Enteroviral testing and length of hospital stay for children evaluated for lyme meningitis.

BACKGROUND: In Lyme disease-endemic areas, many children with aseptic meningitis are hospitalized while awaiting Lyme serology results. Although Lyme serology takes several days, an enteroviral polymerase chain reaction (EV PCR) test takes only a few hours to return results. OBJECTIVE: Our aim was to measure the impact of EV PCR testing on duration of stay for children evaluated for Lyme meningitis. METHODS: A retrospective cohort study was performed with children evaluated for Lyme meningitis at 3 Emergency Departments located in Lyme disease-endemic areas. We defined Lyme meningitis using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans rash). The duration of stay was compared by EV PCR test result (positive, negative, and not obtained). RESULTS: There were 423 study patients identified, 117 (28%) of whom had Lyme meningitis and 209 (49%) had an EV PCR test performed. Median length of stay varied by the EV PCR test status: children with a positive EV PCR test (n = 103; 28 h; interquartile range 17-48 h), those with a negative EV PCR test (n = 106; 72 h; interquartile range 48-120 h), and those who did not have an EV PCR test obtained (n = 214; 48 h; interquartile range 24-96 h; p ≤ 0.001). CONCLUSIONS: Rapid EV PCR testing could assist clinical decision making by Emergency Physicians, avoiding potentially unnecessary hospitalization and parenteral antibiotics for children at low risk of Lyme meningitis.

Aqueous-based spinning of fibers from self-assembling structural proteins.

There has been long-standing interest in generating fibers from structural proteins and a great deal of work has been done in attempting to mimic dragline spider silk. Dragline silk balances stiffness, strength, extensibility, and high energy to break. Mimicking these properties through aqueous-based spinning of recombinant silk protein is a significant challenge; however, an approach has been developed that facilitates the formation of fibers approaching the mechanical properties seen with natural dragline silk. Due to the multitude of solution, spinning and post-spinning variables one has to consider, the method entails a multivariate approach to protein solution processing and fiber spinning. Optimization to maximize mechanical integrity of the fibers is performed by correlating the solution and spinning variables to mechanical properties and using this information for subsequent fiber spinning studies. Here, the method is described in detail and emphasizes the lessons learned during the iterative variable analysis process, which can be used as a basis for aqueous-based fiber spinning of other structural proteins.

Treatment complications in children with lyme meningitis.

BACKGROUND: The rate and type of treatment complications in children treated for Lyme meningitis have not been described. METHODS: We performed a retrospective cohort study of children with Lyme meningitis who presented to 1 of 3 emergency departments located in Lyme disease endemic areas between 1997 and 2010. We defined a case of Lyme meningitis as a child with cerebrospinal fluid pleocytosis and either positive Lyme serology or an erythema migrans rash. We identified prescribed treatment and reasons for all return visits. Our primary outcome was the presence of any treatment complication within 30 days of diagnosis. RESULTS: We identified 157 patients with Lyme meningitis with a median age of 10 years (interquartile range: 7-13 years). Of the 149 children with Lyme meningitis and available follow-up records, 39 (26%) had 1 or more complications, and 21 (14%) required a change in prescribed antibiotic therapy. The median time for developing the first complication was 11 days (interquartile range: 9-14 days). Ten percent of the patients had an adverse drug reaction. Of the 144 children who had a peripherally inserted central catheter placed, 25 (17%) had at least 1 peripherally inserted central catheter-associated complication: 14 (10%) had a mechanical problem, 11 (8%) had an infectious complication and 1 (1%) had a venous thromboembolism. CONCLUSIONS: As current Lyme meningitis treatment regimens have substantial associated morbidity, future research should investigate the efficacy of alternate regimens.

Electrocardiograph Abnormalities in Children With Lyme Meningitis.

OBJECTIVE: The objective of the study was to estimate the prevalence of and identify risk factors for electrocardiographic (ECG) changes in children presenting with Lyme meningitis. DESIGN: This was a cross-sectional study. SETTING: The study was set in three large urban pediatric tertiary care centers. PARTICIPANTS: Children who were diagnosed with Lyme meningitis and underwent ECG testing were included. OUTCOME MEASURE: The presence of an ECG abnormality associated with early-disseminated Lyme infection was the outcome measure. RESULTS: Multivariable logistic regression was used to identify factors independently associated with ECG abnormalities. ECG testing was performed in 103 (66%) of 157 children with Lyme meningitis. The median age of these children was 10.8 years; 68% were male. ECG abnormalities, identified in 34 (33%) subjects, included one or more of the following: atrioventricular block (n = 16; 16%), ST-T wave changes (n = 14; 14%), and prolongation of the corrected QT interval (n = 11; 11%). In multivariate analysis, age ≥13 years and fever for ≥5 days were independently associated with ECG abnormalities. The probability of ECG abnormalities was greater than 50% in those with fever for ≥5 days or age ≥13 years, and if a subject fulfilled both criteria, the probability of ECG abnormalities was 83% (95% confidence interval: 50%-96%). CONCLUSIONS: Electrocardiographic abnormalities occur commonly in children with Lyme meningitis. While older children with prolonged fever were most likely to have such abnormalities, the clinical consequences of asymptomatic ECG abnormalities in children with Lyme meningitis are not known.

Validation of a clinical prediction rule to distinguish Lyme meningitis from aseptic meningitis.

OBJECTIVES: The "Rule of 7's," a Lyme meningitis clinical prediction rule, classifies children at low risk for Lyme meningitis when each of the following 3 criteria are met: <7 days of headache, <70% cerebrospinal fluid (CSF) mononuclear cells, and absence of seventh or other cranial nerve palsy. The goal of this study was to test the performance of the Rule of 7's in a multicenter cohort of children with CSF pleocytosis. METHODS: We performed a retrospective cohort study of children evaluated at 1 of 3 emergency departments located in Lyme disease-endemic areas with CSF pleocytosis and Lyme serology obtained. Lyme meningitis was defined using the Centers for Disease Control and Prevention criteria (either positive Lyme serology test result or an erythema migrans [EM] rash). We calculated the performance of the Rule of 7's in our overall study population and in children without physician-documented EM. RESULTS: We identified 423 children, of whom 117 (28% [95% confidence interval (CI): 24%-32%]) had Lyme meningitis, 306 (72% [95% CI: 68%-76%]) had aseptic meningitis, and 0 (95% CI: 0%-1%) had bacterial meningitis. Of the 130 classified as low risk, 5 had Lyme meningitis (sensitivity, 112 of 117 [96% (95% CI: 90%-99%)]; specificity, 125 of 302 [41% (95% CI: 36%-47%)]). In the 390 children without EM, 3 of the 127 low-risk patients had Lyme meningitis (2% [95% CI: 0%-7%]). CONCLUSIONS: Patients classified as low risk by using the Rule of 7's were unlikely to have Lyme meningitis and could be managed as outpatients while awaiting results of Lyme serology tests.

Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists.

OBJECTIVE: The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. CONCLUSIONS: Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life.

Acute effects of carprofen and meloxicam on canine gastrointestinal permeability and mucosal absorptive capacity.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to dogs for their analgesic, antipyretic, and anti-inflammatory properties. Their beneficial actions can be offset by gastrointestinal (GI) toxicosis. Endoscopy has traditionally been employed to detect GI lesions, but alterations in GI permeability precede the development of mucosal damage. HYPOTHESIS: Carprofen and meloxicam alter GI permeability and mucosal absorptive capacity of dogs. ANIMALS: Twenty adult dogs treated with an NSAID for >7 days were evaluated by permeability tests while receiving either carprofen (10 dogs) or meloxicam (10 dogs). METHODS: Prospective, longitudinal observational study. A 6-sugar permeability test (sucrose, lactulose, rhamnose, 3-O-methyl-D-glucose, D-xylose, and sucralose) was performed on the day before NSAID treatment, and after 3 and 8 days of treatment. RESULTS: There were no significant differences in the urinary recovery ratios of lactulose: rhamnose, D-xylose: 3-O-methyl-D-glucose, or sucralose recovery within either group at any time during the study. Sucrose permeability in the meloxicam group did not alter significantly over time. However, sucrose permeability in the carprofen group decreased significantly by day 3 (P = .049) and increased again by day 8 (P = .049), to a level that was not significantly different to permeability before treatment (P = .695). CONCLUSIONS AND CLINICAL IMPORTANCE: The absence of increased GI permeability and diminished mucosal absorptive capacity in this group of dogs does not support the development of acute GI toxicosis during treatment with either meloxicam or carprofen.

Pain mechanisms and their implication for the management of pain in farm and companion animals.

Over the last two decades there has been a dramatic increase in the literature relating to the mechanisms and management of pain in domestic animals. Understanding the mechanisms of pain is crucial for its effective management. This review highlights the current understanding of the neurophysiology of nociception and the plastic changes involved in chronic pain states. Additionally, we describe a range of novel molecules and pathways that offer opportunities for the development of mechanism-based analgesic therapies. Pain management in animals is limited by pain assessment which remains highly subjective, with clinicians relying on indirect measures of pain, using rating scales and (less frequently) quantifiable physiological and behavioural parameters. The need for a systematic approach which would assess different pain components is well justified. Species-specific issues on pain assessment and management in mammalian companion and farm animals are addressed in the later part of this review.

Ectopic ureterocele in a male dog: a case report and review of surgical management.

A 16-week-old, male border terrier was presented for urinary incontinence. Intravenous urography demonstrated a right-sided, extravesical ectopic ureterocele. Neoureterocystostomy and ureterocele omentalization were performed. Urinary incontinence persisted after surgery. Retrograde urethrography revealed communication between the ureterocele and urethra. Urinary incontinence resolved following partial ureterocelectomy and reconstruction of the proximal urethra.

Can opposites attract? Personality heterogeneity in supervisor-subordinate dyads as a predictor of subordinate outcomes.

Unlike the majority of research hypothesizing that similarity between individuals results in positive individual outcomes, this article examines whether dissimilarity results in positive outcomes. On the basis of interpersonal interaction theory, the authors hypothesized that dissimilarity in the personality dimension of control within supervisor-subordinate dyads is positively associated with the subordinate's satisfaction with the supervisor; results obtained with polynomial regression techniques were supportive. However, for 2 other outcomes, organizational citizenship behaviors and work withdrawal, neither similarity nor dissimilarity within the dyad was important; subordinate level of control was related to organizational citizenship behaviors reported by subordinates, and supervisor level of control was related to work withdrawal reported by subordinates. These findings portray the importance of examining relationship complexities beyond similarity in organizational dyad research.

Preliminary evaluation of a behaviour-based system for assessment of post-operative pain in horses following arthroscopic surgery.

OBJECTIVE: To develop a method for objective assessment of equine post-operative pain. STUDY DESIGN: Prospective nonblinded clinical study. ANIMALS: Twelve adult horses: Group 1 (G1, n = 6), admitted for arthroscopy (under general anaesthesia, with multimodal analgesia); Group 2 (G2, n = 6), 'pain free' controls. MATERIALS AND METHODS: Horses were filmed continuously (CVI, time-lapse video recorder) over 72 hours, from 24 hours pre-surgery (PS) to 48 hours post-recovery (PR) (G1), and over 24 hours (G2). Activity budgets were determined from 24 to 0 hours PS, 0-24 and 24-48 hours PR (G1) and for 24 hours (G2). Using direct observation (DO), active behaviours and postures were recorded at set time points PS and PR (G1) and at two time points (morning/evening) (G2). Heart rate (HR) and respiration rate (RR) were recorded simultaneously. Statistical analysis investigated within-group and between-group time-related changes in behaviour, HR and RR. RESULTS: There was no difference in HR or RR between G1 and G2 at any time point. Anaesthetic 'hangover' and hunger-related activity modulated behaviour from 0 to 6 hours PR, when abnormal postures and locomotion occurred in all G1 horses, but no G2 horses. Compared with G1 (0-24 hours PR), G2 spent more time eating (t = -3.34, p < 0.01), more time at the front of the stable (t = -2.42, p < 0.05), and less time exhibiting 'abnormal' behaviour (U = 56, p < 0.01). Comparing PS and PR behaviour, G1 spent less time exploring from 24 to 48 hours PR (t = 3.49, p < 0.05), less time in sternal recumbency (t = -3.8, p < 0.05) and less time moving (t = 3.19, p < 0.05). Horses tended (p < 0.07) to spend less time positioned in the front of the stable PR (less from 24 to 48 hours PR than from 0 to 24 hours PR). Comparing PR (evening) behaviour, G2 spent more time with head above withers (U = 21.5, p < 0.01), and ears forwards (U = 22, p < 0.01). G1 showed time-related changes (all p < 0.05) in time with lower lip tense (S = 15.8), eating (S = 17.08) and with head positioned above withers (S = 18.04). No differences in event behaviours were observed between G1 and G2. Within G1, only olfactory behaviour varied significantly with time (S = 14.52, p < 0.05). CONCLUSIONS: Changes in equine behaviour suggestive of post-operative discomfort were identified using both DO and CVI. Analysis of activity budgets may be a more sensitive method of identifying behavioural changes indicative of equine discomfort than repeated DO of specific events and postures.

Patent Ductus Arteriosus in the older Dog.

OBJECTIVES: The objectives of this study were to describe the clinical course of Patent Ductus Arteriosus (PDA) in older canine patients (defined as patients greater than 24 months at the time of presentation) with and without intervention. This study was also undertaken to evaluate if adult dogs with persistent flow across the ductus should still be closed, what the benefits are from late closure, and to hypothesise why some animals still continue to deteriorate despite closure. BACKGROUND: Currently accepted therapies for patent ductus arteriosus are surgical ligation and transcatheter coil embolisation. The majority of dogs are diagnosed and treated at young age. Some older dogs survive with few clinical signs and live a normal life span without intervention. Some dogs deteriorate despite intervention. METHODS: The case records of 24 dogs that had reached 24 months of age before diagnosis were reviewed and those animals that had no concurrent congenitaal cardiac diseases were included in the study (n = 21). Those animals that were still alive were requested to participate in a long-term follow-up study. RESULTS: After closure of the ductus (n = 16), the clinical signs disappeared in all but one animal. On follow-up of these animals, there was echocardiographic evidence of left ventricular systolic and diastolic dysfunction in many. Late cardiac death was recorded in 3 animals. In dogs where there was no intervention congestive heart failure was a common, but not an inevitable sequel. Development of mitral valve endocardiosis was a common feature. CONCLUSIONS: Older animals with PDA follow an individual course, independent of pre-existing heart failure. Irreversible left ventricular dysfunction is common, however it does not seem to affect the clinical course. These data show a favourable outcome in a high percentage of adult dogs diagnosed with PDA that undergo closure. Outcome without intervention was less favorable.

Spider silk fibers spun from soluble recombinant silk produced in mammalian cells.

Spider silks are protein-based "biopolymer" filaments or threads secreted by specialized epithelial cells as concentrated soluble precursors of highly repetitive primary sequences. Spider dragline silk is a flexible, lightweight fiber of extraordinary strength and toughness comparable to that of synthetic high-performance fibers. We sought to "biomimic" the process of spider silk production by expressing in mammalian cells the dragline silk genes (ADF-3/MaSpII and MaSpI) of two spider species. We produced soluble recombinant (rc)-dragline silk proteins with molecular masses of 60 to 140 kilodaltons. We demonstrated the wet spinning of silk monofilaments spun from a concentrated aqueous solution of soluble rc-spider silk protein (ADF-3; 60 kilodaltons) under modest shear and coagulation conditions. The spun fibers were water insoluble with a fine diameter (10 to 40 micrometers) and exhibited toughness and modulus values comparable to those of native dragline silks but with lower tenacity. Dope solutions with rc-silk protein concentrations >20% and postspinning draw were necessary to achieve improved mechanical properties of the spun fibers. Fiber properties correlated with finer fiber diameter and increased birefringence.

The effect of abdominal surgery on thresholds to thermal and mechanical stimulation in sheep.

Thresholds to noxious mechanical and thermal stimulation were measured in 6 groups of sheep prior to induction of anaesthesia and subsequently for a period of 2 h in the post-anaesthetic period. Groups 1-4 were anaesthetised using thiopentone and underwent ventral midline laparotomy. Four animals (group 5) underwent anaesthesia but not surgery, and a further 6 sheep (group 6) undergoing surgery were anaesthetised using ketamine. Groups 1-3 were intravenously administered the following drugs intra-operatively: flunixin meglumine, carprofen and buprenorphine, respectively. Groups 4-6 received no additional treatment. Thresholds to the mechanical test were not changed in the post-anaesthetic period for any group. There was a significant reduction in the responses to thermal stimulation after surgery for sheep in group 4 (45 and 60 min), while sheep in group 2 had thresholds to thermal stimulation greater than those recorded in the remaining groups at all time points post-operatively. Responses to thermal stimulation in sheep undergoing anaesthesia but not surgery (group 5) were unaltered during the 2 h recording period after anaesthesia ended. These data indicate that abdominal surgery induces thermal but not mechanical hyperalgesia in sheep, which appears to be centrally mediated. Moreover, the absence of mechanical hyperalgesia raises the possibility that central changes in noxious information processing may not be detected using mechanical stimuli in the same time course as thermal stimuli.

Repeated intradermal injection of low-dose carrageenan induces tachyphylaxis to evoked hyperalgesia.

Changes in the thresholds to noxious mechanical and thermal stimulation were monitored in a group of normal sheep at different times (30 min-24 h) following intradermal injection of either low-dose (0.0625%) carrageenan, a widely used mucopolysaccharide irritant, or saline (0.9%) into the lateral aspect of the fore limb. Thresholds to noxious mechanical stimulation were measured on the ipsilateral limb whereas thresholds to noxious thermal stimulation were measured at a site distant to that of the injection, the ipsilateral ear. During the first 2 h after carrageenan injection the thresholds to noxious thermal stimulation fell, while thresholds to noxious mechanical stimulation were unaltered. The evoked hyperalgesia was reversed by the administration of non-steroidal anti-inflammatory agents. Hyperalgesia was not present 4 h after carrageenan injection in control or treated animals. This experiment was carried out on 3 further occasions and a diminishing response to injection of carrageenan was observed, suggesting development of tachyphylaxis to evoked thermal hyperalgesia.