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In the United States, gonadectomy is common and widely promoted as a component of responsible pet ownership. The recent publication of several studies examining the effect of gonadectomy on future health has challenged long-held assumptions and recommendations for gonadectomy in companion animals. The purpose of this study was to characterize the associations between gonadectomy and two outcomes: overweight/obesity and orthopedic injuries, in a large prospective study of Golden Retrievers. Age at gonadectomy was divided into four categories: intact (reference), ≤ 6 months, > 6 months ‒ ≤ 12 months, and > 12 months. Dogs with a Purina Body Condition Score of 7 or greater were classified as overweight or obese. Orthopedic injuries considered were the first instance of veterinary-reported cranial cruciate ligament injury and clinically evident osteoarthritis. We performed survival analyses on a cohort of Golden Retrievers to estimate the associations of interest using proportional hazards. We adjusted for age at study enrollment, owner-reported activity level, and dog's sex. Compared to intact dogs, all gonadectomy age categories showed increased risk for the development of overweight/obesity. (≤ 6 months, HR: 1.81, 95% CI: 1.36-2.40), p-value: <0.0001; 6 months to ≤ 12 months, HR: 2.21, 95% CI: 1.77-2.73, p-value: < 0.0001; > 12 months, HR: 1.56, 95% CI: 1.24-1.96, p-value: 0.0001). Compared to intact dogs, dogs who were ≤ 6 months at gonadectomy had increased risk for orthopedic injury (HR: 4.06, 95% CI: 2.15-7.67, p-value: <0.00001). This study presents prospectively acquired data demonstrating that gonadectomy is a risk factor for both overweight/obesity and chronic non-traumatic orthopedic injuries in a prospective cohort of Golden Retrievers. Our data suggest that gonadectomy at any age is a risk factor for overweight or obesity, but delaying gonadectomy until dogs are at least 6-12 months of age may help to decrease the risk for orthopedic injury.

Thanks to funding from the AKC Canine Health Foundation (www.akcchf.org), a nonprofit organization dedicated to advancing the health of all dogs through scientific research, veterinary scientists are actively searching for these answers. Since its founding in 1995, the Canine Health Foundation and its donors have invested more than $3 million to study canine epilepsy, resulting in significant progress: CBD oil dosing: A clinical trial is defining the appropriate dose of CBD oil for seizure treatment - providing data on how much of this compound should be given and how often for maximum effect. [...]another clinical trial is examining in-home treatment protocols for cluster seizures, a dangerous condition in which seizures occur frequently.

The present study evaluated the use of computerized equivalence-based instruction (EBI) to teach classes representing schedules of reinforcement to staff members. Four, 5-member classes representing fixed ratio, fixed interval, variable ratio, and variable interval schedules of reinforcement were taught. The participants were 16 staff members between the ages of 22 and 30 years of age that were employed at a private school for individuals with autism. Participants were randomly assigned to either an experimental or control group. A pretest-training-posttest-maintenance design was used to evaluate the effects of EBI on participants’ performance during both a computer-based test and a written multiple-choice test. Participants in the control group were only exposed to pretest and posttests. All participants in the experimental group acquired the baseline trained relations during match-to-sample instruction. Test scores improved from pretest to posttest and derived (untrained) relations emerged across all participants in the experimental group following training but did not change for the participants in the control group. In addition, participants maintained the learned relations one week after EBI was completed. The present study demonstrated that EBI is an effective teaching procedure to teach schedules of reinforcement to staff members in the field of applied behavior analysis.

Considerable confusion exists regarding nomenclature, classification, and management of pediatric diffuse lung diseases due to the relative rarity and differences in the spectrum of disease between adults and young children. A multidisciplinary working group was formed to: (1) apply consensus terminology and diagnostic criteria for disorders presenting with diffuse lung disease in infancy; and (2) describe the distribution of disease entities, clinical features, and outcome in young children who currently undergo lung biopsy in North America. Eleven centers provided pathologic material, clinical data, and imaging from all children less than 2 years of age who underwent lung biopsy for diffuse lung disease from 1999 to 2004. Multidisciplinary review categorized 88% of 187 cases. Disorders more prevalent in infancy, including primary developmental and lung growth abnormalities, neuroendocrine cell hyperplasia of infancy, and surfactant-dysfunction disorders, constituted the majority of cases (60%). Lung growth disorders were often unsuspected clinically and under-recognized histologically. Cases with known surfactant mutations had characteristic pathologic features. Age at biopsy and clinical presentation varied among categories. Pulmonary hypertension, presence of a primary developmental abnormality, or ABCA3 mutation was associated with high mortality, while no deaths occurred in cases of pulmonary interstitial glycogenosis, or neuroendocrine cell hyperplasia of infancy. This retrospective cohort study identifies a diverse spectrum of lung disorders, largely unique to young children. Application of a classification scheme grouped clinically distinct patients with variable age of biopsy and mortality. Standardized terminology and classification will enhance accurate description and diagnosis of these disorders.

Background Self-regulation (SR), or the capacity to control one’s thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively. Methods We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D ( n  = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group. Discussion If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence. Trial registration ClinicalTrials.gov: NCT03688919 ; registered September 28, 2018.

Screening guidelines are used to help identify prediabetes and diabetes before implementing evidence-based prevention and treatment interventions. We examined screening practices benchmarking against two US guidelines, and the capacity of each guideline to identify dysglycemia. Using 2007-2012 National Health and Nutrition Examination Surveys, we analyzed nationally-representative, cross-sectional data from 5,813 fasting non-pregnant adults aged ≥20 years without self-reported diabetes. We examined proportions of adults eligible for diagnostic glucose testing and those who self-reported receiving testing in the past three years, as recommended by the American Diabetes Association (ADA) and the US Preventive Services Task Force (USPSTF-2008) guidelines. For each screening guideline, we also assessed sensitivity, specificity, and positive (PPV) and negative predictive values in identifying dysglycemia (defined as fasting plasma glucose ≥100 mg/dl or hemoglobin A1c ≥5.7%). In 2007-2012, 73.0% and 23.7% of US adults without diagnosed diabetes met ADA and USPSTF-2008 criteria for screening, respectively; and 91.5% had at least one major risk factor for diabetes. Of those ADA- or USPSTF-eligible adults, about 51% reported being tested within the past three years. Eligible individuals not tested were more likely to be lower educated, poorer, uninsured, or have no usual place of care compared to tested eligible adults. Among adults with ≥1 major risk factor, 45.7% reported being tested, and dysglycemia yields (i.e., PPV) ranged from 45.8% (high-risk ethnicity) to 72.6% (self-reported prediabetes). ADA criteria and having any risk factor were more sensitive than the USPSTF-2008 guideline (88.8-97.7% vs. 31.0%) but less specific (13.5-39.7% vs. 82.1%) in recommending glucose testing, resulting in lower PPVs (47.7-54.4% vs. 58.4%). Diverging recommendations and variable performance of different guidelines may be impeding national diabetes prevention and treatment efforts. Efforts to align screening recommendations may result in earlier identification of adults at high risk for prediabetes and diabetes.

Background. In the United States, Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae are increasingly detected in clinical infections; however, the colonization burden of these organisms among short-stay and long-term acute care hospitals is unknown. Methods. Short-stay acute care hospitals with adult intensive care units (ICUs) in the city of Chicago were recruited for 2 cross-sectional single-day point prevalence surveys (survey 1, July 2010–January 2011; survey 2, January–July 2011). In addition, all long-term acute care hospitals (LTACHs) in the Chicago region (Cook County) were recruited for a single-day point prevalence survey during January–May 2011. Swab specimens were collected from rectal, inguinal, or urine sites and tested for Enterobacteriaceae carrying blaKPC. Results. We surveyed 24 of 25 eligible short-stay acute care hospitals and 7 of 7 eligible LTACHs. Among LTACHs, 30.4% (119 of 391) of patients were colonized with KPC-producing Enterobacteriaceae, compared to 3.3% (30 of 910) of short-stay hospital ICU patients (prevalence ratio, 9.2; 95% confidence interval, 6.3–13.5). All surveyed LTACHs had patients harboring KPC (prevalence range, 10%–54%), versus 15 of 24 short-stay hospitals (prevalence range, 0%–29%). Several patient-level covariates present at the time of survey—LTACH facility type, mechanical ventilation, and length of stay—were independent risk factors for KPC-producing Enterobacteriaceae colonization. Conclusions. We identified high colonization prevalence of KPC-producing Enterobacteriaceae among patients in LTACHs. Patients with chronic medical care needs in long-term care facilities may play an important role in the spread of these extremely drug-resistant pathogens.

In equivalence classes, stimulus relatedness is an inverse function of the nodal number for the same type of derived relation. Also, transitive relations are preferred to equivalence relations when the nodal number is held constant. The current study evaluated the combined effects of nodal number and relational type on relatedness of stimuli within equivalence classes. After eight college students formed two 7-node, 9-member equivalence classes, participants were presented with trials during within-class relational preference tests that pitted 1-node equivalence relations against 1- to 5-node transitive relations. Consistent with prior research, 1-node transitive relations were always preferred to 1-node equivalence relations. For the six participants who formed classes rapidly, preference for the 1-node equivalence relation increased as a direct function of increases in the number of nodes in the competing transitive relation. In addition, the 1-node equivalence relation was equally preferred to an approximately 2-node transitive relation. Because equivalence classes remained intact after preference testing, performances documented the coexistence of equal and differential relatedness of class members. Two participants formed the classes on a delayed basis and produced inverted U-shaped preference functions instead of monotonic preference functions. Because the preference functions differed in terms of speed of emergence, the same nominal equivalence classes were not functionally equivalent to each other with regard to stimulus relatedness.