Search

Summary A 7-year-old male neutered Labrador Retriever dog presented with acute-onset fever, shifting limb lameness and anorexia, with development of acute respiratory distress. At necropsy, there was vegetative endocarditis, which effaced the aortic valve. Gram staining of impression smears from the aortic valve and kidney revealed numerous gram-positive rods with some coryneform bacteria. Similar coryneform bacteria were isolated on aerobic culture of the aortic valve. Identification was attempted by matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S sequencing, the latter of which indicated Corynebacterium mustelae. This is the second reported case of endocarditis in a dog involving C. mustelae and the first with a description of post-mortem pathology. This case is an example of the utility of various modalities to identify facultative anaerobic bacterial pathogens that may be difficult to culture and may be more widespread than previously diagnosed.

With an ever-expanding field of illicit drugs available, doctors working in the acute specialties will inevitably be involved in the management of the serious and life-threatening side effects of drug misuse, as outlined in this article.

A 7-year-old, neutered male Labrador Retriever presented for a persistent, productive cough and regurgitation. Radiography, ultrasonography, and computed tomography confirmed a large, smoothly marginated intrathoracic mass causing tracheal compression. The mass was removed via a thoracotomy, and a malignant peripheral nerve sheath tumor, most likely originating from the ventral spinal nerve roots, was confirmed using immunohistochemistry.

Background Randomized controlled trials (RCT) are required to test relationships between physical activity and cognition in children, but these must be informed by exploratory studies. This study aimed to inform future RCT by: conducting practical utility and reliability studies to identify appropriate cognitive outcome measures; piloting an RCT of a 10 week physical education (PE) intervention which involved 2 hours per week of aerobically intense PE compared to 2 hours of standard PE (control). Methods 64 healthy children (mean age 6.2 yrs SD 0.3; 33 boys) recruited from 6 primary schools. Outcome measures were the Cambridge Neuropsychological Test Battery (CANTAB), the Attention Network Test (ANT), the Cognitive Assessment System (CAS) and the short form of the Connor's Parent Rating Scale (CPRS:S). Physical activity was measured habitually and during PE sessions using the Actigraph accelerometer. Results Test- retest intraclass correlations from CANTAB Spatial Span (r 0.51) and Spatial Working Memory Errors (0.59) and ANT Reaction Time (0.37) and ANT Accuracy (0.60) were significant, but low. Physical activity was significantly higher during intervention vs. control PE sessions (p < 0.0001). There were no significant differences between intervention and control group changes in CAS scores. Differences between intervention and control groups favoring the intervention were observed for CANTAB Spatial Span, CANTAB Spatial Working Memory Errors, and ANT Accuracy. Conclusions The present study has identified practical and age-appropriate cognitive and behavioral outcome measures for future RCT, and identified that schools are willing to increase PE time. Trial registration number ISRCTN70853932 (http://www.controlled-trials.com)

Certification is the criterion standard of professional practice, distinguishing excellence in nursing care, mastery of knowledge, skills, and abilities beyond the scope of professional licensure. It is the validation of an individual nurse’s qualifications for practice in a defined area. Becoming certified is a personal and professional commitment that demonstrates the value that the individual nurse places on higher standards of practice and lifelong learning. The American Association of Critical-Care Nurses (AACN) Beacon Award for Excellence, Magnet Recognition Program, and Malcolm Baldrige National Quality Award all recognize certification as a key component of nursing excellence in specialty practice. Both the general public and nurse professionals increasingly recognize the need for practice on the basis of evidence to provide safe, quality patient care. In today’s rapidly changing and complex health care delivery system, certification is becoming the standard by which bedside practice and the impact of nursing care on patient outcomes are measured. This article will provide a review of current best practices in creating a culture of certification, including the journey of 3 hospitals selected as the 2010 Best Practice Roundtable presentations at the AACN National Teaching Institute.

Obstetric cases are normally well managed on the labour suite. However, emergencies are not uncommon, and when they occur, they can be major. It is vital that rapid assessment and management are put in place. Critical care doctors are often called upon to do so.

Background Percutaneous endoscopic colostomy (PEC) on the left side of the colon is a minimally invasive endoscopic technique, increasingly used to treat lower-GI conditions. Objective To evaluate the efficacy and safety of a PEC tube insertion at a single unit. Design Retrospective data collection. Setting District general and teaching hospital in the United Kingdom. Patients Data collected from patients with lower-GI disorders who had a PEC tube inserted. Interventions Data collection. Main Outcome Measurements Incidence of complications and patient outcome. Results Between 2001 and 2005, 31 patients presented for a PEC. Insertion was possible in 27 patients. Indications included functional constipation (n = 8), recurrent sigmoid volvulus (n = 8), colonic pseudo-obstruction (n = 5), and neurologic constipation (n = 6). In 22 patients (81%), symptoms were markedly improved after insertion. Sigmoid volvulus did not recur with a PEC tube in place. The mean (standard error of the mean) duration with tubes in situ was 9.5 ± 1.6 months. Only 2 patients still had a PEC tube in situ. A total of 77% of patients had episodes of infection. Infective episodes led to tube removal in 44% of the total group. Other complications included buried internal bolster, fecal leakage, and pain. Mortality was high (26%), with 7 deaths: 5 from unrelated causes and 2 deaths from fecal peritonitis. Limitations This was a retrospective study. A prospective study in our unit is unlikely because of these results. Conclusions Symptoms were effectively controlled by a PEC tube insertion, and recurrent sigmoid volvulus was prevented. Recurrent complications caused significant morbidity. Infection necessitated tube removal in the majority of patients. Fatal fecal peritonitis occurred in 2 patients. Indiscriminate use of a PEC in the left side of the colon is not recommended. A PEC should only be considered in carefully selected cases.

Furnace facilities for materials processing on the International Space Station (ISS) will include the Space Product Development Experiment Module (SPDEM) which includes a transparent Furnace module and an opaque Furnace Module. The SPDEM is scheduled currently for UF-3 aboard the Materials Science Research Rack(MSRR). Various commercial interests can be satisfied sequentially by scheduled employment of the SPDEM. The CMDS will be the facility manager through whom arrangements can be made for SPDEM access. The ISS should provide long growth periods which are needed to grow large single crystals in microgravity. A typical area of commercial interest is acousto-optic filters (AOTF) based on mercurous halide research which would continue on the ISS, research begun on the STS-77 mission. Another area of commercial interest planned for implementation on ISS is liquid metal sintering of composites to further improve techniques for making better quality materials.

Furnace facilities for materials processing on the International Space Station (ISS) may include the Space Experiment Facility (SEF) which consists of two transparent furnace modules. When SEF is put into operation on ISS, various commercial interests can be satisfied sequentially by scheduled employment of SEF. The CMDS will be the facility manager through whom arrangements can be made for SEF access. Utilizing the transparency of the SEF furnace, real-time observation and control of the crystal growth can be accomplished as demonstrated on the Space Transportation System (STS)-77 mission. The ISS should provide long growth periods which are needed to grow large single crystals in microgravity. One area of particular commercial interest is the acousto-optic filters (AOTF) based on mercurous halide research which would continue on the ISS, research begun on the STS-77 mission. The stability of the thermocouple control has a standard deviation of less than 0.1 °C at temperatures of 573/593 °K. The SEF has ...

This paper focuses on the nurses' role in ethical decision-making in intensive care units (ICUs) of hospitals in the UK. There is a paucity of research on the topic, studies published are generally North American or Canadian in origin. The available literature suggests that although nurses are constantly at the intensive care patient's bedside, often making complex decisions about treatment and care, their involvement in ethical decision-making is limited. This paper provides a review of the literature on how ethical decisions are made and the influences on nurses' participation in this process.

Review(s) of: Is That You, Ruthie?, by Ruth Hegarty, published by University of Queensland Press, St Lucia, Australia: 1999. Includes footnotes.

EDITOR,--I wish to challenge John Guillebaud's editorial1 on the recent warning by the Committee on Safety of Medicines about combined oral contraceptives containing gestodene and desogestrel.2 Some family planning doctors will not agree with his views on a continued role for preparations that seem to double the risk of venous thromboembolism for current users compared with users of low dose monophasic oral contraceptives containing levonorgestrel and norethisterone. There is …

International audience; Several international research and development organizations are promoting conservation agriculture in a wide range of contexts. Conservation agriculture is based on a combination of three main principles: (i) minimal or no mechanical soil disturbance; (ii) diversified crop rotations and (iii) permanent soil cover (consisting of a growing crop or a dead mulch of crop residues). However, in the face of the diversity of practices that can be associated with conservation agriculture, of goals assigned to agricultural systems, and pedoclimatic contexts, there is still no empirical evidence about the overall performance of conservation agriculture in France. Global assessments of conservation agriculture, with the full or partial application of its principles and in different contexts, are required to provide a more comprehensive picture of the performance of such systems. We tackled these objectives simultaneously, by evaluating 31 cropping systems with the MASC (R) model (for Multicriteria Assessment of the Sustainability of Cropping Systems). These systems were selected to represent a wide diversity of practices, from ploughed conventional systems to crop sequences based on the full application of conservation agriculture principles. Positive interactions were observed between the key elements of conservation agriculture, resulting in better sustainability performances (particularly in terms-of environmental criteria). Nevertheless, the systems most closely respecting the principles of conservation agriculture displayed several weaknesses, principally of a social or technical nature, in this study. Careful attention should be paid to attenuating these weaknesses. A more detailed analysis of the results also suggested that decreasing soil tillage tends to decrease the overall performance of the system unless associated with a diversification of the crop rotation.