Factors Associated With Survival and Return to Function Following Synovial Infections in Horses.

Synovial infections (SI) are common in horses of all ages and can be associated with high rates of morbidity and mortality. Identifying factors influencing survival and return to function may be useful for management of affected individuals and determination of prognosis. The objectives of this study were to identify factors associated with survival and return to function of horses and foals with SI presented to an equine hospital. This study is a retrospective case series. Data were collected from medical records of all horses with SI that were presented to a single equine hospital between April 1st, 2008 and May 1st, 2017. Long-term follow up was obtained by a semi-structured telephone questionnaire of clinical outcomes and analysis of online race records. Univariate models were created using generalized linear and linear mixed models to assess factors associated with outcomes. Multivariable models were created using generalized linear and linear mixed models to determine factors significantly associated with outcomes. Of 186 horses presented with SI, 161/186 (86.6%) were treated and 145/161 (90.1%) survived to discharge. The majority of joints were treated with synovial lavage (93.8%). One hundred and twenty horses were included in the return to function analysis and 79 (65%) returned to function. Increasing number of days of treatment with systemic antimicrobials was associated with increased likelihood of survival for each horse (OR 1.15, 95% CI 1.04-1.27, P = 0.025) and when considering each individual synovial structure (OR 1.11, 95% CI 1.04-1.17, P = 0.004). Horses treated with doxycycline were less likely to return to function (OR 0.39, 95% CI 0.19-0.8, P = 0.031). The overall rate of survival of horses treated with SI is good. The likelihood of return to function is lower than for survival. The findings of this study, combined with relevant antimicrobial stewardship practices, can be used as a part of evidence-based decision-making when veterinarians are treating horses with SI.

Effects of continuous positive airway pressure on respiratory function in sedated foals.

OBJECTIVE: To characterize the effects of continuous positive airway pressure (CPAP) delivered by a commercial human CPAP device on respiratory function in foals with pharmacologically induced respiratory suppression. DESIGN: Prospective randomized, cross-over study comparing CPAP with spontaneous respiration and oxygen insufflation. SETTING: University veterinary teaching hospital. ANIMALS: Twelve foals born in consecutive seasons from a university teaching herd. INTERVENTIONS: Foals were randomized to receive 10 minutes of respiratory support by mask oxygen supplementation or CPAP as a first treatment after induction of respiratory depression by intravenous administration of xylazine and fentanyl. Each foal received the alternate treatment after 10 minutes of breathing ambient air, and the procedure was repeated after 48 hours with treatment order reversed. MEASUREMENTS AND MAIN RESULTS: The administration of xylazine and fentanyl by bolus or continuous infusion reliably induced reversible respiratory suppression and recumbency. CPAP was associated with comparable increase in PaO2 relative to mask oxygen supplementation, but with lower respiratory rate, increased oxygen extraction and increased carbon dioxide elimination. Mild increase in PaCO2 was observed during CPAP and O2 supplementation. Expiratory time increased and peak expiratory flow decreased during CPAP. CONCLUSIONS: Findings of the study suggest that CPAP might represent a method for improved respiratory support compared to O2 insufflation due to increased respiratory efficiency. Care must be taken in extrapolation of these findings from foals with pharmacologically induced respiratory compromise to foals with clinical respiratory disease, and further investigation is required to better characterize the cause and impact of marginal hypercapnia observed in these studies.

Mammography image quality and evidence based practice: Analysis of the demonstration of the inframammary angle in the digital setting.

AIM: The aim of this study is to determine the clinical rates of the demonstration of the inframammary angle (IMA) on the mediolateral oblique (MLO) view of the breast on digital mammograms and to compare the outcomes with current accreditation standards for compliance. Relationships between the IMA, age, the posterior nipple line (PNL) and compressed breast thickness will be identified and the study outcomes validated using appropriate analyses of inter-reader and inter-rater reliability and variability. Differences in left versus right data were also investigated. METHOD: A quantitative retrospective study of 2270 randomly selected paired digital mammograms performed by BreastScreen NSW was undertaken. Data was collected by direct measurement and visual analysis. Intra-class correlation analyses were used to evaluate inter- and intra-rater reliability. RESULTS: The IMA was demonstrated on 52.4% of individual and 42.6% of paired mammograms. A linear relationship was found between the posterior nipple line (PNL) and age (p-value <0.001). The PNL was predicted to increase by 0.48 mm for every one year increment in age. The odds of demonstrating the IMA reduced by 2% for every one year increase in age (p-value = 0.001); are 0.4% higher for every 1 mm increase in PNL (p-value = 0.001) and 1.6% lower for every 1 mm increase in compressed breast thickness, (p-value<0.001). There was high inter- and intra-rater reliability for the PNL while there was 100% agreement for the demonstration of the IMA. CONCLUSION: Analysis of the demonstration of the IMA indicates clinically achievable rates (42.6%) well below that required for compliance (50%-75%) to known worldwide accreditation standards for screening mammography. These standards should be aligned to the reported evidence base. Visualisation of the IMA is impacted negatively by increasing age and compressed breast thickness but positively by breast size (PNL).

Circadian regulation of grapevine root and shoot growth and their modulation by photoperiod and temperature.

Some plant species demonstrate a pronounced 24 h rhythm in fine root growth but the endogenous and exogenous factors that regulate these diel cycles are unclear. Photoperiod and temperature are known to interact with diel patterns in shoot growth but it is uncertain how these environmental factors are interrelated with below-ground growth. In this particular study, the fine root system of two grapevine species was monitored over a period of ten days with a high resolution scanner, under constant soil moisture and three different photoperiod regimes. Pronounced diel rhythms in shoot and root growth rates were apparent under a fixed 14 h photoperiod. Maximal root growth rate occurred 1-2 h prior to- and until 2 h after the onset of darkness. Subsequently, during the latter part of the dark period, root growth rate decreased and reached minimal values at the onset of the light period. Relative to 22 °C, exposure to a 30 °C air and soil temperature halved root growth but stimulated shoot growth. Notably, the shoot extension rate peak shifted from late afternoon to midnight at this higher temperature zone. When plants were exposed to a delayed photoperiod or progressively shortening photoperiod, the diel changes in root growth rate followed the same pattern as in the fixed photoperiod, regardless of whether the plant was in light or dark. This suggests that light was not the predominant trigger for stimulating root elongation. Conversely, shoot growth rates were not fixed to a clock, with minimum growth consistently at the completion of the dark period regardless of the time of day. In summary, fine root growth of grapevines was found to have a pronounced diel pattern and an endogenous circadian clock appears to orchestrate this rhythm. Soil temperature modified the amplitude of this pattern, but we argue here that, as evidenced from exhausted starch reserves within root tips by early morning, carbon supply from photosynthesis is also required to maintain maximum root growth.

Reference ranges for the intra-amniotic umbilical cord vein diameter, peak velocity and blood flow in a regional NSW population.

AIM: To construct gestational age (GA)-related reference ranges of the intra-amniotic umbilical cord vein (UCV) diameter, peak velocity (PV) and blood flow (Qucv) using a Central West New South Wales population. MATERIALS AND METHODS: This was a prospective, quasi-experimental study of low risk, singleton pregnancies (n = 321) between 16 and 42 weeks of gestation. Participation was voluntary following informed consent. The UCV diameter and PV were measured using B mode and duplex Doppler respectively, and Qucv calculated. Percentile values and reference range graphs were established using quantile regression modelling in R statistical software. Intraclass correlation coefficients (ICCs) were calculated to assess the intra and intersonographer reliability. RESULTS: Reference ranges for the UCV diameter, PV and Qucv were established and graphed. All three UCV measurements increased with advancing GA, with both diameter and Qucv exhibiting a decline in the late third trimester. The intrasonographer and intersonographer ICCs for the UCV diameter and PV showed almost perfect agreement within and between sonographers. CONCLUSION: Gestational age-related reference ranges for the UCV diameter, PV and Qucv were developed using quantile regression from a cohort of low risk, singleton pregnancies in Central West NSW. These reference ranges have the potential to assist in the diagnosis and monitoring of fetal growth restriction.

Physiological and Behavioral Responses of Horses to Wither Scratching and Patting the Neck When Under Saddle.

Riding is considered to be an arousing activity for horses. It has been suggested that wither scratching may be a more useful tool for relaxation compared with the common practice of neck patting. In the current study, 18 horses were exposed to 3 treatments, including control or no interaction, neck patting, and wither scratching, for 1 min each following a short obstacle course. Heart rate, heart rate variability, and a variety of behaviors were measured in the horses. Wither scratching produced a significantly longer duration of relaxed-type behaviors. Wither scratching could be a useful tool to help a horse relax while under saddle. Additionally, the study identified 2 ear positions that may be useful for future research in horse behavior.

A comparison of a regional NSW obstetrics population to district, state and national statistics.

BACKGROUND: In the central west NSW region, there are variations in population density, socioeconomic status and ethnicity. AIMS: Compare and contrast the maternal characteristics and pregnancy outcomes of an obstetric population in central west New South Wales to district, state and national data. MATERIALS AND METHODS: A prospective cross-sectional study involving 625 pregnant women who attended Orange or Bathurst public hospitals for obstetric ultrasounds. The women were 16 years and older and were greater than 16 weeks pregnant with a single fetus. Maternal characteristics and pregnancy outcomes were compared to district, state and national data. Descriptive comparisons and hypothesis testing were undertaken and P values or confidence intervals were provided where appropriate. RESULTS: The average maternal age was 27.5 years, 24.6% of the women smoked during pregnancy, 31.7% of deliveries were by caesarean, 52.4% of live births were female, 7.8% of babies were born preterm and the mean live birthweight was 3297 g. Four per cent of the participants were indigenous. CONCLUSIONS: Analysis of a regional sample indicated differences in indigenous population distribution, maternal age and smoking when compared to broader statistics. This has local implications for education, workforce, government and public health planning.

Use of chronic disease management algorithms in Australian community pharmacies.

BACKGROUND: In Australia, standardized chronic disease management algorithms are available for medical practitioners, nursing practitioners and nurses through a range of sources including prescribing software, manuals and through government and not-for-profit non-government organizations. There is currently no standardized algorithm for pharmacist intervention in the management of chronic diseases.. AIM: To investigate if a collaborative community pharmacists and doctors' model of care in chronic disease management could improve patients' outcomes through ongoing monitoring of disease biochemical markers, robust self-management skills and better medication adherence. DESIGN: This project was a pilot pragmatic study, measuring the effect of the intervention by comparing the baseline and the end of the study patient health outcomes, to support future definitive studies. Algorithms for selected chronic conditions were designed, based on the World Health Organisation STEPS™ process and Central Australia Rural Practitioners' Association Standard Treatment Manual. They were evaluated in community pharmacies in 8 inland Australian small towns, mostly having only one pharmacy in order to avoid competition issues. The algorithms were reviewed by Murrumbidgee Medicare Local Ltd, New South Wales, Australia, Quality use of Medicines committee. They constitute a pharmacist-driven, doctor/pharmacist collaboration primary care model. The Pharmacy owners volunteered to take part in the study and patients were purposefully recruited by in-store invitation. RESULTS: Six out of 9 sites' pharmacists (67%) were fully capable of delivering the algorithm (each site had 3 pharmacists), one site (11%) with 2 pharmacists, found it too difficult and withdrew from the study, and 2 sites (22%, with one pharmacist at each site) stated that they were personally capable of delivering the algorithm but unable to do so due to workflow demands. CONCLUSION: This primary care model can form the basis of workable collaboration between doctors and pharmacists ensuring continuity of care for patients. It has potential for rural and remote areas of Australia where this continuity of care may be problematic.

Effects of meloxicam and phenylbutazone on renal responses to furosemide, dobutamine, and exercise in horses.

OBJECTIVE: To compare the effects of 2 NSAIDs (phenylbutazone and meloxicam) on renal function in horses. ANIMALS: 9 Thoroughbred or Standardbred mares (mean ± SD age, 5.22 ± 1.09 years [range, 2 to 12 years]; mean body weight, 470 ± 25 kg [range, 442 to 510 kg]). PROCEDURES: A randomized blinded placebo-controlled crossover study was conducted to examine the effects of treatment with phenylbutazone, meloxicam, or a placebo (control solution) on renal responses to the administration of furosemide, dobutamine, and exercise (15 minutes at 60% of maximum heart rate). Renal function was assessed by use of bilateral ureteral catheterization for simultaneous determination of creatinine clearance, sodium excretion, and urine flow rate. RESULTS: Both phenylbutazone and meloxicam attenuated diuresis and natriuresis and reduced glomerular filtration rate, compared with results for the control solution, when horses were treated with furosemide. Mean arterial blood pressure, urine flow rate, and glomerular filtration rate were increased during or after (or both) dobutamine infusion. Both NSAIDs reduced urine flow rate and sodium excretion associated with dobutamine infusion and exercise but had no effect on glomerular filtration rate. CONCLUSIONS AND CLINICAL RELEVANCE: Responses to meloxicam, a cyclooxygenase (COX)-2 preferential agent, appeared comparable to those detected after phenylbutazone treatment, which suggested that COX-2 was the mediator of prostanoid-induced changes to renal function in horses and indicated that COX-2-preferential agents would be likely to have adverse renal effects similar to those for nonselective COX inhibitors in volume-depleted horses.

Is idiopathic toe walking really idiopathic? The motor skills and sensory processing abilities associated with idiopathic toe walking gait.

This study aimed to investigate any differences between the motor skills and sensory processing abilities of children between the ages of 4 and 8, who do and do not have an idiopathic toe walking gait. Children in each cohort were tested with a number of norm referenced assessments. A total of 60 children participated, 30 within each cohort. Those with an idiopathic toe walking gait were found to have different Sensory Profile quadrant scores (P = .002), poorer performance on the Bruininks-Oseretsky Test of Motor Proficiency (P ≤ .001), a lower vibration perception threshold (P = .001), and poorer performance on the Standing Walking Balance subtest of the Sensory Integration and Praxis Test (P = .047), compared with non-toe walking peers. Although this research does not give a causative factor for toe walking gait, it provides a number of theories as to why this gait may not be idiopathic in nature.

Foot and ankle characteristics of children with an idiopathic toe-walking gait.

BACKGROUND: Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers. METHODS: Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non-toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance. RESULTS: There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non-toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort. CONCLUSION: Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non-toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6.

Vibration perception thresholds in children with idiopathic toe walking gait.

This study investigated the vibration perception differences between children with an idiopathic toe walking gait and their non-toe walking peers. Sixty children, between the ages of four and eight years, were grouped into an idiopathic toe walking group and non-toe walking group. Vibration perception threshold was assessed at the right hallux. A highly significant difference in the vibration perception threshold between the groups was determined. The idiopathic toe walking group demonstrated a lower vibration perception threshold (P = .001), indicating this group was highly sensitive to vibration input. This change in vibration perception could be symptomatic of physiological changes in the localized receptors within the skin or at a neural perception level. Heightened sensitivity to touch has not yet been explored with children who have an idiopathic toe walking gait. This finding could assist in understanding this gait pattern and allow further research into improved treatment options.