Focal tetanus involving both thoracic limbs successfully treated with magnesium sulfate in a dog

A six-year-old, male, neutered Cocker spaniel was referred for a three-week history of progressive thoracic limb stiffness. The dog became non-ambulatory due to severe thoracic limb stiffness, which was exacerbated by external stimuli. The pelvic limbs appeared to be normal. Based on the history and the physical examination, a presumptive diagnosis of focal tetanus of the thoracic limbs was made. The dog was treated supportively with tetanus antitoxin, antimicrobials, sedation and muscle relaxants; however, this treatment did not control the muscle spasms adequately. Magnesium sulphate was added to alleviate the muscle spasms and to reduce the sedation requirements. The dog improved and was discharged after three weeks of intensive treatment.

A-03 SCAT5 Cognitive Screening Normative Data and Reliable Change Indices

Objective

This study provides normative data on the SCAT5 Cognitive Screening, establishes test-retest reliability, and creates clinically relevant cut points for low performance.

Method

The multisport baseline sample was composed of 727 uninjured college athletes (52% female) at a Division I university who were administered the SCAT5 before the 2017–2018 season. Descriptive statistics, including base rates of low performance, were calculated for SCAT5 indices. Repeat baseline testing was completed by 325 athletes (48% female) at 1 year (days M = 352.56;SD = 56.03) who were included in the test-retest reliability and practice effect analyses. Reliable change indices were calculated.

Results

Descriptive statistics for SCAT5 were computed for both baselines (Baseline 1: SAC total M = 35.15,SD = 4.93; immediate recall total M = 20.01,SD = 3.46; delayed recall total M = 6.43,SD = 1.75). A difference in descriptive statistics and practice effects by sex on the SCAT5 Cognitive Screening has been demonstrated (Bailey, Meyer, Tangen et al., under review). For female athletes, the 1st administration cutoff scores for abnormal performance (<10th%ile) included SAC total score = 33, immediate recall score = 18, and delayed recall score = 6. For male athletes, the 1st administration cutoff scores for abnormal performance (<10th%ile) included SAC total score = 30, immediate recall score = 17, and delayed recall score = 5. Test-retest reliability of the SAC was similar to previous versions but varied by sex. Reliable change indices (RCI) were created with cut points for significant change.

Conclusions

The present study provides clinically relevant normative data for the SCAT5 Cognitive Screening. Cut points for low performance on both reliable chance indices (RCIs) and normative performance reflected meaningful sex differences that could influence clinical interpretation.

Calibration and validation of the DNDC model to estimate nitrous oxide emissions and crop productivity for a summer maize-winter wheat double cropping system in Hebei, China

The main aim of this paper was to calibrate and evaluate the DeNitrification-DeComposition (DNDC) model for estimating N₂O emissions and crop productivity for a summer maize-winter wheat double cropping system with different N fertilizer rates in Hebei, China. The model's performance was assessed before and after calibration and model sensitivity was investigated. The calibrated and validated DNDC performed effectively in estimating cumulative N₂O emissions (coefficient of determination (1:1 relationship; r²) = 0.91; relative deviation (RD) = -13 to 16%) and grain yields for both crops (r² = 0.91; RD = -21 to 7%) from all fertilized treatments, but poorly estimated daily N₂O patterns. Observed and simulated results showed that optimal N fertilizer treatment decreased cumulative N₂O flux, compared to conventional N fertilizer, without a significant impact on grain yields of the summer maize-winter wheat double cropping system. The high sensitivity of the DNDC model to rainfall, soil organic carbon and temperature resulted in significant overestimation of N₂O peaks during the warm wet season. The model also satisfactorily estimated daily patterns/average soil temperature (^o C; 0-5 cm depth) (r² = 0.88 to 0.89; root mean square error (RMSE) = 4 °C; normalized RMSE (nRMSE) = 25% and index of agreement (d) = 0.89-0.97) but under-predicted water filled pore space (WFPS; %; 0-20 cm depth) (r² = 0.3 to 0.4) and soil ammonium and nitrate (exchangeable NH₄⁺ & NO₃^-; kg N ha^-1; r² = 0.97). With reference to the control treatment (no N fertilizer), DNDC was weak in simulating both N₂O emissions and crop productivity. To be further improved for use under pedo-climatic conditions of the summer maize-winter wheat double cropping system we suggest future studies to identify and resolve the existing problems with the DNDC, especially with the control treatment.

Barley sodium content is regulated by natural variants of the Na+ transporter HvHKT1;5

During plant growth, sodium (Na+) in the soil is transported via the xylem from the root to the shoot. While excess Na+ is toxic to most plants, non-toxic concentrations have been shown to improve crop yields under certain conditions, such as when soil K+ is low. We quantified grain Na+ across a barley genome-wide association study panel grown under non-saline conditions and identified variants of a Class 1 HIGH-AFFINITY-POTASSIUM-TRANSPORTER (HvHKT1;5)-encoding gene responsible for Na+ content variation under these conditions. A leucine to proline substitution at position 189 (L189P) in HvHKT1;5 disturbs its characteristic plasma membrane localisation and disrupts Na+ transport. Under low and moderate soil Na+, genotypes containing HvHKT1:5P189 accumulate high concentrations of Na+ but exhibit no evidence of toxicity. As the frequency of HvHKT1:5P189 increases significantly in cultivated European germplasm, we cautiously speculate that this non-functional variant may enhance yield potential in non-saline environments, possibly by offsetting limitations of low available K+.

Links between self-injury and suicidality in autism

BACKGROUND

Autistic individuals without intellectual disability are at heightened risk of self-injury, and appear to engage in it for similar reasons as non-autistic people. A wide divergence of autistic perspectives on self-injury, including those who frame it as a helpful coping mechanism, motivate investigating the link between self-injury, suicide ideation, and attempts which has been reported in typically developing individuals.

METHOD

One hundred three autistic participants completed the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the Suicide Behaviors Questionnaire (SBQ-R), and the Interpersonal Social Evaluation List (ISEL-12) across two online studies. Logistic regression was conducted to predict self-harming status via responses to questions on suicidality, and to predict whether certain self-injurious behaviors, including cutting, were especially associated with suicide ideation and attempts. Non-parametric correlation analysis examined relationships between suicide ideation/attempts and other variables that might characterize self-harmers especially at risk of suicidality. These included perceived access to social support, purposes or reasons for self-injury, the number of different self-injurious behaviors engaged in, the duration and lifetime incidence of self-injury, and the individual's feelings about their self-injury.

RESULTS

While self-injuring status was significantly predicted by responses to a question on suicide ideation and attempts, there was no relationship between suicide ideation/attempts and a participant's personal feelings about their self-injury. The method of cutting was also predicted by suicide ideation and attempts, though other methods common in autistic people were at borderline significance. Use of self-injury for the regulation of low-energy emotional states like depression, for self-punishment or deterrence from suicide, and for sensory stimulation, was associated with suicide ideation and attempts, as was the number of self-injurious behaviors engaged in. There was no significant relationship between suicide ideation/attempts and the duration and lifetime incidence of self-injury or social support.

CONCLUSIONS

These preliminary data suggest that while individuals might frame their self-injury as a positive or neutral thing, there remains a concerning relationship between self-injury and suicidality which exists regardless of individual feelings on self-injury. This is consistent with the theoretical perspective that self-injury can be a "gateway" through which individuals acquire capability for lethal suicidal behaviors. The data highlight that particular methods (cutting) and reasons for self-injury may be of significant concern, but this information, which might be of extreme value for clinicians, requires further investigation and validation.

Determination of Lipids in Fish Meal

Lipids were extracted from a series of twelve menhaden meals by six methods, and results were compared. The chloroformmethanol extraction method developed by Smith, et al., extracts approximately the same amount of lipids as the official AOAC method, 22.037. The Torry-TNO method with chloroform-methanol extraction, and acid and alkaline hydrolysis methods extract lesser amounts of lipids, but all methods extract more than the ethyl ether method, 22.032. The Smith-Ambrose-Knobl method, rather than AOAC method 22.037, is recommended for extraction of total lipids from fish meal because of its simplicity and efficiency.

Gas Chromatographic Determination of Volatile Congeners in Spirit Drinks: Interlaboratory Study

An interlaboratory study of a gas chromatographic (GC) method for the determination of volatile congeners in spirit drinks was conducted; 31 laboratories from 8 countries took part in the study. The method uses GC with flame ionization detection and incorpo rates several quality control measures which permit the choice of chromatographic system and conditions to be selected by the user. Spirit drink samples were prepared and sent to participants as 10 blind duplicate or split-level test materials for the determination of 1,1-diethoxyethane (acetal), 2-methylbutan-1-ol (active amyl alcohol), 3-methylbutan-1-ol (isoamyl alcohol), methanol (methyl alcohol), ethyl ethanoate (ethyl acetate), butan-1-ol (n-butanol), butan-2-ol (sec-butanol), 2-methylpropan-1-ol(isobutyl alcohol), propan-1-ol (n-propanol), and ethanal (acetaldehyde). The precision of the method for 9 of the 10 analytes was well within the range predicted by the Horwitz equation.The precision of the most volatile analyte, ethanal, was just above statistically predicted levels. This method is recommended for official regulatory purposes.

“Pay for Quality” (P4Q) as a quality strategy

P4Q can be implemented in various health care settings, targeting a range of health care providers or professionals. P4Q schemes can reward high quality measured in terms of structures, processes, and/or outcomes, and/or penalise low quality and are implementable in line with other quality improvement interventions. This presentation aims to clarify the concept of P4Q, highlight the use of P4Q schemes in different settings in European countries, and systematize the evidence on the effectiveness, cost-effectiveness and implementation of P4Q as a quality strategy.

We could identify fourteen primary care P4Q programmes and thirteen hospital P4Q programmes in a total of 16 European countries. P4Q schemes in primary care incentivise mostly process and structural quality with respect to prevention and chronic care. P4Q schemes in hospital care prioritize improvements in health outcomes and patient safety. Studies suggest small positive effects on process-of-care (POC) indicators in primary care but not in hospital care. Evidence on health outcomes and patient safety indicators is inconclusive. Cost-effectiveness is unlikely because of lacking effectiveness. P4Q schemes are more effective when the focus of a scheme is on areas of quality where change is needed and if the scheme embraces a more comprehensive approach, covering many different areas of care; however, such programmes are generally technically and politically difficult to implement. In this light, this presentation will conclude with a number of recommendations, both technical and policy-oriented.

Imaging hepatic angiomyolipomas: key features and avoiding errors

Hepatic angiomyolipomas (HAMLs) are rare mesenchymal neoplasms, which have highly variable imaging appearances, often leading to misdiagnosis. They belong to the family of perivascular epithelioid cell neoplasms (PEComas). HAMLs have a wide spectrum of imaging appearances due to variable amounts of smooth muscle cells, adipose tissue, and blood vessels in their makeup. Although typically sporadic, they are also associated with tuberous sclerosis. Sporadic lesions tend to be solitary whilst patients with tuberous sclerosis often have multiple HAMLs invariably accompanied by renal AMLs. Having been originally considered benign hamartomas, increasing reports of complications, including malignant behaviour, has also resulted in uncertainty in regard to their optimal management. Typically described imaging characteristics are of a hypervascular fat-containing lesion with prominent intratumoural vessels and an early draining vein; however HAMLs commonly demonstrate a paucity of fat or wash-out on contrast-enhanced imaging, and not all HAML lesions are hypervascular. HAMLs can therefore easily be misdiagnosed as other hepatic lesions, in particular hepatocellular carcinoma. This review describes the imaging characteristics of HAMLs, illustrating the wide variety of potential appearances across ultrasound, contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging, and highlights the challenges and potential errors that can be made. This review will aid radiologists in avoiding potentially major pitfalls when faced with this rare but important liver pathology.

B-48 Effects of Anxiety on Response to a Subsymptom Threshold Exercise Program for Treatment of Persistent Post-Concussive Symptoms: A Pilot Randomized Clinical Trial

Objective

There is a growing literature to support the use of subsymptom threshold exercise for treatment of both acute and chronic post-concussion symptoms. The present study aimed to explore the influence of anxiety on response to exercise intervention for patients with persistent post-concussive symptoms.

Methods

Sixteen adolescents (ages 14-18) with persistent (>1 month) concussion symptoms were randomized into a light, home exercise group and a subsymptom threshold exercise group performed by PT’s (modeled after Leddy et al.,2019). Participants underwent intervention for 6 weeks and completed evaluations at Baseline, Mid-Point, and Follow-up after treatment; evaluations included State-Trait Anxiety Inventory (STAI), the Post-Concussive Scale-Revised (PCS-R), as well as additional measures of emotional functioning, balance disturbance, and neuropsychological functioning.

Results

Average PCS-R endorsement improved by 21 points from Baseline to Follow-up across treatment groups (PCS-R Total Change M = -21.29,SD = 13.54). There were meaningful Baseline differences between intervention groups in STAI state anxiety (p < .05) and STAI trait anxiety (p = 0.51); STAI variables were used as covariates in an ANOVA comparing mean PCS-R Percent Change between treatment and control groups. After removing the influence of anxiety, the intervention groups significantly differed and showed large effect (F(3,13) = 6.94,p < .05,partial eta2 = .41), with the intervention group improving (PCS-R Percent Change M = -63.3,SD = 17.4) more than the control group (PCS-R Percent Change M = -56.8,SD = 27.8).

Conclusion

Exercise intervention appears to be more effective than standard-of-care light activity in the treatment of persistent symptoms in adolescents; however, anxiety may alter response to intervention. Complimentary mental health treatment may augment response to exercise intervention and optimize concussion recovery trajectory in patients with persisting symptoms.

Long-term organic farming on a citrus plantation results in soil organic carbon recovery

It has been shown that soil management under organic farming can enhance soil organic carbon, thereby mitigating atmospheric greenhouse gas increases, but until now quantitative evaluations based on long term experiments are scarce, especially under Mediterranean conditions. Changes in soil organic carbon (SOC) content were examined in response to organic management with cover crops in a Mediterranean citrus plantation using 21 years of survey data. Soil organic carbon increase was more apparent 5 years after a land management change suggesting that, for citrus plantations on Mediterranean conditions, studies should be longer than five years in duration. Soil organic carbon sequestration rate did not significantly change during the 21 years of observation, with values ranging from -1.10 Mg C ha-1 y-1 to 1.89 Mg C ha-1 y-1. After 21 years, 61 Mg CO2 ha-1 were sequestered in long-lived soil C pools. These findings demonstrate that organic management is an effective strategy to restore or increase SOC content in Mediterranean citrus systems.

Environmental impacts of dietary shifts in India: A modelling study using nationally-representative data

Food production is a major driver of environmental change, and unhealthy diets are the leading cause of global disease burden. In high-income countries (HICs), modelling studies suggest that adoption of healthy diets could improve population health and reduce environmental footprints associated with food production. We assessed whether such benefits from dietary change could occur in India, where under-nutrition and overweight and obesity are simultaneously prevalent. We calculated the potential changes in greenhouse gas (GHG) emissions, blue and green water footprints (WFs), and land use (LU), that would result from shifting current national food consumption patterns in India to healthy diets (meeting dietary guidelines) and to "affluent diets" (those consumed by the wealthiest quartile of households, which may represent future purchasing power and nutritional trajectories). Dietary data were derived from the 2011-12 nationally-representative household expenditure survey, and we assessed dietary scenarios nationally and across six Indian sub-regions, by rural or urban location, and for those consuming above or below recommended dietary energy intakes. We modelled the changes in consumption of 34 food groups necessary to meet Indian dietary guidelines, as well as an affluent diet representative of those in the highest wealth quartile. These changes were combined with food-specific data on GHG emissions, calculated using the Cool Farm Tool, and WF and LU adapted from the Water Footprint Network and Food and Agriculture Organization, respectively. Shifting to healthy guidelines nationally required a minor increase in dietary energy (3%), with larger increases in fruit (18%) and vegetable (72%) intake, though baseline proportion of dietary energy from fat and protein was adequate and did not change significantly. Meeting healthy guidelines slightly increased environmental footprints by about 3-5% across GHG emissions, blue and green WFs, and LU. However, these national averages masked substantial variation within sub-populations. For example, shifting to healthy diets among those with dietary energy intake below recommended guidelines would result in increases of 28% in GHG emissions, 18 and 34% in blue and green WFs, respectively, and 41% in LU. Decreased environmental impacts were seen among those who currently consume above recommended dietary energy (-6 to -16% across footprints). Adoption of affluent diets by the whole population would result in increases of 19-36% across the environmental indicators. Specific food groups contributing to these shifts varied by scenario. Environmental impacts also varied markedly between six major Indian sub-regions. In India, where undernutrition is prevalent, widespread adoption of healthy diets may lead to small increases in the environmental footprints of the food system relative to the status quo, although much larger increases would occur if there was widespread adoption of diets currently consumed by the wealthiest quartile of the population. To achieve lower diet-related disease burdens and reduced environmental footprints of the food system, greater efficiency of food production and reductions in food waste are likely to be required alongside promotion of healthy diets.

Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review

OBJECTIVES

This study examined patient adherence and persistence to oral bisphosphonates for the treatment of osteoporosis in real-world settings.

METHODS

A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) and National Health Service Economic Evaluation Database NHS EED) databases were searched for studies published in English language up to April 2018. Prospective and retrospective observational studies that used prescription claim databases or hospital medical records to examine patient adherence and persistence to oral bisphosphonate treatment among adults with osteoporosis were included. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the quality of included studies.

RESULTS

The search yielded 540 published studies, of which 89 were deemed relevant and were included in this review. The mean age of patients included within the studies ranged between 53 to 80.8 years, and the follow-up varied from 3 months to 14 years. The mean persistence of oral bisphosphonates for 6 months, 1 year and 2 years ranged from 34.8% to 71.3%, 17.7% to 74.8% and 12.9% to 72.0%, respectively. The mean medication possession ratio ranged from 28.2% to 84.5%, 23% to 50%, 27.2% to 46% over 1 year, 2 years and 3 years, respectively. All studies included scored between 6 to 8 out of 9 on the NOS. The determinants of adherence and persistence to oral bisphosphonates included geographic residence, marital status, tobacco use, educational status, income, hospitalisation, medication type and dosing frequency.

CONCLUSIONS

While a number of studies reported high levels of persistence and adherence, the findings of this review suggest that patient persistence and adherence with oral bisphosphonates medications was poor and reduced notably over time. Overall, adherence was suboptimal. To maximise adherence and persistence to oral bisphosphonates, it is important to consider possible determinants, including characteristics of the patients.

A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability

Background

Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group.

Methods

One hundred and three autistic adults who responded to an online advertisement were classified as current, historic or non-self-harmers in accordance with responses to the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT). Multinomial regression aimed to predict categorisation of participants in accordance with scores on tests of autistic traits, alexithymia, depression, anxiety, mentalising and sensory sensitivity. Linear regression examined relationships between these predictors and the range, frequency, lifetime occurrence and functional purposes of NSSI. Qualitative analysis explored the therapeutic interventions that participants had found helpful, and what they wished people understood about self-injury.

Results

Current, historic and non-self-harming participants did not differ in age, age at diagnosis, male-to-female ratio, level of employment or education (the majority qualified to at least degree level). The most common function of NSSI was the regulation of low-energy affective states (depression, dissociation), followed by the regulation of high-energy states such as anger and anxiety. Alexithymia significantly predicted the categorisation of participants as current, historic or non-self-harmers, and predicted use of NSSI for regulating high-energy states and communicating distress to others. Depression, anxiety and sensory-sensitivity also differentiated participant groups, and sensory differences also predicted the range of bodily areas targeted, lifetime incidence and frequency of NSSI. Sensory differences, difficulty expressing and identifying emotions also emerged as problematic in the qualitative analysis, where participants expressed the need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers, with some participants perceiving NSSI as a practical, non-problematic coping strategy.

Conclusions

Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.

Electronic supplementary material

The online version of this article (10.1186/s13229-019-0267-3) contains supplementary material, which is available to authorized users.

Developing a health interview tool for Medicaid home and community-based services clients and home care aides through a community-engaged approach

We describe a community-engaged approach to develop and pilot a home care aide (HCA) administered health interview with Medicaid Home and Community-based Services clients. Stakeholders identified five priority health topics and selected a card sorting methodology for interviews. A barrier to interviewing clients was decreased communication skills among HCAs, and we modified health interview training to include communication training. Stakeholders reported the interview methodology was feasible within usual care, acceptable to clients, and contributed to increased knowledge on providing person-centered care. Stakeholder engagement resulted in valuable insights regarding the health interview methodology and relevant training needs.