Clinical Trials Radiographers identifying priority challenges associated with implementing a national programme of clinical trials in the United Kingdom's first proton beam therapy centre.

Objectives: This article is an evaluation of the current trial processes within a national proton beam therapy (PBT) clinical trial service in the United Kingdom. The work within the article identifies priority challenges associated with the implementation of PBT trials with a view to improving patient trial processes. Methods: The nominal group technique (NGT) was used. Five Clinical Trials Radiographers were asked the target question "what are the major challenges when implementing PBT clinical trials and facilitating PBT trial-related activities?" Participants individually and silently listed their challenges to the target question. Following this, group discussion clarified and refined responses. Participants then individually selected five challenges that they deemed most pertinent to the target question, giving a weighted score (out of 10). Individual scores were combined to provide a ranked, weighted order of challenges. Further group discussion identified improvement strategies to the highest scored challenges. Results: After combining lists generated by participants, 59 challenges were identified. Group discussion eliminated 27 responses. Eighteen were merged, resulting in 14 challenges. The two challenges that ranked highest were: (i) lack of initial understanding of the responsibilities of teams and who the relevant stakeholders were, and (ii) that a national PBT service requires the provision of shared care across multi-disciplinary teams and sites. Improvement areas include the development of shared protocols, clarifying stakeholder responsibilities and improving communication between centres to streamline PBT trial processes. Conclusions: This work has identified priority areas requiring development to improve the conduct of a national PBT clinical trials programme. Advances in knowledge: This is the first publication to evaluate current clinical trial processes for the United Kingdom's PBT service.

Complete blood count and biochemistry reference intervals for healthy adult sheep in the northeastern United States.

BACKGROUND: Reference intervals (RIs) for routine clinicopathologic data in sheep are sparse. The authors sought to establish hematologic and biochemical RIs from a varied ovine population to improve data interpretation for small ruminant veterinarians. OBJECTIVES: The goal of this study was to establish ovine CBC and biochemistry reference intervals by sampling 120 healthy adult sheep, both male and female, from a variety of breeds, located in the Northeastern United States. METHODS: One hundred and eighteen sheep were included in the CBC RI and 121 sheep were included in the biochemistry panel RI. RESULTS: RIs for 42 CBC and biochemistry analytes were established in accordance with the American Society for Veterinary Clinical Pathology and Clinical Laboratory Standards Institute guidelines. CONCLUSIONS: These RIs are provided to assist small ruminant veterinarians with the interpretation of CBC and biochemistry panel results in sheep.

An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention.

Obesity and overweight in early childhood have detrimental impacts on children's health and development. Changing policy, system and environmental features focused on physical activity and healthy eating behaviors as part of health promotion interventions can play a key role in prevention strategies in early childhood education settings. These types of changes can have broad reach and are often sustained over time, which allows for impact on children who enter the early childhood education setting year after year. However, there is currently a gap between the generation of evidence for health promotion programs and their application into practice. This study used qualitative methods to evaluate intervention-, organizational- and individual-level factors within a dissemination and implementation framework that may be related to the implementation of a health-promoting intervention in early childhood education settings. Intervention-level factors, including feasibility and adaptability, organizational-level factors, including staff and leadership engagement, and individual-level factors, including attitudes, skills and knowledge, were identified as constructs that impacted the successful implementation of the intervention. These findings provide insight into core dissemination and implementation constructs that should be targeted by obesity prevention interventions in early childhood education settings to ensure maximum impact on sustainable behavior change.

Mindfulness and cardiovascular health: Qualitative findings on mechanisms from the mindfulness-based blood pressure reduction (MB-BP) study.

BACKGROUND: Mindfulness-based programs hold promise for improving cardiovascular health (e.g. physical activity, diet, blood pressure). However, despite theoretical frameworks proposed, no studies have reported qualitative findings on how study participants themselves believe mindfulness-based programs improved their cardiovascular health. With an emphasis on in-depth, open-ended investigation, qualitative methods are well suited to explore the mechanisms underlying health outcomes. The objective of this qualitative study was to explore the mechanisms through which the mindfulness-based program, Mindfulness-Based Blood Pressure Reduction (MB-BP), may influence cardiovascular health. METHODS: This qualitative study was conducted as part of a Stage 1 single arm trial with one-year follow-up. The MB-BP curriculum was adapted from Mindfulness-Based Stress Reduction to direct participants' mindfulness skills towards modifiable determinants of blood pressure. Four focus group discussions were conducted (N = 19 participants), and seven additional participants were selected for in-depth interviews. Data analysis was conducted using the standard approach of thematic analysis. Following double-coding of audio-recorded transcripts, four members of the study team engaged in an iterative process of data analysis and interpretation. RESULTS: Participants identified self-awareness, attention control, and emotion regulation as key mechanisms that led to improvements in cardiovascular health. Within these broader themes, many participants detailed a process beginning with increased self-awareness to sustain attention and regulate emotions. Many also explained that the specific relationship between self-awareness and emotion regulation enabled them to respond more skillfully to stressors. In a secondary sub-theme, participants suggested that higher self-awareness helped them engage in positive health behaviors (e.g. healthier dietary choices). CONCLUSION: Qualitative analyses suggest that MB-BP mindfulness practices allowed participants to engage more effectively in self-regulation skills and behaviors lowering cardiovascular disease risk, which supports recent theory. Results are consistent with quantitative mechanistic findings showing emotion regulation, perceived stress, interoceptive awareness, and attention control are influenced by MB-BP.

Mindfulness-Based Blood Pressure Reduction (MB-BP): Stage 1 single-arm clinical trial.

BACKGROUND AND OBJECTIVES: Impacts of mindfulness-based programs on blood pressure remain equivocal, possibly because the programs are not adapted to engage with determinants of hypertension, or due to floor effects. Primary objectives were to create a customized Mindfulness-Based Blood Pressure Reduction (MB-BP) program, and to evaluate acceptability, feasibility, and effects on hypothesized proximal self-regulation mechanisms. Secondary outcomes included modifiable determinants of blood pressure (BP), and clinic-assessed systolic blood pressure (SBP). METHODS: This was a Stage 1 single-arm trial with one year follow-up. Focus groups and in-depth interviews were performed to evaluate acceptability and feasibility. Self-regulation outcomes, and determinants of BP, were assessed using validated questionnaires or objective assessments. The MB-BP curriculum was adapted from Mindfulness-Based Stress Reduction to direct participants' mindfulness skills towards modifiable determinants of blood pressure. RESULTS: Acceptability and feasibility findings showed that of 53 eligible participants, 48 enrolled (91%). Of these, 43 (90%) attended at least 7 of the 10 MB-BP classes; 43 were followed to one year (90%). Focus groups (n = 19) and semi-structured interviews (n = 10) showed all participants viewed the delivery modality favorably, and identified logistic considerations concerning program access as barriers. A priori selected primary self-regulation outcomes showed improvements at one-year follow-up vs. baseline, including attention control (Sustained Attention to Response Task correct no-go score, p<0.001), emotion regulation (Difficulties in Emotion Regulation Score, p = 0.02), and self-awareness (Multidimensional Assessment of Interoceptive Awareness, p<0.001). Several determinants of hypertension were improved in participants not adhering to American Heart Association guidelines at baseline, including physical activity (p = 0.02), Dietary Approaches to Stop Hypertension-consistent diet (p<0.001), and alcohol consumption (p<0.001). Findings demonstrated mean 6.1 mmHg reduction in SBP (p = 0.008) at one year follow-up; effects were most pronounced in Stage 2 uncontrolled hypertensives (SBP≥140 mmHg), showing 15.1 mmHg reduction (p<0.001). CONCLUSION: MB-BP has good acceptability and feasibility, and may engage with self-regulation and behavioral determinants of hypertension.

Evaluation of Translaryngeal Percutaneous Arytenoid Lateralization (TPAL) in dogs with experimentally created laryngeal paralysis.

The aim of this experimental study was to evaluate the effect of Translaryngeal Percutaneous Arytenoid Lateralization (TPAL) in dogs with experimentally created laryngeal paralysis. All dogs (n=5) underwent bilateral recurrent laryngeal neurectomy before TPAL. Two TPAL suture techniques were evaluated. TPAL-CranialCaudal (TPAL-CC) was performed first, followed 11 to 14days later by TPAL-DorsalVentral (TPAL-DV). For both techniques, a mattress suture was placed through the arytenoid cartilage via an oral approach. Laryngeal examination was performed before, immediately after, and on days 1, 3 and 7 for both TPAL techniques. Ipsilateral hemiglottic surface area and the degree of laryngeal swelling or reaction to the suture were recorded. Laryngeal tissue was evaluated by histopathology at the end of the study. For both TPAL techniques, hemiglottic surface area was increased immediately after suture placement (P<0.05). At all other times, hemiglottic area was not statistically different from preoperative value (P>0.05). TPAL-DV resulted in less laryngeal swelling compared to TPAL-CC. Histopathology of the arytenoid cartilage surrounding the mattress suture revealed mucosal ulceration and inflammation consistent with the presence of the suture material. Both TPAL techniques were effective at lateralizing the arytenoid cartilage and significantly increasing hemiglottic surface area immediately after suture placement. However, mucosal swelling and loss of tension on the mattress suture lead to a decrease in glottic area within 24h. Further refinements in suture placement technique are warranted to minimize swelling and improve the duration of arytenoid lateralization prior to clinical application.

Urinalysis in chinchillas (Chinchilla lanigera).

OBJECTIVE: To evaluate urine variables in chinchillas (Chinchilla lanigera). DESIGN: Evaluation study. SAMPLE: Urine samples from 41 chinchillas. PROCEDURES: Voided urine samples were collected from clinically normal chinchillas that were exhibited during a breeder exposition. Urinalysis was performed within 1 hour after collection. Urine specific gravity (USG) was measured before and after centrifugation with a handheld veterinary refractometer. Urine dipstick analysis and microscopic sedimentation examination were performed on all samples. Additionally, a urine sulfosalicylic acid (SSA) precipitation test and quantitative protein analysis were performed on samples with sufficient volume. RESULTS: 17 of 41 (41%) samples had a USG ≥ 1.050, and USG ranged from 1.014 to > 1.060. The USG before centrifugation did not differ significantly from that after centrifugation. Protein was detected in all urine samples on dipstick analysis. The SSA precipitation test yielded negative results for all samples tested. Results of the quantitative protein analyses were not correlated with the results of the dipstick analyses or SSA tests. The recorded pH for all samples was 8.5, which was the upper limit of detection for the reagent strip. Glucose and ketones were detected in 5 and 6 samples, respectively. Crystals were observed in 28 of 41 (68%) samples; 27 of those samples contained amorphous crystals. CONCLUSIONS AND CLINICAL RELEVANCE: Urinalysis results for clinically normal chinchillas were provided. For chinchilla urine samples, measurement of USG by refractometry prior to centrifugation is acceptable and protein concentration should be determined by quantitative protein analysis rather than dipstick analysis or the SSA test.

Electrolyte depletion in white-nose syndrome bats.

The emerging wildlife disease white-nose syndrome is causing widespread mortality in hibernating North American bats. White-nose syndrome occurs when the fungus Geomyces destructans infects the living skin of bats during hibernation, but links between infection and mortality are underexplored. We analyzed blood from hibernating bats and compared blood electrolyte levels to wing damage caused by the fungus. Sodium and chloride tended to decrease as wing damage increased in severity. Depletion of these electrolytes suggests that infected bats may become hypotonically dehydrated during winter. Although bats regularly arouse from hibernation to drink during winter, water available in hibernacula may not contain sufficient electrolytes to offset winter losses caused by disease. Damage to bat wings from G. destructans may cause life-threatening electrolyte imbalances.

Pathogen exposure and blood chemistry in the Washington, USA population of northern sea otters (Enhydra lutris kenyoni).

Northern sea otters (Enhydra lutris kenyoni) from Washington State, United States were evaluated in 2011 to determine health status and pathogen exposure. Antibodies to Brucella spp. (10%) and influenza A virus (23%) were detected for the first time in this population in 2011. Changes in clinical pathology values (serum chemistries), exposure to pathogens, and overall health of the population over the last decade were assessed by comparing 2011 data to the data collected on this population in 2001-2002. Several serum chemistry parameters were different between study years and sexes but were not clinically significant. The odds of canine distemper virus exposure were higher for otters sampled in 2001-2002 (80%) compared to 2011 (10%); likelihood of exposure significantly increased with age. Prevalence of exposure to Sarcocystis neurona was also higher in 2001-2002 (29%) than in 2011 (0%), but because testing methods varied between study years the results were not directly comparable. Exposure to Leptospira spp. was only observed in 2001-2002. Odds of Toxoplasma gondii exposure were higher for otters sampled in 2011 (97%) than otters in 2001-2002 (58%). Substantial levels of domoic acid (n = 2) and saxitoxin (n = 2) were found in urine or fecal samples from animals sampled in 2011. No evidence of calicivirus or Coxiella burnetii exposure in the Washington population of northern sea otters was found in either 2001-2002 or 2011. Changes in exposure status from 2001-2002 to 2011 suggest that the Washington sea otter population may be dealing with new disease threats (e.g., influenza) while also increasing their susceptibility to diseases that may be highly pathogenic in naïve individuals (e.g., canine distemper).

Clinical use of cyclosporine as an adjunctive therapy in the management of feline idiopathic pure red cell aplasia.

The clinical use of cyclosporine is described in a group of client-owned cats diagnosed with idiopathic pure red cell aplasia (PRCA). All 10 cats were treated with combinations of glucocorticoids and cyclosporine. Of the 10 cats, the eight for which follow-up data was available achieved and maintained remission for a median of 31 and 406 days, respectively. Therapy was reduced or discontinued in 7/8 cats; 2/7 maintained remission off therapy and 5/7 cats relapsed. Remission was reinduced in four cats, with 3/4 cats maintained long-term on low dose therapy. Adverse effects associated with cyclosporine therapy were responsive to dose reduction or drug withdrawal. Feline idiopathic PRCA was responsive to combination immunosuppressive therapy with glucocorticoids and cyclosporine. Relapse was common, particularly after drug discontinuation; therefore, most cats required maintenance long-term low dose therapy.

Neoplastic pleocytosis in a dog with metastatic mammary carcinoma and meningeal carcinomatosis.

A 12-year-old female spayed Labrador Retriever was presented with a history of seizures and abnormal vocalization. Approximately 1 year before presentation, multiple mammary cysts had been surgically excised. A mammary mass was noted on physical examination, and 2 separate parenchymal brain lesions were found on imaging studies. Cerebrospinal fluid (CSF) collected from the cisterna magna was analyzed, and abnormalities included moderate pleocytosis with atypical discrete round cells that occasionally formed loose clusters. The dog was euthanized, and on necropsy a primary solid mammary carcinoma was identified as well as multiple metastatic foci in the brain with diffuse meningeal involvement. The cells in the CSF had a morphologic appearance similar to the cells in the primary mammary tumor and in the metastatic tumors in the brain. On immunostaining, cells from the primary mammary tumor, the brain tumors, and the CSF expressed cytokeratin. The CSF cells did not express CD18, CD3, or CD79a. A final diagnosis of mammary carcinoma with brain metastasis and meningeal carcinomatosis was made.