Surgical treatment of canine urethral prolapse via urethropexy or resection and anastomosis.

OBJECTIVES: The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. RESULTS: Seventy-nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. CLINICAL SIGNIFICANCE: Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis.

Long-term clinical outcomes following surgery for spontaneous pneumothorax caused by pulmonary blebs and bullae in dogs - a multicentre (AVSTS Research Cooperative) retrospective study.

OBJECTIVES: To report the clinical characteristics and recurrence rate of spontaneous pneumothorax secondary to pulmonary blebs and bullae following surgical management in a large cohort of dogs. To explore potential risk factors for recurrence and describe outcome. MATERIALS AND METHODS: Medical records were retrospectively reviewed for cases with spontaneous pneumothorax managed surgically between 2000 and 2017. Signalment, clinical presentation, diagnostic imaging, surgery, histopathology findings and patient outcomes were recorded. Follow-up was performed via patient records and telephone contact. RESULTS: Records of 120 dogs with surgically treated pneumothorax were identified and reviewed, with 99 cases appropriate for exploratory statistical analysis. Median follow-up was 850 days (range: 9-5105 days). Two- and 5-year survival rates were 88.4% and 83.5%, respectively. There was recurrence in 14 of 99 dogs (14.1%) with adequate follow-up, with a median time to recurrence of 25 days (1-1719 days). Univariable Cox regression analysis suggested increased risk for recurrence in giant breeds (hazard ratio = 11.05, 95% confidence interval: 2.82-43.35) and with increasing bodyweight (HR = 1.04, 95% confidence interval: 1.00-1.09). Of 14 dogs with recurrence, six were euthanased, two died of causes related to pneumothorax and six underwent further treatment, of which five were resolved. CLINICAL SIGNIFICANCE: Long-term survival for dogs with surgically managed spontaneous pneumothorax was good and associated with a low risk of recurrence. Giant breed dogs and increased bodyweight were the only variables identified as possible risk factors for recurrence. The outcome for dogs with recurrence undergoing a second intervention was also favourable.

Functional symptoms in dermatology: Part 1.

Functional - or somatoform - symptoms are those that arise with no proven organic pathology. Also known as 'medically unexplained' symptoms, they can present in any medical speciality, including dermatology. Mucocutaneous pain syndromes and functional pruritus are two examples of functional disorders encountered by dermatologists. Patients presenting with somatoform symptoms have paradoxically complex and often subjectively severe symptomatology, yet minimal abnormalities on clinical examination or investigation. Such disparity can be frustrating and distressing for patients and clinicians alike, and there are many pitfalls regarding overinvestigation and misleading communication. However, with an honest and open approach - sometimes requiring collaboration with psychological services - management of functional symptoms can be effective, and patients can be successfully rehabilitated.

Functional symptoms in dermatology: Part 2.

Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.

Effect of filament supports on emissive probe measurements.

We have constructed an emissive probe with a thin tungsten filament spot-welded across two nickel wires insulated with ceramic paint. We show that the ceramic supports covering the nickel wires have a large effect on the potential measurements in low-density plasmas. It is found that the potential measured by the emissive probe is more negative than the potential derived from a Langmuir probe current-voltage (I-V) characteristic curve when the plasma density is so low that the emitting filament remains immersed in the sheaths of the ceramic supports. The length of the filament L needs to be larger than about 2 Debye lengths (L > 2λ(De)) in order to avoid the influence of the ceramic supports and to achieve reliable plasma potential measurements using emissive probes.

Detailed observation and measurement of sewer sediment erosion under aerobic and anaerobic conditions.

A greater understanding of the erosion behaviour of sewer sediments is necessary in order to reliably estimate the amount and nature of the sewer sediments released from deposits in sewers and transported either to waste water treatment plants or discharged into the environment. Research has indicated that microbial activity in sediment can influence the physical release of sediment from in-pipe deposits. This paper reports on a series of erosion tests in which sewer sediments from different sewer networks are kept under different environmental conditions and their resistance to erosion is examined. The erosion tests are carried out under aerobic and anaerobic conditions and two temperatures, one representing ambient sewer temperatures and a lower temperature that significantly suppresses bacterial activity.

Evidence for an atypical receptor mediating the augmented bronchoconstrictor response to adenosine induced by allergen challenge in actively sensitized Brown Norway rats.

The bronchoconstrictor response to adenosine is markedly and selectively increased following ovalbumin (OA) challenge in actively sensitized, Brown Norway rats. We present a pharmacological analysis of the receptor mediating this response. Like adenosine, the broad-spectrum adenosine receptor agonist, NECA, induced dose-related bronchoconstriction in actively sensitized, OA-challenged animals. In contrast, CPA, CGS 21680 and 2-Cl-IB-MECA, agonists selective for A(1) A(2A) and A(3) receptors, respectively, induced no, or minimal, bronchoconstriction. Neither the selective A(1) receptor antagonist, DPCPX, nor the selective A(2A) receptor antagonist, ZM 241385, blocked the bronchoconstrictor response to adenosine. MRS 1754, which has similar affinity for rat A(2B) and A(1) receptors, failed to block the bronchoconstrictor response to adenosine despite blockade of the A(1) receptor-mediated bradycardia induced by NECA. 8-SPT and CGS 15943, antagonists at A(1), A(2A), and A(2B) but not A(3) receptors, inhibited the bronchoconstrictor response to adenosine. However, the degree of blockade (approximately 3 fold) did not reflect the plasma concentrations, which were 139 and 21 times greater than the K(B) value at the rat A(2B) receptor, respectively. Adenosine and NECA, but not CPA, CGS 21680 or 2-Cl-IB-MECA, induced contraction of parenchymal strip preparations from actively sensitized OA-challenged animals. Responses to adenosine could not be antagonized by 8-SPT or MRS 1754 at concentrations >50 times their affinities at the rat A(2B) receptor. The receptor mediating the bronchoconstrictor response to adenosine augmented following allergen challenge in actively sensitized BN rats cannot be categorized as one of the four recognized adenosine receptor subtypes.

The relation of preschool child-care quality to children's cognitive and social developmental trajectories through second grade.

The cognitive and socioemotional development of 733 children was examined longitudinally from ages 4 to 8 years as a function of the quality of their preschool experiences in community child-care centers, after adjusting for family selection factors related to child-care quality and development. These results provide evidence that child-care quality has a modest long-term effect on children's patterns of cognitive and socioemotional development at least through kindergarten, and in some cases, through second grade. Differential effects on children's development were found for two aspects of child-care quality. Observed classroom practices were related to children's language and academic skills, whereas the closeness of the teacher-child relationship was related to both cognitive and social skills, with the strongest effects for the latter. Moderating influences of family characteristics were observed for some outcomes, indicating stronger positive effects of child-care quality for children from more at-risk backgrounds. These findings contribute further evidence of the long-term influences of the quality of child-care environments on children's cognitive and social skills through the elementary school years and are consistent with a bioecological model of development that considers the multiple environmental contexts that the child experiences.

Exercise tolerance and quality of life in elderly patients with chronic atrial fibrillation.

BACKGROUND: Atrial fibrillation is the most common arrhythmia affecting the elderly. Although the risk of cardioembolic stroke is well defined, the effects of chronic atrial fibrillation on exercise tolerance and quality of life have been less well quantified. METHODS: We compared a group of 52 elderly patients with chronic atrial fibrillation to a group of 48 control patients in sinus rhythm. Each patient underwent an interview that incorporated the Short Form-36 Health Survey (SF-36) to quantify individual perceptions on quality of life. In addition each person underwent physiologic testing that included a Modified Bruce Protocol exercise tolerance test, 24-hour ambulatory monitor test, and an echocardiogram. RESULTS: Both groups were elderly, 77 vs 76 years of age (P=0.35). The two groups had similar ejection fractions, 55.4% vs 58.4% (P=0.10). The atrial fibrillation patients demonstrated a higher level of comorbidity based on the Charlson Comorbidity Index, 2.46 vs 1.57 (P=0.03). On formal exercise testing there was no statistical difference in exercise duration between the two groups 9.0 vs 10.1 minutes (P=0.24). Similarly the Physical Summary Score (PCS) and the Mental Summary Score (MCS) of the SF-36 quality of life survey did not demonstrate a statistical difference between the two groups. PCS: 43.0 vs 45.9 (P=0.24); MCS: 52.5 vs 55.7 (P=0.07). CONCLUSIONS: Despite a higher level of comorbidity, elderly, ambulatory patients with chronic atrial fibrillation demonstrate similar exercise tolerance and report similar quality of life to a group of age-matched control patients in sinus rhythm. There is a cohort of patients in chronic atrial fibrillation in whom a strategy of rate control and anticoagulation may be appropriate.

Attachment organizations in children with difficult life circumstances.

The purpose of this study was to use the Attachment Q-Set to create categories of attachment organization that were conceptually consistent with organizational categories derived from other attachment assessments, reliable, and valid. We were particularly interested in creating categories that would describe insecure attachment organizations in children from difficult life circumstances. Our sample of relationships included 3062 teacher-child relationships. Children ranged in age from toddlers to kindergartners and were diverse in ethnic background. Two percent of the children were diagnosed with severe social and emotional problems and enrolled in a therapeutic preschool. Sixteen percent were enrolled in intervention programs on the basis of family poverty and another 34% of the children attended subsidized child care programs for low-income children. All of the children's child-teacher relationships were assessed with the Attachment Q-Set (AQS). Independent observers observed or rated children's peer play. Teachers completed behavior problem questionnaires and Student Teacher Relationships Scales. Using the AQS we created five subscales and six attachment organizational categories. These subscales and organizational categories were associated in theoretically meaningful ways with measures of behavior problems, social competence with peers, and teacher perceptions of child-teacher relationship.

Stability and continuity of child-caregiver and child-peer relationships.

We examined the relationship quality of 55 (27 girls) 9-year-old children with their mothers, teachers, and friends as rated by teachers and by the children themselves. The goal of this longitudinal study was to examine stability and continuity in the quality of children's relationships between infancy and 9 years of age. At age 9, children's perception of their relationships with their teachers was associated with their current teachers' ratings of their relationships with the children. Children's perceptions of their relationships with their mothers were consistent with earlier ratings of attachment security. Children's perceptions of their relationships with teachers were predicted by the quality of their attachment relationships with their first teachers. Children's perceptions of their friendship quality was predicted by preschool teacher ratings of friendship quality and the quality of their attachment relationships with their first teachers.

Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients > or = 65 years old.

We sought to validate a previously described clinical prediction rule for classifying left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). As part of the Connecticut cohort of the Cooperative Cardiovascular Project (CCP) pilot study, we identified 3,093 Medicare patients who had been admitted to hospitals throughout Connecticut with an AMI in 1992 and 1993. Retrospective chart review and detailed electrocardiogram interpretation were performed. Of the 1,891 patients with an interpretable EF, 1,378 (73%) had > or = 1 of the rule's exclusion criteria. Of the remaining 513 patients, the clinical prediction rule had a positive predictive value of 89% (i.e., 456 of 513 patients had an EF > or = 40%). In a multivariate model, presentation > 6 hours after the onset of chest pain, a history of bypass surgery, and diabetes mellitus were associated with patients in whom the rule did not correctly predict an EF > or = 40%. Excluding patients with these characteristics from the rule increased the positive predictive value from 89% to 93% and excluded an additional 239 patients. The EF could not be predicted among the patients who did not meet the rule's criteria. In conclusion, a previously published clinical prediction rule for the classification of the EF in patients after an AMI correctly classified 8 of every 9 eligible elderly patients as having an EF > or = 40%. Thus, while not performing as well as it did in the original study, our findings support the use of this rule in providing clinicians with an objective method for estimating an EF > or = 40% in a specific subset of elderly patients.

Gender differences in children's normative beliefs about aggression: how do I hurt thee? Let me count the ways.

This research was designed to assess whether children view relationally manipulative behaviors (i.e., those behaviors labeled relational aggression in past research) as "aggressive." 2 studies were conducted to evaluate whether children view relationally manipulative behaviors as associated with 2 defining features of aggression, anger (Study 1) and intent to harm (Study 2). Results of Study 1 (n = 459, 9-12-year-olds) indicated that relational aggression was the most frequently cited angry behavior for girls' interactions whereas physical aggression was the most frequently cited angry behavior for boys' interactions. Results of Study 2 (n = 60, 9-11-year-olds) demonstrated that relational aggression and verbal insults were the most frequently cited harmful behaviors for girls whereas physical aggression and verbal insults were the most frequently cited harmful behaviors for boys. These studies provide the first evidence that children view relationally manipulative acts (relational aggression) as angry, harmful behaviors (i.e., as "aggressive").

Child care cost and quality.

This article summarizes what is known about the cost and quality of full-time child care in centers and family child care homes, and about parents' attention to quality in making child care choices. It relies primarily upon two recent studies which are among the first to collect detailed information about child care operating costs: the Cost, Quality, and Child Outcomes in Child Care Centers study and the Economics of Family Child Care study. Results indicate that mediocre quality is the rule and that parents often do not choose quality settings for their children. At the present time, child care quality is only modestly related to the cost of providing services. In part, the modesty of this relationship reflects the low wages of child care staff, the availability of in-kind donations in the nonprofit sector, and the altruistic motivations of many providers that depress direct costs and the fees charged for child care. The article concludes with recommendations of future: (1) launch consumer education efforts; (2) implement higher standards for child care at the state level; (3) avoid public policies that encourage people to become child care providers if they have no interest in such a career; (4) increase public and private investments in child care; and (5) develop the means to compensate child care workers as is appropriate for their levels of training, experience, and responsibility.

Child care for children in poverty: opportunity or inequity?

Data from a nationally representative survey of child care centers and a 5-site, observational study of centers were used to examine the quality of care provided to children from low-income families. Comparisons were made to a national sample of centers; among Head Start, public school-sponsored, and other community-based subsidized centers; and among centers that served families from differing socioeconomic groups. The quality of care in centers that served predominantly low-income children was adequate, but highly variable, with structural indices exhibiting higher quality than observations of global quality and of staff-child interactions. When compared to Head Start and public school-sponsored centers, the community-based centers had smaller groups and fewer children per teacher for preschoolers, but also had less well educated and compensated staff. Centers that predominantly served children from upper-income families provided the highest quality of care across multiple indices, and those that predominantly served children from middle-income families almost uniformly provided the poorest quality of care. The centers that served children from low-income families did not differ significantly in quality from the upper-income centers on most indices. However, the teachers in these programs were observed to be less sensitive and more harsh than teachers in the centers that served more advantaged families. The implications of the findings for research and policy are discussed.