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Background As a consequence of their occupation, doctors and other healthcare workers were at higher risk of contracting coronavirus disease 2019 (COVID-19), and more likely to experience severe disease compared to the general population. However, systematic information on post-acute COVID complications in doctors is very limited. Aims This study aimed to determine the symptoms, perceived determinants, health and occupational impact, and consequent needs relating to post-acute COVID complications in UK doctors. Methods An online cross-sectional survey was distributed to UK doctors self-identifying as having Long COVID or other post-acute COVID complications. Results Of 795 responses, 603 fulfilled the inclusion criteria of being a UK-based medical doctor experiencing one or more post-acute COVID complications. Twenty-eight per cent reported a lack of adequate Respiratory Protective Equipment at the time of contracting COVID-19. Eighteen per cent of eligible respondents reported that they had been unable to return to work since acquiring COVID. Conclusions Post-acute COVID (Long COVID) in UK doctors is a substantial burden for respondents to our questionnaire. The results indicated that insufficient respiratory protection could have contributed to occupational disease, with COVID-19 being contracted in the workplace, and resultant post-COVID complications. Although it may be too late to address the perceived determinants of inadequate protection for those already suffering with Long COVID, more investment is needed in rehabilitation and support of those afflicted. [ABSTRACT FROM AUTHOR]

A systematic, semi-automated search for pulsar glitches in the first UTMOST public data release is presented. The search is carried out using a hidden Markov model which incorporates both glitches and timing noise into the model of the assumed phase evolution of the pulsar. Glitches are detected through Bayesian model selection between models with and without glitches present with minimal human intervention. Nine glitches are detected among seven objects, all of which have been previously reported. No new glitches were detected. Injection studies are used to place 90 per cent frequentist upper limits on the size of undetected glitches in each of the 282 objects searched. The mean upper limit obtained is |$\Delta f^{90{{\%}}}/f = 1.9 \times 10^{-8}$|⁠ , with a range of |$4.1 \times 10^{-11} \le \Delta f^{90{{\%}}}/f \le 2.7 \times 10^{-7}$|⁠ , assuming step events with no post-glitch recoveries. It is demonstrated that including glitch recovery has a mild effect, in most cases increasing the upper limit by a factor of ≲5 conservatively assuming complete recovery on a time-scale of |$100\ \mathrm{d}$|⁠. [ABSTRACT FROM AUTHOR]

Background In December 2018, a large, tertiary, university-affiliated hospital in the Philippines discovered that their legitimate supply chain was infiltrated with counterfeit rabies vaccines. Methods All vials suspected to be counterfeit were quarantined and surrendered to the Philippine Food and Drug Administration. Patients who may have received the counterfeit products were recalled, evaluated, and revaccinated accordingly. Vials of the counterfeit vaccines were sent to various laboratories for testing. Results Two batches of counterfeit rabies vaccines were found to have infiltrated the hospital's supply chain between December 2017 and December 2018. Of the 1711 patients who may have received counterfeit vaccines, 1397 patients were successfully contacted, and 734 were revaccinated with at least 1 dose of authentic rabies vaccine. The counterfeit vials were sterile, contained no toxic substances, and both contained active antirabies ingredient. No report of rabies infection or other adverse events were noted. Conclusions Our experience demonstrates the need for strong intervention and collaborative response from all stakeholders—government and regulatory bodies, the pharmaceutical industry, and individual institutions and consumers—to effectively eradicate counterfeiting and protect our patients. [ABSTRACT FROM AUTHOR]

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The dust mass absorption coefficient, κd is the conversion function used to infer physical dust masses from observations of dust emission. However, it is notoriously poorly constrained, and it is highly uncertain how it varies, either between or within galaxies. Here we present the results of a proof-of-concept study, using the DustPedia data for two nearby face-on spiral galaxies M 74 (NGC 628) and M 83 (NGC 5236), to create the first ever maps of κd in galaxies. We determine κd using an empirical method that exploits the fact that the dust-to-metals ratio of the interstellar medium is constrained by direct measurements of the depletion of gas-phase metals. We apply this method pixel-by-pixel within M 74 and M 83, to create maps of κd. We also demonstrate a novel method of producing metallicity maps for galaxies with irregularly sampled measurements, using the machine learning technique of Gaussian process regression. We find strong evidence for significant variation in κd. We find values of κd at 500  |$\mu$| m spanning the range 0.11–0.25  |${\rm m^{2}\, kg^{-1}}$| in M 74, and 0.15–0.80  |${\rm m^{2}\, kg^{-1}}$| in M 83. Surprisingly, we find that κd shows a distinct inverse correlation with the local density of the interstellar medium. This inverse correlation is the opposite of what is predicted by standard dust models. However, we find this relationship to be robust against a large range of changes to our method – only the adoption of unphysical or highly unusual assumptions would be able to suppress it. [ABSTRACT FROM AUTHOR]

Background: The evidence regarding the prognostic impact of a positive circumferential resection margin (CRM) in oesophageal cancer is conflicting, and there is global variability in the definition of a positive CRM. The aim of this study was to determine the impact of a positive CRM on survival in patients undergoing oesophagectomy for oesophageal cancer. Methods: A systematic review and meta‐analysis was performed. PubMed and Embase databases were searched for articles to May 2018 examining the effect of a positive CRM on survival. Cohort studies written in English were included. Meta‐analyses of univariable and multivariable hazard ratios (HRs) were performed using both Royal College of Pathologists (RCP) and College of American Pathologists (CAP) criteria. Risk of bias was assessed using the Newcastle–Ottawa Scale. Egger regression, and Duval and Tweedie trim‐and‐fill statistics were used to assess publication bias. Results: Of 133 studies screened, 29 incorporating 6142 patients were finally included for analysis. Pooled univariable HRs for overall survival in patients with a positive CRM were 1·68 (95 per cent c.i. 1·48 to 1·91; P < 0·001) and 2·18 (1·84 to 2·60; P < 0·001) using RCP and CAP criteria respectively. Subgroup analyses demonstrated similar results for patients by T category, neoadjuvant therapy and tumour type. Pooled HRs from multivariable analyses suggested that a positive CRM was independently predictive of a worse overall survival (RCP: 1·41, 1·21 to 1·64, P < 0·001; CAP: 2·37, 1·60 to 3·51, P < 0·001). Conclusion: A positive CRM is associated with a worse prognosis regardless of classification system, T category, tumour type or neoadjuvant therapy. [ABSTRACT FROM AUTHOR]

Dear Editor, Segmental odontomaxillary dysplasia (SOD) is a rare condition of unknown incidence, with approximately 60 cases reported (as reviewed in 2018).1 It presents at birth or during childhood with a constellation of ipsilateral facial signs: nonprogressive or slowly progressive overgrowth or undergrowth of soft tissues and/or bones (typically centred on the posterior maxilla, and leading to facial asymmetry), dental anomalies (missing teeth or abnormal dentition), gingival hyperplasia or abnormal gingivae, commissural lip fissures, hypertrichosis, cutaneous hyperpigmentation and/or erythema, cutaneous depression, and lip hypopigmentation. We present here that the genetic cause of SOD in four of four patients tested thus far with this rare disease is postzygotic missense variants in the gene I ACTB i . [Extracted from the article]

Background Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs. Methods The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare’s 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases–trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models. Results Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval,.80–.99) and broad-spectrum (0.76;.63–.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant. Conclusions Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline. Clinical Trials Registration NCT03245879 [ABSTRACT FROM AUTHOR]

An equivalent computational approach called ssGTBLUP was formulated for the original single-step GBLUP (ssGBLUP). In ssGTBLUP, the genomic relationship matrix has the form G = ZZ' + C, where the (centered and scaled) Z marker matrix has size n x m (numbers of genotypes and markers), and the C matrix can be easily inverted. The inverse can be written as G-1 = C-1 - T'T where T is an m by n matrix. When the preconditioned conjugate gradient (PCG) method is used to solve the mixed model equations, a matrix vector product G-1d needs to be computed. In ssGBLUP, this requires n² multiplications, but in ssGTBLUP, the product T'Td has 2nm multiplications and C-1d has cn multiplications with the constant c independent of n or m. In an approximate approach called ssGTBLUP(p), the eigendecomposition of Z'C-1Z is used to reduce the number of rows in the T matrix. Here, p is the percentage of total variance explained by the accepted eigenvalues. The objective of this study was to compare the performance of ssGBLUP, ssGTBLUP, ssGTBLUP(p), and the APY (algorithm for proven and young) method. In APY, the core had 50,000 (APY50K), 30,000 (APY30K), or 10,000 (APY10K) animals. The approaches were tested on the Irish beef carcass conformation genetic evaluation which has a heterogeneous multibreed population. The pedigree had 13.3 million animals. There were m = 54,620 markers available from n = 163,277 genotyped animals. For genotyped animals, the correlations of breeding values between ssGBLUP and ssGTBLUP(p) for the 11 traits in the model ranged from 0.999-1.000 for p = 99, 0.998-1.000 for p = 98, and 0.992-0.998 for p = 95 but were 0.994-1.000 for APY50K, 0.969-0.997 for APY30K, and 0.899-0.967 for APY10K. Computing times per iteration were 4.43, 3.30, 2.69, 2.29, 1.55, 1.76, 1.27, and 0.55 min for ssGBLUP, ssGTBLUP, ssGTBLUP(99), ssGTBLUP(98), ssGTBLUP(95), APY50K, APY30K, and APY10K, respectively. The ssGTBLUP(p) approach allowed a well-defined approximation to ssGBLUP and fast computations. [ABSTRACT FROM AUTHOR]

Background and aim Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients. Methods A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings. Results This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI95%: 1.42–1.97), cardiac complications (OR: 1.62, CI95%: 1.10–2.40), pulmonary complications (OR: 1.44, CI95%: 1.11–1.87) and decreased 5-year overall survival (OR: 1.36, CI95%: 1.11–1.66) and 5-year disease-free survival (OR: 1.66, CI95%: 1.40–1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI95%: 0.71–1.59). Conclusion Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent. [ABSTRACT FROM AUTHOR]

Background. Antibiotic use and misuse is driving drug resistance. Much of US healthcare takes place in small community hospitals (SCHs); 70% of all US hospitals have <200 beds. Antibiotic use in SCHs is poorly described. We evaluated antibiotic use using data from the National Healthcare and Safety Network antimicrobial use option from the Centers for Disease Control and Prevention. Methods. We used Intermountain Healthcare's monthly antibiotic use reports for 19 hospitals from 2011 to 2013. Hospital care units were categorized as intensive care, medical/surgical, pediatric, or miscellaneous. Antibiotics were categorized based on spectrum of coverage. Antibiotic use rates, expressed as days of therapy per 1000 patient-days (DOT/1000PD), were calculated for each SCH and compared with rates in large community hospitals (LCHs). Negative-binomial regression was used to relate antibiotic use to predictor variables. Results. Total antibiotic use rates varied widely across the 15 SCHs (median, 436 DOT/1000PD; range, 134-671 DOT/1000PD) and were similar to rates in 4 LCHs (509DOT/1000PD; 406-597DOT/1000PD). The proportion of patient-days spent in the respective unit types varied substantially within SCHs and had a large impact on facility-level rates. Broad-spectrum antibiotics accounted for 26% of use inSCHs (range,8%-36%), similar to the proportion in LCHs (32%; range, 26%-37%). Case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use. Conclusions. There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts. [ABSTRACT FROM AUTHOR]

Objective: Develop and evaluate an automated identification and predictive risk report for hospitalized heart failure (HF) patients.Methods: Dictated free-text reports from the previous 24 h were analyzed each day with natural language processing (NLP), to help improve the early identification of hospitalized patients with HF. A second application that uses an Intermountain Healthcare-developed predictive score to determine each HF patient's risk for 30-day hospital readmission and 30-day mortality was also developed. That information was included in an identification and predictive risk report, which was evaluated at a 354-bed hospital that treats high-risk HF patients.Results: The addition of NLP-identified HF patients increased the identification score's sensitivity from 82.6% to 95.3% and its specificity from 82.7% to 97.5%, and the model's positive predictive value is 97.45%. Daily multidisciplinary discharge planning meetings are now based on the information provided by the HF identification and predictive report, and clinician's review of potential HF admissions takes less time compared to the previously used manual methodology (10 vs 40 min). An evaluation of the use of the HF predictive report identified a significant reduction in 30-day mortality and a significant increase in patient discharges to home care instead of to a specialized nursing facility.Conclusions: Using clinical decision support to help identify HF patients and automatically calculating their 30-day all-cause readmission and 30-day mortality risks, coupled with a multidisciplinary care process pathway, was found to be an effective process to improve HF patient identification, significantly reduce 30-day mortality, and significantly increase patient discharges to home care. [ABSTRACT FROM AUTHOR]

Livestock mature at different rates depending, in part, on their genetic merit; therefore, the optimal age at slaughter for progeny of certain sires may differ. The objective of the present study was to examine sire-level genetic profiles for carcass weight, carcass conformation, and carcass fat in cattle of multiple beef and dairy breeds, including crossbreeds. Slaughter records from 126,214 heifers and 124,641 steers aged between 360 and 1,200 d and from 86,089 young bulls aged between 360 and 720 d were used in the analysis; animals were from 15,127 sires. Variance components for each trait across age at slaughter were generated using sire random regression models that included quadratic polynomials for fixed and random effects; heterogeneous residual variances were assumed across ages. Heritability estimates across genders ranged from 0.08 (±0.02) to 0.34 (±0.02) for carcass weight, from 0.24 (±0.02) to 0.42 (±0.01) for conformation, and from 0.16 (±0.03) to 0.40 (±0.02) for fat score. Genetic correlations within each trait across ages weakened as the interval between ages compared lengthened but were all >0.64, suggesting a similar genetic background for each trait across different ages. Eigenvalues and eigenfunctions of the additive genetic covariance matrix revealed genetic variability among animals in their growth profiles for carcass traits, although most of the genetic variability was associated with the height of the growth profile. At the same age, a positive genetic correlation (0.60 to 0.78; SE ranged from 0.01 to 0.04) existed between carcass weight and conformation, whereas negative genetic correlations existed between fatness and both conformation (–0.46 to 0.08; SE ranged from 0.02 to 0.09) and carcass weight (–0.48 to –0.16; SE ranged from 0.02 to 0.14) at the same age. The estimated genetic parameters in the present study indicate genetic variability in the growth trajectory in cattle, which can be exploited through breeding programs and used in decision support tools. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a natural language processing system in extracting pneumonia-related concepts from chest x-ray reports.Methods: Design: Four physicians, three lay persons, a natural language processing system, and two keyword searches (designated AAKS and KS) detected the presence or absence of three pneumonia-related concepts and inferred the presence or absence of acute bacterial pneumonia from 292 chest x-ray reports. Gold standard: Majority vote of three independent physicians. Reliability of the gold standard was measured.Outcome Measures: Recall, precision, specificity, and agreement (using Finn's R: statistic) with respect to the gold standard. Differences between the physicians and the other subjects were tested using the McNemar test for each pneumonia concept and for the disease inference of acute bacterial pneumonia.Results: Reliability of the reference standard ranged from 0.86 to 0.96. Recall, precision, specificity, and agreement (Finn R:) for the inference on acute bacterial pneumonia were, respectively, 0.94, 0.87, 0.91, and 0.84 for physicians; 0.95, 0.78, 0.85, and 0.75 for natural language processing system; 0.46, 0.89, 0.95, and 0.54 for lay persons; 0.79, 0.63, 0.71, and 0.49 for AAKS; and 0.87, 0.70, 0.77, and 0.62 for KS. The McNemar pairwise comparisons showed differences between one physician and the natural language processing system for the infiltrate concept and between another physician and the natural language processing system for the inference on acute bacterial pneumonia. The comparisons also showed that most physicians were significantly different from the other subjects in all pneumonia concepts and the disease inference.Conclusion: In extracting pneumonia related concepts from chest x-ray reports, the performance of the natural language processing system was similar to that of physicians and better than that of lay persons and keyword searches. The encoded pneumonia information has the potential to support several pneumonia-related applications used in our institution. The applications include a decision support system called the antibiotic assistant, a computerized clinical protocol for pneumonia, and a quality assurance application in the radiology department. [ABSTRACT FROM AUTHOR]

Objective Develop and evaluate an automated case detection and response triggering system to monitor patients every 5 min and identify early signs of physiologic deterioration. Materials and methods A 2-year prospective, observational study at a large level 1 trauma center. All patients admitted to a 33-bed medical and oncology floor (A) and a 33-bed non-intensive care unit (ICU) surgical trauma floor (B) were monitored. During the intervention year, pager alerts of early physiologic deterioration were automatically sent to charge nurses along with access to a graphical point-of-care web page to facilitate patient evaluation. Results Nurses reported the positive predictive value of alerts was 91-100% depending on erroneous data presence. Unit A patients were significantly older and had significantly more comorbidities than unit B patients. During the intervention year, unit A patients had a significant increase in length of stay, more transfers to ICU (p = 0.23), and significantly more medical emergency team (MET) calls (p = 0.0008), and significantly fewer died (p = 0.044) compared to the pre-intervention year. No significant differences were found on unit B. Conclusions We monitored patients every 5 min and provided automated pages of early physiologic deterioration. This before-after study found a significant increase in MET calls and a significant decrease in mortality only in the unit with older patients with multiple comorbidities, and thus further study is warranted to detect potential confounding. Moreover, nurses reported the graphical alerts provided information needed to quickly evaluate patients, and they felt more confident about their assessment and more comfortable requesting help. [ABSTRACT FROM AUTHOR]

Background and aim Debate exists surrounding definitive chemoradiotherapy (dCRT) over neoadjuvant chemoradiotherapy and surgery (nCRS) as a primary treatment for esophageal squamous cell carcinoma (ESCC) owing to the heterogeneity in the quality of current evidence. This study aimed to compare long-term survival of dCRT with nCRT for ESCC from high-quality studies. Methods This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 23rd July 2021. Primary outcome was overall survival (OS) and secondary outcomes were disease-free survival (DFS) and recurrence rates. A meta-analysis was conducted using random-effects modelling to determine pooled adjusted multivariable hazard ratios (HRs). Results This review included ten high-quality studies including 14,092 patients, of which 30% received nCRT. Three studies were randomized controlled trials (RCT), six studies were single-center. dCRT and nCRT regimens were reported in six studies and surgical quality control were reported in two studies. Outcomes for OS and DFS were reported in eight and three studies, respectively. nCRT had significantly longer OS (HR: 0.68, CI95%: 0.54–0.87, P  < 0.001) and DFS (HR: 0.50, CI95%: 0.36–0.70, P  < 0.001) than dCRT. Conclusion nCRS followed by planned esophagectomy appears to remain the optimum curative treatment regime in patients with loco-regional ESCC. Thus, surgery remains an integral component of the management of patients with ESCC. As adjuvant and immunotherapy treatment regimens develop, ongoing prospective assessment of the role of radiotherapy in combination with modern treatment modalities should be studied. [ABSTRACT FROM AUTHOR]

Due primarily to a lack of phenotypic data, little research has been undertaken on the genetics of reproductive performance in beef cattle. The objective of this study was to quantify, using data from the Irish national cattle herd, the contribution of additive genetics to phenotypic differences in reproductive performance in beef cattle and to investigate whether routinely available early predictors of genetic merit for reproductive performance exist. Up to 218,718 parity records from 156,506 animals were used to estimate variance components for a range of reproductive traits using repeatability animal linear mixed models. Covariances with performance traits were estimated using bivariate sire linear mixed models. The reproductive traits were age at first calving, calving in the first 42 d of the calving seasons (defined separately in heifers and cows), calving interval between consecutive calving events, and survival to the next lactation. Performance traits included calving dystocia, linear type traits describing the skeletal, muscular, and functional characteristics of an animal, live weight and price, carcass traits, and producer subjectively scored traits of weanling quality and docility. Heritability for age at first calving was 0.31 while the heritability of the remaining reproductive traits ranged from 0.01 to 0.06; repeatability estimates varied from 0.02 to 0.06. Increased muscularity, measured either by trained assessors or producers on live animals, or by mechanical grading machines on slaughtered animals (i.e., carcass conformation), was genetically correlated with reduced reproductive performance for some of the reproductive variables assessed. This is one of the largest studies undertaken on the genetics of reproduction in beef herds and clearly shows that genetic selection for improved reproductive performance in beef herds is feasible. However, breeding goals that select for muscularity and live weight or growth rate should be cognizant of indirect response to selection that may cause any deterioration in reproductive performance. [ABSTRACT FROM AUTHOR]

Genetic evaluations provide information to aid in breeding decisions that increase longterm performance of animals and herds. However, to date no study has been undertaken to investigate the accuracy of the Irish maternal genetic evaluations in beef cattle. The objective, therefore, of this study was to quantify the relationship between phenotypic performance and measures of genetic merit for predominantly maternal-related traits in Irish beef cattle. The association between animal EBV for calving interval, age at first calving, and both direct and maternal weaning weight with the respective phenotypic performance was quantified using a fixed effects model; the expectation for the regression coefficient of phenotypic performance on EBV was one. The association between genetic merit for cow survival, perinatal mortality, calving assistance, and calving dystocia with the log of the odds of the respective trait was quantified using logistic regression. The association analyses were conducted using field data on up to 38,619 records from 5,236 herds. Age at first calving increased linearly by 0.32 ± 0.15 (P = 0.03) days per day increase in EBV for age at first calving. Calving interval increased by, on average, 0.58 ± 0.16 (P = 0.002) days per day increase in EBV for calving interval although the association differed by parity with a greater association in pluriparae. Weaning weight increased linearly by 1.74 ± 0.09 and 0.84 ± 0.16 kg (P < 0.001) per kilo-gram increase in EBV for direct and maternal weaning weight, respectively. The log of the odds of a cow surviving to next lactation increased linearly by 0.16 ± 0.03 (P < 0.001) per unit increase in EBV for cow survival. The log of the odds of an assisted calving or dystocia both increased linearly by 0.21 ± 0.01 and 0.24 ±0.01, respectively, per unit increase in EBV for direct calving difficulty (P< 0.001). The log of the odds of a dead calf at birth increased linearly by 0.93 ± 0.13 (P < 0.001) pet-unit increase in EBV for calf mortality. Results from this study show that selection of breeding animals for favorable maternal genetic attributes will result in favorable improvements in performance and profitability. [ABSTRACT FROM AUTHOR]

As policing enters an era of financial austerity and increased public scrutiny against the backdrop of an increasingly global criminal economy, this paper describes the value of crime intelligence as a component of future policing strategies. It proposes the Integrated Crime Intelligence Analysis Framework (The Diamond Matrix) as a way of ‘shrinking the crime triangle’ by supporting and educating intelligence practitioners to generate the actionable ideas necessary to drive targeted, coordinated policing. Moreover, it provides the foundations for a wider programme focused on intelligence specialists/advanced specialists, decision-makers, and managers/leaders—a scientifically driven approach to the use and application of crime intelligence to underpin the requirements of a future-focused professional policing service. [ABSTRACT FROM PUBLISHER]

Background. The complexity and subjectivity of ventilator-associated pneumonia (VAP) surveillance limit its value in assessing and comparing quality of care for ventilated patients. A simpler, more quantitative VAP definition may increase utility. Methods. We streamlined the Centers for Disease Control and Prevention definition of VAP to increase objectivity and efficiency. Qualitative criteria were replaced with quantitative criteria, and changes in ventilator settings were used to screen patients for worsening oxygenation. We retrospectively compared surveillance time, reproducibility, and outcomes for streamlined versus conventional surveillance among medical and surgical patients on mechanical ventilation in 3 university hospitals. Results. Application of the streamlined definition was faster (mean 3.5 minutes vs 39.0 minutes per patient) and more objective (interrater reliability κ 0.79 vs 0.45) than the conventional definition. On multivariate analysis, the streamlined definition predicted increases in ventilator days (6.5 days [95% CI, 4.1-10.0] vs 6.4 days [95% CI, 4.7-8.6]), intensive care days (5.6 days [95% CI, 3.2-8.9] vs 6.2 days [95% CI, 4.6-8.2]), and hospital mortality (odds ratio [OR] 0.84 [95% CI, 0.31-2.29] vs OR 0.69 [95% CI, 0.30-1.55]) as effectively as conventional surveillance. The conventional definition was a marginally superior predictor of increased hospital days (5.2 days [95% CI, 3.4-7.6] vs 2.1 days [95% CI, -0.5-5.6]). Conclusions. A streamlined version of the VAP definition was faster, more objective, and predicted patients' outcomes almost as effectively as the conventional definition. VAP surveillance using the streamlined method may facilitate more objective and efficient quality assessment for ventilated patients. [ABSTRACT FROM AUTHOR]

Interest in selection for improved feed efficiency is increasing, but before any steps are taken towards selecting for feed efficiency, correlations with other economically important traits must first be quantified. The objective of this study was to quantify the genetic associations between feed efficiency measured during performance testing, and linear type traits, BW, live animal value, and carcass traits recorded in commercial herds. Feed efficiency data were available on 2,605 bulls from 1 performance test station. There were between 10,384 and 93,442 performance records on either type traits, BW, animal value, or carcass traits from 17,225 commercial herds. (Co)variance components were estimated using linear mixed animal models. Genetic correlations between the muscular type traits in commercial animals and FCR (-0.33 to -0.25), RFI (-0.33 to -0.22), and RG (0.24 to 0.27) suggests that selection for improved feed efficiency should increase muscling. This is further evidenced by the genetic correlations between carcass conformation of commercial animals and FCR (-0.46), RFI (-0.37), and RG (0.35) measured in performance-tested animals. Furthermore, the genetic correlations between RFI and both ultrasonic fat depth and carcass fat score (0.39 and 0.33, respectively) indicate that selection for improved RFI will result in leaner animals. It can be concluded from the genetic correlations estimated in this study that selection for feed efficiency will have no unfavourable effects on the performance traits measured in this study, and will actually lead to an improvement in performance for some traits such as muscularity, animal price, and carcass conformation. Conversely, this suggests that genetic selection for traits such as carcass quality, muscling traits, and animal value might also be indirectly selecting for more efficient animals. [ABSTRACT FROM AUTHOR]

Most studies on feed efficiency in beef cattle have focused on performance in young animals despite the contribution of the cow herd to overall profitability of beef production systems. The objective of this study was to quantify, using a large dataset, the genetic covariances between feed efficiency in growing animals measured in a performance-test station, and beef cow performance including fertility, survival, calving traits, BW, maternal weaning weight, cow price, and cull cow carcass characteristics in commercial herds. Feed efficiency data were available on 2,605 purebred bulls from 1 test station. Records on cow performance were available on up to 94,936 crossbred beef cows. Genetic covariances were estimated using animal and animal-dam linear mixed models. Results showed that selection for feed efficiency, defined as feed conversion ratio (FCR) or residual gain (RG), improved maternal weaning weight as evidenced by the respective genetic correlations of -0.61 and 0.57. Despite residual feed intake (RFI) being phenotypically independent of BW, a negative genetic correlation existed between RFI and cow BW (-0.23; although the SE of 0.31 was large). None of the feed efficiency traits were correlated with fertility, calving difficulty, or perinatal mortality. However, genetic correlations estimated between age at first calving and FCR (-0.55 ± 0.14), Kleiber ratio (KR; 0.33 ± 0.15), RFI (-0.29 ±0.14), RG (0.36 ± 0.15), and relative growth rate (RGR; 0.37 ± 0.15) all suggest that selection for improved efficiency may delay the age at first calving and we speculate, using information from other studies, that this may be due to a delay in the onset of puberty. Results from this study, based on the estimated genetic correlations, suggest that selection for improved feed efficiency will have no deleterious effect on cow performance traits with the exception of delaying the age at first calving. [ABSTRACT FROM AUTHOR]

Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. [ABSTRACT FROM AUTHOR]

Beef outputs from dairy farms make an important contribution to overall profitability in Irish dairy herds and are the sole source of revenue in many beef herds. The aim of this study was to estimate genetic parameters for animal BW and price across different stages of maturity. Data originated from 2 main sources: price and BW from livestock auctions and BW from on-farm weighings between 2000 and 2008. The data were divided into 4 distinct maturity categories: calves (n = 24,513), weanlings (n = 27,877), postweanlings (n = 23,279), and cows (n = 4,894). A univariate animal model used to estimate variance components was progressively built up to include a maternal genetic effect and a permanent environmental maternal effect. Bivariate analyses were used to estimate genetic covariances between BW and price per animal within and across maturity category. Direct heritability estimates for price per animal were 0.34 ± 0.03, 0.31 ± 0.05, 0.19 ± 0.04, and 0.10 ± 0.04 for calves, weanling, postweanlings, and cows, respectively. Direct heritability estimates for BW were 0.26 ± 0.03 for weanlings, 0.25 ± 0.04 for postweanlings, and 0.24 ± 0.06 for cows; no BW data were available on calves. Significant maternal genetic and maternal permanent environmental effects were observed for weanling BW only. The genetic correlation between price per animal and BW within each maturity group varied from 0.55 ± 0.06 (postweanling price and BW) to 0.91 ± 0.04 (cow price and BW). The availability of routinely collected data, along with the existence of ample genetic variation for animal BW and price per animal, facilitates their inclusion in Irish dairy and beef breeding objectives to better reflect the profitability of both enterprises. [ABSTRACT FROM AUTHOR]

ABSTRACT: No genetic parameters for performance and feed efficiency traits are available for Irish performance-tested bulls. The objective of this study was to determine the phenotypic and genetic variation for feed intake, BW, ADG, and measures of feed efficiency including feed conversion ratio (FCR), relative growth rate, Kleiber ratio, residual BW gain (RG), and residual feed intake (RFI). Observations were available on up to 2,605 bulls for each trait from one test station across 24 yr; breeds included in the analyses were Aberdeen Angus (AN), Charolais (CH), Hereford, Limousin (LI), and Simmental. The test period was at least 70 d. Bulls were individually offered concentrates ad libitum, with a restricted forage allowance. Differences in performance and feed efficiency existed among breeds. For example, AN, on average, ate 0.04 kg of DM/d more than CH but had ADG of 0.14 kg/d less over the 70-d test period. Results showed LI and CH were the most efficient breeds when efficiency was defined as FCR or RFI. When animals were partitioned into groups based on high, medium, or low RFI, the low RFI (i.e., most efficient) group were also the more efficient as defined by RG and FCR. The low RFI group had the same ADG as the medium group and a greater ADG (P < 0.01) than the high group (1.67 vs. 1.66 and 1.63 kg/d); yet they ate 0.67 kg of DM/d less (P < 0.001) than the medium RFI group and 1.22 kg of DM/d less (P < 0.001) than the high RFI (i.e., least efficient) group. Genetic parameters for all performance and efficiency measures were estimated across breeds using linear animal mixed models; heritability estimates for feed efficiency traits ranged from 0.28 ± 0.06 (RG) to 0.45 + 0.06 (RFI). An additional series of analyses included a maternal com- ponent in the model; maternal heritability estimates for feed efficiency traits ranged from 0.05 ± 0.03 (RG) to 0.11 ± 0.05 (relative growth rate). Genetic correlations between most of the different feed efficiency measures were strong. Results from this study indicate significant genetic differences in performance and some measures of feed efficiency among performance-tested beef bulls. [ABSTRACT FROM AUTHOR]

Clinicians are required to report selected conditions to public health authorities within a stipulated amount of time. The current reporting process is mostly paper-based and inefficient and may lead to delays in case investigation. As electronic medical records become more prevalent, electronic case reporting is becoming increasingly feasible. However, there is no existing standard for the electronic transmission of case reports from healthcare to public health entities. We identified the major requirements of electronic case reports and verified that the requirements support the work processes of the local health departments. We propose an extendable standards-based model to electronically transmit case information and associated laboratory information from healthcare to public health entities. The HL7 v2.5 message model is currently being implemented to transmit electronic case reports from Intermountain Healthcare to the Utah Department of Health. [ABSTRACT FROM AUTHOR]

The series of Creighton memorial lectures, delivered annually since 1907, reflects changing interests and priorities within British historiography. This centenary address seeks to illustrate attitudes to the history of Europe as revealed especially in the lectures, but also in the context of the development of the historical profession in this country as a whole. Many of the issues raised were already adumbrated in the work of Mandell Creighton himself. How far was Britain a part of Europe for historiographical purposes? Did a British perspective involve any particular presuppositions or yield particular insights? And in what ways did the study of individual foreign countries interplay with attitudes to Britain, and to the Continent as a whole? [ABSTRACT FROM AUTHOR]

Patients who are asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) are major reservoirs for transmission of MRSA to other patients. Medical personnel are usually not aware when these high-risk patients are hospitalized. We developed and tested an enterprise-wide electronic surveillance system to identify patients at high risk for MRSA carriage at hospital admission and during hospitalization. During a two-month study, nasal swabs from 153 high-risk patients were tested for MRSA carriage using polymerase chain reaction (PCR) of which 31 (20.3%) were positive compared to 12 of 293 (4.1%, p < 0.001) low-risk patients. The mean interval from admission to availability of PCR test results was 19.2 hours. Computer alerts for patients at high-risk of MRSA carriage were found to be reliable, timely and offer the potential to replace testing all patients. Previous MRSA colonization was the best predictor but other risk factors were needed to increase the sensitivity of the algorithm. [ABSTRACT FROM AUTHOR]

Authors evaluated the impact of computerized alerts on the quality of outpatient laboratory monitoring for transplant patients. For 356 outpatient liver transplant patients managed at LDS Hospital, Salt Lake City, this observational study compared traditional laboratory result reporting, using faxes and printouts, to computerized alerts implemented in 2004. Study alerts within the electronic health record notified clinicians of new results and overdue new orders for creatinine tests and immunosuppression drug levels. After implementing alerts, completeness of reporting increased from 66 to >99 %, as did positive predictive value that a report included new information (from 46 to >99 %). Timeliness of reporting and clinicians' responses improved after implementing alerts (p <0.001): median times for clinicians to receive and complete actions decreased to 9 hours from 33 hours using the prior traditional reporting system. Computerized alerts led to more efficient, complete, and timely management of laboratory information. [ABSTRACT FROM AUTHOR]

The article examines the quantification of sarin and cyclosarin metabolites isopropyl methylphosphonic acid and cyclohexyl methylphosphonic acid in minipig plasma using isotope-dilution and liquid chromatography-time-of-flight mass spectrometry. The paper presents a method for the quantification of the hydrolysis products of sarin and cyclosarin, IMPA, and CMPA, respectively, in minipig plasma. It uses LC-ESI-MS with time-of-flight detection and isotope dilution to achieve the sensitivity of comparable methods without extensive sample preparation, while utilizing a relatively inexpensive bench-top instrumentation.

Objective: To evaluate the data quality of ventilator settings recorded by respiratory therapists using a computer charting application and assess the impact of incorrect data on computerized ventilator management protocols. DESIGN An analysis of 29,054 charting events gathered over 12 months from 678 ventilated patients (1,736 ventilator days) in four intensive care units at a tertiary care hospital.Measurements: Ten ventilator settings were examined, including fraction of inspired oxygen (Fio (2)), positive end-expiratory pressure (PEEP), tidal volume, respiratory rate, peak inspiratory flow, and pressure support. Respiratory therapists entered values for each setting approximately every two hours using a computer charting application. Manually entered values were compared with data acquired automatically from ventilators using an implementation of the ISO/IEEE 11073 Medical Information Bus (MIB). Data quality was assessed by measuring the percentage of time that the two sources matched. Charting delay, defined as the interval between data observation and data entry, also was measured.Results: The percentage of time that settings matched ranged from 99.0% (PEEP) to 75.9% (low tidal volume alarm setting). The average charting delay for each charting event was 6.1 minutes, including an average of 1.8 minutes spent entering data in the charting application. In 559 (3.9%) of 14,263 suggestions generated by computerized ventilator management protocols, one or more manually charted setting values did not match the MIB data.Conclusion: Even at institutions where manual charting of ventilator settings is performed well, automatic data collection can eliminate delays, improve charting efficiency, and reduce errors caused by incorrect data. [ABSTRACT FROM AUTHOR]

Background Psoriasis has a well-documented, markedly negative effect on patient quality of life. Objectives To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis. Methods The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg−1 induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen. Results At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores ( P < 0·001) and SF-36 physical and mental component summary scores ( P < 0·001) than placebo-treated patients. Significant improvement ( P < 0·001) was also seen in all eight SF-36 subscales, and was greatest for the ‘Bodily Pain’ and ‘Social Functioning’ scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 ( P < 0·001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50. Conclusions Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement. [ABSTRACT FROM AUTHOR]

The effects of methylmercury (MeHg) on components of the cholinergic system were evaluated in captive mink (Mustela vison). Cholinergic parameters were measured in brain regions (occipital cortex, cerebellum, brain stem, basal ganglia) and blood (whole blood, plasma, serum) following an 89-day exposure to MeHg at dietary concentrations of 0, 0.1, 0.5, 1, and 2 ppm (n = 12 animals per treatment). There were no effects of MeHg on brain choline acetyltransferase, acetylcholine, and choline transporter. However, significantly higher densities of muscarinic cholinergic receptors, as assessed by 3H-quinuclidinyl benzilate binding, were measured in the occipital cortex (30.2 and 39.0% higher in the 1 and 2 ppm groups, respectively), basal ganglia (67.5 and 69.1% higher in the 0.5 and 1 ppm groups, respectively), and brain stem (64.4% higher in the 0.5 ppm group), compared to nonexposed controls. The calculated positive relationship between MeHg exposure and muscarinic cholinergic receptor levels in this dosing study were consistent with observations in wild mink. There were no MeHg-related effects on blood cholinesterase (ChE) activity, but ChE activity was significantly higher in the occipital cortex (17.0% in the 1 ppm group) and basal ganglia (34.1% in the 0.5 ppm group), compared to nonexposed controls. The parallel increases in muscarinic cholinergic receptor levels and ChE activity following MeHg exposure highlight the autoregulatory nature of cholinergic neurotransmission. In conclusion, these laboratory data support findings from wild mink and demonstrate that ecologically relevant exposures to MeHg (i.e., 0.5 ppm in diet) have the potential to alter the cholinergic system in specific brain regions. [ABSTRACT FROM PUBLISHER]

Laboratory results provide necessary information for the management of ambulatory patients. To realize the benefits of an electronic health record (EHR) and coded laboratory data (e.g., decision support and improved data access and display), results from laboratories that are external to the health care enterprise need to be integrated with internal results, We describe the development and clinical impact of integrating external results into the EHR at Intermountain Health Care (IHC). During 2004, over 14,000 external laboratory results for 128 liver transplant patients were added to the EHR. The results were used to generate computerized alerts that assisted clinicians with managing laboratory tests in the ambulatory setting. The external results were sent from 85 different facilities and can now be viewed in the EHR integrated with IHC results. We encountered regulatory, logistic, economic, and data quality issues that should be of interest to others developing similar applications. [ABSTRACT FROM AUTHOR]

Objective: This study documented the incidence of acute injuries related to the Army Physical Fitness Test (APFT).Methods: A questionnaire was administered to 1,532 soldiers after they completed a biannual APFT. Self-reported injury responses determined the rates of injuries resulting from the push-up, sit-up, and 2-mile run events and were classified into three categories, i.e., all injuries, performance-limiting injuries, and time-loss injuries.Results: A total of 117 soldiers (injury rate, 7.6%) reported sustaining an injury (all injuries), with 11% attributed to the push-up event, 56% to the sit-up event, and 32% to the run event. Forty-six of these injuries reportedly limited performance (injury rate, 3.0%), and 11 soldiers received a duty-limiting profile (time-loss injury rate, 0.7%), which did not differ among events. Injury rates were not significantly associated with the number of sit-ups performed per week or the number of days per week a soldier participated in physical training and were not greater for soldiers who trained specifically for the APFT. History of previous injury was a significant risk factor for injury.Conclusion: The push-up, sit-up, and run events of the APFT do not pose a considerable acute injury risk to active duty soldiers. [ABSTRACT FROM AUTHOR]

Mechanical ventilators are designed to generate alarms when patients become disconnected or experience other critical ventilator events. However, these alarms can blend in with other accustomed sounds of the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. We developed a system to monitor critical ventilator events through our existing hospital network. Whenever an event is identified, the new system takes control of every computer in the patient's intensive care unit and generates an enhanced audio and visual alert indicating that there is a critical ventilator event and identifies the room number. Once the alert is acknowledged or the event is corrected, all the computers are restored back to the pre-alert status and/or application. This paper describes the development and implementation of this system and reports the initial results, user acceptance, and the increase in valuable information and patient safety. [ABSTRACT FROM AUTHOR]

Objective: Charting systems with decision support have been developed to assist with medication charting, but many of the features of these programs are not properly used in their clinical application. An analysis of medication error reports at LDS Hospital revealed the occurrence of errors that should have been detected and prevented by decision support features if real-time entry at the bedside had taken place. The aim of this study was to increase the real-time bedside charting behavior of nurses. Design: A quasiexperimental before and after design was used. The study took place in two 40-bed surgical units, one of which served as the study unit, the other as control unit. The study unit received educational intervention about error avoidance through real-time bedside charting, and 12 weeks of monitoring and performance feedback. The real-time and bedside charting rates for the study and control units were measured before and after the intervention. Results: Before the intervention on the study unit, the real-time charting rate was 59% and the bedside rate was 40%. At the conclusion of a 12-week intervention period, the real-time rate increased to 73% and the bedside rate increased to 63%. Postintervention real-time rates were 75% after eight weeks and remained at 75% after one year. Equivalent control unit real-time rates varied from 53% to 57%, and bedside rates varied from 34% to 44% during the same intervals. Conclusion: Targeted educational intervention and monitored feedback yielded measurable improvements in the effective use of the computerized medication charting system and must be an ongoing process. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic disease that significantly diminishes the health-related quality of life (HRQOL). Infliximab is a chimeric, tumour necrosis factorα monoclonal antibody that has been shown to improve the signs and symptoms of plaque psoriasis.The objective of this study was to evaluate the effect of infliximab induction therapy on the HRQOL of patients with severe plaque psoriasis.In this double-blind, placebo-controlled trial, 249 patients were randomly assigned to receive intravenous infusions of 3 or 5 mg kg−1 of infliximab or placebo and were treated at weeks 0, 2 and 6. Patients completed the Dermatology Life Quality Index (DLQI) at baseline and week 10.Infliximab induction therapy resulted in a substantial improvement in HRQOL. At week 10, patients in the infliximab 3- and 5-mg kg−1 groups showed a median percentage improvement in DLQI scores of 84·0% and 91·0%, respectively, compared with 0% in the placebo group (P < 0·001). The median decrease from baseline in DLQI score at week 10 was 8·0 and 10·0 for the 3 and 5 mg kg−1 infliximab groups, respectively, compared with 0 in the placebo group (P < 0·001). Thirty-three per cent and 40% of patients in the 3 and 5 mg kg−1 infliximab groups, respectively, had a DLQI score of 0 at week 10, compared with 2% in the placebo group (P < 0·001). There was a strong correlation between the percentage change from baseline at week 10 in Psoriasis Area and Severity Index (PASI) scores and the percentage change in DLQI scores during the same period (Spearman's correlation, 0·61,P < 0·001). When the infliximab and placebo treatment groups were combined, patients with at least 75% improvement in PASI scores between baseline and week 10 had a greater mean improvement in DLQI scores (81%) than those with 50–75% improvement in PASI during the same period (60%).Infliximab induction therapy resulted in significant improvement in HRQOL in patients with severe psoriasis. [ABSTRACT FROM AUTHOR]

Objective: To develop a model to store information in an electronic medical record (EMR) for the management of transplant patients. The model for storing donor information must be designed to allow clinicians to access donor information from the transplant recipient's record and to allow donor data to be stored without needlessly proliferating new Logical Observation Identifier Names and Codes (LOINC) codes for already-coded laboratory tests. Design: Information required to manage transplant patients requires the use of a donor's medical information while caring for the transplant patient. Three strategies were considered: (1) link the transplant patient's EMR to the donor's EMR; (2) use pre-coordinated observation identifiers (i.e., LOINC codes with *^DONOR specified in the system axes) to identify donor data stored in the transplant patient's EMR; and (3) use an information model that allows donor information to be stored in the transplant patient's record by allowing the "source" of the data (donor) and the "name" of the result (e.g., blood type) to be post-coordinated in the transplant patient's EMR. Results: We selected the third strategy and implemented a flexible post-coordinated information model. There was no need to create new LOINC codes for already-coded laboratory tests. The model required that the data structure in the EMR allow for the storage of the "subject" of the test. Conclusion: The selected strategy met our design requirements and provided an extendable information model to store donor data. This model can be used whenever it is necessary to refer to one patient's data from another patient's EMR. [ABSTRACT FROM AUTHOR]

Responses of ecosystems to elevated levels of atmospheric carbon dioxide (CO[sub 2]) remain a critical uncertainty in global change research. Two key unknown factors are the fate of carbon newly incorporated by photosynthesis into various pools within the ecosystem and the extent to which elevated CO[sub 2] is transferred to and sequestered in pools with long turnover times. The CO[sub 2] used for enrichment in many experiments incorporates a dual isotopic tracer, in the sense that ratios of both the stable carbon-13 ([sup 13]C) and the radioactive carbon-14 ([sup 14]C) isotopes with respect to carbon-12 are different from the corresponding ratios in atmospheric CO[sub 2]. Here we review techniques for using [sup 13]C and [sup 14]C abundances to follow the fate of newly fixed carbon and to further our understanding of the turnover times of ecosystem carbon pools. We also discuss the application of nitrogen, oxygen, and hydrogen isotope analyses for tracing changes in the linkages between carbon, nitrogen, and water cycles under conditions of elevated CO[sub 2]. INSETS: Box 1. Isotopes in ecology;Box 2. The Farquhar model of photosynthetic discrimination;Box 3. Models of fractionation in plant water isotopes. [ABSTRACT FROM AUTHOR]

Context Although patient safety is a major problem, most health care organizations rely on spontaneous reporting, which detects only a small minority of adverse events. As a result, problems with safety have remained hidden. Chart review can detect adverse events in research settings, but it is too expensive for routine use. Information technology techniques can detect some adverse events in a timely and cost-effective way, in some cases early enough to prevent patient harm. Objective To review methodologies of detecting adverse events using information technology, reports of studies that used these techniques to detect adverse events, and study results for specific types of adverse events. Design Structured review. Methodology English-language studies that reported using information technology to detect adverse events were identified using standard techniques. Only studies that contained original data were included. Main Outcome Measures Adverse events, with specific focus on nosocomial infections, adverse drug events, and injurious falls. Results Tools such as event monitoring and natural language processing can inexpensively detect certain types of adverse events in clinical databases. These approaches already work well for some types of adverse events, including adverse drug events and nosocomial infections, and are in routine use in a few hospitals. In addition, it appears likely that these techniques will be adaptable in ways that allow detection of a broad array of adverse events, especially as more medical information becomes computerized. Conclusion Computerized detection of adverse events will soon be practical on a widespread basis. [ABSTRACT FROM PUBLISHER]

A retrospective 9-year cohort study was conducted to identify the hospitalization costs, length of hospital stay, and mortality associated with nephrotoxicity (NT) among 494 inpatients who were treated with conventional amphotericin B (CAB). Survival regression methods were used to model the effect of NT. The rate of NT was 12%; the overall in-hospital mortality rate was 22%. After adjustment for confounding, NT was associated with a 2.7-fold higher risk of death (P < .001). Although the unadjusted effects of NT on length of hospital stay and hospitalization costs after the initiation of CAB were consistent with small increases, such effects were not significant in multivariate models (time ratio, 1.2 [P = .2]; cost ratio, 1.1 [P = .8]). The greater the number of days before the onset of NT that were included in the analysis, the greater the apparent effect of NT on costs. CAB-associated NT was associated with increased mortality, but it did not impact the costs and length of hospital stay. [ABSTRACT FROM AUTHOR]

In 1990, a 2-ha plantation of Eucalyptus nitens (Deane and Maiden) Maiden was established in southeastern Tasmania and subjected to different irrigation regimes. Point dendrometers were installed in March 1995 to monitor radial stem movement every 15 min over several growing seasons. In this study, data from two growing seasons (1996–1998) were considered. From these measurements, daily increments of stem radius were determined. At the end of the second growing season, we extracted 12-mm cores and measured microfibril angles (MFA) of the wood at high resolution. Microfibril angles were rescaled on a time axis and mapped to daily and distance-based elements. Among treatments, irrigated trees in particular formed higher MFA early in the growing season (September–November) and lower MFA later in the growing season. Trees subjected to cyclic droughts showed clear relationships between MFA and soil water deficits, with MFA increasing in response to water stress release. Increases in MFA were preceded by accelerations in daily increment of stem radius. Among treatments, trees subjected to severe drought had the smallest MFA and generally low fluctuations in MFA. Irrigated trees were susceptible to changes in climate, whereas growth of the trees in the other treatments was limited by water availability. Use of path-analysis showed that temperature had an effect on stem radius increment but not on MFA; wind speed was the only factor that influenced MFA directly. Microfibril angle was correlated with stem shrinking and expansion phases; growth period length and growth rates were positively related to MFA. [ABSTRACT FROM PUBLISHER]

Deals with a study which determined the effects of applying Tasco-Forage to tall fescue during the grazing season on beef shelf-life and color stability. Changes in sensory characteristics and tenderness of beef due to postmortem aging; Serum cholesterol measurement.

Objective: To analyze whether computer-generated reminders about infections could influence clinicians' practice patterns and consequently improve the detection and management of nosocomial infections.Design: The conclusions produced by an expert system developed to detect and manage infections were presented to the attending clinicians in a pediatric hospital to determine whether this information could improve detection and management. Clinician interventions were compared before and after the implementation of the system.Measurements: The responses of the clinicians (staff physicians, physician assistants, and nurse practitioners) to the reminders were determined by review of paper medical charts. Main outcome measures were the number of suggestions to treat and manage infections that were followed before and after the implementation of COMPISS (Computerized Pediatric Infection Surveillance System). The clinicians' opinions about the system were assessed by means of a paper questionnaire distributed following the experiment.Results: The results failed to show a statistical difference between the clinicians' treatment strategies before and after implementation of the system (P: > 0.33 for clinicians working in the emergency room and P: > 0.45 for clinicians working in the pediatric intensive care unit). The questionnaire results showed that the respondents appreciated the information presented by the system.Conclusion: The computer-generated reminders about infections were unable to influence the practice patterns of clinicians. The methodologic problems that may have contributed to this negative result are discussed. [ABSTRACT FROM AUTHOR]

We report the case of a 40-year-old right-handed man who developed a right subclavian vein thrombosis due to work as a TV cameraman. He presented with a sudden onset of marked swelling and blue discolouration of his right arm 3 weeks after the most strenuous and prolonged episode of TV camera work that he had ever undertaken. This involved carrying a 9 kg camera on his shoulder, with his right arm flexed and abducted, for a 60 min period with provocation of severe pain and marked discomfort persisting during the subsequent 3 weeks before presentation. A clinical diagnosis of upper extremity deep vein thrombosis (UEDVT) was made, with the diagnosis confirmed by ultrasound. He was treated with catheter-induced thrombolysis and a 3 month course of anticoagulation. He was advised that his UEDVT was caused by his occupation and that he should no longer work as a cameraman. This case shows the importance of identifying any occupational cause of UEDVT. [ABSTRACT FROM AUTHOR]