Impact of an Exercise-Based Cardiac Rehabilitation Program on Cardiopulmonary Test Parameters.

INTRODUCTION: Exercise-based cardiac rehabilitation programs (CRPs) represent a multidisciplinary therapeutic approach tailored to improve cardiorespiratory fitness and overall health-related quality of life, while reducing cardiovascular hospitalizations and mortality. Our aim was to determine changes in exercise capacity and cardiac events according to the left ventricular ejection fraction (LVEF) following a CRP. METHODS: This single-center cohort study included 131 patients who completed a center-based CRP from 2015 to 2022. Cardiopulmonary exercise testing (CPET), transthoracic echocardiography, and laboratory analysis were performed before and after program completion. RESULTS: Of 232 enrolled patients, 131 were included in our cohort analysis, with 36.6% having a reduced LVEF. These patients exhibited higher rates of atrial fibrillation (p = 0.019) and NT-proBNP values (p < 0.001). Patients with reduced LVEF had lower peak VO2 (pVO2) (p = 0.046), percentage of predicted oxygen consumption (ppVO2) (p < 0.001), and VO2 at anaerobic threshold (p = 0.015) during baseline CPET. Completion of the CRP led to comparable improvements in exercise performance between groups, assessed through Δ pVO2 (p = 0.990), Δ ppVO2 (p = 0.610), and Δ VE/VCO2 slope (p = 0.200). In the study population, male gender and hypertension independently predicted variation in VE/VCO2 slope (p = 0.017) and oxygen uptake efficiency slope (p = 0.048), respectively, post-CRP. During follow-up, 9.2% of all patients had hospital admissions for cardiac events, and 3.8% died, with no significant differences between groups. CONCLUSION: Patients with reduced LVEF admitted to our CRP showed lower functional status based on specific CPET parameters. After CRP, both reduced and preserved LVEF groups experienced similar functional improvements. Therefore, strategies to increase participation of patients with reduced LVEF in such programs are warranted.

Using Strategies from Physical Training of Athletes to Develop Self-Study Programs for Veterinary Medical Students.

Veterinary medical students, similar to elite collegiate athletes, are developing strategies for learning new skills and for self-care to take their performance to the next level. As veterinary students learn to successfully navigate an information-dense, high-volume curriculum, many sacrifice wellness, leadership opportunities, extracurricular activities, and social interactions. Strategies from athletes' physical training were used to design a self-study program for first-year veterinary medical students. Major considerations in program design were the characteristics of the human being, learning goals, and contextual constraints. The study program included a warm-up, study sessions, and a cooldown. The program was offered to first-year veterinary medical students at Purdue University's College of Veterinary Medicine. Thirty-two students requested study programs and 21 completed surveys at the semester end. Results were analyzed quantitatively and by using an adapted conventional content analysis approach. Responses were organized into three main domains: reason for participation, program utility, and program satisfaction. Students shared that the most helpful aspects of the program were assisting with organization and time management, providing accountability, and reducing overwhelm by enhancing well-being and performance; they reported that these learned skills would support their well-being as future professionals. This article describes the experiences of one group of veterinary students at one college using these programs. The long-term goal is to develop a model program for all veterinary students to manage curricular demands while maintaining well-being.

A Global Veterinary Education Program for North American Veterinary Students: A Description of Purdue University Best Practices.

Worldwide growth in global mobility has transformed the way we communicate, trade, and approach global issues. The rise of global migration and distribution comes with a higher probability of transmitted disease, human-wildlife conflict, and food safety issues. No longer viewed as isolated incidents, the occurrence of global health threats in one part of the globe is now a concern throughout the world. Our society needs globally conscious veterinarians who are dedicated to affecting world change through the improvement of animal and human health; veterinarians who are prepared to collaborate, exchange, and engage with the world around them. Higher education institutions for veterinary medicine have the responsibility to prepare their students to become agents of change within society and rewrite the narrative on global health. This article highlights the intentional approach that Purdue University College of Veterinary Medicine took to address the need for more globally conscious veterinarians. The article provides examples of administrative structures, funding sources, global engagement opportunities, methods to increase student awareness of opportunities, and student support. Finally, we describe the impact of this approach in increasing student participation in global engagement.

Challenges and Issues Surrounding Promotion and Tenure of Faculty with Clinical Service Responsibilities in Veterinary Medicine.

Mentoring, assessing, and rewarding faculty who have clinical service responsibilities with promotion and tenure can be challenging in many respects. Clinical service responsibilities can limit the time that faculty have available to participate in scholarly activities, especially if the scholarship required for promotion is restricted to traditional research efforts where an individual faculty member is assessed in terms of the number of scientific publications in high-tiered journals with senior authorship and the amount of extramural funding garnered. Even if other forms of scholarship are recognized, metrics used to evaluate research efforts are often inappropriately applied to other scholarly activities. This challenge is not unique to veterinary medicine. This literature review reveals information regarding barriers and recommended solutions from other healthcare and service professions as recognizing scholarly engagement in academic veterinary medicine is just beginning. Opportunities and examples of how faculty can derive scholarship from their clinical service activities are provided. In addition, an approach for mentoring faculty in the prospective planning and documenting of scholarly engagement efforts is suggested. Lastly, challenges and guidance for assessing such scholarship in academic veterinary medicine are recommended as one step toward encouraging colleges of veterinary medicine to develop methods to assess scholarly engagement within their promotion and tenure processes. A change in approach to the promotion and tenure process can result in more faculty being rewarded for their clinical, diagnostic, and scholarly excellence, which positively impacts patient care, career fulfillment, institutional reputation, the veterinary profession, and society as a whole.

Reducing time-to-treatment in underserved Latinas with breast cancer: the Six Cities Study.

BACKGROUND: The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women. METHODS: To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer. RESULTS: Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants. CONCLUSIONS: Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork.

League of VetaHumanz SuperPower Pack Program: Introducing Young People from Diverse Backgrounds to STEM Learning Activities and Veterinary Science Careers.

League of VetaHumanz uses a nationwide network of university-community partnerships to provide veterinary STEM learning experiences for children who are more likely to lack access to enriching, supplemental educational opportunities due to systemic barriers based on their race, ethnicity, or socioeconomic status. To include participation beyond in-person programming, SuperPower Packs, self-guided, learning experiences, were developed. Leveraging social cognitive career theory and the "Batman Effect," SuperPower Packs are designed to build self-efficacy, and seed STEM and veterinary science career aspirations by engaging children in STEM learning through connections with a veterinary role model. Four SuperPower Packs were developed. Beginning in the fall of 2021, for 17 months, 16,655 SuperPower Packs were distributed to children in 23 states. A small portion of children who received the game (3.8%, N = 614, 6-12 years old) returned evaluation surveys that measured activity engagement, likelihood of role model identification and demographics. Participants indicated variation in their experiences, but mean scale scores show desirable perceptions of engagement (MRange = 2.38 - 2.90/3) and role model identification (MRange = 2.15 - 2.94/3). These positive learning and role model experiences help set the stage to encourage youth to pursue similar learning and career opportunities in the future.

Navigating Latinas with breast screen abnormalities to diagnosis: the Six Cities Study.

BACKGROUND.: Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS.: The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS.: The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P = .007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P < .001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P = .989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P = .045; within 60 days: 86.2% vs 78.4%; P = .023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P < .001; within 60 days: 94.5% vs 67.2%; P < .001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS.: Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments.

The impact of using a veterinary medicine activity book in the classroom on fifth- and sixth-grade students' depictions of veterinarians.

Efforts to develop a diverse, future veterinary workforce must start as early as elementary school, when children begin to form perceptions about careers. The objective of the current project was to determine the impact of the Veterinary Medicine Activity Book: Grade 5 on fifth- and sixth-grade students' depictions of veterinarians. The book was delivered as part of the curriculum in four classrooms. Students were asked to draw a veterinarian and describe the veterinarian's activities before and after being exposed to the book. Drawings were evaluated for the gender and race/ethnicity of the illustrated veterinarian, the description of the veterinarian's activity, and animals portrayed. Significant differences were detected within three of four classrooms. In one class, after exposure to the activity book, more students drew male veterinarians and veterinarians performing an activity specifically mentioned in the book. In a second class, more students drew large animals after exposure to the activity book. In a third class, after exposure to the activity book, more students drew large animals and veterinarians performing an activity specifically mentioned in the book. Results provide preliminary evidence that children's depictions of veterinarians can be altered through use of educational materials delivered in classrooms through teacher-led discussion or formal lesson plans.

Fat dogs and coughing horses: K-12 programming for veterinary workforce development.

Workforce development strategies to educate, inform, and diversify the veterinary profession of the future must begin with children in elementary school. This article provides a description of the Fat Dogs and Coughing Horses program, which takes a multifaceted approach toward informing young students, beginning in first grade, about the interesting work and career opportunities available in the field of veterinary medicine. The program, a collaboration among Purdue University and Indiana public schools, is supported by a Science Education Partnership Award from the Office of Research Infrastructure Programs, a component of the National Institutes of Health. The overall goal of the program is to provide formal and informal educational opportunities for students, parents, teachers, and the public about the science involved in keeping people and their animals healthy. Examples of health concerns that impact both people and their pets are used to inform and excite children about careers in the health sciences. The program resulted in (1) curricula for students in Grades 1-3, 6, and 9; (2) four children's books and a set of collectible cards which highlight veterinarians, veterinary technicians, and research scientists who work with animals; and (3) four traveling museum-level quality exhibits. Preliminary assessment data has shown that the implementation of the curricula enhanced student science learning and science attitudes and interests. The program provides evidence that partnerships among professionals in veterinary medicine and K-12 education can result in impactful workforce development programs.

Digital home-based multidisciplinary cardiac rehabilitation: How to counteract physical inactivity during the COVID-19 pandemic.

Introduction and Objectives: Center-based cardiac rehabilitation (CR) programs have been forced to close due to COVID-19. Alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be considered. The aim of this study was to assess physical activity (PA) levels after completing a home-based digital CR program. Methods: A total of 116 cardiovascular disease (CVD) patients (62.6±8.9 years, 95 male) who had been attending a face-to-face CR program were recruited and assessed (baseline and at three months) on the following parameters: PA, sedentary behavior, adherence, cardiovascular and non-cardiovascular symptoms, feelings toward the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted of a multidisciplinary digital CR program, including regular patient assessment, and exercise, educational and psychological group sessions. Results: Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out rate). A favorable main effect of time was an increase in moderate to vigorous PA and a decrease in sedentary time at three months. Almost half of the participants completed at least one online exercise training session per week and attended at least one of the online educational sessions. No major adverse events were reported and only one minor event occurred. Conclusion: During the pandemic, levels of moderate to vigorous PA improved after three months of home-based CR in CVD patients with previous experience in a face-to-face CR model. Diversified CR programs with a greater variety of content tailored to individual preferences are needed to meet the motivational and clinical requirements of CVD patients.

Introdução e objetivos: Os programas convencionais de reabilitação cardíaca (RC) foram forçados a encerrar devido à Covid-19. Modelos alternativos para que os doentes tenham acesso a um programa de RC evitando a inatividade física devem ser considerados. O objetivo deste estudo foi avaliar os níveis de atividade física (AF) de um programa digital de RC em casa. Métodos: Foram recrutados e avaliados (inicialmente e aos três meses) 116 doentes cardiovasculares (CV) (62,6±8,9 anos, 95 homens) que frequentavam um programa presencial de RC, nos seguintes parâmetros: AF, comportamento sedentário, adesão, sintomas CV e não CV, sentimentos face à pandemia, hábitos alimentares, fatores de risco, segurança e eventos adversos. A intervenção consistiu num programa digital multidisciplinar de RC, inclusive acompanhamento regular, sessões de exercício, de ensino e de psicologia em grupo. Resultados: Completaram com sucesso todas as avaliações online (15,5% drop-out) 98 pessoas com doença CV. Houve um efeito favorável no aumento da AF moderada a vigorosa e diminuição do tempo sedentário aos três meses. Quase metade da amostra fez, pelo menos, mais de uma sessão de exercício físico online por semana e assistiu a pelo menos uma das sessões educacionais online. Não se verificaram eventos major e registou-se apenas um minor. Conclusão: Em tempo de pandemia, os níveis de AF moderada a vigorosa melhoraram após três meses em doentes CV que frequentavam previamente um modelo presencial de RC. São necessários mais programas de RC com maior variedade de conteúdos adaptados à preferência individual para dar resposta às necessidades motivacionais e clínicas dos doentes CV.

Examining Effects of a Multisite Youth Outreach Program: A Meta-Analysis Approach.

This paper presents the application of a meta-analysis approach to the evaluation of youth-learning data from the nationally distributed This is How We "Role" program. The application of meta-analysis for examining the impact of other multisite youth programs encountering similar data analysis challenges is discussed. At each This is How We "Role" program site, university partners collected data to examine youth-participant learning. Data analysis from these unique sites was challenging as the approach had to accommodate the innate heterogeneity across sites due to differences in implementation, sample size, and learning context. The meta-analysis method revealed details of the underlying variation between sites that could be masked by typical regression approaches, estimated overall program effects, examined subgroups and identified heterogeneity across project sites. The results showed the This is How We "Role" program generally increased learning at each site and as a whole, even though the program effects varied across sites. This example demonstrates the utility of using the meta-analysis approach to similar multi-site youth development programs.

Hidden dysfunctioning in subacute stroke.

BACKGROUND AND PURPOSE: Determining cognitive dysfunctioning (CDF) after stroke is an important issue because it influences choices for management in terms of return to previous activities. Because previous research in subacute stroke has shown important variations in CDF rates, we aimed to describe the frequency and neuropsychological profile of CDF in subacute stroke outside dementia. We used a large battery of tests to screen any potentially hidden CDF. METHODS: Patients with Mini-Mental State Examination scores >or=23 were prospectively and consecutively included 2 weeks after a first-ever ischemic brain infarct. Stroke features were based on MRI. Four domains were evaluated: instrumental and executive functions, episodic memory, and working memory (WM). Patients were scored using means and compared with education- and age-matched control subjects. Then we attributed Z-scores for each test and each domain. The most relevant cognitive tests characterizing CDF were determined using logistic regression. RESULTS: Among 177 patients (mean age, 50.6 years), 91.5% failed in at least one cognitive domain. WM was the most impaired domain (87.6%) with executive functions (64.4%), episodic memory (64.4%), and instrumental functions (24.9%) being relatively preserved. CDF was associated with age, education, depression, neurological deficit, and leukoaraiosis in bivariate analysis. Using logistic regression, WM tests and age predicted CDF (Modified Paced Auditorial Serial Addition Test: OR=0.96 CI=0.93 to 0.98; Owen-spatial-WM: OR=1.07 CI=1.02 to 1.12; age: OR=0.96 CI=0.93 to 0.98). CONCLUSIONS: CDF appears to be almost constant, although underestimated, in subacute stroke. WM could reflect some hidden dysfunctioning, which may interfere with rehabilitation and return to work. Clinical routine may include WM tests in young patients with mild stroke.

Developing a Scalable STEM Career Development Program for Elementary School-Aged Students.

This article describes an approach to designing a scalable career development curriculum for elementary school students using minimal-cost and readily available resources. Content experts, veterinary medical students, university staff, teachers, community partners, evaluation experts, and a children's book illustrator developed a library of low-cost, culturally responsive, fun, and educationally engaging lessons to expose elementary school-aged students to scientific knowledge and careers in veterinary medicine. The home team piloted and evaluated the approach at a local community center. Teams in eight other states were provided materials to pilot and assess the program. Seven of those teams successfully piloted the program and provided evidence of child engagement. Although models, props, and other costly supplies enhance delivery of Science Technology Engineering and Math lessons, our experience with the delivery of this curriculum was proof of concept that a low-cost curricular model is one strategy to facilitate scaling and sustainability of an engaging veterinary science curriculum.

Impact of a chapter book and collectible cards describing the lives of seven veterinarians on third-grade students' career aspirations and expectations.

OBJECTIVE To determine the impact of exposure to a chapter book and collectible cards describing the lives of 7 veterinarians on career aspirations and expectations of third-grade students. DESIGN Survey. SAMPLE 176 third-grade students from 6 schools in Indiana. PROCEDURES Students responded to a questionnaire by stating their career aspirations and expectations before and within 8 days after classroom exposure to the chapter book and collectible cards. RESULTS As a group, significantly more students answered that they would like or expect to be a veterinarian when they are an adult after exposure to the book and cards. By gender, more boys, but not girls, answered that they would like or expect to be a veterinarian after exposure to the book and cards. Additionally, more White students and more rural students answered that they expected to be a veterinarian after exposure to the book and cards. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that young children's career aspirations and expectations can be influenced, at least in the short term, by exposure to educational materials about veterinary medicine when delivered as part of a classroom curriculum.

Insuficiencia adrenal en un paciente tratado con tramadol / Adrenal insufficiency in a patient treated with tramadol

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Tentacularia coryphaenae (Cestoda: Trypanorhyncha) em Fistularia petimba Lacépède, 1803 coletados Estado do Rio de Janeiro, Brasil e sua importância na inspeção do pescado / Tentacularia coryphaenae (Cestoda: Trypanorhyncha), Fistularia petimba Lacépède, 1803 collected off the coast of the State of Rio de Janeiro, Brazil and its importance in fish inspection

A presença de helmintos no pescado resulta em perdas econômicas devido a repugnância, além do risco de desenvolver reações alérgicas, reforçando a importância da inspeção higiênico-sanitária, como o caso dos cestoides da ordem Trypanorhyncha. Entre janeiro e setembro de 2018 foram adquiridos 30 espécimes de Fistularia petimba no Estado do Rio de Janeiro. Após a necropsia no Laboratório de Inspeção e Tecnologia de Pescado da Faculdade de Veterinária-UFF, foi verificado a positividade de dois peixes para o cestoide identificado como sendo da espécie Tentacularia coryphaenae, presente na cavidade abdominal e mesentério, apresentando os seguintes índices parasitários: prevalência 6,6%, intensidade média 1; abundância média 0,06.