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Introduction Ensuring proficiency in responding to, evaluating, and treating chemical, biological, radiological, and nuclear (CBRN) casualties is a critical component of military medical student education. To meet this objective, we developed a case-based CBRN curriculum that can serve as a model to address potential curricular gaps for civilian prehospital, UME, and GME programs. Methods The curriculum was administered in two sessions, 1 month apart, each with individual student preparation, including an optional asynchronous online module and a review of clinical practice guidelines. Session one consisted of a 2-hour introductory lecture, followed by a student reflection. Session two consisted of a 1-hour small-group case study, designed as a multimodal exercise with a corresponding computer-based worksheet and knowledge check. Results Forty-five teams consisting of three to four second-year medical students (N = 170) completed the sessions and course survey. Sixty-four percent of student teams were extremely or quite satisfied with what they learned, 62% found the materials very or quite relevant to their needs, and 69% rated the instructional materials as extremely or quite understandable. Student feedback included designating additional time for worksheet completion. Discussion A case-based training on CBRN patient care earned positive ratings for the clarity of instruction, the impact on students as learners, and the feasibility of the training. Future training evolutions could track student completion of prework, extend the allotted time for activity completion, and evaluate curricular effectiveness through pre-post measurement of students’ confidence in their ability to care for a CBRN patient.

Abstract Rodent models and human clinical studies have shown gut microbiota-derived short-chain fatty acids (SCFAs) play roles in obesity and insulin resistance. These roles have been minimally explored in cats, where in the USA an estimated 60% of cats are overweight or obese. Overweight/obese research cats (n = 7) were transitioned from a maintenance diet to a reduced calorie diet fed ad libitum for 7 days, then calories were restricted to achieve 1–2% weight loss per week for an additional 77 days. Cats then received their original maintenance diet again for 14 days. Significant intentional weight loss was noted after calorie restriction (adjusted p

Abstract Background Urine is routinely evaluated in dogs to assess health. Reference ranges for many urine properties are well established, but the scope of variation in these properties over time within healthy dogs is not well characterized. Objectives Longitudinally characterize urine properties in healthy dogs over 3 months. Animals Fourteen healthy client‐owned dogs. Methods In this prospective study, dogs were evaluated for health; then, mid‐stream free‐catch urine was collected from each dog at 12 timepoints over 3 months. Urine pH, urine specific gravity (USG), protein, cultures, and antimicrobial resistance profiles were assessed at each timepoint. Results Urine pH varied within and between dogs over time (Friedman's test: within P = .03; between P 105 CFU/mL) should not be considered the only indicator of urinary tract infection. Bacterial isolates from dogs in this study had widespread resistance to amoxicillin/oxacillin underscoring the need for antimicrobial stewardship.

This article is aimed at understanding of the complex design of metalorganic chemical vapour deposition ‐grown InGaN‐based red light‐emitting diode (LED) structure. The contribution of different elements of red LED structure to the stress distribution and threading dislocation density (TDD) evolution is theoretically investigated. For this purpose a self‐consistent modeling of the structure growth process is used, taking into account stress‐modulated indium incorporation, mismatch stress relaxation by threading dislocations and V‐pits, and nucleation of new threading dislocations. The simulation results, consisting of composition, stress, and TDD profiles, are then utilized for modeling of device operation, which allows to analyze contribution of different elements to the heterostructure operation. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare a commercially available accelerometer, FitBark 2 (FitBark 2nd Generation; FitBark) with a previously validated accelerometer, Actical (Actical; Respironics Inc) during periods of activity and rest. We hypothesized that the FitBark 2 would correlate strongly with the Actical during periods of activity and rest. METHODS 20 dogs between the ages of 1 and 9 years of variable sex, breed, and body weight were enrolled from April through August 2022 in a 1-week pilot trial. Dogs were fitted with a neck collar with both devices mounted on it and wore it continuously for 1 week. Six time points were established to evaluate varying degrees of activity and periods of rest, which included the week, a 1-mile walk, the day of the walk, the hour the walk occurred in, 6 AM to 7 AM on the morning of the walk, and 11 PM to 12 AM on the evening of the walk. Actical and FitBark 2 were compared using linear regression and correlation analysis. RESULTS Correlation analysis revealed a very strong correlation between the Actical and FitBark 2 during the entire week of the study, with a moderate correlation at other time points. Linear regression revealed the strength of the relationship by the r² = 0.85, F1,13 = 76.08. CONCLUSIONS FitBark 2 can be used to evaluate the activity and rest of dogs with varying degrees of correlation when compared to the Actical. CLINICAL RELEVANCE The time period assessed impacts the correlation of the FitBark 2 and Actical. This should be considered when using the FitBark 2 for data collection. [ABSTRACT FROM AUTHOR]

A 13-year-old spayed female Cairn terrier was referred for surgical resection of a large oesophageal mass. The dog was initially presented to the primary care veterinarian for several days of gagging. The mass was initially diagnosed on thoracic radiographs and confirmed via computed tomography and oesophagoscopy. Endoscopic biopsies were performed that were consistent with oesophagitis. The dog was then referred to The Ohio State University Veterinary Medical Center for surgical resection of the mass. On surgical approach, a small nodule was palpable in the oesophagus; however, a large mass was not found. Oesophagoscopy was repeated intraoperatively, which revealed a small nodule in the same region of the previously described mass. The small nodule was removed, and histopathology was consistent with lymphohistiocytic inflammation and previous haemorrhage, consistent with an oesophageal haematoma. The dogmade a full recovery post-operatively, with continued resolution of clinical signs reported 5months after surgery. [ABSTRACT FROM AUTHOR]

Fecal diagnostics are a mainstay of feline medicine, and fecal identification markers help to distinguish individuals in a multi-cat environment. However, the impact of identification markers on the fecal microbiota are unknown. Given the increased interest in using microbiota endpoints to inform diagnosis and treatment, the objective of this study was to examine the effects of orally supplemented glitter and crayon shavings on the feline fecal microbiota (amplicon sequencing of 16S rRNA gene V4 region). Fecal samples were collected daily from six adult cats that were randomized to receive oral supplementation with either glitter or crayon for two weeks, with a two-week washout before receiving the second marker. No adverse effects in response to marker supplementation were seen for any cat, and both markers were readily identifiable in the feces. Microbiota analysis revealed idiosyncratic responses to fecal markers, where changes in community structure in response to glitter or crayon could not be readily discerned. Given these findings, it is not recommended to administered glitter or crayon shavings as a fecal marker when microbiome endpoints are used, however their clinical use with other diagnostics should still be considered.

Introduction: Emergency Medicine (EM) is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME) during residency. Training and practicing key elements of DME using standardized patients (SP) may enhance preparedness among EM residents in performing this crucial skill in a clinical setting.Methods: This training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training.  Results: After the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high.  Conclusion: Experiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted to other clinical learning environments through creation of specialty-specific scenarios.

Perforated ulcers are a rare cause of abdominal pain, and may not be considered when pain is localized to the right lower quadrant (RLQ). This case highlights an unusual presentation of a perforated duodenal ulcer that presented with RLQ pain, which has been described as Valentino’s Syndrome. Valentino’s Syndrome occurs when gastric or duodenal fluids collect in the right paracolic gutter causing focal peritonitis and RLQ pain. This case highlights that perforated ulcers, while an uncommon cause of RLQ pain, must remain on the differential of any patient that has an abdominal examination consistent with peritonitis.

Wernicke’s encephalopathy (WE) is traditionally seen in the emergency department in patients with chronicalcohol abuse. WE can result in significant morbidity and mortality if untreated, making early diagnosis andintervention paramount. We discuss a case of WE in a 63-year-old female with no history of chronic alcoholabuse, who presented with bilateral opthalmoplegia that resolved after intravenous thiamine administration.This case report highlights the varied clinical settings other than chronic alcohol abuse in which thediagnosis of WE should be considered.

Abstract Background The effects of epidural anesthesia in dogs undergoing cystoscopy are unknown. Objective To investigate the effect of epidural analgesia on postcystoscopy pain in dogs. Animals Twenty‐six dogs undergoing routine cystoscopy for lower urinary tract disease. Methods Prospective, randomized, blinded observational study. Dogs were assigned either to a treatment group that received epidural anesthesia (preservative free morphine sulfate, 0.09 mg/kg; 1% ropivacaine, 0.2 mg/kg; total volume delivered, 1 mL/4.5 kg of body weight to a maximum of 10 mL; n = 9) or to a nonepidural control group (n = 13). Vital signs were monitored for 24 hours, and sedation and pain scores, behavioral assessments, and presence or absence of complications was evaluated for 5 days postprocedure. Results All dogs tolerated the epidural without complications. Four dogs were removed from the study because of status unblinding, lack of patient cooperation, or incomplete follow‐up. No significant differences were noted in postprocedural pain scores in dogs that received epidural analgesia. Significant differences in postprocedural pain scores were noted in the nonepidural control group. No significant differences were noted in vital signs, behavioral assessments, or the proportion of dogs with a 50% increase in pain scores between the epidural and nonepidural groups. Conclusions and Clinical Importance Epidural anesthesia was well‐tolerated. Dogs not receiving the epidural had poor postprocedural pain control. A consistent benefit for the epidural vs nonepidural group could not be identified. Additional studies are required to better assess the impact and efficacy of epidural anesthesia for cystoscopic procedures.

Abstract Gastrointestinal (GI) toxicosis is a common side effect of cytotoxic chemotherapy treatment in humans and dogs. Measurement of cytokeratin 18 (CK18), an intracellular structural protein released during epithelial apoptosis, and Alpha1‐Antitrypsin (A1AT) in faeces provides a mechanism for evaluating damage to the intestinal mucosa secondary to cytotoxic chemotherapy. Our goal was to evaluate the clinical utility of plasma CK18 and faecal A1‐AT levels as non‐invasive biomarkers of cytotoxic chemotherapy induced GI toxicity. We conducted a prospective cohort study in dogs (N = 10) with osteosarcoma undergoing amputation followed by carboplatin chemotherapy. We hypothesized that plasma CK18 and faecal A1‐AT levels would increase following carboplatin administration due to drug‐induced GI epithelial damage/apoptosis, and that plasma CK18 and faecal A1‐AT levels would correlate with severity of GI toxicity. Mean baseline plasma CK18 concentration was variable amongst patients; however, CK18 concentration prior to carboplatin chemotherapy treatment was not significantly different from CK18 levels after treatment. There was significant intra and inter‐patient variability in mean faecal A1‐AT levels at baseline. Mean A1‐AT concentration did not change significantly from day 0 to day 21. Gastrointestinal toxicity was minimal; therefore, we were unable to determine the association of plasma CK18 and faecal A1‐AT concentrations with development of GI toxicosis. In this study population, plasma CK18 and faecal A1‐AT concentration were not clinically useful biomarkers for the detection of GI toxicosis secondary to carboplatin administration. Further prospective evaluation of CK18 and A1‐AT as biomarkers of drug‐induced GI toxicity is warranted in a larger cohort of dogs receiving cytotoxic chemotherapy. AVMA clinical trial registration number: AAHSD004827.

Objectives: Urine specific gravity (USG) is the most common method for the estimation of urine concentration in cats. Utilization of USG as a screening tool is easily accessible and is of low cost to the client if strategically utilized in settings of higher diagnostic value. There is currently minimal population information regarding how USG changes across ages in cats. Methods: Data were collected from electronic pet medical records from more than 1000 hospitals and screened for cats with an apparently healthy clinical status and complete diagnostic information. USG was compared with age in multiple analyses to examine the relationship between the variables. Results: In the absence of other indicators of disease, renal concentrating ability begins to diminish, on average, starting at approximately 9 years of age. By age group, cats aged 11–15 years (1.044, 95% confidence interval [CI] 1.043–1.044) had statistically significantly lower mean USGs compared with cats aged less than 1 year (1.049, 95% CI 1.048–1.051; P <0.001), 1–6 years (1.049, 95% CI 1.049–1.050; P <0.001) or 7–10 years (1.049, 95% CI 1.048–1.049; P <0.001). Cats aged ⩾15 years (1.038, 95% CI 1.036–1.040) had statistically significantly lower mean USGs compared with cats aged less than 1 year (P <0.001), 1–6 years (P <0.001), 7–10 years (P <0.001) or 11–15 years (P <0.001). Conclusions and relevance: Renal concentrating ability begins to diminish, on average, starting at approximately 9 years of age and is progressive as cat age increases. This study provides important and new information to help improve screening practices for disorders of concentrating ability in cats. [ABSTRACT FROM AUTHOR]

Gelatin capsules deliver their contents to the stomach, while delayed‐release (DR) capsules are designed to allow delivery to the small intestine. This study evaluated the gastrointestinal release site of DR capsules in six healthy adult dogs compared to gelatin capsules. Both gelatin and DR capsules were filled with barium‐impregnated polyethylene spheres (BIPS™), and following enteral administration, release site was assessed using abdominal radiographs at baseline, immediately after ingestion, 15 min post‐ingestion, 30 min post‐ingestion, and then every 30 min thereafter. The evaluated phases included fasted conditions (phase 1, n = 6), increased meal size (phase 2, n = 2), double encapsulation (phase 3, n = 2), and altered capsule size (phase 4, n = 1). The released site was the stomach in all phases for both capsule types. In phase 1, DR capsules had a significantly prolonged time (median 60 min, range 60–90) to release BIPS™ compared to gelatin capsules (15 min, range 15–30; p =.03). In phase 2 (full meal size), 3 (double encapsulation), and 4 (smaller capsule size) pilot studies, release time was prolonged but still occurred in the stomach. This is similar to the release site for gelatin capsules but differs from the release site for DR capsules in people. This has implications for pharmacologic outcomes for products that are affected by gastric physiology (e.g. fecal microbiota transplantation). Based on this pilot data, clinicians and researchers should not assume DR capsules will allow for intestinal delivery of contents in dogs. Future studies should be conducted on larger and varied populations of dogs. [ABSTRACT FROM AUTHOR]

Abstract Background Transanal colonoscopy using the single-incision laparoscopic surgical port is routinely used in human patients but has not been described in veterinary literature. The purpose of this study was to describe a novel access technique elucidating its endoscopic clinical potential and benefits. Additionally, its challenges, limitations, and clinical usability will be discussed and critiqued. The aim of this study was to describe the feasibility of the single-incision laparoscopic surgical port (SILS) as a transanal access technique in canine cadavers and compare its technical capabilities and economic value when compared to the traditional approaches of digital pressure and purse string. Results The overall time to reach an intraluminal pressure of 10 mmHg was faster for digital pressure versus purse string (p = 0.05) and faster for single-incision laparoscopic surgical port versus purse string (p

Spontaneous pneumothorax (SPT) is a documented emergency of the respiratory tract condition classified as either primary or secondary based on the presence of underlying pulmonary conditions. All reported SPT in the feline literature are evaluated for respiratory clinical signs. Primary SPT without underlying pathology or without clinical signs is not reported in cats. This case report describes a 10-year-old domestic longhair cat that was referred for evaluation of chronic lethargy with severe azotemia and placement of a subcutaneous ureteral bypass (SUB) system. Prior to presentation, the cat was diagnosed with renal insufficiency and treated medically with no resolution. Clinical examination under sedation revealed right-sided renomegaly. Thoracic radiographs revealed gas in the caudodorsal pleural space and concurrent pulmonary atelectasis. No respiratory clinical signs were present. Thoracic CT showed two pulmonary bullae, one located in the right caudal lung lobe and one in the cranial segment of the left cranial lung lobe. Abdominal ultrasound showed a right-sided ureteral obstruction. Medical management was elected for the spontaneous pneumothorax. A SUB was placed to address the ureteral obstruction; no complications were noted during recovery. The cat was free of clinical signs of respiratory disease after a follow-up time of nine months. This is the first reported case of a cat diagnosed with a nonclinical suspected primary spontaneous pneumothorax with no concurrent predisposing pulmonary pathology.

Chronic inflammatory enteropathy (CE) is a common cause of persistent gastrointestinal signs and intestinal inflammation in dogs. Since evidence links dysbiosis to mucosal inflammation, probiotics, prebiotics, or their combination (synbiotics) may reduce intestinal inflammation and ameliorate dysbiosis in affected dogs. This study’s aim was to investigate the effects of the synbiotic-IgY supplement on clinical signs, inflammatory indices, and mucosal microbiota in dogs with CE. Dogs with CE were enrolled in a randomized prospective trial. Twenty-four client-owned dogs were fed a hydrolyzed diet and administered supplement or placebo (diet) for 6 weeks. Dogs were evaluated at diagnosis and 2- and 6-week post-treatment. Outcome measures included clinical activity, endoscopic and histologic scores, inflammatory markers (fecal calprotectin, C-reactive protein), and composition of the mucosal microbiota via FISH. Eleven supplement- and nine placebo-treated dogs completed the trial. After 6 weeks of therapy, clinical activity and endoscopic scores decreased in both groups. Compared to placebo-treated dogs, dogs administered supplement showed decreased calprotectin at 2-week post-treatment, decreased CRP at 2- and 6-week post-treatment increased mucosal Clostridia and Bacteroides and decreased Enterobacteriaceae in colonic biopsies at trial completion. Results suggest a beneficial effect of diet and supplements on host responses and mucosal microbiota in dogs with CE.

OBJECTIVE Assess the accuracy of predicted daily energy requirement (pDER) reported by a triaxial accelerometer and activity monitor for dogs (FitBark 2; FitBark Inc) and determine whether the activity monitor accurately estimates the observed daily energy requirement (oDER). We hypothesized that the activity monitor would accurately estimate oDER in dogs and meet standards established for human devices. ANIMALS 23 dogs between the ages of 1 and 10 years and variable sex, breed, and body weight were enrolled from May 5, 2021, through July 23, 2021. METHODS Dogs were weighed before and after the study period to ensure stable body weights. Owners recorded their dogs' daily caloric intake for the entire 28-day study period while the device monitored physical activity and calculated pDER. oDER was defined as the reported caloric intake required to maintain a stable body weight over a 28-day period. pDER and oDER were compared using Bland-Altman graphs, Passing-Bablock analysis, and Lin's Concordance correlation analysis. P ≤ .05 was considered significant. RESULTS 23 apparently healthy dogs completed the study. There was no significant difference between starting body weights and ending body weights (P= .5). The activity monitor overpredicted 28-day pDER compared to 28-day oDER in the majority (18/23, 78.3%) of dogs. Based on Bland-Altman analysis, Passing-Bablok regression, and Lin's concordance correlation analysis, there was poor agreement between the pDER and oDER. CLINICAL RELEVANCE The activity monitors consistently reported inaccurate pDER compared to oDER. Its usability for estimating pDER is of limited clinical and research utility based on the results of this study. [ABSTRACT FROM AUTHOR]

Abstract Background Urine specific gravity (USG) is an integral part of the urinalysis and a key component of many clinical decisions, and fluctuations in USG have the potential to impact case management. Objectives To determine the intraindividual variability of first morning USG results in healthy dogs. Animals One hundred three healthy client‐owned dogs. Methods Dogs were deemed healthy based on clinical history and physical examination findings. Repeated USG measurements were performed over the course of 2 weeks. Three urine samples were collected each week for a total of 6 samples per dog. Sample collection was distributed evenly throughout the week. Urine samples were acquired immediately upon waking and before any ingestion of liquids, food, or exertion of physical activity in the dogs. All measurements were made using the same Misco digital refractometer. Results Intraindividual USG was variable over the course of the study. The mean difference between the minimum and maximum USG for each dog was 0.015 (SD, 0.007). The within‐week difference between the minimum and maximum USG was less than over the complete 2‐week study (0.009 [SD 0.006] for week 1 and 0.010 [SD 0.007] for week 2). The mean coefficient of variance across all 6 time points was 15.4% (SD 8.97%). Conclusions and Clinical Importance Clinically important variation occurs in USG in healthy animals and might impact clinical decision‐making when diagnostic cutoff points are utilized. Clinicians should be aware of inherent variability in this clinical variable when analyzing results.