The human connection

For Roeland Wessels, being a successful and happy vet involves mastering one species in which little training is provided. Claire Read reports.

Avoiding procrastination station

Procrastination is a temptation to which many of us succumb, frequently with an impact on our wellbeing. But according to Jane Davidson, there are techniques that can help. Claire Read reports.

A new start

Fifteen years ago a financial crisis swept the world. It was a hard time for Jamie Crittall's practice but, as he tells Claire Read, adversity can bring new and positive opportunities.

The gift of giving

Being kind, and reflecting on that kindness, can offer real benefits to both giver and receiver. Laura Woodward, vet and counsellor to the vet profession, tells Claire Read more.

Necessary support

A survey found one in 10 women had left work because of symptoms caused by the menopause. As World Menopause Awareness Month continues, Laura Black of Vets Now says it's crucial to introduce support to avoid losing expertise from the workforce. Claire Read reports.

Lending an ear

After Charles Chavasse discovered people seemed to find it easy to talk to him about their worries, he decided to train as a mental health and wellbeing champion - taking on a more formal role in supporting his colleagues. He tells Claire Read more.

Building a supportive workplace

As veterinary practices up and down the country prepare to take part in Macmillan's Coffee Morning, Victoria Bowes tells Claire Read about her experience with cancer - and the importance of workplaces supporting those experiencing ill health.

Supporting mind and body

Claire Gillvray has dedicated her career to exploring the link between physical and mental wellbeing. Claire Read speaks to her to find out how being active can impact on the mind as well as the body.

Creating inclusive workplaces

How can we build veterinary workplaces that are equally welcoming to all, and in which all are supported to excel? That's the question at the heart of this month's Balance. Here Claire Read speaks to a number of vets from minority ethnic backgrounds to discuss possible answers to this vital question.

A spectrum of support

Debbie Martin, a veterinary nursing student who is autistic, says supporting neurodiverse people often requires very little adjustment but yields great benefits. Claire Read speaks to her to find out more.

Clinical effects of hypertonic saline boluses in children with severe traumatic brain injury

AIM

To quantify the effects of 3% hypertonic saline (HTS) boluses on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children.

METHODS

A retrospective study of patients admitted to a regional neurosurgical children's intensive care unit.

RESULTS

A total of 156 HTS boluses were given to children with traumatic brain injury. ICP decreased 6 mmHg (P < 0.01) and CPP increased 4 mmHg (P = 0.003) 1-h post-bolus. Effects persisted for 3 h post-dose ICP was 5 mmHg lower) and 4 h post-bolus CPP was 3 mmHg higher. ICP change was not associated with pre-bolus serum sodium concentration.

CONCLUSIONS

Hypertonic saline 3% at 5 mL/kg is an effective osmolar therapy for reducing ICP and increasing CPP in children for up to 3 h. '53-53' is a suitable guide - 5 mL/kg of 3% HTS will on average decrease ICP by at least 5 mmHg for 3 h. Pre-bolus serum sodium concentration is not correlated with effect size.

Investigation of synovial fluid lubricants and inflammatory cytokines in the horse: a comparison of recombinant equine interleukin 1 beta-induced synovitis and joint lavage models

BACKGROUND

Lameness is a debilitating condition in equine athletes that leads to more performance limitation and loss of use than any other medical condition. There are a limited number of non-terminal experimental models that can be used to study early inflammatory and synovial fluid biophysical changes that occur in the equine joint. Here, we compare the well-established carpal IL-1β-induced synovitis model to a tarsal intra-articular lavage model, focusing on serial changes in synovial fluid inflammatory cytokines/chemokines and the synovial fluid lubricating molecules lubricin/proteoglycan 4 and hyaluronic acid. The objectives of this study were to evaluate clinical signs; synovial membrane and synovial fluid inflammation; and synovial fluid lubricants and biophysical properties in response to carpal IL-1β synovitis and tarsal intra-articular lavage.

RESULTS

Hyaluronic acid (HA) concentrations, especially high molecular weight HA, and synovial fluid viscosity decreased after both synovitis and lavage interventions. Synovial fluid lubricin concentrations increased 17-20-fold for both synovitis and lavage models, with similar changes in both affected and contralateral joints, suggesting that repeated arthrocentesis alone resulted in elevated synovial fluid lubricin concentrations. Synovitis resulted in a more severe inflammatory response based on clinical signs (temperature, heart rate, respiratory rate, lameness and joint effusion) and clinicopathological and biochemical parameters (white blood cell count, total protein, prostaglandin E2, sulfated glycosaminoglycans, tumor necrosis factor-α and CC chemokine ligands - 2, - 3, - 5 and - 11) as compared to lavage.

CONCLUSIONS

Synovial fluid lubricin increased in response to IL-1β synovitis and joint lavage but also as a result of repeated arthrocentesis. Frequent repeated arthrocentesis is associated with inflammatory changes, including increased sulfated glycosaminoglycan concentrations and decreased hyaluronic acid concentrations. Synovitis results in more significant inflammatory changes than joint lavage. Our data suggests that synovial fluid lubricin, TNF-α, CCL2, CCL3, CCL5, CCL11 and sGAG may be useful biomarkers for synovitis and post-lavage joint inflammation. Caution should be exercised when performing repeated arthrocentesis clinically or in experimental studies due to the inflammatory response and loss of HA and synovial fluid viscosity.

Detection of herpesvirus capsids in transmission electron microscopy images using transfer learning

The detailed analysis of secondary envelopment of the Human betaherpesvirus 5/human cytomegalovirus (HCMV) from transmission electron microscopy (TEM) images is an important step towards understanding the mechanisms underlying the formation of infectious virions. As a step towards a software-based quantification of different stages of HCMV virion morphogenesis in TEM, we developed a transfer learning approach based on convolutional neural networks (CNNs) that automatically detects HCMV nucleocapsids in TEM images. In contrast to existing image analysis techniques that require time-consuming manual definition of structural features, our method automatically learns discriminative features from raw images without the need for extensive pre-processing. For this a constantly growing TEM image database of HCMV infected cells was available which is unique regarding image quality and size in the terms of virological EM. From the two investigated types of transfer learning approaches, namely feature extraction and fine-tuning, the latter enabled us to successfully detect HCMV nucleocapsids in TEM images. Our detection method has outperformed some of the existing image analysis methods based on discriminative textural indicators and radial density profiles for virus detection in TEM images. In summary, we could show that the method of transfer learning can be used for an automated detection of viral capsids in TEM images with high specificity using standard computers. This method is highly adaptable and in future could be easily extended to automatically detect and classify virions of other viruses and even distinguish different virion maturation stages.

How to Put a Value on the Priceless

A webinar brought together senior figures to consider how we assess the value of sophisticated drugs when the area is such an intellectual and moral maze.

The Nurses who Specialise in Savings

Specialist nurses are far from just the 'icing on the cake' - in inflammatory bowel disease alone they are consistently preventing emergency attendances and ensuring the most appropriate use of services.

Support to Self Manage

The support of a specialist nurse can equip IBD patients to better manage their condition, thereby reducing dependency on hospital services. Claire Read reports.

Supporting Cost Effective Innovations in Treatment

Specialist IBD nurses at key to ensuring cutting edge biological therapies are used in a way which benefits both trust and patient, as Claire Read explains.

How to Go Digital and Influence People

Leaders at some of the NHS global digital exemplar trusts tell Claire Read how stability of leadership and consistency of direction have been key factors in their success.

Ripping up the Rules on Records

Estonia's health record system is a fast-paced success story that began in part when a reorganization left GPs without access to patient information, as Claire Read explains.

Why Good Healing Is A Good Business

Wound infections can dramatically lengthen treatment times and cost the NHS large sums of money, which is why funding for preventative measures is so important, writes Claire Read.

Back to the Drawing Board

A misunderstanding of what 'human factors' means often leads organisations to try to change their people rather than the processes that could transform patient safety, finds Claire Read.

Time to Nurture Better Services

More government funding has been promised to increase specialist mental healthcare for mothers in the perinatal period but this is just part of the action required, writes Claire Read.

Who really wants to see a seven-day clinical service?

The vast majority of the 100 health service leaders surveyed by Siemens and HSJ thought a clinical service operating at the same level every day of the week unnecessary. Claire Reed reports on this and other findings.

Hungry for Change

No one doubts the importance of nutrition in maintaining health and tackling long term conditions but its low priority in the NHS means access is patchy at best. Claire Read asks why this is and what can be done to raise its profile.

Is the NHS Ready to Roster?

E-rostering has long been hailed as an effective solution for organsing the NHS workforce - so why has implementation been slow? Claire Read reports on an HSJ roundtable.

Turning an IT update into a care rethink

An update of an electronic patient record system was seized upon by a Vancouver health authority as the chance to introduce an integrated care plan, reports Claire Read.