Search

On the Ground • The inaugural Range Practicum incorporated practical, hands-on training and demonstrations into the SRM Annual Meeting and Training, contributing to its "new look" in 2020. The Range Practicum translated stockmanship, packing, horse training, and prescribed fire, as well as agency rangeland monitoring and soils training, into practical skills. It also included rangeland monitoring, soils training, equipment demonstrations, and a small tradeshow. • The Range Practicum incorporated the 2020 Producer Forum as the transformative Women in Ranching Forum and included a Producer Reception. • Over 200 rangeland professionals, including students, ranchers, agency managers and specialists, and applied scientists, attended the Range Practicum. Most Range Practicum participants registered for the entire annual meeting. • Most participants were very satisfied or satisfied with the training sessions. The most popular sessions of the Range Practicum were the hands-on livestock workshops, specifically the horse and mule packing and low-stress livestock handling, followed by a wild horse demonstration and a hands-on prescribed fire workshop. • We recommend the Range Practicum be an ongoing event at future SRM annual meetings and trainings. We recommend it include experiential sessions that cannot be included in the traditional format of the annual meeting (e.g., hands-on, with live animals, fire, etc.).

Nonprofits continue to be faced with the pressure to succeed under financial restrictions. While donors assert that financial restrictions help nonprofit service delivery, nonprofit professionals c...

Benchmarking nonprofit performance can be challenging, constraining the ways nonprofits can use operational data to learn from each other and highlight organizational progress. Valid output or outcome data are scarce, and there is much to learn about measuring performance even when these data are available. Data envelopment analysis (DEA) is a mathematical linear programming technique that can be used to measure performance in a way that not only produces valid efficiency scores but also allows for benchmarking nonprofits with similar service missions. Using financial and production data from the nonprofit transportation sector, we walk through an example to explore DEA as a tool to measure and benchmark nonprofits. We conclude with suggestions for practice, emphasizing that DEA is useful for stakeholders looking to benchmark nonprofits by underscoring production and performance.

Social workers are recent additions to integrated health care teams; therefore, there is emerging literature about the work experiences and training needs of social workers in integrated settings. After receiving a Health Resources Services Administration-Behavioral Health Workforce Education and Training (HRSA-BHWET) integrated behavioral health (IBH) grant, our social work program conducted a survey among our social work field education sites to determine training needs. Results of the needs assessment revealed that a lack of clarity exists about what is meant by integrated behavioral health as well as ways to measure and interpret levels of integration within social work field education sites. Barriers to collaboration and areas of needed training revealed gaps in knowledge and workforce readiness for providing integrated care. Recommendations include using a bidirectional level of integration conceptual framework to support greater participation of social workers and social service agencies in integrated care, in addition to specific curricular and continuing education training opportunities. Social work educators are afforded a unique opportunity to support our field education partners in reviewing and enhancing their systems of care as they continue to train future social workers.

The complexity and diversity of the nonprofit sector provides a rich landscape for academic scholarship; and, growing numbers of nonprofit scholars and their associated research publications have established the field of nonprofit research. Yet, it is unclear if this research has been applied appropriately to the evolving landscape of the sector. Although literature reviews have helped us to understand the status of academic scholarship in the field of nonprofit research, these reviews have primarily focused on particular topics without considering the field as a whole. Thus, in this study we review all contemporary nonprofit scholarship (n=972) from three prominent nonprofit journals. The review documents the development of nonprofit research as presented in these journals over the last five years and offers recommendations for future research consideration.

Deaf students are members of a linguistic and cultural minority whose background and experiences provide a unique backdrop for the navigation of higher education. Using the framework of Deaf community cultural wealth, this study examines the experiences of Deaf students in community college and their utilization of various forms of capital. Findings showed that they exhibited instances of resistant, navigational, social, and familial capital in accessing and persisting in higher education.

Objectives This study determined whether in vivo positron emission tomography (PET) of arterial inflammation (18F-fluorodeoxyglucose [18F-FDG]) or microcalcification (18F-sodium fluoride [18F-NaF]) could predict restenosis following PTA. Background Restenosis following lower limb percutaneous transluminal angioplasty (PTA) is common, unpredictable, and challenging to treat. Currently, it is impossible to predict which patient will suffer from restenosis following angioplasty. Methods In this prospective observational cohort study, 50 patients with symptomatic peripheral arterial disease underwent 18F-FDG and 18F-NaF PET/computed tomography (CT) imaging of the superficial femoral artery before and 6 weeks after angioplasty. The primary outcome was arterial restenosis at 12 months. Results Forty subjects completed the study protocol with 14 patients (35%) reaching the primary outcome of restenosis. The baseline activities of femoral arterial inflammation (18F-FDG tissue-to-background ratio [TBR] 2.43 [interquartile range (IQR): 2.29 to 2.61] vs. 1.63 [IQR: 1.52 to 1.78]; p, Central Illustration

Background Several unsuccessful attempts have been made to reach a cross-disciplinary consensus on issues fundamental to the field of eating disorders in the United States (U.S.). In January 2020, 25 prominent clinicians, academicians, researchers, persons with lived experience, and thought leaders in the U.S. eating disorders community gathered at the Legacy of Hope Summit to try again. This paper articulates the points on which they reached a consensus. It also: (1) outlines strategies for implementing those recommendations; (2) identifies likely obstacles to their implementation; and (3) charts a course for successfully navigating and overcoming those challenges. Methods Iterative and consensual processes were employed throughout the Summit and the development of this manuscript. Results The conclusion of the Summit culminated in several consensus points, including: (1) Eating disorder outcomes and prevention efforts can be improved by implementing creative health education initiatives that focus on societal perceptions, early detection, and timely, effective intervention; (2) Such initiatives should be geared toward parents/guardians, families, other caretakers, and frontline healthcare providers in order to maximize impact; (3) Those afflicted with eating disorders, their loved ones, and the eating disorders community as a whole would benefit from greater accessibility to affordable, quality care, as well as greater transparency and accountability on the part of in-hospital, residential, and outpatient health care providers with respect to their qualifications, methodologies, and standardized outcomes; (4) Those with lived experience with eating disorders, their loved ones, health care providers, and the eating disorders community as a whole, also would benefit from the establishment and maintenance of treatment program accreditation, professional credentialing, and treatment type and levels of care guidelines; and (5) The establishment and implementation of effective, empirically/evidence-based standards of care requires research across a diverse range of populations, adequate private and government funding, and the free exchange of ideas and information among all who share a commitment to understanding, treating, and, ultimately, markedly diminishing the negative impact of eating disorders. Conclusions Widespread uptake and implementation of these recommendations has the potential to unify and advance the eating disorders field and ultimately improve the lives of those affected. Plain English summary A cross-disciplinary group of eating disorder professionals, thought leaders, and persons with lived experience have come together and reached a consensus on issues that are fundamental to the battle against the life-threatening and life-altering illnesses that are eating spectrum disorders. Those issues include: (1) the need for early detection, intervention, prevention, and evidenced-based standards of care; (2) the critical need to make specialized care more accessible and affordable to all those in need; (3) the importance of developing uniform, evidenced-based standards of care; (4) the need for funding and conducting eating spectrum disorder research; and (5) the indispensability of advocacy, education, and legislation where these illnesses are concerned. During the consensus process, the authors also arrived at strategies for implementing their recommendations, identified likely obstacles to their implementation, and charted a course for successfully navigating and overcoming those challenges. Above all else, the authors demonstrated that consensus in the field of eating spectrum disorders is possible and achievable and, in doing so, lit a torch of hope that is certain to light the path forward for years to come.

This study assesses the level of agreement on medication therapy problem (MTP) identification and classification between primary care, ambulatory care pharmacists within a health-system that recently implemented system-wide pharmacist provision of comprehensive medication management (CMM) services. Twenty standardized case vignettes were created and distributed to pharmacists who reviewed each case and identified and categorized MTPs. Outcomes include the number of MTPs identified, identification (yes/no) of specific MTPs within each case (e.g., need for a statin), and Pharmacy Quality Alliance (PQA) category used when classifying MTPs. The level of agreement on MTP identification/categorization was measured using intraclass correlation coefficient (ICC) and interpreted using the Landis and Koch interpretation scale. “Moderate agreement” was observed for the number of MTPs identified by pharmacists (ICC equal to 0.45, 95% confidence interval [CI]: 0.31 to 0.65). In approximately one-half of opportunities, the pharmacists agreed perfectly on the number of MTPs, in approximately one-third of opportunities, the number of MTPs identified varied by 1, and approximately one-tenth of the time, the number of MTPs varied by 2. In regard to the MTP identification (yes/no) and categorization, percent agreement was ≥73% across all MTPs. The results support the need for further training and education and provide the information necessary to target specific disease states.

Ophthalmic emergencies are invariably challenging for the non-specialist to identify and evaluate, and may be complicated by occult but vision threatening raised intraocular pressure. We present a case of hypertensive uveitis accompanied by the finding of retinal arterial pulsation, which when visualised by direct ophthalmoscopy allows the non-specialist to identify significantly raised intraocular pressure requiring urgent evaluation by an ophthalmologist.

Model systems that recapitulate the complexity of human tumors and the reality of variable treatment responses are urgently needed to better understand cancer biology and to develop more effective cancer therapies. Here we report development and characterization of a large bank of patient-derived xenografts (PDX) and matched organoid cultures from tumors that represent some of the greatest unmet needs in breast cancer research and treatment. These include endocrine-resistant, treatment-refractory, and metastatic breast cancers and, in some cases, multiple tumor collections from the same patients. The models can be grown long-term with high fidelity to the original tumors. We show that development of matched PDX and PDX-derived organoid (PDxO) models facilitates high-throughput drug screening that is feasible and cost-effective, while also allowing in vivo validation of results. Our data reveal consistency between drug screening results in organoids and drug responses in breast cancer PDX. Moreover, we demonstrate the feasibility of using these patient-derived models for precision oncology in real time with patient care, using a case of a triple negative breast cancer with early metastatic recurrence as an example. Our results uncovered an FDA-approved drug with high efficacy against the models. Treatment with the PDxO-directed therapy resulted in a complete response for the patient and a progression-free survival period more than three times longer than her previous therapies. This work provides valuable new methods and resources for functional precision medicine and drug development for human breast cancer.Graphical Abstract

Background Thousands of phacoemulsification surgeries are performed on eyes with age-related macular degeneration (AMD) complicated by choroidal neovascular membrane (CNV) in the United Kingdom each year. As populations age this number is expected to rise. Controversy over phacoemulsification’s influence on CNV activity limits the information which clinicians and these patients use to decide on surgery. This observational study aims to resolve this controversy by reporting on intravitreal injection (IVI) frequency as a pragmatic marker of CNV activity in a large cohort. Methods A cohort of eyes with AMD complicated by CNV (n = 327) that underwent cataract surgery at a single tertiary centre from 2014 to 2019 were identified. These cases were matched by interval since CNV diagnosis at a specified ‘time zero’ within the follow-up of pseudophakic eyes with AMD (n = 327). Data concerning demographics, visual acuity (VA) and intravitreal injection frequency before and after ‘time zero’/phacoemulsification were collected. Results Following ‘time zero’/phacoemulsification’ the mean reduction in annual IVI frequency was 0.6 injections/year (95% CI 0.4,0.9) and 0.4 injections/year (95% CI 0.1,0.7) in the comparison and phacoemulsification cohorts respectively. The mean VA gain 12 months after phacoemulsification in the intervention cohort was 11.3 (95% CI 9.2,13.4) early treatment of diabetic retinopathy study (ETDRS) letters, with 214 eyes (65.4%) having gained ≥5 ETDRS letters after surgery. Conclusions Phacoemulsification has no clinically significant impact on the activity of pre-existent CNV secondary to AMD. Phacoemulsification should be offered to patients with AMD and cataract that limits vision, regardless of CNV activity.

Comprehensive medication management (CMM) is a patient-centered standard of care that ensures a patient&rsquo, s medications are optimized. The CMM Practice Management Assessment Tool (PMAT) is a tool to assess areas of CMM practice management. The purpose of this project was to assess the state of CMM practice management based on clinical pharmacist perception for two health systems in the state of Utah, and to identify areas of excellence and/or improvement utilizing a novel method for PMAT analysis. The PMAT was distributed to all primary care-focused ambulatory care pharmacists employed by University of Utah Health (U of U Health) and Intermountain Healthcare (Intermountain). Ordinal responses were assigned to three possible categories of CMM support (High, Indifferent, and Low). Ten surveys were completed from U of U Health, and nine were completed from Intermountain. Thirty-two of the 86 survey questions resulted in a high level of support, and 25 questions resulted in a low level of support from the majority of respondents. Statistically significant differences between the institutions were found for 18 questions. The utilization of the PMAT within two Utah health systems highlighted areas of excellence and improvement and demonstrates a unique method for analysis of PMAT results.

Mood disorders are common mental illnesses. Among the factors associated with major depression are exposures to infectious diseases including hepatitis C, influenza, varicella-zoster, and herpes viruses. In this study, we sought to evaluate further associations between viral exposure and depression. From the US Center for Disease Control's National Health and Nutrition Examination Survey, we obtained data about depression status, antidepressant use, exposure to hepatitis A, hepatitis B, herpes simplex virus type 1, herpes simplex virus type 2, human immunodeficiency virus, and cytomegalovirus, and sociodemographic variables and evaluated associations between depression and viral exposure in adjusted multivariable models. Herpes simplex virus type 2 was associated with an increased risk of depression, whereas hepatitis A, hepatitis B, and herpes simplex virus type 1 were not. Higher cytomegalovirus antibody levels were associated with depression in subjects seropositive for cytomegalovirus. In conclusion, exposure to herpes simplex virus type 2 and possibly cytomegalovirus are associated with depression in an adult US sample.

There are an estimated 15.5 million cancer survivors in the United States, with numbers projected to increase. Many cancer survivors are receiving survivorship care in primary care settings, yet primary care providers report a need for additional training on addressing medical and psychosocial concerns of cancer survivors. This paper presents findings from a pilot study on the effectiveness of a novel training for interprofessional primary care providers on the clinically significant issue of fear of cancer recurrence. The on-site training was provided to a total of 46 participants, including physicians (61%), physician assistants (11%), nurse practitioners (7%), nurses (17%), and social workers (4%) in six different primary care practices. The average number of years of professional experience was 18.8, with standard deviation of 10.9. Results of paired-sample t tests indicated that the training increased knowledge and self-efficacy of providers in identifying and addressing FCR. The training was well-received by participants, who had high confidence in implementing practice behavior changes, although they also identified barriers. Results suggest the feasibility of a brief training for continuing education and have implications for models of care delivery in cancer survivorship.

ZusammenfassungEin 4-jähriger Königspython wurde 3 Wochen nach Bissverletzungen durch eine Ratte mit großflächigen Hautläsionen und einer bakteriellen Pyodermie mit Anzeichen einer Sepsis und neurologischen Sym -ptomen vorgestellt. Die betroffene Haut löste sich von der Muskulatur, wodurch Teile des Muskelgewebes frei lagen. Klinische und zytolo -gische Untersuchung ergaben eine bakterielle Pyodermie. Sepsisverdacht bestand aufgrund der klinischen Symptomatik. Die empirische Behandlung mit Lincomycin und Marbofloxacin (Befund der bakteriologischen Untersuchung waren multiresistente Stenotrophomonas maltophilia, sensibel gegenüber Fluorchinolonen) verbesserte das All-gemeinbefinden und die Hautläsionen demarkierten sich zu Brand-schorf mit intrazellulären stäbchenförmigen Bakterien. Eine weiterfüh-rende Diagnostik konnte kostenbedingt nicht durchgeführt werden und die Euthanasie des Tieres wurde erwogen. Im Verlauf von 4 Wochen erfolgte sechsmalig eine Behandlung mit Kaltplasma (cold atmospheric pressure plasma, CAPP). Innerhalb einer Woche verbesserten sich die Entzündungssymptome. Die Reepithelisierung war wenige Wochen später abgeschlossen. Drei Häutungen im Folgejahr verliefen ohne Anzeichen von Dysecdysis. CAPP könnte bei Schlangen mit bak-teriellen Pyodermien (insbesondere mit resistenten Keimen) und Hautnekrosen eine nützliche Behandlungsoption darstellen.

Unmanned aerial vehicles (UAV) enable detailed historical preservation of large-scale infrastructure and contribute to cultural heritage preservation, improved maintenance, public relations, and development planning. Aerial and terrestrial photo data coupled with high accuracy GPS create hyper-realistic mesh and texture models, high resolution point clouds, orthophotos, and digital elevation models (DEMs) that preserve a snapshot of history. A case study is presented of the development of a hyper-realistic 3D model that spans the complex 1.7 km2 area of the Brigham Young University campus in Provo, Utah, USA and includes over 75 significant structures. The model leverages photos obtained during the historic COVID-19 pandemic during a mandatory and rare campus closure and details a large scale modeling workflow and best practice data acquisition and processing techniques. The model utilizes 80,384 images and high accuracy GPS surveying points to create a 1.65 trillion-pixel textured structure-from-motion (SfM) model with an average ground sampling distance (GSD) near structures of 0.5 cm and maximum of 4 cm. Separate model segments (31) taken from data gathered between April and August 2020 are combined into one cohesive final model with an average absolute error of 3.3 cm and a full model absolute error of &lt, 1 cm (relative accuracies from 0.25 cm to 1.03 cm). Optimized and automated UAV techniques complement the data acquisition of the large-scale model, and opportunities are explored to archive as-is building and campus information to enable historical building preservation, facility maintenance, campus planning, public outreach, 3D-printed miniatures, and the possibility of education through virtual reality (VR) and augmented reality (AR) tours.

Canine demodicosis is a common disease in small animal practice. Although a number of studies evaluating treatment efficacy for canine demodicosis have used clinical scoring systems, none have been validated.This study evaluated the validity, reliability, reproducibility and sensitivity to change of a clinical scoring system for canine demodicosis.Fifty-eight dogs with generalised demodicosis were evaluated using a clinical scoring system that assessed erythema, comedones/ papules/pustules, follicular casts/scales/crusts and alopecia, rated from none to mild, moderate and severe in 36 body locations. Two evaluators scored lesions at monthly consecutive visits during treatment. Mites were counted to a maximum of 50 in four deep skin scrapings. With50 mites, the approximate mite number was calculated with the help of a grid drawn onto the slide before placing the scraped material onto it.A Pearson correlation coefficient showed a high interobserver reliability (r = 0.97) between two different clinicians evaluating the same dog. The Wilcoxon signed rank test showed good sensitivity to change with a reduction of clinical scores with each of the first six evaluations (P 0.0001). A linear mixed model also showed a clear reduction in mite counts (P 0.001) and clinical scores (P 0.0001) from the first evaluation with time.The clinical scoring system for canine demodicosis evaluated in this study showed a good sensitivity to change and interobserver reliability, and can be used in studies evaluating canine demodicosis.La démodécie canine est une maladie fréquente en pratique des petits animaux. Bien qu’un nombre d’études évaluant l’efficacité des traitements pour la démodécie canine aient utilisé des systèmes de scoring, aucun n’a été validé.Cette étude évalue la validité, la fiabilité, la reproductibilité et la sensibilité pour changer le système de scoring clinique pour la démodécie canine. MATÉRIELS ET MÉTHODES: Cinquante huit chiens avec démodécie généralisée ont été évalués à l’aide d’un système d’évaluation clinique qui concerne érythème, comédons/papules/pustules, manchons pilaires/squames/croûtes et alopécie notés de aucun à faible, modéré et sévère sur 36 zones corporelles. Deux investigateurs ont noté les lésions à des visites consécutives mensuelles au cours du traitement. Les acariens ont été comptés pour un maximum de 50 dans quatre raclages cutanés profonds. Avec plus de 50 acariens, le nombre approximatif d’acariens a été calculé avec l’aide d’une grille sous la lame avant de placer le matériel raclé dessus. RÉSULTATS: Un coefficient de corrélation de Pearson a montré une fiabilité inter-observateur élevé (r = 0.97) entre deux différents cliniciens évaluant le même chien. Le test de Wilcoxon a montré une bonne sensibilité au changement avec une réduction des scores cliniques avec chacune des six premières évaluations (P 0.0001). Un modèle mixte linéaire a aussi montré une réduction claire des comptages d’acariens (P 0.001) et des scores cliniques (P 0.0001) de la première évaluation avec le temps.Le système de scoring clinique pour la démodécie canine évalué dans cette étude a montré une bonne sensibilité au changement et à la fiabilité interobservateur et peut être utilisé dans les études évaluant la démodécie canine.INTRODUCCIÓN: la demodicosis canina es una enfermedad común en la práctica de animales pequeños. Aunque se han publicado estudios que evalúan la eficacia del tratamiento para la demodicosis canina utilizando sistemas de puntuación clínica, ninguno ha sido validado. OBJETIVOS: en este estudio evaluó la validez, fiabilidad, reproducibilidad y sensibilidad a cambios de un sistema de valoración clínica para la demodicosis canina. MÉTODOS Y MATERIALES: se evaluaron cincuenta y ocho perros con demodicosis generalizada utilizando un sistema de valoración clínica que puntuaba eritema, comedones /pápulas /pústulas /cilindros foliculares /escamas /costras y alopecia, calificados de nada a leve, moderado y grave en 36 ubicaciones corporales. Dos evaluadores puntuaron las lesiones en visitas mensuales consecutivas durante el tratamiento. Los ácaros se contaron hasta un máximo de 50 en cuatro raspados profundos de la piel. Con50 ácaros, el número aproximado de ácaros se calculó con la ayuda de una cuadrícula dibujada en el portaobjetos antes de colocar el material raspado sobre él. RESULTADOS: el coeficiente de correlación de Pearson mostró una alta fiabilidad interobservador (r = 0,97) entre dos clínicos diferentes que evaluaban al mismo perro. La prueba de rango señalado de Wilcoxon mostró una buena sensibilidad al cambio con una reducción de las puntuaciones clínicas con cada una de las primeras seis evaluaciones (P0,0001). Un modelo lineal mixto también mostró una clara reducción en los recuentos de ácaros (P0,001) y puntuaciones clínicas (P0,0001) desde la primera evaluación con el tiempo. CONCLUSIÓN Y RELEVANCIA CLÍNICA: el sistema de puntuación clínica para la demodicosis canina evaluado en este estudio mostró una buena sensibilidad al cambio y fiabilidad entre observadores, y puede utilizarse en estudios que evalúen la demodicosis canina.Die canine Demodikose ist eine häufige Erkrankung in der Kleintierpraxis. Obwohl eine Anzahl an Studien die Wirksamkeit der Behandlung mit Hilfe eines klinischen Bewertungssystems evaluiert hat, ist noch keines davon validiert worden.Diese Studie evaluierte die Validität, Reliabilität, Reproduzierbarkeit und Sensibilität auf Veränderung eines klinischen Bewertungssystems für die canine Demodikose.Achtundfünfzig Hunde mit einer generalisierten Demodikose wurden mittels klinischem Bewertungssystem welches an 36 Körperstellen Erythem, Komedonen/Papeln/Pusteln, Follikuläre Manschetten/Schuppen/Krusten und Alopezie, von nicht vorhanden bis mild, moderat und schwerwiegend bewertete. Zwei BeurteilerInnen bewerteten die Veränderungen an monatlich aufeinanderfolgenden Besuchen während der Behandlung. Die Milben wurden bis zu einem Maximum von 50 in vier tiefen Hautgeschabseln gezählt. Bei50 Milben wurde die annähernde Milbenzahl mit Hilfe eines Rasters, welcher auf den Objektträger aufgezeichnet wurde, bevor das Material des Hautgeschabsels darauf aufgebracht wurde, kalkuliert.Ein Pearson Korrelationskoeffizient zeigte eine hohe Interbeobachter Reliabilität (r = 0,97) zwischen zwei unterschiedlichen KlinikerInnen, die denselben Hund untersuchten. Der Wilcoxon-Vorzeichen-Rang-Test zeigte eine gute Sensibilität auf Veränderung durch eine Verringerung der klinischen Werte bei einer jeden der ersten sechs Evaluierungen (P0,0001). Ein lineares gemischtes Modell zeigte auch eine klare Reduzierung der Milbenzählung (P0,001) und der klinischen Werte (P0,0001) mit der Zeit nach der ersten Evaluierung.Das klinische Bewertungssystem für die canine Demodikose, welches in dieser Studie evaluiert wurde, zeigte eine gute Sensibilität auf Veränderung und InterbeobachterInnen Reliabilität und kann daher in Studien, die die canine Demodikose evaluieren, eingesetzt werden.背景: 犬ニキビダニ症は小動物臨床では一般的な疾患である。犬ニキビダニ症に対する治療効果を評価する研究では、臨床的なスコアリングシステムが用いられているが、検証されたものはない。 目的: 本研究の目的は、犬ニキビダニ症の臨床スコアリングシステムの妥当性、信頼性、再現性、変化に対する感度を評価することであった。 材料と方法: 汎発性ニキビダニ症の58頭の犬が、体の36箇所で、紅斑、面ぽう/丘疹/膿疱、毛包円柱/鱗屑/痂皮、脱毛を評価する臨床スコアリングシステムを使用して評価され、無から軽度、中等度、重度に評価された。治療期間中、2人の評価者が毎月連続して病変部を採点した。ダニは4回の深部皮膚掻爬で最大50匹まで数えられた。50匹以上の場合は、掻き取った材料をスライドに載せる前に、スライドに描かれたグリッドを用いておおよそのダニの数を算出した。 結果: ピアソン相関係数により、同じ犬を評価する2人の異なる臨床医の間で高い観察者間信頼性 (r = 0.97) が示された。Wilcoxon signed rank testでは、最初の6回の評価ごとに臨床スコアが低下し、変化に対する感度が高いことが示された (P0.0001) 。また、線形混合モデルでは、最初の評価から時間の経過とともにダニの数 (P0.001) と臨床スコア (P0.0001) が明らかに減少した。 結論と臨床的妥当性: 本研究で評価された犬のニキビダニ症の臨床スコアリングシステムは、変化に対する良好な感度と観察者間の信頼性を示し、犬ニキビダニ症を評価する研究に使用することが可能である。.背景: 犬蠕形螨病是小动物临床中的常见疾病。尽管许多评估犬蠕形螨病治疗有效性的研究使用了临床评分系统, 但均未得到验证。 目的: 本研究评估了犬蠕形螨病临床评分系统变化的有效性、可靠性、重复性和敏感性。 方法和材料: 使用临床评分系统对58只患有全身性蠕形螨病的犬进行评估, 该系统评估了36个身体部位的红斑、粉刺/丘疹/脓疱、毛囊管型/鳞屑/结痂和脱毛, 评级为无至轻度、中度和重度。两名评估者在治疗期间每月连续观察时对病变进行评分。在4次皮肤深层刮片中, 螨虫最大计数值为50。对于50个螨虫刮取物, 将其置于载玻片上之前, 借助绘制在载玻片上的网格计算螨虫数近似值。 结果: Pearson相关系数显示, 评估同一只犬的两名不同临床医生的观察者间可靠性较高(r = 0.97)。Wilcoxon符号秩和检验显示, 前6次评估的临床评分均降低, 对变化具有良好的敏感性(P0.0001)。线性混合模型还显示, 随着时间的推移, 首次评估的螨虫计数(P0.001)和临床评分(P0.0001)明显减少。 结论和临床相关性: 本研究中评估的犬蠕形螨病临床评分系统显示出对变化的良好敏感性和观察者间可靠性, 可用于评价犬蠕形螨病的研究。.A demodiciose canina é uma doença comum na prática de pequenos animais. Embora vários estudos que avaliam a eficácia do tratamento para demodiciose canina tenham usado sistemas de pontuação clínica, nenhum foi validado.Este estudo avaliou a validade, confiabilidade, reprodutibilidade e sensibilidade à mudança de um sistema de pontuação clínica para demodiciose canina. MÉTODOS E MATERIAIS: Cinquenta e oito cães com demodiciose generalizada foram avaliados usando um sistema de pontuação clínica que avaliou eritema, comedões/pápulas/pústulas, cilindros foliculares/escamas/crostas e alopecia, classificado como nenhum, leve, moderado e grave em 36 localizações do corpo. Dois avaliadores pontuaram as lesões em visitas mensais consecutivas durante o tratamento. Os ácaros foram contados até um máximo de 50 em quatro raspagens de pele profundas. Com50 ácaros, o número aproximado de ácaros foi calculado com a ajuda de uma grade desenhada na lâmina antes de colocar o material raspado nela.O coeficiente de correlação de Pearson mostrou uma alta confiabilidade interobservador (r = 0,97) entre dois clínicos diferentes avaliando o mesmo cão. O teste de classificação sinalizada de Wilcoxon demonstrou boa sensibilidade à mudança com uma redução dos escores clínicos em cada uma das seis primeiras avaliações (P0,0001). O modelo linear misto também mostrou uma redução clara na contagem de ácaros (P0,001) e escores clínicos (P0,0001) desde a primeira avaliação ao longo do tempo. CONCLUSÃO E RELEVÂNCIA CLÍNICA: O sistema de pontuação clínica para demodiciose canina avaliada neste estudo mostrou boa sensibilidade à mudança e confiabilidade interobservador, podendo ser usado em estudos que avaliam demodiciose canina.

SummaryA cutaneous infection with Alternaria spp. was diagnosed in a 2-yearold male intact Irish setter dog, presenting with multifocal papules, plaques and ulcerations involving all four distal limbs, shoulder blades, scrotum, pinnae and nasal mucous membranes. The dog had been treated for inflammatory bowel disease and lymphangiectasia with immunosuppressive doses of cyclosporine and prednisolone for approximately 3 months. The diagnosis was based on clinical signs, the demonstration of fungal elements within skin biopsies, deep fungal culture and fungal PCR from a formalin-fixed tissue specimen. Complete clinical remission was achieved by tapering and cessation of the immunosuppressive medication, treatment with cold atmospheric-pressure plasma (CAPP) and topical enilconazole within 8 weeks.

Bronchiolitis (inflammation of the lower respiratory tract) in infants is primarily due to viral infection and is the single most common cause of infant hospitalization in the United States. To increase epidemiological understanding of bronchiolitis (and, subsequently, develop better prevention strategies), this research analyzes data on infant bronchiolitis cases from the U.S. Military Health System between the years 2003-2013 in Norfolk, Virginia, USA. For privacy reasons, child home addresses, birth dates, and diagnosis dates were randomized (jittered) creating spatio-temporal uncertainty in the geographic location and timing of bronchiolitis incidents. Using spatio-temporal point patterns, we created a modeling strategy that accounts for the jittering to estimate and quantify the uncertainty for the incidence proportion (IP) of bronchiolitis. Additionally, we regress the IP onto key covariates including pollution where we adequately account for uncertainty in the pollution levels (i.e., covariate uncertainty) using a land use regression model. Our analysis results indicate that the IP is positively associated with sulfur dioxide and population density. Further, we demonstrate how scientific conclusions may change if various sources of uncertainty (either spatio-temporal or covariate uncertainty) are not accounted for. Code submitted with this article was checked by an Associate Editor for Reproducibility and is available as an online supplement.

Degenerative disc disease (DDD) is a primary contributor to low-back pain, a leading cause of disability. Progression of DDD is aided by inflammatory cytokines in the intervertebral disc (IVD), particularly TNF-α and IL-1β, but current treatments fail to effectively target this mechanism. The objective of this study was to explore the feasibility of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) epigenome editing-based therapy for DDD, by modulation of TNFR1/IL1R1 signaling in pathological human IVD cells. Human IVD cells from the nucleus pulposus of patients receiving surgery for back pain were obtained and the regulation of TNFR1/IL1R1 signaling by a lentiviral CRISPR epigenome editing system was tested. These cells were tested for successful lentiviral transduction/expression of deactivated Cas9 fused to Kruppel Associated Box system and regulation of TNFR1/IL1R1 expression. TNFR1/IL1R1 signaling disruption was investigated through measurement of NF-κB activity, apoptosis, and anabolic/catabolic changes in gene expression postinflammatory challenge. CRISPR epigenome editing systems were effectively introduced into pathological human IVD cells and significantly downregulated TNFR1 and IL1R1. This downregulation significantly attenuated deleterious TNFR1 signaling but not IL1R1 signaling. This is attributed to less robust IL1R1 expression downregulation, and IL-1β-driven reversal of IL1R1 expression downregulation in a portion of patient IVD cells. In addition, RNAseq data indicated novel transcription factor targets, IRF1 and TFAP2C, as being primary regulators of inflammatory signaling in IVD cells. These results demonstrate the feasibility of CRISPR epigenome editing of inflammatory receptors in pathological IVD cells, but highlight a limitation in epigenome targeting of IL1R1. This method has potential application as a novel gene therapy for DDD, to attenuate the deleterious effect of inflammatory cytokines present in the degenerative IVD.

Objective:The death of a child from cancer is an intense and life-changing loss for a parent. Guided by the principles of patient- and family-centered care, hospital-based caregivers developed a program to provide bereavement support for parents through phone calls and mailings. The aim of the present qualitative phenomenological study was to understand how parents experienced participating in this bereavement program.Method:A total of eight parents from six families participated in a focus-group evaluation of the two-year hospital-based bereavement program. Two social work clinicians/researchers independently analyzed the transcript of the focus group to define themes.Results:Four themes were identified: (1) lived experience of grief, (2) importance of relationships with the hospital-based team, (3) bereavement support from hospital-based providers, and (4) extending bereavement care.Significance of Results:Participants indicated the value of ongoing communication and connection with members of the healthcare team, who were often central to a family's life for years during their child's cancer treatment. Parents also provided suggestions for extending bereavement support through continued contact with providers and informal annual gatherings, as well as through a peer (parent-to-parent) support program.

Background Helicobacter pylori (H. pylori) infection is associated with cognitive deficits in humans, an association potentially mediated or moderated by folate concentration or inflammation. Materials and Methods We used the National Health and Nutrition Examination Survey (NHANES) datasets to examine whether folate concentration or inflammation mediates or moderates the relationship between H. pylori and cognitive function. Models were performed using linear, Poisson, and zero-inflated Poisson regression, and we performed separate analyses for groups aged 20–59 and 60–90 years with sample sizes ranging from 700 to 1700. Results We did not find evidence of mediation in either age group. In the 20- to 59-year group, interactions between H. pylori and ferritin (p values ranging from .004 to .039) were associated with worse processing speed, better working memory, and worse reaction time. Interactions between H. pylori and fibrinogen (p values ranging from .023 to .045), C-reactive protein (CRP) (p = .023), and the inflammatory index (p = .045) were associated with worse processing speed. In 60- to 90-year-olds, H. pylori interacted with ferritin and the inflammatory index to predict fewer mathematical errors (p values of .036 and .023). Interactions with folate (p values of .016 and .006) and C-reactive protein (p values ranging from

Nursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts’ nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an intervention targeting Certified Nurses’ Aides (CNAs) was developed and tested. We hypothesized that following the training, CNAs would have increased knowledge and self-efficacy toward providing oral health care to the residents in their charge.This pilot study used a one-group pretest-posttest design to test the effectiveness of a psycho-educational training intervention. Utilizing the constructs of knowledge and self-efficacy from the Theory of Planned Behavior and the Social Cognitive Theory, we framed the content of a training intervention and administered a 21-item instrument. The survey was distributed to the CNA staff of a single midsize nursing home immedi...

Introduction: University of Utah Health is an academic health care system that serves residents in Utah and beyond. Clinical pharmacists with the health care system’s pharmacy primary care services (PPCS) team provide medication education, population-based care, and medication management through collaborative practice agreements. With the expansion of clinical pharmacist and technician positions and services, the need to measure and assess the impact of pharmacy services and create a value proposition for internal and external stakeholders became an important goal, and the decision was made to better align practices across all PPCS sites. This paper highlights University of Utah Health’s approach to implement comprehensive medication management (CMM) across all primary care clinics with embedded clinical pharmacy staff and subsequent evaluation of implementation fidelity. Methods: Implementation of CMM was assisted by participation in the National A3 Collaborative and by using selected principles from the Active Implementation Framework. Stages of implementation included exploration, instillation, and initiating improvement cycles. An implementation team consisting of PPCS employees was created to help with standardization, developing implementation plans, and creating a dissemination strategy for all PPCS team members. The CMM care process was subsequently presented and implemented by clinical pharmacists in primary care clinics. Following implementation, fidelity measures were collected including identification and resolution of medication therapy problems (MTPs) and responses from a questionnaire distributed to the clinical pharmacists to self-report understanding and implementation of CMM key elements. The number and type of MTPs identified were tracked over 18 months. Results: Within the measurement window, clinical pharmacists identified 17,953 MTPs. Of the total number of MTPs identified, 21% were related to indication, 53% to efficacy, 15% to safety and 11% to adherence. The questionnaire was distributed to clinical pharmacists 9 months after CMM implementation, with a 71% response rate. Pharmacists reported “always” or “often” performing each step in the patient care process as follows: indication (93%), effectiveness (93%), safety (87%), and adherence (93%). Reported barriers to implementation of the CMM include lack of time to complete all aspects of the process efficiently, lack of a standardized format for documentation, and changing practice habits. Conclusion: Implementation of a CMM process within University of Utah Health’s PPCS services with the help of a national collaborative and implementation framework yielded identification of 17,953 MTPs over 18 months and foundational fidelity to core principles. Article type: Clinical Experience

Media architecture within urban spaces such as large scale media walls, building facades and art installations are increasingly being installed throughout cities. The digital media content displayed on such media architecture can vary, from advertisements to digital designs to data-driven visualisation. While digital media content has a unique ability to inform, entertain and promote interactions among the audience, new questions emerge when it is intended to cause societal impact by conveying a deeper narrative and resonating with the audience.

Background: Autism Spectrum Disorders (ASD) are lifelong neurodevelopmental conditions characterised by persistent difficulties in reciprocal social interaction, communication, restricted interests, stereotypic behaviours and resistance to change. The increasing recognition of adult ASD has resulted in the ongoing development of specialist services, some of which offer genetic testing for individuals with ASD. This study aims to examine i) the rate of rare neurodevelopmental copy number variants (CNVs) and, ii) the polygenic risk scores (PRS) of a cohort of individuals diagnosed with ASD in adulthood. Methods: 90 individuals with ASD but without intellectual disability, and 60 age- and sex-matched controls were drawn from the National Centre for Mental Health (NCMH) sample. Inclusion criteria were diagnosis of ASD at age ≥18 consistent with ICD10 diagnostic criteria by secondary health care professional on casenote review, without comorbid intellectual disability. Clinical psychiatric, physical and social phenotypic data and DNA was retrieved. Genotyping was carried out on two versions of the Illumina PsychChip. CNVs were called from the 90% common content of the two chips using PennCNV run through a Galaxy pipeline. We then annotated a list of 53 CNVs associated with neurodevelopmental disorders. For PRS analysis, PRS scores for ASD, attention deficit hyperactivity disorder, bipolar affective disorder, major depressive disorder, Alzheimer's disease and schizophrenia were generated following marker and individual quality control. Results: The rate of neurodevelopmental CNVs was 3.8% (n = 5) in individuals with ASD and 1.3% (n = 1) in control but this difference was not statistically significant. The five neurodevelopmental CNVs detected were 2q13 deletion (n = 2), 15q13.3 duplication (n = 1), 16p13.11 duplication (n = 1) in individuals with ASD and a 2p16.3 deletion in a control individual. Of the PRS scores calculated by presence or absence of ASD, only the PRS derived from the ASD GWAS showed statistically significant difference by caseness. We calculate that approximately 0.1286 (P < .00001) of variance can be explained from PRS derived from linkage independent markers showing association at P < 1e-3 in the ASD GWAS (SNPS in model = 433). Discussion: Individuals with ASD had an increased rate of neurodevelopmental CNVs though this was not statistically significant. A statistically significant increase in burden of CNVs in this group might be confirmed in a larger sample. However, it appears that the CNV rate was lower than that reported in pediatric ASD populations, who may have a greater neurodevelopmental symptom profile. PRS analysis demonstrated a significant contribution of polygenic load of ASD-associated common variants, detectable even in this relatively small sample size. Taken together, these results suggest that adults presenting with ASD may have a lower burden of rare penetrant variants and a higher polygenic contribution of common risk alleles than childhood ASD populations, potentially reflecting less severe neurodevelopmental disability.

Lower limb peripheral arterial disease (PAD) is becoming increasingly common. Lower limb perfusion, as determined by the ankle brachial pressure index (ABPI), is a recognised predictor of overall mortality. The increasing role of non-invasive imaging in patient assessment may aid in the ability to predict poor patient outcomes.This study included all patients undergoing a lower limb arterial duplex over a period of 20 months. The site and burden of atherosclerosis within the lower limb was determined using the well validated Bollinger score. Patient demographic data were also collated. The primary outcome measure was all cause mortality.A total of 678 patients were included (median age 74 years). The overall median follow up period was 69.9 months. Of these, 307 patients reached the primary end point, which was death. Independent predictors of all cause mortality included total Bollinger score (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.05-1.18 [p .001]; OR per 10 points), femoropopliteal Bollinger score (OR 1.34, 95% CI 1.11-1.08 [p = .05]; OR per 10 points), and crural Bollinger score (OR 1.03, 95% CI 1.01-1.03 [p = .03]). There was also a significant association between mortality and age, a prior history of ischaemic heart disease, a history of congestive cardiac failure and chronic renal failure (chronic kidney disease ≥ 3). Statin and antiplatelet therapy were protective.This contemporary study confirms poor long-term outcomes still exist in patients with PAD. The site and severity of lower limb atherosclerosis are independent predictors of long-term mortality.

Epilepsy is associated with stigma throughout the world, which leads to poor treatment of people with epilepsy (PWE). In Uganda, there are more than 75,000 PWE and a large treatment gap. This study evaluated the knowledge, attitudes, and practices regarding epilepsy among first-year medical students at Mulago Hospital. A 22-question survey was developed based on the previous studies of Birbeck et al.'s regarding the stigma of epilepsy in Zambia. This was administered to first-year medical students (96 respondents) at Mulago Hospital in Uganda. More than 80% said that they would not allow their children to marry PWE. Most respondents believed that epilepsy was a mental illness, and many believed that PWE cannot have normal intelligence. Students reported that there was a negative perception and negative treatment of PWE in the community. Some students believed that epilepsy was caused by supernatural causes and was contagious. These misperceptions must be identified and corrected among medical students and other healthcare providers to allow for fair treatment of PWE; this should be incorporated into medical school curriculums in Uganda.

Naloxone is a common treatment option for the reversal of an opioid overdose. The law regulating naloxone varies from state to state and therefore so does the drug’s availability. The state of Rhode Island has legalized naloxone for over-the-counter use while a number of states allow prescriptions to opioid abusers and family members. The medical community as a whole appears to be divided on the issue of availability to lay persons. This is largely due to a lack of information on this relatively new subject, as well as discrepancies within the existing naloxone research in regard to the use of naloxone among the general public. This literature review provides an objective examination of the pros and cons of increasing the availability of naloxone to the public, with an emphasis on the state of West Virginia (WV). Due to WV’s high rates of opioid abuse and overdose, the implications of increasing public accessibility to naloxone could be invaluable in the effort to reduce opioid related deaths. To this end, a WV law that has recently gone into effect allows emergency personnel and family members of opioid addicts to carry naloxone. Ongoing research investigations will determine the impact of this law in regard to the overall wellbeing of the residents of WV and the implications on future laws regulating naloxone use.

Caused by the parasitic nematodes Toxocara canis and cati, toxocariasis in humans can result in covert toxocariasis, ocular toxocariasis, visceral larval migrans, and neurotoxocariasis. A common infection, toxocariasis exposure varies widely within and between countries, with a previous estimate of Toxocara seroprevalence using data from 1988 to 1994 in the United States of approximately 13%. Age, poverty, sex, educational attainment, ethnicity, and region have been associated with Toxocara seroprevalence. In this study, we sought to determine the seroprevalence of and factors associated with Toxocara seropositivity in the United States using data from the National Health and Nutrition Examination Survey from 2011 to 2014 to provide a more recent estimate of Toxocara seroprevalence in the United States. We found an overall Toxocara seroprevalence of 5.1%. Increasing age, male sex, low educational attainment, low income, and immigration status each was associated with Toxocara seropositivity. Mexican Americans had reduced odds of exposure. These findings show that exposure to Toxocara continues in the United States and that several demographic factors influence the risk of exposure.

Long-wave infrared (LWIR) hyperspectral imagers (HSI) image a scene by collecting high-resolution spectra at each pixel. The data are similar to a camera image but have a large number of narrow spectral bands rather than the familiar broad three bands of red-green-blue in a traditional digital camera. Materials in LWIR are emissive (rather than reflective) and have unique spectra that can be used for material detection and identification. The measured spectra are a convolution of the material spectra (emissivity), the black body temperature (Planck curve), other interacting environmental spectral sources, and measurement error. One approach to material identification is temperature-emissivity separation (TES), which separates or deconvolves the material spectra from the temperature curve. To accomplish this task, we develop a unique flexible model which combines the mathematical model of the physical processes within a Bayesian nonparametric framework. In addition to offering interpretable estimates of mo...

The growing availability of data in the nonprofit sector necessitates a better sophistication of methods from both scholars and practitioners. Linear panel data analysis, with its advantage in addr...

BackgroundInfectious diseases might affect cognitive aging and dementia risk, possibly via neuroinflammation. Similarly, risk factors for cardiovascular and cerebrovascular diseases are associated with cognitive function and dementia. We hypothesized that cardiovascular risk factors moderate the association of exposure to infectious diseases with cognitive function.MethodsWe studied 5662 participants aged 20 to 59 years from the third National Health and Nutrition Examination Survey (1988-1994) in the United States. We used linear regression to investigate whether the Framingham general cardiovascular risk index moderated the association of infection burden based on exposure to eight different infectious diseases with cognitive functioning as measured by the Symbol Digit Substitution, Serial Digit Learning, and Reaction Time tests.ResultsThe multiplicative interaction between the infection-burden index and the cardiovascular-risk index was associated with performance on the Symbol Digit Substitution (B = .019 [95% CI: .008, .031], p < .001) but not on the Serial Digit Learning (B = .034 [95% CI: -.025, .094]) or for Reaction Time (B = -.030 [95% CI: -.848, .787]). Participants with a lower cardiovascular risk appeared to be more resilient against the potential adverse effects of higher infection burden on the Symbol Digit Substitution task.ConclusionsParticipants at zero risk for a cardiovascular event in the next 10 years had no differences in processing speed with increasing exposure to infectious disease, whereas participants with higher risk for a cardiovascular event had worse processing speed with increased exposure to infectious disease.

iPhone apps are being used to promote healthier diets. The purpose of this study was to evaluate the extent to which diet apps' content was guided by health behavior theory in their design and user interface. This study consisted of 58 diet apps from iTunes' Health & Fitness category. Coders downloaded the apps and rated their inclusion of theory. Scores ranged from 0 to 26 on a 100-point scale. Most apps were theory deficient and provided just general information/assistance. An opportunity exists for health behavior change experts to partner with app developers to incorporate health behavior theories into the development of individually tailored apps.

The Open Aid Malawi initiative has collected an unprecedented database that identifies as much location-specific information as possible for each of over 2500 individual foreign aid donations to Malawi since 2003. Ensuring efficient use and distribution of that aid is important to donors and to Malawi citizens. However, because of individual donor goals and difficulty in tracking donor coordination, determining presence or absence of efficient aid allocation is difficult. We compare several Bayesian spatial generalized linear mixed models to relate aid allocation to various economic indicators within seven donation sectors. We find that the spatial gamma regression model best predicts current aid allocation. Using this model, first we use inferences on coefficients to examine whether or not there is evidence of efficient aid allocation within each sector. Second, we use this model to determine a more efficient aid allocation scenario and compare this scenario to the current allocation to provide insight for future aid donations.

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women’s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.