Economic and Clinical Benefits of Orthopedic/Sports Medicine and Rehabilitation.

Orthopedic/Sports Medicine and Rehabilitation can be both a valuable comprehensive patient care service and economic addition to many veterinary practices. As partners within the hospital, the Orthopedic/Sports Medicine and Rehabilitation service not only provides consultations for all patients with the ultimate goal of return to function (regardless of their "job"), the service also contributes to the recovery of patients in hospital, provides critical pain management and mobility assistance for hospitalized and postoperative patients, and champions a wide variety of supportive patient care solutions in many services within a hospital. After patient discharge, the team can then aid in the client and patient recovery at home with key home exercise programs and communications to bolster the patient's home recovery, ongoing rehabilitation, and eventual return to function.

Multiple climate change-driven tipping points for coastal systems.

As the climate evolves over the next century, the interaction of accelerating sea level rise (SLR) and storms, combined with confining development and infrastructure, will place greater stresses on physical, ecological, and human systems along the ocean-land margin. Many of these valued coastal systems could reach "tipping points," at which hazard exposure substantially increases and threatens the present-day form, function, and viability of communities, infrastructure, and ecosystems. Determining the timing and nature of these tipping points is essential for effective climate adaptation planning. Here we present a multidisciplinary case study from Santa Barbara, California (USA), to identify potential climate change-related tipping points for various coastal systems. This study integrates numerical and statistical models of the climate, ocean water levels, beach and cliff evolution, and two soft sediment ecosystems, sandy beaches and tidal wetlands. We find that tipping points for beaches and wetlands could be reached with just 0.25 m or less of SLR (~ 2050), with > 50% subsequent habitat loss that would degrade overall biodiversity and ecosystem function. In contrast, the largest projected changes in socioeconomic exposure to flooding for five communities in this region are not anticipated until SLR exceeds 0.75 m for daily flooding and 1.5 m for storm-driven flooding (~ 2100 or later). These changes are less acute relative to community totals and do not qualify as tipping points given the adaptive capacity of communities. Nonetheless, the natural and human built systems are interconnected such that the loss of natural system function could negatively impact the quality of life of residents and disrupt the local economy, resulting in indirect socioeconomic impacts long before built infrastructure is directly impacted by flooding.

An economic evaluation of adaptation pathways in coastal mega cities: An illustration for Los Angeles.

Sea level rise and uncertainty in its projections pose a major challenge to flood risk management and adaptation investments in coastal mega cities. This study presents a comparative economic evaluation method for flood adaptation measures, which couples a cost-benefit analysis with the concept of adaptation pathways. Our approach accounts for uncertainty in sea level rise projections by allowing for flexibility of adaptation strategies over time. Our method is illustrated for Los Angeles County which is vulnerable to flooding and sea level rise. Results for different sea level rise scenarios show that applying adaptation pathways can result in higher economic efficiency (up to 10%) than individual adaptation strategies, despite the loss of efficiency at the initial strategy. However, we identified 'investment tipping points', after which a transition could decrease the economic efficiencies of a pathway significantly. Overall, we recommend that studies evaluating adaptation strategies should integrate cost-benefit analysis frameworks with adaptation pathways since this allows for better informing decision makers about the robustness and economic desirability of their investment choices.

Dynamic flood modeling essential to assess the coastal impacts of climate change.

Coastal inundation due to sea level rise (SLR) is projected to displace hundreds of millions of people worldwide over the next century, creating significant economic, humanitarian, and national-security challenges. However, the majority of previous efforts to characterize potential coastal impacts of climate change have focused primarily on long-term SLR with a static tide level, and have not comprehensively accounted for dynamic physical drivers such as tidal non-linearity, storms, short-term climate variability, erosion response and consequent flooding responses. Here we present a dynamic modeling approach that estimates climate-driven changes in flood-hazard exposure by integrating the effects of SLR, tides, waves, storms, and coastal change (i.e. beach erosion and cliff retreat). We show that for California, USA, the world's 5th largest economy, over $150 billion of property equating to more than 6% of the state's GDP and 600,000 people could be impacted by dynamic flooding by 2100; a three-fold increase in exposed population than if only SLR and a static coastline are considered. The potential for underestimating societal exposure to coastal flooding is greater for smaller SLR scenarios, up to a seven-fold increase in exposed population and economic interests when considering storm conditions in addition to SLR. These results highlight the importance of including climate-change driven dynamic coastal processes and impacts in both short-term hazard mitigation and long-term adaptation planning.

Comparison of three walkway cover types for use during objective canine gait analysis with a pressure-sensitive walkway.

OBJECTIVE To compare the effects of 3 walkway cover types on temporospatial and ground reaction force measurements of dogs during gait analysis with a pressure-sensitive walkway (PSW). ANIMALS 35 client- and staff-owned dogs (25 nonlame and 10 lame). PROCEDURES In a crossover study design, all dogs were evaluated at a comfortable walk on a PSW to which 3 cover types (a 0.32-cm-thick corrugated vinyl mat or a 0.32- or 0.64-cm-thick polyvinyl chloride yoga mat) were applied in random order. Temporospatial and ground reaction force measurements were obtained and compared among cover types within the nonlame and lame dog groups. RESULTS Several variables, including maximum peak pressure, maximum force (absolute and normalized as a percentage of body weight), and vertical impulse (absolute and normalized) differed significantly in most comparisons among cover types for both nonlame and lame dogs. There was no significant difference in maximum force values between the 0.32-cm-thick corrugated vinyl and 0.64-cm-thick polyvinyl chloride cover types for both nonlame and lame dogs. CONCLUSIONS AND CLINICAL RELEVANCE To the authors' knowledge, the cover type used during data collection with a PSW is rarely provided in published reports on this topic. The findings in this study suggested that to ensure that PSW data for dogs are collected in a standardized manner, the same cover type should be used during follow-up visits to evaluate clinical outcomes, for the duration of research studies, and at all locations for multi-institutional studies. The cover type should be specified in future PSW studies to allow direct comparisons of findings between studies.

Pathways to resilience: adapting to sea level rise in Los Angeles.

Los Angeles (LA) County's coastal areas are highly valued for their natural benefits and their economic contributions to the region. While LA County already has a high level of exposure to flooding (e.g. people, ports, and harbors), climate change and sea level rise will increase flood risk; anticipating this risk requires adaptation planning to mitigate social, economic, and physical damage. This study provides an overview of the potential effects of sea level rise on coastal LA County and describes adaptation pathways and estimates associated costs in order to cope with sea level rise. An adaptation pathway in this study is defined as the collection of measures (e.g., beach nourishment, dune restoration, flood-proofing buildings, and levees) required to lower flood risk. The aim of using different adaptation pathways is to enable a transition from one methodology to another over time. These pathways address uncertainty in future projections, allowing for flexibility among policies and potentially spreading the costs over time. Maintaining beaches, dunes, and their natural dynamics is the foundation of each of the three adaptation pathways, which address the importance of beaches for recreation, environmental value, and flood protection. In some scenarios, owing to high projections of sea level rise, additional technical engineering options such as levees and sluices may be needed to reduce flood risk. The research suggests three adaptation pathways, anticipating a +1 ft (0.3 m) to +7 ft (+2 m) sea level rise by year 2100. Total adaptation costs vary between $4.3 and $6.4 bn, depending on measures included in the adaptation pathway.

Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs.

OBJECTIVE To compare owner satisfaction between custom-made stifle joint orthoses and tibial plateau leveling osteotomy (TPLO) for the management of medium- and large-breed dogs with cranial cruciate ligament disease (CCLD). DESIGN Owner survey. SAMPLE 819 and 203 owners of dogs with CCLD that were managed with a custom-made stifle joint orthosis or TPLO, respectively. PROCEDURES Client databases of an orthosis provider and veterinary teaching hospital were reviewed to identify potential survey respondents. An online survey was developed to evaluate owner-reported outcomes, complications, and satisfaction associated with the nonsurgical (orthosis group) and surgical (TPLO group) interventions. Survey responses were compared between groups. RESULTS The response rate was 25% (203/819) and 37% (76/203) for the orthosis and TPLO groups, respectively. The proportion of owners who reported that their dogs had mild or no lameness and rated the intervention as excellent, very good, or good was significantly greater for the TPLO group than for the orthosis group. However, ≥ 85% of respondents in both groups reported that they would choose the selected treatment again. Of 151 respondents from the orthosis group, 70 (46%) reported skin lesions associated with the device, 16 (11%) reported that the dog subsequently underwent surgery, and 10 (7%) reported that the dog never tolerated the device. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated high owner satisfaction rates for both interventions. Owners considering nonsurgical management with an orthosis should be advised about potential complications such as persistent lameness, skin lesions, patient intolerance of the device, and the need for subsequent surgery.

18F-FDG Positron Emission Tomography - An Innovative Technique for the Diagnosis of a Canine Lameness.

INTRODUCTION: Positron emission tomography (PET) imaging with fluorine-18-fluorodeoxyglucose (18F-FDG) is widely known for its use in the diagnosis and tracking of primary and metastatic tumors via uptake and retention of the radiopharmaceutical by hypermetabolic cells. 18F-FDG is also used to study the normal physiology of glucose uptake, metabolism, and muscle activity during and after exercise. BACKGROUND: A pilot study adding PET imaging to the diagnostic evaluation of canine patients undergoing computed tomography (CT) for mild or intermittent thoracic and pelvic limb lameness is ongoing. Dogs with an observable (grade 1-2/5) lameness that have undergone routine radiography and complete physical examination by board-certified veterinary surgeons and sports medicine and rehabilitation specialists are enrolled. Each patient undergoes leash walking for 15 min prior to premedication and induction of general anesthesia for the PET-CT examination. 18F-FDG is injected intravenously, and a whole-body PET examination is conducted after 1 h of radiopharmaceutical uptake time. Standard algorithm, whole-body pre- and post-contrast CT examinations, and focused, standard, and bone algorithm CT scans of the thoracic or pelvic limb areas of interest are obtained concurrently. Abnormal PET-CT findings are further investigated with additional diagnostic imaging or at surgery (e.g., ultrasound, MRI, and arthroscopy). DISCUSSION: This case report uses a canine patient referred for thoracic limb lameness to illustrate the role of advanced imaging in a diagnostic plan and to discuss a recommended PET-CT procedure for lameness evaluation. The PET-CT imaging protocol recommended in this report was designed to significantly enhance a routine thoracic limb CT examination and to identify areas of muscle, tendon, or ligament overuse, inflammation, or injury for further diagnostic procedures or definitive treatment. CONCLUDING REMARKS: 18F-FDG PET-CT adds valuable physiologic and anatomic information to the diagnostic evaluation of patients presenting with indistinct or intermittent clinical signs of musculoskeletal inflammation or injury. In addition, tailoring the PET acquisition and radiopharmaceutical parameters allows for detailed information gathering to more closely assess normal and abnormal physiology, unlocking a new frontier in the study of canine athletic injury and optimal performance.

Assessment of novel digital and smartphone goniometers for measurement of canine stifle joint angles.

OBJECTIVE To evaluate accuracy and reliability of 3 novel goniometers for measurement of canine stifle joint angles and compare the results with those obtained with a universal goniometer (UG). SAMPLE 8 pelvic limbs from 4 canine cadavers. PROCEDURES Each limb was secured to a wooden platform at 3 arbitrarily selected fixed stifle joint angles. Goniometry was performed with 2 smartphone-based applications (novel goniometers A and B), a digital goniometer (novel goniometer C), and a UG; 3 evaluators performed measurements in triplicate for each angle with each device. Results were compared with stifle joint angle measurements on radiographs (used as a gold standard). Accuracy was determined by calculation of bias and total error, coefficients of variation were calculated to estimate reliability, and strength of linear association between radiographic and goniometer measurements was assessed by calculation of correlation coefficients. RESULTS Mean coefficient of variation was lowest for the UG (4.88%), followed by novel goniometers B (7.37%), A (7.57%), and C (12.71%). Correlation with radiographic measurements was highest for the UG (r = 0.97), followed by novel goniometers B (0.93), A (0.90), and C (0.78). Constant bias was present for all devices except novel goniometer B. The UG and novel goniometer A had positive constant bias; novel goniometer C had negative constant bias. Total error at 50° and 100° angles was > 5% for all devices. CONCLUSIONS AND CLINICAL RELEVANCE None of the devices accurately represented radiographically measured stifle joint angles. Additional veterinary studies are indicated prior to the use of novel goniometers in dogs.

The long arm of climate change: societal teleconnections and the future of climate change impacts studies.

"Societal teleconnections" - analogous to physical teleconnections such as El Niño - are human-created linkages that link activities, trends, and disruptions across large distances, such that locations spatially separated from the locus of an event can experience a variety of impacts from it nevertheless. In the climate change context, such societal teleconnections add a layer of risk that is currently neither fully appreciated in most impacts or vulnerability assessments nor in on-the-ground adaptation planning. Conceptually, societal teleconnections arise from the interactions among actors, and the institutions that guide their actions, affecting the movement of various substances through different structures and processes. Empirically, they arise out of societal interactions, including globalization, to create, amplify, and sometimes attenuate climate change vulnerabilities and impacts in regions far from those where a climatic extreme or change occurs. This paper introduces a simple but systematic way to conceptualize societal teleconnections and then highlights and explores eight unique but interrelated types of societal teleconnections with selected examples: (1) trade and economic exchange, (2) insurance and reinsurance, (3) energy systems, (4) food systems; (5) human health, (6) population migration, (7) communication, and (8) strategic alliances and military interactions. The paper encourages further research to better understand the causal chains behind socially teleconnected impacts, and to identify ways to routinely integrate their consideration in impacts/vulnerability assessment and adaptation planning to limit the risk of costly impacts.

Fixation and fate of C and N in the cyanobacterium Trichodesmium using nanometer-scale secondary ion mass spectrometry.

The marine cyanobacterium Trichodesmium is ubiquitous in tropical and subtropical seas and is an important contributor to global N and C cycling. We sought to characterize metabolic uptake patterns in individual Trichodesmium IMS-101 cells by quantitatively imaging (13)C and (15)N uptake with high-resolution secondary ion mass spectrometry (NanoSIMS). Trichodesmium fix both CO(2) and N(2) concurrently during the day and are, thus, faced with a balancing act: the O(2) evolved during photosynthesis inhibits nitrogenase, the key enzyme in N(2) fixation. After performing correlated transmission electron microscopy (TEM) and NanoSIMS analysis on trichome thin-sections, we observed transient inclusion of (15)N and (13)C into discrete subcellular bodies identified as cyanophycin granules. We speculate that Trichodesmium uses these dynamic storage bodies to uncouple CO(2) and N(2) fixation from overall growth dynamics. We also directly quantified both CO(2) and N(2) fixation at the single cell level using NanoSIMS imaging of whole cells in multiple trichomes. Our results indicate maximal CO(2) fixation rates in the morning, compared with maximal N(2) fixation rates in the afternoon, bolstering the argument that segregation of CO(2) and N(2) fixation in Trichodesmium is regulated in part by temporal factors. Spatial separation of N(2) and CO(2) fixation may also have a role in metabolic segregation in Trichodesmium. Our approach in combining stable isotope labeling with NanoSIMS and TEM imaging can be extended to other physiologically relevant elements and processes in other important microbial systems.