Differentiation of Cardiac from Noncardiac Pleural Effusions in Cats using Second-Generation Quantitative and Point-of-Care NT-proBNP Measurements

BACKGROUND: Pleural effusion is a common cause of dyspnea in cats. N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) measurement, using a first‐generation quantitative ELISA, in plasma and pleural fluid differentiates cardiac from noncardiac causes of pleural effusion. HYPOTHESIS/OBJECTIVES: To determine whether NT‐proBNP measurements using second‐generation quantitative ELISA and point‐of‐care (POC) tests in plasma and pleural fluid distinguish cardiac from noncardiac pleural effusions and how results compare to the first‐generation ELISA. ANIMALS: Thirty‐eight cats (US cohort) and 40 cats (UK cohort) presenting with cardiogenic or noncardiogenic pleural effusion. METHODS: Prospective cohort study. Twenty‐one and 17 cats in the US cohort, and 22 and 18 cats in the UK cohort were classified as having cardiac or noncardiac pleural effusion, respectively. NT‐proBNP concentrations in paired plasma and pleural fluid samples were measured using second‐generation ELISA and POC assays. RESULTS: The second‐generation ELISA differentiated cardiac from noncardiac pleural effusion with good diagnostic accuracy (plasma: sensitivity, 95.2%, specificity, 82.4%; pleural fluid: sensitivity, 100%, specificity, 76.5%). NT‐proBNP concentrations were greater in pleural fluid (719 pmol/L (134–1500)) than plasma (678 pmol/L (61–1500), P = 0.003), resulting in different cut‐off values depending on the sample type. The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%). Diagnostic accuracy was similar between first‐ and second‐generation ELISA assays. CONCLUSIONS AND CLINICAL IMPORTANCE: Measurement of NT‐proBNP using a quantitative ELISA in plasma and pleural fluid or POC test in plasma, but not pleural fluid, distinguishes cardiac from noncardiac causes of pleural effusion in cats

Atmospheric concentrations of carbon dioxide and its isotopic composition in southern Poland: comparison of high-altitude mountain site and a near-by urban environment

International audienceThe results of regular observations of atmospheric CO2 mixing ratios and its carbon isotope composition (?13C, ?14C), carried out at two continental sites located in central Europe are presented and discussed. The sites (Kasprowy Wierch, 49°14' N, 19°59' E, 1989 m a.s.l.; Krakow, 50°04' N, 19°55' E, 220 m a.s.l.), are located in two contrasting environments: (i) high-altitude mountaneous area, relatively free of anthropogenic influences, and (ii) typical urban environment with numerous local sources of carbon dioxide. Despite of relative proximity of those sites (ca. 100 km), substantial differences in both the recorded CO2 levels and their isotopic composition were detected. The CO2 mixing ratios measured in the urban atmosphere revealed quasi-permanent excess concentration of this gas when compared with near-by background atmosphere. The annual mean CO2 concentration recorded in Krakow in 2004 was almost 10% higher than that recorded at high-altitude mountain site (Kasprowy Wierch). Such effect is occuring probably in all urban centers. Carbon isotopic composition of atmospheric CO2 proved to be efficient tool for identification the surface CO2 fluxes into the atmosphere related to fossil fuel burning and their influence on the recorded levels of this gas in the local atmosphere. The available records of ?14C for Krakow and Kasprowy Wierch suggest gradual reduction of 14C-free CO2 fluxes into the urban atmosphere of Krakow in the past several years

A phenomenonological investigation into mentors’ helping behaviors in a nurse residency program: an emerging model

The purpose of this study was to evaluate Graduate Nurses’ (GN) perceptions of helping behaviors of their preceptors, mentors, or coaches, during their nurse residency program. The nurse residency program correlates with the GNs transition into the nursing profession to become a competent Registered Nurse (RN).With the ever growing increase in the shortage of nurses nationally there is a need to evaluate and identify themes that will assist in easing the transition, retention, and recruitment of competent new nurses into the nursing profession. These themes are of significance to both the hiring Healthcare facilities and the educational institutions that prepare and train future nurses.The phenomenon of the perceptions of the graduate nurse’s lived experiences of the helping behaviors through the residency programs was studied. A qualitative phenomenological method was used. Data collection included a series of three focus group sessions; with a total of nineteen participants included in this study. In addition to the focus group sessions, audio recordings were used along with the researcher’s notes and participant data collection sheets and comments. Participants were Graduate Nurse’s attending the Nurse Residency Program at Pennsylvania Hospital in Center City Philadelphia.Results of the study identified three primary themes. First, Graduate Nurses feel that a facilitative learning environment in the academic and clinical setting would be beneficial. Second, the participants added the need for more “hands on” interactions in their nursing education programs. And third, nurse’s needed a supportive learning environment with the guidance of a mentor who was readily available in the residency program.The researcher stated five conclusions. First, the new nurses want the ability to be autonomous in their practice setting. Second, there is the need for a supportive and nurturing working environment. Third, there needs to be a mentor is readily available to provide guidance and structure to the novice nurse. Fourth, mentors need to model their behavior to provide realistic guidelines and expectations that will the advanced beginners develop a competent method of practice. And fifth, nursing education programs need to integrate a more facilitative method of teaching this generation of nurses.This study is significant to both the fields of education and nursing respectively. This research supports and extends various comprehensive research studies. This study specifies that additional research is needed in the areas of mentoring, Nurse Residency Programs, and the retention of competent registered nurses within the profession to combat the issues related to the ever growing nursing shortage.Ph.D., Education -- Drexel University, 200

Near-Infrared Adaptive Optics Imaging of the Central Regions of Nearby Sc Galaxies. II. NGC 247 and NGC 2403

J, H, and K' images obtained with the Canada-France-Hawaii Telescope adaptive optics system are used to investigate the star-forming histories of the central regions of the Sc galaxies NGC 247 and NGC 2403. The brightest resolved red stars within 15 arcsec of the nucleus of each galaxy are red supergiants, indicating that the central few hundred parsecs of these galaxies experienced star formation within the last ~ 0.1 Gyr. However, when averaged over Gyr time scales, the star-forming histories of the inner disks of these galaxies have been remarkably similar, as expected if the long-term evolution of disks is defined by local characteristics such as mass density. It is demonstrated that NGC 247 and NGC 2403, like M33, harbour nuclear star clusters with stellar contents that differ from the surrounding central light concentrations. The nucleus of NGC 2403 is significantly bluer than that of the other two galaxies and the K-band surface brightnesses near the centers of NGC 247 and NGC 2403 are 1 -- 2 mag per square arcsec lower than in M33. Finally, it is noted that young or intermediate-age nuclear star clusters are a common occurence in nearby spirals, indicating that nuclear star formation in these objects is either continuous or episodic on time scales of 0.1 - 1 Gyr.Comment: 27 pages of text and 14 figures; to appear in the Astronomical Journa

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational use of Antithrombotics in Veterinary Critical Care (CURATIVE) Guidelines: Small Animal

Objectives To systematically review available evidence and establish guidelines related to the risk of developing thrombosis and the management of small animals with antithrombotics. Design Standardized, systematic evaluation of the literature (identified by searching Medline via PubMed and CAB abstracts) was carried out in 5 domains (Defining populations at risk; Defining rational therapeutic use; Defining evidence‐based protocols; Refining and monitoring antithrombotic therapies; and Discontinuing antithrombotic therapies). Evidence evaluation was carried out using Population, Intervention, Comparison, Outcome generated within each domain questions to address specific aims. This was followed by categorization of relevant articles according to level of evidence and quality (Good, Fair, or Poor). Synthesis of these data led to the development of a series of statements. Consensus on the final guidelines was achieved via Delphi‐style surveys. Draft recommendations were presented at 2 international veterinary conferences and made available for community assessment, review, and comment prior to final revisions and publication. Settings Academic and referral veterinary medical centers. Results Over 500 studies were reviewed in detail. Worksheets from all 5 domains generated 59 statements with 83 guideline recommendations that were refined during 3 rounds of Delphi surveys. A high degree of consensus was reached across all guideline recommendations. Conclusions Overall, systematic evidence evaluations yielded more than 80 recommendations for the treatment of small animals with or at risk of developing thrombosis. Numerous significant knowledge gaps were highlighted by the evidence reviews undertaken, indicating the need for substantial additional research in this field

Clinical Application of the American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational use of Antithrombotics in Veterinary Critical Care (CURATIVE) Guidelines to Small Animal Cases

Objective To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case‐based approach. Etiology Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis. Diagnosis Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis. Therapy Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included. Prognosis In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus‐based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation