A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention

Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10882-022-09853-w.

Investigation of the association between gall bladder wall thickness and hypoalbuminaemia in dogs

OBJECTIVES

To assess the correlation between gallbladder wall thickness and serum/plasma albumin concentrations in dogs.

MATERIALS AND METHODS

Retrospective searches of digital medical record databases were conducted to identify dogs that had either severely low serum/plasma albumin concentration (<1.5 g/dL) or ultrasonographic evidence of gallbladder wall thickening (>2 mm). Analysis of covariance models were used to analyze gallbladder wall thickness with sample type (serum vs plasma), age, etiology, albumin, and albumin ' etiology as the covariates.

RESULTS

A total of 216 dogs met inclusion criteria. One-hundred and forty-six dogs had a thickened gallbladder wall (Group 1). Median serum/plasma albumin concentration for dogs in this group was 2.2 g/dL (1 to 5 g/dL), and 84 dogs (57.5%) had hypoalbuminemia (<2.5 g/dL). The search for dogs with severe hypoalbuminemia (< 1.5 g/dL) identified 70 dogs (Group 2). In this group, median gallbladder wall thickness was 1.3 mm (0.2 to 6.1 mm) and 17 dogs (24.3%) had a thickened gallbladder wall. Serum/plasma albumin concentration and gallbladder wall thickness were not significantly correlated for Group 1 (r = 0.0044, p = 0.9580) or Group 2 (r = -0.1137, p = 0.3487). A moderate negative correlation (-0.64) was identified between gallbladder wall thickness and albumin concentration in dogs with immune-mediated diseases (p = 0.03).

CLINICAL SIGNIFICANCE

Gallbladder wall thickness and serum/plasma albumin concentration are independent variables in dogs.

Luminal epithelial cells within the mammary gland can produce basal cells upon oncogenic stress

In the normal mammary gland, the basal epithelium is known to be bipotent and can generate either basal or luminal cells, whereas the luminal epithelium has not been demonstrated to contribute to the basal compartment in an intact and normally developed mammary gland. It is not clear whether cellular heterogeneity within a breast tumor results from transformation of bipotent basal cells or from transformation and subsequent basal conversion of the more differentiated luminal cells. Here we used a retroviral vector to express an oncogene specifically in a small number of the mammary luminal epithelial cells and tested their potential to produce basal cells during tumorigenesis. This in-vivo lineage-tracing work demonstrates that luminal cells are capable of producing basal cells on activation of either polyoma middle T antigen or ErbB2 signaling. These findings reveal the plasticity of the luminal compartment during tumorigenesis and provide an explanation for cellular heterogeneity within a cancer.

Portal hypertension: pathophysiology, diagnosis, and treatment

Portal hypertension (PH) is the result of increased vascular resistance in the portal circulation, increased portal venous blood flow, or both. In veterinary medicine, where portal pressure is seldom measured directly, the diagnosis of PH often is inferred from identification of associated complications including multiple acquired portosystemic shunts, ascites, and hepatic encephalopathy. Likewise, treatment of PH primarily is aimed at controlling these complications. The goal of this review is to provide an update on the pathophysiology, diagnosis, and treatment of PH. The review draws from information in the veterinary hepatology literature, reviews, and consensus statements in human hepatology and the literature on experimental models of PH.

Memory consolidation in day-old chicks requires BDNF but not NGF or NT-3; an antisense study

Neurotrophins have been implicated in memory consolidation and recall as well as in other forms of neural plasticity. This study examined the effects of Brain-Derived Neurotrophic Factor (BDNF), Nerve Growth Factor (NGF) and Neurotrophin-3 (NT-3) on consolidation of memory for a one-trial passive avoidance task in day-old chicks. In this task chicks, having pecked once at a bitter tasting bead, avoid a similar but dry bead subsequently. Intracerebral administration of antisense ODNs to BDNF 6-12 h prior to training induced amnesia for the avoidance response by 3 h after training. Administration of a "control" scrambled sequence or saline had no effect on recall; chicks continued to avoid the bead. Treatment with BDNF-AS did not inhibit shorter-term recall; amnesia was not present 1 h after training, but prevented longer-term recall, as amnesia was still present 24 h after training. Treatment with BDNF-antisense reduced both BDNF mRNA and BDNF protein in the chick brain, but did not alter mRNA levels of glyceraldehyde-3-phosphate dehydrogenase. By contrast, no effect of antisense to NGF or NT-3 on behaviour was observed, even though administration reduced the mRNA for each. There were no significant effects of any antisense on other behavioural measures at the doses used. Thus we conclude that BDNF has a specific role in memory consolidation for the passive avoidance task.

Task- and time-dependent memory enhancement by dehydroepiandosterone in day-old chicks

We have previously reported the presence of dehydroepiandosterone (DHEA) in the day-old-chick brain, and a role for it in enhanced memory formation. Here we confirm that intracerebral injections of DHEA 5 min before training on the weak passive avoidance task enhanced recall 24 hours after training. Recall per se on an appetitive visual categorization task was not altered by administration of DHEA 5 min before training. However administration of DHEA 5 min before limited or very limited training on a visual categorization task (20 or 10 pecks only) appeared to enhance consolidation of this task at test 24 h after training; reducing the latency and total time taken to complete the test (60 pecks), while not detrimentally altering accuracy. Moreover, DHEA is unlikely to induce this effect via possible anxiolytic effects because it did not alter behavior in the open field test. We also examined diffusion of DHEA throughout the brain at various stages following intracerebral injection.

APP is required during an early phase of memory formation

The amyloid beta/A4 protein precursor (APP) has been shown to be implicated in age-associated plastic changes at synapses that might contribute to memory loss in Alzheimer's disease. As APP has previously been reported to have multiple functions during normal development, we have employed a one-trial passive avoidance task in day-old chicks to study its role in the process of memory formation. Administration of anti-APP antibodies, injected 30 min pretraining, prevented memory for a one-trial passive avoidance task in day-old chicks without effects on general behaviour or initial acquisition. Amnesia was apparent by 30 min post-training and lasted for at least 24 h. The same result was obtained by down-regulation of APP expression by APP-antisense, injected 8-12 h pretraining. However, injections of anti-APP antibodies or APP antisense at later post-training time did not cause amnesia for the task. Unlike antibodies and antisense, injection of the APP328-332 pentapeptide, in either orientation, 30 min pretraining, rescued the memory and prevented antisense-induced amnesia. The post-training time within which the antibody- and antisense-induced amnesia, and within which the APP peptides prevent amnesia, correspond to that during which memory formation is vulnerable to disruption of the putative signal transduction functions of APP. These results suggest that: (i) APP is required during an early phase of memory formation, and (ii) the memory enhancing effect of secretory APP is localized within a 5-mer sequence of growth-promoting domain.

Light exposure of chick embryo influences lateralized recall of imprinting memory

Environmental cues, such as light during the later part of incubation, are known to establish lateralization of some forms of visually guided behaviors in birds. The authors investigated the effect of light on lateralized recall of imprinting memory in chicks. On Day E19 of incubation, one eye was occluded for 24 hr. The other eye received stimulation by light. Chicks were imprinted and then tested for their imprinting preferences after administration of a low dose (500 ng) of glutamate into either hemisphere. Chicks that had the right eye exposed to light during incubation showed recall of the imprinting stimulus after injection of the left hemisphere but not after injection into the right hemisphere. The reverse was found for chicks that had the left eye exposed to light. Hence, the hemisphere ipsilateral to the eye exposed to light before hatching became essential for recall of imprinting memory. The hemisphere used in recall of imprinting memory received indirect visual inputs and was determined by environmental stimulation (asymmetrical light input).

Light exposure of chick embryo influences lateralized recall of imprinting memory

Environmental cues, such as light during the later part of incubation, are known to establish lateralization of some forms of visually guided behaviors in birds. The authors investigated the effect of light on lateralized recall of imprinting memory in chicks. On Day E19 of incubation, one eye was occluded for 24 hr. The other eye received stimulation by light. Chicks were imprinted and then tested for their imprinting preferences after administration of a low dose (500 ng) of glutamate into either hemisphere. Chicks that had the right eye exposed to light during incubation showed recall of the imprinting stimulus after injection of the left hemisphere but not after injection into the right hemisphere. The reverse was found for chicks that had the left eye exposed to light. Hence, the hemisphere ipsilateral to the eye exposed to light before hatching became essential for recall of imprinting memory. The hemisphere used in recall of imprinting memory received indirect visual inputs and was determined by environmental stimulation (asymmetrical light input).

Role of brain-derived neurotrophic factor and presynaptic proteins in passive avoidance learning in day-old domestic chicks

The consolidation of a one-trial passive avoidance learning task in the day-old chick involves a number of transient and longer-term biochemical processes, including increased release of glutamate. This study demonstrated that brain-derived neurotrophic factor, a proposed modulator of synaptic transmission and neurotransmitter release, is involved in the cascade associated with memory consolidation in the chick and that its actions were linked to modulation of expression of SNAP-25, syntaxin and synaptophysin, required for exocytosis. Intracerebral injections of 5 microl of antibodies to brain-derived neurotrophic factor into the left and right intermediate medial hyperstriatum ventrale resulted in a dose-dependent reduction in avoidance of an "aversive" bead by 3 h after training. Neurotrophin antibodies (0.5 microg/chick) administered between 1 h before, and up to 30 min after, training induced amnesia by 3 h which was sustained for at least 24 h. Injections of recombinant brain-derived neurotrophic factor (50 microg/ml; 0.5 microg/chick) just before training maintained avoidance in birds trained with a weaker aversant (10% methylanthranilate), such that chicks showed enhanced recall at times (24 h) beyond that when shorter-term forms of memory have decayed. In lysed synaptosomal membranes prepared from chicks injected with antibodies to brain-derived neurotrophic factor there was a decrease in expression of SNAP-25 and syntaxin in the left, but not the right, intermediate medial hyperstriatum ventrale, a region known to be associated with memory formation, which correlated with the decrease in neurotrophin concentration. Thus, these data indicate that brain-derived neurotrophic factor is involved in the formation of a long-term memory for an aversive stimulus and may function as a modulator of presynaptic proteins associated with exocytosis, enabling increases in neurotransmitter release.

Right hemisphere involvement in imprinting memory revealed by glutamate treatment

The lateralized use of the forebrain hemispheres during recall of imprinting memory was investigated using unilateral intrahemispheric injections of glutamate. Administration of glutamate to the right hemisphere 1.3, or 6 h after exposure to the imprinting stimulus disrupted recall 8 h after the end of training, whereas the same treatment of the left hemisphere had no effect. Imprinted chicks treated with glutamate injected into the right hemisphere did not approach the imprinting stimulus in preference to an alternative, unfamiliar stimulus during a simultaneous choice test, whereas imprinted chicks treated with glutamate injected into the left hemisphere showed a preference for the imprinting stimulus. Thus, the left and right hemispheres are involved differentially in the recall of imprinting memory. Fear behavior or activity levels were not altered by glutamate treatment of either the right or left hemisphere, indicating that the effects of glutamate were specific to recall of imprinting memory. However, the amnestic effect of treatment of the right hemisphere with glutamate was transient: it was no longer evident by 48 h after the end of training. Also, glutamate had no effect when the chicks were treated 9 h after the end of training. These results suggest that regions in right hemisphere of the chick brain are involved in early (0-8 h after training) recall of imprinting memory.

Isolation-stress-induced facilitation of passive avoidance memory in the day-old chick

This study showed that facilitation of recall of a weak version of the 1-trial passive avoidance learning task could be achieved by behavioral "stressing" of day-old chicks after training. Recall, usually retained for less than 9 hr, was extended by socially isolating the chicks for 1 hr immediately after training. There was a brief 3-fold increase in plasma corticosterone levels 10 min after isolation. Facilitated recall was not evident when chicks were isolated 2 hr after training, and it was blocked by intracerebral administration of 2-ng RU 38486, a specific glucocorticoid receptor antagonist, per chick. Male chicks responded more to isolation than did female chicks, presumably a consequence of the additional stress of the injection procedure.

Exposure to light prior to hatching induces asymmetry of receptor binding in specific regions of the chick forebrain

This paper describes neurochemical asymmetries present in forebrain regions of the newly hatched chick that result from environmental conditions; specifically from asymmetrical exposure of the chick embryo to light prior to hatching. Quantitative autoradiography was used to determine GABA and glutamate receptor subtype binding in a number of regions of the left and right forebrain hemispheres of chicks that had either the left (LES), or the right (RES), eye system exposed to light prior to hatching. On day 19 of incubation the embryo's head was withdrawn from the egg and the left or the right eye was occulded until hatching. [3H]MK-801, [3H]AMPA and [3H]muscimol binding assays were performed on frozen sections from 2 different coronal regions of the forebrain, sampled on day-1 posthatching. Significant [3H]MK-801, [3H]AMPA and [3H]muscimol binding asymmetries were determined in forebrain regions from chicks that had their RES exposed to light prior to hatching, particularly in forebrain regions which are known to receive afferent visual input. The reverse pattern of asymmetry was found for all 3 ligands in regions such as the ectostriatum of chicks that had their LES exposed to light, while asymmetry of muscimol and AMPA binding, present in many regions in right eye system chicks was not present in chicks that had the left eye system exposed to light during incubation. Thus, the presence and pattern of experience-dependent neurochemical asymmetries in the chick forebrain are specific to both region and receptor type.

[3H]MK-801 binding asymmetry in the IMHV region of dark-reared chicks is reversed by imprinting

Glutamate NMDA-type receptor binding in the intermediate medial hyperstriatum ventrale (IMHV) of dark-hatched chicks is lateralized. This lateralization was found to be markedly influenced by imprinting. In dark-reared chicks the binding of the selective ligand [3H]MK-801 was two-fold higher in the right IMHV than in the left IMHV. In contrast, imprinted chicks have significantly higher levels of [3H]MK-801 binding in the left IMHV region than in the right IMHV. Imprinting results in 2a learning-related increase in NMDA-type receptor binding levels in the left IMHV, whereas [3H]MK-801 binding levels in the right IMHV remain unchanged by imprinting. Thus, the plasticity present in the NMDA-type receptor system and associated with imprinting appears to occur in the left hemisphere only.

Glutamate and imprinting memory: the role of glutamate receptors in the encoding of imprinting memory

Glutamate-sensitive receptors have been implicated in many forms of neural plasticity and learning, including imprinting of chicks. Previous studies have indicated that glutamate binding levels in the left intermediate medial hyperstriatum ventrale (IMHV) region of the chick forebrain increase as a correlate of the acquisition of an imprinting memory; however, it has not been determined whether this is due to an increase in the number of glutamate receptors or to increased receptor affinity. The area specificity of these changes, within the left and right hemisphere, was also unexplored. We have performed Scatchard displacement binding analyses to examine changes in both the number and affinity of glutamate receptors in the left and right hyperstriatum ventrale (HV) and also the left and right archistriatal/lobus parolfactorius (AS/LPO) areas from imprinted and non-imprinted chicks. The results of this study demonstrate lateralised increases in both the number and affinity of glutamate receptors in the left HV area at 7-8 h after imprinting. Significant increases in the affinity, but not the number, of glutamate receptors were found in the left AS/LPO. This suggests that the left AS/LPO, which has previously been shown to be involved in the acquisition of a passive avoidance memory, may also be involved in the formation of an imprinting memory.

Post accident/incident counseling: some exploratory findings

An examination of the literature, and other sources of information, suggested that there might be prophylactic value in early psychological intervention following crewmember involvement in stressful incidents. An exploratory study, at a small commercial pilot base (c.200 pilots), was undertaken to assess the value of early intervention. Pilots were automatically referred to an independent counseling service if abnormal flight events were judged to have involved sudden, unanticipated, or extreme stress. While some individuals came through their experience relatively unaffected, a surprising proportion did not. Several individuals took the opportunity to voluntarily return for additional counseling while others required anxiolytic drug treatment. The initial findings of this exploratory study strongly suggest that commercial pilots are more frequently subject to a potentially debilitating stress reaction than heretofore suspected. This has obvious implications for intervention and prevention, as well as long-term stress management for commercial pilots.