A rare case of emphysematous pyelonephritis caused by Candida parapsilosis and Finegoldia magna complicated by medical care avoidance.

Emphysematous pyelonephritis (EPN) is a necrotizing gas producing infection of the renal parenchyma that commonly occurs in patients with diabetes. EPN requires early diagnosis and treatment due to the possible life-threatening septic complications. We report a rare case of EPN caused by an unfavorable mixed infection of Candida parapsilosis and Finegoldia magna. To our knowledge, this is the first reported case of EPN caused by Finegoldia magna. A 62-year-old male with diabetes mellitus (DM) presented with abdominal pain, shortness of breath, and nausea in which a diagnosis of septic shock was made due to EPN. Our patient first noticed abdominal pain 3 weeks prior to hospital presentation; however, he avoided getting treatment due to a fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This patient exhibited deterioration and expired after surgical intervention despite uneventful nephrectomy. This case suggests that medical care avoidance behaviors among patients could potentially complicate their clinical course.

Low cost CO2 sensing: A simple microcontroller approach with calibration and field use.

Understanding the spatial variability of gaseous carbon flux at a landscape scale requires intensive monitoring campaigns necessitating significant and perhaps prohibitive financial investment. Commercially available CO2 sensors may only partially fulfil the requirements of the researcher, thereby generating inadequate data. In this context we present the fully replicable designs for a low-cost, microcontroller-based gaseous CO2 concentration data logger suitable for field deployment at scale. It demonstrates a post-calibration accuracy of 96-99% and large onboard data storage for data collected at user-defined intervals. The sensor can be powered via USB or batteries, assembled by novice users, and produced for approximately £155. Post-calibration it was used to measure CO2 evasion from a peatland stream, environments known to be spatially and temporally variable CO2 sources, although potential applications are much wider in scope. The proliferation of low-cost, open-source, and user-made sensors in physical sciences could allow researchers to answer questions previously unanswerable due to the limitations of existing proprietary equipment. We encourage other research teams to use and adapt this design for a range of purposes and research questions beyond carbon processing in peatlands.

The nociceptive withdrawal response of the foot in the spinalized rat exhibits limited dependence on stimulus location.

The nociceptive withdrawal response (NWR) of the limb is a protective, multi-joint movement in response to noxious stimulation of the homonymous limb. Previous studies in animal models differed as to the dependence of the response direction and magnitude on stimulus location. The specific aim of our research was to use three-dimensional high-speed video to determine whether movement of the foot in response to heat stimuli delivered to the foot and lower leg depended on the location of the stimulus. In particular, we sought to determine whether the movement strategy was categorical or continuous. In spinalized rats, localized, presumably nociceptive heat stimuli were delivered along three dimensions-circumferentially around the lower leg, circumferentially around the foot and along the plantar surface of the foot. Our results demonstrate that in spite of a wide range of stimulus locations over the hind foot and leg, response directions were restricted to two-rostral/medial/dorsal and caudal/medial/dorsal-directions, consistent with a categorical strategy. Further, the preference for these two directions was also reflected in the distance of the movement, which was greatest for stimuli directly opposite the preferred response directions. However, significant but weak dependencies of response direction and distance on stimulus location were found for all three dimensions of stimulus application, supporting a continuous strategy. Together, our results demonstrate, based on movement analysis, that the NWR employs a hybrid categorical-continuous strategy that may minimize the harmful consequences of noxious stimuli.

Folinic acid administration after MTX GVHD prophylaxis in pediatric allo-SCT.

Cyclosporine (CsA) and MTX are commonly used for GVHD prophylaxis in pediatric allo-SCT. Mucositis and hepatic toxicity frequently restrict the delivery of the fourth dose of MTX. Folinic acid (FA) may ameliorate MTX toxicity. We conducted a retrospective chart review of all pediatric patients who received CsA and MTX for GVHD prophylaxis from January 2000 to July 2010. Patients treated before July 2007 (N=29) did not receive FA and those treated from July 2007 onward did receive FA (N=18). Patients who received FA were significantly more likely to receive day +11 MTX (odds ratio (OR) 10.42, 95% confidence interval (CI): 1.21-262.27) but there was no significant difference in Grade III-IV GVHD between the two groups (OR 1.15, 95% CI: 0.08-18.14). FA did not impact relapse-free survival (RFS) (P=0.82). Increased likelihood of receiving day +11 MTX suggests that FA ameliorates MTX toxicity, such as severe mucositis. FA administration for MTX GVHD prophylaxis should be studied in a prospective, randomized fashion.

A review of oscillating water columns.

This paper considers the history of oscillating water column (OWC) systems from whistling buoys to grid-connected power generation systems. The power conversion from the wave resource through to electricity via pneumatic and shaft power is discussed in general terms and with specific reference to Voith Hydro Wavegen's land installed marine energy transformer (LIMPET) plant on the Scottish island of Islay and OWC breakwater systems. A report on the progress of other OWC systems and power take-off units under commercial development is given, and the particular challenges faced by OWC developers reviewed.

Pressure ulcers in cancer palliative care patients.

Terminally ill cancer patients are considered at high risk for pressure ulcers because of their clinical condition. However, in Italy, data about pressure ulcers and their prevalence are insufficient. This paper reports a study on pressure ulcers incidence and prevalence in a population of oncology patients cared for in an Italian palliative care service. A retrospective analysis of 414 clinical records of patients admitted over 6 months showed a prevalence of pressure ulcers of 22.9% and an incidence of 6.7%. Karnofsky Performance Scale Index scores, age and length of the stay were significantly related to the pressure sore development. These results support the need to focus attention on pressure ulcers prevention and treatment in terminally ill cancer patients, and to further define specific guidelines aimed at warranting patients' comfort and quality of life.

Mood and anxiety disorders in females with the FMR1 premutation.

Fragile X syndrome (FXS) is a model for studying the relative contributions of genetic and environmental factors to psychiatric disorders in mothers of children with disabilities. Here, we examine the frequency and predictors of mood and anxiety disorders in mothers with the FMR1 premutation. Ninety-three females with the FMR1 premutation were in the study and were compared to 2,159 women from the National Comorbidity Survey Replication (NCS-R) dataset. Mood and anxiety disorders were assessed using the SCID-I. Our data reflect elevated lifetime major depressive disorder (MDD), lifetime panic disorder without agoraphobia and current agoraphobia without panic disorder in the FMR1 premutation sample. Also, we found a low frequency of lifetime social phobia, specific phobia, and post-traumatic stress disorders and current specific phobia in the FMR1 premutation sample. The profile of MDD in the FMR1 premutation sample was not episodic or comorbid with an anxiety disorder, as in the NCS-R dataset. Never having been married and smaller CGG repeat length were associated with increased likelihood of MDD while increased children with FXS in the family and greater child problem behaviors were associated with increased likelihood of an anxiety disorder in the FMR 1 premutation group. Major depression in females with the FMR1 premutation may not be characterized as an episodically chronic recurrent disorder as it is in community samples and may have a genetic basis given the relationship with CGG repeat length and lack of association with all child and most demographic factors.

Pharmacokinetics of a controlled-release liposome-encapsulated hydromorphone administered to healthy dogs.

The purpose of the study was to assess the pharmacokinetics of liposome-encapsulated (DPPC-C) hydromorphone administered intravenously (IV) or subcutaneously (SC) to dogs. A total of eight healthy Beagles aged 12.13 +/- 1.2 months and weighing 11.72 +/- 1.10 kg were used. Dogs randomly received liposome encapsulated hydromorphone, 0.5 mg/kg IV (n = 6), 1.0 mg/kg (n = 6), 2.0 mg/kg (n = 6), or 3.0 mg/kg (n = 7) SC with a 14-28 day washout between trials. Blood was sampled at serial intervals after drug administration. Serum hydromorphone concentrations were measured using liquid chromatography with mass spectrometry. Serum concentrations of hydromorphone decreased rapidly after IV administration of the DPPC-C formulation (half-life = 0.52 h, volume of distribution = 12.47 L/kg, serum clearance = 128.97 mL/min/kg). The half-life of hydromorphone after SC administration of DPPC-C formulation at 1.0, 2.0, and 3.0 mg/kg was 5.22, 31.48, and 24.05 h, respectively. The maximum serum concentration normalized for dose (C(MAX)/D) ranged between 19.41-24.96 ng/mL occurring at 0.18-0.27 h. Serum hydromorphone concentrations fluctuated around 4.0 ng/mL from 6-72 h after 2.0 mg/kg and mean concentrations remained above 4 ng/mL for 96 h after 3.0 mg/kg DPPC-C hydromorphone. Liposome-encapsulated hydromorphone (DPPC-C) administered SC to healthy dogs provided a sustained duration of serum hydromorphone concentrations.

Initial work experiences of veterinarians who graduated from Australian universities in 2005.

OBJECTIVE: To describe the location, type, support from and effects of their first position for the veterinary graduates of 2005, and to make comparisons with graduates of 1950-2000. PROCEDURE: Questionnaires were sent to veterinarians who had graduated from an Australian university in 2005, and data were analysed with SAS System 8 for Windows. RESULTS: One-sixth of the graduates left for overseas, and 55% (Murdoch) to 85% (Melbourne) of the remainder found their first veterinary position in the state where they were trained. More were in small animal (48%) and less in mixed practice (48%) than in previous decades, and they spent more time (79%) with dogs and cats, and less with horses (9%), cattle (8%) and other production animals (1%). The median income of males working full-time was $43,000 and $39,000 for equivalent females. Most were satisfied with the help and support received from their boss and workplace; approximately 20% felt that support was inadequate, and many felt overworked and underpaid. The graduates with inadequate support were more likely to suffer stress and were less likely to have enjoyed their first year or to agree that they would become a veterinarian again. The levels of perceived support, and of stress, were similar to those reported by graduates of 2000, though more favourable than in the previous 2 decades. CONCLUSIONS: Graduates of 2005 were less likely than their predecessors to start in mixed practice or to work with cattle and horses. Most felt poorly paid, but most, though not all, felt well supported in their first position.

Number, distribution and concentration of Australian veterinarians in 2006, compared with 1981, 1991 and 2001.

OBJECTIVE: To determine the number, concentration and distribution of veterinarians working in Australia in 2006, and compare with data from 1981, 1991 and 2001. Procedure Data on each veterinarian who was registered, resident and apparently working in each Australian state and territory were obtained from relevant veterinary board lists, entered into an Excel spreadsheet and analysed with SAS System for Windows 8. Other data were obtained from the Official Australian Postcode Map, and the Australian Bureau of Statistics. RESULTS: A total of 7510 veterinarians, of whom 46% were female, were working in Australia in 2006. The rate of increase (230/year) between 2001 and 2006 was greater than for the previous 20 years. The number per million people (360) was 73% higher than in 1981, and more than 30% higher than in the USA and UK. With the establishment of three new veterinary schools the number of graduates, and the total number of veterinarians, will increase further. By 2011 the number of veterinarians is likely to be three-fold greater, and the number per million people two-fold greater than in 1981. The number of veterinarians per million dogs and cats will increase at a greater rate if dog and cat numbers continue to fall. As more than 75% of Australian veterinary work involves dogs and cats this has serious implications for the profession. CONCLUSIONS: Progressively increasing numbers of veterinarians will compete for a constant or diminishing resource--the dogs and cats of Australia. It seems likely that overt signs of oversupply will appear before sufficient numbers of veterinarians enter alternative forms of employment.

Longitudinal study of veterinary students and veterinarians: the first 20 years.

OBJECTIVE: To describe the career paths of veterinary graduates from the University of Queensland during the first 15 years after they graduated, paying particular attention to the fifteenth year. PROCEDURE: Longitudinal study. Questionnaires were completed by 154 first year veterinary students in 1985 and 1986, then while they were in fifth year, and after 1, 5, 10 and 15 years after they graduated. This paper describes findings from the most recent questionnaire but includes comparisons with previous ones. RESULTS: Completed questionnaires were received from 134 of the 137 graduates. They were spread widely, but 58% were in Queensland and 20% in New South Wales; 17% were overseas. Most (85%) were in private practice, and 56% of them were part or sole owners; 58% were working in cities with > 100,000 people, and 28% in centres with < 10,000 people. Overall 80% of the workload of the group was with dogs and cats, 8% with horses and 11% with farm animals. Most felt that their income was too low. Of those doing less than half-time or no veterinary work, 44% were at home with family, 8% in another business, 11% another profession, and the rest in a wide variety of occupations. Changed interests, need for greater challenges, poor remuneration, loss of interest in veterinary work, and caring for family were, in order, the top five (of 15) reasons for leaving veterinary work. Three-quarters (78%) of all those doing veterinary work, but 52% of those no longer doing veterinary work agreed that their career had lived up to their expectations. CONCLUSION: After 15 years 77% were still doing veterinary work, 85% in private practice, and 80% of their work was with dogs and cats. Almost all were either very glad or generally glad that they had done the veterinary course, though most (78%) felt that their income was too low.

Longitudinal study of veterinary students and veterinarians: family and gender issues after 20 years.

OBJECTIVE: To examine and compare some family issues and work experiences of males and females who graduated as veterinarians 15 years ago. PROCEDURE: Questionnaires were completed by 134 of 137 veterinarians who graduated 15 years ago, and who had been surveyed in their first and final years as students, and 1, 5, 10 and 15 years after they graduated. Comparisons were made with official statistics, information from earlier surveys in this longitudinal study, and data from a previously published national study. RESULTS: By 15 years after they graduated, 82% had been married or in a comparable long-term relationship, and 23% of these were to another veterinarian. Thirteen percent of those who had been married were now separated or divorced, and 50% of them had remarried, a similar proportion to official statistics for Australians of comparable age. Approximately 20% of both males and females were doing no veterinary work, but more males (68%) than females (37%) were doing veterinary work full time. Most who were doing veterinary work were in private practice, and of these, small animals represented 76% of the work of the males and 88% of the work of the females. Females in private practice were more likely to be employees, especially if working part time, but those working full time were just as likely as males to be practice owners. In general males earned more than females. CONCLUSION: By 15 years after graduation, the percentages of males and females doing some veterinary work are similar, although males are more likely than females to be working full time. Females and males in full time private practice are equally likely to be practice owners, but female owners and female employees earn less than comparable males. Males and females have similar attitudes to having done the veterinary course.

Longitudinal study of veterinary students and veterinarians: effects of growing up on a farm with animals.

OBJECTIVE: To compare the career paths of veterinarians who had grown up on farms with animals with those of veterinarians from other backgrounds, during the first 15 years after they graduated. PROCEDURE: Questionnaires were completed by veterinary students in their first and fifth year, and after 1, 5, 10 and 15 years after they graduated. The most recent questionnaires were returned by 134 of 137 graduates, 20% of whom had grown up, or lived for at least two years, on farms where animals were a primary source of income. This paper includes findings from that questionnaire but also contains comparisons with previous ones. RESULTS: Fifteen years after they graduated, veterinarians who had grown up on farms with animals were more likely than those of other backgrounds to be living in centres with < 10,000 people (58% farm, 20% other), irrespective of the type of work they were doing. Although they were more likely to be doing no veterinary work (42% farm, 21% other), they were also more likely to be working in mixed practice (15% farm, 9% other) and with cattle and sheep generally (11% full time equivalent farm, 5% full time equivalent other). However, > 80% of those who had started their careers in mixed practice were no longer in mixed practice after 15 years. Veterinarians of farm origin who were in private practice were more likely to be sole or part owners (93% farm, 46% other) and less likely to be employees (7% farm, 54% other). CONCLUSIONS: In this study, veterinarians who had grown up on farms with animals seemed slightly more likely than those from other backgrounds to continue working in mixed practice and to work with cattle or sheep, although the numbers were small and the differences not significant. Whatever their background, the majority who started their careers in mixed practice left over the next few years, and by 15 years only 15% remained.

Effect of different methods of selection on the background, attitudes and career plans of first year veterinary students.

OBJECTIVES: To compare the family, educational and animal-related backgrounds and career aspirations of students who were selected on the basis of academic criteria with those selected using additional criteria. METHODS: Questionnaires were completed during class time in the first few weeks of enrolment by incoming veterinary students at the University of Sydney, who had been selected on the basis of academic background, and at Charles Sturt University, selected using more broadly-based criteria. The data were transferred to an Excel spreadsheet, and frequency distributions and chi2 statistics estimated using the SAS System for Windows 8. RESULTS: Students selected principally on academic criteria alone had higher average UAI scores, were more likely to have completed high school in a capital city, and to have parents with higher education levels than those selected using additional criteria. Both groups indicated that their choice of veterinary science was based largely on their affinity for animals and keenness to work in a veterinary practice. However, those at CSU placed much greater importance than those at Sydney on a desire to live and work in a rural area, and a desire to help farmers. The broad-based selection methods were the main reasons for students applying to CSU whereas the reputation of the university was the main attraction for Sydney students. Two-thirds of CSU students, but one-third of Sydney students, planned to enter rural mixed practice when they graduated, and most planned to stay for at least 10 years. Conversely, no CSU students, but 42% of those at Sydney, planned to enter small animal practice initially. The percentage planning to work full-time in the first, fifth and tenth year after graduation was not significantly different between the two groups. CONCLUSIONS: Criteria which included actual experience with farm animals have resulted in the selection of more students who plan to enter and remain in rural mixed practice. Further studies over the longer term will be necessary to assess the extent to which these plans are realized.

Recent veterinary graduates over the last five decades: recollections and perceptions.

OBJECTIVE: To describe the attitudes of veterinary graduates over the last 50 years to their experiences as recent graduates DESIGN: A questionnaire, sent by mail. PROCEDURE: A questionnaire seeking information on experiences as a recent graduate was sent to about 100 veterinarians who graduated in or about 1950, 1960, 1970, 1980, 1990 and 2000, and 68% responded. Data were entered onto an Excel spreadsheet, and analysed with the SAS System 8 for Windows. RESULTS: Most veterinarians who graduated in 1970 and earlier were generally satisfied with their conditions, even though these were often taxing. In the 1970s the cattle industry faltered and rural practice suffered a downturn. Veterinary positions became scarce, and there were few opportunities for graduates to move on from an unsatisfactory workplace--as many were at that time. By 1980 many recent graduates were questioning their decision to study veterinary science. Many of them, working long hours under often stressful conditions, felt that that they were not receiving adequate help or support--or remuneration--from their employers, or respect from their clients. This also afflicted many who graduated in 1990, but by 2000 graduates were reporting an improvement. Their hours of work and the expectations placed on them were more manageable, and the level of help and support, and remuneration, were more acceptable. As a result they found their first year much more enjoyable than had those who had graduated since about 1970. Many of the factors contributing to this improvement resulted from changes in society generally. Specifically, both graduates and employers have become more conscious of what might reasonably be expected, an Award specified minimum levels, the AVA started accrediting New Graduate Friendly Practices, publishing a most informative New Graduate Guide, and helping in other ways. Remuneration, especially when compared with comparable professions, continues to be a source of discontent. Furthermore, despite improved conditions on average, many graduates still suffer under substandard conditions, and these can have an adverse effect on their health and their attitude to their career in veterinary science. CONCLUSIONS: Average conditions of employment of recent veterinary graduates have improved somewhat after a nadir in the 1970s and 1980s, but they are still substandard for some. Remuneration remains the greatest source of dissatisfaction for recent graduates.