Web-based intervention for young adults experiencing anxiety and hazardous alcohol use: Study protocol for an 18-month randomized controlled trial.

BACKGROUND AND AIMS: Alcohol use and anxiety often co-occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and cost-effectiveness of a web-based, self-guided alcohol and anxiety-focused program, compared with a web-based brief alcohol-focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects. DESIGN: This RCT will be conducted with a 1:1 parallel group. SETTING: The study will be a web-based trial in Australia. PARTICIPANTS: Individuals aged 17-30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks. INTERVENTION AND COMPARATOR: Participants will be randomly allocated to receive a web-based, integrated alcohol-anxiety program plus technical and motivational telephone/e-mail support (intervention) or a web-based brief alcohol-feedback program (control). MEASUREMENTS: Clinical measures will be assessed at baseline, post-intervention (2 months), 6 months (primary end-point), 12 months and 18 months. Co-primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge-drinking frequency; alcohol-related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post-intervention), health-care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention-to-treat framework. The economic evaluation will analyze individual-level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change. COMMENTS: This will be the first trial to test whether a developmentally targeted, web-based, integrated alcohol-anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol-anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost.

Successful use of cinacalcet monotherapy in the management of siblings with homozygous calcium-sensing receptor mutation.

OBJECTIVES: Neonatal severe hyperparathyroidism (NSHPT) due to pathogenic mutations in the calcium-sensing receptor (CASR) is a serious medical condition that can lead to symptomatic hypercalcaemia and has detrimental effects on a child's growth and development. What is new: This report adds to evidence that homozygous CASR mutations can be managed with cinacalcet monotherapy as an alternative to parathyroidectomy. And, early use of cinacalcet in NSHPT can result in improvements in symptoms, growth and developmental milestones. CASE PRESENTATION: We present two siblings with NSHPT due to homozygous mutation in the CASR gene with moderate hypercalcaemia. Both were treated with cinacalcet monotherapy and showed significant improvement in growth parameters including head circumference, developmental milestones and hypercalcaemic symptoms, once their calcium and parathyroid hormone levels normalised. CONCLUSIONS: This report highlights the role of cinacalcet in managing elevated serum calcium levels in a select group of infants with NSHPT due to homozygous CASR mutations, resulting in improvement in hypercalcaemic symptoms, growth and neurodevelopmental outcomes.

Organizational Interventions to Support Second Victims in Acute Care Settings: A Scoping Study.

OBJECTIVES: Health care providers that experience harm after adverse events have been termed "second victims." Our objective was to characterize the range and context of interventions to support second victims in acute care settings. METHODS: We performed a scoping study using Arksey and O'Malley's process. A library scientist searched PubMed, Cumulative Index of Nursing and Allied Health, EMBASE, and Cochrane Central Register of Controlled Trials in September 2017, and updated the search in November 2018. We sought gray literature (Canadian Electronic Library, Proquest and Scopus) and searched reference lists of included studies. Stakeholder organizations and authors of included studies were contacted. Two reviewers independently reviewed titles and abstracts and extracted data. A qualitative approach was used to categorize the context and characteristics of the 22 identified interventions. RESULTS: After screening 5634 titles and abstracts, 173 articles underwent full-text screening. Twenty-two interventions met the criteria and were categorized as providing peer support (n = 8), proactive education (n = 6), or both (n = 8). Programs came from Canada (n = 2), Spain (n = 2), and the United States (n = 18). A specific traumatic event triggered the development of 5 programs. Some programs used a standard definition of second victims, (n = 6), whereas other programs had a broader scope (n = 12). Confidentiality was explicitly assured in 9 peer support programs. Outcome measures were often not reported. CONCLUSIONS: This is a new area of study with little qualitative data from which to determine whether these programs are effective. Many programs had a similar design, based on the structure proposed by the same small group of experts in this new field. Concerns about potential legal proceedings hinder documentation and study of program effectiveness.

Successful Management of Open, Contaminated Metacarpal Fractures in an Adult Snowy Owl ( Bubo scandiacus) With a Minimal Type II External Skeletal Fixator.

An adult, male snowy owl ( Bubo scandiacus) was found down and unable to fly in western New York State. Physical examination and radiographs revealed a subacute, open wound and fractured major and minor metacarpals of the right wing. A minimal type II external skeletal fixator (ESF) device was placed on the right major metacarpal bone and the open wound was allowed to granulate and close. After evidence of bone union, the ESF device was removed. The owl performed auto-physiotherapy throughout the process and was released with sustained flight 2 months postoperatively. It was recaptured 7 weeks later and underwent further rehabilitation to allow successful release 11 months after surgical stabilization. To our knowledge, this is the first case report describing use of a type II ESF device on the metacarpus of a bird.

Vaccination of Ferrets for Rabies and Distemper.

Companion ferrets need to be vaccinated against 2 viral diseases that cause neurologic illness: canine distemper and rabies. Although not common in ferrets, both viruses are fatal in ferrets and rabies virus is also fatal in humans. In this article, we provide a basic review of the 2 diseases, highlighting key neurologic concerns. We also review and update current vaccine concerns from a practitioner's perspective, including available vaccines, vaccine schedule recommendations, vaccine reactions, and risk assessment. Last, we mention the ferret and its use in cutting-edge vaccine development.

The role of vocal tract and subglottal resonances in producing vocal instabilities.

During speech and singing, the vibrating vocal folds are acoustically loaded by resonant ducts upstream (the trachea) and downstream (the vocal tract). Some models suggest that the vocal fold vibration (at frequency fo) is more stable at frequencies below that of a vocal tract resonance, so that the downstream load is inertive (mass-like). If so, vocal fold vibration might become unstable when fo and resonance frequencies "cross over" and the load varies rapidly in phase and magnitude. In one experiment, singers produced a slow diphthong at constant pitch, thus shifting the first tract resonance R1 across fixed fo. In another, pitch glides took fo across the tract and subglottal resonances. Few instabilities occurred when singers could change lip geometry and thus alter R1. This suggests that avoiding resonance crossings can aid vibrational stability. In experiments in which R1 was constrained using a mouth ring, instabilities occurred at frequencies above R1. When subjects sang into an acoustically infinite pipe, which provided a purely resistive load at the lips, R1 was eliminated. Here, instabilities were reduced and concentrated near the lower limit of the head voice.

Upregulation of ATF3 inhibits expression of the pro-inflammatory cytokine IL-6 during Neisseria gonorrhoeae infection.

Neisseria gonorrhoeae regulates the expression of epithelial cell genes, activates cytoprotective pathways in the infected cell and protects it from apoptosis. Many of these responses are enhanced by the Type IV pilus (Tfp). We tested the hypothesis that N. gonorrhoeae modulates the innate immune response by inducing expression of ATF3, a transcription factor that negatively regulates the expression of many cytokine genes. We further determined whether Tfp are involved in these events. We found that N. gonorrhoeae induces ATF3 expression in mucosal epithelial cells through activation of mitogen-activated protein kinases. Maximal ATF3 expression requires Tfp retraction. Knocking down endogenous levels of ATF3 results in higher levels of IL-6 transcript. Our findings strongly suggest that ATF3 is involved in suppressing cytokine expression during gonococcal infection. We propose a model for the role of ATF3 in the context of N. gonorrhoeae infection.

Bacterial and parasitic diseases of Columbiformes.

Bacterial and parasitic diseases are not uncommon in domestic doves and pigeons. Many of the bacteria and parasites found in columbids do not cause disease unless the birds are immunocompromised. Often there are underlying viral infections that contribute to illness. This article focuses on some of the more common infections from a practical clinical point of view. Recent updates from the literature are included.

Restraint and administration of subcutaneous fluids and intramuscular injections in psittacine birds.

This column provides an overview of restraint in psittacine birds and administration of subcutaneous fluids and intramuscular injections. The principles described here may be also used on other families of birds.

Administration of doxycycline in drinking water for treatment of spiral bacterial infection in cockatiels.

OBJECTIVE: To determine efficacy of providing drinking water medicated with doxycycline for treatment of spiral bacterial infection in cockatiels. DESIGN: Randomized controlled clinical trial. Animals-18 cockatiels (Nymphicus hollandicus) naturally infected with spiral bacteria. PROCEDURES: Spiral bacterial infection was diagnosed by means of cytologic examination of swab specimens from the choana and oropharynx. Eleven birds (treatment group) were given drinking water to which doxycycline hyclate had been added at a concentration of 400 mg/L for 30 days; the remaining 7 birds (control group) were given unmedicated water. After completion of the study, 6 control birds were treated with drinking water medicated with doxycycline for 21 days. RESULTS: Daily mean plasma doxycycline concentration for birds in the treatment group ranged from 2.26 to 2.86 Mg/mL (overall range, 0.83 to 4.34 Mg/mL). All treated birds were negative for spiral bacteria after treatment for 21 days and remained negative when examined 160 days after treatment ended. Control birds remained positive for spiral bacteria. Control birds treated with doxycycline after completion of the study were negative for spiral bacteria after treatment for 21 days and 30 days after treatment ended. No clinically important adverse effects were associated with treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that providing drinking water to which doxycycline had been added at a concentration of 400 mg/L was effective in eliminating spiral bacterial infections in cockatiels.

GTP cyclohydrolase I gene transfer reverses tetrahydrobiopterin deficiency and increases nitric oxide synthesis in endothelial cells and isolated vessels from diabetic rats.

Nitric oxide (NO) synthesis in endothelial cells is impaired in diabetes. We previously showed that impaired NO synthesis in the spontaneously diabetic BB (BBd) rat is due to decreased levels of tetrahydrobiopterin (BH4), secondary to decreased expression of GTP cyclohydrolase I (GTPCH). The aim of this study was to utilize adenoviral GTPCH gene transfer to reverse BH4 deficiency and repair the ability of endothelial cells to produce NO. GTPCH gene transfer increased BH4 levels in BBd endothelial cells from 0.17 +/- 0.02 (mean +/-SE) to 73.37 +/- 14.42 pmol/million cells and NO production from 0.77 +/- 0.07 to 18.74 +/- 5.52 nmol/24 h/million cells. To demonstrate a functional effect of increasing BH4 concentrations in tissues, we transferred GTPCH into aortic rings from BBd and Zucker diabetic fatty (ZDF) rats, models of human type I and type II diabetes, respectively. GTPCH gene transfer led to a dose-dependent increase in acetylcholine-induced vasorelaxation, preventable by inhibiting NO synthase. Maximal relaxation of virus-treated rings (10(10) virus particles/ml) to acetylcholine was significantly higher than sham-treated rings (BBd 64% vs. 37%, P<0.005; ZDF 80% vs. 44%, P<0.05). This study demonstrates that GTPCH gene transfer can reverse BH4 deficiency in both type I and type II diabetes and provides an experimental basis for using gene therapy to treat cardiovascular complications in diabetic patients.

Nutritional support for children with cancer.

Children with cancer are at risk of suffering from under nutrition, which can affect tolerance of therapy and may influence their overall survival. The goals of nutritional support in the cancer patient are to achieve and maintain desirable weight and to prevent or correct nutritional deficiencies. So early identification of patients at high risk for malnutrition is essential. There are different options for nutritional support. Oral feeding, when possible, is the first line. Enteral nutrition should be considered for those patients who cannot consume adequate macronutrients by mouth. Options are nasogastric tube or gastrostomy tube feeding. The advantages of enteral nutrition, when compared with parenteral nutrition, include better maintenance of the structural and functional integrity of the gastrointestinal tract, a decreased risk of bacterial translocation, greater ease and safety of administration, more physiologic and efficient use of nutrient substrates, decreased hepato-biliary complications, improved outcome and cost-effectiveness. Thus, parenteral nutrition should be considered if the gut is not functioning adequately to allow the normal absorption and digestion of nutrients or if enteral nutritional support is not sufficient to meet nutritional needs. Nutritional assessment and support should be integrated into treatment protocols for all children with neoplastic diseases.