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Introduction: Variation in image ordering exists across Alberta emergency departments (EDs). Evidence-based, pocket-sized knowledge dissemination tools were developed for two conditions (acute asthma [AA] and benign headache [BHA]) for which imaging (chest x-ray [CXR] and computed tomography [CT], respectively) has limited utility. This study explored tool acceptability among ED patients and emergency physicians (EPs). Methods: Tool feedback was provided by EPs, via online survey, and adult patients with AA and BHA via in-person survey. EPs qualitative interviews further explored communication tools. Preliminary descriptive analyses of survey responses and content analysis of interview data were conducted. Results: Overall, 55 EPs (55/192; 29%) and 38 consecutive patients participated in the AA study; 73 EPs (73/192; 38%) and 160 patients participated in the BHA study. In both studies, approximately 50% of EPs felt comfortable using the tool; however, they suggested including radiation risk details and imaging indications and removing references to imaging variation and health system cost. In the BHA study, EPs opposed the four Choosing Wisely® campaign questions fearing they would increase imaging expectations. In both conditions, most patients ( >90%) understood the content and 68% felt the information applied to them. Less than half (AA:45%; BHA: 38%) agreed that they now knew more about when a patient should have imaging workup done. Following tool review, 71% of AA and 50% of BHA patients stated they would discuss their imaging needs with their ED care provider today or during a future presentation. Both patient groups suggested including: additional imaging details (i.e., indications, risk, clinical utility), removing imaging overuse references, and including instructions that encourage patients to ask their EP questions. EP interviews (n = 12) identified preferences for personalized and interactive tools. Tensions were perceived around ED time pressure as well as remuneration schemes that fail to prioritize patient conversation. Tool centralization, easy access, and connection with outpatient support were also key themes. Conclusion: Both patients and EPs provided valuable information on how to improve ED knowledge dissemination tools, using two chronic conditions to demonstrate how these changes would improve tool utility. Implementing these recommendations, and considering preferences of EPs and patients, may improve future tool uptake and impact.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Structural modifications occurring in corroded potassium silicate glasses were studied using x-ray amorphous scattering techniques. Pair function distribution curves are compared and the differential method is used to follow the structural changes. The structure appears to approach that of vitreous silica after long leaching times.
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk – Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: ‘junk/snack foods’, ‘healthy/guideline foods’ and ‘breast milk/formula’. A significant group difference was observed in ‘breast milk/formula’ dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows’ milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
We are now reaching the last flurry of half-century commemorations of the 1960s. What is striking in these backwards glances – most recently, fifty years since 1967’s Summer of Love, and fifty years since ‘1968’ – is the truncation of events, the conflation of ideas, the simplification of meaning. Years and eras are impossible to encapsulate in sound bites or longer narratives of public memorialization, so music often serves as a convenient shorthand; yet popular songs of 1967 and 1968 only occasionally spoke to contemporary events, and more often skated over the surface of deep cultural rifts and political upheaval. What we now retain is a sort of shared mythology – 1967 was peaceful, 1968 was violent – that complicates our ability to see the past in the present. As I aim to show here, the 1960s continue to resonate today in ways that force us to confront history, for as William Faulkner wrote, ‘the past is never dead. It's not even past.’
Stanley Cavell’s moral perfectionism places the task of cultivating richer self-understanding and self-expression at the center of corporate life. We show how his approach reframes business as an opportunity for moral soul-craft, achieved through the articulation of increasingly reflective inner life in organizational culture. Instead of norming constraints on business activity, perfectionism opens new possibilities for conducting commercial exchange as a form of conversation, leading to personal growth. This approach guides executives in designing businesses that foster genius and channel creativity, while giving all stakeholders a meaningful voice within a culture of trust. We first give an account of Cavellian perfectionism. Then, we explain how this underrepresented strand of moral reflection challenges and enriches, but does not supplant, prevailing ethical theories—including other versions of perfectionism. We then demonstrate the salience of Cavellian perfectionism to business ethics through examples from marketing, human resources, and executive organizational design and development.
Cross-sectional and longitudinal research has shown that race-related stress is associated with increased depressive symptoms among racial/ethnic minorities. Rumination has long been considered a maladaptive self-regulatory response to race-related stress, and growing evidence suggests that it may be an important link in the relation between race-related stress and depression. More adaptive forms of self-regulation, such as active coping, may counteract the negative impact of rumination. We examined the influence of rumination on the relation between race-related stress and depressive symptoms in a sample (N = 69) of young adult (mean age = 20 ± 1.5 years) African American women. We also considered the possible moderating effects of John Henryism, a form of persistent and determined goal striving, and vagally mediated heart rate variability, a purported biomarker of coping. Anticipatory race-related stress was indirectly associated with depressive symptoms through rumination: estimate = 0.07, 95% confidence interval [0.01, 0.16]. Both John Henryism and vagally mediated heart rate variability moderated the relationship between race-related stress and rumination; however, only John Henryism reliably influenced the indirect association between race-related stress and depression through rumination. We discuss these findings in the context of growing research examining the interplay between cultural and biological factors in the risk for poorer mental health.
The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants’ gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more ‘mature’ microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children’s feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.
One of the more consistent characterizations of both American Fundamentalism and other versions of conservative Evangelicalism is that these groups represent authoritarian religious and social systems. Such characterizations are not entirely without some basis in fact. Fundamentalism will almost always appear authoritarian, and so too will forms of Pentecostalism which, like Fundamentalism, place a heavy emphasis on correct thinking and combine a belief in the infallibility of scripture with a commitment to literal readings. Outsiders are sometimes disconcerted to find that “authoritarian” and related concepts are not assessed negatively in conservative Evangelical circles. Quite the contrary is the case: the Bible, infallible, inerrant, “God-breathed,” is the clear center of Evangelical authority. Many a Fundamentalist sermon has sought to clinch its case with the phrase, “on authority of the holy Word of God.”
OBJECTIVES/SPECIFIC AIMS: Specialized pro-resolving lipid mediators (SPM) actively counter proinflammatory cascades. A deficit of SPMs is one possible mechanism through which inflammation leads to the development of atherosclerotic disease. The purpose of this study is to characterize the profiles of intermediates of SPM synthesis pathways and end-product SPMs in the plasma of patients with peripheral artery disease (PAD). METHODS/STUDY POPULATION: A cross-sectional sample of 52 patients with PAD was recruited at the San Francisco Veterans Affairs Medical Center. PAD was defined as the presence of claudication symptoms and an ankle-brachial index <0.9, or a history of revascularization for claudication. Patients were excluded if they were taking immunosuppressive medications, had a severe acute illness (infection, surgery, illness, critical limb ischemia) within the last 30 days, or had severe hepatic, renal, or nonvascular inflammatory disease. Intermediates of SPM synthesis pathways and end-product SPMs were measured in plasma samples of patients by liquid chromatography-tandem mass spectrometry. RESULTS/ANTICIPATED RESULTS: The average age of the cohort was 69±6.3 and patient comorbidities reflected common comorbidities associated with PAD (hypertension 96%, hyperlipidemia 87%, diabetes mellitus 42%, coronary artery disease 34%). Rutherford categories, measurements of PAD symptom severity, ranged from 0 to III (0 10%, I 40%, II 27%, III 23%). Three EPA products were measured: 18-hydroxyeicosapentaenoic acid (18-HEPE), resolvin E1 (RvE1), and resolvin E2 (RvE2). 18-HEPE, an intermediate of SPM synthesis, was detectable in the plasma of every patient (median: 105 pg/mL, IQR: 54.9–195), whereas the SPM end-products, RvE1 and RvE2, were only detectable in 6 and 10 patients, respectively. In total, 7 DHA products were measured: 14-hydroxydocosahexaenoic acid (14-HDHA), 17-HDHA, resolvin D1 (RvD1), resolvin D2 (RvD2), protectin D1, protectin DX, and maresin 1. The intermediates 14-HDHA (median: 6546 pg/mL, IQR: 3329–12061) and 17-HDHA (median: 644 pg/mL, IQR: 340–1056) were detectable in the plasma of every patient. However, the end-products RvD1, RvD2, protectin D1, protecin DX, and maresin 1 were identified in less than half of the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: We report the presence of several intermediates of SPM synthesis pathways (18-HEPE, 14-HDHA, and 17-HDHA) in every patient but the presence of SPM end-products in only a limited portion of the cohort. These results suggest that some patients with PAD may have a deficit of SPMs. Further investigation is required to better understand the role of SPMs and mediators of resolution of inflammation in PAD.
OBJECTIVES/SPECIFIC AIMS: The purpose of this study was to characterize the pharmacokinetics of phosphatidylethanol (PEth) 16:0/20:4 homolog in uncoagulated, human blood samples taken from 18 participants in a clinical laboratory setting after consumption of 2 doses of ethanol. METHODS/STUDY POPULATION: Male and female participants received either 0.4 or 0.8 g/kg oral doses of ethanol during a 15-minute period. Blood samples were collected before and throughout 6 hours immediately after alcohol administration, then after 2, 4, 7, 11, and 14 days of administration day. PEth 16:0/20:4 levels were quantified by liquid mass spectrometry. Breath ethanol concentrations were measure concurrently with each blood collection during the administration day, as well as transdermal ethanol concentrations monitored constantly before, during and after ethanol administration day. RESULTS/ANTICIPATED RESULTS: (1) Single doses of 0.4 and 0.8 g ethanol/kg produced proportional increases in BrAC and PEth 16:0/20:4 levels; (2) the increase of Peth 16:0/20:4 from base line to Cmax was less than either PEth 16:0/18:1 or PEth 16:0/18:2 during the 6-hour period after ethanol administration; (3) the mean rate of formation of PEth 16:0/20:4 was lower than those of the other 2 homologs; (4) the mean half-life of PEth 16:0/20:4 was 2.18 days, which was shorter than that of either PEth 16:0/18:1 and PEth 16:0/18:2, which were 6.80 and 6.62, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of this study further confirm that PEth homologs are a sensitive biomarker for ethanol consumption. The measurement of three PEth homologs appears to provide additional information about the level and time frame of drinking.
Introduction: The effectiveness of intravenous alteplase is highly time dependent, and very short door-to-needle times (DNT) of 30 minutes or less have been reported in single centre hospitals, but never in an entire population. QuICR (Quality Improvement and Clinical Research) Alberta Stroke Program aimed to reduce DNT to a median of 30 minutes across the Canadian province of Alberta. Methods: We used the Improvement Collaborative Methodology from early 2015 to September 2016 with participation from all 17 Stroke Centres in Alberta. This methodology included 4 face-to-face workshops, site visits, webinars, data collection, data feedback, intensive process mapping, and process improvements. We compared data in the pre-intervention period from 2009-2014 (collected during the Alberta Provincial Stroke Strategy) to data in the post-intervention period from March 2016-February 2017 (collected during the QuICR DTN Collaborative). Data from January 2015-February 2016 were excluded, as improvements were being implemented during this time. Results: There were a total of 2,322 treated cases in the pre- and post-intervention periods. The results show that the median DNT dropped from 68 minutes (n=1846) in the pre-intervention period to 36 minutes (n=476) in the post-intervention period (p<0.001). There were reductions in DNT across all hospital types: median DNT dropped from 63 to 32 minutes in Urban Tertiary Centres (p<0.001), from 73 to 32 minutes in Community with 24/7 neurology (p<0.001), from 85 to 62 minutes in Community with limited/no neurology (p<0.001), and from 74 to 52.5 minutes in rural centres (p<0.001). Conclusion: There were 21.5 to 41 minute reductions in median DNT across all hospital types including smaller rural and community hospitals. A targeted multi-site improvement collaborative can be an effective intervention to reduce DNT across an entire population.
Rates of genetic improvement in dairy cattle breeding programmes have increased substantially in the last decade, not only in Europe where there has been substantial immigration of North American stock. More accurate statistical evaluation procedures, including the use of best linear unbiased prediction (BLUP) with the animal model, have been introduced; higher selection intensities have been achieved, particularly on production traits, through better organized and focused schemes; and developments in multiple ovulation and embryo transfer (MOET) have been both a stimulus and to some extent a cause. Continued rapid improvement can be expected as research and development enables more accurate and timely use to be made of recording data, because there is evidence that heritability values for milk production are rising, perhaps because of better cow management, and as competition among breeders internationally increases. There are a number of consequent challenges to geneticists and breeders. Attention will have to be given to maintaining the fitness of very high producing animals by recording health, fertility, longevity and parlour traits, and using the results of research to give them appropriate weight in selection decisions. Developments in molecular methods and in reproductive technologies present new opportunities, but are unlikely to do more for some time than complement progress from conventional selection on the important production traits.
In nutritional terms productivity in dairy cows is best expressed in multiples of their energy requirements for maintenance, which is directly related to Metabolic Body Weight (MBW). Energy requirements can further be specified as those for free energy (fME), ketogenic energy (kME), glucogenic energy (gME) and aminogenic energy (aME). For maintenance, energy is required in an approximate ratio fME:gME:aME of 85:5:10.For a production level of 6x maintenance the required ratio of fME:kME:gME:aME is approximately 18:31:29:22, hence 70% of the required ME has to be delivered as specific nutrients.
During their productive life, dairy cattle alternate periods with high and periods with low risk of an inadequate nutrient supply. A period of high risk is between 10 days pre-partum and 90 days postpartum. High risk in this period means a high susceptibility for metabolic and reproductive disorders, many of which are interrelated. Negative Energy Balance (NEB) in early lactation is a metabolic status that is almost inevitable in high yielding dairy cows. In severe cases this is an important predisposing factor for metabolic disorders (paturient paresis, fatty liver, ketosis, displaced abomasum) and reproductive disorders (undetected heat, delayed ovarian cycle, reduced fertility, increased between calving interval).
Adequate nutrient supply is required from 2 weeks pre-partum onwards. Critical issues are energy density, distribution between structural and non-structural carbohydrates and distribution between fME, kME, gME and aME. Practical solutions, which can help alleviate the metabolic and reproductive problems, could be a nutrient based feed evaluation system, a lower peak yield combined with an improved persistence and maybe a deliberately increased calving interval.
Factors that influence variability between and within populations at levels ranging from the molecular to quantitative traits are reviewed. For quantitative traits, models of how levels of variation are determined and how they change have to be based on simplifying assumptions. At its simplest, variation is maintained by a balance between gain by mutation and loss by sampling due to finite population size. Rates of response in commercial breeding programmes and long-term selection experiments are reviewed. It is seen that rates of progress continue to be high in farmed livestock, but not in race horses, and that continuing responses have been maintained for 100 generations in laboratory experiments. Hence variability can be maintained over long periods despite intense selection in populations of limited size. The potential role of conserved populations is reviewed, and it is suggested that their role is unlikely to be as a useful source of variation in commercial populations but mainly to preserve our culture and to fill particular niches.
The relations between genetic change in domestic livestock and infectious disease (including both its epidemiology and the animal's reaction to it) are examined. The overall picture is confusing because there are different, and seemingly unrelated, ways of considering the issue. An attempt is made to put these together into a more general framework. Four processes of particular interest are distinguished and discussed in more detail: (i) the way a population's genetic potential for immunocompetence can be changed by breeding, (ii) the way an animal's immunocompetence is influenced by that animal's production potential, in combination with the environmental resources that are available to it at a given time, (iii) the way the disease status of an animal (and a population of animals) is influenced by its immunocompetence, and (iv) the way the production level of an animal is influenced by activation of its immune system. Ultimately, all four processes influence the realised level of production.
This comes down to four questions that need to be addressed: (i) can we use genetic variation in immunocompetence in animal breeding? (ii) does a higher production potential (today's direction of breeding) have a negative impact on immunocompetence? (iii) does improved immunocompetence result in improved health? and (iv) how large is the negative impact of disease on production?