A RETROSPECTIVE EVALUATION OF MORBIDITY AND MORTALITY IN ASSOCIATION WITH INFESTATION BY THE MITE STERNOSTOMA TRACHEACOLUM IN AN AVIARY-HOUSED POPULATION OF GOULDIAN FINCHES (CHLOEBIA GOULDIAE).

The Rhynonyssid mesostigmatic mite, Sternostoma tracheacolum, is a well-documented endoparasitic hematophagous arthropod of the respiratory tracts of multiple avian species, particularly Estrildid finches and canaries. In this retrospective study, 175 medical and 278 pathology records for the Gouldian finch (Chloebia gouldiae) population (N = 377) at the San Diego Zoo between 2013 and 2021 were analyzed to evaluate the effectiveness of ivermectin-based prophylaxis. A multivariable negative binomial regression model was constructed to evaluate the population effects of monthly treatments on morbidity or mortality associated with respiratory mites. While controlling for other factors in the model, the prophylactic treatment did not significantly reduce the monthly rate of mite-associated morbidity or mortality (IRR = 1.017, 95% CI: 0.997-1.036, P = 0.0759); however, low proportions of the population were prophylactically treated over time. Different factors were significant when separately evaluating adjusted associations with respiratory morbidity and mortality. The findings suggest increased rates of respiratory morbidity for each successive year of the study period (IRR = 1.180, 95% CI: 1.046-1.342, P = 0.0090) and increased rates of mite-associated mortality occurring annually between May and October (IRR = 1.697, 95% CI: 1.034-2.855, P = 0.0404) compared to the wet winter season. Our findings highlight the need to continually evaluate and optimize treatment regimens in zoological collections. Further investigations into this host-parasite relationship and potential treatments and preventive therapies are warranted.

CLINICAL AND PATHOLOGIC FINDINGS IN IGUANIDS WITH SODIUM URATE CHOLELITHIASIS.

Four green iguanas (Iguana iguana) and one blue iguana (Cyclura lewisi) from five facilities were diagnosed with sodium urate cholelithiasis. One case was diagnosed antemortem via ultrasonography, and the iguana underwent a choledochotomy for treatment. The other four cases were identified at necropsy. Pathologic hepatic and biliary changes were present in four of the five cases at necropsy. Histologically, four iguanas had hepatic fibrosis, three had bile duct hyperplasia, and one had cholangiohepatitis and pancreaticocholedochitis. Two iguanas had pathologic renal changes. This is the first report of sodium urate cholelithiasis in reptiles. This case series highlights the potential significant clinical disease caused by sodium urate cholelithiasis and the importance of biliary system evaluation. Further investigation is recommended to explore the pathogenesis of reptilian sodium urate cholelith formation.

Educational Costs Expended and Career Incomes in Advanced Healthcare Professions.

The financial desirability of dollar/time investments in postbaccalaureate healthcare professional education is needed. We therefore compared postbaccalaureate educational costs and career earnings for nurse anesthetists, eight other advanced degree, nonphysician professions, and 14 physician specialties with internal rate of return (IRR) and net present value (NPV) analysis. The IRR and NPV integrated educational costs (tuition, finance charges, lost salary opportunity costs), and career earnings using U.S. Bureau of Labor and Medscape 2022 Physician Compensation Report data. Costs were discounted to 2022 U.S. real dollars using the 3.97% 50-year, U.S. average inflation rate. Annual IRRs for educational investment were 1) hospital CEOs = 48.8%; 2) managed care finance directors = 48.2%; 3) Doctors of Nurse Anesthesia Practice = 26.0%; 4) specialist physicians = 20.3%; 5) primary care physicians = 19.2%; 6) Doctors of Physical Therapy = 18.8%; 7) healthcare attorneys = 18.4%; 8) Doctors of Dental Surgery (dentists) = 18.1%; 9) Doctors of Pharmacy = 17.2%; and 10) Advanced Nurse Practitioners = 10.8%. Considering the educational money/time invested for career monetary returns, the financial desirability of nurse anesthetist and nonphysician, healthcare executive education exceeded that of physicians. Lifetime earnings for nurse anesthetists exceeded those of Doctors of Dental Surgery (Doctors of Dental Medicine), Doctors of Pharmacy, Doctors of Physical Therapy, managed care MBAs, biomedical engineers, healthcare attorneys, and Advanced Nurse Practitioners.

RETROSPECTIVE REVIEW OF UROLITHIASIS-RELATED MORBIDITY AND MORTALITY IN ASIAN COLOBINE MONKEYS.

Obstructive and incidental urolithiasis cases were evaluated in 5 Asian colobine monkey species (n= 21 individuals) that included 12 silvery langurs (Trachypithecus cristatus), 6 spectacled langurs (Trachypithecus obscurus), 1 Javan langur (Trachypithecus auratus auratus), 1 François' langur (Trachypithecus francoisi), and 1 red-shanked douc langur (Pygathrix nemaeus) from eight zoologic institutions. All institutions that responded were Association of Zoos and Aquariums, European Association of Zoos and Aquaria, or World Association of Zoos and Aquariums accredited. Males were more commonly represented in the total number of cases (86%), and all cases of obstructive urolithiasis occurred in males. The most common clinical signs observed in obstructive cases included stranguria (58.8%), lethargy (41.2%), anorexia (29.4%), depression (17.6%), and penile manipulation (11.8%). Clinicopathologic abnormalities revealed azotemia (76.5%), anemia (35.3%), and hyperkalemia (23.5%). Eleven of the 21 cases included urinalysis results, and crystalluria was reported in all 11. Obstructive cases were more commonly managed surgically, with medical management following. Instances of individual obstruction ranged from 0 (incidental finding) to 18, with a median of 8 (mean of 4.3) recurrent obstructions. A total of 39 urolith analyses were available from 17 of 21 cases, with calcium carbonate being the most common type isolated (37 of 39, 94.9%). Calcium oxalate was observed in the remaining 5.1% of cases (2 of 39). No cases exhibited a consistent match of crystalluria and urolith type. Death or euthanasia secondary to obstructive urolithiasis occurred in 52.4% of cases. Urinary obstruction secondary to urolithiasis appears to be a relevant cause of morbidity and mortality in Asian colobine species, and further study into etiology and preventive medicine should be undertaken.

Mothers' experience of having a child with cerebral palsy. A systematic review.

AIM: To explore, synthesise and present findings of qualitative studies describing the experiences of mothers raising a child with cerebral palsy. DESIGN: A systematic literature review of the qualitative evidence. METHODS: A systematic search for qualitative studies published in the following databases: CINAHL (EBSCO), Medline via OVID, SCOPUS, and Google Scholar. The authors independently assessed eligibility, appraised methodological quality using the Critical Appraisal Skills Program tool for qualitative Research (CASP). An inductive thematic analysis method was adopted to synthesise major findings and to construct core concepts and themes. RESULTS: Five overarching themes reflecting the experiences and perceptions of mothers raising and caring for a child with cerebral palsy are developed: 1) adapting and making sacrifices; 2) guilt and cultural blame; 3) social stigma and marginalisation; 4) physical, environmental, and financial challenges and 5) healthcare experiences.

SURVEY OF CLINICAL OPHTHALMIC DISEASE IN THE GIANT PANDA (AILUROPODA MELANOLEUCA) AMONG NORTH AMERICAN ZOOLOGICAL INSTITUTIONS.

This study surveyed six North American zoologic institutions to collect retrospective information on the incidence of ocular disease in the giant panda. Reported information included sex and age at presentation, as well as diagnosis, treatment, duration, and clinical outcome for each episode of ocular disease. Among the 42 animals included in the survey, 10 (23.8%) had clinical ocular abnormalities reported. Multiple disease episodes were reported in four animals, with 20 clinical episodes, and one additional animal who presented with corneal scarring from historic keratitis. Age at presentation varied from 0.4 to 26 yr (mean, 11.8 yr; median, 10.4 yr). Corneal abnormalities (including corneal opacity or haze, keratitis, corneal ulcers, and bullous keratopathy) were the most common pathologies reported, followed by conjunctivitis and/or ocular discharge. Additional reported abnormalities included limbal squamous cell carcinoma and lipid degeneration. Six cases resolved without intervention. Treatment protocols included topical and/or systemic medication with or without surgical intervention, which commonly resulted in resolution with or without persistent corneal scar. The prevalence of ocular disease identified in the giant panda in this study is higher than previous publications surveying ocular disease in the family Ursidae, indicating that this is an important source of morbidity in this species.

The Andean bear alopecia syndrome may be caused by social housing.

The Andean bear alopecia syndrome is a progressive and chronic condition documented in ex situ populations. Recent advances focus on treating symptoms, not preventing future cases. We therefore explored the epidemiology of this syndrome through an analysis of husbandry and veterinary conditions of 63 Andean bears (26M:37F) housed in North and South American zoos and other ex situ circumstances. We had the most complete information for the North American population and found that 29% of females (n = 24) were affected. No males (n = 26) were affected. An analysis of generalized linear models indicated that three models were competitive in describing the occurrence of the condition (i.e., ΔAICc ≤ 2): the model including only the individual's sex (χ2 = 13.41, df = 1, p < .001), the model including both individual sex and social housing status (χ2 = 1.36, df = 2, p < .001), and the model including both individual sex and the expression of stereotypical behaviors (χ2 = 13.82, df = 2, p = .001). Stereotypical behaviors were common among both males (50%, n = 26) and females (51.9%, n = 27) whether or not they were affected, but the syndrome was seen only in females who had been socially housed. Therefore, we suggest that the Andean bear alopecia syndrome is a symptomatic response to the long-term social housing of bears that would otherwise not live socially. To prevent new cases, we recommend that female Andean bears be housed with adult conspecifics only when females choose to cohabitate.

A patient with a diagnosis of nodal marginal zone B-cell lymphoma and a t(2;14)(p24;q32) involving MYCN and IGH.

BACKGROUND: Nodal marginal zone B-cell lymphoma is a rare entity in which the cytogenetic findings are not well defined. The t(2;14)(p24;q32) has previously been reported in three patients with blastic mantle cell lymphoma and one patient with follicular lymphoma. This rearrangement has not been reported previously in a patient with a diagnosis of nodal marginal zone B-cell lymphoma. CASE PRESENTATION: We present a male patient who presented with lymphadenopathy. On the basis of his clinicoradiologic presentation, morphological appearances, immunophenotype and molecular findings he was determined to have a diagnosis of nodal marginal zone B-cell lymphoma. Cytogenetic analysis demonstrated a t(2;14)(p24;q32). Further FISH testing showed this rearrangement to involve the MYCN and IGH genes. CONCLUSIONS: We present the first patient with a diagnosis of nodal marginal zone B-cell lymphoma with a t(2;14)(p24;q32). This rearrangement has been described in three other patients who have had a diagnosis of lymphoma. Our findings suggest this rearrangement is not specific to mantle cell lymphoma or follicular lymphoma. The number of cases described are still too low to draw firm conclusions regarding the nature of this rearrangement. In order to refine the clinical and prognostic picture of this finding, publication of further cases is required.

SEASONAL DERMATOPATHY AND CONCURRENT REPRODUCTIVE FINDINGS IN CAPTIVE FOSSA ( CRYPTOPROCTA FEROX).

Six female intact fossa ( Cryptoprocta ferox) in the San Diego Zoo collection presented with episodic, seasonal alopecia and variable pruritus between the years 1984 and 2015. Presentation was often accompanied by findings such as prominent palpable uterus or cervix and thickened, enlarged uterus on ultrasound. Dermatologic testing has been consistently nondiagnostic for primary cause of alopecia. Both the alopecia and reproductive findings have a higher occurrence from midspring to midsummer. Hormonal changes associated with reproductive activity are proposed as a possible explanation for the dermal clinical signs seen in these six fossas.

Tibial plateau leveling osteotomy in a cape clawless otter (Aonyx capensis) with cranial cruciate ligament ruptures.

A 13-yr-old female Cape clawless otter (Aonyx capensis) presented with an acute mild right pelvic limb lameness that progressed to a non-weight-bearing lameness. Diagnosis of a ruptured cranial cruciate ligament (CCL) was made based on positive cranial drawer during physical examination and was supported by radiographs. A surgical repair with a tibial plateau leveling osteotomy (TPLO) and bone anchor with an OrthoFiber suture was performed. The tibial plateau angle was reduced from 30 to 5 degrees. The otter returned to normal function after 12 wk of exercise restriction. Twelve months after surgery, the left CCL ruptured and a TPLO was performed. No complications developed after either surgery, and the otter had an excellent return to function. This is the first report of a cranial cruciate ligament rupture and TPLO procedure in a mustelid, supporting its application to noncanid and felid species.

Esophageal dissection and hematoma associated with obstruction in an Indian elephant (Elephas maximus indicus).

A 42-year-old female Indian elephant (Elephas maximus indicus) developed a sudden onset of excessive salivation and dysphagia. Esophageal obstruction was suspected; possibly related to palm frond ingestion. Esophageal endoscopy revealed a mat of plant material in the distal esophagus. An initial attempt at relieving the obstruction was unsuccessful, but subsequent use of custom-made instruments along with insufflation and hydropulsion enabled partial removal of the material. Postimmobilization care included aggressive intravenous and rectal fluids, anti-inflammatory and antibiotic administration, and fasting. Despite treatment, the dysphagia persisted and the elephant was euthanized due to lack of improvement and grave prognosis. Postmortem examination revealed remaining plant material in the esophagus, complicated by an esophageal dissection, mural hematoma, and secondary bacterial infection. Iatrogenic trauma may have contributed to the extent of esophageal injury. Although treatment was ultimately unsuccessful, the supportive care employed could potentially aid recovery in cases of less severe esophageal trauma.

Evidence of weekly cyclicity in mood and functional impairment in those with a bipolar disorder.

A key characteristic of bipolar disorder is fluctuation in mood symptoms and functional capacity, yet assessment of bipolar symptomatology often relies heavily on interval measurement that is unable to capture the full range of daily symptom variability and severity. The current study provides a detailed analysis of the variability in mood symptoms, functional impairment and medication compliance in a large sample of individuals newly diagnosed with bipolar disorder. Individuals diagnosed with bipolar disorder in the previous 12 months (n=192) rated their mood, functional impairment, medication compliance and symptom triggers daily over 10 consecutive weeks. High mood, low mood and functional impairment were found to vary on a weekly cycle, independently of medication compliance. Low mood and functional impairment were worse on weekdays, particularly Mondays and Tuesdays, whereas mood was most elevated on Saturdays. Work-related stressors were the most common symptom triggers on weekdays, whereas sleep-related problems and positive social events were the most common triggers on weekends. This study provides evidence that individuals newly diagnosed with bipolar disorder experience fluctuations in mood and functioning that vary according to a weekly cycle. This finding has implications for the assessment and treatment of patients, and for future research.

Gastrointestinal torsions and intussusception in northern koalas (Phascolarctos cinereus) at San Diego Zoo (1976-2012).

The recent classification as threatened status of the northern koala (Phascolarctos cinereus) by the Australian Government highlights the importance of the conservation and health management of this iconic Australian marsupial. This case series describes gastrointestinal torsion and intussusception in six northern koalas (three males, three females, 2-11 yr old) at the San Diego Zoo from 1976 to 2012. Two koalas died shortly after presentation. Diagnoses of ileocecal intussusception, resulting from enteritis in one case and cecal torsion in the other, were made at postmortem examination. One koala died 4 days after an exploratory laparotomy, with negative findings, and an acute double colonic intussusception was diagnosed at postmortem examination. Two small intestinal mesenteric torsion and one proximal colon mesenteric torsion cases were successfully corrected surgically. In the case of colonic mesenteric torsion, the koala had recurrent clinical signs 2 wk later, and a second surgery requiring resection and anastomosis of ischemic jejunum was performed, with the koala dying shortly afterward. One koala with small intestinal torsion had a recurrence of torsion 22 mo later and subsequently died. The koala with the second case of small intestinal torsion remains alive 14 mo postsurgical correction. All six koalas presented with signs of colic that included anorexia, lethargy, depression, acute abdominal distension, abdominal stretching, decreased fecal output, open-mouth gasping, or a combination of symptoms. Abdominal radiographs may show stacked gastrointestinal linear gas patterns and contrast stasis. Prevalence of torsion and intussusception is low at this institution (2%), although recurrence in individuals is common (50%) and overall survival is poor (83%), which emphasizes the importance of timely recognition, surgical correction, and postoperative management. While inciting etiologies were unable to be determined in these cases, monitoring generalized gastrointestinal health and differing Eucalyptus sp. effects on individual koala's gastrointestinal function, parasite control, and stress minimization through standardized husbandry practices are likely important.

Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder.

BACKGROUND: The increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder. METHOD: This qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study. RESULTS: Qualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies. CONCLUSIONS: Examples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.

Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: a randomised controlled trial.

OBJECTIVES: To examine the comparative effectiveness of an online psychoeducation program for people diagnosed with bipolar disorder within the previous 12 months, completed alone or with adjunctive peer support, on symptoms and perceived control over the illness. METHOD: Participants were randomly allocated to an eight-week online psychoeducation program (n=139), a psychoeducation program plus online peer support (n=134) or an attentional control condition (n=134). RESULTS: Increased perceptions of control, decreased perceptions of stigmatisation and significant improvements in levels of anxiety and depression, from pre- to post-intervention were found across all groups. There were no significant differences between groups on outcome measures, although a small clinical difference was found between the supported and unsupported conditions in depression symptoms and in functional impairment at the six-month follow-up. Adherence to the treatment program was significantly higher in the supported intervention than in the unsupported program. Gender and age were also significant predictors of adherence, with females and those over the age of 30 showing greater adherence. LIMITATIONS: Mood state at study entry was measured by self-report rather than by clinical interview. CONCLUSIONS: The pattern of outcomes suggests a primary influence of non-specific or common therapeutic factors across all three intervention groups. A personally tailored intervention may be more suitable for individuals recently diagnosed with bipolar disorder, and longer term coaching may increase program adherence and long-term improvement in symptoms and functioning.

The ins and outs of an online bipolar education program: a study of program attrition.

BACKGROUND: The science of eHealth interventions is rapidly evolving. However, despite positive outcomes, evaluations of eHealth applications have thus far failed to explain the high attrition rates that are associated with some eHealth programs. Patient adherence remains an issue, and the science of attrition is still in its infancy. To our knowledge, there has been no in-depth qualitative study aimed at identifying the reasons for nonadherence to-and attrition from- online interventions. OBJECTIVE: This paper explores the predictors of attrition and participant-reported reasons for nonadherence to an online psycho-education program for people newly diagnosed with a bipolar disorder. METHODS: As part of an ongoing randomized controlled trial (RCT) evaluating an online psycho-education program for people newly diagnosed with a bipolar disorder, we undertook an in-depth qualitative study to identify participants' reasons for nonadherence to, and attrition from, the online intervention as well as a quantitative study investigating predictors of attrition. Within the RCT, 370 participants were randomly allocated to 1 of 2 active interventions or an attention control condition. Descriptive analyses and chi-square tests were used to explore the completion rates of 358 participants, and standard regression analysis was used to identify predictors of attrition. The data from interviews with a subsample of 39 participants who did not complete the online program were analyzed using "thematic analysis" to identify patterns in reported reasons for attrition. RESULTS: Overall, 26.5% of the sample did not complete their assigned intervention. Standard multiple regression analysis revealed that young age (P= .004), male gender (P= .001), and clinical recruitment setting (P= .001) were significant predictors of attrition (F(7,330)= 8.08, P< .001). Thematic analysis of interview data from the noncompleter subsample revealed that difficulties associated with the acute phases of bipolar disorder, not wanting to think about one's illness, and program factors such as the information being too general and not personally tailored were the major reasons for nonadherence. CONCLUSIONS: The dropout rate was equivalent to other Internet interventions and to face-to-face therapy. Findings from our qualitative study provide participant-reported reasons for discontinuing the online intervention, which, in conjunction with the quantitative investigations about predictors, add to understanding about Internet interventions. However, further research is needed to determine whether there are systematic differences between those who complete and those who do not complete eHealth interventions. Ultimately, this may lead to the identification of population subgroups that most benefit from eHealth interventions and to informing the development of strategies to improve adherence. TRIAL REGISTRATION: ACTRN12608000411347; http://www.anzctr.org.au/ACTRN12608000411347.aspx (Archived by WebCite at http://www.webcitation.org/5uX4uYwVN).

Characterization of progressive keratitis in otariids.

OBJECTIVE: To characterize a form of progressive keratitis that occurs commonly in otariids. MATERIALS AND METHODS: One hundred and thirteen captive otariids were evaluated by ophthalmologic examination and digital photography. RESULTS: Forty-six females and 67 males were in the reference population, average age of 14 years. California sea lions predominated (n = 100); there were also six Steller sea lions, five brown fur seals, one Guadalupe fur seal and one northern fur seal. Three stages of progressive keratitis are described. Overall, 64.6% animals and 142 eyes from 113 animals (62.8%) were affected with one of three stages. The mildest form, Stage 1 keratitis, occurred in 78 of 226 eyes (34.5%); the intermediate Stage 2 keratitis occurred in 30 of 226 eyes (13.3%); and the most severe, Stage 3 keratitis, occurred in 34 of 226 eyes (15%). All but six animals had bilateral disease. Animals with Stage 1 keratitis were significantly younger than those in more advanced stages. DISCUSSION: 'Otariid Keratitis' occurs in all populations of eared seals evaluated. A large-scale epidemiological study is ongoing to identify the risk factors that contribute to this disease. Exposure to chronic sunlight appears to be an important risk factor as shade diminishes clinical signs; animals kept out of sunlight the majority of the time have less severe clinical signs. Age may be important since exposure accumulates with aging. Progression of the disease is also associated with secondary opportunistic bacterial and fungal infections. The surface immune system may be imbalanced contributing to these infections and progression.

A prospective study of the impact of smoking on outcomes in bipolar and schizoaffective disorder.

BACKGROUND: Tobacco smoking is more prevalent among people with mental illnesses, including bipolar disorder, than in the general community. Most data are cross-sectional, and there are no prospective trials examining the relationship of smoking to outcome in bipolar disorder. The impact of tobacco smoking on mental health outcomes was investigated in a 24-month, naturalistic, longitudinal study of 240 people with bipolar disorder or schizoaffective disorder. METHOD: Participants were interviewed and data recorded by trained study clinicians at 9 interviews during the study period. RESULTS: Comparisons were made between participants who smoked daily (n = 122) and the remaining study participants (n = 117). During the 24-month study period, the daily smokers had poorer scores on the Clinical Global Impressions-Depression (P = .034) and Clinical Global Impressions-Overall Bipolar (P = .026) scales and had lengthier stays in hospital (P = .012), compared with nonsmokers. LIMITATIONS: Smoking status was determined by self-report. Nicotine dependence was not measured. CONCLUSION: These findings suggest that smoking is associated with poorer mental health outcomes in bipolar and schizoaffective disorder.