burden, social isolation, financial hardship, and deterioration of physical health. Tremendous need exists for primary care-based interventions that concurrently address the care needs of dyads and aim to improve care and outcomes for both individuals with ADRD and TBI and their family caregivers. Methods: The Aging Brain Care Acquiring New Skills While Enhancing Remaining Strengths (ABC ANSWERS) study is a randomized controlled trial that tests the effectiveness of an intervention based on two evidence-based programs that have been developed for and previously tested in populations with ADRD, TBI, stroke, and late-life depression and/or who have survived an intensive care unit stay. This study includes 200 dyads comprised of a veteran with a diagnosis of ADRD or TBI and the veteran's primary informal caregiver. Dyads are randomized to receive the ABC ANSWERS intervention or routine Veterans Health Administration (VHA) primary care with a standardized educational and resource information packet. Data collection occurs at baseline and three follow-up time points (3 months, 6 months, and 12 months). The primary outcome is caregiver quality of life (QoL). A secondary measure for the caregiver is caregiver burden. Secondary measures for both the veteran and caregiver include symptoms of depression and anxiety. Discussion: The ABC ANSWERS intervention integrates common features of an evidence-based collaborative care model for brain health while concurrently attending to the implementation barriers of delivering care and skills to dyads. We hypothesize that caregivers in dyads randomized to the ABC ANSWERS program will experience higher levels of QoL and lower levels of depression, anxiety, dyadic strain, and caregiver burden at 12 months than those receiving usual VHA primary care

Improving Nursing Facility Care Through an Innovative Payment Demonstration Project: Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care Phase 2

Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) is a 2‐phase Center for Medicare and Medicaid Innovations demonstration project now testing a novel Medicare Part B payment model for nursing facilities and practitioners in 40 Indiana nursing facilities. The new payment codes are intended to promote high‐quality care in place for acutely ill long‐stay residents. The focus of the initiative is to reduce hospitalizations through the diagnosis and on‐site management of 6 common acute clinical conditions (linked to a majority of potentially avoidable hospitalizations of nursing facility residents1): pneumonia, urinary tract infection, skin infection, heart failure, chronic obstructive pulmonary disease or asthma, and dehydration. This article describes the OPTIMISTIC Phase 2 model design, nursing facility and practitioner recruitment and training, and early experiences implementing new Medicare payment codes for nursing facilities and practitioners. Lessons learned from the OPTIMISTIC experience may be useful to others engaged in multicomponent quality improvement initiatives

Monitoring neonicotinoid exposure for bees in rural and peri-urban areas of the UK during the transition from pre- to post-moratorium

Concerns regarding the impact of neonicotinoid exposure on bee populations recently led to an EU-wide moratorium on the use of certain neonicotinoids on flowering crops. Currently evidence regarding the impact, if any, the moratorium has had on bees’ exposure is limited. We sampled pollen and nectar from bumblebee colonies in rural and peri-urban habitats in three UK regions; Stirlingshire, Hertfordshire and Sussex. Colonies were sampled over three years; prior to the ban (2013), during the initial implementation when some seed-treated winter-sown oilseed rape was still grown (2014), and following the ban (2015). To compare species-level differences, in 2014 only, honeybee colonies in rural habitats were also sampled. Over half of all samples were found to be contaminated (n=408), with thiamethoxam being the compound detected at the highest concentrations in honeybee- (up to 2.29 ng/g in nectar in 2014, median≤0.1 ng/g, n=79) and bumblebee-collected pollen and nectar (up to 38.77 ng/g in pollen in 2013, median ≤0.12 ng/g, n=76). Honeybees were exposed to higher concentrations of neonicotinoids than bumblebees in 2014. While neonicotinoid exposure for rural bumblebees declined post-ban (2015), suggesting a positive impact of the moratorium, the risk of neonicotinoid exposure for bumblebees in peri-urban habitats remained largely the same between 2013 and 2015

Compounding heatwave-extreme rainfall events driven by fronts, high moisture, and atmospheric instability

Heatwaves have been shown to increase the likelihood and intensity of extreme rainfall occurring immediately afterward, potentially leading to increased flood risk. However, the exact mechanisms connecting heatwaves to extreme rainfall remain poorly understood. In this study, we use weather type data sets for Australia and Europe to identify weather patterns, including fronts, cyclones, and thunderstorm conditions, associated with heatwave terminations and following extreme rainfall events. We further analyze, using reanalysis data, how atmospheric instability and moisture availability change before and after the heatwave termination depending on whether the heatwave is followed by extreme rainfall, as well as the location of the heatwave. We find that most heatwaves terminate during thunderstorm and/or frontal conditions. Additionally, atmospheric instability and moisture availability increase several days before the heatwave termination; but only if heatwaves are followed by extreme rainfall. We also find that atmospheric instability and moisture after a heatwave are significantly higher than expected from climatology for the same time of the year, and that highest values of instability and moisture are associated with highest post-heatwave rainfall intensities. We conclude that the joint presence of high atmospheric instability, moisture, as well as frontal systems are likely to explain why rainfall is generally more extreme and likely after heatwaves, as well as why this compound hazard is mainly found in the non-arid mid and high latitudes. An improved understanding of the drivers of these compound events will help assess potential changing impacts in the future

Cannabis use is associated with increased psychotic symptoms and poorer psycho-social functioning in first-episode psychosis: A report from the UK National EDEN study

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Schizophrenia Bulletin following peer review. The version of record Seddon, J. L., et al. (2016). Cannabis Use Is Associated With Increased Psychotic Symptoms and Poorer Psychosocial Functioning in First-Episode Psychosis: A Report From the UK National EDEN Study. Schizophrenia Bulletin, 42(3), 619-625. https://doi.org/10.1093/schbul/sbv154 is available online at: https://academic.oup.com/schizophreniabulletin/article/42/3/619/2413898#39400533Background: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode psychosis (FEP) and the link with symptomatic course and outcome over one year post psychosis onset. Method: 1027 FEP patients were recruited upon inception to specialised early intervention services for psychosis in the UK. Participants completed assessments at baseline, six and twelve months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psycho-social functioning. Continued use of cannabis following the first episode of psychosis was prognostic of outcome at one year. These associations were significant after adjusting for age, gender, DUP, age of psychosis onset, ethnicity and other drug use. Conclusion: This is the largest cohort study of first-episode psychosis patients receiving care within early intervention services. Cannabis use, in particular continued use, is associated with poorer symptomatic and functional outcome during the first-episode of psychosis. The results highlight the need for effective and early intervention for cannabis use in FEP

A 3-D PYRAMID/PRISM APPROACH TO VIEW KNOWLEDGE REQUIREMENTS FOR THE BATCH MEANS METHOD WHEN TAUGHT IN A LANGUAGE-FOCUSED, UNDERGRADUATE SIMULATION COURSE

We develop a 3-D knowledge pyramid/prism model to structure the relationships of (i) lower-level learning, (ii) ‘optional ’ knowledge bases, (iii) concurrent knowledge, and (ii) new knowledge; so one may view the learning needs of a higher-level learning objective. Our paradigm stems from Bloom’s taxonomy of learning, but has the advantage of supporting ‘just-in-time ’ and ‘learn-by-doing’ delivery, teaching and learning styles. We illustrate the paradigm through the BMMKP (the 3-D knowledge pyramid/prism model of the highest-level, batch-means-method learning objective for our language-focused, undergraduate course). The BMMKP reveals how highly dependent and fully integrated this learning is to calculus, probability, statistics, and queuing theory—regardless of the simulation modeling language chosen to teach in the course. The BMMKP is then used to develop a set of lower-level learning objectives for the undergraduate course. The 3-D pyramid/prism approach should lend itself well as a communication tool for visualizing other simulation learning objectives.

Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting

AbstractObjective: Radial artery harvesting for coronary artery bypass may lead to digit ischemia if collateral hand circulation is inadequate. The modified Allen's test is the most common preoperative screening test used. Unfortunately, this test has high false-positive and false-negative rates. The purpose of this study was to compare the results of a modified Allen's test with digit pressure change during radial artery compression for assessing collateral circulation before radial artery harvest. Methods: One hundred twenty-nine consecutive patients were studied before coronary artery bypass operations. A modified Allen's test was performed with Doppler ultrasound to assess blood flow in the superficial palmar arch before and during radial artery compression. A decreased audible Doppler signal after radial artery compression was considered a positive modified Allen's test. First and second digit pressures were measured before and during radial artery compression. A decrease in digit pressure of 40 mm Hg or more (digit ΔP) with radial artery compression was considered positive. Results: Seven of 14 dominant extremities (50%) and 8 of the 16 nondominant extremities (50%) with a positive modified Allen's test had a digit ΔP of less than 40 mm Hg (false positive). Sixteen of 115 dominant extremities (14%) and 5 of 112 nondominant extremities (4%) with a negative Allen's test had a digit ΔP of 40 mm Hg or more with radial artery compression (false negative). Conclusion: Use of the modified Allen's test for screening before radial artery harvest may unnecessarily exclude some patients from use of this conduit and may also place a number of patients at risk for digit ischemia from such harvest. Direct digit pressure measurement is a simple, objective method that may more precisely select patients for radial artery harvest. Additional studies are needed to define objective digital pressure criteria that will accurately predict patients at risk for hand ischemia after radial harvest. (J Thorac Cardiovasc Surg 1999;117:261-6

A comparison of two fat suppressed magnetic resonance imaging pulse sequences to standard T2-weighted images for brain parenchymal contrast and the identification of lesions in dogs with inflammatory intracranial disease

T2-weighted sequences are commonly relied upon in magnetic resonance (MR) imaging protocols for the detection of brain lesions in dogs. Previously the effect of fluid suppression via fluid attenuated inversion recovery (FLAIR) has been compared to T2-weighting with mixed results. Short tau inversion recovery (STIR) has been reported to increase the detection of some CNS lesion in people. The purpose of the current study was to evaluate the effect of fat suppression on brain parenchymal contrast resolution and lesion detection in dogs. We compared three sequences: T2-weighted images (T2w), STIR, and T2-weighted fluid attenuated inversion recovery with chemical fat suppression (T2-FLAIR-FS) in dogs with meningoencephalitis. Dogs with meningoencephalitis and dogs with idiopathic epilepsy were retrospectively identified and anonymized. Evaluators recorded the presence or absence of lesions within 12 predetermined brain regions on randomized sequences, viewing and scoring each sequence individually. Additionally signal to noise ratios, contrast to noise ratios, and relative contrast were measured in a reference population. STIR sequences had the highest relative contrast between grey and white matter. While descriptively more lesions were identified by evaluators on T2-FLAIR-FS images, there was no statistical difference in the relative sensitivity of lesion detection between the sequences. Nor was there a statistical difference in false lesion detection within our reference population. STIR may be favored for enhanced anatomic contrast depiction in brain imaging. No benefit of the inclusion of a fat suppressed T2-weighted FLAIR sequence was found.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1740-82612016-03-31hb201