Association between body mass and hypotension in dogs under general anaesthesia.

OBJECTIVES: To investigate the association between body mass and hypotension during general anaesthesia in dogs undergoing surgical and diagnostic procedures within a referral hospital. MATERIALS AND METHODS: Retrospective evaluation of the anaesthetic records of 1789 dogs was performed. Data on signalment, anaesthetic protocol and physiological variables, including mean arterial pressure, were collected. A multivariable generalised linear model was used to identify associations between explanatory variables, including body mass, and hypotension. RESULTS: In the population studied, increasing body mass (per 10 kg) was significantly associated with decreasing odds of hypotension (odds ratio 0.68; 95% confidence interval: 0.60 to 0.77). Additional variables associated with a decreased odds of hypotension were pre-anaesthetic medication with alpha-2 agonists (odds ratio 0.63; 95% confidence interval 0.48 to 0.82) and increased body temperature (per 1°C) during general anaesthesia (odds ratio 0.77; 95% confidence interval 0.67 to 0.88). Brachycephaly (odds ratio 1.72; 95% confidence interval 1.25 to 2.38), ASA physical status classification >3 (odds ratio 2.03; 95% confidence interval 1.16 to 3.56), undergoing a surgical procedure (versus diagnostic) (odds ratio 1.57; 95% confidence interval 1.10 to 2.23) and bradycardia (odds ratio 1.37; 95% confidence interval 1.05 to 1.80) were independently associated with increased odds of hypotension. CLINICAL SIGNIFICANCE: Dogs of lower body mass and brachycephalic breeds may be at higher risk of hypotension during general anaesthesia or alternatively represent subpopulations in which accurate blood pressure measurement presents a greater challenge. Monitoring blood pressure accurately in these groups requires particular attention and provisions for treating hypotension should be readily accessible.

A qualitative study to explore the experiences of first contact physiotherapy practitioners in the NHS and their experiences of their first contact role.

PURPOSE: First Contact Practitioner (FCP) roles have been developed for health professionals with advanced practice skills to take on many of the musculoskeletal responsibilities currently carried out by general practitioners. FCP roles are new and still developing. Currently there is little research that has investigated the experiences of FCPs. This knowledge could help stakeholders and other clinicians gain an understanding into what makes a successful FCP role. The aim of this research was to explore the experiences of FCP working in North West England to gain insight into the first point of contact service, and their experiences of this developing full time FCP role. METHODS: A qualitative design using in-depth semi-structured, face-to-face interviews was undertaken to explore the experiences of FCP providing a first point of contact service. The study took place in an economically deprived and ethnically diverse location in North West England. FINDINGS: Ten FCPs were recruited, four were appointed from Band 6 posts to FCP training posts, 9 were male. The mean years qualified was 12.8. Five themes were identified: 1. 'It's the level of clinical complexity that you're dealing with', 2. FCP role - rewards and challenges, 3. Own wellbeing, 4. Professional development and education, 5. Realities of working in practice governed by business. CONCLUSION: FCP roles are an exciting development for people with MSK conditions, the physiotherapy profession, primary care providers and MSK physiotherapists. Mentorship support, workload and standards of training and practice are important when considering future expansion for the sustainability of these roles.

αv integrins on mesenchymal cells regulate skeletal and cardiac muscle fibrosis.

Mesenchymal cells expressing platelet-derived growth factor receptor beta (PDGFRß) are known to be important in fibrosis of organs such as the liver and kidney. Here we show that PDGFRß+ cells contribute to skeletal muscle and cardiac fibrosis via a mechanism that depends on αv integrins. Mice in which αv integrin is depleted in PDGFRß+ cells are protected from cardiotoxin and laceration-induced skeletal muscle fibrosis and angiotensin II-induced cardiac fibrosis. In addition, a small-molecule inhibitor of αv integrins attenuates fibrosis, even when pre-established, in both skeletal and cardiac muscle, and improves skeletal muscle function. αv integrin blockade also reduces TGFß activation in primary human skeletal muscle and cardiac PDGFRß+ cells, suggesting that αv integrin inhibitors may be effective for the treatment and prevention of a broad range of muscle fibroses.

Healing scars: targeting pericytes to treat fibrosis.

Fibrosis, with resultant loss of organ function, is the endpoint of many diseases. Despite this, no effective anti-fibrotic therapies exist. The myofibroblast is the key cell driving fibrosis but its origins remain controversial. A growing body of work provides strong evidence that the pericyte, a perivascular cell present throughout the microvasculature, is a major myofibroblast precursor in multiple tissues. This review summarizes the principle experimental and clinical evidence underpinning this conclusion and outlines strategies for targeting pericyte transdifferentiation during fibrogenesis. Successful targeting of pro-fibrogenic pericytes has the potential to halt or even reverse fibrosis and thus reduce the enormous worldwide healthcare burden that currently exists as a result of fibrotic disease.

Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer.

Insufficiency fractures are recognised consequences of radiotherapy in gynaecological malignancy with reported incidences between 2.7% and 89%. We aimed to determine the incidence and risk factors for insufficiency fractures in patients receiving radical pelvic radiotherapy for uterine and cervical cancer. A case-note review was undertaken of patients treated between January 2007 and December 2008. Insufficiency fractures were identified from radiographs, computed tomography and magnetic resonance images. Chi-squared and Mann-Whitney tests were performed to determine associations between insufficiency fractures and chemotherapy, steroids and age. A total of 285 patients received pelvic radiotherapy, 137 with uterine and 148 with cervical cancer. Mean age was 59 years. A total of 144 patients received chemotherapy, 101 concurrently and 35 adjuvantly. Bone abnormalities affected 67 patients, 33 had pelvic insufficiency fractures, 12 had multiple fractures and 3 patients developed femoral head avascular necrosis. Use of chemotherapy was not associated with development of fractures (P = 0.949). However, cervical cancer patients had a significantly higher incidence of insufficiency fractures (P = 0.018) and bone pain (P = 0.03) compared with uterine cancer patients. This suggests concurrent chemotherapy may be a significant factor in increasing insufficiency fractures and bone morbidity in these patients and highlights a need for further research to identify, prevent and reduce these long-term complications.

Compression injury in the mouse spinal cord elicits a specific proliferative response and distinct cell fate acquisition along rostro-caudal and dorso-ventral axes.

Harnessing the regenerative capabilities of endogenous precursor cells in the spinal cord may be a useful tool for clinical treatments aimed at replacing cells lost as a consequence of disease or trauma. To better understand the proliferative properties and differentiation potential of the adult spinal cord after injury, we used a mouse model of compression spinal cord injury (SCI). After injury, adult mice were administered BrdU to label mitotic cells and sacrificed at different time-points for immunohistochemical analysis. Our data show that the rate of proliferation increased in all regions of the spinal cord 1day after injury, peaked after 3days, and remained elevated for at least 14days after injury. Proliferation was greater at the injury epicenter than in rostral and caudal adjacent spinal segments. The number of proliferative cells and rate of proliferation varied between dorsal and ventral regions of the spinal cord and between the gray and white matter. Newly generated cells expressed markers for progenitor cells (Nestin and Olig2), oligodendrocytes (Sox10), astrocytes (S100b and glial fibrillary acidic protein), and microglia (Iba1), but not neuronal markers (Map2 and NeuN). Marker expression varied with regard to the dorso-ventral region, rostro-caudal proximity to the injury epicenter, and time after injury. At early time-points after injury, BrdU(+) cells mainly expressed microglial/macrophage and astrocytic markers, while at these same time-points in the control spinal cord the mitotic cells predominately expressed oligodendrocyte and oligodendrocyte progenitor cell markers. The profile of proliferation and cell fate marker expression indicates that after moderate compression, the spinal cord has the capacity to generate a variety of glial cells but not neurons, and that this pattern is space and time specific. Future studies should focus on ways to control proliferation and cell fate after injury to aid the development of cell replacement treatments for SCI.

Pilot study of a novel educational programme for 11-16 year olds with type 1 diabetes mellitus: the KICk-OFF course.

AIMS: To pilot an educational programme (KICk-OFF) for children and adolescents with type 1 diabetes mellitus (DM). Evaluation included (i) independent assessment of curriculum quality, (ii) acceptability to families and (iii) possible impact on standardised outcome measures (HbA1c, body mass index (BMI), diary reports of hypoglycaemia, quality of life (QoL)). METHODS: 48 children aged 11-16 years (mean age 13.60 (SD 1.36) years) were recruited from three UK centres. Six 5-day outpatient courses on carbohydrate counting and insulin dose adjustment were held. Semi-structured interviews were conducted with children and parents before and after the course. Glycaemic control (HbA1c), BMI and frequency of hypoglycaemia were assessed before the course and at 3 and 6 months after intervention. QoL was assessed before the course and at 2 weeks, 3 and 6 months. RESULTS: Educational evaluation indicated the course format was appropriate and consistent. Parent and child interviews suggested that pre-course expectations were largely met. There were no changes in HbA1c, BMI or episodes of hypoglycaemia, but children and parents reported improved QoL (p<0.05). CONCLUSIONS: KICk-OFF was well-received by children and parents and was associated with improved QoL. In this small pilot study, glycaemic control did not change but findings justify conducting a future randomised controlled trial involving a revised curriculum, a larger study population including a control group and longer follow-up.

Forearm blood glucose testing in diabetes mellitus.

AIMS: To compare the accuracy and acceptability of capillary blood glucose testing from the forearm with finger prick testing in diabetic children. METHODS: Blood glucose measurements from samples taken from the forearm and the finger were compared in an outpatient setting from 52 children and adolescents with diabetes mellitus aged 6-17 years. Opinions on forearm sampling were collected by questionnaire. RESULTS: Blood glucose results obtained from forearm sampling correlated well with results from the finger measured by the Yellow Springs Instrument analyser. Error grid analysis showed that 100% of measurements were clinically acceptable; 61% of children reported that forearm testing was painless and 19% that it was less painful than finger prick testing. CONCLUSION: Forearm testing is an acceptable alternative to finger prick testing for blood glucose measurement in children and adolescents.

A potential integrated water quality strategy for the Mississippi River Basin and the Gulf of Mexico.

Nutrient pollution, now the leading cause of water quality impairment in the U.S., has had significant impact on the nation"s waterways. Excessive nutrient pollution has been linked to habitat loss, fish kills, blooms of toxic algae, and hypoxia (oxygen-depleted water). The hypoxic "dead zone" in the Gulf of Mexico is one of the most striking illustrations of what can happen when too many nutrients from inland watersheds reach coastal areas. Despite programs to improve municipal wastewater treatment facilities, more stringent industrial wastewater requirements, and agricultural programs designed to reduce sediment loads in waterways, water quality and nutrient pollution continues to be a problem, and in many cases has worsened. We undertook a policy analysis to assess how the agricultural community could better reduce its contribution to the dead zone and also to evaluate the synergistic impacts of these policies on other environmental concerns such as climate change. Using a sectorial model of U.S. agriculture, we compared policies including untargeted conservation subsidies, nutrient trading, Conservation Reserve Program extension, agricultural sales of carbon and greenhouse gas credits, and fertilizer reduction. This economic and environmental analysis is watershed-based, primarily focusing on nitrogen in the Mississippi River basin, which allowed us to assess the distribution of nitrogen reduction in streams, environmental co-benefits, and impact on agricultural cash flows within the Mississippi River basin from various options. The model incorporates a number of environmental factors, making it possible to get a more a complete picture of the costs and co-benefits of nutrient reduction. These elements also help to identify the policy options that minimize the costs to farmers and maximize benefits to society.

Helping children to learn about their diabetes.

Health education is essential if children are to learn to live with diabetes and prevent any related problems developing in the future. A programme of education sessions for five- to seven-year-olds was designed to be practical and fun.

Improving school teachers' knowledge of diabetes.

The incidence of diabetes among school children is increasing. Apart from parents, school teachers are the main carers of school-aged children. Teachers generally have a poor level of knowledge about diabetes and its management. Better communication and dissemination of information between the specialist health visitors, school nurses and teachers is required.

A university-community model for the integration of nutrition research, practice, and education.

A model to integrate nutrition research, practice, and education was conceptualized and implemented to enhance student learning opportunities. The model encourages partnerships between educators and practitioners by providing a mechanism for faculty researchers to work with community practitioners to identify applied research and education projects in which students can participate in the design, implementation, analysis, and reporting. Learning experiences are discussed in relation to the knowledge and performance requirements for entry-level dietitians as mandated by The American Dietetic Association. Faculty and community practitioner relationships to support student learning and goal attainment are described. The research, practice, and education model has particular application to other universities struggling to balance limited resources with increasing expectations for community-university partnerships, and expectations for excellent teaching and scholarship. Resources needed (ie, staff, support services, and physical facilities) to develop and implement the model are discussed. Finally, acquisition options such as shared resources and in-kind contributions are suggested.

Attitude changes of dietetic students performing nutritional assessment on healthy elderly.

As the population of individuals over 65 yrs of age continues to grow, so does the demand for nutrition counseling and intervention for this age group. Dietetic students traditionally have minimal exposure to groups of healthy elderly yet entry level dietitians must effectively interact with these groups immediately upon employment. Attitudes and perceptions held by dietetic students about the elderly are important to their professional development and may affect the quality of care these students provide in the future. This study investigated attitudes of dietetic students before and after a short, direct experience with a group of elderly. Students had a significant positive change in attitudes as a result of interacting with the older adults.

Population studies in China: privileged past, anxious future.

PIP: This paper attempts to summarize current population research being conducted in China's demographic institutes. The data are from the author's travels in China and a questionnaire survey conducted by mail in 1987. The author suggests that demography's relatively privileged status over the past decade stems principally from its focus upon the information needed to formulate the country's population control policies.^ieng

Fertility policy in China: future options.

A wide range of social, economic, and demographic criteria are used to evaluate China's present one-child policy and five alternative fertility policies that might guide China's population control efforts until the end of the century when the one-child policy is scheduled to be abandoned. These criteria include the policies' macrodemographic impact on total population size and population aging; their microdemographic effects on the family's ability to support the elderly, its economic capabilities, and the position of women; and their cultural acceptability to the majority Han Chinese population. The results suggest that the least desirable strategy is to retain the present policy; all the two-child alternatives perform better than the current one-child policy in achieving the policy goals considered.