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Innovation Concept: The outcome of emergency medicine training is to produce physicians who can competently run an emergency department (ED) shift. While many workplace-based ED assessments focus on discrete tasks of the discipline, others emphasize assessment of performance across the entire shift. However, the quality of assessments is generally poor and these tools often lack validity evidence. The use of entrustment scale anchors may help to address these psychometric issues. The aim of this study was to develop and gather validity evidence for a novel tool to assess a resident's ability to independently run an ED shift. Methods: Through a nominal group technique, local and national stakeholders identified dimensions of performance reflective of a competent ED physician. These dimensions were included in a new tool that was piloted in the Department of Emergency Medicine at the University of Ottawa during a 4-month period. Psychometric characteristics of the items were calculated, and a generalizability analysis used to determine the reliability of scores. An ANOVA was conducted to determine whether scores increased as a function of training level (junior = PGY1-2, intermediate = PGY3, senior = PGY4-5), and varied by ED treatment area. Safety for independent practice was analyzed with a dichotomous score. Curriculum, Tool or Material: The developed Ottawa Emergency Department Shift Observation Tool (O-EDShOT) includes 12-items rated on a 5-point entrustment scale with a global assessment item and 2 short-answer questions. Eight hundred and thirty-three assessment were completed by 78 physicians for 45 residents. Mean scores differed significantly by training level (p < .001) with junior residents receiving lower ratings (3.48 ± 0.69) than intermediate residents who received lower ratings (3.98 ± 0.48) than senior residents (4.54 ± 0.42). Scores did not vary by ED treatment area (p > .05). Residents judged to be safe to independently run the shift had significantly higher mean scores than those judged not to be safe (4.74 ± 0.31 vs 3.75 ± 0.66; p < .001). Fourteen observations per resident, the typical number recorded during a 1-month rotation, were required to achieve a reliability of 0.80. Conclusion: The O-EDShOT successfully discriminated between junior, intermediate and senior-level residents regardless of ED treatment area. Multiple sources of evidence support the O-EDShOT producing valid scores for assessing a resident's ability to independently run an ED shift.
Unlike for many other respiratory infections, the seasonality of pertussis is not well understood. While evidence of seasonal fluctuations in pertussis incidence has been noted in some countries, there have been conflicting findings including in the context of Australia. We investigated this issue by analysing the seasonality of pertussis notifications in Australia using monthly data from January 1991 to December 2016. Data were made available for all states and territories in Australia except for the Australian Capital Territory and were stratified into age groups. Using a time-series decomposition approach, we formulated a generalised additive model where seasonality is expressed using cosinor terms to estimate the amplitude and peak timing of pertussis notifications in Australia. We also compared these characteristics across different jurisdictions and age groups. We found evidence that pertussis notifications exhibit seasonality, with peaks observed during the spring and summer months (November–January) in Australia and across different states and territories. During peak months, notifications are expected to increase by about 15% compared with the yearly average. Peak notifications for children <5 years occurred 1–2 months later than the general population, which provides support to the theory that older household members remain an important source of pertussis infection for younger children. In addition, our results provide a more comprehensive spatial picture of seasonality in Australia, a feature lacking in previous studies. Finally, our findings suggest that seasonal forcing may be useful to consider in future population transmission models of pertussis.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
We investigated risk factors for severe acute lower respiratory infections (ALRI) among hospitalised children <2 years, with a focus on the interactions between virus and age. Statistical interactions between age and respiratory syncytial virus (RSV), influenza, adenovirus (ADV) and rhinovirus on the risk of ALRI outcomes were investigated. Of 1780 hospitalisations, 228 (12.8%) were admitted to the intensive care unit (ICU). The median (range) length of stay (LOS) in hospital was 3 (1–27) days. An increase of 1 month of age was associated with a decreased risk of ICU admission (rate ratio (RR) 0.94; 95% confidence intervals (CI) 0.91–0.98) and with a decrease in LOS (RR 0.96; 95% CI 0.95–0.97). Associations between RSV, influenza, ADV positivity and ICU admission and LOS were significantly modified by age. Children <5 months old were at the highest risk from RSV-associated severe outcomes, while children >8 months were at greater risk from influenza-associated ICU admissions and long hospital stay. Children with ADV had increased LOS across all ages. In the first 2 years of life, the effects of different viruses on ALRI severity varies with age. Our findings help to identify specific ages that would most benefit from virus-specific interventions such as vaccines and antivirals.
Mechanical forces during machine milking induce changes in teat condition which can be differentiated into short-term and long-term changes. Machine milking-induced short-term changes in teat condition (STC) are defined as tissue responses to a single milking and have been associated with the risk of new intramammary infection. Albeit, their association with teat characteristics, such as teat-end shape, has not been investigated by rigorous methods. The primary objective was to determine the association of STC, as measured by ultrasonography, with teat-end shape. The second objective was to describe possible differences in the recovery time of teat tissue after machine milking among teats with different teat-end shapes. Holstein cows (n=128) were enrolled in an observational study, housed in free-stall pens with sand bedding and milked three times a day. Ultrasonography of the left front and right hind teat was performed after teat preparation before milking (t−1), immediately after milking (t0) and 1, 3, 5 and 7 h after milking (t1, t3, t5, t7). The teat tissue parameters measured from ultrasound scans were teat canal length, teat-end diameter, teat-end diameter at the midpoint between the distal and proximal end of the teat canal, teat wall thickness, and teat cistern width. Teat-end shape was assessed visually and classified into three categories: pointed, flat and round. Multivariable linear regression analyses showed differences in the relative change of teat tissue parameters (compared with t−1) at t0 among teats with different teat-end shapes, with most parameters showing the largest change for round teats. The premilking values were reached (recovery time) after 7 h in teats with a pointed teat-end shape, whereas recovery time was greater than 7 h in teats with flat and round teat-end shapes. Under the same liner and milking machine conditions, teats with a round teat-end shape had the most severe short-term changes. The results of this observational study indicated that teat-end shape may be one of the factors that contribute to the severity of STC.
The history of British saints on the Continent is notoriously difficult to research – and I deliberately use the word ‘British’ and ‘Briton’ even where others might prefer ‘Breton’, because for the sixth century it is usually impossible to make a definite distinction between those who originated in Great Britain and those who came from Brittany. The majority of our sources are late: the most substantial body of material is hagiographic, but the Vita Winwaloei was written by Wrdestin and Clement in the first years of the ninth century, that of Machutus (Malo) by Bili around 860, and that of Paul Aurelian by Wrmonoc in 884. Of the two Lives of Gildas, the earliest appears to belong to the eleventh century, and the second, by Caradoc of Llancarfan, to the twelfth. The first Life of Samson (VIS) would seem to have been composed initially during the seventh century, which is when the author himself claims to have been active, and there are certain linguistic and terminological features in the Life that support such a date. There may, of course, have been a subsequent moment of what French scholars are now describing as réécriture, but even so the fact that the text makes no mention of a diocese of Dol surely indicates that the work as we have it antedates the foundation of the see, whose existence is not clearly attested before the mid-ninth century.
For Samson, unlike Gildas, Paul Aurelian, Winwaloe (Gwennolé), and Malo, we at least have the evidence of the subscription list of the Council of Paris, which can be dated by means of the other signatories to the period 556 to 573. The Council provides us with a useful point of departure for considering the activities of British ascetics in the Merovingian world. Having considered the early evidence for Samson, I will turn to that relating to the Irish saint Columbanus, which arguably gives us our most extensive block of dateable evidence for the influence of Britons on the Continent, before returning to what the Vita Samsonis has to say about the saint's Continental career, and the ways in which it complements and differs from the Columbanian material.
Reliable and affordable technology for collecting and managing livestock production process information is being developed. The advances in data measurement, collection and transfer technology enable us to retrieve information from one or more remote sites to be processed and managed centrally. This opens up the opportunity to advance from open loop, prescriptive production to closed loop systems where factors influencing the actual performance of animals are used to modify and improve their production parameters (feed, environment, medication). We strive from producing animals by predicting what is needed using outdated data, to measuring what is actually happening as they grow, processing this information and acting to optimise animal performance by modifying production parameters in real time.
This paper describes commercially available systems that make possible the retrieval, collection, processing and distribution of near real time production information. Various aspects of production management using this technology are discussed, and examples of how it can be applied to monitor water usage, how it relates to pig performance and how energy usage can be influenced, are considered.
A major focus for improving the diets in many less developed countries (LDCS) is the provision of rumen fermentable nitrogen (N) using protein supplements to complement N-deficient foods. However, in vitro digestibility methods usually use N-rich environments for the degradation of single foods. This conventional approach may give data which do not reflect the nutritive value of the N-deficient diets often on offer in LDCS, neither is it appropriate for using in vitro gas production to study protein supplementation. Our earlier study indicated that, by using a N-free medium, the gas production technique responded to added ammonium sulphate and urea. The ADAS standardized methodology, which used 10 ml of inoculum instead of the 5 ml used in the earlier study, was found not to be very responsive to N supplementation. The ADAS methodology was therefore investigated in order to develop a modified protocol for fermenting foods in an N-limited environment. The study involved using inocula diluted to different extents in N-free medium for fermenting N-deficient substrates in N-free and N-rich media. The modified protocol was then used for investigating the interactions between N-rich and N-deficient foods from north-west India.
In ewe lambs, acceleration of growth and accumulation of both muscle and fat leads to earlier sexual maturity and better reproductive performance. The next stage in the development of this theme is to test whether these aspects of growth in young ewes affect milk production in their first lactation and the growth of their first progeny. We studied 75 young Merino ewes that had known phenotypic values for depth of eye muscle (EMD) and fat (FAT), and known Australian Sheep Breeding Values for post-weaning weight (PWT) and depths of eye muscle (PEMD) and fat (PFAT). They lambed for the first time at 1 year of age. Their lambs were weighed weekly from birth to weaning at 10 weeks to determine live weight gain and weaning weight. Progeny birth weight was positively associated with live weight gain and weaning weight (P<0.001). The PWT of the mothers was positively associated with birth weight (P<0.01), live weight gain and weaning weight of the progeny (P<0.05); however, these progeny traits were not influenced by EMD, FAT, PEMD, PFAT of the mothers (P>0.05). The PWT of the sire was positively associated with live weight gain (P<0.05) and weaning weight of the progeny (P<0.01). At around day 20 postpartum, we measured milk production and milk composition (fat, protein, lactose, total solids). Milk production was influenced positively by birth type (single or twin; P<0.05) and negatively by birth weight (P<0.05), but not by mother phenotype or genotype, sire genotype of the mother or the sex of the progeny (P>0.05). The concentrations of fat, protein, lactose and total solids in the milk were not affected by the phenotype or genotype of the mothers or of the sires of the mothers, or by the sex of the progeny (P>0.05). We conclude that selection of young Merino ewes for better growth, and more rapid accumulation of muscle and fat, will lead to progeny that are heavier at birth, grow faster and are heavier at weaning. Moreover, milk production and composition do not seem to be affected by the genetic merit of the mother for post-weaning live weight or PEMD or PFAT. Therefore, Merino ewes can lamb at 1 year of age without affecting the production objectives of the Merino sheep industry.
The solar magnesium II core-to-wing ratio has been a well-studied proxy for chromospheric activity since 1978. Daily measurements at high spectral (0.1 nm) resolution began with the launch of the Solar Radiation and Climate Experiment (SORCE) in 2003. The next generation of measurements from the Extreme Ultraviolet Sensor (EUVS) on the Geostationary Operational Environmental Satellite 16 (GOES-16) will add high time cadence (every 30 seconds) to the observational Mg II irradiance record. We present a comparison of the two measurements during the period of overlap.
Ultraviolet (UV) Solar spectral Irradiance (SSI) has been measured from orbit on a regular basis since the beginning of the space age. These observations span four Solar Cycles, and they are crucial for our understanding of the Sun-Earth connection and space weather. SSI at these wavelengths are the main drivers for the upper atmosphere including the production and destruction of ozone in the stratosphere. The instruments that measure UV SSI not only require good preflight calibration, but also need a robust method to maintain that calibration on orbit. We will give an overview of the catalog of current and former UV SSI measurements along with the calibration philosophy of each instrument and an estimation of the uncertainties in the published irradiances.
Knowledge of the genetic and phenotypic relationships for muscle fibre characteristics with meat and eating quality in pigs is required by the pig breeding industry for two reasons. Muscle fibre traits, determined from muscle biopsy, could be used as genetic predictors of meat and eating quality traits and, secondly, if responses in meat and eating quality traits are partially due to changes in muscle fibre traits, then selection criteria can be designed to compensate for such responses. The current study estimated the genetic and phenotypic relationships for muscle fibre traits with meat and eating quality traits.
The study consisted of 160 Large White pigs from lines divergently selected for lean growth rate on ad-libitum or restricted feeding regimes, lean food conversion ratio and daily food intake for seven generations in the Edinburgh lean growth selection experiment. Within each selection line, there were 10 pairs of full-sibs. Boars and gilts were tested from 30 kg, individually penned and fed a diet consisting of 224 g CP/kg DM and 15.9 MJ DE/kg DM.
The aim of future beef production is healthier, tastier products which consumers will find attractive. Combinations of breed and feeding system are required to fulfil these aims. In this project we compared the Holstein- Friesian (HF) breed, an allegedly inferior beef producer, with Welsh Black (WB), a traditional beef breed. Of particular interest was the role of polyunsaturated fatty acids (PUFA) in flavour development.
Thirty six steers, 18 HF and 18 WB, were reared on grass silage plus one of three concentrates. The concentrates contained different fat sources at 0.03 of intake: 1. megalac (control, C16:0); 2. formaldehyde-protected whole linseed (Lin, C18:3 n-3); and 3. an equal mix on a fat basis of protected linseed and fish oil (Lin/fish, C20:5 and C22:6 n-3). The animals were slaughtered after 90 days consumption of the diets. Fortyeight hours after slaughter, three forequarter muscles (M. supraspinatus, M. infraspinatus and M. triceps brachii caput longum) were trimmed of fat, minced and displayed in modified atmosphere packs (0.8 02:0.2 CO2, 4°C in 1000 Lux) for 3 or 10 days.
Ruminant products are considered as a major source of saturated fatty acids (SFA) in the human diet and a reduction in the intake of SFA along with a concomitant increase in the intake of n-3 series PUFA is recommended by nutritionists (Department of Health, 1994). The major fatty acid classes in beef are the saturated fatty acids (SFA), monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) and beef is a nutritionally important source of the beneficial n-3 series PUFA. Experiments investigating the effects of age on lipid composition in beef muscle have, in the main, used short time periods and also been subject to confounding effects of differences in growth rate (Rule et al., 1997). This study is part of a larger investigation into the effects of breed and diet, as well as age, on muscle lipids (Warren et al., 2003). This paper will focus on the effect of age.
Under controlled experimental conditions, ruminally protected lipid supplements (PLS) rich in 18:2n-6 and 18:3n-3 have been successful in creating large shifts in the fatty acid composition of beef muscle (Scollan et al., 2003). However, there is a need to test methodology under commercial conditions and with a wider range of breed types. This study was conducted at a Yorkshire Farm and used Charolais Cross and the Stabiliser breed, a mix of 5 breeds designed to combine efficient production and good carcass quality.
Recommendations to improve the UK diet suggest an increase in the ratio of polyunsaturated to saturated fatty acids (P:S ratio) and a higher consumption of n-3 polyunsaturated fatty acids (PUFA). Ruminant meats have a poor P:S ratio, approximately 0.1 compared to the recommendation of 0.4-1.0 for the whole diet. However, the ratio of C18:2 n-6/C18:3 n-3 (the n-6:n-3) is well within the recommended value of <4.0 at approximately 2 and ruminant muscle also supplies longer-chain n-3 PUFA. By feeding lipid in a formaldehyde cross-linked protein matrix, rumen biohydrogenation can be avoided and the tissue PUFA level increased but with potential effects on oxidative shelf-life, colour and flavour of the meat. This trial investigated the fatty acid composition and quality of meat produced by feeding a protected lipid supplement (PLS).
There is increasing interest in the use of red clover (Trifolium pratense) as a high protein forage crop to finish growing lambs. Red clover contains the isoflavanoid compound formononetin which is converted to the non-steroidal oestrogen analogue equol by rumen micro-organisms. Equol is absorbed by the animal, and can have significant effects, such as suppressing reproductive cycling in ewes. Very few commercial red clover varieties have been bred with a low formononetin content to prevent this problem. Although human health benefits have been linked to the consumption of oestrogenically active compounds in foods such as soya (Kurzer and Xu, 1997), there is a need to investigate the presence of oestrogenically active compounds in animal products. The objective of this study was to investigate plasma metabolite and hormone concentrations, and the residual levels of equol in meat, of lambs grazing two varieties of red clover differing in their formononetin contents, compared to control animals grazing grass.
Skatole is formed as a result of bacterial degradation of tryptophan in the rumen of cattle and sheep, and the hindgut of pigs. It accumulates in fat where it is an important component of boar taint in pigs (Claus et al, 1994), and with branched chain fatty acids, has been implicated as a contributor to the strong flavour characteristic of sheepmeat (Young et al, 1997). This study examines the role of breed, diet and age on skatole deposition in the fat and perception of beef flavour.
We explore the dynamics of starting plumes by analysis of a series of new small-scale laboratory experiments combined with a theoretical model for mass, momentum, and buoyancy conservation. We find that the head of the plume ascends with a speed which is approximately 0.6 times the characteristic speed of the fluid in the following steady plume, in accord with Turner (J. Fluid Mech., vol. 13 (03), 1962, pp. 356–368), and so the fluid released from the source eventually catches the head of the flow. On reaching the top of the plume it recirculates and mixes in the plume head. We estimate that approximately
of the total buoyancy released from the source accumulates in the plume head, with the remainder in the following steady plume. Using measurements of the volume of the head, we estimate that a fraction
of the volume of the head is entrained directly from the ambient, with the remainder of the fluid in the head being supplied by the following steady plume. These results imply that the buoyancy force exerted on the plume head plus the momentum flux supplied by the following plume exceeds the rate of change of momentum of the plume head even including the added mass of the plume head. We propose that the difference is associated with a drag force resulting from the displacement of ambient fluid around the plume head. Using our experimental data, we estimate that the drag coefficient
has a value
, with the range in values associated with the uncertainty in our estimate of entrainment of fluid directly into the plume head. As a test, the proposed model is shown to provide a reasonable description of a starting plume rising through a stratified environment in the region below the maximum height of rise of the associated steady plume, although, above this point, the shape of the plume head changes and the model breaks down.