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SUMMARY: Recent research within our laboratory has determined the optimal Ross 708 × Ross YP male broiler dIle:dLys ratio for the starter and grower phases to be 70 and 68%, respectively. Thus, the current objective was to continue to re-evaluate the optimal dIle:dLys ratio for this broiler, focusing on the finisher phase. On d of hatch, 2,400 chicks were equally allocated to 96 pens and fed a common starter (d 0–14; 70% dIle:dLys) and grower diet (d 14–28; 68% dIle:dLys). Pen weights were equalized at d 28 by block (12/treatment). Experimental finisher diets (d 28–42;18.0% crude protein, 3,200 kcal/kg, 0.97% dLys, 130% dLeu:dLys) were created from a common deficient (54% dIle:dLys) corn and soybean meal-based diet and contained animal protein. Half of the deficient was retained to create the summit (84% dIle:dLys). The remaining 5 diets were blended proportions of the deficient and summit diets (ranging from 59 to 79% dIle:dLys). A practical control diet (PRAC-CON; 69% dIle:dLys) was manufactured separately to verify the blended control diet (BLEND-CON). All dIle:dLys ratios were estimated using quadratic regression (QR; 95% of the asymptote), as well as linear and quadratic broken line models (LBL; QBL). Feeding equivalent to or slightly lower than current breeder dIle:dLys recommendations (69%) improved broiler performance from d 28 to 42. Based on the current data and multiple regression models, the estimated ratios ranged from 62 to 66% for BW and BWG and 63 to 66% for FCR. Further research should evaluate the optimal dIle:dLys ratio for this broiler throughout the remaining withdrawal phase.

Households in which grandparents are raising grandchildren, known as grandfamilies, represent a growing and underserved population. The Healthy Grandfamilies Project, a program for grandparents raising grandchildren, comprises 3 months of educational discussion group sessions delivered by West Virginia State University Extension staff followed by 3 months of support services delivered by a licensed social worker. We collected data for a preliminary study of the program through an intake form, pre- and posteducation measures, and a participant satisfaction survey. Preliminary results suggest a profile of grandfamilies and indicate that a model of education combined with social support holds potential for addressing unmet needs of this population.

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

The need to train physicians committed to learning throughout their careers has prompted medical schools to encourage the development and practice of self-regulated learning by students. Longitudinal integrated clerkships (LICs) require students to exercise self-regulated learning skills. As mobile tools, tablets can potentially support self-regulation among LIC students.We provided 15 LIC students with tablet computers with access to the electronic health record (EHR), to track their patient cohort, and a multiplatform online notebook, to support documentation and retrieval of self-identified clinical learning issues. Students received a 1-hour workshop on the relevant features of the tablet and online notebook. Two focus groups with the students were used to evaluate the program, one early and one late in the year and were coded by two raters.Students used the tablet to support their self-regulated learning in ways that were unique to their learning styles and increased access to resources and utilization of down-time. Students who used the tablet to self-monitor and target learning demonstrated the utility of tablets as learning tools.LICs are environments rich in opportunity for self-regulated learning. Tablets can enhance students' ability to develop and employ self-regulatory skills in a clinical context.

PurposeWhen medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups.MethodWe invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences.ResultsIn both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills.ConclusionsStudents achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.

SUMMARY: Primary breeder companies are continuously striving to improve existing commercial broiler crosses to increase performance and reduce cost. The objective of this study was to evaluate the response of a new commercial broiler cross (Cobb MV × Cobb 500) under 4 different amino acid density (AAD) regimens on live performance and carcass yield during a 36 d grow-out period with 2 processings to collect data at 32 and 35 d. Two basal diets were formulated to low AAD (LAAD, digestible lysine, dLys 1.08, 0.95, and 0.87% for starter, grower, and finisher) and very high AAD (VHAAD, dLys 1.39, 1.26, and 1.12%). Medium and high AAD (MAAD and HAAD) diets were created by mixing the LAAD and VHAAD diets at ratios of 66.6:33.3 and 33.3:66.6, respectively. This was a randomized complete block design with 12 replications/treatment (16 birds/pen, 0.07 m2/bird). Feed intake/bird was reduced (P < 0.05) when birds were fed the VHAAD diet at 0–32 and 0–35 d. As AAD increased, FCR decreased significantly in a stepwise manner by approximately 4 points at each AAD level (P < 0.05). Feeding higher levels of AAD improved broiler live performance and carcass yields. At 33 d, birds fed the HAAD diet had the highest potential gross profit/bird, and at 36 d, birds fed the VHAAD diet had the highest potential gross profit/bird. Further research should evaluate the effects of feeding increased AAD diets to male and female Cobb MV × Cobb 500 separately, as well as in different feeding phases and longer grow-out periods.

ABSTRACT: Recent research has tried to maximize broiler chick health and performance by utilizing commercial in-feed probiotics to inoculate fertile hatching eggs, and thus expose birds earlier to beneficial bacteria. However, the in ovo inoculation of a specific serotype of Bacillus subtilis was detrimental for broiler hatchability. Therefore, the objective of this study was to determine if other B. subtilis serotypes negatively affect hatchability or if it is associated with a specific serotype. It was also of interest to determine if the B. subtilis serotype influence chick performance and intestinal microflora. On d18 of incubation, 1886 fertile broiler eggs were in ovo inoculated with the following treatments (T): T1 = Marek's vaccine (MV), T2 = MV + B. subtilis (ATCC 6051), T3 = MV + B. subtilis (ATCC 8473), and T4 = MV + B. subtilis (ATCC 9466). It should be noted that in a previous study, T2 was detrimental to hatchability. Inoculated eggs were transferred to 3 hatchers/T. At hatch, chicks were weighed, feather sexed, and hatch residue analysis was conducted. Male chicks were randomly assigned to 40 raised wire cage so that there were 10 birds/cage. On d 0, 7, 14, and 21 of the grow-out, chicks and feed were weighed to calculate performance data. On these days, the ileum and ceca were aseptically collected to enumerate total aerobes and coliforms. No differences were observed for percentage of mid dead embryos, cracked eggs, and cull chicks (P > 0.05). However, hatch of transfer was significantly reduced by T2 compared to T1, T3, and T4 (P < 0.001). T2 had significantly higher percentages of late dead embryos and pips when compared to the other treatments (P = 0.002 and P < 0.001, respectively). Chicks hatched from T2 were not vigorous and, thus, not used for the grow-out trial. No differences were observed for growth performance characteristics for any of the treatments (P > 0.05). For bacterial enumeration, the ileum had equal or fewer bacterial counts for T3 and T4 when compared to T1 on most sampling days, except on d21 where T4 had higher aerobic and coliform counts (P ≤ 0.0001). For the ceca, T3 and T4 had equal or fewer bacterial counts than T1 on every sampling day (P ≤ 0.0001). These data demonstrate that not all B. subtilis evaluated are detrimental to hatchability, but rather, serotype dependent. In addition, different B. subtilis serotypes can modify the intestinal microflora with potential to reduce pathogenic bacteria present in young broiler, without impacting overall performance.

The challenge of spreading antibiotic resistance calls for systematic efforts to develop more “irresistible” drugs based on a deeper understanding of dynamics and mechanisms of antibiotic resistance acquisition. To address this challenge, we have established a comparative resistomics approach which combines experimental evolution in a continuous-culturing device, the morbidostat, with ultradeep sequencing of evolving microbial populations to identify evolutionary trajectories (mutations and genome rearrangements) leading to antibiotic resistance over a range of target pathogens.

The COVID-19 global pandemic has stretched the capacities of public health institutions and health systems around the world, opening the door to a range of technologically-driven solutions. In this article, we seek to historicize the expanding role of digital health technologies and examine the political-economic context from which they have emerged. Drawing on critical insights from science and technology studies, we maintain that the rise of digital health technologies has been catalyzed by broad shifts in global health governance that have expanded the role of market forces in public health and a unique set of political and economic crises that have accelerated the adoption of digital technologies—often under the guise of appeals to technological innovation to address “unprecedented” crises. These interrelated historical trends, we contend, are critical for understanding current state responses to the pandemic and possibilities for more equitable and democratic applications of technology in public health.

Telehealth has become an increasingly important part of health care delivery, with a dramatic rise in telehealth visits during the COVID-19 pandemic. Telehealth visits will continue to be a part of care delivery after the pandemic subsides, and it is important that medical students receive training in telehealth skills to meet emerging telehealth competencies. This paper describes strategies for successfully integrating medical students into telehealth visits in the ambulatory setting based on existing literature and the extensive experience of the authors teaching and learning in the telehealth environment.

Summary: Probiotics, such as Bacillus licheniformis (BL), and some trace minerals, such as copper (supplied via tribasic copper chloride; [TBCC]), have been explored singularly in the literature for use in antibiotic-free poultry production. However, these additives are often applied in combination, without much peer-reviewed research conducted on their interactive effects. Therefore, the objective was to examine the individual and interactive effects of supplementing commercially available BL (yes or no) and TBCC (0, 125, or 250 ppm) within an all-vegetable diet on day 0–42 male broiler performance. Interactions between BL x TBCC were established for day 18–30 BW gain (BWG) and day 0–30 feed intake (FI)/bird. For BWG, 125-ppm TBCC maximized gain, whereas including BL + TBCC decreased gain. For day 0–30 FI, feeding TBCC alone increased the FI, whereas inclusions of BL + TBCC decreased the FI; from day 0 to 30, regardless of the FI, the feed conversion ratio was not affected. For day 30–42 BWG, broilers receiving 250-ppm TBCC had the highest BWG, whereas broilers fed all other TBCC inclusions performed similarly. On day 42, 5 birds/treatment were randomly selected for cecal tonsil sampling to determine the presence of Salmonella or Escherichia coli. Although Salmonella was not detected, birds fed diets containing TBCC had less E. coli as compared with birds fed diets without TBCC; BL had no effect on E. coli. Overall, no significant overall performance differences were found. However, the observed intermittent BL × TBCC interactions demonstrate their combined use may negatively affect performance, warranting further research to ensure they and other combined antibiotic alternatives do not have antagonistic effects.

Comprehensive clinical competency curricula for hazardous drinking and substance use disorders (SUDs) exists for medical students, residents, and practicing health care providers. Evaluations of these curricula typically focus on learner attitudes and knowledge, although changes in clinical skills are of greater interest and utility. The authors present a pre-post clinical skill evaluation of a 10-hour screening, brief intervention, and referral to treatment (SBIRT) curriculum for hazardous drinking and SUDs for primary care internal medicine residents using standardized patient examinations to better determine the impact of SBIRT training on clinical practice. Residents had large improvements in history taking, substance use screening skills, SUD assessment and diagnostic skills, and in SBIRT knowledge, including documentation, systems, and diversity issues. Residents made moderate improvements in brief intervention skills. Future SBIRT curricular evaluations would ideally include a controlled comparison with larger samples from multiple institutions.

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

Deep inside the temporal lobe of the brain, the hippocampus has a central role in our ability to remember, imagine and dream.

Across a broad spectrum of memory tasks, retention is superior following a night of sleep compared to a day of wake. However, this result alone does not clarify whether sleep merely slows the forgetting that would otherwise occur as a result of information processing during wakefulness, or whether sleep actually consolidates memories, protecting them from subsequent retroactive interference. Two influential studies suggested that sleep protects memories against the subsequent retroactive interference that occurs when participants learn new yet overlapping information (interference learning). In these studies, interference learning was much less detrimental to memory following a night of sleep compared to a day of wakefulness, an indication that sleep supports this important aspect of memory consolidation. In the current replication study, we repeated the protocol of and, additionally, we examined the impact of intrinsic motivation on performance in sleep and wake participants. We were unable to replicate the finding that sleep protects memories against retroactive interference, with the detrimental effects of interference learning being essentially the same in wake and sleep participants. We also found that while intrinsic motivation benefitted task acquisition it was not a modulator of sleep-wake differences in memory processing. Although we cannot accept the null hypothesis that sleep has no role to play in reducing the negative impact of interference, the findings draw into question prior evidence for sleep's role in protecting memories against interference. Moreover, the current study highlights the importance of replicating key findings in the study of sleep's impact on memory processing before drawing strong conclusions that set the direction of future research.