Broiler Chicken Behavior and Activity Are Affected by Novel Flooring Treatments.

The objective was to determine broiler chicken behavioral differences in response to novel flooring treatments. Broilers (n = 182) were housed in 14 pens (a random subset from a larger-scale study including 42 pens), with 13 birds/pen. One of seven flooring treatments were randomly allocated to 14 pens (2 pens per treatment). The flooring treatments (provided from day 1 {1} or day 29 {29}) included regularly replaced shavings (POS), a mat with 1% povidone-iodine solution (MAT), and the iodine mat placed on a partially slatted floor (SLAT). In addition, a negative control treatment was included with birds kept on used litter from day 1 (NEG). Behavior was recorded in weeks 1, 2, 5, and 6. In week 5, treatments affected the behavioral repertoire (p ≤ 0.035). Birds in POS-1 showed more locomoting, preening and activity overall compared to MAT and/or SLAT treatments. Birds in POS-29 showed more drinking, foraging, preening and overall activity than birds in MAT and/or SLAT treatments. In week 6, birds in the POS-1 treatment spent more time foraging compared to birds in all MAT and SLAT treatments (p ≤ 0.030). In addition, birds in the POS-1 treatment spent more time preening than birds in the MAT-1 treatment (p = 0.046). Our results indicate that access to partially slatted flooring and/or disinfectant mats does not benefit broiler chicken welfare in terms of their ability to express highly motivated behaviors. Access to clean, regularly replaced litter is beneficial for broiler chicken welfare in terms of their ability to express their normal behavioral repertoire.

Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement.

OBJECTIVE: We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. METHODS: Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. RESULTS: Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). CONCLUSIONS: Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.

Remedying Contact Dermatitis in Broiler Chickens with Novel Flooring Treatments.

Contact dermatitis (footpad dermatitis (FPD), hock burns, and breast dermatitis) is a welfare issue for broiler chickens, causing pain and behavioral restrictions. Once lesions develop, often nothing is done to remedy the issue for the affected flock. Our objective was to evaluate novel flooring treatments at the flock level by providing preventative and remedial treatments against contact dermatitis, plumage soiling, and gait impairment. Broilers (n = 546) were housed in 42 pens, with 13 birds/pen. The flooring treatments (four) included used litter (NEG), new pine shavings replaced regularly (POS), a mat filled with 1% povidone-iodine solution (MAT), and the iodine mat placed on a slatted floor (SLAT). Flooring treatments were provided from day one of age (preventative approach; PREV) or day 29 (remedial approach; REM). Contact dermatitis, soiling, gait, and weight were recorded weekly (seven birds/pen). Results showed a treatment effect for all measures, dependent on bird age. Overall, the POS treatment resulted in the best welfare outcomes (FPD, hock burns, and gait). The worst contact dermatitis was found in the MAT and SLAT groups. NEG birds showed little contact dermatitis, opposite to expectations. Weights were lower for PREV-POS in week seven only. The treatments with povidone-iodine were deemed ineffective against contact dermatitis. Access to clean litter prevented and remedied contact dermatitis, and a comparable approach may be commercially feasible.

Violence as a health disparity: Adolescents' perceptions of violence depicted through photovoice.

Violence is a public health issue that disproportionately affects adolescents from historically marginalized communities. In response to growing concerns of local violence, our community-academic partnership explored adolescents' perspectives about violence, including perceptions of its causes, consequences, and potential solutions. Ten adolescents participated in a 12-week photovoice project. They received training in basic research methodologies, documented representations of violence through digital photography and creative writing, engaged in empowerment-based photo-discussions, and presented their work to influential advocates in a community forum. Adolescents and staff conducted a thematic analysis of photographs and narratives from which 10 themes emerged across 3 domains: a culture of violence and oppression, structural violence, and mental and physical health. Adolescents presented their work to community stakeholders in a public forum to foster additional discussions regarding violence in the community. This photovoice project yielded rich qualitative insight into adolescents' experiences with and perceptions of violence.

Residents' Preferences and Performance of Three Techniques for Ultrasound-Guided Central Venous Cannulation After Simulation Training.

BACKGROUND: Obtaining central venous cannulation of the internal jugular vein is an important skill for physicians to master. To our knowledge, no studies to date have examined residents' preferences or the safety of the oblique approach compared to other approaches. This study compared medical residents' preferences for and performance of ultrasound-guided central venous access using the transverse, longitudinal, and oblique approaches. METHODS: Emergency medicine and internal medicine residents (n = 72) at an urban community hospital participated in a central venous access course. To assess the residents' preferences, residents were asked to rank the transverse, longitudinal, and oblique approaches as first, second, or third. In addition to preference, skin-to-vein time, carotid artery puncture, and successful completion on the first attempt during a final skills analysis were measured. RESULTS: During the final skills analysis, the majority (87.5%) of residents preferred the transverse approach. The oblique approach had a significantly larger proportion of failures of technique than the transverse approach (P = 0.02). No significant differences in successful cannulation on the first attempt, skin-to-vein time, or carotid artery puncture among the 3 approaches were found during the final skills assessment. CONCLUSION: The majority of residents preferred the transverse approach to the longitudinal and oblique approaches. Although no significant differences among the 3 approaches were found in performance measures, more failures of technique occurred with the oblique approach. This study suggests that novices may require in-depth training and supervision to become proficient with the oblique approach.

Regulation of Blood Pressure, Appetite, and Glucose by Leptin After Inactivation of Insulin Receptor Substrate 2 Signaling in the Entire Brain or in Proopiomelanocortin Neurons.

Insulin receptor substrate 2 (IRS2) is one of the 3 major leptin receptor signaling pathways, but its role in mediating the chronic effects of leptin on blood pressure, food intake, and glucose regulation is unclear. We tested whether genetic inactivation of IRS2 in the entire brain (IRS2/Nestin-cre mice) or specifically in proopiomelanocortin (POMC) neurons (IRS2/POMC-cre mice) attenuates the chronic cardiovascular, metabolic, and antidiabetic effects of leptin. Mice were instrumented with telemetry probes for measurement of blood pressure and heart rate and with venous catheters for intravenous infusions. After a 5-day control period, mice received leptin infusion (2 µg/kg per minute) for 7 days. Compared with control IRS2(flox/flox) mice, IRS2/POMC-cre mice had similar body weight and food intake (33±1 versus 35±1 g and 3.6±0.5 versus 3.8±0.2 g per day) but higher mean arterial pressure (MAP) and heart rate (110±2 versus 102±2 mm Hg and 641±9 versus 616±5 bpm). IRS2/Nestin-cre mice were heavier (38±2 g), slightly hyperphagic (4.5±1.0 g per day), and had higher MAP and heart rate (108±2 mm Hg and 659±9 bpm) compared with control mice. Leptin infusion gradually increased MAP despite decreasing food intake by 31% in IRS2(flox/flox) and in Nestin-cre control mice. In contrast, leptin infusion did not change MAP in IRS2/Nestin-cre or IRS2/POMC-cre mice. The anorexic and antidiabetic effects of leptin, however, were similar in all 3 groups. These results indicate that IRS2 signaling in the central nervous system, and particularly in POMC neurons, is essential for the chronic actions of leptin to raise MAP but not for its anorexic or antidiabetic effects.