Improvement Science Increases Routine Lipid Screening in General Pediatric Cardiology.

OBJECTIVE: To evaluate the effectiveness of patient education, physician counseling, and point-of-care (POC) testing on improving adherence to lipid screening national guidelines in a general pediatric cardiology practice (2017-2023). STUDY DESIGN: Regional primary care providers were surveyed regarding lipid screening practices. Key drivers were categorized (physician, patient, and system) with corresponding interventions. Pediatric cardiologists started offering lipid screening during regular visits by providing families with preventive cardiovascular education materials and lab phlebotomy testing. System redesign included educational posters, clinical intake protocol, physician counseling, electronic health record integration, and POC testing. Run charts and statistical process control charts measured screening rates and key processes. RESULTS: The primary care survey response rate was 32% (95/294); 97% supported pediatric cardiologists conducting routine lipid screening. Pediatric cardiology mean baseline lipid screening rate was 0%, increased to 7% with patient education, and to 61% after system redesign including POC testing. Screening rates among 1467 patients were similar across age groups (P = .98). More patients received lipid screening by POC (91.7%) compared with phlebotomy (8.3%). Lipid abnormalities detected did not differ by screening methodology (P = .49). CONCLUSION: Patient education, counseling, and POC testing improved adherence to national lipid screening guidelines, providing a possible model for primary care implementation.

Digestive physiology of captive capybara (Hydrochoerus hydrochaeris).

The capybara (Hydrochoerus hydrochaeris), the largest living rodent, probably has a "mucus-trap" colonic separation mechanism. To test this hypothesis, we measured the mean retention time of a solute marker (MRTSolute ), 2 mm (MRT2 mm ), 10 mm (MRT10 mm ), and 20 mm (MRT20 mm ) particle markers and nutrient digestibility in adult captive capybaras (27-52 kg body mass (BM), 2-11 yr). In addition, total gut fill and the selectivity factor (MRTSolute /MRT2 mm ) were calculated, and mean faecal particle size and metabolic fecal nitrogen of captive capybaras were compared to those of free-ranging specimens. Finally, we also measured methane production in one animal. The MRT2 mm (29.2 ± 8.2 hr) was different (p < 0.01) from MRTSolute (37.0 ± 13.1 hr), MRT10 mm (36.5 ± 8.2 hr), and MRT20 mm (35.1 ± 9.6 hr). The selectivity factor (1.26 ± 0.30) was in the range considered typical for a "mucus-trap" colonic separation mechanism. The estimated total gut fill was 1.50 ± 0.37% and 1.73 ± 0.25% of BM calculated from the results of the 2-mm and 10-mm particle markers, respectively. The CH4 emission was 13.7 L/day. Captive capybaras had greater mean fecal particle size (0.44 ± 0.06 vs. 0.29 ± 0.05 mm, p < 0.001) and metabolic fecal nitrogen (65.5 ± 3.91 vs. 46.8 ± 10.5% of fecal nitrogen, p < 0.001) than free-ranging capybaras. Organic matter digestibility decreased less steeply with increasing dietary crude fiber content in capybaras as compared to published data from rabbits or guinea pigs. Accordingly, the digestive physiology of the capybara is characterized by a comparatively high fiber digestibility, with a "mucus-trap" colonic separation mechanism, allowing capybaras to thrive on forage-only diets.

Would Parents Consent to a Comparative Effectiveness Trial of Oral Doxycycline Versus Intravenous Ceftriaxone for the Treatment of Children with Lyme Meningitis?

Children with Lyme meningitis are often treated with intravenous ceftriaxone, although oral doxycycline may be effective. Parents were surveyed after observing a video describing a hypothetical Lyme meningitis treatment trial. Eighty-four of 102 (82%) would consent to their child participating. Parents would accept 2 additional days of symptoms (noninferiority margin) with doxycycline even if ceftriaxone hastened symptom resolution.

Diastereoselective 1,3-dipolar cycloaddition of nitrones to donor-acceptor cyclopropanes catalyzed by a calcium(II) complex.

Calcium triflate has been identified as an efficient catalyst for the cycloaddition of nitrones to donor-acceptor cyclopropanes. The reaction proceeds with good to excellent yields of the corresponding tetrahydro-1,2-oxazines with high levels of diastereoselectivity. The generality of the reaction allowed for the synthesis of tetrahydro-1,2-oxazines bearing alkyl, aryl, and heteroaromatic substitution.

Evaluation of three immobilization combinations in the capybara (Hydrochoerus hydrochaeris).

Capybaras (Hydrochoerus hydrochaeris) are the world's largest rodent. Owing to its uniqueness, 50 AZA institutions in North America display this species. As shown by a survey, no standard anesthetic protocol has been developed for this species. As a part of an ongoing behavioral study in Venezuela, capybaras were surgically implanted with radio transmitters. Animals were randomly assigned to one of the three immobilization protocols: (1) Tiletamine HCl/Zolazepam HCl, (2) Tiletamine HCl/Zolazepam HCl/Medetomidine HCl, and (3) Tiletamine HCl/Zolazepam HCl/Medetomidine HCl/Butorphanol tartrate. The protocol recommended for minimally invasive procedures when inhalant anesthetics are unavailable is a combination of Tiletamine HCl/Zolazepam HCl/Medetomidine HCl/Butorphanol tartrate. This is based on ease of administration, volume, onset of action, depth of anesthetic achieved, reversibility, safety, and costs.