The Patient's Experience of Working with Multiple Allied Health Professional Students - A Qualitative Interview Study.

There are increasing numbers of learners in clinical settings as part of approaches to meet workforce demands. As a result, patients are now working with multiple learners at the same time, yet little is known about how people experience this. The aim of this study was to explore the patient experience of working with multiple allied health professional students. Structured interviews were carried out with 22 patients across hospital wards in one hospital in the North-West of England. Data was analysed using thematic analysis and four themes were identified: consent to work with multiple students; responses to working with multiple students; multiple students and feelings of safety; making connections with multiple students. Findings indicated that patients experienced positive relationships and feelings of safety with groups of students. However, patients were given limited advance or tailored information about working with a group of students which is an important area to address.

active@home: Investigating the Value of a Home Care Worker-Led Exercise Program for Older Adults With Complex Care Needs.

Exercise has proven health benefits for older adults independent of age, disability, and disease. However, barriers to exercise participation exist, including travel to, and access to, appropriate facilities and programs. Evidence shows that in-home exercise delivered by allied health professionals can improve physical health and prolong independence among individuals with government supported aged care packages. A less costly alternative is program delivery by home care workers. However, effective training for workers and resources to guide the consumer is required. This project evaluated an exercise training module for home care workers and a consumer resource to promote in-home exercise participation among older Australians with government supported aged care packages. Outcomes included a significant improvement in functional capacity as measured by the short physical performance battery (mean increase of 1.4 points), a 19% reduction in participants classified as frail and a reduction in healthcare service access of 47% across the intervention.

Impact of Feed Delivery Pattern on Aerial Particulate Matter and Behavior of Feedlot Cattle.

Fine particulate matter with less than 2.5 microns diameter (PM2.5) generated by cattle in feedlots is an environmental pollutant and a potential human and animal health issue. The objective of this study was to determine if a feeding schedule affects cattle behaviors that promote PM2.5 in a commercial feedlot. The study used 2813 crossbred steers housed in 14 adjacent pens at a large-scale commercial West Texas feedlot. Treatments were conventional feeding at 0700, 1000, and 1200 (CON) or feeding at 0700, 1000, and 1830 (ALT), the latter feeding time coincided with dusk. A mobile behavior lab was used to quantify behaviors of steers that were associated with generation of PM2.5 (e.g., fighting, mounting of peers, and increased locomotion). PM2.5 samplers measured respirable particles with a mass median diameter ≤2.5 µm (PM2.5) every 15 min over a period of 7 d in April and May. Simultaneously, the ambient temperature, humidity, wind speed and direction, precipitation, air pressure, and solar radiation were measured with a weather station. Elevated downwind PM2.5 concentrations were measured at dusk, when cattle that were fed according to the ALT vs. the CON feeding schedule, demonstrated less PM2.5-generating behaviors (p < 0.05). At dusk, steers on ALT vs. CON feeding schedules ate or were waiting to eat (standing in second row behind feeding cattle) at much greater rates (p < 0.05). Upwind PM2.5 concentrations were similar between the treatments. Downwind PM2.5 concentrations averaged over 24 h were lower from ALT compared with CON pens (0.072 vs. 0.115 mg/m³, p < 0.01). However, dry matter intake (DMI) was less (p < 0.05), and average daily gain (ADG) tended to be less (p < 0.1) in cattle that were fed according to the ALT vs. the CON feeding schedules, whereas feed efficiency (aka gain to feed, G:F) was not affected. Although ALT feeding may pose a challenge in feed delivery and labor scheduling, cattle exhibited fewer PM2.5-generating behaviors and reduced generation of PM2.5 when feed delivery times matched the natural desires of cattle to eat in a crepuscular pattern.

Comment on "Redefining the age of Clovis: implications for the peopling of the Americas".

Waters and Stafford (Reports, 23 February 2007, p. 1122) provided useful information about the age of some Clovis sites but have not definitively established the temporal span of this cultural complex in the Americas. Only a continuing program of radiometric dating and careful stratigraphic correlations can address the lingering ambiguity about the emergence and spread of Clovis culture.

Apolipoprotein E4 forms a molten globule. A potential basis for its association with disease.

The amino-terminal domain of apolipoprotein (apo) E4 is less susceptible to chemical and thermal denaturation than the apoE3 and apoE2 domains. We compared the urea denaturation curves of the 22-kDa amino-terminal domains of the apoE isoforms at pH 7.4 and 4.0. At pH 7.4, apoE3 and apoE4 reflected an apparent two-state denaturation. The midpoints of denaturation were 5.2 and 4.3 m urea, respectively. At pH 4.0, a pH value known to stabilize folding intermediates, apoE4 and apoE3 displayed the same order of denaturation but with distinct plateaus, suggesting the presence of a stable folding intermediate. In contrast, apoE2 proved the most stable and lacked the distinct plateau observed with the other two isoforms and could be fitted to a two-state unfolding model. Analysis of the curves with a three-state unfolding model (native, intermediate, and unfolded) showed that the apoE4 folding intermediate reached its maximal concentration ( approximately 90% of the mixture) at 3.75 m, whereas the apoE3 intermediate was maximal at 4.75 m ( approximately 80%). These results are consistent with apoE4 being more susceptible to unfolding than apoE3 and apoE2 and more prone to form a stable folding intermediate. The structure of the apoE4 folding intermediate at pH 4.0 in 3.75 m urea was characterized using pepsin proteolysis, Fourier transform infrared spectroscopy, and dynamic light scattering. From these studies, we conclude that the apoE4 folding intermediate is a single molecule with the characteristics of a molten globule. We propose a model of the apoE4 molten globule in which the four-helix bundle of the amino-terminal domain is partially opened, generating a slightly elongated structure and exposing the hydrophobic core. Since molten globules have been implicated in both normal and abnormal physiological function, the differential abilities of the apoE isoforms to form a molten globule may contribute to the isoform-specific effects of apoE in disease.

Comparison of the stabilities and unfolding pathways of human apolipoprotein E isoforms by differential scanning calorimetry and circular dichroism.

Differential scanning calorimetry and circular dichroism experiments were performed to study structural differences among the common isoforms of human apolipoprotein E (apoE2, apoE3, and apoE4) and their N-terminal, 22-kDa fragments. Here, we examine thermodynamic properties that characterize the structural differences among isoforms, and also differences in their unfolding behavior. The 22-kDa fragments and their full-length counterparts were found to exhibit similar differences in thermal stability (apoE4