Diagnostic quality of ultrasound-guided fine-needle aspirates samples from the canine liver and spleen is not significantly affected by using 22-, 23-, and 25-gauge needles.

Ultrasound-guided fine-needle aspirates (FNA) of the liver and spleen for cytological analysis are a commonly performed procedure in canine veterinary practice. Based on our review of the literature, this is the first published study investigating whether needle size affects the diagnostic quality of hepatic and splenic samples. The aim of this prospective analytical study was to compare the diagnostic quality of ultrasound-guided FNA cytological samples of canine liver and spleen based on cellularity, blood contamination, and overall cell preservation between three different needle sizes (22-, 23-, and 25-gauge). A total of 282 splenic aspirates from 94 dogs and 348 hepatic aspirates from 116 dogs were enrolled in the study and examined by two board-certified veterinary clinical pathologists. In this study, no significant differences in diagnostic quality were identified between different needle gauge sizes when sampling canine liver and spleen. Blood contamination was higher using 22-gauge needles compared with 25-gauge needles (P = 0.024) when sampling the liver.

Survey of factors affecting satisfaction and success of residents enrolled in European College of Veterinary Diagnostic Imaging (ECVDI) residency programs.

Several published studies have described the success and satisfaction of residents enrolled in human radiology training programs, however comparable studies for veterinary radiology residents are currently lacking. The purpose of this descriptive, survey study was to evaluate resident perceptions of the European College of Veterinary Diagnostic Imaging (ECVDI) residency training programs. A web-based survey was sent to all listed 114 ECVDI residents and received a 57.0% response (65/114). Of these, 88% of respondents enjoyed their training and 73.5% of finishing respondents agreed they felt ready to work as a veterinary radiologist. First-time pass rates for the theoretical and practical components of the board certifying examinations were >80%. Regarding research and exam preparation, 41.5% and 49.2% of respondents, respectively, did not feel they received appropriate guidance. Eleven percent of respondents felt a lack of mentoring and 7.7% reported  not receiving annual appraisals. Findings from this study can be used as background for future studies on perceptions of ECVDI residents and ECVDI residency program directors and for future policy decisions regarding ECVDI residency training programs.

Prevalence of Trauma-Induced Hypocalcemia in the Prehospital Setting.

BACKGROUND: Recent data published by the Special Operations community suggest the Lethal Triad of Trauma should be changed to the Lethal Diamond, to include coagulopathy, acidosis, hypothermia, and hypocalcemia. The purpose of this study is to determine the prevalence of trauma-induced hypocalcemia in level I and II trauma patients. METHODS: This is a retrospective cohort study conducted at a level I trauma center and Special Operations Combat Medic (SOCM) training site. Adult patients were identified via trauma services registry from September 2021 to April 2022. Patients who received blood products prior to emergency department (ED) arrival were excluded from the study. Ionized calcium levels were utilized in this study. RESULTS: Of the 408 patients screened, 370 were included in the final analysis of this cohort. Hypocalcemia was noted in 189 (51%) patients, with severe hypocalcemia identified in two (<1%) patients. Thirty-two (11.2%) patients had elevated international normalized ratio (INR), 34 (23%) patients had pH <7.36, 21 (8%) patients had elevated lactic acid, and 9 (2.5%) patients had a temperature of <35°C. CONCLUSION: Hypocalcemia was prevalent in half of the trauma patients in this cohort. The administration of a calcium supplement empirically in trauma patients from the prehospital environment and prior to blood transfusion is not recommended until further data prove it beneficial.

Assessing the Impact of a Shinrin-Yoku (Forest Bathing) Intervention on Physician/Healthcare Professional Burnout: A Randomized, Controlled Trial.

Professional healthcare worker burnout is a crisis in the United States healthcare system. This crisis can be viewed at any level, from the national to local communities, but ultimately, must be understood at the level of the individual who is caring for patients. Thus, interventions to reduce burnout symptoms must prioritize the mental health of these individuals by alleviating some of the symptoms of depression, grief, and anxiety that accompany burnout. The practice of Shinrin-Yoku (Forest Bathing) is a specific evidence-based practice which research has shown can improve an individual's mental health and, when performed in a group, can support a sense of social connection. We investigated the impact of a three-hour, guided Shinrin-Yoku (Forest Bathing) nature-based intervention on burnout symptoms among physicians and other healthcare workers by using a randomized, controlled trial. The Oldenburg Burnout Inventory (OLBI) and Mini-Z assessments were used to collect baseline burnout scores and participants were randomized into the intervention group, which completed the assessment again after the Shinrin-Yoku walk, or into a control group, which completed the assessments again after a day off from any clinical duties. A total of 34 participants were enrolled in the intervention group and a total of 22 participants were enrolled in the control group. Ultimately, no statistically significant differences were detected between the pre-test and post-test scores for the intervention group or between the post-test scores of the intervention group compared to the control group. However, the subjective responses collected from participants after participating in the Shinrin-Yoku walk overwhelmingly reported decreased feelings of stress and increased mental wellbeing. This raises important questions about the difference between symptoms of burnout and other aspects of mental health, as well as the limitations of a one-time nature-based intervention on levels of chronic burnout symptoms. Thus, further research on the effects of engaging healthcare providers in an ongoing practice of Shinrin-Yoku is warranted.

The Implementation of a Stress Management Program for Health Care Workers Through a Rural Occupational Health Clinic.

BACKGROUND: Stress affects U.S. healthcare workers (HCWs) and costs US$191 billion annually. About 30% to 50% of healthcare providers report burnout. Based on an assessment of a U.S. rural hospital system, 94% of workers experienced negative health consequences. We conducted a quality improvement (QI) project for the purpose of implementing a stress management program for HCWs in a hospital system. METHODS: A total of 500 HCWs were informed of the program through hospital communication channels. Using the Plan-Do-Study-Act (PDSA) process, we screened workers presenting to the occupational health clinic for care. Project team members recruited other workers for stress screening throughout the organization. Interventions included contacting workers with elevated scores on the Perceived Stress Survey (PSS; N = 213). The nurse practitioner scheduled them for a shared-decision-making (SDM) appointment (N = 33) where workers were informed of and encouraged to participate in stress reduction activities. Surveys were used to assess effectiveness of SDM appointments and the stress reduction activities. After each 2-week PDSA cycle, interventions were adjusted. FINDINGS: Of the 42% (N = 213) of workers who were screened for stress, 24% (n = 52) had elevated scores. Fifty percent (n = 26) completed an SDM appointment. Participants reported an 86% assurance level that they would use personalized stress management plans. Participants utilizing the interventions (n = 271) reported 25% to 72% reduced stress levels. CONCLUSIONS/APPLICATION TO PRACTICE: This successful project, in a rural setting, included workers across job classifications. Team engagement, PSS screening, SDM opportunities, and stress management activities were project strengths. This low-cost project can be replicated.

Variation in the MRI appearance of the canine pituitary gland.

A recent publication described pathological findings in the pituitary gland incidentally discovered during routine necropsies of the brain of dogs and cats; however, imaging characteristics of these lesions were not reported. Aims of this retrospective, observational study were to characterize MRI variants and incidental lesions in pituitary glands of dogs with no clinical signs of pituitary disease. Cranial MRIs from dogs with no suspicion of pituitary disease, based on history and presenting clinical signs, were retrieved from a veterinary teleradiology database during the period of January 2014 to January 2016. Images were reinterpreted by two observers and pituitary lesions were described based on consensus. A total of 580 scans were evaluated and pituitary lesions were detected in 78 dogs (13.44%). Pituitary cystic lesions were the most common finding and occurred in 31 dogs (5.34%). Of these 31 dogs, the majority (74%) were of toy or brachycephalic breed. Partial or total empty sella lesions were detected in 14 dogs (2.41%), and all of these were small or toy breeds. A significantly increased incidence of the partial empty sella lesion was found in male dogs (P = .034). Pituitary lesions greater than 1 cm occurred rarely (0.69%). There was a significant association between low-field (LF) MRI strength and detection of a partial or total empty sella lesion (P = .0112), and detection of a pituitary lesion greater than 1 cm (P = .0125). A significant difference was present between the MRI field strength (FS) that identified pituitary cysts and the FS that detected an empty sella (P = .0068), with the former being a high FS and the latter a LF strength. The findings from this study indicated that up to 13% of dogs with no presenting clinical signs of pituitary disease may have MRI pituitary lesions.

MRI findings of neuronal ceroid lipofuscinosis in a cat.

CASE SUMMARY: A 2-year-old male domestic shorthair cat presented to the University of Liverpool Small Animal Teaching Hospital with a 2 week history of altered mentation, blindness and focal epileptic seizures. MRI examination revealed generalised cerebral and cerebellar atrophy, diffuse T2-weighted hyperintensity of the white matter and meningeal thickening. Neuronal ceroid lipofuscinosis was confirmed on post-mortem examination. RELEVANCE AND NOVEL INFORMATION: This is the first report of the MRI findings of neuronal ceroid lipofuscinosis in a cat.

Computed tomographic findings in three dogs naturally infected with Crenosoma vulpis.

Crenosoma vulpis is a nematode lungworm found in wild and domestic canids in some parts of North America and Europe. Reported radiographic findings are nonspecific and consist of a combination of bronchial and interstitial changes of variable severity. This retrospective, case series study aimed to describe thoracic computed tomographic (CT) findings for a group of dogs with confirmed crenosomosis. Selection criteria were presentation with a chronic cough during the period of January 2016 to February 2017, evaluation by thoracic CT, and final diagnosis of C. vulpis infection based on bronchoscopic findings, bronchoalveolar lavage fluid analysis, and quantitative polymerase chain reaction. Medical records and CT images were retrieved and reviewed by a board-certified veterinary internist, a veterinary internal medicine resident, two board-certified veterinary radiologists, and a veterinary radiology intern, and findings were recorded. Three dogs met inclusion criteria. Thoracic CT findings for all dogs included the following: diffuse bronchial wall thickening, multifocal peribronchial ground glass attenuation, consolidation of the pulmonary parenchyma, and cylindrical bronchiectasis. In two dogs, the bronchial wall thickening was irregular to nodular, which was consistent with the bronchoscopic findings. Two dogs showed pulmonary parenchymal bands. Thoracic computed tomographic changes in dogs with C. vulpis are consistent with those seen on thoracic radiographs and crenosomosis should be considered in dogs with these findings.

Practical and Legal Challenges to Electroconvulsive Therapy in Malignant Catatonia.

In cases of malignant catatonia, prompt administration of electroconvulsive therapy (ECT) can decrease mortality, whereas delays to initiating ECT have resulted in adverse outcomes, including death. We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York. As compared to standard practice for other clinical interventions when a patient lacks decision-making capacity, ECT is highly regulated; in some cases, these regulations can interfere with life-saving treatment.

Intensive care unit patients in the postanesthesia care unit: a case study exploring nurses' experiences.

PURPOSE: The purpose of this study was to understand the experiences of postanesthesia nurses caring for intensive care unit (ICU) patients in the postanesthesia care unit (PACU). DESIGN: Qualitative interpretive description. METHODS: Six PACU nurses participated in semi-structured interviews. Interviews were digitally recorded, transcribed verbatim, and analyzed using constant comparative analysis. Quality of the data collection and analysis process was maintained through constructing codes and themes jointly by several investigators and taking interpretive accounts back to participants. FINDING: Three main themes were constructed: expert mind-set, specialty practice, and identity and relationships. The expert mind-set described knowing but not doing and straddling concurrent foci and duties. Specialty practice entailed doing but not knowing and the unsupportive context that perpetuated this. Identity and relationships described the lost identity of postanesthesia nursing and tension in the relationships with ICU. CONCLUSIONS: Findings illuminate the challenges expert nurses face when an unplanned practice change is implemented.

A psychopharmacology course for psychiatry residents utilizing active-learning and residents-as-teachers to develop life-long learning skills.

OBJECTIVE: The authors describe the implementation and evaluation of a 1-year psychopharmacology course using residents-as-teachers and active-learning exercises intended to improve understanding of current psychopharmacology and its evidence base, and skills for life-long learning. METHOD: Weekly classes were devoted to psychotropic medications, treating specific disorders, and use of psychotropics in special patient populations. Each class was divided into three sections: a pharmacology review, a literature review and a faculty-led discussion of clinical questions. Each class included residents as teachers, an audience response system and questions for self-assessment. Resident and faculty presenters evaluated the course weekly and all residents were given a year-end evaluation RESULTS: Resident and faculty evaluations indicated an overall positive response. The residents reported improved perception of knowledge and engagement with this interactive format. CONCLUSION: The course was well received, demonstrating the viability and value of residents taking a more active role in their own learning.

Neurofibromatosis-1 heterozygosity increases microglia in a spatially and temporally restricted pattern relevant to mouse optic glioma formation and growth.

Whereas carcinogenesis requires the acquisition of driver mutations in progenitor cells, tumor growth and progression are heavily influenced by the local microenvironment. Previous studies from our laboratory have used Neurofibromatosis-1 (NF1) genetically engineered mice to characterize the role of stromal cells and signals to optic glioma formation and growth. Previously, we have shown that Nf1+/- microglia in the tumor microenvironment are critical cellular determinants of optic glioma proliferation. To define the role of microglia in tumor formation and maintenance further, we used CD11b-TK mice, in which resident brain microglia (CD11b+, CD68+, Iba1+, CD45low cells) can be ablated at specific times after ganciclovir administration. Ganciclovir-mediated microglia reduction reduced Nf1 optic glioma proliferation during both tumor maintenance and tumor development. We identified the developmental window during which microglia are increased in the Nf1+/- optic nerve and demonstrated that this accumulation reflected delayed microglia dispersion. The increase in microglia in the Nf1+/- optic nerve was associated with reduced expression of the chemokine receptor, CX3CR1, such that reduced Cx3cr1 expression in Cx3cr1-GFP heterozygous knockout mice led to a similar increase in optic nerve microglia. These results establish a critical role for microglia in the development and maintenance of Nf1 optic glioma.

Reduced striatal dopamine underlies the attention system dysfunction in neurofibromatosis-1 mutant mice.

Learning and behavioral abnormalities are among the most common clinical problems in children with the neurofibromatosis-1 (NF1) inherited cancer syndrome. Recent studies using Nf1 genetically engineered mice (GEM) have been instructive for partly elucidating the cellular and molecular defects underlying these cognitive deficits; however, no current model has shed light on the more frequently encountered attention system abnormalities seen in children with NF1. Using an Nf1 optic glioma (OPG) GEM model, we report novel defects in non-selective and selective attention without an accompanying hyperactivity phenotype. Specifically, Nf1 OPG mice exhibit reduced rearing in response to novel objects and environmental stimuli. Similar to children with NF1, the attention system dysfunction in these mice is reversed by treatment with methylphenidate (MPH), suggesting a defect in brain catecholamine homeostasis. We further demonstrate that this attention system abnormality is the consequence of reduced dopamine (DA) levels in the striatum, which is normalized following either MPH or l-dopa administration. The reduction in striatal DA levels in Nf1 OPG mice is associated with reduced striatal expression of tyrosine hydroxylase, the rate-limited enzyme in DA synthesis, without any associated dopaminergic cell loss in the substantia nigra. Moreover, we demonstrate a cell-autonomous defect in Nf1+/- dopaminergic neuron growth cone areas and neurite extension in vitro, which results in decreased dopaminergic cell projections to the striatum in Nf1 OPG mice in vivo. Collectively, these data establish abnormal DA homeostasis as the primary biochemical defect underlying the attention system dysfunction in Nf1 GEM relevant to children with NF1.

Neurofibromatosis-1 regulates neuroglial progenitor proliferation and glial differentiation in a brain region-specific manner.

Recent studies have shown that neuroglial progenitor/stem cells (NSCs) from different brain regions exhibit varying capacities for self-renewal and differentiation. In this study, we used neurofibromatosis-1 (NF1) as a model system to elucidate a novel molecular mechanism underlying brain region-specific NSC functional heterogeneity. We demonstrate that Nf1 loss leads to increased NSC proliferation and gliogenesis in the brainstem, but not in the cortex. Using Nf1 genetically engineered mice and derivative NSC neurosphere cultures, we show that this brain region-specific increase in NSC proliferation and gliogenesis results from selective Akt hyperactivation. The molecular basis for the increased brainstem-specific Akt activation in brainstem NSCs is the consequence of differential rictor expression, leading to region-specific mammalian target of rapamycin (mTOR)/rictor-mediated Akt phosphorylation and Akt-regulated p27 phosphorylation. Collectively, these findings establish mTOR/rictor-mediated Akt activation as a key driver of NSC proliferation and gliogenesis, and identify a unique mechanism for conferring brain region-specific responses to cancer-causing genetic changes.

Crack propagation in teeth: a comparison of perimortem and postmortem behavior of dental materials and cracks.

This study presents a new method for understanding postmortem heat-induced crack propagation patterns in teeth. The results demonstrate that patterns of postmortem heat-induced crack propagation differ from perimortem and antemortem trauma-induced crack propagation patterns. Dental material of the postmortem tooth undergoes dehydration leading to a shrinking and more brittle dentin material and a weaker dentin-enamel junction. Dentin intertubule tensile stresses are amplified by the presence of the pulp cavity, and initiates crack propagation from the internal dentin, through the dentin-enamel junction and lastly the enamel. In contrast, in vivo perimortem and antemortem trauma-induced crack propagation initiates cracking from the external surface of the enamel toward the dentin-enamel junction where the majority of the energy of the crack is dissipated, eliminating the crack's progress into the dentin. These unique patterns of crack propagation can be used to differentiate postmortem taphonomy-induced damage from antemortem and perimortem trauma in teeth.

Loss of the protein NUPR1 (p8) leads to delayed LHB expression, delayed ovarian maturation, and testicular development of a sertoli-cell-only syndrome-like phenotype in mice.

The high mobility group factor NUPR1, also known as p8 and com1, plays a role in temporal expression of the beta subunit of luteinizing hormone, LHB, during gonadotroph development. At Embryonic Day (e) 16.5, LHB is detectable in wild-type (Nupr1(+/+)) but not Nupr1 knockout (Nupr1(-/-)) mice. LHB is initiated by e17.5 in Nupr1(-/-) mice, and expression is fully recovered by Postnatal Day (p) 2. Factors indicative of pituitary maturation, GATA2, CGA, and TSH, are not differentially expressed in Nupr1(-/-) and Nupr1(+/+) embryos at e17.5. Therefore, the delay in LHB expression does not appear to result from delayed pituitary development. In addition, the role of NUPR1 in gonadotropin expression appears specific for LHB, as no difference in FSHB is observed in Nupr1(-/-) and Nupr1(+/+) embryos. The gonads are also impacted by the absence of NUPR1. Ovaries of female Nupr1(-/-) mice lack corpora lutea (CL) at 8 wk, an age at which CL are present in all Nupr1(+/+) littermates. Sexual maturity is recovered by 11 wk in Nupr1(-/-) mice. Conversely, the testes of Nupr1(-/-) males appear normal through 8 mo of age. By 10 mo, however, these mice develop a condition in which a significant number of seminiferous tubules lack germ cells, an abnormality reminiscent of human Sertoli-cell-only syndrome. NUPR1 is undetectable in Nupr1(+/+) gonadotrophs by p2 and remains absent in adulthood, but quantitative PCR analysis indicates Nupr1(+/+) adult ovaries and testes express Nupr1 mRNA. Therefore, the ovarian and testicular phenotypes may be due to the loss of NUPR1 directly at the gonads.