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Leadership is a quality, not a position. Learn more about what makes a good leader in equine practice. What is leadership? If you are a solo practitioner, the owner of [...]

Lawyers and bar associations have a critical role to play in activating decarbonization and adaptation, and creating a more climate-conscious legal practice. The American Bar Association (ABA) has been working [...]

With data breaches on the exponential rise, (1) organizations must get their heads out of the sand and embrace the (nearly) inevitable: a breach is coming. In 2022, nearly 2,000 [...]

High-intensity interval training (HIIT) is considered a novel and time-efficient method to reduce cardiovascular disease risk, a leading cause of mortality in kidney transplant recipients. However, research in this population is severely limited. The aim of this study was to understand kidney transplant recipients' perceptions and experiences of HIIT and their readiness to participate in HIIT. Individual, semi-structured interviews were conducted in adults with a kidney transplant (n = 13; 53[+ or -]13 years). Interviews were audio-recorded, transcribed verbatim, and subjected to framework analysis. Overall, participants had a good knowledge of HIIT and were open to participation. Acknowledgment of the superior benefits to cardiovascular, mental, and general health, as well as the lower time commitment, were all motivators for participation. There were some heightened concerns around damaging the kidney and 'knowing your limits.' Personalization, physician's approval, and supervision were all important factors in participation. This study provides evidence that HIIT would be, in principle, largely accepted by recipients of a kidney transplant. However, several considerations are also identified in the present study, which would be essential to the success of any future efficacy trial or rehabilitation program. Key Words: Kidney transplantation, chronic kidney disease, exercise, semi-structured interview, qualitative research, rehabilitation, high-intensity interval training., NCPD 1.4 contact hours High-intensity interval training (HIIT) is considered a novel and time-efficient method to reduce cardiovascular disease (CVD) risk. CVD remains a leading cause of morbidity and mortality [...]

Problems with cash flow can cripple small businesses as well as large corporations. Every firm has fixed costs, most of which must be paid on a monthly or quarterly basis. [...]

Ethics is a broad term that explores the nature of moral behavior and specific moral choices that might need to be made. In general, moral norms for ethical conduct are [...]

All over the world, practices are struggling to hire equine veterinarians. In the U.S. in 2021,1.4% (46) of new graduates accepted equine positions as associates directly after graduation, and an [...]

In order to evaluate how horse owners experienced the availability of equine veterinary services during the challenges of the pandemic in 2020-2021 and what they are experiencing in 2022, a [...]

The Family Caregiver Activation in Transitions (FCAT) tool in its current, non-scalar form is not pragmatic for clinical use as each item is scored and intended to be interpreted individually. The purpose of the current study was to create a scalar version of the FCAT to facilitate better care communications between hospital staff and family caregivers. We also assessed the scale's validity by comparing the scalar version of the measure against patient health measures. Data were collected from 463 family caregiver–patient dyads from January 2016 to July 2019. An exploratory factor analysis was performed on the 10-item FCAT, resulting in a statistically homogeneous six-item scale focused on current caregiving activation factors. The measure was then compared against patient health measures, with no significant biases found. The six-item scalar FCAT can provide hospital staff insight into the level of caregiver activation occurring in the patient's health care and help tailor care transition needs for family caregiver–patient dyads. [Journal of Gerontological Nursing, 48(12), 35–42.], Family caregivers are characteristically defined as individuals who assist a care recipient in completing activities of daily living (ADLs), such as bathing, toileting, taking medications, and managing appointments (Coleman, Ground, [...]

Obesity in children and adolescents is a growing global public health concern. Recent data indicate that upwards of 18.5% of children and adolescents in the United States have obesity. (1,2) [...]

Most equine practices are small, employing just a few team members. Practice owners frequently find that managing their support staffs is a challenge that increases as the practice grows. Because [...]

What is cybersecurity? According to Juliana DeGroot of the data loss prevention software company Digital Guardian, 'Cybersecurity is the application of technologies, processes and controls to protect systems, networks, programs, [...]

A recent survey published in EquiManagement reported that equine practices have been much busier in the last two years, and hiring veterinarians for associate positions has been difficult. Many equine [...]

'We are at a tipping point in the equine industry,' said one speaker at the 2021 AAEP Convention. This article discusses issues and solutions to make the industry thrive. On [...]

Thinking about selling your practice to a corporate veterinary investor? Make sure you know how valuations work and other options you might have. Mike Pownall, DVM, MBA, a respected veterinarian [...]

As of the end of December 2021, at the time of this survey, more than 53 million U.S. residents had been infected with coronavirus and at least 820,000 had died, [...]

Many practices that need associates to help with a growing workload have been unable to hire anyone. Other practices have experienced the departure of one or more of their employed [...]

The 2016 AVMA AAEP Equine Economic Study revealed that 16% of practices had no employees. A more recent study conducted by this author for EquiManagement in November 2021 had similar [...]

The Wellness session at the 2021 AAEP Convention featured a presentation by Jay McChord on 'Relevant Leadership: Leading & Communicating Effectively in a Multi-Generational Workplace.' McChord, a former Global Senior [...]

On August 24, 2022, President Biden announced a plan to give relief to borrowers by forgiveness of a portion of their educational loan debt. During his campaign in 2020, he [...]

IMPORTANCE: Chronic pain is a common condition for which efficacious interventions tailored to highly affected populations are urgently needed. People with HIV have a high prevalence of chronic pain and share phenotypic similarities with other highly affected populations. OBJECTIVE: To evaluate the efficacy of a behavioral pain self-management intervention called Skills to Manage Pain (STOMP) compared to enhanced usual care (EUC). DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial included adults with HIV who experienced at least moderate chronic pain for 3 months or more. The study was set at the University of Alabama at Birmingham and the University of North Carolina–Chapel Hill large medical centers from August 2019 to September 2022. INTERVENTION: STOMP combined 1-on-1 skill-building sessions delivered by staff interventionists with group sessions co-led by peer interventionists. The EUC control group received the STOMP manual without any 1-on-1 or group instructional sessions. MAIN OUTCOMES AND MEASURES: The primary outcome was pain severity and the impact of pain on function, measured by the Brief Pain Inventory (BPI) summary score. The primary a priori hypothesis was that STOMP would be associated with a decreased BPI in people with HIV compared to EUC. RESULTS: Among 407 individuals screened, 278 were randomized to STOMP intervention (n = 139) or EUC control group (n = 139). Among the 278 people with HIV who were randomized, the mean (SD) age was 53.5 (10.0) years; 126 (45.0%) identified as female, 146 (53.0%) identified as male, 6 (2.0%) identified as transgender female. Of the 6 possible 1-on-1 sessions, participants attended a mean (SD) of 2.9 (2.5) sessions. Of the 6 possible group sessions, participants attended a mean (SD) of 2.4 (2.1) sessions. Immediately after the intervention compared to EUC, STOMP was associated with a statistically significant mean difference for the primary outcome, BPI total score: −1.25 points (95% CI, −1.71 to −0.78 points; P < .001). Three months after the intervention, the mean difference in BPI total score remained statistically significant, favoring the STOMP intervention −0.62 points (95% CI, −1.09 to −0.14 points; P = .01). CONCLUSION AND RELEVANCE: The findings of this randomized clinical trial support the efficaciousness of STOMP as an intervention for chronic pain in people with HIV. Future research will include implementation studies and work to understand the optimal delivery of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03692611

Postacute sequelae after the coronavirus disease (COVID) of 2019 (PASC) is increasingly recognized, although data on solid organ transplant (SOT) recipients (SOTRs) are limited. Using the National COVID Cohort Collaborative, we performed 1:1 propensity score matching (PSM) of all adult SOTR and nonimmunosuppressed/immunocompromised (ISC) patients with acute COVID infection (August 1, 2021 to January 13, 2023) for a subsequent PASC diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariable logistic regression was used to examine not only the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8769 SOT and 1 576 769 non-ISC patients with acute COVID infection. After PSM, 8756 SOTR and 8756 non-ISC patients were included; 2.2% of SOTR (n = 192) and 1.4% (n = 122) of non-ISC patients developed PASC (Pvalue < .001). In the overall matched cohort, SOT was independently associated with PASC (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09-2.01). Among SOTR, COVID infection severity (aOR, 11.6; 95% CI, 3.93-30.0 for severe vs mild disease), older age (aOR, 1.02; 95% CI, 1.01-1.03 per year), and mycophenolate mofetil use (aOR, 2.04; 95% CI, 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR, 1.96; 95% CI, 1.24-3.07) and COVID infection severity were. In conclusion, PASC occurs more commonly in SOTR than in non-ISC patients, with differences in risk profiles based on SOT status.

With the advances in smartphone and tablet screens, as well as their processing power and software, mobile apps have been developed reporting to assess visual function. This review assessed those mobile apps that have been evaluated in the scientific literature to measure visual acuity, reading metrics, contrast sensitivity, stereoacuity, colour vision and visual fields; these constitute just a small percentage of the total number of mobile apps reporting to measure these metrics available for tablets and smartphones. In general, research suggests that most of the mobile apps evaluated can accurately mimic most traditionally paper-based tests of visual function, benefitting from more even illumination from the backlit screen and aspects such as multiple tests and versions (to minimise memorisation) being available on the same equipment. Some also utilise the in-built device sensors to monitor aspects such as working distance and screen tilt. As the consequences of incorrectly recording visual function and using this to inform clinical management are serious, clinicians must check on the validity of a mobile app before adopting it as part of clinical practice.

Central nervous system (CNS) lesions become surrounded by neuroprotective borders of newly proliferated reactive astrocytes; however, fundamental features of these cells are poorly understood. Here we show that following spinal cord injury or stroke, 90% and 10% of border-forming astrocytes derive, respectively, from proliferating local astrocytes and oligodendrocyte progenitor cells in adult mice of both sexes. Temporal transcriptome analysis, single-nucleus RNA sequencing and immunohistochemistry show that after focal CNS injury, local mature astrocytes dedifferentiate, proliferate and become transcriptionally reprogrammed to permanently altered new states, with persisting downregulation of molecules associated with astrocyte–neuron interactions and upregulation of molecules associated with wound healing, microbial defense and interactions with stromal and immune cells. These wound repair astrocytes share morphologic and transcriptional features with perimeningeal limitans astrocytes and are the predominant source of neuroprotective borders that re-establish CNS integrity around lesions by separating neural parenchyma from stromal and immune cells as occurs throughout the healthy CNS.

Delirium is common during critical illness and is associated with long-term cognitive impairment and disability. Antipsychotics are frequently used to treat delirium, but their effects on long-term outcomes are unknown. We aimed to investigate the effects of antipsychotic treatment of delirious, critically ill patients on long-term cognitive, functional, psychological, and quality-of-life outcomes.

Genotype prediction from RNA sequencing (RNA-seq) data has become widespread, but there is a lack of clarity in current policy and inconsistency in data handling. To address this we call for a framework consisting of registered access for RNA-seq data, controlled access for genotypes, a code of conduct and enhanced downstream protections.

Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n= 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported “fair” or “poor” general health [OR = 2.914 (95% CI = 1.521–5.581)], reporting at least one chronic condition [2.028 (1.024–4.018)], and “low” fruit and vegetable intake [2.421 (1.258–4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings.Using both the common Hunger Vital Sign food security screener and the new brief nutrition security screener allowed for the identification of participants with the highest odds for poor dietary and health outcomes.Food security and nutrition security are related to a household’s ability to get enough food and to get food that is good for their health, respectively. Patients at hospitals, or clients who go to food pantries for help, are often asked about their food security status. This is referred to as screening. On the basis of their answers, they may get help such as referral to a food pantry and/or consultation with a dietitian. While there is a standard tool to screen for food security status, until recently, there has not been one for nutrition security. We used both the commonly used Hunger Vital Sign (HVS) food security screener and the newly developed brief nutrition security screener to identify food and nutrition security screening status. Being in the food insecure and nutrition insecure groups (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for poor dietary and health outcomes. These findings support using both the HVS and brief nutrition security screener simultaneously in health-related social needs screening to identify participants at the highest risk.

While North American fishes are often overlooked by the ornamental fish industry, there is growing interest in fishes native to the southeastern USA, a hot spot for fish diversity. The Metallic Shiner Pteronotropis metallicus, a small‐bodied leuciscid native to Florida and Georgia, is sometimes available in the ornamental fish trade through wild collection and limited captive production. This species exhibits a distinctive color pattern straddling the lateral line: a dorsal pink to red line, fading to a black to blue stripe. This group of minnows is largely unknown to ornamental aquaculture and lacks defined culture protocols. Our objective was to develop culture protocols for the Metallic Shiner. Following collection of wild broodstock, we used routine culture methods to experimentally determine substrate preference, egg incubation, egg disinfection, larval feeding, and larval development. Metallic Shiner spawning was more successful on yarn mops compared with other media, with average output of >50 embryos per tank per day. Hatching success was similar for static incubators (24%) and upwelling incubators (20%) and was also similar among egg disinfection treatments (iodine, hydrogen peroxide, and formalin). Larval feeding regimes altered survival, with Otohime A1 exhibiting higher survival (44%) over 14 days posthatch (dph) and better growth than other feeding regimes. During the developmental trial with water temperature at a relatively constant 25°C, length increased from 5 mm notochord length (4 dph) to 8.7 mm standard length (45 dph), with significant milestones occurring at 4 dph (swim bladder inflation), 16 dph (flexion), and 23 dph (hypural plate formation). These data provide basic culture information for the Metallic Shiner while also providing a place of reference to begin investigating culture protocols for related species, including species of conservation concern. Impact statementThese data provide basic culture protocols to establish commercial production for the Metallic Shiner, an overlooked species native to North America. These data provide basic culture protocols to establish commercial production for the Metallic Shiner, an overlooked species native to North America.

Valoctocogene roxaparvovec transfers a human factor (F)VIII coding sequence into hepatocytes of people with severe hemophilia A to provide bleeding protection.

Background: Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women.Methods: Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use.Results: The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use.Discussion: Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.

Background:Desmopressin (1-deamino-8-D-arginine vasopressin [DDAVP]) has demonstrated efficacy as a treatment option for patients with inherited bleeding disorders. Because of individuals’ variable response to the medication, it is recommended to complete a challenge to document appropriate hemostatic response to the medication before recommending its use prior to surgical procedures or treatment of bleeding symptoms. The project aimed to reduce the errors in hemostatic response assessments for patients with bleeding disorders undergoing a DDAVP challenge (process outcome), particularly timing and number of blood samples drawn, from an error rate baseline of 36% to 0% by December 2021 and sustained for one year. Method:Plan-Do-Study-Act methodology was employed for this qualitative improvement initiative. Interventions designed and implemented included: an order set with medication doses and corresponding laboratory orders as clinically indicated for the bleeding disorder indication, clinical procedure guidelines for infusion nurses to follow, hemostasis nurse coordination of appointments with patients, and family education. Results:Baseline data on 22 patients who completed a DDAVP challenge demonstrated a 36% error rate not involving doses of medication administered. Errors encountered included improper timing of laboratory draw after DDAVP administration, incomplete laboratory evaluation, laboratory results displayed incorrectly due to testing orders released at once instead of in a sequential manner. These interventions resulted in a reduction of DDAVP challenge errors to 0% that were sustained for one year. Conclusion:Improvement in procedural medication administration and appropriate laboratory evaluation of patients undergoing a DDAVP challenge leads to a complete and reliable assessment of hemostatic response following medication administration.

Multigroup latent profile analysis examined whether patterns of alcohol, cannabis, and tobacco use varied between college student and nonstudent young adults (N= 745), and profiles were characterized by alcohol- and drug-related problems, psychological distress, and perceived stress. Findings supported three profiles (high use across substances, primarily high tobacco use, and low use across substances) among students. Students in the high use group, relative to other groups, experienced the highest number of problems and psychological distress. Among nonstudents, two profiles emerged (high use across substances and primarily high tobacco use), and noncollege participants in the high use group experienced the highest problems, psychological distress, and perceived stress. Students, compared to nonstudents, reported more variability in their substance use profiles, as a low substance use group was not observed among nonstudents. Prevention and intervention efforts should target nonstudents, which could aid in reducing negative health outcomes based on disparities in education.

Undoubtedly the best way to handle accounts receivable (AR) is not to have any! Accounts receivable are monies owed to you from invoices that clients have received for your services [...]

Veterinary students accumulate a substantial amount of educational debt while completing four years of veterinary school. Some continue on to internships and residencies, during which time they often defer repayment [...]

The Gallup State of the Global Workplace 2022 survey revealed that only 33% of employees feel they are thriving in the workplace and only 21% are engaged. Workplace boundaries help [...]

Impostor Syndrome is defined as 'the persistent inability to believe that one's success is deserved or has been legitimately achieved as a result of one's own efforts or skills.' First [...]

In the following article, we will focus on the practice performance and veterinarian wellness results of a survey created by the author and conducted for EquiManagement in late October/early November [...]

As the equine veterinary profession struggles with attracting and retaining veterinarians, the experience that new graduates have in their internship programs can markedly influence their future paths. As the number [...]

President Joe Biden announced on January 30, 2023, that https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023. Biden’s announcement came [...]

Every business has a brand identity, and equine veterinary practices are no exception. Some firms work hard to create that identity, and some are completely unaware of how they are [...]

As a continuation of the article 'Leaving Equine Practice,' published in EquiManagement magazine in winter 2019 (and available online), a conversation was initiated on the Facebook page Equine Vet2Vet in [...]

Due to the pandemic, the 66th Annual Convention of the AAEP was held virtually. With the presentations available on demand, many members were pleased that they did not have to [...]

Physical well-being was the focus of the AAEP Annual Conventions Lifestyle & Wellness sessions. These sessions covered utilizing ergonomics to minimize physical injuries in practice and ways to decrease the [...]

Not all men are equal, as our Founders knew. 'No two men are perfectly equal in person, property, understanding, activity, and virtue,' wrote John Adams in 1776. Nor can they [...]

Significant increases in workload have emerged over the past two years, as elucidated in the late 2021 equine veterinary industry survey and highlighted in the article 'State of Equine Practice [...]

Risk mitigation is important to protect your equine veterinary practice and the assets of the practice owners. Risk can be managed in several ways: Accepting the risk and planning for [...]

Are you having problems hiring lay staff or associates? You aren't alone! A survey conducted in late 2021 showed that the vast majority of veterinarians and practices looking to hire [...]