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The present work evaluates the electrochemical behavior of the construction steel of an oil pipeline in the presence of two waters of different origins. The electrochemical techniques of linear polarization resistance and polarization curves were used to estimate the resistance of the steel to corrosion when the steel was in contact with the corrosive media. By the physicochemical and microbiological composition of the media, the difference between their corrosive aggressiveness was appreciated, in correspondence with the corrosion speed measurements determined by the Linear Polarization Resistance (LPR) method. The corrosion resistance of the evaluated material was noted to decrease with increasing temperature, in both aqueous media. The polarization curves of the steel showed processes of load transfer and oxygen diffusion in the tests carried out.

Este trabajo analiza la estrategia de seguridad del presidente George W. Bush y su posible vinculación con el comportamiento internacional de Donald Trump, ahondando en las similitudes de ambos casos, tanto en sus objetivos como contexto internacional. Sobre la base del accionar de Trump durante los primeros meses de su mandato, este trabajo sugiere que el actual mandatario estadounidense está desarrollando, y consolidará, una estrategia de seguridad sustentada en principios, valores y objetivos comparables a aquellos defendidos por George W. Bush a inicios del presente siglo.

This article discusses the concept of risk from an epidemiological viewpoint as well as that of vulnerable populations. Three components of resource availability are pertinent to the concept of risk of a population: social status, social capital, and human capital. These components are illustrated through an example of a project to reduce preventable adverse health outcomes and increase competency in self-care among residents of an inner-city community. Activities and outcomes of the project are discussed. Copyright (c) 1999 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

Las exploraciones internacionales llevadas a cabo durante la denominada era heroica de la historia antártica, fueron determinantes en la configuración del futuro político del continente helado. Pese a ello, y mientras el Reino Unido, Francia, Bélgica, Noruega y otras naciones realizaban importantes y continuos esfuerzos para asegurar su presencia en dicha región, Estados Unidos -por entonces, una potencia en ascenso- permanecía al margen del proceso. De acuerdo a lo anterior, el presente trabajo intenta dilucidar algunas de las razones del comportamiento del país del norte, y -particularmente- examina las perspectivas que algunas influyentes sociedades científicas norteamericanas desarrollaron respecto de la inacción norteamericana en materia antártica durante la primera década del siglo XX. El trabajo -de carácter exploratorio- se basa, principalmente, en material de prensa, documentación institucional, y en artículos publicados en las revistas y boletines de las sociedades científicas analizadas.

The success of chemical engineering graduates depends on their aptitude and the skills received during the academic formation. Employers not only require that graduates have the knowledge of basic chemical engineering principles but knowing how to apply this knowledge in solving practical problems. In this paper, one form to obtain important skills is presented. The working practice is one of the most important subjects in the curriculum. HYSYS simulator which can realize the energetic evaluation was introduced. A simulation model of the preheat train of Fluid Catalytic Cracking Unit was obtained. The model was built using prebuilt models in HYSYS, however a fired heater to steady state doesn’t exist. In this case, a spreadsheet was utilized in programming the energetic evaluation. Sometimes it is useful because it is necessary to use our models for specific equipment. Finally, the model was utilized to predict the system efficiency when changes on the operation variables occur. The use of simulation inside of core subjects helps to improve the level and quality of students’ formation.

The ABC transporter gene family encodes proteins that form transmembrane channels and hydrolyze ATP to pump various substrates into and out of cells. Adult stem cell populations in numerous mammalian tissues express members of this gene family in order to efflux toxins or vital dyes, thereby conferring the "side population" trait, and cancer stem cells exhibit multidrug resistance upon expression of members of this gene family. In this study we investigated the expression of ABC transporters in a leading model organism stem cell niche, the Drosophila testis. We screened enhancer and gene trap lines with insertions near ABC transporter genes and identified six transporters with tissue-specific expression in the testis (ABCB7, MRP, rdog, CG3164, CG31121, and CG9663). Contrary to our expectation, we did not observe mostly stem cell-restricted expression patterns for these genes. We also report the expression patterns of ABC transporter genes in the testis from the published Fly Cell Atlas consortium single-cell sequencing of the testis (Li et al., 2022). Comparison of the expression levels and patterns of the six positive genes from the enhancer/gene trap screen with the FCA data showed only weak correlation between the two gene expression approaches. While there are reasons that the techniques might show different results, our work highlights the need for caution in over-reliance on single techniques to investigate gene expression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Understanding causal relationships between evolution and ocean oxygenation hinges on reliable reconstructions of marine oxygen levels, typically from redox-sensitive geochemical proxies. Here, we develop a proxy, using dolomite U-Pb geochronology, to reconstruct seawater U/Pb ratios. Dolomite samples consistently give U-Pb dates and initial 207 Pb/ 206 Pb ratios lower than expected from their stratigraphic ages. These observations are explained by resetting of the U-Pb system long after deposition; the magnitude of deviations from expected initial 207 Pb/ 206 Pb are a function of the redox-sensitive U/Pb ratios during deposition. Reconstructed initial U/Pb ratios increased notably in the late-Paleozoic, reflecting an increase in oxygenation of marine environments at that time. This timeline is consistent with documented shifts in some other redox proxies and supports evolution-driven mechanisms for the oxygenation of late-Paleozoic marine environments, as well as suggestions that early animals thrived in oceans that on long time scales were oxygen-limited compared to today., (© 2024. The Author(s).)

Background and Objectives: Currently approved therapies for spinal muscular atrophy (SMA) reverse the degenerative course, leading to better functional outcome, but they do not address the impairment arising from preexisting neurodegeneration. Apitegromab, an investigational, fully human monoclonal antibody, inhibits activation of myostatin (a negative regulator of skeletal muscle growth), thereby preserving muscle mass. The phase 2 TOPAZ trial assessed the safety and efficacy of apitegromab in individuals with later-onset type 2 and type 3 SMA., Methods: In this study, designed to investigate potential meaningful combinations of eligibility and treatment regimen for future studies, participants aged 2-21 years received IV apitegromab infusions every 4 weeks for 12 months in 1 of 3 cohorts. Cohort 1 stratified ambulatory participants aged 5-21 years into 2 arms (apitegromab 20 mg/kg alone or in combination with nusinersen); cohort 2 evaluated apitegromab 20 mg/kg combined with nusinersen in nonambulatory participants aged 5-21 years; and cohort 3 blindly evaluated 2 randomized apitegromab doses (2 and 20 mg/kg) combined with nusinersen in younger participants ≥2 years of age. The primary efficacy measure was mean change from baseline using the Hammersmith Functional Motor Scale version appropriate for each cohort. Data were analyzed using a paired t test with 2-sided 5% type 1 error for the mean change from baseline for predefined cohort-specific primary efficacy end points., Results: Fifty-eight participants (mean age 9.4 years) were enrolled at 16 trial sites in the United States and Europe. Participants had been treated with nusinersen for a mean of 25.9 months before enrollment in any of the 3 trial cohorts. At month 12, the mean change from baseline in Hammersmith scale score was -0.3 points (95% CI -2.1 to 1.4) in cohort 1 (n = 23), 0.6 points (-1.4 to 2.7) in cohort 2 (n = 15), and in cohort 3 (n = 20), the mean scores were 5.3 (-1.5 to 12.2) and 7.1 (1.8 to 12.5) for the 2-mg/kg (n = 8) and 20-mg/kg (n = 9) arms, respectively. The 5 most frequently reported treatment-emergent adverse events were headache (24.1%), pyrexia (22.4%), upper respiratory tract infection (22.4%), cough (22.4%), and nasopharyngitis (20.7%). No deaths or serious adverse reactions were reported., Discussion: Apitegromab led to improved motor function in participants with later-onset types 2 and 3 SMA. These results support a randomized, placebo-controlled phase 3 trial of apitegromab in participants with SMA., Trial Registration Information: This trial is registered with ClinicalTrials.gov (NCT03921528)., Classification of Evidence: This study provides Class III evidence that apitegromab improves motor function in later-onset types 2 and 3 spinal muscular atrophy.

Compared with traditional letter grading, pass/fail grading is an assessment approach that can alter the educational environment and enhance student wellbeing without compromising education quality. Little is known about the experiences of students during the transition from traditional grading to pass/fail grading. The onset of the COVID-19 pandemic resulted in an abrupt move to modified pass-fail (MPF) grading at North Carolina State University College of Veterinary Medicine (NCSU-CVM), followed by a decision to permanently adopt MPF grading for the entire core pre-clinical doctor of veterinary medicine (DVM) curriculum. This study employed a narrative inquiry of surveys and interviews to facilitate deep understanding of student perspectives during the transition to MPF grading. Focus was placed on understanding what this transition meant for DVM students in terms of life and learning quality. Our analysis identified seven key themes that captured student experiences, which were generally positive, during this transition: education culture, student perceptions of instructor impact, shift from extrinsic to intrinsic valuation of curricular content, competitiveness for external merit-based opportunities, use of letter grading and MPF in a single semester, student recommendations, and wellbeing. Through exploration of these themes and presentation of concerns identified in students' stories, this study provides guidance for other programs considering revision of their own assessment frameworks.

The geologically rapid appearance of fossils of modern animal phyla within Cambrian strata is a defining characteristic of the history of life on Earth. However, temporal calibration of the base of the Cambrian Period remains uncertain within millions of years, which has resulted in mounting challenges to the concept of a discrete Cambrian explosion. We present precise zircon U-Pb dates for the lower Wood Canyon Formation, Nevada. These data demonstrate the base of the Cambrian Period, as defined by both ichnofossil biostratigraphy and carbon isotope chemostratigraphy, was younger than 533 Mya, at least 6 My later than currently recognized. This new geochronology condenses previous age models for the Nemakit-Daldynian (early Cambrian) and, integrated with global records, demonstrates an explosive tempo to the early radiation of modern animal phyla.

The prevalence of distant metastases (DM) in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. A PRISMA systematic review of DM rates in patients with HPV-related OPSCC was performed. PubMed-MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched. The primary outcome was prevalence of DM. Data on demographics, tumor classification, and clinical outcomes were also collected. Meta-analysis of pooled DM rate was determined. Ten articles met inclusion criteria, representing 1860 patients with mean follow-up of 3.6 years. Overall DM rate was 7.0% (95% CI: 5.9-8.2). T3 or T4 classification disease was associated with a 4.88-fold (95% CI: 1.92-12.40) risk of DM compared to T1 or T2 classification disease. This study is the first to systematically review the prevalence of DM among patients with HPV-related OPSCC, where pooled DM rate was found to be 7%., (© 2022 Wiley Periodicals LLC.)

Objective: To analyze how the COVID-19 pandemic has influenced trends in head and neck squamous cell carcinoma (HNSCC) presentation and diagnosis-including referral patterns, stage at presentation, and time to diagnosis-over a longitudinal time course., Setting: Multicenter tertiary care academic institution., Methods: A retrospective review of patients with HNSCC presenting between January 1, 2019 and December 31, 2020 was performed. Patients were stratified into pre-COVID and COVID cohorts based upon presentation date either before or after the COVID pandemic was declared a national emergency. Data was collected on demographics, referral site, symptoms, tumor characteristics, and time to diagnosis., Results: Of 203 patients with HNSCC identified, 77.3% (157/203) were in the pre-COVID cohort and 22.7% (46/203) were in the COVID cohort. Patients in the COVID cohort were more likely to present through inpatient or ER consultation (26% vs. 11%) than outpatient setting. There was a greater than 50% decrease in new tumor board case presentations per month in the COVID cohort (4.8) relative to the pre-COVID (10.9) cohort. Cancer stage at presentation was similar between cohorts. Time from presentation to diagnosis was similar between the cohorts at approximately 30 days., Conclusions: These results suggest that patients presenting during the COVID pandemic may have unique referral patterns. A significant decrease in tumor board presentations was noted, which may contribute to more delayed presentations that have yet to be observed. Further investigation with a larger sample size is warranted., Lay Summary: The COVID-19 pandemic may have changed where and how patients with head and neck cancer initially seek care. We found that patients with newly diagnosed head and neck cancer more often were initially seen in urgent settings than before the pandemic., Level of Evidence: 3., Competing Interests: The author declares there is no potential conflicts of interest., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Higher body mass index (BMI) may have a protective effect on survival in patients with head and neck cancer. The aim of this study was to determine the effect of BMI on overall survival (OS) in veterans with head and neck squamous cell carcinoma (HNSCC)., Methods: A cohort of 702 patients diagnosed with HNSCC between 1995 and 2019 were identified at the Washington DC Veterans Affairs Medical Center, and 342 patients were included for analysis. Records were queried for clinical-demographic data, BMI, and outcomes., Results: HNSCC patients categorized as overweight or obese at time of diagnosis had a lower 3-year risk of death (p = 0.033) and improved OS (p < 0.001) compared to patients who were underweight or normal weight. The majority of locoregional recurrences occurred in patients with low or normal pretreatment BMI., Conclusions: Higher BMI at diagnosis may have a protective effect on OS in veterans with HNSCC., (© 2021 Wiley Periodicals LLC.)

Scores and scales used in pediatric motor development for neuromuscular disorders have evolved greatly since the beginning of their development. In this review we provide a brief history of scales used in pediatric patients with neuromuscular disorders and an update regarding the advancement of the scales commonly used in patients with spinal muscular atrophy and Duchenne muscular dystrophy. We focus on the collaborative effort that has led to the development of outcomes and speak to the possible future of Clinical Outcome Assessments., Competing Interests: Declaration of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Morphologically complex trace fossils, recording the infaunal activities of bilaterian animals, are common in Phanerozoic successions but rare in the Ediacaran fossil record. Here, we describe a trace fossil assemblage from the lower Dunfee Member of the Deep Spring Formation at Mount Dunfee (Nevada, USA), over 500 m below the Ediacaran-Cambrian boundary. Although millimetric in scale and largely not fabric-disruptive, the Dunfee assemblage includes complex and sediment-penetrative trace fossil morphologies that are characteristic of Cambrian deposits. The Dunfee assemblage records one of the oldest documented instances of sediment-penetrative infaunalization, corroborating previous molecular, ichnologic, and paleoecological data suggesting that crown-group bilaterians and bilaterian-style ecologies were present in late Ediacaran shallow marine ecosystems. Moreover, Dunfee trace fossils co-occur with classic upper Ediacaran tubular body fossils in multiple horizons, indicating that Ediacaran infauna and epifauna coexisted and likely formed stable ecosystems., (© 2020 John Wiley & Sons Ltd.)

The fossil record of the terminal Ediacaran Period is typified by the iconic index fossil Cloudina and its relatives. These tube-dwellers are presumed to be primitive metazoans, but resolving their phylogenetic identity has remained a point of contention. The root of the problem is a lack of diagnostic features; that is, phylogenetic interpretations have largely centered on the only available source of information-their external tubes. Here, using tomographic analyses of fossils from the Wood Canyon Formation (Nevada, USA), we report evidence of recognizable soft tissues within their external tubes. Although alternative interpretations are plausible, these internal cylindrical structures may be most appropriately interpreted as digestive tracts, which would be, to date, the earliest-known occurrence of such features in the fossil record. If this interpretation is correct, their nature as one-way through-guts not only provides evidence for establishing these fossils as definitive bilaterians but also has implications for the long-debated phylogenetic position of the broader cloudinomorphs.

Introduction: Glucocorticosteroids (GC) are effective in slowing weakness in boys with Duchenne muscular dystrophy (DMD)., Methods: This is a multisite, 1-year, open-label trial of twice-weekly prednisolone (5 mg/kg/dose) in infants/young boys (0.4-2.4 years) with DMD. We compared changes in Bayley III Scales of Infant Development (Bayley-III) with untreated boys followed for 1 year (historical control cohort [HCC]). Twenty-three of 25 participants completed the study., Results: Treated boys gained an average of 0.5 points on the Bayley-III gross motor scaled score (GMSS) compared with the HCC who, on average, declined 1.3 points (P = 0.03). All boys maintained linear growth, and none developed Cushingoid features. Excessive weight gain occurred in 13 of 23 (56%) boys., Discussion: This study provides evidence that twice-weekly GC is well tolerated in infants and young boys with DMD and improves GMSS. Excessive weight gain is a potential risk. Longer follow-up is required to determine whether early GC initiation is feasible in most infants/boys with DMD. Muscle Nerve 59:650-657, 2019., (© 2019 Wiley Periodicals, Inc.)

Veterinary internships are common 1-year post-graduate clinical training programs that are offered both at veterinary colleges and in private practice settings. To promote the quality of these training programs, the American Association of Veterinary Medical Colleges (AAVMC) charged a working group to develop these internship guidelines, which were approved by the AAVMC in 2018 and have also been endorsed by the American Association of Veterinary Clinicians. These guidelines are intended to be applicable to all internships, in both academic and private practice settings, and they place particular emphasis on three aspects of internship training programs: competency-based education, intern well-being, and program outcome.

Owing to the lack of temporally well-constrained Ediacaran fossil localities containing overlapping biotic assemblages, it has remained uncertain if the latest Ediacaran ( ca 550-541 Ma) assemblages reflect systematic biological turnover or environmental, taphonomic or biogeographic biases. Here, we report new latest Ediacaran fossil discoveries from the lower member of the Wood Canyon Formation in Nye County, Nevada, including the first figured reports of erniettomorphs, Gaojiashania , Conotubus and other problematic fossils. The fossils are spectacularly preserved in three taphonomic windows and occur in greater than 11 stratigraphic horizons, all of which are below the first appearance of Treptichnus pedum and the nadir of a large negative δ 13 C excursion that is a chemostratigraphic marker of the Ediacaran-Cambrian boundary. The co-occurrence of morphologically diverse tubular fossils and erniettomorphs in Nevada provides a biostratigraphic link among latest Ediacaran fossil localities globally. Integrated with a new report of Gaojiashania from Namibia, previous fossil reports and existing age constraints, these finds demonstrate a distinctive late Ediacaran fossil assemblage comprising at least two groups of macroscopic organisms with dissimilar body plans that ecologically and temporally overlapped for at least 6 Myr at the close of the Ediacaran Period. This cosmopolitan biotic assemblage disappeared from the fossil record at the end of the Ediacaran Period, prior to the Cambrian radiation., (© 2017 The Author(s).)

OBJECTIVE To evaluate effects of laparoscopic-assisted incisional gastropexy (LAIG) on gastric motility in dogs by use of a wireless motility device (WMD). ANIMALS 10 healthy client-owned large or giant-breed dogs. PROCEDURES 10 dogs owned by clients interested in prophylactic LAIG were enrolled. To determine effects of LAIG on gastrointestinal motility in dogs during the nonfed state, each dog was evaluated by use of a noninvasive WMD before and > 4 weeks after LAIG. All dogs underwent LAIG, with or without concurrent elective gonadectomy. Data obtained before and after LAIG were analyzed by use of proprietary software to determine the gastric emptying time, small bowel transit time, large bowel transit time, whole bowel transit time, and motility index. RESULTS No changes in variables were detected between measurements obtained before and after prophylactic LAIG. CONCLUSIONS AND CLINICAL RELEVANCE In this study, prophylactic LAIG did not have an effect on gastrointestinal motility. The WMD was tolerated well by all dogs and appeared to be a safe and effective method for evaluating gastrointestinal motility in this population of dogs.

Objective: To prospectively evaluate the efficacy of thin film band attenuation of congenital extrahepatic portosystemic shunts (CEPSS) in dogs using clinical, biochemical, and imaging-related outcome measures., Study Design: Prospective case series., Animals: Dogs with CEPSS (n=20)., Methods: Client-owned dogs with CEPSS were enrolled and thin film banding of the shunting vessel was performed. Before and at least 6 months after surgery, serum bile acids and computed tomography (CT) angiography were performed and owners completed a health questionnaire regarding the dog's clinical signs. Postoperative CT images were assessed for the effectiveness of band closure, change in portal vein/aorta ratio, change in liver volume/weight ratio, and whether the band was placed in the appropriate location. Preoperative and postoperative health questionnaire data and serum bile acids were compared., Results: The band resulted in complete closure of the vessel around which it was placed in 13 dogs. In the remaining 7 dogs, the vessel lumen was narrowed but not completely closed. In 8 dogs the band location was suboptimal, allowing systemic drainage of visceral blood or secondary shunting branches to persist. Liver volume/body weight ratios and portal vein/aorta diameter ratios increased in most dogs. Serum bile acids decreased in all but 1 dog and owners reported improved health in 19 dogs., Conclusion: Thin film banding resulted in complete occlusion of many, but not all vessels around which it was placed. Even in dogs with inappropriate band location or with incomplete closure, clinical improvement can be expected based on our results., (© Copyright 2016 by The American College of Veterinary Surgeons.)

Objective: To describe the versatility of the axial pattern flap based on the cutaneous perforating branch of the angularis oris artery for reconstruction of large facial defects in dogs, including complications and clinical outcomes., Study Design: Retrospective clinical case series., Animals: Client-owned dogs (n = 8)., Methods: Facial flaps (n = 9) based at the commissure of the lip with a caudodorsal orientation were utilized, with established anatomical borders. Flaps were elevated deep to the panniculus carnosus in a caudal to rostral direction, preserving the angularis oris artery, its cutaneous perforator, and surrounding cutaneous vasculature. Flaps were rotated dorsally or ventrally to cover the defect. Primary closure of the donor site was by direct apposition in all cases., Results: Angularis oris axial pattern flaps were most commonly used to close large defects of the nasomaxillary area rostral to the eyes (6 dogs), followed by orbital (2) and intermandibular (1) defects. Defects occurred because of tumor resection (6 dogs), trauma (2), and a chronic, non-healing wounding (1). All flaps healed with acceptable functional and cosmetic outcomes without major complications. Followup ranged from 10 days to 16 months. Minor postoperative complications included flap edema (8 dogs), partial incisional dehiscence (3), distal tip necrosis (2), and oroantral fistula recurrence (1)., Conclusion: Angularis oris axial pattern flaps provided hirsute, full-thickness skin coverage of a variety of large facial defects with minor complications, and should be considered when restructuring large defects of the rostral face or chin., (© Copyright 2015 by The American College of Veterinary Surgeons.)

Objective: To investigate differences in clinical variables among dogs with extrahepatic portosystemic shunts (EHPSSs) of various morphologies., Design: Retrospective case series., Animals: 53 dogs with EHPSSs., Procedures: Medical records of dogs undergoing preoperative CT angiography of an EHPSS over a 3-year period were reviewed. Analysis was performed to investigate relationships of clinical variables with shunt morphology. Morphologies were analyzed individually as well as in several groups., Results: Shunt morphologies included 10 splenocaval, 9 splenophrenic, 11 splenoazygos, 10 right gastric-caval, 12 right gastric-caval with a caudal loop, and 1 right gastric-azygos with a caudal loop. Several biochemical variables associated with EHPSS were lowest in dogs with splenocaval shunts. Preoperative clinical signs were more common in dogs that had shunts with vena caval than right azygos vein insertion (36/41 [88%] vs 7/12 [58%]) and insertion caudal to the liver than diaphragmatic insertion (29/32 [91%] vs 14/21 [67%]). Neurologic signs were more common when shunts inserted into the vena cava caudal to the liver than in other locations (21/32 [66%] vs 6/21 [29%]) and were most frequent with splenocaval shunts. Urinary tract signs were more common when shunts had right gastric vein origin than gastrosplenic vein origin (14/23 [61%] vs 10/30 [33%])., Conclusions and Clinical Relevance: Splenocaval shunts caused more clinical abnormalities than did other shunt morphologies. Results suggested that dogs with shunt insertion in the caudal vena cava, especially caudal to the liver, were most likely to have clinical signs.

The selection of topics for the special issue on peace psychology (October 2013) probably gave readers the impression that peace psychology should be defined as the study of conflict and peace at intergroup, societal, and global levels., ((c) 2014 APA, all rights reserved.)

Gastric dilatation-volvulus (GDV) is a devastating disease that most commonly affects large and giant-breed dogs. Though a number of risk factors have been associated with the development of GDV, the etiology of GDV remains unclear. Abnormal gastric motility patterns and delayed gastric emptying have been previously described in dogs following GDV. Work evaluating the effects of gastropexy procedures and changes to gastric motility after experimental GDV has not found the same changes as those found in dogs with naturally occurring GDV. Although the role of abnormal gastric motility in dogs with GDV will need to be clarified with additional research, such study is likely to be facilitated by improved access to and development of noninvasive measurement techniques for the evaluation of gastric emptying and other motility parameters. In particular, the availability of Food and Drug Administration-approved wireless motility devices for the evaluation of gastrointestinal motility is particularly promising in the study of GDV and other functional gastrointestinal diseases of large and giant-breed dogs., (Published by Elsevier Inc.)

Introduction: Trial design for SMA depends on meaningful rating scales to assess outcomes. In this study Rasch methodology was applied to 9 motor scales in spinal muscular atrophy (SMA)., Methods: Data from all 3 SMA types were provided by research groups for 9 commonly used scales. Rasch methodology assessed the ordering of response option thresholds, tests of fit, spread of item locations, residual correlations, and person separation index., Results: Each scale had good reliability. However, several issues impacting scale validity were identified, including the extent that items defined clinically meaningful constructs and how well each scale measured performance across the SMA spectrum., Conclusions: The sensitivity and potential utility of each SMA scale as outcome measures for trials could be improved by establishing clear definitions of what is measured, reconsidering items that misfit and items whose response categories have reversed thresholds, and adding new items at the extremes of scale ranges., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: To test a multidisciplinary approach to reduce heart failure (HF) readmissions that tailors the intensity of care transition intervention to the risk of the patient using a suite of electronic medical record (EMR)-enabled programmes., Methods: A prospective controlled before and after study of adult inpatients admitted with HF and two concurrent control conditions (acute myocardial infarction (AMI) and pneumonia (PNA)) was performed between 1 December 2008 and 1 December 2010 at a large urban public teaching hospital. An EMR-based software platform stratified all patients admitted with HF on a daily basis by their 30-day readmission risk using a published electronic predictive model. Patients at highest risk received an intensive set of evidence-based interventions designed to reduce readmission using existing resources. The main outcome measure was readmission for any cause and to any hospital within 30 days of discharge., Results: There were 834 HF admissions in the pre-intervention period and 913 in the post-intervention period. The unadjusted readmission rate declined from 26.2% in the pre-intervention period to 21.2% in the post-intervention period (p=0.01), a decline that persisted in adjusted analyses (adjusted OR (AOR)=0.73; 95% CI 0.58 to 0.93, p=0.01). In contrast, there was no significant change in the unadjusted and adjusted readmission rates for PNA and AMI over the same period. There were 45 fewer readmissions with 913 patients enrolled and 228 patients receiving intervention, resulting in a number needed to treat (NNT) ratio of 20., Conclusions: An EMR-enabled strategy that targeted scarce care transition resources to high-risk HF patients significantly reduced the risk-adjusted odds of readmission.

Objective: To describe (1) the radiographic appearance of intact hydraulic urethral sphincters (HUS) and (2) the success of leak detection using clinically feasible methods., Study Design: Prospective, blinded in vitro study., Sample Population: Thirty HUS devices (10 each of 8, 10, and 12 mm diameter sizes)., Materials and Methods: All devices were inflated with saline (0.9% NaCl) solution to complete occlusion, inspected, and weighed over a 24-hour period for manufacturing defects. HUS phantoms were created to mimic surrounding soft tissues. One randomly selected HUS of each size was evaluated radiographically at different inflation volumes and angles. All HUS systems were then evaluated in random order before and after puncture with volumetry, manometry, radiography, and contrast fluoroscopy. Volumetry was the total volume (mL) retrieved from each HUS system. Manometry was the pressure (cm H2 O) within each HUS system. The HUS devices were filled to a known volume before each measurement., Results: When all HUS sizes were considered, volumetry did not reveal significant differences before and after puncture, but manometry was significantly different (P < .001). Radiography was 63.8% sensitive and 88.3% specific for puncture diagnosis, with inter-observer agreement of 0.58. Contrast fluoroscopy was 78.4% sensitive and 100% specific, with inter-observer agreement of 0.97., Conclusions: Of those methods tested, contrast fluoroscopy was the most sensitive, specific, and consistent method of leak detection. Manometry was also helpful, but may be difficult to use clinically. Volumetry and radiography were relatively poor indicators of leakage in this model., (© Copyright 2013 by The American College of Veterinary Surgeons.)

Case Description: An 8-year-old 38-kg (84-lb) castrated male German Shepherd Dog cross was evaluated because of respiratory distress secondary to pneumothorax (detected radio-graphically prior to referral)., Clinical Findings: CT of the thorax confirmed the presence of pneumothorax and revealed pulmonary blebs without evidence of infiltrative pulmonary changes. A tentative diagnosis of primary spontaneous pneumothorax was made., Treatment and Outcome: Exploratory median sternotomy revealed emphysematous changes along the margins of all lung lobes, with the ventral margins of the left cranial, right cranial, and right middle lung lobes most affected. Partial lobectomies of the ventral aspects of these lobes were performed. Histologic examination of tissue samples from the lung lobes revealed diffuse smooth muscle hypertrophy of the terminal and respiratory bronchioles with moderate numbers of peribronchiolar eosinophils. Mucus plugs and mucous cell metaplasia within the airway epithelium were also evident. After surgery, clinical signs resolved and the dog was discharged from the hospital 2 days later. Eight months after surgery, the dog developed a mild cough, and treatment with prednisolone (tapering dosage starting at 0.5 mg/kg [0.023 mg/lb], PO, q 12 h) was initiated. Dosage reduction resulted in recurrence of coughing; however, with continued prednisolone treatment at a dosage of 0.5 mg/kg, PO, once daily, the dog was not coughing at 10 months after surgery., Clinical Relevance: Reactive bronchopneumopathy should be included as a differential diagnosis for spontaneous pneumothorax in dogs.

Background: Guidelines recommend that patients with new-onset systolic heart failure (HF) receive a trial of medical therapy before an implantable cardiac defibrillator (ICD). This strategy allows for improvement of left ventricular ejection fraction (LVEF), thereby avoiding an ICD, but exposes patients to risk of potentially preventable sudden cardiac death during the trial of medical therapy., Methods: We reviewed a consecutive series of patients with HF of <6 months duration with a severely depressed LVEF (<30%) evaluated in a HF clinic (N = 224). The ICD implantation was delayed with plans to reassess LVEF approximately 6 months after optimization of β-blockers. Mortality was ascertained by the National Death Index., Results: Follow-up echocardiograms were performed in 115 of the 224 subjects. Of these, 50 (43%) had mildly depressed or normal LVEF at follow-up ("LVEF recovery") such that an ICD was no longer indicated. In a conservative sensitivity analysis (using the entire study cohort, whether or not a follow-up echocardiogram was obtained, as the denominator), 22% of subjects had LVEF recovery. Mortality at 6, 12, and 18 months in the entire cohort was 2.3%, 4.5%, and 6.8%, respectively. Of 87 patients who tolerated target doses of β-blockers, only 1 (1.1%) died during the first 18 months., Conclusion: Patients with new-onset systolic HF have both a good chance of LVEF recovery and low 6-month mortality. Achievement of target β-blocker dose identifies a very low-risk population. These data support delaying ICD implantation for a trial of medical therapy., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Remnants of the pharyngeal apparatus can (rarely) form cysts. This retrospective case series describes clinical and histologic findings of such lesions. Clinical and histology databases were searched for cases of pharyngeal remnants. Eight patients were diagnosed with cysts located subcutaneously in the head and neck, adjacent to the submandibular salivary gland, near the thyroid, and in the mediastinum. Cyst linings included ciliated epithelium, and surgical excision was curative. Knowledge of pharyngeal development is useful for their characterization. Clinicians should consider pharyngeal remnants as differentials for cystic lesions in small animals.

For more than thirty years, the dog has been used as a model for human diseases. Despite efforts made to develop canine embryonic stem cells, success has been elusive. Here, we report the generation of canine induced pluripotent stem cells (ciPSCs) from canine adult fibroblasts, which we accomplished by introducing human OCT4, SOX2, c-MYC, and KLF4. The ciPSCs expressed critical pluripotency markers and showed evidence of silencing the viral vectors and normal karyotypes. Microsatellite analysis indicated that the ciPSCs showed the same profile as the donor fibroblasts but differed from cells taken from other dogs. Under culture conditions favoring differentiation, the ciPSCs could form cell derivatives from the ectoderm, mesoderm, and endoderm. Further, the ciPSCs required leukemia inhibitory factor and basic fibroblast growth factor to survive, proliferate, and maintain pluripotency. Our results demonstrate an efficient method for deriving canine pluripotent stem cells, providing a powerful platform for the development of new models for regenerative medicine, as well as for the study of the onset, progression, and treatment of human and canine genetic diseases.

Surgical site infections (SSIs) are a significant source of morbidity, mortality, and cost associated with small animal surgery. The most well-established strategies to reduce the impact of SSI are preventive, focusing on bolstering host immunity while decreasing wound contamination during surgery. When SSI is identified, the use of consistent definitions and culture-based therapy help to facilitate surveillance and appropriate management. Debridement and open wound management of infected wounds are important for successful treatment.

Congenital extrahepatic portosystemic shunts are anomalous vessels joining portal and systemic venous circulation. These shunts are often diagnosed sonographically, but computed tomography (CT) angiography produces high-resolution images that give a more comprehensive overview of the abnormal portal anatomy. CT angiography was performed on 25 dogs subsequently proven to have an extrahepatic portosystemic shunt. The anatomy of each shunt and portal tributary vessels was assessed. Three-dimensional images of each shunt type were created to aid understanding of shunt morphology. Maximal diameter of the extrahepatic portosystemic shunt and portal vein cranial and caudal to shunt origin was measured. Six general shunt types were identified: splenocaval, splenoazygos, splenophrenic, right gastric-caval, right gastric-caval with a caudal shunt loop, and right gastric-azygos with a caudal shunt loop. Slight variations of tributary vessels were seen within some shunt classes, but were likely clinically insignificant. Two shunt types had large anastomosing loops whose identification would be important if surgical correction were attempted. A portal vein could not be identified cranial to the shunt origin in two dogs. In conclusion, CT angiography provides an excellent overview of extrahepatic portosystemic shunt anatomy, including small tributary vessels and loops. With minor variations, most canine extrahepatic portosystemic shunts will likely be one of six general morphologies., (© 2011 Veterinary Radiology & Ultrasound.)

Congenital muscular dystrophies are a group of rare neuromuscular disorders with a wide spectrum of clinical phenotypes. Recent advances in understanding the molecular pathogenesis of congenital muscular dystrophy have enabled better diagnosis. However, medical care for patients with congenital muscular dystrophy remains very diverse. Advances in many areas of medical technology have not been adopted in clinical practice. The International Standard of Care Committee for Congenital Muscular Dystrophy was established to identify current care issues, review literature for evidence-based practice, and achieve consensus on care recommendations in 7 areas: diagnosis, neurology, pulmonology, orthopedics/rehabilitation, gastroenterology/ nutrition/speech/oral care, cardiology, and palliative care. To achieve consensus on the care recommendations, 2 separate online surveys were conducted to poll opinions from experts in the field and from congenital muscular dystrophy families. The final consensus was achieved in a 3-day workshop conducted in Brussels, Belgium, in November 2009. This consensus statement describes the care recommendations from this committee., Competing Interests: Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Objective: To identify risk factors associated with ventral luxation (VL) of canine total hip replacement (THR), and outcome., Study Design: Retrospective study., Animals: Dogs (n=602) that had THR (563 cemented, 35 cementless, 4 hybrid)., Methods: Dogs (1999-2004) with VL after THR were compared with dogs with uncomplicated THR. Data included signalment, body weight, diagnosis, implant size, acetabular cup orientation, and femoral displacement ratio (FDR)., Results: VL was diagnosed in 11 (1.8%) dogs after primary THR. Including 2 other dogs that had VL after the study period, 10 (77%) of 13 dogs had VL within 7 days of surgery. Risk factors for VL included Saint Bernard-type dogs (P=.0001), short neck extension (P=.0005), and high angle of lateral opening in other breeds (P=.018). There were trends toward higher risk of VL with lower FDR in Saint Bernard types (P=.060), and with cementless implants (P=.061). Twelve dogs had revision arthroplasty that was successful in all cementless and 2 cemented VL cases. Five dogs had recurrent VL and a poor outcome., Conclusion: VL is generally an early complication of THR, with no single common risk factor identified., Clinical Relevance: Saint Bernard types and short neck extensions are associated with increased risk of VL. Poor cup orientation is a determining factor for VL in some dogs, but a protective orientation of the acetabular cup was not found. Revision is successful in most dogs, but recurrent VL merits a guarded prognosis.

Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized., Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (sumQRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (sumQRS <12 mV) and its prevalence was compared in the two cohorts. The associations of low voltage with 1-year outcomes were assessed in the clinic cohort., Results: In the clinic cohort, the frequency of low voltage was higher in New York Heart Association class 4 versus class 1-3 patients (34% vs 22% respectively, P = .04). The frequency of low voltage in the pretransplant cohort (47%) was twice that of the clinic cohort (24%, P < .001). After 1 year of follow-up in the clinic cohort, low ECG voltage was associated with a higher rate of death (14% vs 5%, P = .008) and the composite end point of death or HF hospitalization (35% vs 20%, P = .004). These associations persisted in multivariable analyses adjusting for important confounders., Conclusions: Low ECG voltage is a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year.

Background: Sodium restriction is important in the management of heart failure (HF). Although many low-sodium educational resources are available, few are directed specifically at urban African Americans., Methods and Results: A registered dietitian prospectively interviewed 50 African-American and 25 white patients in an urban public hospital (derivation cohort) in Dallas, TX, using a food-frequency instrument that listed 146 food choices. Foods >300 mg sodium/serving consumed at least weekly by 50% of an ethnic group were classified as being a high-sodium core food for that group. Classification of foods (core or not core) was validated in a second African-American cohort (n = 144). Five high-sodium food choices were classified as core food in both the derivation and validation African-American cohorts (salt in cooking, canned vegetables, cheese, processed meats, and cold cereal) and another 3 when the derivation and validation cohorts were combined (fast food, fried chicken, and corn bread). Four of these 8 foods were not classified as core foods in whites., Conclusion: Eight high-sodium foods were frequently consumed by southern, urban African Americans with heart failure. Several of these foods were not commonly consumed by whites, emphasizing the need to be sensitive to ethnic differences in dietary habits when educating patients about sodium intake.

Background: Despite their known benefits, beta-blockers (BBL) are not yet widely prescribed for heart failure, especially in the primary care setting. We wanted to identify patient characteristics that could guide primary care physicians in deciding whether they or a cardiologist should initiate BBL. A second objective was to determine the tolerability of BBL in clinical practice., Methods: A retrospective chart review was conducted on a consecutive series of 551 patients with systolic dysfunction referred to a heart failure clinic in an urban public hospital. Patient responses to BBL were stratified into three categories: favorable (improvement of left ventricular ejection fraction by serial echocardiography), unfavorable (development of decompensated heart failure), or neither. Tolerability of BBL was assessed by the need to permanently discontinue BBL., Results: Of 551 patients, 363 (66%) tolerated BBL. Among patients who had BBL initiated in the clinic, 48 had a favorable response, 34 had an unfavorable response, and 57 had neither a favorable or unfavorable response, as defined. A lower systolic blood pressure and higher diuretic dose were associated with development of decompensated heart failure as compared to improvement of ejection fraction., Conclusions: A majority of patients with heart failure in an urban public hospital can tolerate BBL. Easily measurable characteristics such as lower systolic blood pressure and higher diuretic dose may assist primary care physicians in triaging patients for referral to cardiologists for beta-blocker initiation.

African-American patients with heart failure treated at urban public hospitals are at high risk for adverse outcomes likely due to complex socioeconomic factors. While establishing a heart failure disease management program at Parkland Memorial Hospital in Dallas, TX, the authors completed two studies that address the high rates of heart failure hospitalizations seen in this population. The first study found high rates of adverse outcomes following emergency department discharge for heart failure. The second identified important deficiencies in dietary sodium knowledge. Both 90-day outcomes (return emergency department visit or heart failure hospitalization) following an index emergency department discharge and dietary sodium knowledge represent new potential measures of quality of care of heart failure. Studies of this high-risk population of heart failure patients may offer insights that lead to improved outcomes both in the urban setting and elsewhere.

Background: The concept of family quality of life (QoL) has emerged as an important outcome of service delivery for individuals with disabilities and their families. The present study describes the process of developing a tool to measure family QoL., Methods and Results: A total of 1197 respondents participated in a national field test. Through factor analysis, the survey was refined in several ways: (1) the preliminary 10-domain structure was reduced to a five-domain structure; (2) a total of 41 items were selected for the revised survey; and (3) wordings were clarified., Conclusions: The implications for future research and practice are discussed.

Impaired dichotic listening has been documented in numerous etiologies, but there is limited information on patients who present with anterior communicating artery (ACoA) aneurysm. The sequelae following ACoA aneurysm is frequently associated with neurobehavioral impairments, such as confabulation, memory, and behavior, as a result of the areas of innervation (DeLuca, 1992; DeLuca & Diamond, 1995). Clinical experience, however, shows ACoA aneurysm to also be associated with impairments in dichotic listening. Participants in this study were divided into 2 groups: patients who presented with ACoA aneurysm with age-matched controls, and patients who presented moderate to severe traumatic brain injury (TBI) with age-matched controls. TBI patients were included for test-validity purposes and to allow a comparison between diffuse and focal cerebral damage. Dichotic listening results revealed a similar pattern for patients with ACoA aneurysm and those with brain injury. The findings suggest that central auditory pathways are susceptible to damage following ACoA aneurysm.