Medical and surgical management of gallbladder sludge and mucocoele development in a Miniature Schnauzer

The factors enhancing mucocoele development in dogs remain poorly understood. A 7-year-old female spayed Miniature Schnauzer was presented to the Massey University Veterinary Teaching Hospital for progressive lethargy, inappetance and abdominal discomfort. Initial physical examination findings revealed a moderate degree of cranial abdominal pain, with subsequent diagnostic tests confirming the patient as having diabetes mellitus, with a concurrent marked hypertriglyceridaemia. In an attempt to localise the source of pain, an ultrasound examination of the abdomen was performed, revealing a marked degree of gallbladder sludge. With appropriate medical management including ursodeoxycholic acid and insulin therapy, the patient stabilised and was discharged. With persistence of clinical signs three months later, progression of the gallbladder sludge towards mucocoele development was suspected. Exploratory laparotomy was instigated, and an emergency cholecystectomy was performed. This case report therefore entails a suspected gallbladder mucocoele that developed in a diabetic patient with previously diagnosed biliary sludge. A unique feature of this case report is the presence of diabetes mellitus, which has been suggested to be a causative factor in the development of gallbladder mucocoeles. It is also hypothesised that gallbladder sludge and mucocoeles are associated, however it is yet to be ascertained whether this association is causal or contributory. The authors examined the possible relationship between this endocrinopathy and biliary sludge, and their possible effects on mucocoele development. Specific associated factors to sludge formation are also examined. The medical and surgical management of gallbladder mucocoeles is discussed

Inequality in an Equal Society

A society in which everybody of a given age has the same income will exhibit substantial income and wealth inequality. We use this idea to empirically quantify inter‐cohort inequality – the share of observed inequality attributable to life‐cycle profiles of income and wealth – using data on male earnings and household wealth. We document that recent increases in income and wealth inequality in the USA and other developed countries are larger than observed rates would suggest due to favourable demographics. That is, while demographic change played a substantial role in the dynamics of income and wealth inequality until 1990, the stark increase in inequality in the USA and elsewhere ever since is despite not because of demographic change. Moreover, we show that there is important variation across countries in the level and trends in the extent of inequality that is due to lifecycle effects, and that taking this into account gives a more nuanced view of cross‐country comparisons

Opioid Overdoses Among High-Risk Medicaid Members: Healthcare Cost, Service Utilization, and Risk Factor Analysis

Research Objective: Identify risk factors associated with opioid overdoses among three high-risk populations of Medicaid members related to cost and service utilization. Study Design: Repeated cross-sectional study using five years of Massachusetts Medicaid (MassHealth) claims and state agency data. Population Studied: MassHealth members aged 11-64 years considered to be high-risk (homeless, unstably housed, and/or criminal justice-involved) and in need of support services, especially those with extensive behavioral health (BH) needs. These three populations were identified as being particularly vulnerable to non-fatal and/or fatal opioid overdoses. Principal Findings: MassHealth members who were both justice-involved and unstably housed were at much higher risk of an opioid overdose than the MassHealth population overall, especially those with a substance use disorder (SUD) or a serious mental illness (SMI). Experiencing both homelessness and justice involvement substantially compounded members’ non-fatal overdose risk, regardless of BH diagnosis. Co-occurring SUD/SMI was a key driver of high overdose prevalence, particularly among the justice-involved. Compared to MassHealth members in general, those with justice involvement and unstable housing had costs that were 50-65% higher; members who experienced homelessness had triple the costs. Healthcare service use both before and after an overdose was relatively low, including the timeframe between multiple non-fatal overdoses. In multivariate analyses, all three high-risk factors (i.e., populations) were significantly related to an increased opioid overdose risk after controlling for additional risk factors (BH diagnoses, chronic medical conditions, and demographic characteristics). Males and whites were more likely to have an opioid overdose; those with diabetes or hypertension were less likely. These results were similar when assessing various opioid overdose outcomes (non-fatal and/or fatal). Conclusions: These findings helped inform MassHealth’s understanding of its members’ experiences regarding medical and BH services, especially among high-risk populations with an opioid overdose. The identification of risk factors most predictive of a subsequent overdose may help address the needs of these high-risk groups. For most of the populations studied, prevalence of co-occurring BH diagnoses was much higher than MassHealth members in general and appeared to impact opioid overdose rates. Most members received services for 1-2 months in both the pre- and post-overdose periods; service use was relatively low in the year following a non-fatal overdose, suggesting retention was also low. Multivariate analyses consistently showed that gender and race were significantly associated with increased overdose risk. Implications for Policy or Practice: Understanding opioid overdose risk factors and identifying service utilization gaps and missed opportunities are important. As payment reforms evolve under the umbrella of accountable care organizations, BH community partnership models are key for collaborating with healthcare and social service providers, and community resources for care management, care coordination, and referrals to support services. Our study initially developed an in-depth descriptive analysis of individuals with SUD, SMI, or both identified as being at high risk for an opioid overdose. Understanding service trajectory and outcomes through additional analyses was critical for planning and prioritizing appropriate services. As payors are actively making decisions about effective systems of care, they are particularly interested in understanding the need for community-based and residential services, particularly for those with housing instability and/or criminal justice involvement

Tomographic Separation of Composite Spectra. VIII. The Physical Properties of the Massive Compact Binary in the Triple Star System HD 36486 (delta Orionis A)

Double-lined spectroscopic orbital elements have recently been found for the central binary in the massive triple, delta Orionis A based on radial velocities from cross-correlation techniques applied to IUE high dispersion spectra and He I 6678 spectra obtained at Kitt Peak. The primary and secondary velocity amplitudes were found to be 94.9 +/- 0.6 km/s and 186 +/- 9 km/s respectively. Tomographic reconstructions of the primary and secondary stars' spectra confirm the O9.5 II classification of the primary and indicate a B0.5 III type for the secondary. The widths of the UV cross-correlation functions are used to estimate the projected rotational velocities, Vsin i = 157 +/- 6 km/s and 138 +/- 16 km/s for the primary and secondary, respectively implying that both stars rotate faster than their orbital motion. We used the spectroscopic results to make a constrained fit of the Hipparcos light curve of this eclipsing binary, and the model fits limit the inclination to the range between 67 and 77 degrees. The i = 67 degrees solution, which corresponds to a near Roche-filling configuration, results in a primary mass of 11.2 solar masses and a secondary mass of 5.6 solar masses, both of which are substantially below the expected masses for stars of their luminosity. This binary may have experienced a mass ratio reversal caused by Case A Roche lobe overflow, or the system may have suffered extensive mass loss through a binary interaction, perhaps during a common envelope phase, in which most of the primary's mass was lost from the system rather than transferred to the secondary.Comment: 27 pages, 15 figures in press, the Astrophysical Journal, February 1, 200

New possibilities for research on reef fish across the continental shelf of South Africa

[From introduction] Subtidal research presents numerous challenges that restrict the ability to answer fundamental ecological questions related to reef systems. These challenges are closely associated with traditional monitoring methods and include depth restrictions (e.g. safe diving depths for underwater visual census), habitat destruction (e.g. trawling), mortality of target species (e.g. controlled angling and fish traps), and high operating costs (e.g. remotely operated vehicles and large research vessels. Whereas many of these challenges do not apply or are avoidable in the shallow subtidal environment, the difficulties grow as one attempts to sample deeper benthic habitats. This situation has resulted in a paucity of knowledge on the structure and ecology of deep water reef habitats around the coast of South Africa and in most marine areas around the world. Furthermore, the inability to effectively survey deep water benthic environments has limited the capacity of researchers to investigate connectivity between shallow and deep water habitats in a standardised and comparable fashio

Observations of the 6 Centimeter Lines of OH in Evolved (OH/IR) Stars

Recent observational and theoretical advances have called into question traditional OH maser pumping models in evolved (OH/IR) stars. The detection of excited-state OH lines would provide additional constraints to discriminate amongst these theoretical models. In this Letter, we report on VLA observations of the 4750 MHz and 4765 MHz lines of OH toward 45 sources, mostly evolved stars. We detect 4765 MHz emission in the star forming regions Mon R2 and LDN 1084, but we do not detect excited-state emission in any evolved stars. The flux density and velocity of the 4765 MHz detection in Mon R2 suggests that a new flaring event has begun.Comment: 4 pages, to appear in ApJ