Effect of Post-Grazing Sward Height, Sire Genotype and Indoor Finishing Diet on Steer Intake, Growth and Production in Grass-Based Suckler Weanling-to-Beef Systems.

This study evaluated the effects of post-grazing sward height (PGSH, 4 or 6 cm) on herbage production, its nutritive value, dry matter (DM) intake, grazing behaviour and growth of early- (EM) and late-maturing (LM) breed suckler steers (n = 72), and the subsequent effect of indoor finishing diet (grass silage + 3.8 kg concentrate DM/head daily (SC), or grass silage only (SO)) on performance and carcass traits. Animals rotationally grazed pasture for 196 days, followed by indoor finishing for 119 days. At pasture, daily live-weight gain (LWG) was 0.10 kg greater for PGSH-6 than PGSH-4, resulting in a tendency for carcass weight to be 11 kg heavier. Although EM had a 0.10 kg greater daily LWG at pasture than LM, carcass weight did not differ between the genotypes. There was a genotype × PGSH interaction for carcass fat score, whereby there was no difference between EM-4 (8.83, 15-point scale) and EM-6 (8.17), but LM-6 (7.28) was greater than LM-4 (6.33). Although concentrate supplementation during indoor finishing increased carcass weight (+37 kg) and fat score (1.75 units), the majority of steers (83% of EM and 78% of LM) achieved a commercially-acceptable carcass fat score (6.78) at slaughter in the grass-forage-only system.

Python script for homogeneous aqueous chemical reaction analysis and associated data related to radiolysis simulations.

A script was developed to perform homogenous radiolysis calculations. It was used specifically to calculate radiolysis products under various neutron and gamma flux environments [1]. The routine may be used to calculate a single radiolysis condition, multiple independent conditions, or multiple conditions computed in series (the final concentration set of run i is the initial concentration of run i+1). While designed for radiolysis of water, the routine is easily adapted to a variety of aqueous reaction systems and may even be altered with minimal effort for more general homogenous chemical analysis. In the present article, the Python routine is explained along with various outputs and inputs. It and the relevant input and output text files are included as supplementary materials. They are the raw data used for calculation of figures in the associated journal article.

Decreasing Pediatric PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction.

PURPOSE: To describe how a pediatric postanesthesia care unit used a two-phased approach of bundled interventions to reduce unit noise levels and improve staff perceptions of their work environment. DESIGN: Pre/post design. METHODS: Postanesthesia care unit sound levels and monitor alarms were measured at baseline and after implementing both project phases. Nursing staff members were surveyed at baseline and after completion of the project. FINDINGS: Monitor alarms were reduced by more than 50% after Phase I. However, noise measurement data did not reflect a difference in sound levels between baseline and intervention phases. Despite this, staff perceived the unit as much quieter. CONCLUSIONS: The reduction in monitor alarms did not cause an appreciable change in sound levels as measured by noise dosimeters in either intervention phase. Despite these findings, nurses perceived a quieter and more pleasant workplace. These impressions might have resulted from subjective expectations versus actual volume levels, or they might owe to the reduction in incidence of alarms themselves, which they had viewed as nuisance sounds.

Intravenous Versus Oral Acetaminophen in Ambulatory Surgical Center Laparoscopic Cholecystectomies: A Retrospective Analysis.

STUDY OBJECTIVE: The primary aim was to compare postoperative pain scores in patients undergoing laparoscopic cholecystectomy and receiving intravenous (IV) or oral (PO) acetaminophen (APAP) as part of a multimodal analgesic regimen to examine whether PO APAP is non-inferior to IV APAP. DESIGN: Retrospective analysis. SETTING: Ambulatory surgical center (ASC) in an academic setting. PATIENTS: 579 patients (18-70 years old), American Society of Anesthesiologists physical status I-III, undergoing laparoscopic cholecystectomy. INTERVENTIONS: Patients received 1,000 mg IV APAP intraoperatively (n = 319) or 1,000 mg PO APAP preoperatively (n = 260). MEASUREMENTS: The primary outcome was the median difference in post-anesthesia care unit (PACU) end-pain scores between the groups. Median pain scores were also compared on PACU admission, and at 15, 30, 45, and 60 minutes. Additional measures include PACU rescue-analgesia consumption, time to first PACU rescue analgesia, intraoperative use of opioid and nonopioid analgesics, PACU length of stay, and PACU rescue nausea and vomiting therapy. MAIN RESULTS: In both groups, the PACU median end-pain score was 2. The 90% confidence interval (CI) for difference in median pain scores between groups was [0, 0]; the CI upper limit was below the non-inferior margin of 1 pain-score point, indicating PO APAP's non-inferiority to IV APAP. There were no statistically significant differences in the percentages of patients receiving PACU hydromorphone equivalents between the IV and PO groups (75% vs. 77%, P = 0.72) or in the mean dose received (0.5 mg vs. 0.5 mg, P = 0.66). CONCLUSION: Single-dose PO APAP is non-inferior to IV APAP for postoperative analgesia in ASC laparoscopic cholecystectomy patients. The value of single-dose IV APAP in this population should be further explored.

A set of MATLAB routines and associated files for prediction of radiation-enhanced diffusion in ion irradiated materials.

This article presents MATLAB routines that may be used to evaluate radiation-enhanced diffusion (RED) in ion irradiation materials. Four routines are included: Main, DataCollect, Diffuse, and Directory. A sample input file and README are also included. The input may be directly modified as provided and used as an input to the routines. Data from Stopping Range of Ions in Matter (SRIM) is also required as an input. A stream of data files at different damage conditions is created by the routines.

Randomized controlled evaluation of an insulin pen storage policy.

PURPOSE: Results of a quality-improvement project to enhance safeguards against "wrong-pen-to-patient" insulin pen errors by permitting secure bedside storage of insulin pens are reported. METHODS: A cluster-randomized controlled evaluation was conducted at an academic medical center to assess adherence with institutional policy on insulin pen storage before and after implementation of a revised policy allowing pen storage in locking boxes in patient rooms. In phase 1 of the study, baseline data on policy adherence were captured for 8 patient care units (4 designated as intervention units and 4 designated as control units). In phase 2, policy adherence was assessed through direct observation during weekly audits after lock boxes were installed on intervention units and education on proper insulin pen storage was provided to nurses in all 8 units. RESULTS: Phase 1 rates of adherence to insulin pen storage policy were 59% in the intervention units and 49% in the control units (p = 0.56). During phase 2, there was no significant change from baseline in control unit adherence (67%, p = 0.26), but adherence in intervention units improved significantly, to 89% (p = 0.005). Common types of observed nonadherence included pens being unsecured in patient rooms or nurses' pockets or left in patient-specific medication drawers after patient discharge. CONCLUSION: An institutional policy change permitting secure storage of insulin pens close to the point of care, paired with nurse education, increased adherence more than education alone.

Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU.

BACKGROUND: Alarm fatigue in the ICU setting has been well documented in the literature. The ICU's high-intensity environment requires staff's vigilant attention, and distraction from false and non-actionable alarms pulls staff away from important tasks, creates dissatisfaction, and is a potential patient safety risk if alarms are missed or ignored. This project was intended to improve patient safety by optimizing alarm systems in a cardiovascular surgical intensive care unit (CVSICU). Specific aims were to examine nurses' attitudes toward clinical alarm signals, assess nurses' ability to discriminate audible alarm signals, and implement a bundled set of best practices for monitor alarm reduction without undermining patient safety. METHODS: CVSICU nurses completed an alarm perception survey and participated in alarm discriminability testing. Nurse survey data and baseline monitor alarm data were used to select targeted alarm reduction interventions, which were progressively phased in. Monitor alarm data and cardiorespiratory event data were trended over one year. RESULTS: Five of the most frequent CVSICU monitor alarm types-pulse oximetry, heart rate, systolic and diastolic blood pressure, pulse oximetry sensor, and ventricular tachycardia > 2-were targeted. After implementation, there was a 61% reduction in average alarms per monitored bed and a downward trend in cardiorespiratory events. CONCLUSION: To reduce alarm fatigue it is important to decrease alarm burden through targeted interventions. Methods to reduce non-actionable alarms include adding short delays to allow alarm self-correction, adjusting default alarm threshold limits, providing alarm notification through a secondary device, and teaching staff to optimize alarm settings for individual patients.

Heavy Loads and Lifting are Risk Factors for Musculoskeletal Injuries in Deployed Female Soldiers.

The purpose of this prospective cohort study was to investigate physical, occupational, and psychosocial risk factors for musculoskeletal injuries (MSI) in deployed female soldiers. Before deployment, participants completed performance testing and surveys and after deployment an additional survey detailing occupational demands and MSI. Data analyzed found 57/160 (36%) suffered 78 MSI. In unadjusted analyses, these factors increased the relative risk (RR, 95% confidence interval) of injury: wearing an average load >10% body weight (BW) (RR = 2.00, 1.31-4.57), wearing an average load >1 hour (RR = 2.44, 1.30-4.57), heaviest load worn >15% BW (RR = 5.83, 1.51-22.50), wearing a backpack (RR = 1.82, 1.23-2.80), wearing body armor >1 hour (RR = 1.62, 1.002-2.62), lifting objects weighing above 22.68 kg (RR = 1.96, 1.08-3.57), lifting objects one to two times (RR = 1.73, 1.002-2.97), carrying objects >7.62 m (RR = 2.01, 1.19-3.42), and Y Balance composite score <95.23 (RR = 1.71, 1.13-2.60). The best logistic regression model predicting MSI was average load as % BW (odds ratio [OR] = 1.04, 1.01-1.07), heaviest load as % BW (OR = 1.03, 1.01-1.05), average repetitions lifting objects (OR = 1.07, 1.01-1.14), and sit-ups (OR = 0.93, 0.93-0.99). Results indicate that risk of MSI in deployed female soldiers increased with heavier equipment worn and more repetitious lifting, although more performing more sit-ups on the fitness test before deployment reduced the risk.

Diagnosis of giant cell arteritis: when should we biopsy the temporal artery?

Giant cell arteritis (GCA) can be diagnosed histopathologically by biopsy of the temporal artery, and clinically using the 5-point score of the 1990 American College of Rheumatology (ACR) classification. We aimed to find out whether some patients are referred for biopsy unnecessarily. We audited all referrals (n=100) made to the Department of Oral and Maxillofacial Surgery over 34 months, and used the ACR classification to find out whether patients had had a clinical diagnosis of GCA at referral (ACR score: 3 or more). We then compared them with the result of the biopsy. Of the 100 referred, 98 had a biopsy, and of them, 15 were diagnosed with GCA (2 results were not included). Thirteen of the 15 had already been diagnosed clinically (based on the ACR classification) at referral. Our results gave an ACR specificity of 96% (95% CI: 85% to 99%) but only 20% sensitivity (95% CI: 11% to 32%). There was a linear correlation of high ACR scores with histopathological confirmation. Biopsy is most beneficial when there is a degree of diagnostic uncertainty (ACR: 1 or 2), an atypical presentation, or when steroids may be relatively contraindicated. On the basis of our study, we designed a new referral form for biopsy based on the ACR criteria.

Effect of concentrate supplementation on nutrient digestibility and growth of Brahman crossbred cattle fed a basal diet of grass and rice straw.

BACKGROUND: An experiment was conducted in Vietnam to test the hypothesis that total dry matter (DM) intake and liveweight (LW) gain would increase in a curvilinear manner with increasing amounts of concentrate offered. METHOD: There were five treatments: a basal diet of Guinea grass fed at 1 % of LW and rice straw fed ad libitum (T0), or this diet supplemented with concentrate at 0.6 (T1), 1.2 (T2), 1.8 (T3), or 2.4 % of LW (T4). The concentrate comprised locally available ingredients, namely cassava chips, rice bran, crushed rice grain, fishmeal, salt, and urea, mixed manually. RESULTS: Concentrate intake increased from T0 to T3, but there was no difference in concentrate intake between T3 and T4. Total feed intake increased in a curvilinear manner from 4.0 to 6.4 kg DM/d as the quantity of concentrate consumed increased. The substitution of concentrate for grass and rice straw increased with increasing consumption of concentrate and was as high as 0.49 kg DM reduction per kg of concentrate consumed. LW gain increased curvilinearly, with significant differences between T0 (0.092 kg/d), T1 (0.58 kg/d) and T2 (0.79 kg/d); but there were no significant differences in LW gain between T2, T3 (0.83 kg/d) and T4 (0.94 kg/d).With increasing amount of concentrate in the diet, the digestibilities of dry matter, organic matter, crude protein, and crude fat increased, but NDF digestibility decreased. CONCLUSION: Based on these results, young Vietnamese Brahman-cross growing cattle will respond to a locally-sourced concentrate mix offered at a level of up to 1.2 % of LW.

Description of musculoskeletal injuries occurring in female soldiers deployed to Afghanistan.

Each year musculoskeletal injuries (MSIs) result in thousands of lost duty days and medical discharges. Women represent 15% of the Army and have higher incidence of injury than male soldiers; studies that have investigated MSIs in deployed women are lacking. Therefore, the purpose of this prospective cohort study was to investigate MSIs in women during a 9-month deployment to Afghanistan. Participants were recruited from three Brigade Combat Teams. Participants completed a demographic survey before deployment and a second survey on occupational demands and MSIs after deployment. Of the 160 women, 57 (36%) suffered 78 MSIs resulting in 1,642 days of limited duty, a median of 7 days per MSI, losing 10% of the available duty time to MSIs. Most injuries affected the knee (24%) or low back (18%). Soldiers attributed the majority of injuries (27%) to physical training and trips/falls (17%). Of the MSIs, 93% caused limitations to physical training and 76% resulted in large limitations to occupational tasks. Most MSIs (41%) resolved within 3 weeks and most (37%) occurred before the fourth month of deployment. Prevention measures should target knee and low back injuries. Physical training should be further investigated to discover modifications capable of reducing injuries.

Patient safety reporting systems: sustained quality improvement using a multidisciplinary team and "good catch" awards.

BACKGROUND: Since 1999, hospitals have made substantial commitments to health care quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. At the Weinberg Surgical Suite at The Johns Hopkins Hospital (Baltimore), a 16-operating-room inpatient/outpatient cancer center, a patient safety reporting process was developed to maximize the usefulness of the reports and the long-term sustainability of quality improvements arising from them. METHODS: A six-phase framework was created incorporating UHC's Patient Safety Net (PSN): Identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with "Good Catch" awards, and follow up to determine if quality improvements were sustained over time. RESULTS: Good Catch awards have been given in recognition of 29 patient safety hazards identified since 2008; in each of these cases, an initiative was developed to mitigate the original hazard. Twenty-five (86%) of the associated quality improvements have been sustained. Two Good Catch award-winning projects--vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control--are described in detail. CONCLUSION: A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting process entailed positive recognition with a Good Catch award, education of practitioners, and long-term follow-up.

Momentary emotion surrounding bulimic behaviors in women with bulimia nervosa and borderline personality disorder.

BACKGROUND: Bulimia nervosa (BN) and borderline personality disorder (BPD) are disorders that involve emotion dysregulation, for negative emotion in particular, as well as impulsive behaviors beyond binge eating and vomiting. Given these similarities in psychopathology, it is not surprising that those with BN also present with BPD in approximately one third of cases. Improved understanding of similarities and differences in the experience of negative and positive emotion could aid in the development of treatments specifically tailored to the needs of these disorders. METHODS: In this study, we examined Ecological Momentary Assessment (EMA) data from 133 women diagnosed with BN, 25 of whom also exhibited diagnostic levels of BPD. Emotions and behaviors were assessed daily, with multiple random and event-contingent signals to complete questionnaires on portable digital devices, for a period of two weeks. RESULTS: Results indicated that the BPD group experienced higher negative emotional variability on bulimic event days. Both groups also demonstrated increasing negative emotion and decreasing positive emotion pre- binge eating and vomiting, with levels of negative emotion decreasing and positive emotion increasing after, for both behaviors. CONCLUSIONS: In terms of group differences, additive effects were found for the BN comorbid with BPD group, who demonstrated greater negative emotional variability, on bulimic event days, and also had higher overall levels of negative emotion pre- and post-binge eating. Those with BN only, however, displayed increasing trajectories of positive emotion before and after binge eating and after vomiting, indicating a potential emotional dampening effect of BPD.

Emotional intelligence and selection to administrative chief residency.

OBJECTIVE: The authors sought to determine whether emotional intelligence, as measured by the BarOn emotional quotient inventory (EQ-i), is associated with selection to administrative chief resident. METHOD: Authors invited senior-year residents at the University of Texas Health Science Center at Houston to participate in an observational cross-sectional study using the BarOn EQ-i. In October 2009 they sent an invitation e-mail to 66 senior residents, with a reminder e-mail 1 month later. The study was designed to detect a 15-point difference in EQ-i scores with 80% power. RESULTS: Of the 66 invited residents, 69.6% participated in the study. Average total EQ-I score was 104.9. Among senior-year residents, there were no statistically significant differences in EQ-i scores between administrative chief residents (at 109) and non-administrative chief residents (at 103.2). CONCLUSION: Administrative chief residents do not demonstrate higher Emotional Intelligence, as measured by the EQ-i, than other senior-year residents.