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To investigate the nutrition education provided by primary-care physicians (PCP).
An integrative review was used to examine literature on nutrition care provided by PCP from 2012 to 2018. A literature search was conducted in MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scopus using key search terms.
USA, Netherlands, Germany, Denmark, UK, Lebanon, Australia and New Zealand.
Sixteen qualitative and quantitative studies were analysed thematically using meta-synthesis informed by the COM-B model of behaviour (capability, motivation and opportunity), to understand the influences on PCP behaviours to provide nutrition care. PCP perceive that they lack nutrition capability. While PCP motivation to provide nutrition care differs based on patient characteristics and those of their own, opportunity is influenced by medical educators, mentors and policy generated by professional and governmental organisations.
The development of PCP capability, motivation and opportunity to provide nutrition care should begin in undergraduate medical training, and continue into PCP training, to create synergy between these behaviours for PCP to become confident providing nutrition care as an integral component of disease prevention and management in contemporary medical practice.
High-resolution Chirp sub-bottom data were obtained offshore from the Northern Channel Islands (NCI), California, to image submerged paleoshorelines and assess local uplift rates. Although modern bathymetry is often used for modeling paleoshorelines, Chirp data image paleoshorelines buried beneath sediment that obscures their seafloor expression. The NCI were a unified landmass during the last glacial maximum (LGM; ~20 ka), when eustatic sea level was ~120 m lower than present. We identified seven paleoshorelines, ranging from ~28 to 104 m in depth, across this now-submerged LGM platform. Paleoshoreline depths were compared to local sea-level curves to estimate ages, which suggest that some were reoccupied over multiple sea-level cycles. Additionally, previous studies determined conflicting uplift rates for the NCI, ranging from 0.16 to 1.5 m/ka. Our results suggest that a rate on the lower end of this range better fits the observed submerged paleoshorelines. Using the uplift rate of ~0.16 m/ka, we estimate that paleoshorelines formed during Marine Oxygen Isotope Stage 3, the LGM, and the Younger Dryas stade are preserved on the NCI platform. These results help clarify uplift rates for the NCI and illustrate the importance of sub-bottom data for mapping submerged paleoshorelines.
The Australian prime lamb industry is seeking to improve lean meat yield (LMY) as a means to increasing efficiency and profitability across the whole value chain. The LMY of prime lambs is affected by genetics and on-farm nutrition from birth to slaughter and is the total muscle weight relative to the total carcass weight. Under the production conditions of south eastern Australia, many ewe flocks experience a moderate reduction in nutrition in mid to late pregnancy due to a decrease in pasture availability and quality. Correcting nutritional deficits throughout gestation requires the feeding of supplements. This enables the pregnant ewe to meet condition score (CS) targets at lambing. However, limited resources on farm often mean it is difficult to effectively manage nutritional supplementation of the pregnant ewe flock. The impact of reduced ewe nutrition in mid to late pregnancy on the body composition of finishing lambs and subsequent carcass composition remains unknown. This study investigated the effect of moderately reducing ewe nutrition in mid to late gestation on the body composition of finishing lambs and carcass composition at slaughter on a commercial scale. Multiple born lambs to CS2.5 target ewes were lighter at birth and weaning, had lower feedlot entry and exit weights with lower pre-slaughter and carcass weights compared with CS3.0 and CS3.5 target ewes. These lambs also had significantly lower eye muscle and fat depth when measured by ultrasound prior to slaughter and carcass subcutaneous fat depth measured 110 mm from the spine along the 12th rib (GR 12th) and at the C-site (C-fat). Although carcasses were ~5% lighter, results showed that male progeny born to ewes with reduced nutrition from day 50 gestation to a target CS2.5 at lambing had a higher percentage of lean tissue mass as measured by dual energy X-ray absorptiometry and a lower percentage of fat during finishing and at slaughter, with the multiple born progeny from CS3.0 and CS3.5 target ewes being similar. These data suggest lambs produced from multiple bearing ewes that have had a moderate reduction in nutrition during pregnancy are less mature. This effect was also independent of lamb finishing system. The 5% reduction in carcass weight observed in this study would have commercially relevant consequences for prime lamb producers, despite a small gain in LMY.
Over 80% of CTSA programs have a community advisory board (CAB). Little is known about how research discussed with CABs aligns with community priorities (bidirectionality). This program evaluation assessed researcher presentations from 2014 to 2018 to the CABs linked to our CTSA at all three sites (Minnesota, Arizona, and Florida) for relevance to local community needs identified in 2013 and/or 2016. From content analysis, of 65 presentations total, 41 (63%) addressed ≥1 local health needs (47% Minnesota, 60% Florida, and 80% Arizona). Cross-cutting topics were cancer/cancer prevention (physical activity/obesity/nutrition) and mental health. Results could help to prioritize health outcomes of community-engaged research efforts.
The verse hinc subitae mortes atque intestata senectus (Juv. 1.144) has long fuelled considerable debate and discussion among classical scholars. This hexameter occurs in the passage of the first satire that describes the aspect of the patron-client relationship where the rich patron, ignoring the plight of his poor and hungry clients, enjoys a sumptuous but deadly feast. After dining on delicacies such as boar and peacock, he bathes on a bloated stomach, causing him to die suddenly and apparently intestate, and causing those angry at being deprived of their legacy to cheer at his funeral (1.140b–6):
Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes – where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.
OBJECTIVES/SPECIFIC AIMS: Over 80% of CTSA programs have a community advisory board (CAB), an effective strategy to increase community engagement (CE) in research. Little is known about how the research discussed with CABs aligns with community priorities (i.e., bi-directionality). This program evaluation assessed the health topics presented by researchers to the CABs linked to our CE Program at all three Mayo Clinic sites (MN, AZ, and FL) for relevance to local community needs. METHODS/STUDY POPULATION: Two coders classified Mayo researcher presentations to our CABs from 2014-2018 for relevance to needs identified in the local 2013 and/or 2016 County Health Needs Assessments and specific topic(s); with high levels of agreement (Kappa=0.90). RESULTS/ANTICIPATED RESULTS: Overall, of the 65 presentations 41 (63%) addressed one or more local health needs (47% MN, 60% FL, 80% AZ). Cross-cutting health topics addressed at 2 sites were physical activity/obesity/nutrition and mental health. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings were shared with our CABs to obtain input on future directions. The FL and AZ CABs are systematic in seeking out or initiating research projects that address local health needs, an approach the MN site is interested in adopting. Ultimately, it is important to demonstrate improved health outcomes with CTSA-based CE research strategies. Understanding community health needs and depth of researchers in those areas may help to focus priorities for demonstrating such outcomes.
Breakthrough Listen is a 10-yr initiative to search for signatures of technologies created by extraterrestrial civilisations at radio and optical wavelengths. Here, we detail the digital data recording system deployed for Breakthrough Listen observations at the 64-m aperture CSIRO Parkes Telescope in New South Wales, Australia. The recording system currently implements two modes: a dual-polarisation, 1.125-GHz bandwidth mode for single-beam observations, and a 26-input, 308-MHz bandwidth mode for the 21-cm multibeam receiver. The system is also designed to support a 3-GHz single-beam mode for the forthcoming Parkes ultra-wideband feed. In this paper, we present details of the system architecture, provide an overview of hardware and software, and present initial performance results.
To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.
A prospective quasi-experimental pilot study.
Two rural VAMCs with acute-care and long-term care units.
At each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.
Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.
Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.
This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.
The combination of sensitivity and large sky coverage of the ALFALFA HI survey has enabled the detection of difficult to observe low mass galaxies in large numbers, including dwarf galaxies overlooked in optical surveys. Three different, but connected, studies of dwarf galaxies from the ALFALFA survey are of particular interest: SHIELD (Survey of HI in Extremely Low-mass Dwarfs), candidate gas-rich ultra-faint dwarf galaxies, and the (Almost) Dark population. SHIELD is a systematic multiwavelength study of all dwarf galaxies from ALFALFA with MHI < 107.2M⊙ and clear optical counterparts. Candidate gas-rich ultra-faint dwarf galaxies extend the dwarf galaxy population to even lower masses. These galaxies are identified as isolated HI clouds with no discernible optical counterpart but subsequent observations reveal that some are extremely faint, gas-dominated galaxies. Leo P, discovered first as an HI detection, and then found to be an actively star-forming galaxy, bridges the gap between these candidate galaxies and the SHIELD sample. The (Almost) Dark sample consists of galaxies whose optical counterparts are overlooked in current optical surveys but which are clear detections in ALFALFA. This sample includes field gas-rich ultra-diffuse galaxies. Coma P, with a peak surface brightness of only ∼26.4 mag arcsec−2 in g’, demonstrates the sort of extreme low surface brightness galaxy that can be discovered in an HI survey.
The overall objective of a series of experiments to investigate ‘metabolic stress’ was to examine the relationships between ‘metabolic load’, disease and other parameters associated with the welfare of the dairy cow. In the main, these used several well controlled herd based studies complimented with more basic and strategic investigations. In this paper we compare and contrast practical aspects of health and welfare in two high genetic merit herds managed at the extremes of inputs and outputs for dairy farming in south-west Scotland. The hypothesis was that high output herds would have more health and welfare problems than low input herds. Two herds (70 Holstein-Friesian cows each) at SAC Acrehead Dumfries of a similar genetic background (overall in the top 5% of UK cows by PIN and ITEM), were housed in identical buildings and tended by the same herdsman. Both herds had autumn- and spring-calving cattle. The ‘low input’ herd (LI) was given a minimum of concentrate (approx. 0.5 t per cow per year) and milked twice a day and had a restricted quota of 385 000 l. The ‘high output’ herd (HO) was managed for high yields (unrestricted quota) and was given concentrates (2 t per cow per year) and forage ad libitum and milked three times daily. In 1995-96 the sole source of winter forage was grass/clover silage (LI) or grass silage (HO) but in 1996-1998 ensiled cereal and fodder beet were included in both diets. ‘Metabolic load’ could only be inferred from overall inputs, milk outputs, weight loss, body condition score and behaviour. There were significant differences in 305-day lactation yields between herds, and season of calving especially in 1995-96 (LI autumn; 5952 l at 30 g/kg protein (P); LI spring; 5741 l, 32.5 g/kg P; HO autumn; 9541 l at 32.8 g/kg P; HO spring; 8402 l, 32.6 g/kg P). LI weight and body condition-score losses were greatest in this year and behavioural studies showed substantial differences in feeding time (HO < LI, P < 0.05) and total lying time (LI < HO; P < 0.05). However these differences were much less marked in subsequent years. There was a significant difference in the prevalence and incidence of clinical lameness between herds (HO > LI; P < 0.05) and season (autumn > spring P < 0.05) but not for mastitis or metabolic disease. An in-depth study of subclinical claw horn lesion development in first calving heifers showed significant differences between herds in 1996-97 (LI > HO, P < 0.05) but none in 1995-96. There was a significant difference for season in both years (autumn > spring, P < 0.05). Analysis of blood biochemistry parameters of samples taken at approximately 1 month after calving showed some significant differences between LI and HO generally indicating a greater ‘metabolic load’ for LI. Although the full effects of ‘metabolic load’ on immune function and reproduction are dealt with elsewhere our preliminary data showed no significant differences between herds for the former but some significant differences for the latter, in particular there were differences in aspects of the progesterone profiles between herds and more importantly between seasons. However these latter differences were not clearly reflected in conception rates. It was concluded that the hypothesis was not fully sustained and that both systems had pitfalls in terms of welfare. The three major areas causing difficulties for both systems were the need first to ensure adequate intake of forage; secondly to limit the environmental challenge to the feet and udder and finally to marry these systems to the factors limiting reproduction, primarily calving season and ability of reproduction management.
As a continuation of our earlier work (Gottesman and Hunter, 1982), we have reobserved the HI emission from the galaxy NGC 3992. We have combined all the data and produced new maps, at a significantly improved signal-to-noise ratio, of the gas density and velocity distribution with resolutions of ~ 22″ and 25 km s−1. The resultant, angle averaged, HI rotational velocity is shown in Figure 1 for the symmetric and nearly circular flows for r ≤ 3.35′ from the center (r ≤ 14.0 kpc, assuming de Vaucouleurs' (1979) distance of 14.2 mpc for NGC 3992). Shown, also, in Figure 1 is a fit to the observations provided by a Toomre disk of index n = o. No attempt was made to fit the observational data within 1′, in view of the low signal to noise.
We report observations of the atomic hydrogen properties of the barred spiral galaxies NGC 3992 and NGC 4731. These systems were observed in 1980 and 1981 with the VLA telescope of the National Radio Astronomy Observatory. In Table 1 we list the systemic parameters of interest.
In studies of extragalactic radio sources with multiple compact components the determination of which components, if any, are stationary and which moving is of importance. In order to learn about the radio properties of the individual components it is also relevant to be able to register maps made at several wavelengths. Both tasks are usually not possible with VLBI because of the irrecoverable corruption of the fringe phase introduced by the propagation medium and the instrumentation. However, when two or more compact radio sources are separated by only a small angle from each other difference techniques can be used to help tackle both questions.
We report on the first sub-arcsecond resolution mid-IR images of the nuclei of galaxies from the IRAS ultraluminous sample. This sample contains galaxies which emit most of their energy in the far-infrared (10-100μm) and have luminosities approaching that of quasars. Previous observations in the mid-IR using single element detectors suggest that the IR luminosity is derived from a region smaller than the instrumental aperture, typically 5″(1.6 kpc at 65 Mpc). Our observations are capable of imaging the morphology of the mid-IR emission region to a factor of eight smaller than previously known.