Advancing Excellence in Transgender Health: An International Professional Development Conference on Affirming Care for Transgender and Gender Diverse People

OBJECTIVE

Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international conference that offers continuing professional development on evidence-based medical and behavioral healthcare for transgender and gender diverse people across the lifespan.

METHODS

Registration data and post-conference evaluation data were descriptively analyzed to assess conference reach, participant satisfaction, and participant intentions to change practice.

RESULTS

Between 2015 and 2022, AETH trained 2677 participants from all US states and 24 countries. Based on post-conference evaluations, 2017-2022, participant satisfaction was high (mean ≥4.4 on a 5-point scale) on all measures, including meeting learning objectives, quality of presentations, and relevance to practice. Participants reported intentions to: implement new information or skills (86.7%); create or revise protocols, policies, and/or procedures (63.2%); and seek additional information (64.2%). To increase equity, the conference waives fees for transgender and gender diverse participants and offers free online sessions. The conference also holds sessions specifically for transgender and gender diverse participants to promote opportunities for community-building, self-care, and professional networking.

CONCLUSION

The broad reach of AETH demonstrates a large demand for more continuing professional development on transgender and gender diverse healthcare. This conference has expanded the availability of training designed to increase and enhance clinical workforce capacity to meet the health needs of transgender and gender diverse communities in the US and across the world.

Placement of ureteral stents in three rabbits for the treatment of obstructive ureterolithiasis

Management of ureteral obstruction with stenting is often associated with a lower rate of complications than ureterotomy in domestic carnivores, but this treatment has not been previously evaluated in rabbits. Three rabbits (7, 6 and 10 years old) were diagnosed with unilateral obstructive ureterolithiasis associated with hydronephrosis and hydroureter on abdominal ultrasound. Decreased overall renal function was confirmed in all three cases. Ureteral stents were placed retrogradely via cystotomy without complication in two cases and anterogradely via nephrostomy in the third case. Survival after stent placement was 30, 3 and 8 months, with encrustation of the stent and re-obstruction occurring 18, 1 and 6 months after stent placement in successive cases. Ureteral stenting can be considered for short-term management of ureterolithiasis in rabbits to improve renal function and maintain quality of life. Ultrasound or radiographic monitoring is recommended to detect encrustation of the stent. Studies comparing ureteral stenting to ureterotomy in rabbits are needed to determine the effectiveness of these techniques.

Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries

INTRODUCTION

Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities.

METHODS

This study used 2009-2014 Medicare claims to identify people with gender identity-related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non-gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019.

RESULTS

Gender minority beneficiaries had higher unadjusted suicidality than non-gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health-adjusted logistic regression models, gender minorities had higher odds of suicidality than non-gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region.

CONCLUSIONS

Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.

Investigating Responses to Food Insecurity Among HIV Positive People in Resource Rich Settings: A Systematic Review

Many of the 36.7 million people living with HIV are also assumed to be food insecure. The implications of food insecurity in people living with HIV are significant, with food insecurity associated with an increased likelihood of tobacco, alcohol, and illicit drug use, experiences of depression or depressive symptoms, poor adherence and delayed uptake of HIV medication, nutritional vulnerability leading to interference of medication, and the uptake of risky behaviours as a way to gain access to food resources. This review sought to present the current intervention research around the experiences of food insecurity in PLWHA in high resource countries to determine successful models to address the issue. Only five articles were identified in a systematic search, three reported on studies that were conducted in the USA and two in Canada. Two articles were cross sectional, one was a program evaluation, one ethnography, and one took a qualitative approach. This review highlights a lack of published research in the area of HIV and food insecurity in resource rich countries. The findings of this study suggest that there are currently no standard or best practice ways to provide food aid to PLWHA to reduce food security. The lack of published results means that while there may be good programs operating in the community, this information and knowledge is not being shared, resulting in a lack of consistency in approach, possible duplication, and the potential for wasted resources. Overall, this review suggests a need for more dedicated evaluation and longitudinal research.

TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial

BACKGROUND

Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment.

METHODS

The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes.

DISCUSSION

The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship.

TRIAL REGISTRATION

Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Anticoagulant activity of oral rivaroxaban in healthy dogs

Rivaroxaban is an oral, direct factor Xa inhibitor used in human thrombotic disorders. In view of the in vitro concentration dependent anticoagulant effects of rivaroxaban in dogs, the time course of its anticoagulant effects was characterized in healthy dogs. Twenty-four healthy Beagles were randomized into three groups (n = 8 per group) and received orally either a placebo or 20 mg rivaroxaban once or twice at an 8 h interval. Fifteen blood samples were collected over a 30 h period, and blindly assayed for prothrombin time (PT), activated partial thromboplastin time (aPTT), tissue factor induced thrombin generation (TG) and anti-factor Xa activity. Thromboelastography (TEG) was evaluated at 0, 1, 4, 8 and 24 h. Peak/baseline anticoagulant effect ratios were analyzed with generalized linear models using β distributions and times to return to baseline with survival analyses (α = 0.05). Peak/baseline anticoagulant effect ratios of PT, aPTT, anti-factor Xa activity, TG and R (TEG) differed significantly between placebo and both rivaroxaban groups (P <0.0001). The peak anticoagulant effect of rivaroxaban occurred 1.5 to 2 h after dosing. The median return to baseline occurred significantly sooner (P <0.01) with 20 mg rivaroxaban administered once (7.9-18.7 h) versus twice (17.5-26.8 h). The inter-individual variability differed amongst assays, but overall was moderate to large. No adverse effects were recorded. Twice oral administration of 2 mg/kg rivaroxaban at an 8 h interval maintained 24 h anticoagulant activity, but larger studies are needed to establish guidelines for the use of rivaroxaban in dogs.

Acute-Phase Proteins and Iron Status in Cats with Chronic Kidney Disease

Background

The role of inflammation in the development and progression of chronic kidney disease (CKD) in cats is not well characterized. Hepcidin is a recently discovered acute‐phase protein (APP) that plays an important role in iron metabolism and contributes to the development of anemia in humans with CKD.

Objectives

To compare serum APP concentrations, iron status, and erythropoietin (EPO) concentrations in healthy cats and cats with naturally occurring CKD.

Animals

A total of 18 healthy control cats and 38 cats with CKD.

Methods

Prospective study. After complete physical examination and routine blood analysis, the following tests were performed: serum amyloid A (SAA), haptoglobin (HAP), EPO, serum iron and ferritin concentration as well as total iron‐binding capacity (TIBC). Serum hepcidin‐25 concentration was measured by ELISA kit designed for use in humans.

Results

Mean SAA and hepcidin concentrations were significantly higher and mean total iron and TIBC were significantly lower in the CKD group (P < .05). There was a significant positive correlation between serum creatinine concentration (CRT) and 2 of the APPs (SAA and hepcidin; P < .05). Increases in SAA and hepcidin were associated with decreases in TIBC and hematocrit in the CKD group. Fourteen (37%) of the cats with CKD were anemic, and these cats had significantly lower TIBC (P < .05), suggesting a functional iron deficiency. There was no association between survival time and APP, iron status, or EPO concentrations.

Conclusions

Our data suggest that CKD in cats is associated with systemic inflammation and altered iron metabolism. With further validation in cats, hepcidin assays may help better characterize these relationships.

Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates

OBJECTIVES

A new guideline for the early respiratory management of preterm infants that included early nCPAP and INSURE was recently introduced in our NICU. This case series describes the clinical courses of a group of preterm infants managed according to this guideline, and reports the rates of successful extubation within 30 minutes of surfactant administration with and without the use of naloxone and adverse events encountered.

STUDY DESIGN

Descriptive case series of all preterm babies admitted to our unit who were candidates for INSURE procedure with premedication from August 2012 to August 2013.

RESULTS

A total of 31 infants were included with a mean birth weight of 1178 grams and a mean gestational age of 28.4 weeks. Twelve out of thirteen (92%) infants in the naloxone group were extubated within 30 minutes of surfactant administration while only 12/18 (67%) in the non-naloxone group were extubated within the same time frame. No adverse reactions were noted with naloxone usage in this context.

CONCLUSION

Naloxone can be effective in reversing the respiratory depressive effect of analgesic premedication and in turn facilitates expeditious extubation in some preterm infants intubated for INSURE procedure.

Reversal of the Cry-Wolf Effect: An Investigation of Two Methods to Increase Alarm Response Rates

In complex task environments, false alarms have been associated with less frequent and slower alarm responses. This research attempted to improve alarm responses using a hearsay method, in which participants were told that false alarms would be less frequent than they actually were, and an urgency method, in which the urgency of alarms was increased. Response frequency, speed, and accuracy of three groups of 20 students (Urgency, Hearsay, and Control) were compared across groups and sessions using analyses of variance and t tests. Both methods were successful; hearsay participants increased their response rates across sessions, and urgency participants decreased their response times. The results are discussed with regard to design of alarm systems and theory of human performance.

Use of CT to evaluate and compare intranasal features in brachycephalic and normocephalic dogs

OBJECTIVES

To evaluate and compare nasal mucosal contact, septal deviation and caudal aberrant nasal turbinates in brachycephalic and normocephalic dogs using computed tomography.

METHODS

Dogs without nasal disease and having undergone computed tomography scan of the head (plica alaris to the cribiform plate) were retrospectively selected and divided into brachycephalic and normocephalic groups. Eighteen brachycephalic and 32 normocephalic dogs were included. Anatomic criteria were used to locate predetermined pairs of intranasal structures and nasal mucosal contact was described as present or absent for each site. Septal deviations were identified and measured using angle of septal deviation. Caudal aberrant nasal turbinates were identified and categorised when present.

RESULTS

Prevalence of nasal mucosal contact was significantly higher in brachycephalic dogs. No significant difference was seen in prevalence or in angle of septal deviation between groups. Prevalence of caudal aberrant nasal turbinates was significantly higher in brachycephalic dogs.

CLINICAL SIGNIFICANCE

Nasal mucosal contact and caudal aberrant nasal turbinates were significantly more prevalent in brachycephalic dogs than in normocephalic dogs in our study. Computed tomography can be a valuable aid in obtaining data on nasal mucosal contact, caudal aberrant nasal turbinates and septal deviations. Combination of computed tomography with endoscopy and functional airway testing would be useful to further evaluate the correlation between intranasal features and symptoms of brachycephalic airway syndrome.

Location! Location! Location! The Impact of Single-Room Design on Neurodevelopment of Preterm Infants

BACKGROUND: The impact of neonatal intensive care unit (NICU) design on neurodevelopmental outcomes of preterm infants is uncertain. Although single room design (SRD) reduces nosocomial infections and improves breastfeeding rates and parental satisfaction, recent data suggests that SRD may be associated with language delays and alterations in cortical development.

OBJECTIVES: To compare neurodevelopmental outcomes of preterm infants who received care in a contemporary SRD environment compared with a similar cohort who received care during an earlier period with an open bay design (OBD).

DESIGN/METHODS: Retrospective single-centre cohort study comparing the neurodevelopmental outcomes of all surviving extremely low birth weight (ELBW) i nfants admitted within 24 hours of birth in 2009 (OBD epoch) and 2011 (SRD epoch). The primary outcome was moderate or severe neurodevelopmental impairment using the Bayley Scales of Infant Development, third edition (BSID-III) at 18 months corrected age. Secondary outcomes included severe NDI and BSID-III scores. Multivariable logistic regression (MLR) analysis was used to evaluate the independent association between NICU design and outcomes.

RESULTS: The study included 100 ELBW infants in 2009, and 98 in 2011. The 2 epochs were similar in follow-up rates (80% in 2009; 82% in 2011) and infant characteristics (including those lost to follow up). Mortality was 7.9% in 2009 and 6.1% in 2011. BSID-III language scores (median [interquartile range]) were similar for infants in the OBD and SRD epochs (86 [71,100] vs. 81 [71,94], p=NS). On MLR analysis, NICU design was not associated with significant differences in NDI or BSID-III language score less than 80 after adjustment for antenatal and perinatal confounders. (Table1)

CONCLUSION: There was no significant difference in NDI between cohorts of ELBW infants cared for in an SRD compared with an OBD NICU design environment. The contrast in findings from earlier studies may be attributable to the local context of government-supported parental leave and strong promotion of parental presence in the NICU.

Collapse

Effects of endothelin on cultured human and rat glomerular mesangial cells

Figure 5 summarizes our results and the data in the literature with regard to both short-term signalling and long-term signalling induced by endothelin. Short-term signalling, which induces vasoconstriction, is undoubtedly mediated by multiple signals including increments of cytosolic calcium, stimulation of protein kinase C and alkalinization of the cytosol. Endothelin also activates negative feedback pathways including arachidonate release with the synthesis of vasorelaxant prostaglandins and potentiation, in a prostaglandin-dependent manner, of beta-adrenergic-stimulated adenylate cyclase. Long-term signalling is less well understood and may depend not only on phospholipase activation with subsequent changes of calcium and protein kinase C but also stimulation of other protein kinases which phosphorylate key intermediates. Endothelin stimulates the transient appearance of protooncogenes that might play a role in the induction of cellular proliferation.

Personal health records for patients with chronic disease: a major opportunity

BACKGROUND

Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease.

OBJECTIVES

To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations.

METHODS

A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations.

RESULTS

Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged.

CONCLUSION

This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.

The neurology of autism: many unanswered questions

Autism is a behaviorally defined developmental disorder of the brain almost always presenting in infancy or the preschool years. Its symptoms persist life-long, although partial compensation is possible through targeted special education that addresses children's deficits in sociability, verbal and non-verbal communication, and atypical range of interests, activities, and cognitive skills. Although a majority of autistic individuals are mentally deficient, IQ is not a defining feature and verbal autistic persons of normal intelligence are increasingly being identified, referred to as Asperger syndrome. Meager neuropathologic data have disclosed subtle prenatal cellular limbic and cerebellar abnormalities. Autism is associated with a variety of defined genetic and acquired conditions, with multifactorial genetic traits, alone or interacting with environmental events, presumably responsible for most unexplained cases. Autistic regression is frequent and poorly understood and may be associated with clinical or subclinical epilepsy. Unravelling the neurobiologic basis of a disorder that may affect 1-2 in 1000 children will require a concerted multidisciplinary attack.

Sarcoidosis, alveolar β-actin and pulmonary fibrosis

BACKGROUND

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Proteins present within the alveolar space early in sarcoidosis disease may provide an insight into novel mechanisms for the development of fibrotic disease and in particular pulmonary fibrosis.

METHODS

A modified two-dimensional difference gel electrophoresis protocol was applied to the human bronchoalveolar lavage fluid (hBALF) of four patients with non-persistent pulmonary interstitial disease at 4-year follow-up (defined as mild disease) and four patients who developed pulmonary interstitial disease at 4-year follow-up (defined as severe disease). The protein β-actin was identified by LC-MS/MS from a preparative gel and found to be significantly elevated in early lavages from the severe disease group. To look at the potential pro-fibrotic effects of this protein, primary human pulmonary fibroblasts (CCD-19Lu) were treated with recombinant β-actin following which qPCR and ELISA assays were used to measure any effects.

RESULTS

We found that β-actin levels were significantly elevated in early hBALF samples in patients who subsequently developed severe disease when compared to the mild group. Treating primary human pulmonary fibroblasts with recombinant β-actin led to enhanced gene expression of the pro-fibrotic markers alpha smooth muscle actin and collagen 1 as well as the increased secretion of interleukin-13 and metalloproteinases 3 and 9.

CONCLUSION

Free β-actin within the lungs of sarcoidosis patients potentially may contribute to disease pathogenesis particularly in the context of abnormal remodelling and the development of pulmonary fibrosis.

Esophageal stenting for treatment of refractory benign esophageal strictures in dogs

BACKGROUND

Benign esophageal strictures can recur despite multiple dilatation procedures and palliative management can be challenging.

OBJECTIVE

To describe the technique and determine the outcome of esophageal stenting for treatment of refractory benign esophageal strictures (RBES) in dogs.

ANIMALS

Nine dogs with RBES.

METHODS

Retrospective review of records for dogs with RBES. Indwelling intraluminal esophageal stents were placed transorally with endoscopy, fluoroscopic guidance, or both. Follow-up information was obtained via medical record or telephone interview.

RESULTS

Nine dogs had 10 stents placed including biodegradable stents (BDS) (6/10), self-expanding metallic stents (SEMS) (3/10), and a self-expanding plastic stent (SEPS) (1/10). All dogs had short-term improved dysphagia. Complications included ptyalism, apparent nausea, gagging, vomiting, or regurgitation (8/9), confirmed recurrence of stricture (6/9), stent migration (3/9), stent shortening (1/9), megaesophagus (1/9), incisional infection (1/9), and tracheal-esophageal fistula (1/9). Eight of 9 dogs required intervention because of the complications of which 4 of 8 dogs were eventually euthanized because of stent-related issues. One dog was lost to follow-up examination.

CONCLUSIONS AND CLINICAL IMPORTANCE

Findings suggest that esophageal stent placement was safe and technically effective, but unpredictably tolerated in dogs with RBES. If a stent is placed, dogs should be monitored carefully for stent migration, dissolution of absorbable stents, and recurrence of strictures.

Developmental delay of infants and young children with and without fetal alcohol spectrum disorder in the Northern Cape Province, South Africa

OBJECTIVE

To describe the extent and nature of developmental delay at different stages in childhood in a community in South Africa, with a known high rate of Fetal Alcohol Spectrum Disorder (FASD).

METHOD

cohort of infants, clinically examined for FASD at two time periods, 7-12 months (N= 392; 45 FASD) and 17-21 months of age (N = 83, 35 FASD) were assessed using the Griffiths Mental Developmental Scales (GMDS).

RESULTS

Infants and children with FASD perform worse than their Non-FASD counterparts over all scales and total developmental quotients. Mean quotients for both groups decline between assessments across subscales with a particularly marked decline in the hearing and language scale at Time 2 (scores dropping from 110.6 to 83.1 in the Non-FASD group and 106.3 to 72.7 in the FASD group; P = 0.004). By early childhood the developmental gap between the groups widens with low maternal education, maternal depression, high parity and previous loss of sibling/s influencing development during early childhood.

CONCLUSION

The FASD group show more evidence of developmental delay over both time points compared to their Non-FASD counterparts. Demographic and socio-economic factors further impact early childhood. These findings are important in setting up primary level psycho-educational and national prevention programmes especially in periurban communities with a focus on early childhood development and FASD.

Enumeration of Microbial Populations in Radioactive Environments by Epifluorescence Microscopy

Epifluorescence microscopy was utilized to enumerate halophilic bacterial populations in two studies involving inoculated, actual radioactive waste/brine mixtures and pure brine solutions. The studies include an initial set of experiments designed to elucidate potential transformations of actinide-containing wastes under salt-repository conditions, including microbially mediated changes.

The first study included periodic enumeration of bacterial populations of a mixed inoculum initially added to a collection of test containers. The contents of the test containers are the different types of actual radioactive waste that could potentially be stored in nuclear waste repositories in a salt environment. The transuranic waste was generated from materials used in actinide laboratory research. The results show that cell numbers decreased with time. Sorption of the bacteria to solid surfaces in the test system is discussed as a possible mechanism for the decrease in cell numbers.

The second study was designed to determine radiological and/or chemical effects of239Pu,243Am,237Np,232Th and238U on the growth of pure and mixed anaerobic, denitrifying bacterial cultures in brine media. Pu, Am, and Np isotopes at concentrations of ≤1×10–5M, ≤5×10–6M and ≤5×10-4M respectively, and Th and U isotopes at concentrations of ≤4×10-3M were tested in these media. The results indicate that high actinide concentrations affected both the bacterial growth rate and morphology. However, relatively minor effects from Am were observed at all tested concentrations with the pure culture.

The potential of subterranean microbes in facilitating actinide migration at the Grimsel Test Site and Waste Isolation Pilot Plant

Microorganisms may affect the long-term stability and mobility of radionuclides disposed of in deep geological formations. Of particular concern is the association of radionuclides with subterranean microbial cells and their subsequent transport as biocolloids. We characterized the total microbial populations in two groundwater samples: one from the Culebra dolomite member of the Rustler Formation at the Waste Isolation Pilot Plant (WIPP), NM, and the other from the granitic formation at the Grimsel Test Site (GTS), Switzerland. Culebra groundwater (ionic strength 2.8 M, pH 7) contained 1.51 ± 1.08 × 105cells ml-1, with a mean cell length of 0.75 ± 0.04 μm and width of 0.58 ± 0.02 μm. In contrast, low ionic-strength GTS groundwater (0.001 M, pH 10) contained 3.97 ± 0.37 × 103cells ml-1, with a mean cell length of 1.50 ± 0.14 μm and width of 0.37 ± 0.01 μm. Adding appropriate electron donors and acceptors to the groundwaters facilitated the growth of aerobic, denitrifying, fermentative, and acetogenic microorganisms. Uranium biosorption was studied in two isolates from these groundwaters, as well as several pure cultures from saline and non-saline environments. Halophilic and non-halophilic bacteria exhibited differences in the amount of U associated with the cells. Plutonium uptake by Acetobacterium sp. isolated from GTS varied from 30 - 145 pg of Pu mg-1dry weight of cells.

Effects of prednisone on blood lactate concentrations in healthy dogs

BACKGROUND

Glucocorticoids affect carbohydrate and lactate metabolism.

HYPOTHESIS

Administration of prednisone to healthy dogs will result in clinically relevant hyperlactatemia.

ANIMALS

Twelve healthy adult Beagle dogs.

METHODS

Prospective, controlled experimental study. Twelve healthy adult Beagles were divided into 2 groups (3 of each sex per group). One group served as control. The other group received 2 treatments: low, 1 mg/kg prednisone PO q24h for 2 weeks; high, 4 mg/kg prednisone PO q24h for 2 weeks. A washout period of 6 weeks separated the treatments. Blood samples were drawn for whole blood lactate measurement on day (D) 0, D4, and D14 and measured in duplicate.

RESULTS

Compared with the control group, low and high groups had significantly higher blood lactate concentrations at D4 and D14. There was no difference at D0. There was no effect of time within the control group. In the low and high groups, blood lactate concentration was increased at D4 and D14 versus D0. Blood lactate concentration was greater in the high group than the low group at D14 only.

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs treated with prednisone experience statistically significant increases in blood lactate concentrations, which can result in type B hyperlactatemia. In such cases, improving tissue perfusion, treatment for the commonest form of hyperlactatemia (type A) would be unnecessary.