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The historical evolution of the rehabilitation profession is addressed, and current issues facing rehabilitation educators and professionals are identified. Clearly, both our practice environments and our consumers are continuously evolving and becoming more diverse. Simultaneously, a need exists to be seen as a stable, unified profession. Specific issues including the continuing development of private rehabilitation licensure and accreditation, increasing consumer diversity, and movement toward evidence-based practices are identified as critical issues for rehabilitation educators and professionals. [ABSTRACT FROM AUTHOR]

To examine the longitudinal effects of a history of neonatal abstinence syndrome (NAS) on language development over the first 10 years of life. This study used a retrospective, longitudinal design. The data were analyzed using generalized linear mixed models (GLMM) to examine the effects of NAS on language delay over time while controlling for demographic, prenatal, and household factors. There was a significant difference in the pattern of language delays over time between the NAS and non-NAS groups. At the age of 5 (est: −1.788, p <.001), children with a history of NAS had a decreased log odds of developing language delays than those without NAS. Conversely, compared with age 1, at the age of 10 (est: 1.098 p <.001), children with a history of NAS had an increased log odds of developing language delays than those without NAS. Children with a history of NAS had significantly different rates of language delays over time. Children with a history of NAS had significantly higher rates of language delays at 10 years than children without NAS. There is a need to increase developmental surveillance, along with referrals for specialized services, for children with a history of NAS through middle childhood. • By the age of 10 years, 24% of the NAS sample presented with a language delay. • There was a significant difference in the pattern of language delays over time between the NAS and non-NAS groups. • At five, children with a history of NAS had an decreased risk of developing language delays than those without NAS. • At 10, children with a history of NAS had an increased risk of developing language delays than those without NAS. • Neighborhood safety predicted language delays; as index scores increased, the log odds of language delay increased. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study was to collect preliminary data on relevant features and preventative measures of feline inappropriate scratching. Preliminary data could then be used to inform future randomized controlled studies. Methods A paper questionnaire was distributed to 140 cat-owning clients of a small animal practice. The response rate was 82.9%. Questions related to features of inappropriate and designated items scratched, frequency of the behavior and how owners attempted to modify the behavior. The frequency of scratching was ranked and analyzed with repeated-measures models for differences between features of items. The effectiveness of techniques to modify scratching was analyzed with Student’s t-tests comparing frequencies of scratching between cats of survey participants who did and did not use specific techniques. Results Scratching of inappropriate items was reported for 83.9% of cats. Most cats (81.5%) scratched chairs or other furniture and 64.1% scratched carpet. The frequency of scratching inappropriate items was significantly influenced by type and material of the items scratched, with furniture and carpet, and fabric and carpet, respectively, being scratched most often. Most cats (76.1%) had a designated scratching item. The frequency of scratching designated items was significantly influenced by type, with cats using scratching posts and other items more often than scratch pads. Owners used a variety of punishment- and reward-based techniques to stop inappropriate scratching and encourage scratching of designated items; only one technique was found to have a significant effect, with the frequency of scratching designated items being significantly lower in cats that were placed near the item. Conclusions and relevance Furniture covered with fabric was an object frequently scratched. Fabric should be further investigated as a potential material to encourage desired scratching behavior. Scratch pads appeared less desired than scratching posts. Punishment was a common strategy to deter scratching but did not appear to influence the frequency of scratching. [ABSTRACT FROM AUTHOR]

Conflicting data predominantly describes the equine nuchal ligament lamellae (NLL) attachments as C2–C6 or C2–C7; however, preliminary evidence suggests C2–C5. This study aimed to identify morphological variations in the attachments of the NLL in four species of the family equidae and determine if the variations were species or breed linked. Cadaveric examination evaluated 98 equids; Equus asinus (n = 2) , Equus ferus caballus (n = 93), Equus przewalskii (n = 2), and Equus quagga boehmi (n = 1). Twenty breeds of E . f . caballus were included according to breed type—modern horse (n = 81), ancient type (n = 10), primitive (n = 4). Of the 98 equids, observations were divided into three categories according to the NLL attachments: C2–C5, C2–C6, and C2–C7; in category C2–C7, E . f . caballus (n = 3/93), modern horse 0 of 81, ancient 1 of 8, primitive 2 of 4; in category C2–C6, modern horse 2 of 81; in category C2–C5, modern horse 79 of 81, ancient type 7 of 8, primitive 2 of 4. Equus asinus , E . przewalskii , and E . q . boehmi all expressed category C2–C7. In total, 88 of 98 expressed category C2–C5; 2 of 98 category C2–C6; and 8 of 98 category C2–C7. These findings suggest that category C2–C5 provides sufficient evidence to suggest a normal occurrence. The high incidence of an absent NLL on C6 and C7 may be considered a contributing factor in caudal cervical osteoarthritis. Furthermore, category C2–C7 still exists in an ancient and primitive breed closely related to the tarpan, implying the NLL may have been attached from C2 to C7 in prehistoric horse before domestication. This hypothesis is supported by the findings of E . asinus , E . przewalskii , and E . q . boehmi, displaying attachments from C2 to C7. [ABSTRACT FROM AUTHOR]

Hereditary multiple exostoses (HME) is a condition rarely diagnosed in horses, which has not been previously reported in Dutch Warmblood horses. Its presentation resembles that diagnosed in humans, and it is predominantly active during periods of skeletal maturation. This case study reports a link between a granddam with no obvious HME lesions and its first and second generations presenting with HME, albeit with different sires. The severity in affected horses (n = 5) varied from one foreleg to the other with extensive multiple lesions of 123 of 205 bones in a half sibling in the first generation. In the second generation, axial deviations were reported, including similar lesions to those found in the first generation. Rib and limb lesions were the most commonly reported in the first and second generations by age four. However, an extensive examination of the 4-year Dutch Warmblood first generation male revealed lesions from the first cervical vertebra to the first caudal vertebra, inclusive of rib and limb lesions. As all horses with this condition are untreatable, early detection and diagnosis would provide the owner/breeder with options to avoid financial loss and emotional stress. [ABSTRACT FROM AUTHOR]

Objective: Hepatorenal Syndrome (HRS) is a devastating form of acute kidney injury (AKI) in advanced liver disease patients with high morbidity and mortality, but phenotyping algorithms have not yet been developed using large electronic health record (EHR) databases. We evaluated and compared multiple phenotyping methods to achieve an accurate algorithm for HRS identification.Materials and Methods: A national retrospective cohort of patients with cirrhosis and AKI admitted to 124 Veterans Affairs hospitals was assembled from electronic health record data collected from 2005 to 2013. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. Five hundred and four hospitalizations were selected for manual chart review and served as the gold standard. Electronic Health Record based predictors were identified using structured and free text clinical data, subjected through NLP from the clinical Text Analysis Knowledge Extraction System. We explored several dimension reduction techniques for the NLP data, including newer high-throughput phenotyping and word embedding methods, and ascertained their effectiveness in identifying the phenotype without structured predictor variables. With the combined structured and NLP variables, we analyzed five phenotyping algorithms: penalized logistic regression, naïve Bayes, support vector machines, random forest, and gradient boosting. Calibration and discrimination metrics were calculated using 100 bootstrap iterations. In the final model, we report odds ratios and 95% confidence intervals.Results: The area under the receiver operating characteristic curve (AUC) for the different models ranged from 0.73 to 0.93; with penalized logistic regression having the best discriminatory performance. Calibration for logistic regression was modest, but gradient boosting and support vector machines were superior. NLP identified 6985 variables; a priori variable selection performed similarly to dimensionality reduction using high-throughput phenotyping and semantic similarity informed clustering (AUC of 0.81 - 0.82).Conclusion: This study demonstrated improved phenotyping of a challenging AKI etiology, HRS, over ICD-9 coding. We also compared performance among multiple approaches to EHR-derived phenotyping, and found similar results between methods. Lastly, we showed that automated NLP dimension reduction is viable for acute illness. [ABSTRACT FROM AUTHOR]

During the dissection and skeletal examination of 151 horses, a congenital malformation (CM) of the first sternal rib that influenced the aperture of the Thoracic inlet was noted in six horses. The presentation of this CM was variable between horses in gross anatomic appearance; notably, an absent first sternal rib, bifid tuberculum costae, bifid sternochondral articulation onto the sternum, flared shaft, normal first sternal rib inserting onto the cranial branch of a bifid sternochondral articulating second sternal rib, straight costal shaft, and an articulating rudimentary tuberculum costae with a ligamentous extension replacing the bony shaft and attaching to a rudimentary sternochondral articulation onto the sternum. Of the 151 horses examined, the CM of the first sternal rib was restricted to 6/60 Thoroughbred horses, and only in those that were affected by either the unilateral or bilateral transposition of the caudal ventral tubercle from C6 onto the ventral surface of C7. The normal anatomic presentation of the thoracic inlet was altered, along with associative musculature including neurological pathways. These CMs are likely to produce clinical and functional ramifications of the thoracic inlet, thoracic limb, and thoracic viscera, with the probability of altering postural and locomotive function as noted in four horses demonstrating the CM. [ABSTRACT FROM AUTHOR]

Background: The utility of quality dashboards to inform decision-making and improve clinical outcomes is tightly linked to the accuracy of the information they provide and, in turn, accuracy of underlying prediction models. Despite recognition of the need to update prediction models to maintain accuracy over time, there is limited guidance on updating strategies. We compare predefined and surveillance-based updating strategies applied to a model supporting quality evaluations among US veterans.Methods: We evaluated the performance of a US Department of Veterans Affairs-specific model for postcardiac catheterization acute kidney injury using routinely collected observational data over the 6 years following model development (n=90 295 procedures in 2013-2019). Predicted probabilities were generated from the original model, an annually retrained model, and a surveillance-based approach that monitored performance to inform the timing and method of updates. We evaluated how updating the national model impacted regional quality profiles. We compared observed-to-expected outcome ratios, where values above and below 1 indicated more and fewer adverse outcomes than expected, respectively.Results: The original model overpredicted risk at the national level (observed-to-expected outcome ratio, 0.75 [0.74-0.77]). Annual retraining updated the model 5×; surveillance-based updating retrained once and recalibrated twice. While both strategies improved performance, the surveillance-based approach provided superior calibration (observed-to-expected outcome ratio, 1.01 [0.99-1.03] versus 0.94 [0.92-0.96]). Overprediction by the original model led to optimistic quality assessments, incorrectly indicating most of the US Department of Veterans Affairs' 18 regions observed fewer acute kidney injury events than predicted. Both updating strategies revealed 16 regions performed as expected and 2 regions increasingly underperformed, having more acute kidney injury events than predicted.Conclusions: Miscalibrated clinical prediction models provide inaccurate pictures of performance across clinical units, and degrading calibration further complicates our understanding of quality. Updating strategies tailored to health system needs and capacity should be incorporated into model implementation plans to promote the utility and longevity of quality reporting tools. [ABSTRACT FROM AUTHOR]

Background Correct inhaler technique is vital in the management of asthma and chronic obstructive pulmonary disease. However, inhaler misuse is ubiquitous and patients seldom receive effective education on how to use inhalers. Prisoners may have additional contributing factors for inhaler misuse, i.e. low health literacy and intellectual disability. Consequently, health professionals within correctional service facilities have a unique opportunity, and arguably an even more critical role, in the training of inmates in inhaler use. Aim To evaluate correctional services health professionals' baseline inhaler techniques; to assess the impact of training on inhaler techniques; and to evaluate the impact of the training on service delivery to inmates. Method Nurses working in a correctional services hospital complex were recruited. Their baseline inhaler technique (i.e. prior to training) was assessed using inhaler technique checklists. An education intervention was then delivered, following which participants' inhaler technique was reassessed. Results A total of 23 nurses participated in the study. At baseline, proportions demonstrating correct technique were 42, 0 and 5% for metered dose inhalers, Turbuhaler and Accuhaler, respectively. Following training, there was a statistically significant increase in the proportion of participants demonstrating correct inhaler techniques (84% (p = 0.008), 84% (p < 0.001) and 90% (p < 0.001)). Conclusions Nurses in correctional care are expected to check inmates' inhaler techniques as part of clinical care, but were unable to use inhalers correctly and needed training in this regard. Pharmacists are well placed to provide this training. [ABSTRACT FROM AUTHOR]

During the dissection of seven Thoroughbred (Tb) and two Thoroughbred derivative (TbD) horses (9) displaying the congenital malformation of C6 and/or C6 and C7; variations in the gross morphology of the Longus colli muscle were noted. In the absence of the caudal ventral tubercle (CVT) on C6 only, the insertion of the medial and ventral layers and thoracic portion of the L. colli muscle attached to the cranial ventral tubercle (CrVT) on C6. However, on transposition of the CVT from C6 to the ventral surface of C7, the medial and ventral layers, a single deep bundle, and thoracic portion of the L. colli muscle attached to the CrVT on C6 and the transposed CVT on C7. In the unilateral malformation, this placed a distinct asymmetry in the paired left-to-right longitudinal presentation and cross-sectional samples of the L. colli muscle. In the bilateral malformation, the CrVTs were longitudinally malaligned and the L. colli replicated the unilateral presentation to a lesser extent. In this presentation, asymmetry was noted in entheses patterns and articular process joints, implying abnormal mechanical load, as was confirmed in the cross sections. As the L. colli muscle has specific cybernetic roles linked to posture and locomotion, these anatomic variations imply dysfunction. Premortem examinations confirmed eight of the nine horses exhibited proprioceptive and neurologic dysfunction (stillborn not included). This raises questions as to the equilibrium of affected horses and therefore the safety in handling and riding such horses, as was found in this study. [ABSTRACT FROM AUTHOR]

During the dissection and skeletal examination of 123 horses, it was observed that a significant number had a gross skeletal congenital malformation of the sixth and seventh cervical vertebrae. In the sixth cervical vertebra (C6), either a unilateral or bilateral absence of the caudal ventral tubercle (CVT) was noted. In the presence of the C6 malformation, the seventh cervical vertebra (C7) presented either as normal or with a unilateral or bilateral transposition of the CVT from C6 onto the ventral surface of C7 with an arterial foramen. This transposition onto C7 was noted to be present on the corresponding side as the absent CVT on C6. Of the 123 horses examined, the congenital malformation of C6 was noted in 19 of 50 Thoroughbred horses; three of three Thoroughbred derivative horses; one of 15 nondescript bred horses; and none of 55 purpose bred horses of mixed breeds. In total, 23 horses expressed a C6 congenital malformation of which 22 were Thoroughbreds or Thoroughbred derivatives. Of these 22 Thoroughbred and Thoroughbred derivative horses, 11 of 22 expressed either a unilateral or bilateral transposition of the CVT from C6 onto the ventral surface of C7 with an arterial foramen on the corresponding side. This malformation could have functional and clinical ramifications in the postural and locomotive properties of the equine neck and cervicothoracic junction as reported in other species. [ABSTRACT FROM AUTHOR]

Early literature depicting equine anatomy began with stylized illustrations portraying anatomic structures in a congenial format. This study shows that modern day literature often reflects those early portrayals and, in particular, the description and depiction of the nuchal ligament lamellae (NLL) and its attachments from the second to seventh cervical vertebrae. In the dissection of 35 horses of no specific breed, which were unrelated and of mixed gender and age, it was noted that the NLL was not attached to the sixth and seventh cervical vertebrae. Furthermore, the attachment of the NLL on the fifth cervical vertebrae was quite thin and feeble in nine of those horses and that incomplete fibers were noted in the caudal attachments of the NLL in 15 horses. These variations do not correlate to those early depictions or to most of the existing equine anatomic text. This new information on the equine NLL has functional and clinical implications, with particular reference in the way we currently understand the postural and locomotive properties of the equine neck and cervicothoracic junction. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the nature of the learning and teaching processes that emerged in an elementary music setting in which popular music and informal learning processes were salient components of the pedagogical approach. Initial research questions focused on the ways in which children engage in learning popular music in a general music setting and the pedagogical approaches used by the teacher in support of the childrens use of informal learning processes. Participants in this action research study were 24 nine- and ten-year old students in one fourth-grade class. Data were gathered using multiple ethnographic techniques including video and audio recording, field notes, and multiple interviews. A narrative discussion describes the informal processes that the children used in order to cover a popular song of their choice. Working with popular music fostered immediate engagement and escalated the emotional connection to the music, which was paramount to the children. Performing meaningful music uncovered musical identity, propelled performance agency, and promoted social consciousness [ABSTRACT FROM AUTHOR]

Abstract: Background: Social determinants of health are increasingly being addressed as a causal factor for disparities in health. The purpose of this study was to assess the effects of specified social determinants of health on cardiovascular disease (CVD) clinical risk factors in Black and White men residing in rural and urban Georgia. Methods: Self-report data were collected on a total of 548 Black and White men aged >18 years from 2004–2005. Data were derived from a random telephone survey. Separate logistic regression models were conducted to examine the effects of specified social determinants on the presence of two or more CVD clinical risk factors. In addition, differences within rural and urban men were also assessed. Results: Lower education, unemployment, lower income, and higher general stress were all significantly related to the presence of two or more CVD clinical risk factors. As expected, the covariates of age, race, and residential location also played a significant role in cardiovascular health. Rural men were nearly twice as likely to have two or more CVD risk factors compared to urban men (P <0.01). Models examining location separately found urban Black men to be 2.6 times as likely to have more than two CVD risk factors (P <0.02). Conclusion: Findings reveal social determinants are associated with CVD risk factor differences between Black and White men and between rural and urban residents. It is important for policymakers and the healthcare industry to address these social determinants of health as they try to improve the health of the people they serve. [Copyright &y& Elsevier]

Abstract: The primary goal of environmental enrichment should be the avoidance of abnormal behaviors in laboratory animals such as rodents, lagomorphs, dogs, cats, and nonhuman primates. A total of 13 male single-housed New Zealand White rabbits were offered 3 different toys, and the time spent chewing on the toys instead of on the cage was evaluated. Each rabbit was offered each of the toys for 2 separate 1-week periods. Each rabbit was monitored for 15 minutes 4 times a week for a total of total 1 hour per week. Observations included, 1-hour of baseline data before the toys were offered, for a total of 2 and 2 hours of observation per rabbit per toy. Having a toy available had a significant effect on the behavior of New Zealand White rabbits. Rabbits with toys spent significantly more time chewing than the rabbits without toys. They did not develop a preference between the offered toys and did not show stereotypies. This study highlights the importance of environmental enrichment to improve the welfare of laboratory animals. [Copyright &y& Elsevier]

Aim: To create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital. Method: Phase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies. Results: Of the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided 'extra' stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in-house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short-term 'end of shelf life' real-time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications. Conclusion: Creation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance. [ABSTRACT FROM AUTHOR]

Using the Counselor Trainee Attitudes Measure (CTAM) to assess student attitudes toward alcohol and other drug abuse (AODA), results indicated that students had more positive attitudes toward AODA when they were in recovery or had a family member in recovery. Furthermore, completion of AODA related courses predicted more positive attitudes toward AODA. Undergraduate versus graduate standing also appear to play a role in model adherence. [ABSTRACT FROM AUTHOR]

Abstract: It is possible to modify lifting techniques in small laboratory pigs to evoke less of a fear response, strengthen the human–animal bond, and improve welfare. The authors hypothesized that recently weaned pigs lifted with a ventral (belly) scoop method would show less fear of new humans and less fear during treatment than pigs lifted vertically by their hind limbs. To evaluate this hypothesis, 32 Yorkshire-cross pigs (age 3 weeks) were divided into 8 groups of 4. All pigs were acclimated to humans for 11 days and uniformly enriched prior to any lifting tests. Pigs were randomly assigned to 1 of 4 different combinations of ventral and/or vertical lifting techniques that varied by consecutive day (1 ventral-ventral; 2 ventral-vertical; 3 vertical-ventral; 4 vertical-vertical). Each day, data were collected regarding pigs’ aversion to lifting and willingness to be caught multiple times. Two hours later, their time to approach a new person and proportion of time spent hiding from the new person were also measured. Aversion scores were assigned based on duration of squealing, shaking, and freezing responses during lifting. Pigs that were lifted using alternate methods on consecutive days showed significantly less aversion when being scooped ventrally (P = 0.008) as compared to lifted vertically by their hind limbs. Additionally, behavioral trends were identified during the study. Based on standardized aversion scores, this research shows that the ventral scoop method induces less fear than the vertical lift method. [Copyright &y& Elsevier]