Using Clinical Decision Intelligence Applications to Improve Pathways For Earlier Detection Of Underrecognized Cognitive Disorders.

Cost estimates for care for those with dementia and other cognitive impairments are rising globally, estimated to reach US $1 trillion by 2025. Lack of specialized personnel, infrastructure, diagnostic capabilities, and healthcare access impedes the timely identification of patients progressing to dementia, particularly in underserved populations. International healthcare infrastructure may be unable to handle existing cases in addition to a sudden increase due to undiagnosed cognitive impairment and dementia. Healthcare bioinformatics offers a potential route for quicker access to healthcare services; however, a better preparedness plan must be implemented now if expected demands are to be met. The most critical consideration for implementing artificial intelligence/machine learning (AI/ML) -driven clinical decision intelligence applications (CDIA) is ensuring patients and practitioners take action on the information provided.

Key actors in driving behavioural change in relation to on-farm biosecurity; a Northern Ireland perspective.

BACKGROUND: Agriculture and farming are valued contributors to local economy in Northern Ireland (NI). There is limited knowledge about farmers' behaviours and attitudes towards disease biosecurity measures. As part of a larger project, a scenario-based workshop with key stakeholders was organised by the Agri-Food and Biosciences Institute (AFBI)-NI in December 2015. RESULTS: A total of 22 participants belonging to 12 different institutions took part in the workshop. Participants were presented with an overview of previously conducted biosecurity research in NI and England. In small groups, participants were subsequently asked to discuss and give their opinions about a series of questions across four key areas in a semi-structured approach with an external facilitator. The key areas were 1- disease risk perception at the farm level; 2-perceived barriers to implementing on farm biosecurity measures; 3- avenues to successful behaviour change and 4-key industry responsibilities and roles. The discussion showed that training in biosecurity for farmers is important and necessary. Training was recommended to be provided by veterinary surgeons, preferably via a face-to-face format. The discussion addressing disease disclosure proved particularly challenging between those who were prospective buyers of cattle, and those who sold cattle. CONCLUSIONS: This workshop provided a unique and invaluable insight into key issues regarding farm level biosecurity activities. From a policy perspective, delivering improved on-farm biosecurity must be addressed via a multidisciplinary approach. This can only be achieved with active involvement, commitment and support of a number of key industry and government stakeholders.

Effectiveness of different footbathing frequencies using copper sulfate in the control of digital dermatitis in dairy cows.

Two experiments were conducted to test the effectiveness of different footbathing frequencies using CuSO4 in the control of digital dermatitis (DD) in groups of dairy cows with low and high DD prevalence in an endemically infected herd. During the study, groups of cows walked through allocated footbath solutions after milking on 4 consecutive milkings each week, 2 wk, or monthly, depending on treatment. The footbath solutions were changed either after 200 cows had passed through the footbath or within 24 h. All cows were scored weekly during milking for DD lesion stage on the hind feet using a 5-point nominal scale. A transition grade was assigned based on whether the DD lesions improved (1) or deteriorated or did not improve (0) from week to week, and was averaged for all cows in the group. Furthermore, from the longitudinal study data, all transitions between different DD lesion stages between the different time points were used in a discrete, first-order Markov chain (state transition matrix) model. In experiment 1, 70 Holstein-Friesian cows with DD lesions present on at least one of their hind feet were allocated to 1 of 2 footbath treatments for 14 wk: (1) 5% CuSO4 each week or (2) 5% CuSO4 every 2 wk. At the end of the study, no active DD lesions were observed in cows in either treatment group, but significantly more cows had no DD lesions (0.48 ± 0.097 vs. 0.24 ± 0.094) and fewer cows had lesions in the healing stage (0.52 ± 0.104 vs. 0.77 ± 0.090) for the weekly compared with the 2-wk footbathing regimen. The number of active DD lesions that the transition matrix model predicted over time was 3 and 8% for weekly and every 2 wk footbathing treatments, respectively. In experiment 2, 64 cows with no DD lesions on either of their hind feet were allocated to 1 of 2 footbath treatment regimens for 14 wk: (1) 5% CuSO4 every 2 wk or (2) 5% CuSO4 each month. At the end of the trial, significantly more cows had no DD (0.80 ± 0.088 vs. 0.65 ± 0.102) and fewer cows had DD lesions in the healing stage (0.20 ± 0.088 vs. 0.35 ± 0.102) in the every 2 wk regimen than in the monthly footbathing regimen. The number of active DD lesions that the transition matrix model predicted over time was low for both footbathing interventions (1 and 4%, respectively). Increasing the interval between footbaths does not appear the most appropriate mechanism for reducing CuSO4 usage.

Pilot trial of IOM duty hour recommendations in neurology residency programs: unintended consequences.

OBJECTIVE: To study the potential effect of the 2008 Institute of Medicine (IOM) work duty hour (WDH) recommendations on neurology residency programs. METHODS: This study evaluated resident sleepiness, personal study hours, quality of life, and satisfaction and faculty satisfaction during a control month using the Accreditation Council for Graduate Medical Education WDH requirements and during an intervention month using the IOM WDH recommendations. Resident participation in both schedules was mandatory, but both resident and faculty participation in the outcome measures was voluntary. RESULTS: Thirty-four residents (11 postgraduate year [PGY]-4, 9 PGY-3, and 14 PGY-2) participated. End-of-work shift sleepiness, mean weekly sleep hours, personal study hours, and hours spent in lectures did not differ between the control and intervention months. Resident quality of life measured by the Maslach Burnout Inventory declined for 1 subscore in the intervention month (p = 0.03). Resident education satisfaction declined during the intervention month for issues related to continuity of care, patient hand-offs, and knowledge of their patients. Faculty satisfaction declined during the intervention month, without a decline in quality of life. CONCLUSIONS: The results from 3 residency programs suggest that the IOM WDH recommendations may negatively affect neurology resident education. This study was limited by the short duration of implementation, negative bias against the IOM recommendations, and inability to blind faculty. Additional study of the IOM WDH recommendations is warranted before widespread implementation.

Effectiveness of different footbath solutions in the treatment of digital dermatitis in dairy cows.

Three experiments were conducted to test the effectiveness of different footbath solutions and regimens in the treatment of digital dermatitis (DD) in dairy cows. During the study, groups of cows walked through allocated footbath solutions after milking on 4 consecutive occasions. All cows were scored weekly for DD lesion stage on the hind feet during milking. A "transition grade" was assigned on the basis of whether the DD lesions improved (1) or deteriorated or did not improve (0) from week to week. This grade per cow was averaged for all cows in the group. In experiment 1, 118 cows were allocated to 1 of 3 footbath treatments for 5 wk: (1) 5% CuSO(4) each week, (2) 2% ClO(-) each week, or (3) no footbath (control). The mean transition grade, and proportion of cows without DD lesions at the end of the trial were significantly higher for treatment 1 above (0.36, 0.13, and 0.11, respectively; standard error of the difference, SED = 0.057). In experiment 2, 117 cows were allocated to 1 of 4 footbath treatment regimens for 8 wk: (1) 5% CuSO(4) each week, (2) 2% CuSO(4) each week, (3) 5% CuSO(4) each fortnight, or (4) 2% CuSO(4) each fortnight. For welfare reasons, cows allocated to the weekly and fortnightly footbath regimens had an average prevalence of >60% and ≤25% active DD at the start of the trial, respectively. Significantly more cows had no DD lesions (0.53 vs. 0.36, respectively; SED = 0.049), and the mean transition grade of DD lesions was higher in the 5% compared with the 2% weekly CuSO(4) treatment (0.52 vs. 0.38, respectively; SED = 0.066). Similarly, significantly more cows had no DD lesions in the 5% compared with the 2% fortnightly CuSO(4) treatments (0.64 vs. 0.47, respectively; SED = 0.049). In experiment 3, 95 cows were allocated to 1 of 3 footbath treatments: (1) each week alternating 5% CuSO(4) with 10% salt water, (2) each week alternating 5% CuSO(4) with water, or (3) 5% CuSO(4) each fortnight (control). After 10 wk, more cows had no DD in the salt water treatment than in the control treatment (0.35 vs. 0.26, respectively; SED = 0.038), but levels of active lesions were higher for this treatment than in the other 2 treatments (0.17, 0.00, and 0.13, respectively; SED = 0.029). Treatment did not affect mean transition grade of DD lesions. In conclusion, CuSO(4) was the only footbath solution that was consistently effective for treatment of DD. In cases when DD prevalence was high, a footbath each week using 5% CuSO(4) was the most effective treatment.

Emotional indifference in Alzheimer's disease.

One of the most common and disabling symptoms of Alzheimer's disease is apathy. Patients with Alzheimer's disease might appear apathetic for several reasons, including deficits in emotional communication, presence of depression, perceptual-semantic-cognitive deficits, and a degeneration of areas of the brain important in experiencing emotions. The purpose of this study was to learn if patients with Alzheimer's disease have a reduction in the depth of their emotional experiences. Participants with Alzheimer's disease and healthy comparison subjects were asked to view pleasant and unpleasant pictures and to rate these pictures by making a mark on pieces of paper that had a happy face on one end (proximal or distal) and a sad face at the other end. The more pleasant they found this picture, the closer their mark should be to the happy face and vice versa. Patients with Alzheimer's disease judged these pictures' emotional valence as less intense than did the comparison subjects and also made more valence-inconsistent responses. These results might have been induced by impaired picture comprehension or a reduction of emotional experiences induced by degeneration of the limbic-cortical-reticular networks.

Incremental limb hypometria.

To find out if patients with right hemisphere strokes (RHD) demonstrate a form of progressive or incremental limb hypometria (ILH), 11 RHD patients and eight matched controls were tested by having them draw a series of horizontal lines while blindfolded. Unlike controls, six RHD patients displayed an incremental decrease in the length of lines they drew, a sign of ILH. ILH might be a common source of disability and hinder rehabilitation efforts.

Assortative mating in lesser snow geese (Anser caerulescens).

Assortative mating occurs in the dimorphic lesser snow geese in the wild. Mixed matings between the blue and white phases are much less frequent than would be expected by chance. Evidence from marked birds in field conditions indicated that mate choice was correlated with familial color. Birds from white families usually chose white mates, birds from blue families usually chose blue mates, and birds from mixed families chose mates of either color. Similar results were obtained under captive conditions when offspring from foster families with particular parental and offspring color combinations were allowed to choose mates. Both parental color and sibling color appeared to influence mate choice. The bird's own color did not appear to be important in mate choice in either field or experimental conditions, and in those cases where male and female parents differed in color neither parental color was more influential than the other in determining offspring mate choice. The results provide the first evidence, to our knowledge, that mate selection based on familial appearance operates intraspecifically in the wild.

Carcinoma of the breast: pathological criteria as an aid in treatment.

Pathologic and clinical features of a group of breast cancer patients were studied in an effort to find out if the prognosis of any individual case of breast cancer could be assessed preoperatively. The size, location, type of tumor, histologic grade and presence or absence of metastatic nodes were studied. Unfortunately, it was not possible to predict the prognosis with any degree of accuracy. We must agree with Haagensen, who said, "The truth is that we already know enough regarding the inferiority of lumpectomy and simple mastectomy, with or without supplementary irradiation, to conclude that it is not wise or humane to condemn a woman to be treated with these methods."