Pyloric outflow obstruction secondary to sclerosing encapsulating peritonitis in a dog.

A 6-year-old, male neutered mixed breed dog was presented emergently with a three-week history of hyporexia, vomiting, diarrhoea and weight loss. Upon examination, the patient was dull, had generalised muscle atrophy, moderate abdominal pain and a mild amount of peritoneal effusion. A fluid-filled, distended, corrugated small bowel with marked gastroparesis and moderate peritoneal effusion was noted on abdominal ultrasonography. Endoscopy revealed hyperaemic and friable mucosa and a subjectively narrowed pylorus. Emergency exploratory celiotomy was performed due to worsening patient condition and revealed thick, diffuse, fibrous adhesions of the abdominal cavity. Based on these findings, sclerosing encapsulating peritonitis (SEP) was suspected. A large mass of omentum adjacent to the greater curvature of the stomach had caused a pyloric outflow obstruction. Adhesiolysis was attempted but was unsuccessful due to the friability of the small intestines. The dog was humanely euthanased under anaesthesia. A diagnosis of SEP was confirmed via necropsy. No underlying cause was identified. This is the first known case of a pyloric outflow obstruction secondary to SEP in a dog. Although rare, this condition should be considered as a differential for dogs with signs of a pyloric outflow obstruction with concurrent ascites and abdominal pain, hyporexia, vomiting and diarrhoea.

Direct hospital cost determinants following hip and knee arthroplasty.

OBJECTIVE: Total joint arthroplasty (TJA) places a significant economic burden on health care resources. This cohort study examines the costs associated with arthroplasty in 827 patients undergoing hip and knee TJA from January 2011 to June 2012 at a single center in Melbourne, Australia. METHODS: Data included total inpatient, outpatient, and readmissions costs in the 30 days following TJA. Factors associated with cost were modeled using negative binomial regression and extrapolated to the Australian population. RESULTS: The base cost (i.e., the cost for a patient with no modifying factors) over the first 30 days following TJA was $13,060 Australian (AU) (interquartile range $12,126-14,067 AU). The median length of stay was 4 days (range 2-33 days) and 35 patients (4%) were readmitted in the first 30 days following index TJA, the majority of whom had a surgical site infection (SSI) (74%). The following factors were independently associated with increased costs: SSI, preoperative warfarin therapy, American Society of Anesthesiologists score of 3 or 4, hip TJA, increasing operation time, increasing postoperative blood transfusion requirements, other nosocomial infections, postoperative venous thromboembolism (VTE), pressure ulcers, postoperative confusion, and acute urinary retention. Based on data from the present study, the cost of TJA in Australia is estimated to exceed $1 billion AU per year. Preventable postoperative complications were major cost drivers: SSI and VTE added a further $97 million AU and $66 million AU, respectively, to arthroplasty costs in the first 30 days following surgery. CONCLUSION: This unique study has identified important factors influencing TJA costs and providing guidance for future research and resource allocation.

The Ras oncogene signals centrosome amplification in mammary epithelial cells through cyclin D1/Cdk4 and Nek2.

Centrosome amplification (CA) contributes to carcinogenesis by generating aneuploidy. Elevated frequencies of CA in most benign breast lesions and primary tumors suggest a causative role for CA in breast cancers. Clearly, identifying which and how altered signal transduction pathways contribute to CA is crucial to breast cancer control. Although a causative and cooperative role for c-Myc and Ras in mammary tumorigenesis is well documented, their ability to generate CA during mammary tumor initiation remains unexplored. To answer that question, K-Ras(G12D) and c-Myc were induced in mouse mammary glands. Although CA was observed in mammary tumors initiated by c-Myc or K-Ras(G12D), it was detected only in premalignant mammary lesions expressing K-Ras(G12D). CA, both in vivo and in vitro, was associated with increased expression of the centrosome-regulatory proteins, cyclin D1 and Nek2. Abolishing the expression of cyclin D1, Cdk4 or Nek2 in MCF10A human mammary epithelial cells expressing H-Ras(G12V) abrogated Ras-induced CA, whereas silencing cyclin E1 or B2 had no effect. Thus, we conclude that CA precedes mammary tumorigenesis, and interfering with centrosome-regulatory targets suppresses CA.

An international human becoming hermeneutic study of Tom Hegg's A cup of Christmas Tea.

This article seeks to contribute to human becoming theory and to nursing by providing an international human becoming hermeneutic study of Thomas Hegg's A Cup of Christmas Tea. The human becoming hermeneutic method was used in this study to discover emergent meanings about human experiences. Guided by the method, the authors discovered three emergent meanings: honoring the cherished; communing with the was, is, and will be; and triumphing with new vision. These meanings were synthesized by the authors. A Cup of Christmas Tea is the story of the way triumphing with new vision arises with honoring the cherished in communing with the was, is, and will be. The conclusion for families and nurses is that by remaining open to all possibilities that exist in each now, moments of serendipitous togetherness can transform human trepidation and negative views of later life.

Consistency and change in the behavior of rhesus macaque abusive mothers with successive infants.

This study investigated the abusive behavior and parenting styles of 7 rhesus macaque mothers with infants born in 2 consecutive years. All subjects lived in captive social groups and were observed during the first 12 weeks of infant life. With the exception of 1 individual, mothers were generally consistent in the frequency with which they abused their successive infants. Similarities were also found in the temporal course of infant abuse, the use of the most common pattern of abuse, and some measures of parenting style, notably those reflecting maternal protectiveness. The findings of this study are discussed in relation to different hypothesized relationships between infant abuse and parenting style in macaques.

Child abuse and neglect: usefulness of the animal data.

This article reviews and critically discusses the relevance of animal data to research on child abuse and neglect. Although parental investment theory can be useful in investigating the adaptiveness, if any, of child abuse and neglect, the evolutionary approach also has some limitations. The most suitable animal models for investigating the psychosocial processes underlying child abuse and neglect are probably found among the nonhuman primates. Whereas the heuristic value of social deprivation paradigms may be limited, recent studies suggest that the spontaneous occurrence of infant maltreatment in monkeys may be the closest approximation to child maltreatment provided by nonhuman animals. The investigation of adaptive and maladaptive processes in the parenting behavior of socially living nonhuman primates can inform research on child abuse and neglect and allow investigators to conduct studies that would be difficult or impossible in humans.

Infant abuse and neglect in monkeys--a discussion of definitions, epidemiology, etiology, and implications for child maltreatment: reply to Cicchetti (1998) and Mason (1998)

In response to D. Cicchetti's (1998) and W. A. Mason's (1998) commentaries, this article scrutinizes infant maltreatment in monkeys and its public health implications. Studies of infant abuse and neglect in monkeys have used operational definitions based on (a) adult behavior or (b) adult behavior and infant outcome (depending on data available for analysis). Direct comparisons between the incidence of maltreatment in monkey and human populations can be only tentative as a result of differences in operational definitions of maltreatment. A simplified version of the ecological-transactional model of maltreatment can be used in research with nonhuman primates, and different species can be used to model different aspects of the human phenomenon. Although abuse and neglect take different forms in animals and humans, research with animal models can make an important contribution to elucidating the adaptive function, if any, of child maltreatment and the proximate mechanisms underlying its occurrence.

Genealogical and demographic influences on infant abuse and neglect in group-living sooty mangabeys (Cercocebus atys).

This study investigated the occurrence of infant abuse and neglect in a large population of group-living mangabeys over a period of almost 3 decades. The prevalence of infant abuse and neglect did not differ significantly among the 9 families comprising the population, but within some families there was evidence of genealogical effects on infant abuse. Maternal inexperience and infant age were risk factors for neglect but not for abuse. Whereas neglecting mothers neglected only 1 of their offspring, usually their first-born infant, abusive mothers abused several of their offspring, and risk of severe abuse increased with later births. Infant sex was not a risk factor for neglect or abuse. These and other results concur with the findings of a previous investigation of infant abuse and neglect in a different primate species in indicating that neglect and abuse are different phenomena and in emphasizing genealogical influences on infant abuse in primates. The investigation of biological, experiential, and social determinants of the spontaneous occurrence of infant abuse and neglect in relatively undisturbed primate populations could significantly enhance our understanding of the etiology of child abuse and neglect in humans.

Infant abuse runs in families of group-living pigtail macaques.

OBJECTIVE: The aims of this study were to investigate genealogical and demographic influences on maternal abuse and neglect of offspring in pigtail macaques and identify some maternal and infant characteristics that may be risk factors for abuse or neglect. METHOD: Infant abuse and neglect were investigated in five large families of group-living pigtail macaques over a period of 33-years (5-7 generations). The data were obtained from the Animal Records of the Yerkes Regional Primate Research Center. RESULTS: Abuse and neglect are likely to be two distinct phenomena in pigtail macaques. Neglect was mostly limited to first-born and newborn infants. Abuse was more likely to occur in some families than in others, and within-abusive families, it was more-likely to occur among closely-related females than among distantly-related females. Infants whose siblings had previously been abused were themselves especially at risk of abuse. Material health and infant sex were not risk factors for abuse. CONCLUSIONS: This study provides the first evidence of genealogical effects on infant abuse in nonhuman primates. Several characteristics of infant abuse in socially living macaques suggest that this phenomenon could represent a good animal model for studying the etiology of child abuse and neglect.

Statewide dental auxiliary career mobility: an emerging reality for Kentucky.

The lack of articulation in allied health education has been identified as a significant barrier to career mobility. This paper describes an attempt to improve articulation of dental auxiliary training in Kentucky. Results included the development of a dental auxiliary core curriculum, an articulation model, and the successful negotiation of a systemwide transfer agreement. In addition, the project instilled a commitment on the part of the group members to continue working toward greater articulation for dental auxiliaries.

Statewide articulation for allied health: a conceptual model in action.

Under the auspices of the Kentucky Council on Higher Education, and with the aim of delineating issues in allied health education and making recommendations for alleviating the issues, an indepth, two-year study was completed in 1975. The primary recommendations pertained to the development of a statewide plan for allied health education that would result in an articulated statewide system permitting entry and exit of prepared personnel at a variety of levels and improving inter-institutional efforts to share educational resources. In the following four years a foundation was laid for developing the system. An articulated system of allied health education was developed in six disciplinary clusters to serve as a model for other states: clinical laboratory, dental auxiliaries, dietetics/nutrition, rehabilitation therapies, radiological science, and respiratory therapy programs. All levels of programs within each discipline cluster existing in Kentucky are included in the system. The study includes a design phase and an implementation phase. During the design phase, six discipline advisory groups developed articulation models for the programs in each discipline. Implementation phase accomplishments include signed transfer agreements, development of model and core curricula, design for graduate follow-up, publications, development of manpower models, and increased cooperation among project participants.