Vitamin A deficiency in peafowl with secondary visceral urate deposition

Clinical History: In a flock of approximately 180 peafowl, several were showing signs of a possible upper respiratory infection and had mouth gaping per the owner. They were also reported to be lethargic, to have excessive phlegm or mucus in the mouths, had trouble swallowing, and were losing weight. They were being treated with Baytril and Metronidazole with no improvement. Approximately eight had died. Five peafowl were submitted for necropsy and diagnostic work-up, including three peahens and two peacocks. Gross Findings: In all five peafowl, the oral cavity contained excess mucus. The oral, crop, and esophageal mucosa had disseminated, smooth, raised, round nodules with a central pore. The proximal esophagus was the most severely affected site. The nodules measured on average ~2 mm in diameter. Upon squeezing some of these nodules, pale tan, caseous material could be expressed. In all five peafowl, the heart was diffusely coated by abundant white, chalky, urate material. Similar though lesser amounts of urates partially coated the surface of the liver and other coelomic membranes. In one peahen, the ureters were multifocally distended and contained consolidated accumulations of tan to pale yellow, caseous material. The kidneys in this bird were pale. Follow-up questions: Morphologic diagnoses Cause Pathogenesis

Concurrent Validity and Reliability of the Transfer Assessment Instrument Questionnaire as a Self-Assessment Measure.

OBJECTIVES: To evaluate the psychometric properties of the Transfer Assessment Instrument Questionnaire (TAI-Q), a self-assessment measure to evaluate transfer quality compared with clinician-reported measures. DESIGN: Participants self-assessed transfers from their wheelchair to a mat table using the TAI-Q. For session 1, participants self-assessed their transfer both before and after reviewing a video of themselves completing the transfer (session 1). Self-assessment was completed for another transfer after a 10-minute delay (session 2, intrarater reliability) and after a 1- to 2-day delay (session 3, test-retest reliability). Self-assessment was compared with a criterion standard of an experienced clinician scoring the same transfers with the Transfer Assessment Instrument (TAI) version 4.0 (concurrent validity). SETTING: 2017 National Veterans Wheelchair Games. PARTICIPANTS: Convenience sample of full-time wheelchair users (N=44). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TAI-Q and TAI. RESULTS: After video review of their transfer, acceptable levels of reliability were demonstrated for total TAI-Q score for intrarater (intraclass correlation [ICC], 0.627) and test-retest reliability (ICC, 0.705). Moderate to acceptable concurrent validity was demonstrated with the TAI (ICC, 0.554-0.740). Participants tended to underestimate the quality of their transfer (reported more deficient items) compared with the TAI. However, this deficit decreased and reliability improved from pre-video review to post-video review and from session 1 to session 2. The minimum detectable change indicated that a change of 1.63 to 2.21 in the TAI-Q total score is needed to detect a significant difference in transfer skills. CONCLUSIONS: When paired with video review, the TAI-Q demonstrates moderate to acceptable levels of reliability and validity for the total score. Self-assessment was completed quickly (<5min) and could help to potentially screen for deficiencies in transfer quality and opportunities for intervention.

Immediate Biomechanical Implications of Transfer Component Skills Training on Independent Wheelchair Transfers.

OBJECTIVE: To evaluate the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on the upper limb biomechanics during transfers. DESIGN: Pre-post intervention. SETTING: Biomechanics laboratory. PARTICIPANTS: Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded. INTERVENTION: Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training. MAIN OUTCOME MEASURES: TAI part 1 summary scores and biomechanical variables calculated at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training. RESULTS: Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training (P<.05). On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training (P<.04). CONCLUSIONS: The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users' upper limbs, such as better shoulder positioning and lower joint loadings. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries.

Basic psychometric properties of the transfer assessment instrument (version 3.0).

OBJECTIVES: To refine the Transfer Assessment Instrument (TAI 2.0), develop a training program for the TAI, and analyze the basic psychometric properties of the TAI 3.0, including reliability, standard error of measurement (SEM), minimal detectable change (MDC), and construct validity. DESIGN: Repeated measures. SETTING: A winter sports clinic for disabled veterans. PARTICIPANTS: Wheelchair users (N=41) who perform sitting-pivot or standing-pivot transfers. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: TAI version 3.0, intraclass correlation coefficients, SEMs, and MDCs for reliable measurement of raters' responses. Spearman correlation coefficient, 1-way analysis of variance, and independent t tests to evaluate construct validity. RESULTS: TAI 3.0 had acceptable to high levels of reliability (range, .74-.88). The SEMs for part 1, part 2, and final scores ranged from .45 to .75. The MDC was 1.5 points on the 10-point scale for the final score. There were weak correlations (ρ range, -.13 to .25; P>.11) between TAI final scores and subjects' characteristics (eg, sex, body mass index, age, type of disability, length of wheelchair use, grip and elbow strength, sitting balance). CONCLUSIONS: With comprehensive training, the refined TAI 3.0 yields high reliability among raters of different clinical backgrounds and experience. TAI 3.0 was unbiased toward certain physical characteristics that may influence transfer. TAI fills a void in the field by providing a quantitative measurement of transfers and a tool that can be used to detect problems and guide transfer training.