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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.
Childhood adversity is associated with poor mental and physical health outcomes across the life span. Alterations in the hypothalamic–pituitary–adrenal axis are considered a key mechanism underlying these associations, although findings have been mixed. These inconsistencies suggest that other aspects of stress processing may underlie variations in this these associations, and that differences in adversity type, sex, and age may be relevant. The current study investigated the relationship between childhood adversity, stress perception, and morning cortisol, and examined whether differences in adversity type (generalized vs. threat and deprivation), sex, and age had distinct effects on these associations. Salivary cortisol samples, daily hassle stress ratings, and retrospective measures of childhood adversity were collected from a large sample of youth at risk for serious mental illness including psychoses (n = 605, mean age = 19.3). Results indicated that childhood adversity was associated with increased stress perception, which subsequently predicted higher morning cortisol levels; however, these associations were specific to threat exposures in females. These findings highlight the role of stress perception in stress vulnerability following childhood adversity and highlight potential sex differences in the impact of threat exposures.
The rapid, quantitative and qualitative analysis of particulates on air filter samples is becoming increasingly important as more air pollution sampling stations are set up throughout the countiy. Although atomic absorption provides a sensitive technique for the analysis of many elements, the disadvantages of complex sample preparation, sample destruction and the necessity to analyze one element at a time make this technique unsuitable for a large volume of samples. X-ray energy spectroscopy when combined with automated sample handling and the latest dedicated data reduction systems provides a technique which enables the analyst to process large numbers of samples and obtain precise quantitative and qualitative data rapidly. This paper will describe the preparation and analysis of typical air filter type samples, and the steps taken to identify the elements in the samples and obtain computerized reduction of the data in μg/cm2, ppm or percent.
During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. This suggests that for many, their psychosocial disability is enduring, and targeted interventions are therefore needed earlier in their developmental trajectories to ensure that psychosocial disability does not become entrenched. Poor psychosocial functioning also affects individuals with a range of different emerging mental health problems, putting these young people at risk of long-term social marginalisation and economic disadvantage; all of which are known risk factors for the development of psychosis. Identification of the markers of poor psychosocial functioning will help to inform effective treatments. This editorial will discern the early trajectories and markers of poor psychosocial outcome in psychosis, and highlight which individuals are most at risk of having a poor outcome. This editorial will also discuss whether early interventions are currently being targeted appropriately and will propose how intervention and preventative strategies can be implemented, to restore psychosocial trajectories in a way that enables young people to maximise their life chances.
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.
This study compared the effect of feeding AmyPlus, a moist feed, as opposed to rolled wheat on the yield and composition of milk from dairy cows consuming grass silage based total mixed ration (TMR). Seventy-two Holstein-Friesian cows were distributed into AmyPlus (Treatment) and Wheat (Control) groups and loose housed on straw in an open shed. Each kg Wheat based concentrate contained 345g rolled wheat, 230g rapeseed meal, 115g sugarbeet pulp, 115g Molaferm 20, 115g soybean meal, 56g barley straw and 24g vitamin-minerals. In contrast, each kg AmyPlus based concentrate contained 501g AmyPlus (480g DM /kg), 105g rapeseed meal, 126g sugarbeet pulp, 126g Molaferm 20, 84g soybean meal, 41g barley straw and 17g vitamin-minerals. Here, AmyPlus was loaded directly into the mixer wagon to prepare fresh AmyPlus based TMR with a silage to concentrate ratio of 68:32. Each TMR was fed once daily to the corresponding group of cows also receiving 2kg of Distillers’ grains per cow in the parlour during milking. Daily milk yield and composition was recorded from November 1999 to February 2000. The overall daily Dry matter intake (DMI) of each TMR per cow remained uniform (20.19 vs 20.15 kg for Treatment and Control group respectively) across both groups. Daily milk yield and total cell counts per cow did not vary significantly (P>0.05) between groups during various months. While, milk fat and protein contents were greater in Treatment than Control group during each month, the differences were significant (P<0.05) only during November and December for fat and in January for protein. On average, the Treatment group tended to show a non-significant increase (P>0.05) in daily milk yield per cow by 0.144 kg than the Control group. The fat (46.2 vs 43.7) and protein (34.5 vs 33.5) contents in g /kg milk were also increased significantly (P<0.001) in Treatment compared with Control group. Total cell counts did not vary significantly (P>0.05) and remained within the acceptable limits. The cows consuming AmyPlus maintained their health as indicated by their intake, production, cell counts and general appearance. It would appear that AmyPlus can replace rolled wheat in TMR. However, it may be necessary to evaluate the storage, economic and environmental implications of using such moist co-products in silage based dairy rations.
Scientists have long known that certain pesticides, industrial chemicals and heavy metals have a detrimental impact on the reproductive health of a wide range of species (including humans) by disrupting the endocrine system. As exposure to, and the effects of, ‘endocrine disrupters’ are likely to be more pronounced in wild species with a short gestation period and life-cycle we have chosen to develop non-invasive tools based upon faecal steroid analysis to monitor the reproductive status of the short-tailed field vole (Microtus agrestis). This approach is hoped to eventually provide a sensitive means of detecting environmental disturbances that could adversely affect humans, livestock and wildlife by establishing the the field vole as a terrestrial biomarker. Faecal steroid hormone analysis has already been demonstrated as being a convenient and reliable means of diagnosing reproductive state in a large range of mammalian species (including gazelle, rhino, macaque and mice), however, as of yet little is known regarding the hormonal changes that occur during pregnancy in M. agrestis.
Gliricidia sepium (Jacq.) Steud. is widely used as a high-protein supplementary food for ruminants in many parts of the tropics. Native to Central America and Mexico, it has become widely naturalized elsewhere but the introduced populations are mostly of unknown origin and uncertain quality. Studies of the genetic resources from the native range, under a research programme at OFI, have shown great variation between populations in yield (Dunsdon and Simons, 1996). The objective of the research described here was to investigate whether there is also important genetic variation in fodder quality, to inform decisions on future distribution of ‘superior’ germplasm of G. sepium under the OFI programme.
This experiment was conducted to evaluate the effect of adding some herbal feed additives (HF A) [thyme (T, Thymus Vulgaris L.), dianthus (D, Delphinum Ajaews), and fennel (F, Foeniculum Vulgare L.)] at a level of 10g/kg to Japanese quail diets on performance and some metabolic functions. Adding HFA to the control diet improved (P<0.05) body gain, feed intake and feed conversion (feed/gain) efficiency. The birds fed dietary F additive exhibited the best (P<0.05) values of these parameters during the entire period (0 to 6 weeks of age), compared with other dietary treatments. There was an improvement (P<0.05) in total protein, globulin, and albumin for birds fed dietary T or F at six weeks of age. Birds fed on dietary F recorded the lowest (P<0.05) value of these components compared with other dietary treatments.
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.
The pre-requisites for nutritional management of dairy cows are information about how much feed is being consumed as well as the nutrients that are being derived from that feed. Studies of feed intake and nutrient supply have been limited by difficult experimental techniques, particularly with grazing animals. The models derived from much earlier work are of only general applicability and there is a need for more site-specific information in order to benefit further from conceptual advances.
We have adopted a different approach to studying herbage intake and nutrient supply, using less-invasive approaches as well as techniques that monitor more accessible aspects of these processes, such as jaw movements. These techniques have a major advantage, in addition to their value as research tools, because they could translate directly into commercial applications in on-farm monitoring. The use of diagnostics and behavioural recording is well explored in relation to health monitoring; here we argue for its potential to advance the application of knowledge about grazing and nutrition. We will illustrate this approach using our experiences in measuring grazing behaviour, using IGER behaviour recorders and assessing rumen function, using a series of non-invasive techniques.
The IGER grazing behaviour recorder allows us to record jaw movements and hence grazing and ruminating time and bite dynamics. It also allows the recording of steps and is now being developed to incorporate non-invasive rumen state sensors. It has made a major contribution to our understanding of the foraging strategies of grazing animals and their effect on herbage intake. This technology has the potential to be developed for on-farm monitoring of foraging behaviour providing valuable inputs to the prediction of herbage intake, in decision support systems for grazing.
The introduction of concept of protein degradation and microbial synthesis in the rumen are significant advances in protein rationing schemes. However, real progress has been limited because the lack of consistent experimental results means that models have little relevance to specific farm situations. We foresee considerable opportunities to monitor products of rumen degradation and synthesis that appear in milk (e.g. odd-chain fatty acids) or breath (e.g. sulphides).
Taken together these technologies open the possibilities of an entirely new approach to nutritional management of dairy cows, with site-specific recommendations based on information gathered using new sensors that are incorporated into computerised feeding equipment and milking parlours.
Boar taint is a major meat quality defect, which affects about 10% of entire male pigs. It is due to an excessive accumulation of skatole and androstenone in adipose tissue. One of the reasons for accumulation of these compounds is a low rate of their metabolism. Androstenone is metabolised in liver via the enzyme 3-beta-hydroxysteroid dehydrogenase (HSD). This enzyme is well characterised in the testis, where it participates in the synthesis of steroids, while its properties in liver are unknown. The aim of the present study was to characterise and compare properties of HSD from pig liver versus pig testis when metabolising androstenone.
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).
Increasing the ratio polyunsaturated:saturated fatty acids (P:S) in beef muscle by nutrition is hampered by the high levels of ruminal biohydrogenation of dietary polyunsaturated fatty acids (PUFA). Effective ruminal protection of dietary fatty acids, such as that provided by encapsulation of PUFA in formaldehyde-treated protein may ameliorate this situation. This study evaluated the effects of including in the diet a ruminally protected lipid supplement (PLS), containing linoleic (C18:2) and α -linolenic (C18:3) acids, on the fatty acid composition of the m. longissimus.
Effective ruminal protection of dietary polyunsaturated fatty acids (PUFA) is very useful in helping to reduce microbial biohydrogenation of PUFA and results in major improvements in the ratio of polyunsaturated:saturated fatty acids (P:S) in beef muscle (Scollan et al., 2003). However, in that study the protected lipid study (PLS) used which consisted of soya beans, linseed and sunflower oils mixed to give a 2.4:1 ratio of 18:2n -6:18:3n -3, was less successful in improving the n -6:n -3 ratio in beef muscle. This study reports the effects of including in the diet a PLS with a lower ratio of 18:2n -6:18:3n -3 on the fatty acid composition of the m. longissimus.
Increasing the n-3 polyunsaturated fatty acid (PUFA) content of ruminant products may be important in reducing the incidence of cardiovascular diseases in man. Previous experiments suggest that a-linolenic acid (C18:3n -3) in the form of whole linseed is extensively biohydrogenated both in vitro (Cooper et al., 2001) and in vivo (Wachira et al., 2000) and that some form of protection is required. By contrast the long chain PUFA’s in fish oils appear less susceptible to biohydrogenation (Wachira et al., 2000). The objective of the present study was to quantify the extent to which n-3 PUFA from different sources were biohydrogenated in the rumen and to determine the degree to which they were incorporated into plasma lipids.
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.
Unprotected n-3 PUFA supplements fed to ruminants are subject to lipolysis and biohydrogenation in the rumen (Wachira et al. 1998). Improving the n-3 PUFA content of ruminant products therefore requires some form of protection of dietary lipid from microbial activity in the rumen. The in-vitro incubation of PUFA sources offers the opportunity of rapidly determining the level of protection offered against ruminal biohydrogenation. The objectives of the current experiment were therefore to determine the biohydrogenation of a number of sources containing a-linolenic acid using the in-vitro gas production technique.