Availability of Certified Sexual Assault Nurse Examiners in Appalachian States.

INTRODUCTION: Sexual assault nurse examiners are crucial care providers in cases of sexual assault. However, it is not clear whether sexual assault nurse examiner availability differs throughout the 13 states that comprise the Appalachian region of the United States. Therefore, this cross-sectional analysis identified sexual assault nurse examiner availability in 13 states and determined differences in availability by both county-level Appalachian status and county-level rurality status. METHODS: Data were downloaded from 2 public sexual assault nurse examiner registries for the included 13 states. Descriptive statistics of sexual assault nurse examiner certification type and availability by state were calculated. In addition, bivariate analyses of sexual assault nurse examiner availability by rurality and by Appalachian status were performed using 2-sample z-tests for equality of proportions. RESULTS: State-level sexual assault nurse examiner availability ranged from 0.34 to 0.86 sexual assault nurse examiners per 100,000 residents. Sexual assault nurse examiner availability in these 13 states did not differ by Appalachian status. However, rural areas had significantly lower sexual assault nurse examiner availability than urban areas in these 13 states. DISCUSSION: These data support previous literature on the need for stronger sexual assault nurse examiner programs in rural areas in the United States. Future research should take sexual assault prevalence into account to determine whether local sexual assault nurse examiner access needs, as well as appropriate support for sexual assault nurse examiners, are being met throughout Appalachian states.

Right dorsal colitis in horses: A multicenter retrospective study of 35 cases.

BACKGROUND: Right dorsal colitis (RDC) is a nonsteroidal anti-inflammatory drug (NSAID) induced, protein losing enteropathy in horses associated with a high case fatality rate. OBJECTIVES: To describe signalment, NSAID usage, clinical presentations, clinical pathology, ultrasonographic findings, treatments, outcomes, and factors associated with survival in horses diagnosed with RDC. ANIMALS: Thirty-five horses from 7 Australian equine hospitals diagnosed with RDC. METHODS: Retrospective case series. Clinical records of cases were accepted if definitively or presumptively diagnosed by an internist with RDC and had ≥3 of: hypoproteinemia or hypoalbuminemia; diarrhea with negative test results for infectious diseases; colic for which other diseases were excluded or right dorsal colon thickening on ultrasound. Descriptive data analysis was performed for categorical and continuous variables. Univariate binominal logistic regressions were used to assess factors associated with survival. RESULTS: An overdose of NSAIDs occurred in 84% (21/25) cases where dose was known. Common clinical presentations included diarrhea (69%; 22/32), colic (61%; 20/33), and tachycardia (53%, 17/32). Common clinicopathological findings included hypoalbuminemia (83%; 26/31), hypocalcaemia (79%, 23/29), and hyperlactatemia (77%, 14/18). The right dorsal colon wall appeared subjectively thickened in 77% (24/31) cases using ultrasonography. Case fatality rate was 43% (15/35). Odds of survival significantly decreased with increasing heart rate (odds 0.84, 95% CI = 0.71-0.92, P = .01), packed cell volume (odds 0.91, 95% CI 0.82-0.98, P = .05) and abnormal appearance of mucous membranes (odds 0.05, 95% CI 0.005-0.28, P = .001) on hospital presentation. CONCLUSIONS AND CLINICAL IMPORTANCE: An overdose of NSAIDs is common in horses diagnosed with RDC. Serum albumin concentrations should be monitored in horses receiving a prolonged course of NSAIDs. Overall prognosis for RDC remains fair.

Work hard, play hard: how sexually differentiated microglia work to shape social play and reproductive behavior.

Microglia are brain-resident immune cells that play a critical role in synaptic pruning and circuit fine-tuning during development. In the adult brain, microglia actively survey their local environment and mobilize inflammatory responses to signs of damage or infection. Sex differences in microglial gene expression and function across the lifespan have been identified, which play a key role in shaping brain function and behavior. The levels of sex hormones such as androgens, estrogens, and progesterone vary in an age-dependent and sex-dependent manner. Microglia respond both directly and indirectly to changes in hormone levels, altering transcriptional gene expression, morphology, and function. Of particular interest is the microglial function in brain regions that are highly sexually differentiated in development such as the amygdala as well as the pre-optic and ventromedial hypothalamic regions. With a focus on hormone-sensitive developmental windows, this review compares male and female microglia in the embryonic, developing, and adult brain with a particular interest in the influence of sex hormones on microglial wiring of social, reproductive, and disordered behavior circuits in the brain.

Implementation and evaluation of an expectation maximization reconstruction algorithm for gamma emission breast tomosynthesis.

PURPOSE: We are developing a dual modality tomosynthesis breast scanner in which x-ray transmission tomosynthesis and gamma emission tomosynthesis are performed sequentially with the breast in a common configuration. In both modalities projection data are obtained over an angular range of less than 180° from one side of the mildly compressed breast resulting in incomplete and asymmetrical sampling. The objective of this work is to implement and evaluate a maximum likelihood expectation maximization (MLEM) reconstruction algorithm for gamma emission breast tomosynthesis (GEBT). METHODS: A combination of Monte Carlo simulations and phantom experiments was used to test the MLEM algorithm for GEBT. The algorithm utilizes prior information obtained from the x-ray breast tomosynthesis scan to partially compensate for the incomplete angular sampling and to perform attenuation correction (AC) and resolution recovery (RR). System spatial resolution, image artifacts, lesion contrast, and signal to noise ratio (SNR) were measured as image quality figures of merit. To test the robustness of the reconstruction algorithm and to assess the relative impacts of correction techniques with changing angular range, simulations and experiments were both performed using acquisition angular ranges of 45°, 90° and 135°. For comparison, a single projection containing the same total number of counts as the full GEBT scan was also obtained to simulate planar breast scintigraphy. RESULTS: The in-plane spatial resolution of the reconstructed GEBT images is independent of source position within the reconstructed volume and independent of acquisition angular range. For 45° acquisitions, spatial resolution in the depth dimension (the direction of breast compression) is degraded with increasing source depth (increasing distance from the collimator surface). Increasing the acquisition angular range from 45° to 135° both greatly reduces this depth dependence and improves the average depth dimension resolution from 10.8 to 4.8 mm. The 135° acquisition results in a near-isotropic, spatially uniform 3D resolution of approximately 4.3 mm full width at half maximum. Background nonuniformity (cupping) artifacts arise primarily from angular incompleteness for small angular range acquisition but primarily from gamma ray attenuation at larger angular range. However, background artifacts can be largely eliminated if both prior information regularization and AC are applied. An artificial decrease in lesion voxel value with increasing lesion depth can also be substantially reduced through a combination of AC and RR. In experiments using compressible gelatin breast phantoms, lesion contrast and SNR are about 2.6-8.8 times and 2.3-5.6 times higher, respectively, in GEBT than in planar breast scintigraphy depending on the acquisition angle, the gamma camera trajectory, and the lesion location. In addition, the strong reduction in lesion contrast and SNR with increasing lesion depth that is observed in planar breast scintigraphy can be largely overcome in GEBT. CONCLUSIONS: The authors have demonstrated a promising EM-based reconstruction scheme for use in GEBT. Compared to planar breast scintigraphy GEBT provides superior and less position-dependent lesion contrast, lesion SNR, and spatial resolution as well as more accurate quantification of lesion-to-background activity concentration ratio.

The Impact of Reduced Injected Radioactivity on Image Quality of Molecular Breast Imaging Tomosynthesis.

This study's objective is to compare image quality in 3-D molecular breast imaging tomosynthesis (MBIT) with that in planar molecular breast imaging (MBI) over a range of breast radioactivity concentrations. Using gelatin and point source phantoms lesion contrast, lesion signal-to-noise ratio (SNR) and spatial resolution were compared for a range of lesion sizes and depths. For both MBI and MBIT, lesion contrast is essentially constant with changing activity while SNR decreases by a factor of 1.5 - 2 between 100% and 25% activity levels. For nearly all lesion sizes and locations contrast and SNR are significantly higher for MBIT than MBI, potentially permitting greater reductions in injected dose. Spatial resolution in MBI is dependent on lesion depth but independent of lesion location with MBIT. Reconstructed MBIT spatial resolution is substantially better than that in the projection images, suggesting future use of higher sensitivity collimators for even further reductions in injected activity.