Assessment of the likelihood of hypothyroidism in dogs diagnosed with and treated for hypothyroidism at primary care practices: 102 cases (2016-2021).

BACKGROUND: There is a possibility that an incorrect diagnosis of hypothyroidism could be made in euthyroid dogs, and the prevalence of hypothyroidism in the dog population remains unknown. OBJECTIVES: To retrospectively assess the percentage of dogs diagnosed with, and treated for, hypothyroidism at first opinion practice which are likely to be hypothyroid and require levothyroxine supplementation. ANIMALS: One hundred two client-owned dogs were included in this study. MATERIALS AND METHODS: The computerized databases of 7 first opinion practices were searched to identify dogs treated with levothyroxine supplementation. Three European College of Veterinary Internal Medicine-Companian Animals (ECVIM-CA) diplomates independently assigned 1 of 4 clinical assessments to each case as follows: confirmed or likely hypothyroid, hypothyroidism suspected but not confirmed, hypothyroidism considered unlikely, and no reason to suspect hypothyroidism. They commented as to whether or not they thought levothyroxine supplementation was appropriate. RESULTS: The clinical assessments of "confirmed or likely hypothyroid"; "Hypothyroidism suspected but not confirmed"; "Hypothyroidism considered unlikely"; and "No reason to suspect hypothyroidism" was assigned respectively by Clinician 1 to 38.2%, 5.9%, 3.9%, and 52% of cases, by Clinician 2 to 48%, 22.6%, 22.6%, 6.9% of cases, and by Clinician 3 to 55.9%, 11.8%, 13.7% and 18.6%. Clinician 1, Clinician 2, and Clinician 3 considered levothyroxine supplementation not indicated in 58.8%, 52.9%, and 45.1% of cases, respectively. CONCLUSION: These results support the concern that hypothyroidism might be overly and incorrectly diagnosed in first opinion practice, and that thyroid function testing should be performed only in those dogs with a high pretest probability of the disease.

A case of Elexacaftor-Tezacaftor-Ivacaftor induced rash resolving without interruption of treatment.

The triple combination of Elexacaftor-Tezacaftor-Ivacaftor (ELX-TEZ-IVA) has been shown to markedly improve lung function in persons with cystic fibrosis (pwCF). An important adverse effect of the drug is rash, which was reported in clinical trials and highlighted in case reports. Our report demonstrates a similar adverse event with the drug in one of our patients with spontaneous resolution of the rash not necessitating cessation of treatment or desensitization to the drug as were done in other cases. We highlight through our report the heterogeneity of the clinical presentation of the rash when on triple therapy and the need for further studies to understand the immunological mechanism of this adverse event.

Explicit Instruction of Scientific Uncertainty in an Undergraduate Geoscience Field-Based Course.

Understanding and communicating uncertainty is a key skill needed in the practice of science. However, there has been little research on the instruction of uncertainty in undergraduate science education. Our team designed a module within an online geoscience field course which focused on explicit instruction around uncertainty and provided students with an uncertainty rating scale to record and communicate their uncertainty with a common language. Students then explored a complex, real-world geological problem about which expert scientists had previously made competing claims through geologic maps. Provided with data, expert uncertainty ratings, and the previous claims, students made new geologic maps of their own and presented arguments about their claims in written form. We analyzed these reports along with assessments of uncertainty. Most students explicitly requested geologists' uncertainty judgments in a post-course assessment when asked why scientists might differ in their conclusions and/or utilized the rating scale unprompted in their written arguments. Through the examination of both pre- and post-course assessments of uncertainty and students' course-based assessments, we argue that explicit instruction around uncertainty can be introduced during undergraduate coursework and could facilitate geoscience novices developing into practicing geoscientists.

Using a learning health system to understand the mismatch between medicines supply and actual medicines use among adults with cystic fibrosis.

BACKGROUND: Studies in separate cohorts suggest possible discrepancies between inhaled medicines supplied (median 50-60%) and medicines used (median 30-40%). We performed the first study that directly compares CF medicine supply against use to identify the cost of excess medicines supply. METHODS: This cross-sectional study included participants from 12 UK adult centres with ≥1 year of continuous adherence data from data-logging nebulisers. Medicine supply was measured as medication possession ratio (MPR) for a 1-year period from the first suitable supply date. Medicine use was measured as electronic data capture (EDC) adherence over the same period. The cost of excess medicines was calculated as whole excess box(es) supplied after accounting for the discrepancy between EDC adherence and MPR with 20% contingency. RESULTS: Among 275 participants, 133 (48.4%) were females and mean age was 30 years (95% CI 29-31 years). Median EDC adherence was 57% (IQR 23-86%), median MPR was 74% (IQR 46-96%) and the discrepancy between measures was median 14% (IQR 2-29%). Even with 20% contingency, mean potential cost of excess medicines was £1,124 (95% CI £855-1,394), ranging from £183 (95% CI £29-338) for EDC adherence ≥80% to £2,017 (95% CI £1,507-2,526) for EDC adherence <50%. CONCLUSIONS: This study provides a conservative estimate of excess inhaled medicines supply cost among adults with CF in the UK. The excess supply cost was highest among those with lowest EDC adherence, highlighting the importance of adherence support and supplying medicine according to actual use. MPR provides information about medicine supply but over-estimates actual medicine use.

Sustainability science education: our animalistic response-ability.

In this paper, we craft a dialogue between "The Anthropocene as we know it: posthumanism, science education and scientific literacy as a path to sustainability," by Sophia Jeong, Brandon Sherman, and Deborah Tippins and, "The quest for sustainable futures: designing transformative spaces for youth through critical response-ability," by Shakhnoza Kayumova and Deborah Tippins. We argue for an optimistic approach to post-Anthropocene science education that acknowledges humans as the animals we are, albeit with a more sophisticated understanding of our place in the world. It is this understanding that gives us both responsibility and a response-ability to our human and non-human actors within our earthly entanglement. To do this requires reimagining science classrooms as locations of opportunity where students develop agential literacy. These classrooms provide an environment that allow students to develop their skills as sustainability engineers. We advocate for embracing indigenous ways of knowing, opening locations of possibilities through policy reform, fostering an integrated model of STEM education, and re-imagining teacher education to promote and move toward equitable science education.

En este artículo, elaboramos un diálogo entre "El Antropoceno como lo conocemos: posthumanismo, educación en ciencias y alfabetización científica como un camino hacia la sostenibilidad", según Sophia Jeong, Brandon Sherman y Deborah Tippins y, "La búsqueda de futuros sostenibles: diseñando espacios transformadores para los jóvenes a través de la capacidad de respuesta crítica", según Shakhnoza Kayumova y Deborah Tippins. Discutimos un enfoque optimista de la educación en ciencias post-antropoceno que reconozca a los humanos como los animales que somos, aunque con una comprensión más sofisticada de nuestro lugar en el mundo. Dicha comprensión es la que nos da tanto responsabilidad como capacidad de respuesta frente a los actores humanos y no humanos dentro de nuestro entrelazamiento terrenal. Hacer esto requiere reinventar las aulas de ciencias como lugares de oportunidad donde los estudiantes desarrollan una alfabetización activa. Estas aulas proporcionan un entorno que permite a los estudiantes desarrollar sus habilidades como ingenieros de la sostenibilidad. Abogamos por adoptar las formas de saber indígenas, abriendo espacios de posibilidades a través de reformas políticas, fomentando un modelo integrado de educación STEM y reinventando la formación docente para promover y avanzar hacia una educación en ciencias equitativa.

Master of science in medical leadership and management and its role in the current NHS.

Traditionally there has been little formal leadership and management education in the core medical curriculum. The Department of Health has recently emphasised the development of clinical leadership within the NHS. In this article, trainees share their experience of the Master of Science in medical leadership and management postgraduate qualification.