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It is dangerous for both riders and horses when a horse suddenly startles. Sometimes horses do this in familiar environments because familiar objects may look different when rotated. The purpose of this study was to determine whether horses that had been habituated to a complex object (children's playset) would react to the object as novel when rotated 90 degrees. Twenty young horses were led past the playset 15 times by a handler. Next, the rotated group was led past the rotated playset 15 times. Each time the horse was led by the object was a pass. The behavioral responses observed and analyzed were ears focused on the object, nostril flares, neck raising, snort, avoid by stopping, avoid by moving feet sideways, and avoid by flight. An increasing reactivity scale was used to quantify behavioral responses. A two-sample t -test was performed on the reactivity scores comparing the first pass by the novel object to the first pass by the rotated object. The horses in the rotated group reacted to the rotated orientation similarly to the first exposure ( p = 0.001, α < 0.05). Being aware of potential reactions to changes in previously familiar environments can help keep the handler safer.

Guided by the theoretical frameworks of the "health halo effect" and consumer expertise, this research was undertaken to determine how two individual factors, health consciousness and health literacy, differentially influence evaluations of nutrient-content claimed messaging for an unhealthy food (i.e., chocolate) and whether such evaluations are moderated by the reading of the food's Nutrition Facts Label displaying different serving sizes. The research found that health consciousness positively influenced evaluative responses to unhealthy food messaging, and that the positive influence persisted following the reading of a Nutrition Facts label listing a large quantity of unhealthy ingredients per serving size. In contrast, health literacy negatively influenced perceived healthiness and purchase intention when the nutrition label communicated a higher serving size, indicating that subjective and objective expertise work differently. The results advance understanding of the information processing of nutrient-claimed unhealthy foods, and suggest implications for food marketing communication and public health policy.

In the U.S., the most severe animal welfare problems caused by COViD-19 were in the pork industry. Thousands of pigs had to be destroyed on the farm due to reduced slaughter capacity caused by ill workers. In the future, both short-term and long-term remedies will be needed. In the short-term, a portable electrocution unit that uses scientifically validated electrical parameters for inducing instantaneous unconsciousness, would be preferable to some of the poor killing methods. A second alternative would be converting the slaughter houses to carcass production. This would require fewer people to process the same number of pigs. The pandemic revealed the fragility of large centralized supply chains. A more distributed supply chain with smaller abattoirs would be more robust and less prone to disruption, but the cost of pork would be greater. Small abattoirs can coexist with large slaughter facilities if they process pigs for specialized premium markets such as high welfare pork. The pandemic also had a detrimental effect on animal welfare inspection and third party auditing programs run by large meat buyers. Most in-person audits in the slaughter plants were cancelled and audits were done by video. Video audits should never completely replace in-person audits.

Competing Interests: The authors declare no funding or conflicts of interest.

Livestock bruising is both an animal welfare concern and a detriment to the economic value of carcasses. Understanding the causes of bruising is challenging due to the numerous factors that have been shown to be related to bruise prevalence. While most cattle bruising studies collect and analyze data on truckload lots of cattle, this study followed a large number ( n = 585) of individual animals from unloading through postmortem processing at five different slaughter plants. Both visual bruise presence and location was recorded postmortem prior to carcass trimming. By linking postmortem data to animal sex, breed, trailer compartment, and traumatic events at unloading, a rich analysis of a number of factors related to bruise prevalence was developed. Results showed varying levels of agreement with other published bruising studies, underscoring the complexity of assessing the factors that affect bruising. Bruising prevalence varied across different sex class types ( P < 0.001); 36.5% of steers [95% confidence interval (CI): 31.7, 41.6; n = 378], 52.8% of cows (45.6, 60.0; 193), and 64.3% of bulls (no CI calculated due to sample size; 14) were bruised. There was a difference in bruise prevalence by trailer compartment ( P = 0.035) in potbelly trailers, indicating that cattle transported in the top deck were less likely to be bruised (95% CI: 26.6, 40.4; n = 63) compared to cattle that were transported in the bottom deck (95% CI: 39.6, 54.2; n = 89). Results indicated that visual assessment of bruising underestimated carcass bruise trimming. While 42.6% of the carcasses were visibly bruised, 57.9% of carcasses were trimmed due to bruising, suggesting that visual assessment is not able to capture all of the carcass loss associated with bruising. Furthermore, bruises that appeared small visually were often indicators of larger, subsurface bruising, creating an "iceberg effect" of trim loss due to bruising., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Society of Animal Science.)

Background Situated cognition theory argues that thinking is inextricably situated in a context. In clinical reasoning, this can lead to context specificity: a physician arriving at two different diagnoses for two patients with the same symptoms, findings, and diagnosis but different contextual factors (something beyond case content potentially influencing reasoning). This paper experimentally investigates the presence of and mechanisms behind context specificity by measuring differences in clinical reasoning performance in cases with and without contextual factors. Methods An experimental study was conducted in 2018-2019 with 39 resident and attending physicians in internal medicine. Participants viewed two outpatient clinic video cases (unstable angina and diabetes mellitus), one with distracting contextual factors and one without. After viewing each case, participants responded to six open-ended diagnostic items (e.g. problem list, leading diagnosis) and rated their cognitive load. Results Multivariate analysis of covariance (MANCOVA) results revealed significant differences in angina case performance with and without contextual factors [Pillai's trace = 0.72, F = 12.4, df =(6, 29), p < 0.001, η p 2 = 0.72 $\eta &#95;{\rm p}^2 = 0.72$ ], with follow-up univariate analyses indicating that participants performed statistically significantly worse in cases with contextual factors on five of six items. There were no significant differences in diabetes cases between conditions. There was no statistically significant difference in cognitive load between conditions. Conclusions Using typical presentations of common diagnoses, and contextual factors typical for clinical practice, we provide ecologically valid evidence for the theoretically predicted negative effects of context specificity (i.e. for the angina case), with large effect sizes, offering insight into the persistence of diagnostic error.

Background The cognitive pathways that lead to an accurate diagnosis and efficient management plan can touch on various clinical reasoning tasks (1). These tasks can be employed at any point during the clinical reasoning process and though the four distinct categories of framing, diagnosis, management, and reflection provide some insight into how these tasks map onto clinical reasoning, much is still unknown about the task-based clinical reasoning process. For example, when and how are these tasks typically used? And more importantly, do these clinical reasoning task processes evolve when patient encounters become complex and/or challenging (i.e. with contextual factors)? Methods We examine these questions through the lens of situated cognition, context specificity, and cognitive load theory. Sixty think-aloud transcripts from 30 physicians who participated in two separate cases - one with a contextual factor and one without - were coded for 26 clinical reasoning tasks (1). These tasks were organized temporally, i.e. when they emerged in their think-aloud process. Frequencies of each of the 26 tasks were aggregated, categorized, and visualized in order to analyze task category sequences. Results We found that (a) as expected, clinical tasks follow a general sequence, (b) contextual factors can distort this emerging sequence, and (c) the presence of contextual factors prompts more experienced physicians to clinically reason similar to that of less experienced physicians. Conclusions These findings add to the existing literature on context specificity in clinical reasoning and can be used to strengthen teaching and assessment of clinical reasoning.

Objectives Uncertainty is common in clinical reasoning given the dynamic processes required to come to a diagnosis. Though some uncertainty is expected during clinical encounters, it can have detrimental effects on clinical reasoning. Likewise, evidence has established the potentially detrimental effects of the presence of distracting contextual factors (i.e., factors other than case content needed to establish a diagnosis) in a clinical encounter on clinical reasoning. The purpose of this study was to examine how linguistic markers of uncertainty overlap with different clinical reasoning tasks and how distracting contextual factors might affect physicians' clinical reasoning process. Methods In this descriptive exploratory study, physicians participated in a live or video recorded simulated clinical encounter depicting a patient with unstable angina with and without contextual factors. Transcribed think-aloud reflections were coded using Goldszmidt's clinical reasoning task typology (26 tasks encompassing the domains of framing, diagnosis, management, and reflection) and then those coded categories were examined using linguistic markers of uncertainty (e.g., probably, possibly, etc.). Results Thirty physicians with varying levels of experience participated. Consistent with expectations, descriptive analysis revealed that physicians expressed more uncertainty in cases with distracting contextual factors compared to those without. Across the four domains of reasoning tasks, physicians expressed the most uncertainty in diagnosis and least in reflection. Conclusions These results highlight how linguistic markers of uncertainty can shed light on the role contextual factors might play in uncertainty which can lead to error and why it is essential to find ways of managing it.

Animal temperament is complex and has implications for productivity and economic profitability. Quantifying an animal's response to differing stimuli may facilitate breeding selections and identify animals that are better suited to specific management strategies. Multiple tests have been developed to evaluate cattle temperament (e.g., exit velocity, chute score, pen score, open field test, startle test, bovine zero maze), but each of these tests evaluates the animal's response to different stimuli (e.g., isolation, novel environment, startle, willingness to enter an enclosed area). Cattle temperament has been observed to be relatively stable over time. However, the evaluation of temperament has the potential to be influenced by current conditions, previous experiences, and observer bias. Many of these temperament tests have been improperly categorized as fear tests and have also been criticized for being subjective. This paper provides a framework for standardizing behavioral tests for cattle and suggests that these different evaluations assess different aspects of the animal's overall temperament.

Background: Clinical reasoning is at the core of health professionals' practice. A mapping of what constitutes clinical reasoning could support the teaching, development, and assessment of clinical reasoning across the health professions., Methods: We conducted a scoping study to map the literature on clinical reasoning across health professions literature in the context of a larger Best Evidence Medical Education (BEME) review on clinical reasoning assessment. Seven databases were searched using subheadings and terms relating to clinical reasoning, assessment, and Health Professions. Data analysis focused on a comprehensive analysis of bibliometric characteristics and the use of varied terminology to refer to clinical reasoning., Results: Literature identified: 625 papers spanning 47 years (1968-2014), in 155 journals, from 544 first authors, across eighteen Health Professions. Thirty-seven percent of papers used the term clinical reasoning; and 110 other terms referring to the concept of clinical reasoning were identified. Consensus on the categorization of terms was reached for 65 terms across six different categories: reasoning skills, reasoning performance, reasoning process, outcome of reasoning, context of reasoning, and purpose/goal of reasoning. Categories of terminology used differed across Health Professions and publication types., Discussion: Many diverse terms were present and were used differently across literature contexts. These terms likely reflect different operationalisations, or conceptualizations, of clinical reasoning as well as the complex, multi-dimensional nature of this concept. We advise authors to make the intended meaning of 'clinical reasoning' and associated terms in their work explicit in order to facilitate teaching, assessment, and research communication.

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Introduction: Contextual factors (eg, diagnostic suggestion and burnout) can affect physician clinical reasoning performance, leading to diagnostic error. Yet, contextual factors have only recently been studied and none of that work focused on how physicians appraise (ie, evaluate) the clinical situation as they reason. The purpose of this qualitative study was to use appraisal to describe the effect of contextual factors on clinical reasoning., Materials and Methods: Physicians (n = 25) either viewed two video cases or participated in two live scenarios, one with contextual factors and one without. Afterwards, they completed a "think-aloud" reflection while reviewing the cases. Transcribed think-alouds were coded for appraisal markers, comparing cases with and without contextual factors., Results: When contextual factors were present, participants expressed more emotional evaluation and uncertainty about those emotions. Across all types of cases, participants expressed uncertainty about the case and assessed what "could" or "would" have gone differently., Conclusions: This study suggests that one major effect of contextual factors may be that they induce emotions, which may affect the process of clinical reasoning and diagnostic error. It also suggests that uncertainty may be common in clinical practice, and we should thus further explore its impact., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Objectives: Caregiver burden associated with dementia-related agitation is one of the commonest reasons a community-dwelling person with dementia (PWD) transitions to a care facility. Behavioral and Environmental Sensing and Intervention for Dementia Caregiver Empowerment (BESI) is a system of body-worn and in-home sensors developed to provide continuous, noninvasive agitation assessment and environmental context monitoring to detect early signs of agitation and its environmental triggers., Research Design and Methods: This mixed methods, remote ethnographic study is explored in a 3-phase, multiyear plan. In Phase 1, we developed and refined the BESI system and completed usability studies. Validation of the system and the development of dyad-specific models of the relationship between agitation and the environment occurred in Phase 2., Results: Phases 1 and 2 results facilitated targeted changes in BESI, thus improving its overall usability for the final phase of the study, when real-time notifications and interventions will be implemented., Conclusion: Our results show a valid relationship between the presence of dementia related agitation and environmental factors and that persons with dementia and their caregivers prefer a home-based monitoring system like BESI.

The environmental risks from explosive manufacturing and testing activities are usually evaluated using a qualitative process such as environmental impact prioritisation as recommended by legislation and guidance. However, standard environmental management system (EMS) guidance rarely provides detailed information on how to objectively assess the significance of the environmental impacts based on a rational scientific evidence. Quantitative exposure and eco-toxicity assessments are frequently used in combination with environmental threshold limit guidelines, but these omit important environmental impacts such as physical damage to land, nuisance and contribution to climate change. These impacts are particularly relevant to the explosives industry where noise nuisance and physical damage are given high priority. In addition, contamination from explosive compositions may comprise mixtures of multiple legacy and new generation explosives such as 1,3,5-trinitro-1,3,5-triazinane (RDX), 2,4,6-trinitrotoluene (TNT), 5-nitro-1,2,4-triazol-3-one (NTO), 2,4-dinitroanisole (DNAN) and nitroguandine (NQ), which may have combined impacts not captured by conventional eco-toxicity assessments. Further, threshold limits for energetic materials in soil and water have not been established for most nations. Additionally, in the explosive industry wider concerns such as legislative compliance and stakeholder concerns may help to provide a more broadly applicable assessment of environmental impact. Therefore in this study a novel decision framework was developed to integrate empirical data with business risks to enable rational decision making for the environmental management of explosive manufacturing facilities. The application of the framework was illustrated using three case studies from the explosive manufacturing industry to demonstrate how the framework can be used to justify environmental management decision making. By linking the environmental impacts to business risks, we demonstrate that manufacturers are able to assess a wide spectrum of issues that might not be identified in the initial environmental assessment such as non-toxic pollution incidents, breaches in legislation and stakeholder perceptions., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Clinical reasoning is considered to be at the core of health practice. Here, we report on the diversity and inferred meanings of the terms used to refer to clinical reasoning and consider implications for teaching and assessment. Methods: In the context of a Best Evidence Medical Education (BEME) review of 625 papers drawn from 18 health professions, we identified 110 terms for clinical reasoning. We focus on iterative categorization of these terms across three phases of coding and considerations for how terminology influences educational practices. Results: Following iterative coding with 5 team members, consensus was possible for 74, majority coding was possible for 16, and full team disagreement existed for 20 terms. Categories of terms included: purpose/goal of reasoning, outcome of reasoning, reasoning performance, reasoning processes, reasoning skills, and context of reasoning. Discussion: Findings suggest that terms used in reference to clinical reasoning are non-synonymous, not uniformly understood, and the level of agreement differed across terms. If the language we use to describe, to teach, or to assess clinical reasoning is not similarly understood across clinical teachers, program directors, and learners, this could lead to confusion regarding what the educational or assessment targets are for "clinical reasoning."

Hair cortisol is a novel biomarker of chronic stress. The objective of this study was to determine the effect of hair color and length, as well as, animal age on hair cortisol concentration in beef feedlot steers. Nineteen beef crossbred steers used for nutrition research and housed in a small feedlot setting were used for this study. Seven of the steers (680 ± 4.5 kg; ~9 years of age) were fitted with ruminal fistulas and duodenal cannulas. The other 12 steers (473 ± 3.1 kg; ~2.5 years of age) were fitted with only ruminal fistulas. Hair samples from each steer were collected throughout a period of 6 weeks from six different areas and analyzed for cortisol concentrations. One pre-determined area was shaved each week for 5 weeks (Weeks 1-5). During week 6, all five, previously shaved areas and an additional area was shaved to collect hair samples of various lengths. Hair length was recorded prior to the collection of each hair sample. Only data from the last week (Week 6) of collection were included in the analyses. Steers were categorized into one of three groups: old with black hair (OB, n = 3); old with white hair (OW, n = 3); young with black hair (YB, n = 12). Older steers exhibited greater hair cortisol concentrations than younger steers ( P < 0.001). Hair cortisol concentration was not impacted by duration of growth ( P = 0.33). Cortisol concentrations exhibited a weak, positive correlation with hair length ( r = 0.33, P -value = 0.01). The average hair growth per week of beef steers in the winter months was calculated to be 0.90 mm. Further research should be performed to improve our understanding of the effect of hair characteristics, sampling methodologies and analysis techniques on hair cortisol concentrations., (Copyright © 2019 Baier, Grandin, Engle and Edwards-Callaway.)

Hind limb post stunning kicking in properly stunned unconscious cattle is a safety hazard for employees. Three different captive bolt lengths of 15.2 cm (STRD), 16.5 cm (MED), and 17.8 cm (LON) were evaluated for amount of tissue damage and hind limb kicking in a Jarvis USSS-1 pneumatic stunner. The air pressure setting was 1378.95 to 1447.90 pKa for all captive bolts. All 45 test cattle were rendered unconscious with a single shot. There was a trend (P = .06) for less kicking to occur when the 16.5 cm length bolt was used in the stunner. Visual appraisal of the brains on the split heads indicated that the shortest bolt caused the least amount of brain damage. The brainstems were intact for all cattle regardless of captive bolt treatment. Young fed English, Continental European, and Holstein steers and heifers can be effectively stunned without visible brainstem disruption., (Published by Elsevier Ltd.)

I was born in 1947 and had autism with speech delay until age four. I am now a college professor of animal science. Horse activities enabled me to make friends through a shared interest in horses. This paper describes the benefits that I experienced from working with horses and my friendships and work skills. A close friendship developed with another student through both riding and horse craft projects. Keeping employment is a serious problem for many people with Autism Spectrum Disorder (ASD). The responsibility of caring for horses and cleaning stalls every day taught me good work skills. My experiences suggest that there were valuable outcomes from working with horses. This may be a beneficial intervention to include in programming for youth with ASD.

Background A framework of clinical reasoning tasks used by physicians during clinical encounters was previously developed proposing that clinical reasoning is a complex process composed of 26 possible tasks. The aim of this paper was to analyze the verbalized clinical reasoning processes of medical students utilizing commonly encountered internal medicine cases. Methods In this mixed-methods study, participants viewed three video recorded clinical encounters. After each encounter, participants completed a think-aloud protocol. The qualitative data from the transcribed think-aloud transcripts were analyzed by two investigators using a constant comparative approach. The type, frequency, and pattern of codes used were analyzed. Results Seventeen third and fourth year medical students participated. They used 15 reasoning tasks across all cases. The average number of tasks used in cases 1, 2, and 3 was (respectively) 5.6 (range 3-8), 5.9 (range 4-8), and 5.3 (range 3-10). The order in which medical students verbalized reasoning tasks varied and appeared purposeful but non-sequential. Conclusions Consistent with prior research in residents, participants progressed through the encounter in a purposeful but non-sequential fashion. Reasoning tasks related to framing the encounter and diagnosis were not used in succession but interchangeably. This suggests that teaching successful clinical reasoning may involve encouraging or demonstrating multiple pathways through a problem. Further research exploring the association between use of clinical reasoning tasks and clinical reasoning accuracy could enhance the medical community's understanding of variance in clinical reasoning.

The objective of the control study was to assess 2 prominent fluctuations in a single optical signal as being either a true first hoof contact or a last break-over based on descriptive measures. The study builds on initial findings from a preliminary investigation of the embedded-optical-base system's (EOBS) capabilities in signal capturing and feasibility as potential alternative to existing gait technologies, such as piezoelectric (e.g., load cell) systems. Hoof contacts and break-overs were measured (0 to 1 au; arbitrary units) using a 2.4-m (length) × 0.9-m (width) platform containing 1 EOBS. Three mixed-breed horses ( n = 3) were injected with saline or either 100 IU or 200 IU Botox (i.e., onabotulinumtoxinA) with a 2.5-mL final volume. Injections were made into the deep digital flexor muscle at the motor end plates, with electromyography and ultrasound guidance. Horses were observed for 3 time points (pre-, post-, and recovery test days) over the span of a 4-mo period. Signal fluctuations [i.e., amplitude of hoof impacts based on true first hoof contacts (Δ S TS ) and true last break-overs (Δ S TL )] and kinematics [i.e., complete gait pass (CGP) time duration ( T )] were recorded from each horse. Visual observations and video analysis were used for determining gait pattern categories. Individual horse measurements were analyzed for each trial, compared with video data and classified. Comparison of primary signal fluctuations (i.e., Δ S TS vs. Δ S TL ; forelimb vs. hindlimb) exhibited significant differences between hoof contacts and break-overs ( P < 0.05). Right and left forelimb hoof contacts and hindlimb break-overs were not significantly different ( P = 0.966; 0.063 ± 0.135; Estimate ± SE; P = 0.606; 0.176 ± 0.142; Estimate ± SE, respectively). Additionally, treatment vs. saline forelimbs did not exhibit significant difference ( P = 0.7407; -0.098 ± 0.279; Estimate ± SE). Overall, data showed that the EOBS can collect repeatable and unique primary signal fluctuations as prominent and different gait measurements providing evidence to further development and research of the sensing system., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Society of Animal Science.)

Purpose: An evidence-based approach to assessment is critical for ensuring the development of clinical reasoning (CR) competence. The wide array of CR assessment methods creates challenges for selecting assessments fit for the purpose; thus, a synthesis of the current evidence is needed to guide practice. A scoping review was performed to explore the existing menu of CR assessments., Method: Multiple databases were searched from their inception to 2016 following PRISMA guidelines. Articles of all study design types were included if they studied a CR assessment method. The articles were sorted by assessment methods and reviewed by pairs of authors. Extracted data were used to construct descriptive appendixes, summarizing each method, including common stimuli, response formats, scoring, typical uses, validity considerations, feasibility issues, advantages, and disadvantages., Results: A total of 377 articles were included in the final synthesis. The articles broadly fell into three categories: non-workplace-based assessments (e.g., multiple-choice questions, extended matching questions, key feature examinations, script concordance tests); assessments in simulated clinical environments (objective structured clinical examinations and technology-enhanced simulation); and workplace-based assessments (e.g., direct observations, global assessments, oral case presentations, written notes). Validity considerations, feasibility issues, advantages, and disadvantages differed by method., Conclusions: There are numerous assessment methods that align with different components of the complex construct of CR. Ensuring competency requires the development of programs of assessment that address all components of CR. Such programs are ideally constructed of complementary assessment methods to account for each method's validity and feasibility issues, advantages, and disadvantages.

The objective of this study was to benchmark how cow-calf producers were marketing their calves, their priorities when selecting replacements, and if producers saw value in a quality assessment focusing on animal handling and care. A total of 1,414 responses from cow-calf producers in 44 states were collected through a survey conducted in partnership with BEEF . Thirty questions were asked of respondents to gather demographic information, establish at what age and through what avenue respondents were marketing their calves, and gauge respondent perspectives on selection decisions, pain management and a quality assessment outlining handling and care guidelines. The percentage of respondents who marketed their calves at certain ages varied by herd size ( P < 0.001). Respondents with 50 head or less or more than 1,000 head most commonly retained their calves through finishing and respondents with 51 to 200 head and 201 head to 500 head more frequently backgrounded and then sold their calves. Respondents' top priorities when selecting bulls were calving ease, followed by growth and feed efficiency traits. When selecting females, top priorities were reproductive efficiency, followed by mothering ability. The percentage of respondents using pain management differed by whether a veterinarian had offered to administer a drug for pain management ( P < 0.001). 13.5% of respondents answered yes, and a veterinarian had offered to administer a drug for pain management when castrating or dehorning. Of those 13.5% who responded yes pain management had been offered, and 54.55% of respondents chose to use a pain relief method. A higher percentage of respondents that precondition also more frequently indicated that they used a pain relief method when castrating or dehorning, though it was still a low percentage ( P = 0.006). Overall, 46.3% of respondents saw value in handling and care guidelines and 54.9% of respondents saw value in a program including source and age verification, a vaccination plan, and handling and care guidelines. Respondents who were Beef Quality Assurance (BQA) certified had a beef cow inventory of 501 to 1,000 head, who preconditioned their calves and backgrounded them before selling, and who lived in the West most commonly saw value in a quality assessment outlining handling and care guidelines., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Society of Animal Science.)

The objectives of this study were to benchmark cow-calf producer perspectives on management strategies and challenges, and to determine if demographic differences and Beef Quality Assurance (BQA) certification status influenced the frequency of certain management strategies. A total of 1,414 responses from cow-calf producers in 44 states were collected through an online survey conducted in partnership with BEEF , a producer-focused magazine. Survey recipients were asked 30 questions to gather demographic information, respondents' current handling and health management practices, and how they prioritized industry challenges. The frequency of management methods and decisions such as preconditioning and identification methods were impacted by respondent age, operation size, location, and BQA certification ( P s ≤ 0.009). BQA-certified respondents more frequently used electronic ear tags and freeze branding ( P s = 0.009). Overall, 74.5% of respondents were preconditioning their calves. Respondents who were BQA certified more frequently preconditioned their calves (449; 81.5%) compared with those who were not BQA certified (582; 70.4%) ( P < 0.001). BQA training seems to be having a positive impact on production practices. Respondents identified cow-calf health as the biggest beef industry challenge and identified land availability or price as the biggest challenge to producers' own operation. Respondents identified bovine respiratory disease, flies, pinkeye, and reproductive health as the most important animal health issues on producers' operations. Health challenge responses varied significantly by producer age, beef cow inventory, and region of the United States ( P s < 0.001). Calf or neonate health was most commonly identified as the biggest challenge for respondents under the age of 30 years. Producers between the ages of 55 and 70 years most commonly responded that the Veterinary Feed Directive or regulations were more of a challenge than other age groups. Respondents clearly identified managing herd health as a challenge throughout the survey. Respondents with similar herd health challenges were identified based on demographic categorization, such as age of respondent and region., (© The Author(s) 2018. Published by Oxford University Press on behalf of the American Society of Animal Science.)

The objective of this study was to assess the effects of captive bolt length and breed type on post-stun leg activity in cattle. A total of 2850 Holstein (HOL) and non-Holstein British/Continental bred (NHOL) steers and heifers were observed post-stunning at a large commercial slaughter facility. A pneumatically powered penetrating captive bolt stunner was used with three different bolt lengths: CON, 15.24 cm; MED, 16.51 cm; and LON, 17.78 cm. Hind limb kicking, forelimb activity, take away belt stops, carcass swing and number of knife sticks during exsanguination were recorded for each animal from video recording. Hind limb and forelimb kicks observed ranged from 0 to 25 and 0 to 8, respectively. Analysis of post-stun hind limb and forelimb activity indicated that increasing pneumatically powered penetrating captive bolt length does not decrease post-stun leg activity. There was a higher percentage of cattle experiencing take away belt stops and carcass swing in HOL as compared with NHOL., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Studies have shown that a physician's clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance., Methods: Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes., Results: Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data., Discussion: The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.

Poor production and handling practices continue to persist that are both detrimental to animal welfare and financially burdensome. These practices continue to persist for three reasons: (1) a segmented marketing chain where a producer is not held financially accountable for losses; (2) failure to measure and assess chronic painful problems such as lame livestock; and (3) repeating old mistakes, such as housing fattening cattle for long periods of time on bare concrete. Two examples of the first type of losses are bruises caused by poor handling and sick cattle at feedlots caused by failure to vaccinate and precondition weaned calves at the farm of origin. In some segmented marketing systems, there is no economic incentive to vaccinate. When the animals get sick, the responsibility gets passed to the next person. Buyers of meat products can reduce these "passed on" losses by source verification. The first step to reducing problems, such as lame livestock, is to measure the percentage of lame animals and work with the producers to reduce them. Also, transportation payments should be changed and contracts should be based on the condition of the animals at delivery.

Clinical reasoning is an essential component of a health professional's practice. Yet clinical reasoning research has produced a notably fragmented body of literature. In this article, the authors describe the pause-and-reflect exercise they undertook during the execution of a synthesis of the literature on clinical reasoning in the health professions. Confronted with the challenge of establishing a shared understanding of the nature and relevant components of clinical reasoning, members of the review team paused to independently generate their own personal definitions and conceptualizations of the construct. Here, the authors describe the variability of definitions and conceptualizations of clinical reasoning present within their own team. Drawing on an analogy from mathematics, they hypothesize that the presence of differing "boundary conditions" could help explain individuals' differing conceptualizations of clinical reasoning and the fragmentation at play in the wider sphere of research on clinical reasoning. Specifically, boundary conditions refer to the practice of describing the conditions under which a given theory is expected to hold, or expected to have explanatory power. Given multiple theoretical frameworks, research methodologies, and assessment approaches contained within the clinical reasoning literature, different boundary conditions are likely at play. Open acknowledgment of different boundary conditions and explicit description of the conceptualization of clinical reasoning being adopted within a given study would improve research communication, support comprehensive approaches to teaching and assessing clinical reasoning, and perhaps encourage new collaborative partnerships among researchers who adopt different boundary conditions.

Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.

Inadequate corral facilities and improper handling are major causes of stress in beef cattle. The purpose of this study was to evaluate the effects of minor changes in the corral and adoption of good handling practices on the behavior, cortisol release, and time spent taking blood samples in Nellore cows. Minor corral changes included obstructing the cow's vision when the handler walked deep into the animal's flight zone and the elimination of bright objects, color contrasts, puddles, shadows, and darkness in the corral. Handling was improved by eliminating dogs, electric goads (prods), and yelling, as well as adopting a calm behavior. A total of 141 Nellore cows from two typical extensive livestock farms were studied. The cows were evaluated individually before and after the corral changes. Blood samples were collected in the restraint device for cortisol measurement. The minor corral changes and the adoption of good handling practices result in better results for all variables studied. The results showed differences in the interactions between treatment and ranch for chute score (P = 0.0091) and exit score (P < 0.0001). The cortisol release was lower (P < 0.001) and better for the improved methods, resulting in calmer cows compared to cortisol released before the minor changes (41.03 ± 2.9 vs 60.40 ± 3.8 ng/mL). Minor changes made in the corrals and the adoption of good handling practices were effective in improving cow behavior in the chute and in reducing exit velocity, cortisol released, and the time spent taking blood samples.

This trial sought to evaluate whether vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, was superior to placebo, on a background of standard of care, in increasing the time to the first occurrence of the composite endpoints of cardiovascular (CV) death and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction (HFrEF). Deficiency in sGC-derived cyclic guanosine monophosphate (cGMP) causes both myocardial dysfunction and impaired endothelium-dependent vasomotor regulation that includes the myocardial microcirculation. Experimental studies have suggested multiple potential benefits of sGC stimulators including prevention, or even reversal, of left ventricular hypertrophy and fibrosis, as well as reduction of ventricular afterload through both systemic and pulmonary vasodilation. Hence, restoration of sufficient nitric oxide (NO)-sGC-cGMP signaling has been proposed as an important treatment target in HF. Vericiguat has been shown to directly stimulate sGC and enhance sGC sensitivity to endogenous NO. Available phase IIb data in HFrEF patients indicate vericiguat is safe and well-tolerated, and exploratory analyses indicate that it results in a dose-dependent, clinically significant reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at the highest tested dose. VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) is a randomized, placebo-controlled, parallel group, multicenter, double-blind, event-driven phase 3 trial of vericiguat in subjects with HFrEF. Approximately 4,872 subjects will be randomized to evaluate the efficacy and safety of vericiguat compared with placebo on a background of standard of care. After a screening phase of up to 30 days, eligible subjects will be treated until the required number of cardiovascular deaths is observed. The estimated median follow-up duration is approximately 18 months. All subjects will be followed until study completion to assess for the occurrence of endpoint events. VICTORIA will establish the efficacy and safety of vericiguat on cardiovascular death and HF hospitalization in patients with HFrEF. (A Randomized Parallel-Group, Placebo-Controlled, Double-Blind, Event-Driven, Multi-Center Pivotal Phase III Clinical Outcome Trial of Efficacy and Safety of the Oral sGC Stimulator Vericiguat in Subjects With Heart Failure With Reduced Ejection Fraction [HFrEF]-VerICiguaT Global Study in Subjects With Heart Failure With Reduced Ejection Fraction [VICTORIA]; NCT02861534)., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Scientists are often reluctant to attribute emotions to nonhuman animals that are similar to human emotions. When the author published her early studies, reviewers prohibited the word fear. Fearful behavior had to be described as agitated. The core emotional systems described by Panksepp may provide a useful framework for people who work hands-on with animals. The core systems are fear, rage, panic (separation distress), seek, lust, nurture, and play. Some scientists who deny that animals have real emotions often fail to review important areas of the literature. The areas that are sometimes left out are the effects of psychiatric medications on animals and genetic influences on differences in animal behavior. In both people and animals, genetics has an influence on both fearfulness and novelty seeking. Visualizing the seven core emotional systems as separate volume controls on a music mixing board may help zoo professionals determine the motivation of both normal and abnormal behavior. It may also help them to design more effective environmental enrichments.

Background: The impact of context on the complex process of clinical reasoning is not well understood. Using situated cognition as the theoretical framework and videos to provide the same contextual "stimulus" to all participants, we examined the relationship between specific contextual factors on diagnostic and therapeutic reasoning accuracy in board certified internists versus resident physicians., Methods: Each participant viewed three videotaped clinical encounters portraying common diagnoses in internal medicine. We explicitly modified the context to assess its impact on performance (patient and physician contextual factors). Patient contextual factors, including English as a second language and emotional volatility, were portrayed in the videos. Physician participant contextual factors were self-rated sleepiness and burnout.. The accuracy of diagnostic and therapeutic reasoning was compared with covariates using Fisher Exact, Mann-Whitney U tests and Spearman Rho's correlations as appropriate., Results: Fifteen board certified internists and 10 resident physicians participated from 2013 to 2014. Accuracy of diagnostic and therapeutic reasoning did not differ between groups despite residents reporting significantly higher rates of sleepiness (mean rank 20.45 vs 8.03, U = 0.5, p < .001) and burnout (mean rank 20.50 vs 8.00, U = 0.0, p < .001). Accuracy of diagnosis and treatment were uncorrelated (r = 0.17, p = .65). In both groups, the proportion scoring correct responses for treatment was higher than the proportion scoring correct responses for diagnosis., Conclusions: This study underscores that specific contextual factors appear to impact clinical reasoning performance. Further, the processes of diagnostic and therapeutic reasoning, although related, may not be interchangeable. This raises important questions about the impact that contextual factors have on clinical reasoning and provides insight into how clinical reasoning processes in more authentic settings may be explained by situated cognition theory.

Handling and stunning at slaughter plants has greatly improved through the use of numerical scoring. The purpose of this paper is to encourage the use of numerical scoring systems at the slaughter plants to assess conditions that compromise welfare that occurred either during transport or on the farm. Some of the transport problems that can be assessed are bruises, death losses, and injured animals. Welfare issues that occurred on the farm that can be assessed at the abattoir are body condition, lameness, lesions, injuries, animal cleanliness and internal pathology. There are important welfare issues that cannot be assessed at slaughter. They are on-farm euthanasia methods, use of analgesics during surgeries, and the type of animal housing systems. Welfare evaluations at slaughter have the potential to greatly improve welfare., (Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.)

A 47-year-old man with a history of alcohol abuse, cirrhosis, and grade II esophageal varices is admitted for treatment of alcohol withdrawal. He reports having some dark-colored stools a week prior to admission, but his stools since then have been normal in color. A repeat hemoglobin is stable, but a fecal occult blood test is positive. What should be done next?, (© 2017 Society of Hospital Medicine.)

Lameness is among the most important welfare and production issues affecting dairy cattle. Recently, it has received significant research emphasis. Certain events in 2013 within the cattle industry heightened the focus on mobility issues in finished cattle. Scoring systems are needed in the finished cattle industry to capture and measure mobility issues at packing facilities. The North American Meat Institute Animal Welfare Committee helped facilitate the creation of a scoring system to evaluate mobility of cattle at packing plants, providing the cattle industry with a tool to benchmark and improve the welfare of finished cattle., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Animal welfare is an important aspect of veterinary responsibility, yet the current curriculum at many US veterinary schools provides little training in this field. The Animal Welfare Judging and Assessment Contest provides an opportunity for students to learn about general principles of animal welfare, challenging them to apply critical reasoning skills in a competitive environment. Here we provide an overview of the contest and an example of how Colorado State University educates and prepares its students.

Objectives: To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group's experiences and learning preferences., Methods: A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR's intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes., Secondary Outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning., Results: MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters., Conclusions: MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation., Practice Implications: MPathic-VR's virtual human simulation offers an effective and engaging means of advanced communication training., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The use of open outdoor feedlots for housing large numbers of cattle is increasing in many parts of the world. In these systems cattle are kept in large outdoor pens on a soil surface. One major welfare concern associated with this type of housing is keeping cattle clean and preventing muddy conditions. If the annual rainfall exceeds 20 in (51 cm). It is more difficult to keep the surface dry. In dry parts of the world with low rainfall, it is much easier to keep cattle clean and dry. Another issue is heat stress, and there are warmer parts of the world where shade may be required. The third issue is handling and vaccinating large numbers of cattle. In the U.S. this is an area where conditions have improved because management is now more aware about animal welfare. There are three major outcome based measurements that should be used to assess cattle welfare in open feedlots. They are: scoring of hide cleanliness, panting scoring for heat stress and numerical scoring of cattle handling practices., (© 2016 The Authors.)

n/a., Competing Interests: The author declare no conflict of interest.

Purpose: A framework of clinical reasoning tasks thought to occur in a clinical encounter was recently developed. It proposes that diagnostic and therapeutic reasoning comprise 24 tasks. The authors of this current study used this framework to investigate what internal medicine residents reason about when they approach straightforward clinical cases., Method: Participants viewed three video-recorded clinical encounters portraying common diagnoses. After each video, participants completed a post encounter form and think-aloud protocol. Two authors analyzed transcripts from the think-aloud protocols using a constant comparative approach. They conducted iterative coding of the utterances, classifying each according to the framework of clinical reasoning tasks. They evaluated the type, number, and sequence of tasks the residents used., Results: Ten residents participated in the study in 2013-2014. Across all three cases, the residents employed 14 clinical reasoning tasks. Nearly all coded tasks were associated with framing the encounter or diagnosis. The order in which residents used specific tasks varied. The average number of tasks used per case was as follows: Case 1, 4.4 (range 1-10); Case 2, 4.6 (range 1-6); and Case 3, 4.7 (range 1-7). The residents used some tasks repeatedly; the average number of task utterances was 11.6, 13.2, and 14.7 for, respectively, Case 1, 2, and 3., Conclusions: Results suggest that the use of clinical reasoning tasks occurs in a varied, not sequential, process. The authors provide suggestions for strengthening the framework to more fully encompass the spectrum of reasoning tasks that occur in residents' clinical encounters.

OBJECTIVE To explore the extent to which veterinary colleges and schools accredited by the AVMA Council on Education (COE) have incorporated specific courses related to animal welfare, behavior, and ethics. DESIGN Survey and curriculum review. SAMPLE All 49 AVMA COE-accredited veterinary colleges and schools (institutions). PROCEDURES The study consisted of 2 parts. In part 1, a survey regarding animal welfare, behavior, and ethics was emailed to the associate dean of academic affairs at all 49 AVMA COE-accredited institutions. In part 2, the curricula for the 30 AVMA COE-accredited institutions in the United States were reviewed for courses on animal behavior, ethics, and welfare. RESULTS Seventeen of 49 (35%) institutions responded to the survey of part 1, of which 10 offered a formal animal welfare course, 9 offered a formal animal behavior course, 8 offered a formal animal ethics course, and 5 offered a combined animal welfare, behavior, and ethics course. The frequency with which courses on animal welfare, behavior, and ethics were offered differed between international and US institutions. Review of the curricula for the 30 AVMA COE-accredited US institutions revealed that 6 offered a formal course on animal welfare, 22 offered a formal course on animal behavior, and 18 offered a formal course on animal ethics. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that AVMA COE-accredited institutions need to provide more formal education on animal welfare, behavior, and ethics so veterinarians can be advocates for animals and assist with behavioral challenges.

Objective: To characterize patent and proprietary medicine vendors and shops in Nigeria and to assess their ability to help improve access to high-quality, primary health-care services., Methods: In 2013 and 2014, a census of patent and proprietary medicine shops in 16 states of Nigeria was carried out to determine: (i) the size and coverage of the sector; (ii) the basic characteristics of shops and their staff; and (iii) the range of products stocked for priority health services, particularly for malaria, diarrhoea and family planning. The influence of the medical training of people in charge of the shops on the health-care products stocked and registration with official bodies was assessed by regression analysis., Findings: The number of shops per 100,000 population was higher in southern than in northern states, but the average percentage of people in charge with medical training across local government areas was higher in northern states: 52.6% versus 29.7% in southern states. Shops headed by a person with medical training were significantly more likely to stock artemisinin-based combination therapy, oral rehydration salts, zinc, injectable contraceptives and intrauterine contraceptive devices. However, these shops were less likely to be registered with the National Association of Patent and Proprietary Medicine Dealers and more likely to be registered with the regulatory body, the Pharmacist Council of Nigeria., Conclusion: Many patent and proprietary medicine vendors in Nigeria were medically trained. With additional training and oversight, they could help improve access to basic health-care services. Specifically, vendors with medical training could participate in task-shifting interventions.

Purpose: To compare the relative utility of open-book examinations (OBEs) and closed-book examinations (CBEs) given the rapid expansion and accessibility of knowledge., Method: A systematic review of peer-reviewed articles retrieved from MEDLINE, ERIC, Embase, and PsycINFO (through June 2013). In 2013-2014, articles that met inclusion criteria were reviewed by at least two investigators and coded for six outcome categories: (1) examination preparation, (2) test anxiety, (3) exam performance, (4) psychometrics and logistics, (5) testing effects, and (6) public perception., Results: From 4,192 identified studies, 37 were included. The level of learner and subject studied varied. The frequency of each outcome category was as follows: (1) exam preparation (n = 20; 54%); (2) test anxiety (n = 14; 38%); (3) exam performance (n = 30; 81%); (4) psychometrics and logistics (n = 5; 14%); (5) testing effects (n = 24; 65%); and (6) public perception (n = 5; 14%). Preexamination outcome findings were equivocal, but students may prepare more extensively for CBEs. For during-examination outcomes, examinees appear to take longer to complete OBEs. Studies addressing examination performance favored CBE, particularly when preparation for CBE was greater than for OBE. Postexamination outcomes suggest little difference in testing effects or public perception., Conclusions: Given the data available, there does not appear to be sufficient evidence for exclusively using CBE or OBE. As such, a combined approach could become a more significant part of testing protocols as licensing bodies seek ways to assess competencies other than the maintenance of medical knowledge.

An animal that has been carefully acclimated to handling may willingly re-enter a restrainer. Another animal may have an intense agitated behavioral reaction or refuse to re-enter the handling facility. Physiological measures of stress such as cortisol may be very low in the animal that re-enters willingly and higher in animals that actively resist restraint. Carefully acclimating young animals to handling and restraint can help improve both productivity and welfare by reducing fear stress. Some of the topics covered in this review are: How an animal perceives handling and restraint, the detrimental effects of a sudden novel event, descriptions of temperament and aversion tests and the importance of good stockmanship.

Background: Sensemaking is the social act of assigning meaning to ambiguous events. It is recognized as a means to achieve high reliability. We sought to assess sensemaking in daily patient care through examining how inpatient teams round and discuss patients., Objective: Our purpose was to assess the association between inpatient physician team sensemaking and hospitalized patients' outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates., Design: Eleven inpatient medicine teams' daily rounds were observed for 2 to 4 weeks. Rounds were audiotaped, and field notes taken. Four patient discussions per team were assessed using a standardized Situation, Task, Intent, Concern, Calibrate (STICC) framework., Participants: Inpatient physician teams at the teaching hospitals affiliated with the University of Texas Health Science Center at San Antonio participated in the study. Outcomes of patients admitted to the teams were included., Main Measures: Sensemaking was assessed based on the order in which patients were seen, purposeful rounding, patient-driven rounding, and individual patient discussions. We assigned teams a score based on the number of STICC elements used in the four patient discussions sampled. The association between sensemaking and outcomes was assessed using Kruskal-Wallis sum rank and Dunn's tests., Key Results: Teams rounded in several different ways. Five teams rounded purposefully, and four based rounds on patient-driven needs. Purposeful and patient-driven rounds were significantly associated with lower complication rates. Varying the order in which patients were seen and purposefully rounding were significantly associated with lower LOS, and purposeful and patient-driven rounds associated with lower ULOS. Use of a greater number of STICC elements was associated with significantly lower LOS (4.6 vs. 5.7, p = 0.01), ULOS (0.3 vs. 0.6, p = 0.02), and complications (0.2 vs. 0.5, p = 0.0001)., Conclusions: Improving sensemaking may be a strategy for improving patient outcomes, fostering a shared understanding of a patient's clinical trajectory, and enabling high reliability.

This review identifies priorities for beef cattle welfare research in the USA. Based on our professional expertise and synthesis of existing literature, we identify two themes in intensive aspects of beef production: areas where policy-based actions are needed and those where additional research is required. For some topics, considerable research informs best practice, yet gaps remain between scientific knowledge and implementation. For example, many of the risk factors and management strategies to prevent respiratory disease are understood, but only used by a relatively small portion of the industry. This is an animal health issue that will require leadership and discussion to gain widespread adoption of practices that benefit cattle welfare. There is evidence of success when such actions are taken, as illustrated by the recent improvements in handling at US slaughter facilities. Our highest priorities for additional empirical evidence are: the effect of technologies used to either promote growth or manage cattle in feedlots, identification of management risk factors for disease in feedlots, and management decisions about transport (rest stops, feed/water deprivation, climatic conditions, stocking density). Additional research is needed to inform science-based recommendations about environmental features such as dry lying areas (mounds), shade, water and feed, as well as trailer design.

Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. After watching each video recording, participants completed a think-aloud protocol. Transcripts from the think-aloud protocols were analyzed using a constant comparative approach. After iterative coding, utterances were analyzed for emergent themes with utterances grouped into categories, themes and subthemes. Ten residents participated in the study with saturation reached during analysis. Participants universally acknowledged the presence of contextual factors in the video recordings. Four categories emerged as a consequence of the contextual factors: (1) emotional reactions (2) behavioral inferences (3) optimizing the doctor patient relationship and (4) difficulty with closure of the clinical encounter. The presence of contextual factors may impact clinical reasoning performance in resident physicians. When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory.