How do veterinarians mitigate liability concerns with workforce shortages?

The challenge of meeting pet healthcare demands with inadequate staff resources creates legal and ethical considerations for the veterinary profession. Inadequate staffing can result in access to care issues that impact companion animal health, public health, and the human animal bond. An overburdened work environment may also result in liability issues related to standard of care, client dissatisfaction, and subsequent complaints. The following recommendations may ameliorate the legal and ethical impacts to include: a focus on how to optimize current resources (human and technology); improve client communications and medical record-keeping strategies; promote preventive care; develop and memorialize clinical standard operating procedures; and prioritize staff well-being to prevent burn out. These recommendations should be considered good practices when functioning under optimal conditions but are even more valuable to implement effectively in an overburdened companion animal medicine environment.

Individual cells generate their own self-reinforcing contact guidance cues through local matrix fiber remodeling.

Directed cell migration arises from cells following a microenvironmental gradient (e.g. of a chemokine) or polarizing feature (e.g. a linear structure). However cells not only follow, but in many cases, also generate directionality cues by modifying their microenvironment. This bi-directional relationship is seen in the alignment of extracellular matrix (ECM) fibers ahead of invading cell masses. The forces generated by many migrating cells cause fiber alignment, which in turn promotes further migration in the direction of fiber alignment via contact guidance and durotaxis. While this positive-feedback relationship has been widely described for cells invading en masse, single cells are also able to align ECM fibers, as well as respond to contact guidance and durotaxis cues, and should therefore exhibit the same relationship. In this study, we directly tested this hypothesis by studying the migration persistence of individual HT-1080 fibrosarcoma cells migrating in photocrosslinked collagen matrices with limited remodeling potential. Our results demonstrate that this positive-feedback relationship is indeed a fundamental aspect of cell migration in fibrillar environments. We observed that the cells' inability to align and condense fibers resulted in a decrease in persistence relative to cells in native collagen matrices and even relative to isotropic (glass) substrates. Further experiments involving 2D collagen and electrospun polymer scaffolds suggest that substrates composed of rigid, randomly oriented fibers reduce cells' ability to follow another directionality cue by forcing them to meander to follow the available adhesive area (i.e. fibers). Finally, our results demonstrate that the bi-directional relationship between cell remodeling and migration is not a "dimensionality" effect, but a fundamental effect of fibrous substrate structure.

InterRAI Child and Youth Mental Health-Screener (ChYMH-S): A Psychometric Evaluation and Validation Study.

Mental health concerns among children are pervasive, with one in five in North America experiencing a mental health issue. Unfortunately, only about a quarter will receive the support they need. interRAI is an organization of expert researchers and clinicians who develop integrated assessment systems to improve evaluation for vulnerable populations. The interRAI Child and Youth Mental Health Screener (ChYMH-S) is a brief screener that provides an initial assessment for early identification, triaging, and prioritization of services. This study assesses the psychometric properties of the ChYMH-S. Data from children aged 4-18 years across Ontario mental health agencies were obtained. The screener demonstrated strong inter-item reliability on all measured scales and good convergent validity with the Behaviour Assessment System for Children, with all hypothesized comparisons demonstrating positive, significant correlations. Overall, results provide initial support for the reliability and convergent validity of the ChYMH-S in detecting mental health concerns in child populations.

Two replications of an investigation on empathy and utilitarian judgement across socioeconomic status.

Research by Côté, Piff, and Willer (2013) found that through the induction of empathy in an experimental condition, the association between socioeconomic status (SES) and utilitarian moral judgment was diminished. Participant self-reported income interacted with experimental condition such that high SES participants who empathized with a disadvantaged group member redistributed fewer experimental dollars during an online task at the losing member's expense. This suggests that lower levels of empathy could help explain utilitarian decision-making in high SES individuals. Two pre-registered, high-powered replications were conducted in order to assess the magnitude and reliability of this finding. While the first replication attempt failed to uncover the effect, the second attempt found a pattern consistent with the original study. A meta-analysis of the replication attempts with the original author's interaction effects was conducted. The confidence interval of the meta-analytic effect suggests that the true effect size may be as robust as reported by the original authors, or may be close to zero. Implications of the results found in the replication attempts are discussed.

Legal implications of zoonotic disease transmission for veterinary practices.

Increased recognition of veterinarians' capabilities and their role in public health raises concerns as to their legal duty to both clients and the public. With the numerous potential situations and variety of clients, the veterinarians' role in public health issues associated with zoonotic agents seems vague. However, analysis of the legal duty provides a more precise road map to the responsibilities and actions needed in companion animal medicine. The authors discuss mitigation measures to apply to potential situations regarding the ethical and legal requirements of zoonotic diseases and the legal repercussions of failing to act.

Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response.

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations.