Oral omeprazole is used in the management of equine gastric ulcer syndrome (EGUS). However, its use may have limitations with regard to individual variation in absorption and the impact of dietary management on bioavailability. The objective of this study was to determine whether a novel compounded longacting injectable omeprazole (LAO-USA) formulation would provide consistent serum omeprazole concentrations and to determine whether it was clinically safe and efficacious in the reduction of EGUS. Twenty-three horses with EGUS described as having evidence of equine squamous gastric disease (ESGD) and/or equine glandular gastric disease (EGGD) received a 5 mg/kg bwt intramuscular injection of LAO-USA once every 7 days for four doses. Gastroscopy was performed prior to the study and at Days 14 and 28. Pharmacokinetic analysis was performed to determine omeprazole concentrations over 7 days. Safety was measured by monitoring injection site reactions daily and bloodwork screening prior to and following the study. Of the horses with ESGD, 78% had improvement by Day 14 (p = 0.0035), with no further improvement from Day 14 to 28 (p > 0.99). ESGD grades from Day 0 to 28 decreased significantly (95% CI À1.92 to À0.91 grades) (p = 0.0002). Out of the horses (6/23) that had glandular lesions, 5/6 healed over time; however, this was not a significant change (p = 0.75). Injection reactions included oedema, heat and pain at the injection site. Considering the total number of injections across the whole study, 23% of horses experienced an injection site reaction. The number of injection site reactions increased following each dose (8%, 13%, 22% and 48%, respectively). The formulation did not appear to have adverse systemic effects. Serum omeprazole mean C max was 46.2 ng/ml (AE17.4 ng/ml), and these concentrations maintained at approximately 9.6 ng/ ml (AE4.6 ng/ml) for 7 days following dosing. This formulation is compounded and has not completed FDA investigation, which may increase formulation variability as it is produced or stored. The lack of control groups and potential bias in lesion grading are additional recognised limitations. The results of this study provide preliminary safety and efficacy data with regard to a novel LAO-USA formulation. Future study is warranted to describe safety and efficacy for both ESGD and EGGD and would support further FDA investigation.

BackgroundIdentity formation is a dynamic process and key developmental task that begins in adolescence. During this time, children look to adults as role models and mentors. These adults can have a significant impact on adolescents' decisions of appropriate or inappropriate behaviors, potentially causing a positive or negative change. Little research has been performed to identify these role models and understand how they affect the development of physical and mental health of children. ObjectiveThe goal of this study is to see if there is a relationship between identified role models, mentors, and/or heroes and adolescents' interest in education, participation in risky behavior, confidence level, happiness, safety, violence-related behaviors, and physical activity. MethodsIn this study, 198 children aged 11-18 years were identified on the scheduling platforms at various Hershey Medical Center sites to take a 10-minute survey via RedCap. The survey identified their role model, mentor, and/or hero and followed up with outcome questions from validated tools. ResultsThe results show that 140 participants (70.7%) identified having a role model compared to 88 (44.4%) having mentors and 61 (30.8%) having heroes, and family members were the most identified figures for each category. There were significant differences between identified categories of role models, mentors, and heroes, and interest in education, happiness, risky behavior, and safety, while no significant differences were found for violence-related behavior, physical activity, and confidence level. Adolescents with family heroes had safer behavior (2.39 ± 0.70) than those with celebrity heroes (3.16 ±1.86, p=0.0277), and those with peer heroes (11.3 ± 2.31) had more risky behavior than those with celebrity heroes (9.16 ± 1.98, p=0.0347). However, children with adult peer heroes had a higher interest in education (2.00 ± 0) compared to those with celebrities (3.79 ± 1.03, p=0.0246) or public figures (3.78 ± 1.09, p=0.0333) as their heroes. Additionally, those with family (3.48 ± 1.05) or adult peers (3.32 ± 1.38) as their mentors had a higher interest in education compared to those with same-age peer mentors (5.80 ± 1.30, p=<0.0001). Adolescents with family mentors also had higher happiness scores (3.25 ± 0.33) than those with same-age peer mentors (2.59 ± 1.47, p=0.0358) and also engaged in safer behavior (2.52 ± 0.80) compared to all other categories (3.03 ±1.59, 0.0462). ConclusionThese results point to the idea that who adolescents choose to look up to has effects on various aspects of their life that could affect both their physical and mental health status, with family members having the most impact. Further research could explore differences between which family members are chosen as role models, mentors, and heroes and what effect they might have on adolescent development.

Hiatal hernia with focal megaoesophagus was diagnosed in a 10-year-old Friesian stallion presenting to the referral hospital for further investigation of recurrent oesophageal obstruction. Oesophageal endoscopy revealed dilation of the distal oesophagus with alterations in the mucosa characteristic of gastric mucosa in the distal oesophagus. In addition, a moderate amount of feed material was identified in the distal oesophagus. Positive contrast radiography showed that approximately half of the stomach was herniated cranially through the diaphragm. Management of the disease included recommendations to elevate the patient's torso during feeding and provide mash-only feeds. Provided that successful control of the megaoesophagus could be achieved, surgical repair of the hiatal hernia may be an option for the future. This is the first report of hiatal herniation in horses. We report the successful conservative management of a stallion with both megaoesophagus and hiatal herniation through elevated feedings and selective exercise management.

Objective The purpose of this study was to determine whether surgical scheduling affected patient outcomes following lumbar laminectomy. Physician fatigue caused by prolonged work hours has been shown to worsen outcomes. Previous research has also established a relationship between surgical scheduling and outcomes. Methods This was a retrospective chart review of single-level lumbar laminectomy patients at the Penn State Milton S. Hershey Medical Center between 1992 and 2019. Patients who underwent a one-level laminectomy between 1992 and 2019 were included in the study. Patients with procedures defined as complex (>1 level, tumor or abscess removal, discectomy, implant removal) were excluded. The surgical complication rate [cerebrospinal fluid (CSF) leak, 30-day redo, 30-day ED visit, weakness, sensation loss, infection, urinary retention] was compared across surgical start times, day of the week, proximity to a holiday, and procedure length. Results Procedures that started between 9:01-11:00 were more likely to have a complication than those between 7:01-9:00 (p=0.04). For every 60-min increase in surgery length, odds of having a complication increased by 2.01 times (p=0.0041). Surgeries that started between 11:01-13:00 had a significantly longer median surgery length than those between 7:01-9:00. Conclusion The time of the day when the procedure was started was predictive of worse outcomes following laminectomy. This may be attributed to several factors, including fatigue and staff turnover. Additionally, increased surgical length was predictive of more complications. It remains unclear whether increased surgical time results from correction of noticed errors or a fatigue-related decline in speed and performance. These findings on one-level laminectomy warrant further investigations since they have implications for reducing systemic failures that impact patient outcomes.

INTRODUCTION:Cerebrospinal fluid shunting is the mainstay for intracranial hydrocephalus but has a high rate of surgical revision secondary to infections and blockage. Traditionally, the hospital stay is one day post-operative for a non-complicated shunt revision. However, in the appropriate population we believe the same day discharge after a shunt revision is safe.METHODS:We perform a retrospective chart review of all shunt revisions performed at Penn State Milton S. Hershey Medical Center between 2014 and 2021. Patient characteristics were evaluated for the ideal demographics for same day discharge. We compared rates of emergency department visits, hospitalization, and revision at 30 and 90 days between same day discharge and control patients following shunt revision. Non-parametric, Logistic regression and Chi-squared testing was done for statistically significant with and without Propensity Score Matching.RESULTS:A total of 996 patient were examined with 56 (5.6%) patients being discharged on the same day as the surgery. On univariate analysis, patient with same day discharge were older (OR 1.019; 1.007-1.032), more like for distal shunt failure (OR 4.914; 2.792-8.649), more likely for elective surgery (OR 5.472; 2.346-12.763), and less likely to have visited the emergency department in the prior 30 d (OR 0.216; 0.112-0.413). On multivariate analysis, recent ED visit, elective surgery, and distal shunt failure remained significant. In unmatched data, same-day discharge patients had significantly less 30-day revisions (p=.035) but a comparable rate of 90-day revisions as well as 30-day and 90-day emergency room visits and hospitalization. Propensity-score matching compared 29 revisions in each group; all covariates were non-significant (p > 0.05) and all 30-day and 90-day outcomes were not significantly different.CONCLUSION:These findings validate the safety profile for same day discharge in post-operative shunt patients as well as describe the preferred characteristics of our patient cohort. Elective, distal shunt failure patients are preferred for early discharge post-operatively.