Novel characteristics identified in two cases of feline Cow Pox Virus infection

Case series summary This case series discusses novel characteristics identified in two cases of cowpox. One presented with upper airway signs, and was identified to have a focal laryngeal lesion. The other had central neurological signs at the terminal stages, with intracytoplasmic inclusion bodies identified within the cerebral hemispheres on histopathology. Relevance and novel information Currently, cowpox would be an unlikely consideration in patients with neurological signs or upper respiratory noise. These cases both document novel presentations of cowpox infection, which clinicians should be aware of and consider as differential diagnoses in patients with these atypical presentations

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Outcome and Prognostic Factors for Canine Splenic Lymphoma Treated by Splenectomy (1995-2011) : A VSSO Retrospective Study

OBJECTIVE: To assess the outcome of canine splenic lymphoma treated with splenectomy and to evaluate prognostic factors, including involvement of other sites, adjuvant chemotherapy, and the effect of World Health Organization (WHO) histological classification of canine malignant lymphoma. DESIGN: Multi-institutional, retrospective study. ANIMALS: Client-owned dogs (n = 28). METHODS: Medical records (1995-2011) of dogs with a histological diagnosis of splenic lymphoma and treated by splenectomy submitted by Veterinary Society of Surgical Oncology members were reviewed. Included were dogs treated with or without adjuvant therapy. Overall survival, disease-free interval, and cause of death were determined. Prognostic factors and the WHO histological classification of canine malignant lymphoma were evaluated with respect to outcome. RESULTS: Dogs with splenic lymphoma treated by splenectomy had a 1-year survival rate of 58.8%, after which no animals died of their disease. B cell lymphoma held a better prognosis for survival than other variants of splenic lymphoma. Marginal zone lymphoma and mantle cell lymphoma were the most common B cell lymphoma subtypes in our study. Hemoabdomen and clinical signs related to splenic lymphoma, including abdominal distention, lethargy, and anorexia, were poor prognostic indicators, whereas disease confined to the spleen was a positive prognostic indicator. Pre- or postoperative adjuvant chemotherapy did not provide a survival benefit. CONCLUSION: Based on our sample population, splenectomy alone was an effective treatment for splenic lymphoma in cases with disease confined to the spleen. Chemotherapy may not improve survival in cases of lymphoma restricted to the spleen

The influence of spatiotemporal structure of noisy stimuli in decision making

Decision making is a process of utmost/nimportance in our daily lives, the study of which has/nbeen receiving notable attention for decades. Nevertheless,/nthe neural mechanisms underlying decision making/nare still not fully understood. Computational modeling/nhas revealed itself as a valuable asset to address some of/nthe fundamental questions. Biophysically plausible models,/nin particular, are useful in bridging the different levels/nof description that experimental studies provide, from the/nneural spiking activity recorded at the cellular level to the/nperformance reported at the behavioral level. In this/narticle, we have reviewed some of the recent progress/nmade in the understanding of the neural mechanisms that/nunderlie decision making. We have performed a critical/nevaluation of the available results and address, from a/ncomputational perspective, aspects of both experimentation/nand modeling that so far have eluded comprehension./nTo guide the discussion, we have selected a central/ntheme which revolves around the following question: how/ndoes the spatiotemporal structure of sensory stimuli affect/nthe perceptual decision-making process? This question is a/ntimely one as several issues that still remain unresolved/nstem from this central theme. These include: (i) the role of/nspatiotemporal input fluctuations in perceptual decision/nmaking, (ii) how to extend the current results and models/nderived from two-alternative choice studies to scenarios/nwith multiple competing evidences, and (iii) to establish/nwhether different types of spatiotemporal input fluctuations/naffect decision-making outcomes in distinctive ways./nAnd although we have restricted our discussion mostly to/nvisual decisions, our main conclusions are arguably/ngeneralizable; hence, their possible extension to other/nsensory modalities is one of the points in our discussion.AI acknowledges funding from the SUR, DEC of the Generalitat de/nCatalunya and FSE. LDM is a Ramon y Cajal Fellow and acknowledges funding/nfrom the Ministry of Science and Innovation through the Ramon y Cajal/nprogramme. She also acknowledges financial support from the research project/nTIN2010-21771-C02-02 funded by the Ministry of Science and Innovation. MP was/nsupported by the CONSOLIDER-INGENIO 2010 Program CSD2007-00012. GD was/nsupported by the ERC Advanced Grant: DYSTRUCTURE (n. 295129), by the Spanish/nResearch Project SAF2010-16085 and by the CONSOLIDER-INGENIO 2010 Program/nCSD2007-00012, and the FP7-ICT BrainScales and Coronet. RR was supported by/ngrants from the Dirección de Personal Académico de la Universidad Nacional/nAutónoma de México and the Consejo Nacional de Ciencia y Tecnología