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OBJECTIVE To characterize objective and subjective elements of the personal lives of American College of Veterinary Surgeons (ACVS) diplomates and identify elements of personal life associated w ith professional life or career success. SAMPLE 836 ACVS diplomates. PROCEDURES An 8 1-item questionnaire was sent to 1,450 diplomates in 2015 via email and conducted by means of an online platform. Responses were analyzed to summarize trends and identify associations among selected variables. RESULTS Men were more likely than women to be married or in a domestic partnership (88% vs 68%, respectively) and to have children (77% vs 47%). Among women but not men, respondents in large animal practice were less likely than were those in small animal practice to be represented in these categories. Women had children later in their career than did men and indicated that the ir stage of training played an im portant role in family planning. Respondents with children worked significantly fewer hours than did those with out children, with a greater reduction in hours fo r women versus men (6.0 vs 3.1 hours, respectively). Women were more likely to require external childcare services than were men. Women were more likely to report that having children had negatively impacted th e ir professional lives. No negative associations between measures of professional success (eg, advancement or personal income) and parenthood were identified. CONCLUSIONS AND CLINICAL RELEVANCE Family demographics differed between male and female ACVS diplomates, yet no objective impact on career success was identified. Work-life balance may play an important role in recruitment, retention, and job satisfaction of veterinary surgeons. [ABSTRACT FROM AUTHOR]

Psychiatry residents are required to be exposed to community psychiatry. Historically, this occurred in public hospitals or assertive community treatment (ACT) teams. A new model of psychiatric care delivery, integrated care, has become prevalent. While integrated care shares some features with traditional community psychiatry rotations, no research exists to demonstrate if integrated care rotations can accomplish the aims of traditional rotations. This pilot study compared learning outcomes in ACT team rotations versus integrated care rotations. Pre- and post-rotation surveys were disseminated to third-year psychiatry residents (N = 8) who were randomized to complete a rotation with an ACT team or an integrated care team. By rotation end, many in both settings changed how conservative they were in treatment philosophies, but this did not result in a difference between groups. Residents in both groups were satisfied with their rotations. Training in integrated care may be a reasonable alternative to traditional community psychiatry rotations. [ABSTRACT FROM AUTHOR]

Effect of PR Interval on CRT Outcomes Background Prolonged PR intervals may impair atrioventricular mechanical coupling and adversely affect cardiac performance. We hypothesize that patients with advanced systolic heart failure, wide QRS complexes, and prolonged PR intervals will have improved survival from CRT-D regardless of whether left bundle branch block (LBBB) or non-LBBB is present. Methods and Results A total of 308 patients enrolled in the optimal pharmacologic therapy (OPT) and 595 patients in the cardiac resynchronization therapy with defibrillation (CRT-D) arms of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial were stratified according to normal (≤230 ms) or prolonged PR interval (>230 ms). The incidence of all-cause mortality (ACM) or hospitalization (primary endpoint) and ACM (secondary endpoint) was compared using Kaplan-Meier curves. Cox proportional hazards models for the primary and secondary endpoints were fit with LBBB status and baseline PR interval. CRT-D treatment reduced both hospitalization/ACM (P = 0.002) and ACM (P = 0.003) compared to OPT. However, CRT-D was increasingly more effective in reducing ACM hazard in patients with longer baseline PR intervals (P = 0.002) regardless of LBBB status. In particular, in the prolonged baseline PR interval subgroup, ACM was reduced with CRT-D compared to OPT (P = 0.001) with little evidence of ACM reduction in the normal PR subgroup (P = 0.07). Conclusions In patients with advanced systolic heart failure, wide QRS complexes, and prolonged PR intervals, restoration of atrioventricular mechanical coupling with CRT-D may improve survival regardless of LBBB status. In patients with non-LBBB, a benefit from CRT-D may occur with prolonged PR intervals. [ABSTRACT FROM AUTHOR]

Abstract: Background: Lateral epicondylosis is a prevalent and costly musculoskeletal disorder characterized by degeneration of the common extensor tendon origin at the lateral epicondyle. Grip strength is commonly affected due to lateral epicondylosis. However, less is known about the effect of lateral epicondylosis on other functional parameters such as ability to react to rapid loading. Methods: Twenty-nine lateral epicondylosis participants and ten controls participated in a case-control study comparing mechanical parameters (mass, stiffness and damping), magnetic resonance imaging signal intensity and grip strength of injured and uninjured limbs. A mixed effects model was used to assess the effect of dominance and injury on mechanical parameters and grip strength. Findings: Significant effect of injury and dominance was observed on stiffness, damping and grip strength. An injured upper limb had, on average, 18% less stiffness (P <0.01, 95% CI [9.8%, 26%]), 21% less damping (P <0.01, 95% CI [11%, 31%]) and 50% less grip strength (P <0.01, 95% CI [37%, 61%]) than an uninjured upper limb. The dominant limb had on average 15% more stiffness (P <0.01, 95% CI [8.0%, 23%], 33% more damping (P <0.01, 95% CI [22%, 45%]), and 24% more grip strength (P <0.01, 95% CI [6.6%, 44%]) than the non-dominant limb. Interpretation: Lower mechanical parameters are indicative of a lower capacity to oppose rapidly rising forces and quantify an important aspect of upper limb function. For individuals engaged in manual or repetitive activities involving the upper limb, a reduction in ability to oppose these forces may result in increased risk for injury or recurrence. [Copyright &y& Elsevier]

Abstract: Objectives: To determine reference intervals for bioavailable testosterone for the Siemens Centaur analyzer and to assess the need for ethnicity-specific ranges for total testosterone and/or bioavailable testosterone in South Asians. Design and methods: Testosterone was measured before and after ammonium sulphate precipitation on specimens collected from a small cohort of healthy male South Asians and Europeans. Results: Inter-ethnicity differences in BioT and TT were not significant. Age-specific BioT reference intervals are reported. Conclusions: Ethnicity-specific TT and BioT reference intervals for South Asians do not appear necessary. [Copyright &y& Elsevier]

Abstract: Background: : Calculated quantities that combine results of multiple laboratory tests have become popular for screening, risk evaluation, and ongoing care in medicine. Many of these are ratios. In this paper, we address the specific issue of propagated random analytical error in calculated ratios. Methods: : Standard error propagation theory is applied to develop an approximate formula for the mean, standard deviation (SD), and coefficient of variation (CV) of the ratio of two independent, normally distributed random variables. A method of mathematically modeling the problem by random simulations to validate these formulas is proposed and applied. Comparisons are made with the commonly quoted formula for the CV of a ratio. Results: : The approximation formula for the CV of a ratio R = X/Y of independent Gaussian random variables developed herein has an absolute percentage error less than 4% for CVs of less than 20% in Y. In contrast the commonly quoted formula has a percentage error of up to 16% for CVs of less than 20% in Y. Conclusion: : The usual formula for the CV of a ratio functions well when the CV of the denominator is less than 10% but for larger CVs, the formula proposed here is more accurate. Random analytical error in calculated ratios may be larger than clinicians and laboratorians are aware. The magnitude of the propagated error needs to be considered when interpreting calculated ratios in the clinical laboratory, especially near medical decision limits where its effect may lead to erroneous conclusions. [Copyright &y& Elsevier]

Purpose: Normative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies. Methods: The growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion's superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances. Results: Growth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region. Conclusions: Our findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions. [ABSTRACT FROM AUTHOR]

Background: Postcancer work limitations may affect a substantial proportion of patients and contribute to the "financial toxicity" of cancer treatment. The degree and nature of work limitations and employment outcomes are poorly understood for cancer patients, particularly in the immediate period of transition after active treatment. We prospectively examined employment, work ability, and work limitations during and after treatment. Methods: A total of 120 patients receiving curative therapy who were employed prior to their cancer diagnosis and who intended to work during or after end of treatment (EOT) completed surveys at baseline (pretreatment), EOT, and 3, 6, and 12 months after EOT. Surveys included measures of employment, work ability, and work limitations. Descriptive statistics (frequencies, percentages, means with standard deviations) were calculated. Results: A total of 111 participants completed the baseline survey. On average, participants were 48 years of age and were mostly white (95%) and female (82%) with a diagnosis of breast cancer (69%). Full‐time employment decreased during therapy (from 88% to 50%) and returned to near prediagnosis levels by 12‐month follow‐up (78%). Work‐related productivity loss due to health was high during treatment. Conclusions: This study is the first to report the effects of curative intent cancer therapy on employment, work ability, and work limitations both during and after treatment. Perceived work ability was generally high overall 12 months after EOT, although a minority reported persistent difficulty. A prospective analysis of factors (eg, job type, education, symptoms) most associated with work limitations is underway to assist in identifying at‐risk patients. Adjuvant therapy for cancer can have a negative effect on a patient's ability to work, but the degree of work limitation due to cancer treatment has not been captured prospectively in a longitudinal fashion. This prospective study of patients with cancer receiving adjuvant chemotherapy who worked during cancer treatment reveals that most patients eventually returned to the same level of work that they had performed before treatment. [ABSTRACT FROM AUTHOR]

Background: Patients with diabetes and acute coronary syndrome (ACS) are at high risk for subsequent heart failure. Apabetalone is a selective inhibitor of bromodomain and extra-terminal (BET) proteins, epigenetic regulators of gene expression. Preclinical data suggest that apabetalone exerts favorable effects on pathways related to myocardial structure and function and therefore could impact subsequent heart failure events. The effect of apabetalone on heart failure events after an ACS is not currently known. Methods: The phase 3 BETonMACE trial was a double-blind, randomized comparison of apabetalone versus placebo on the incidence of major adverse cardiovascular events (MACE) in 2425 patients with a recent ACS and diabetes. This prespecified secondary analysis investigated the impact of apabetalone on hospitalization for congestive heart failure, not previously studied. Results: Patients (age 62 years, 74.4% males, 90% high-intensity statin use, LDL-C 70.3 mg/dL, HDL-C 33.3 mg/dL and HbA1c 7.3%) were followed for an average 26 months. Apabetalone treated patients experienced the nominal finding of a lower rate of first hospitalization for heart failure (2.4% vs. 4.0%, HR 0.59 [95%CI 0.38–0.94], P = 0.03), total number of hospitalizations for heart failure (35 vs. 70, HR 0.47 [95%CI 0.27–0.83], P = 0.01) and the combination of cardiovascular death or hospitalization for heart failure (5.7% vs. 7.8%, HR 0.72 [95%CI 0.53–0.98], P = 0.04). Conclusion: Apabetalone treatment was associated with fewer hospitalizations for heart failure in patients with type 2 diabetes and recent ACS. Future studies are warranted to define the potential for BET inhibition with apabetalone to prevent heart failure in patients with diabetes and ACS. [ABSTRACT FROM AUTHOR]

Importance: Bromodomain and extraterminal proteins are epigenetic regulators of gene transcription. Apabetalone is a selective bromodomain and extraterminal protein inhibitor targeting bromodomain 2 and is hypothesized to have potentially favorable effects on pathways related to atherothrombosis. Pooled phase 2 data suggest favorable effects on clinical outcomes.Objective: To test whether apabetalone significantly reduces major adverse cardiovascular events.Design, Setting, and Participants: A randomized, double-blind, placebo-controlled trial, conducted at 190 sites in 13 countries. Patients with an acute coronary syndrome in the preceding 7 to 90 days, type 2 diabetes, and low high-density lipoprotein cholesterol levels were eligible for enrollment, which started November 11, 2015, and ended July 4, 2018, with end of follow-up on July 3, 2019.Interventions: Patients were randomized (1:1) to receive apabetalone, 100 mg orally twice daily (n = 1215), or matching placebo (n = 1210) in addition to standard care.Main Outcomes and Measures: The primary outcome was a composite of time to the first occurrence of cardiovascular death, nonfatal myocardial infarction, or stroke.Results: Among 2425 patients who were randomized (mean age, 62 years; 618 women [25.6%]), 2320 (95.7%) had full ascertainment of the primary outcome. During a median follow-up of 26.5 months, 274 primary end points occurred: 125 (10.3%) in apabetalone-treated patients and 149 (12.4%) in placebo-treated patients (hazard ratio, 0.82 [95% CI, 0.65-1.04]; P = .11). More patients allocated to apabetalone than placebo discontinued study drug (114 [9.4%] vs 69 [5.7%]) for reasons including elevations of liver enzyme levels (35 [2.9%] vs 11 [0.9%]).Conclusions and Relevance: Among patients with recent acute coronary syndrome, type 2 diabetes, and low high-density lipoprotein cholesterol levels, the selective bromodomain and extraterminal protein inhibitor apabetalone added to standard therapy did not significantly reduce the risk of major adverse cardiovascular events.Trial Registration: ClinicalTrials.gov Identifier: NCT02586155. [ABSTRACT FROM AUTHOR]

BACKGROUND Testosterone treatment in men with hypogonadism improves bone density and quality, but trials with a sufficiently large sample and a sufficiently long duration to determine the effect of testosterone on the incidence of fractures are needed. METHODS In a subtrial of a double-blind, randomized, placebo-controlled trial that assessed the cardiovascular safety of testosterone treatment in middle-aged and older men with hypogonadism, we examined the risk of clinical fracture in a time-to-event analysis. Eligible men were 45 to 80 years of age with preexisting, or high risk of, cardiovascular disease; one or more symptoms of hypogonadism; and two morning testosterone concentrations of less than 300 ng per deciliter (10.4 nmol per liter), in fasting plasma samples obtained at least 48 hours apart. Participants were randomly assigned to apply a testosterone or placebo gel daily. At every visit, participants were asked if they had had a fracture since the previous visit. If they had, medical records were obtained and adjudicated. RESULTS The full-analysis population included 5204 participants (2601 in the testosterone group and 2603 in the placebo group). After a median follow-up of 3.19 years, a clinical fracture had occurred in 91 participants (3.50%) in the testosterone group and 64 participants (2.46%) in the placebo group (hazard ratio, 1.43; 95% confidence interval, 1.04 to 1.97). The fracture incidence also appeared to be higher in the testosterone group for all other fracture end points. CONCLUSIONS Among middle-aged and older men with hypogonadism, testosterone treatment did not result in a lower incidence of clinical fracture than placebo. The fracture incidence was numerically higher among men who received testosterone than among those who received placebo. [ABSTRACT FROM AUTHOR]

Background: Survivorship care plans (SCPs) and care-planning sessions have been recommended for over a decade, yet evidence for their benefit remains mixed. In a randomized trial, changes in survivor knowledge and satisfaction before and after the receipt of an SCP were assessed.Methods: Patients with breast cancer who had completed curative-intent treatment were randomized to immediate versus delayed receipt of an individualized SCP. All participants completed the modified Wisconsin Survey of Cancer Diagnosis and Management in Breast Cancer and the Preparing for Life As a New Survivor survey to assess individual knowledge about cancer diagnosis, treatment, side effects, and follow-up as well as satisfaction with communication and care coordination. Surveys were completed at baseline, at 4 weeks (before delayed receipt), and again at 12 weeks (after all participants had received SCPs); the primary outcome was change in knowledge at 4 weeks.Results: In total, 127 eligible women were randomized. An improvement in individual knowledge was observed between baseline and week 12 for both arms combined (+1.6; 95% confidence interval, 0.9-2.3; P < .001). There was no statistically significant difference in the change in knowledge from baseline through week 4 between the arms. No significant change occurred for satisfaction scores over time.Conclusions: This randomized trial of immediate versus delayed SCP receipt demonstrated a small improvement (4%) in survivor knowledge. However, this improvement did not appear to be related to SCP provision. The authors hypothesized that the improvement was because of repeated administration of the knowledge survey. If improved survivor knowledge is a goal, then strategies beyond the 1-time provision and review of an SCP should be explored. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate potential risk factors for development of primary angle-closure glaucoma (PACG) in Bouviers des Flandres. DESIGN Prospective, observational study. ANIMALS 98 Bouviers des Flandres. PROCEDURES All dogs underwent slit-lamp biomicroscopy, indirect ophthalmoscopy, gonioscopy, applanation tonometry, streak retinoscopy, and A-scan, B-scan, and high-resolution ultrasonography. Iridocorneal angles and degree of pectinate ligament dysplasia sheeting were graded, and an angle index was mathematically derived for each eye on the basis of these values. Ciliary clefts evaluated by high-resolution ultrasonography were classified as open, narrow, or closed. Owners were contacted by telephone 7 to 9 years after the initial examination to determine whether dogs had a subsequent diagnosis of PACG. Relationships between previously recorded variables and the development of PACG were evaluated by logistic regression methods. Available pedigrees were reviewed to assess genetic relationships among affected dogs. RESULTS 9 of 92 (9.8%) dogs with follow-up information available developed PACG. An angle index < 1 and presence of a narrow or closed ciliary cleft in 1 or both eyes were each significantly associated with development of PACG. Odds of developing PACG for dogs with an angle index < 1 (indicating marked reduction in outflow capacity through the iridocorneal angle), a narrow or closed ciliary cleft in > 1 eye, or both findings were 13, 20, and 28 times those for dogs that did not have these findings, respectively. All dogs that developed PACG shared 1 common male sire or grandsire. CONCLUSIONS AND CLINICAL RELEVANCE Several anatomic factors were significant risk factors for development of PACG in this population of dogs. Results also suggested a genetic component for the disease. [ABSTRACT FROM AUTHOR]

Purpose: Atypical vowel production contributes to reduced speech intelligibility in children and adults with Down syndrome (DS). This study compares the acoustic data of the corner vowels /i/, /u/, /æ/, and /ɑ/ from speakers with DS against typically developing/developed (TD) speakers. Method: Measurements of the fundamental frequency (fo) and first four formant frequencies (F1–F4) were obtained from single word recordings containing the target vowels from 81 participants with DS (ages 3–54 years) and 293 TD speakers (ages 4–92 years), all native speakers of English. The data were used to construct developmental trajectories and to determine interspeaker and intraspeaker variability. Results: Trajectories for DS differed from TD based on age and sex, but the groups were similar with the striking change in fo and F1–F4 frequencies around age 10 years. Findings confirm higher fo in DS, and vowel-specific differences between DS and TD in F1 and F2 frequencies, but not F3 and F4. The measure of F2 differences of front-versus-back vowels was more sensitive of compression than reduced vowel space area/centralization across age and sex. Low vowels had more pronounced F2 compression as related to reduced speech intelligibility. Intraspeaker variability was significantly greater for DS than TD for nearly all frequency values across age. Discussion: Vowel production differences between DS and TD are age- and sex-specific, which helps explain contradictory results in previous studies. Increased intraspeaker variability across age in DS confirms the presence of a persisting motor speech disorder. Atypical vowel production in DS is common and related to dysmorphology, delayed development, and disordered motor control. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses guidelines for statistical analysis plans (SAPs) which deal with the design, monitoring, and reporting of randomized clinical trials, and it mentions another article in the same issue of the journal which examines the content of a SAP. According to the article, clear statements of hypotheses, descriptions of trial designs, and SAPs should be prepared in advance of randomized clinical trials.

Reply to The effects of curative-intent cancer therapy on employment, work ability, and work limitations Additionally, stage may not reflect what treatment will be rendered, especially in a cancer population in which treatment is driven by receptor status (eg, breast). Kobayashi et al stated, "The authors collected information before the initiation of cancer treatment (baseline information).". [Extracted from the article]

Purpose: The Institute of Medicine (IOM) recommends cancer survivors receive survivorship care plans after completing active cancer treatment. However, care plan creation requires significant time and effort, contributing to diminished adoption of this recommendation. Electronic health record (EHR) systems have been proposed as a solution. We assessed the feasibility of creating and delivering care plans within an EHR system. Methods: Thirty-eight breast cancer survivors without existing care plans were recruited during a follow-up visit to their primary oncologist. Using an EHR template, an oncologist created an individualized care plan for each participant. Time spent creating each plan was recorded. Participant use and feedback were collected. Results: Participants enrolled a median of 19.7 months after diagnosis (range, 4.3 to 57 months). A minority of IOM-recommended plan elements could be automatically imported without any manual entry. The majority of elements required interpretation and manual import by the clinician. However, with an established infrastructure for importing elements, the time needed to create a care plan electronically was short (median, 3 minutes; range 2 to 12 minutes). Most survivors (n = 36; 95%) successfully accessed their care plans online and spent a median of 12 minutes (range, 0.5 to 61.9 minutes) reviewing them. Survivors perceived the plans as useful and did not generally report difficulty in accessing them online or understanding content. Conclusion: Rapid care plan creation and delivery within an EHR is possible. Plans were available to all (survivors, oncologists, primary care physicians) via the EHR. Further research is required to explore the barriers to automating data importation into plans as well as the impact of EHR-integrated plans. [ABSTRACT FROM AUTHOR]

Abstract: Background : The atherogenic index of plasma (AIP), defined as the base 10 logarithm of the ratio of plasma triglyceride (TG) to high density lipoprotein cholesterol (HDL-C), has been employed as a predictor of cardiovascular risk. We seek to quantify the analytical precision of the AIP using the coefficients of variation (CVs) of the TG and HDL-C assays. Methods : Error propagation methods are employed to develop a simple formula for the standard deviation of the random analytical error in the AIP assuming that the errors in the TG and HDL-C assays are normally distributed. An alternative derivation assuming log-normal distribution of errors gives nearly identical results while avoiding subtle technical problems. Results : The SD of the AIP is given by and this formula will provide SD results that are accurate within 0.4% for CVs of TG and HDL-C less than 5%, as compared with results of Monte Carlo simulation. We also explain that the concept of CV cannot be applied to the AIP since it is a logarithm. Conclusions : The formula provides a simple means to quantify the precision of the AIP from precision data available for the TG or HDL-C assays. [Copyright &y& Elsevier]

To assess the effects of two sizes of silicone endotracheal tubes with internal diameter 26 mm (ETT 26) and 30 mm (ETT 30) inflated to minimum occlusive volume on tracheal and laryngeal mucosa of adult horses anesthetized for 2 hours with isoflurane. Prospective, randomized, blinded, crossover experimental study. A total of eight healthy adult mares. Upper airway endoscopy and ultrasound measurements of internal tracheal diameter were performed the day before anesthesia. Horses were anesthetized and orotracheally intubated with ETT 26 or ETT 30. Ease of intubation was scored. The cuff was inflated in 10 mL increments to produce a seal. Final volume of air used and intracuff (IC) pressure (measured by pressure transducer) were recorded. At the end of anesthesia, a manometer was used to measure IC pressure and these measurements compared against measurements from the pressure transducer. Laryngeal and tracheal mucosa were assessed via endoscopy and assigned a score 0–3 before anesthesia, and at 2 and 24 hours following extubation. Data are from seven horses because one horse with laryngeal hemiplegia was excluded. Mean tracheal ultrasound measurement was 3.5 ± 0.4 cm. No significant differences were noted between endotracheal tube sizes for intubation score, IC pressures, inflation volumes or tracheal or laryngeal injury scores at any time point. IC pressure measured by manometer was slightly higher than that by transducer (+1.0 ± 2.8 mmHg). Results identified no clear advantage of one endotracheal tube size over the other in the population of horses studied, when endotracheal intubation is properly applied and IC pressure is carefully monitored. However, given that ETT 26 was associated with the highest observed IC pressures and the only observed incidents of tracheal circumferential erythema, the larger ETT 30 may be the better choice in most cases where tracheal size is sufficient. [ABSTRACT FROM AUTHOR]

Background: Barriers to achieving work‐life balance, as well as gender‐based differences, exist in the male‐dominated surgical specialty in veterinary medicine. Similar information does not exist for the more feminized American College of Veterinary Internal Medicine (ACVIM). Hypothesis/Objectives: To provide data on the professional and personal lives of Diplomates of the ACVIM so as to help define the state of the specialty, including gender‐related differences, and identify areas requiring intervention to improve work‐life balance. Sample A total of 896 surveys (781 completed) of Diplomates of the ACVIM, including cardiology, large animal internal medicine, neurology, oncology, and small animal internal medicine. Methods: An 82‐item online survey was distributed in February 2017 to ACVIM Diplomates via their respective ACVIM listserv. Participation was voluntary. Results: Thirty percent of the total ACVIM registered membership responded and 26% completed surveys; 25% were men and 75% were women. Specialists in academia worked significantly more hours, with larger numbers of diplomates per specialty section, and made less money compared with those in private practice. Women were less likely to report full‐time employment, practice ownership, or higher academic rank, and reported 20% lower income overall (after adjustment for relevant factors) as compared with men. Men and women differed in their subjective assessment of the effect of gender in the workplace. Eighty‐three percent of respondents were somewhat satisfied or better with their career. Conclusions and Clinical Importance: Specialization in the ACVIM is a satisfying and potentially profitable career. However, despite a highly feminized workforce, significant gender‐related imbalances are evident. [ABSTRACT FROM AUTHOR]

Background: In the field of veterinary surgery, women neither marry nor have children at the same rate as men, and those who do may experience more career disruption as a result. The American College of Veterinary Internal Medicine (ACVIM) is 1 of the few areas of specialized medicine that is predominantly female; it is unknown if such a demographic shift would produce a different environment for individuals cultivating their personal life. Hypothesis/Objectives: To report data regarding subjective and objective aspects of the intersection of the personal and professional lives of Diplomates of the ACVIM. Sample Eight hundred ninety‐six surveys (781 completed) of ACVIM Diplomates, including cardiology, large and small animal internal medicine, neurology, and oncology. Methods: An 82‐item online survey was distributed to ACVIM Diplomates via Diplomate college listservs. Participation was voluntary. Results: Men were more likely to be married and have children than were women. Women had or adopted their first child at a later career stage compared with men, and agreed more strongly that career stage was an influential factor in family planning. Those with children worked fewer hours compared with those without, and this effect was greater among women. Women were more likely to require external childcare, but most men and women shared childcare responsibilities equally outside of working hours. Conclusions and Clinical Importance: The intersection of personal and professional life differs between men and women in the ACVIM, which may create different needs, preferences, or barriers to work‐life balance in the workforce. [ABSTRACT FROM AUTHOR]

OBJECTIVE To characterize elements of employment, professional success, and personal life fo r American College of Veterinary Surgeons (ACVS) diplomates and identify elements of practice that may serve as barriers to work-life balance or affect men and women differently. SAMPLE 836 ACVS diplomates. PROCEDURES An 8 1-item questionnaire was sent to 1,450 ACVS diplomates in 2015 via email and conducted by means of an online platform. Responses were analyzed to identify associations among selected variables. RESULTS The survey response rate was 58% (836/1,450). The median age category among respondents was 41 to 45 years. The ra tio of male to female diplomates was equivalent among those < 40 years old. Respondents in small animal private practice worked the fewest number of hours; those in equine or large animal private practice worked the most and had the most on-call responsibility. Women were more likely than men to be employed in academia. In both private practice and academia, respondents in small animal practice earned more than did those in equine or large animal practice, and women earned less than did men, even a fter adjustment fo r relevant covariates. Women were less likely than men to be practice owners or to hold a prestigious academic title and rank. Perceptions about the effect of gender in the workplace differed between men and women. CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that the veterinary surgical profession is demanding fo r both genders, although increased fle x ib ility in certain areas may improve work-life balance. [ABSTRACT FROM AUTHOR]

Purpose Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. Results One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. Conclusion A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use. [ABSTRACT FROM AUTHOR]

Objective To compare rates of retinal detachment ( RD) postphacoemulsification in American Bichon Frises with and without prophylactic retinopexy. Procedures Medical records of 54 Bichon Frises undergoing phacoemulsification with or without prophylactic retinopexy between 2003 and 2013 in one or both eyes were reviewed from five Midwestern university veterinary teaching hospitals. Inclusion criteria were preoperative ERG, at least 6 months of follow-up postphacoemulsification, and the absence of preexisting RD as determined by ophthalmic examination and/or ultrasound. Statistical analyses were performed using chi-squared test, and Wilcoxon rank-sum tests and Wilson confidence intervals with the P-value <0.05 were considered significant. Results Phacoemulsification was performed without retinopexy in 79 eyes (42 dogs, non- PR group) and with prophylactic retinopexy in 23 eyes (12 dogs, PR group). Incidence of diabetes mellitus was 10/42 and 3/12 in the non- PR and the PR groups, respectively ( P = 0.93). Intraocular lens implantation was performed in 40/42 non- PR dogs and 11/12 PR dogs ( P = 0.63, 73/79 vs. 21/23 eyes). At final re-examination, RD occurred in 4/79 eyes without retinopexy, compared to 0/23 RD in the retinopexy group. There was no statistically significant difference in RD rates between the two groups ( P = 0.27). Conclusions These data provide no statistical evidence to support prophylactic retinopexy in Bichon Frises. Due to the low rate of retinal detachment following phacoemulsification without prophylactic retinopexy, the procedure appears to offer limited benefit to offset cost, procedural risk, and risk of extended or repeated anesthesia in Bichon Frises. [ABSTRACT FROM AUTHOR]

Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. Methods: PCPs (N = 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n = 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR. Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EH R-generated plans would disrupt clinic workflow (14%) or take too much time (11 %). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81 %) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion: Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to develop a reliable method for determining friction and pulling forces during a weighted sled pull conducted with different loads. After developing and testing the method researchers concluded that it was effective in determining friction and pulling forces.

Background: Inhibition of cholesteryl ester transfer protein (CETP) has been shown to have a substantial effect on plasma lipoprotein levels. We investigated whether torcetrapib, a potent CETP inhibitor, might reduce major cardiovascular events. The trial was terminated prematurely because of an increased risk of death and cardiac events in patients receiving torcetrapib. Methods: We conducted a randomized, double-blind study involving 15,067 patients at high cardiovascular risk. The patients received either torcetrapib plus atorvastatin or atorvastatin alone. The primary outcome was the time to the first major cardiovascular event, which was defined as death from coronary heart disease, nonfatal myocardial infarction, stroke, or hospitalization for unstable angina. Results: At 12 months in patients who received torcetrapib, there was an increase of 72.1% in high-density lipoprotein cholesterol and a decrease of 24.9% in low-density lipoprotein cholesterol, as compared with baseline (P<0.001 for both comparisons), in addition to an increase of 5.4 mm Hg in systolic blood pressure, a decrease in serum potassium, and increases in serum sodium, bicarbonate, and aldosterone (P<0.001 for all comparisons). There was also an increased risk of cardiovascular events (hazard ratio, 1.25; 95% confidence interval [CI], 1.09 to 1.44; P=0.001) and death from any cause (hazard ratio, 1.58; 95% CI, 1.14 to 2.19; P=0.006). Post hoc analyses showed an increased risk of death in patients treated with torcetrapib whose reduction in potassium or increase in bicarbonate was greater than the median change. Conclusions: Torcetrapib therapy resulted in an increased risk of mortality and morbidity of unknown mechanism. Although there was evidence of an off-target effect of torcetrapib, we cannot rule out adverse effects related to CETP inhibition. (ClinicalTrials.gov number, NCT00134264.) N Engl J Med 2007;357:2109-22. [ABSTRACT FROM AUTHOR]

The authors discuss a report about the original Hoffmann method that used normal probability paper to plot cumulative percentages against the measurement values.