Utilization of an Electronic Best Practice Advisory Decreases Brain Computed Tomography in an Academic Emergency Department Setting

More than 1.3 million people seek emergency care following a mild traumatic brain injury (MTBI) each year. While most MTBI patients are safely discharged, a small proportion experience serious intracranial processes. The wide availability of computed tomography (CT) has generated a dramatic increase in the number of CTs performed to identify those patients with clinically important traumatic brain injury (ciTBI), generating expense and radiation exposure risks for patients. To address unwarranted variation in practice, we implemented an electronic best practice advisory (eBPA) based upon a validated clinical prediction rule that appears when emergency department (ED) clinicians order CT following MTBI

Adverse Childhood Experiences in Rural and Urban Contexts

Recent research shows that rural children are more likely than urban children to experience certain kinds of adversity. Researchers at the Maine Rural Health Research Center looked at how adverse childhood experiences (ACEs) have affected rural and urban adults. Using data from the Behavioral Risk Factor Surveillance System Assessment, this study found that, while the prevalence of ACEs was comparable in rural and urban adults, over half of rural adults surveyed reported having ACE exposure.Among those with any ACE history, about one quarter experienced four or more ACEs. Policy implications and strategies are highlighted in this brief. Key Findings: Past research has shown that adverse childhood experiences (ACEs) have long-term, negative implications for health and well-being: as the number of ACEs increases, the risk for health problems in adulthood rises. Adverse childhood experiences (ACEs) are a significant problem among rural adults. Over half of rural residents reported some ACE exposure, and over one in ten reported high levels of exposure (four or more ACEs). After adjustment for demographics, rural and urban populations showed similar odds of experiencing high-level ACE exposure. Rural primary care providers can play a leadership role in forging community partnerships to raise public awareness about ACEs, conduct ACE-focused community needs assessments, and launch initiatives to create new services geared toward building resilience in families

Epidemiology of companion animal AMR in the United States of America: filling a gap in the one health approach

IntroductionAntimicrobial resistance (AMR) is a global health concern that affects all aspects of the One Health Triad, including human, animal, and environmental health. Companion animals, such as cats and dogs, may contribute to the spread of AMR through their close contact with humans and the frequent prescription of antimicrobials. However, research on AMR in companion animals is limited, and there are few surveillance measures in place to monitor the spread of resistant pathogens in the United States.MethodsThis study aims to explore the practicality of using data from commercial laboratory antimicrobial susceptibility testing (AST) services for epidemiological analyses of AMR in companion animals in the United States.ResultsThe study analyzed 25,147,300 individual AST results from cats and dogs submitted to a large commercial diagnostic laboratory in the United States between 2019 and 2021, and found that resistance to certain antimicrobials was common in both E. coli and S. pseudintermedius strains.ConclusionThere has been a paucity of information regarding AMR in companion animals in comparison to human, environmental and other animal species. Commercial AST datasets may prove beneficial in providing more representation to companion animals within the One Health framework for AMR

Retrospective Survey of Dog and Cat Endoparasites in Ireland: Antigen Detection

Endoparasites of dogs and cats, play an important role in both veterinary medicine and public health. Untreated and stray dogs and cats, in particular, play an important role in contaminating the environment with important zoonotic parasites. Thus, the aim of this study was to estimate the prevalence of intestinal parasites in stray dogs and cats using highly sensitive and specific copro-antigen tests. Archive faecal samples from previous surveys conducted between 2016–2019 from dogs (n = 789) and cats (n = 241) were included in this study. The IDEXX Fecal Dx™ antigen panel was used for the detection of Toxocara, hookworms, Trichuris and the SNAP™ Giardia antigen assay was used for the detection of Giardia infection. Giardia duodenalis was the most common parasite (26%, n = 205) detected in the dogs, followed by ascarids (17.6%, n = 139) and hookworms (5.3%, n = 42). Trichuris vulpis was only detected in 1 dog. Ascarids (23.2%, n = 56) was the most common parasite detected in the cats, followed by Giardia (12.9%, n = 31) and hookworms (n = 7, 2.9%). No whipworms were detected in cats. Overall, there was little difference in the positivity between sexes in both dogs and cats. However, in terms of age, adolescent dogs (G. duodenalis and ascarids being the most prevalent. This study shows a high prevalence of parasite infection in untreated and stray dogs and cats in the greater Dublin area in Ireland. Since they live in synanthropic conditions and can roam over vast distances they can contaminate public areas and pose a risk to both humans and owned pets that utilise these spaces. It is therefore important to raise public awareness and increase the knowledge on zoonotic parasites

Mental Health First Aid in Rural Communities: Appropriateness and Outcomes

Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health (BH) in rural communities by encouraging treatment-seeking. This study examined MHFA\u27s appropriateness and impacts in rural contexts, using a mixed-methods approach to study MHFA trainings conducted from November 2012 through September 2013 in rural communities across the country. Findings show that MHFA appears aligned with some key rural needs. MHFA may help to reduce unmet need for BH treatment in rural communities by raising awareness of BH issues and mitigating stigma, thereby promoting appropriate treatment-seeking. However, rural infrastructure deficits may limit some communities’ ability to meet new demand generated by MHFA. MHFA may help motivate rural communities to develop initiatives for strengthening infrastructure, but additional tools and consultation may be needed

A retrospective evaluation of the relationship between symmetric dimethylarginine, creatinine and body weight in hyperthyroid cats.

Hyperthyroidism in cats can mask changes in renal function, including chronic kidney disease (CKD), because of hyperfiltration and muscle loss. Symmetric dimethylarginine (SDMA) has been shown to increase earlier than creatinine in cats with renal dysfunction, and, unlike creatinine, SDMA is not impacted by lean muscle mass. The aim of this study was to describe the relationship between SDMA, creatinine, body weight and TT4 over time during treatment of hyperthyroidism. Cats were retrospectively identified from the US IDEXX Reference Laboratories database where TT4, SDMA and creatinine were measured on the same cat at multiple time points. A hyperthyroid treated group was identified (TT4 ≤ 4.7 μg/dL and decreased by a minimum of 2.5 μg/dL) that had body weight and laboratory results available from more than one visit, and was used to evaluate body weight, creatinine, SDMA and TT4 pre-treatment and at 1-30, 31-60, 61-90, 91-120 days post-treatment. Creatinine significantly decreased with increasing concentrations of TT4 (Spearman's ρ = -0.37, P < 0.001), whereas SDMA did not. Body weight, SDMA and creatinine concentrations significantly increased during the immediate 1-30 day post-treatment period (P < 0.012, P < 0.001, P < 0.001, respectively). During treatment creatinine continued to increase as cats gained weight. In contrast, SDMA remained stable during treatment and was comparable to age-matched control cats. Therefore, SDMA may be a more reliable biomarker of renal function than creatinine in hyperthyroid cats before and during treatment

Assessing the potential for infections of Echinococcus multilocularis in dogs in a hotspot of human alveolar echinococcosis infections in North America

Echinococcus multilocularis is a zoonotic tapeworm, whose metacestode larval stage is the etiological agent for alveolar echinococcosis in humans and is a parasite of emerging concern according to the World Health Organization which is difficult to diagnose and has a case mortality rate of &gt;90% when left untreated. Echinococcus multilocularis requires two mammalian hosts to complete its lifecycle: wild and domestic canids as definitive hosts, and small mammals (mostly rodents) as intermediate ones. Because of their close relations with humans, domestic dogs have been indicated as a mean of infection to people. Alveolar echinococcosis has historically been rare in North America, however, since 2013, at least seventeen diagnoses have been confirmed in Alberta, Canada. Because of this unprecedented series of cases, assessing the frequency of infections in dogs in Alberta is key to estimate risk for dog owners and animal health professionals. This study was carried out in Edmonton to determine the frequency of E. multilocularis infection in domestic dogs and potential risk factors. Fecal samples and corresponding behavior risk surveys were collected from 775 dogs in seven urban off-leash parks within Edmonton city limits during the summer of 2020. A quantitative PCR fecal test was used to diagnose E. multilocularis infection. We found a single case of E. multilocularis infection (1/775) and determined that the overall true prevalence was 0.2% (95% CI: 0.0–0.8%) corrected for detection sensitivity and specificity. Overall, these findings confirm the presence of E. multilocularis infection in domestic dogs in Edmonton although further work is required to fully understand the risk factors that may contribute to infection and potential transmission to humans

A Clinical Study on Urinary Clusterin and Cystatin B in Dogs with Spontaneous Acute Kidney Injury

Novel biomarkers are needed in diagnosing reliably acute kidney injury (AKI) in dogs and in predicting morbidity and mortality after AKI. Our hypothesis was that two novel tubular biomarkers, urinary clusterin (uClust) and cystatin B (uCysB), are elevated in dogs with AKI of different etiologies. In a prospective, longitudinal observational study, we collected serum and urine samples from 18 dogs with AKI of different severity and of various etiology and from 10 healthy control dogs. Urinary clusterin and uCysB were compared at inclusion between dogs with AKI and healthy controls and remeasured one and three months later. Dogs with AKI had higher initial levels of uClust (median 3593 ng/mL; interquartile range [IQR]; 1489–10,483) and uCysB (554 ng/mL; 29–821) compared to healthy dogs (70 ng/mL; 70–70 and 15 ng/mL; 15–15; p < 0.001, respectively). Initial uCysB were higher in dogs that died during the one-month follow-up period (n = 10) (731 ng/mL; 517–940), compared to survivors (n = 8) (25 ng/mL; 15–417 (p = 0.009). Based on these results, uClust and especially uCysB are promising biomarkers of AKI. Further, they might reflect the severity of tubular injury, which is known to be central to the pathology of AKI