Search

The veterinary profession has a unique responsibility to animals during the final stages of their lives. The veterinarian’s obligations extend to humane endings, involving all species of animals in a range of circumstances including, but not limited to, euthanasia of individually owned animals, euthanasia of animals for research purposes, depopulation of animals during emergencies, and slaughter of animals raised for food. The veterinary profession continues to improve animal welfare through advances in end-of-life decision-making and humane killing techniques,1–3 but the psychological impacts on veterinarians have not received the same level of consideration. Building on the influential AVMA Humane Endings Guideline, the AVMA recognizes that support for the mental health of veterinarians engaged in such activities needs to be a priority. This article aims to provide the foundation and rationale for improved preparation and establishment of sustainable mental health resources and to offer recommendations on pragmatic solutions to support and prepare veterinary professionals as leaders impacted by participation in humane endings–related activities. While end-of-life decision-making and implementation may present mental health challenges to veterinarians, it is crucial to recognize that there are stressors specific to each situation and that every individual’s experience is valid. Addressing the mental health issues surrounding the decision-making process and implementation of humane endings activities start with a comprehensive understanding of each activity’s unique context and the veterinarian’s leadership role. Therefore, this article highlights the psychological impact of depopulation and its similarities and exclusive challenges compared with euthanasia and humane slaughter.

On dryland hillslopes, vegetation water availability is often subsidized by the redistribution of rainfall runoff from bare soil (sources) to vegetation patches (sinks). In regions where rainfall volumes are too low to support spatially continuous plant growth, such functional connectivity between bare soil and vegetated areas enables the establishment and persistence of dryland ecosystems. Increasing the connectivity within bare soil areas can intensify runoff and increase water losses from hillslopes, disrupting this redistribution and reducing the water available to sustain ecosystem function. Inferring functional connectivity (from bare to vegetated, or within bare areas) from structural landscape features is an attractive approach to enable rapid, scalable characterization of dryland ecosystem function from remote observations. Such inference, however, would rely on metrics of structural connectivity, which describe the contiguity of bare soil areas. Several studies have observed non-stationarity in the relations between functional and structural connectivity metrics as rainfall conditions vary. Consequently, the suitability of using structural connectivity to provide a reliable proxy for functional connectivity remains uncertain and motivates the work here. Rainfall-runoff simulations across a wide range of dryland hillslopes, under varying soil and rainfall conditions, are used to establish relations between structural and functional connectivity metrics. The model results identify that the relations vary between two hydrologic limits -- a `local' limit, in which functional connectivity is related to structural connectivity, and a ‘global’ limit, in which functional connectivity is most related to the hillslope vegetation fraction regardless of the structural connectivity of bare soil areas. The transition between these limits within the simulations depends on rainfall intensity and duration, and soil permeability. While the local limit may strengthen positive feedbacks between vegetation and water availability, the implications of these limits for dryland functioning need further exploration, particularly considering the timescale separation between storm runoff production and vegetation growth.

Ethical frameworks are the foundation for any research with humans or nonhuman animals. Human research is guided by overarching international ethical principles, such as those defined in the Helsinki Declaration by the World Medical Association. However, for nonhuman animal research, because there are several sets of ethical principles and national frameworks, it is commonly thought that there is substantial variability in animal research approaches internationally and a lack of an animal research 'Helsinki Declaration', or the basis for one. We first overview several prominent sets of ethical principles, including the 3Rs, 3Ss, 3Vs, 4Fs and 6Ps. Then using the 3Rs principles, originally proposed by Russell & Burch, we critically assess them, asking if they can be Replaced, Reduced or Refined. We find that the 3Rs principles have survived several replacement challenges, and the different sets of principles (3Ss, 3Vs, 4Fs and 6Ps) are complementary, a natural refinement of the 3Rs and are ripe for integration into a unified set of principles, as proposed here. We also overview international frameworks and documents, many of which incorporate the 3Rs, including the Basel Declaration on animal research. Finally, we propose that the available animal research guidance documents across countries can be consolidated, to provide a similar structure as seen in the Helsinki Declaration, potentially as part of an amended Basel Declaration on animal research. In summary, we observe substantially greater agreement on and the possibility for unification of the sets of ethical principles and documents that can guide animal research internationally.

Hydrogen sulfide (H2S) plays a crucial signalling role in a variety of physiological systems, existing as the hydrosulfide anion (HS−) at physiological pH. Combining the potency of halogen bonding (XB) for anion recognition in water with coumarin fluorophore incorporation in acyclic host structural design, the first XB receptors to bind and, more importantly, sense the hydrosulfide anion in pure water in a reversible chemosensing fashion are demonstrated. The XB receptors exhibit characteristic selective quenching of fluorescence upon binding to HS−. Computational DFT and molecular dynamics simulations in water corroborate the experimental anion binding observations, revealing the mode and nature of HS− recognition by the XB receptors., Reversible chemosensing of hydrosulfide (HS−) in pure water is demonstrated using halogen bonding (XB) fluorescent hosts. The XB receptors exhibit characteristic selective quenching of fluorescence upon binding HS− whereas the hydrogen bonding receptor analogues proved incapable of functioning as chemosensors under aqueous conditions.

RATIONALE & OBJECTIVE: Traditional risk estimates for atherosclerotic vascular disease (ASVD) and death may not perform optimally in the setting of CKD. We sought to determine whether the addition of measures of inflammation and kidney function to traditional estimation tools improves prediction of these events in a diverse cohort of patients with CKD. STUDY DESIGN: Observational cohort study SETTING & PARTICIPANTS: 2399 Chronic Renal Insufficiency Cohort (CRIC) study participants without history of cardiovascular disease at study entry. PREDICTORS: Baseline plasma levels of biomarkers of inflammation (interleukin (IL)-1β, IL-1RA (IL-1 receptor antagonist), IL-6, tumor necrosis factor (TNF)-α, transforming growth factor β (TGFβ), high sensitivity C-Reactive protein (hs-CRP), fibrinogen, and serum albumin), measures of kidney function (estimated glomerular filtration rate (eGFR) and albuminuria), and the Pooled Cohort Equation Probability (PCEP) estimate. OUTCOMES: Composite of ASVD events (incident myocardial infarction (MI), peripheral arterial disease (PAD), and stroke) and death. ANALYTICAL APPROACH: Cox proportional hazard models adjusted for PCEP estimates, albuminuria, and eGFR. RESULTS: During a median follow-up of 7.3 years, 86, 61, 48, and 323 participants experienced MI, PAD, stroke, or death, respectively. 1-decile greater levels of IL-6 (adjusted Hazard Ratio [aHR], 1.12; 95% CI, 1.08-1.16; p

Earthquakes cause rock fracturing, opening new flow pathways which can result in the mixing of previously isolated geofluids with differing geochemistries. Here we present the first evidence that seismic events can significantly reduce groundwater pH without the requirement for fluid mixing, solely through the process of dynamic rock fracturing. At the Grimsel Test Site, Switzerland, we observe repeated, short-lived groundwater pH drops of 1-3.5 units, while major and minor ion groundwater concentrations remain constant. Acidification coincides with reservoir drainage and induced microseismic events. In laboratory experiments, we demonstrate that fresh rock surfaces made by particle cracking interact with the in situ water molecules, likely through creation of surface silanols and silica radicals, increasing the H+ concentration and significantly lowering groundwater pH. Our findings are significant; pH exerts a fundamental control on the rate and outcome of most aqueous geochemical reactions and microseismic events are commonplace, even in seismically inactive regions.

Compassion fatigue (CF) has been described in various "caring professions," particularly the human medical field. Recently, CF has been identified as a concern in animal care professions, specifically veterinary medicine. Despite the perception that veterinary personnel in animal research are at increased risk of CF, few studies have assessed CF in this population. The cur-rent cross-sectional study aimed to describe the prevalence of both CF and compassion satisfaction (CS) among active-duty veterinary personnel in Department of Defense animal research environments, using the Professional Quality of Life Scale (ProQOL). The ProQOL measures burnout and secondary traumatic stress as representative of compassion fatigue, while also measuring the inverse of CF, or CS. The current study set out to identify factors associated with both CF and CS. Validated scales of measurement were used to assess the frequency of exposures and outcomes of interest, while associations were analyzed using linear regression models. The study found that most survey respondents reported high levels of CS and low levels of BO and STS. Factors associated with higher levels of CF and lower CS included working with NHPs, difficulty working with primary investigators, loneliness, and euthanasia distress. These findings can inform future studies of CF in animal research environments and bolster initiatives to reduce occupational stress by the preventing and mitigating CF.

Robust event detection of low signal-to-noise ratio (SNR) events, such as those characterized as induced or triggered seismicity, remains a challenge. The reason is the relatively small magnitude of the events (usually less than 2 or 3 in Richter scale) and the fact that regional permanent seismic networks can only record the strongest events of a microseismic sequence. Monitoring using temporary installed short-period arrays can fill the gap of missed seismicity but the challenge of detecting weak events in long, continuous records is still present. Further, for low SNR recordings, commonly applied detection algorithms generally require pre-filtering of the data based on a priori knowledge of the background noise. Such knowledge is often not available. We present the NpD (Non-parametric Detection) algorithm, an automated algorithm which detects potential events without the requirement for pre-filtering. Events are detected by calculating the energy contained within small individual time segments of a recording and comparing it to the energy contained within a longer surrounding time window. If the excess energy exceeds a given threshold criterion, which is determined dynamically based on the background noise for that window, then an event is detected. For each time window, to characterize background noise the algorithm uses non-parametric statistics to describe the upper bound of the spectral amplitude. Our approach does not require an assumption of normality within the recordings and hence it is applicable to all datasets. We compare our NpD algorithm with the commonly commercially applied STA/LTA algorithm and another highly efficient algorithm based on Power Spectral Density using a challenging microseismic dataset with poor SNR. For event detection, the NpD algorithm significantly outperforms the STA/LTA and PSD algorithms tested, maximizing the number of detected events whilst minimizing the number of false positives.

A summary of the support given to paramedic students who attended the Manchester Arena bombing in May 2017.

In each issue, the paramedic education team at Edge Hill University focuses on the clinical skills carried out by paramedics on the frontline, highlighting the importance of these skills and how to perform them. Here, Sally Thompson discusses the importance of monitoring blood pressure trends in acutely ill or injured patients

Methods are lacking to characterize critical zone (CZ) structure at spatial scales relevant to earth system and dynamic global vegetation models. This knowledge gap results in poor quantification of CZ plant-available water storage capacity, hindering realistic prediction of the response of plants and streamflow to anticipated changes in the hydrological cycle. Here, we exploit the phase offset between water and energy delivery in rain-dominated Mediterranean climates to use plants as sensors to infer belowground water storage capacity. We hypothesize that if the magnitude of stored plant-available subsurface water is the primary control on dry season plant water use, then (remotely sensed) measures of transpiration may be used to infer rooting zone storage capacity. We encapsulate this idea within an ecohydrological modeling framework that describes how the stochastic properties of rainfall interact with storage capacity on intra-annual timescales to control annual variations in plant-available water storage, and thus dry season plant water use. The model reveals that where storage capacity is high relative to mean annual rainfall, plant-available water storage is not replenished in all years, and so storage and thus plant water use are sensitive to annual total rainfall. Where storage capacity is low, storage is typically replenished but can be depleted rapidly between storm events, resulting in plant insensitivity to annual total rainfall but sensitivity to spring rainfall patterns. Both high and low storage capacity result in relatively highly variable stored water for summer, and thus predicted highly variable summer transpiration; in contrast, variability is minimized at intermediate storage capacity. The model captures these diverse responses of stored water (and consequently summer vegetation water use) -- as mediated by water storage capacity -- to precipitation dynamics. Consequently, we show that a simple model inversion can be used to estimate rooting zone water storage capacity. We validate model inversion predictions using direct observations of plant-available water storage capacity in soils and weathered bedrock at two intensively monitored sites in the Northern California Coast Ranges. The model accurately predicts the magnitude of the combined dry season soil and rock moisture loss that supports transpiration, in contrast to existing soils maps, which underestimate plant-available water storage by up to a factor of three. Strongly contrasting weathering profiles and hence porosity structures at the study sites demonstrate the method is robust across diverse modes of storage and runoff generation.

Background In 2008 an end of life care government strategy cited research which showed that people don’t want to spend their last year or last days in hospital but this often occurred due to poorly coordinated crisis driven care. In response to this in 2013 the My Care Choices Register (MCCR) was launched to record end of life care choices for those living in north east Essex with an incurable illness, dementia and frailty. Aims A marketing campaign was commissioned by the North East Essex Health and Wellbeing Alliance in October 2018 with a budget of £50,000 with the aim to: Raise public awareness in north east Essex amongst local people about the MCCR; Enable potentially difficult conversations with loved ones; Enable more people to access the My Care Choices Register. Method An ‘elephant in the room’ campaign, with the elephant representing the conversation about future care including death and dying. The elephant appeared on backs of buses, bus tickets, bus stops, petrol nozzles, pharmacy bags, village publications, pens, mouse mats and key rings. We covered a diverse range of options to ensure we targeted as many people as possible. Segmenting this market was particularly difficult. The key promotional tool was an animation entitled ‘The elephant in the room’. Produced as a modest, yet sophisticated old style cartoon to appeal to all ages. It has the ability to be a ‘white label’ film to be used by other organisations wishing to promote advance care planning. Results 1083 new register entries were created between 1 October 2018 and 31 March 2019, a 22% increase in new entries from the same period in 2017/18. Conclusion A good budget and a simple idea can be very effective in promoting a sensitive and taboo subject, encouraging choice for people living with life limiting illness.

Background: Given Australia’s population ageing and predicted impacts related to health, productivity, equity and enhancing quality of life outcomes for senior Australians, lifelong learning has been identified as a pathway for addressing the risks associated with an ageing population. To date Australian governments have paid little attention to addressing these needs and thus, there is an urgent need for policy development for lifelong learning as a national priority. The purpose of this article is to explore the current lifelong learning context in Australia and to propose a set of factors that are most likely to impact learning in later years. Conclusion: Evidence based policy that understands and incorporates learning opportunities for all citizens is required to meet emerging global challenges. Providing appropriate learning opportunities to seniors is one clear pathway for achieving diverse health, social and economic outcomes.

Objective To investigate the prescription medication use practices of a sample of non-institutionalised older persons and to determine any differences with age (65–74 years versus 75 years and over). Method Data were gathered via 204 detailed in-home interviews, completed between March, 1993, and November, 1995. Respondents were identified through general practitioners (GPs). Practice patterns investigated included routines to assist with remembering when to use regular prescription medication, alterations to prescribed regimens, the borrowing and lending of prescription medication and patterns of prescription medication storage. Setting The study was conducted in Melbourne, Australia. Key findings Most respondents were found to have well-defined routines to assist with remembering when to use their prescription medication and in almost two-thirds of cases this was to use the medication with a meal. Almost a quarter of respondents said that on at least one occasion over the past few years they had intentionally used a lower dose of a medication than was prescribed and slightly less than one in 10 had intentionally used a higher dose. Less than one in 10 respondents admitted to having borrowed prescription medication on at least one occasion; almost double that number had lent medication. Most respondents stored their prescription medication appropriately, usually in the kitchen. Only 10 per cent of respondents were found to have more than three additional packs of the prescription medication they currently used. The hoarding of older medications was not uncommon; 42 per cent had prescription medication they no longer used. No differences in practice patterns were found with age. Conclusion Previous concerns about widespread poor quality use of medicines among non-institutionalised older persons were not generally supported by the findings of this study. However, the problems detected emphasise the need for vigilance. GPs and pharmacists could further promote the quality use of medicines among older persons through closer monitoring and review of prescription medication. Older persons need to be encouraged to discuss medicines and/or doses they feel are in some way inappropriate with their GP or pharmacist. Pharmacies should be promoted as places where unwanted or out-of-date medications can be taken for disposal.

Objectives (1) To explore older persons' opinions about their receipt of prescription drug information from general practitioners (GPs) and pharmacists, (2) to determine the information older persons wish to know about their prescription medication and the information sources they use, (3) to determine the opinions of older persons about prescription medication labels and patient information leaflets, and (4) to determine any significant differences between those aged 65–74 years and those aged 75 years and over. Method Data were gathered via 204 detailed in-home interviews completed between March,1993, and November, 1995. Respondents were identified through GPs. Setting The study was conducted in Melbourne, Australia. Key findings The vast majority of respondents liked to receive verbal counselling from GPs and pharmacists about their prescription medication and the majority were willing to share responsibility for receiving that information. However, a small minority of patients seemed to receive little information from GPs and pharmacists about their prescription medication and had no real perception of a need for information. As might be expected, the item of information most desired by respondents was when and how to use the medication (89 per cent). This was followed by the condition for which the medication was prescribed (76 per cent) and side effects (72 per cent). For 90 per cent of respondents GPs were their greatest prescription drug information source; pharmacists featured highly as a secondary source (57 per cent of respondents). Almost all respondents (92 per cent) thought that the information pharmacists printed on prescription medication labels was adequate although numerous suggestions were advanced for label improvement. Seventy-six per cent of respondents were of the opinion that, when receiving a prescription medication that was new to them, an information leaflet written for the consumer about that medication would be helpful. The 75 and over age group were less enthusiastic about receiving such leaflets than the 65–74 age group (P=0.015). Conclusion Education programmes aimed at improving the quality use of medicines in Australia still need to encourage older persons to actively seek, and health professionals to volunteer, prescription drug information. Patient information leaflets are well accepted by older persons; however, it is important that the information be adequately explained.

A recent study has indicated that quality assurance for interventional pain management procedures (IPMPs) can be achieved in university pain clinics. However, the issue of quality assurance for IPMPs in private practice has not yet been addressed.This study was designed to monitor the quality of IPMPs in a private pain practice in north Florida.From November 2005 to July 2006, we monitored the quality of IPMPs in a private pain practice in north Florida. Questionnaires regarding degree of pain relief, patient satisfaction, and complications were handed to patients immediately after the completion of each IPMP. Follow-up phone calls were also made to patients 1 day after the IPMPs.A total of 771 (male: 249, female: 522) patients with a mean age of 58.1 years participated in the study. Office-based IPMPs included lumbar and cervical epidural steroid injections, lumbar and cervical facet joint blocks, selective nerve root blocks, lumbar and cervical sympathetic nerve blocks, sacroiliac joint injection, and large joint injections. Seven-hundred patients (90.8%) reported various degrees of pain relief immediately following IPMPs. Average pain score decreased by 4.3 on a 0 to 10 scale (p=0.001). Number needed to be treated (NNT) to reach 50% or more pain relief immediately after IPMPs was 1.4. Six-hundred ninety-two (89.7%) patients were satisfied or very satisfied with the results of IPMPs. Sixty-two patients (8%) developed headaches after IPMPs, which lasted from 30 minutes to 4 days. None of these patients required a blood patch. Five patients developed moderate vasovagal responses during IPMPs, in which their heart rates decreased to45/min, BP90/60mmHg. The IPMPs were aborted immediately. All of these patients recovered uneventfully within a few minutes. No other serious adverse events were reported.The results of the current study suggest that high quality private interventional pain programs with high efficacy, high patient satisfaction, and low complication rates can be achieved through appropriate staff training, proper monitoring of patients during IPMPs, and adequate handling of patients after the IPMPs.

Aims: MSCs are cells being investigated for use in various therapies including facilitation of HSC transplantation and as gene therapy delivery vehicles. We have explored the potential to increase the number of bone marrow (BM) MSCs in vivo, induce mobilization using various cytokine regimens and improve gene transfer into these cells with adeno-associated virus (AAV) in a baboon model. Method: Baboons received cytokines as follows: 1. G-CSF 100mcg/kg/day for 5 days; 2. pegylated G-CSF (pegG-CSF), single dose 300mcg/kg day −5; 3. G-CSF 100mcg/kg/day + stem cell factor (SCF) 50mcg/kg/day for 5 days; and 4. pegylated megakaryocyte growth and development factor (pegMGDF) 1mcg/kg second daily for 10 days + G-CSF 100mcg/kg/day for 5 days starting day −5. Animals underwent BM aspiration at baseline and on the final day of cytokines along with leukapheresis to isolate PBMNCs for detection of peripheral blood (PB) CFU-F. The immunophenotype and differentiation potential of CFU-F derived from animals before and after cytokines was compared. The ability of AAV vectors pseudotyped with capsids derived from AAV of serotypes 1, 2, 3, 4, 5, 6, and 8 to mediate transduction of baboon and human MSCs was assessed. Results: Augmentation of bone marrow MSCs was observed with all cytokine regimens with the fold-increase compared to baseline as follows: 4.1, 2.1, 7.6 and 11.2 after G-CSF, pegG-CSF, G-CSF+SCF and G-CSF+pegMGDF respectively (see Figure 1). The immunophenotype of MSCs obtained after cytokines was identical to baseline cells as was their differentation potential. CFU-F were not detected in baseline PB however they were detected in 3/5 animals after G-CSF+SCF at a frequency of 0.8 to 1.5/mL, but no other cytokine regimen. A similar pattern of transduction efficiency using AAV was shared by human and baboon MSCs (see Figure 2) using control Ad293 cells. Specifically AAV vectors expressing capsids of serotypes 2, 3 and 5 were most efficient in transducing human and baboon MSCs. Those expressing capsids from serotypes 1, 4, 6, and 8 were much less efficient in transducing MSCs from either species. Baboon MSCs were able to be transduced by about 100-fold more than their human equivalent cells using AAV serotypes 2, 3, and 5. Conclusion: This is the first report of mobilization of primate MSCs and, together with the demonstration of in vivo augmentation and AAV gene transfer, offers increased therapeutic opportunities for their safe application in a burgeoning number of diseases. Figure 1: In vivo Bone Marrow CFU-F Augmentation following cytokines Figure 1:. In vivo Bone Marrow CFU-F Augmentation following cytokines Figure 2: Transduction profile of AAV vectors expressing capsids of various serotypes Figure 2:. Transduction profile of AAV vectors expressing capsids of various serotypes

Based on a sample of 76 artifacts of the Paleo-Indian Tradition from the Jurgens Site, Kersey, Colorado, the problem of functional diversity within a single morphological category of Plano (Jenning...

The early Cistercians were remarkable for their hostility to the feminine sex. ‘No religious body’ wrote Southern, was ‘more thoroughly masculine in its temper and discipline than the Cistercians, none that shunned female contact with greater determination or that raised more formidable barriers against the intrusion of women.’ The whole tenor of several of the early Cistercian statutes was that women were to be avoided at all costs. One decree enjoined the monks to sing like men and not imitate the high-pitched tinkling of women. Apart from these disparaging references to the female sex in general, an early statute explicitly stated that no Cistercian abbot or monk should bless a nun. In the thirteenth century this was interpreted as applying to the solemn consecration of nuns—a task which pertained to the bishop. It is stated that abbots did have the power to bless nuns at the end of their novitiate. But this later interpretation may well reflect later subtleties. It seems probable that the decree was originally intended to stop the Cistercians concerning themselves with nuns. The view that it was originally a straight-forward prohibition is strengthened by the fact that the same early decree went on to forbid the baptizing of infants. This decree, therefore, is crucial to any analysis of the position of nuns within the Cistercian order in the twelfth century. Dating it is difficult.