Factors affecting beef cattle producer perspectives on feed efficiency.

To establish the basis for implementation of a producer education program, a social assessment of the willingness and barriers to adoption of a measure of feed efficiency in beef cattle [residual feed intake (RFI)] was conducted. A 35-question mailed survey was sent to 1,888 producers acquired from the stratified random sample of the Idaho Cattle Association member list (n = 488), Red Angus Association of America member list (n = 2,208), and Red Angus Association of America bull buyer list (n = 5,325). The adjusted response rate for the survey was 49.9%. Of the survey respondents, 58.7% were commercial cow/calf producers and 41.3% were seedstock producers or operated a combination seedstock/commercial operation. Commercial operations had an average of 223 ± 17 cows and 13 ± 3 bulls, whereas seedstock herds (including combination herds) had slightly fewer cows (206 ± 24) and more bulls (23 ± 6). Both commercial and seedstock operators indicated that calving ease/birth weight was the most important trait used to evaluate genetic merit of breeding bulls. Only 3.8 and 4.8% of commercial and seedstock producers indicated that feed efficiency was the most important characteristic used for bull selection. Binary logistic regression models were used to predict willingness of seedstock producers to begin collecting data for the calculation of RFI on their bulls, or to predict willingness of commercial producers to begin selecting bulls based on RFI data. In response, 49.1% of commercial producers and 43.6% of seedstock producers indicated they were willing to adopt RFI as a measure of feed efficiency. These data indicate that feed efficiency was one of the traits that producers consider important; those who perceive feed efficiency as important tended to be actively involved in data collection on their herds, underpinning the notion that objective assessment was valued and used by some. Additional data collection in a future social assessment will continue to elaborate the proportion of producers who perceive feed efficiency as an increasingly important decision and management tool for beef production.

Oestrogen and progesterone receptor status of individual foci in multifocal invasive ductal breast cancer.

Widespread acceptance of breast conserving surgery for early breast cancer has led to renewed interest in multifocality, which is seen in 13-63% of breast cancers. According to current guidelines, oestrogen/progesterone receptor status is assessed on the sample obtained at initial core biopsy or the main tumour focus in multifocal breast cancer (more than one distinct tumour focus in a quadrant). We assessed receptor status of individual foci in multifocal breast cancer. Mastectomy specimens for 18 cases of multifocal breast cancer were identified. Immunohistochemical staining for oestrogen and progesterone receptors was performed on all tumour foci. On histological examination 11 patients demonstrated two independent tumour foci, three demonstrated three foci and four demonstrated four foci. Minor differences in oestrogen receptor score were seen between foci (attributed to the subjective nature of the scoring system), which did not affect the overall positive/negative classification. Sixteen patients (88%) were oestrogen receptor-positive. Progesterone receptor staining showed more variability between foci in two patients but, since the tumours were oestrogen receptor-positive this would not have affected clinical decision-making. No major differences in oestrogen receptor status between multiple tumour foci in the same quadrant were found in this pilot study.

Direct polymerase chain reaction amplification of formalin-fixed, paraffin-wax-embedded tissue after automated sequential laser microdissection and pressure catapulting.

A robust method to facilitate rapid laser microdissection and pressure catapulting (LMPC) coupled with direct polymerase chain reaction (dPCR) to eliminate the need for extraction of DNA before a PCR-based assay is described. This sequential LMPC-dPCR method is rapid and decreases the number of processing steps, reducing the chance of tissue loss and contamination.

Validity and reliability of SCREEN II (Seniors in the community: risk evaluation for eating and nutrition, Version II).

BACKGROUND: Nutrition risk screening for community-living seniors is of great interest in the health arena. However, to be useful, nutrition risk indices need to be valid and reliable. The following three studies describe construct validation, test-retest and inter-rater reliability of SCREEN II. METHODS: Study (1) seniors were recruited from the general community and from a geriatrician's clinic to complete a nutritional assessment and SCREEN II. 193 older adults provided medical and nutritional history, 3 days of dietary recall and anthropometric measurements. A dietitian reviewed all information collected and ranked seniors on risk: 1 (low) to 10 (high risk). Receiver operating characteristic curves were completed. An abbreviated SCREEN II was developed through statistical analysis and expert ranking of the 17 items. Studies (2) and (3) seniors were recruited from the community to self-administer (n = 149) or be interviewed (n = 97) using SCREEN II twice within 2 weeks. For self-administration one index was completed via mail. Interviewer administration was completed via telephone with two interviewers. Intra-class correlations were calculated. RESULTS: (1) Total and abbreviated SCREEN II have increased sensitivity and specificity as compared to SCREEN I in identifying seniors at nutritional risk. (2) Test-retest reliability was adequate (intra-class correlation (ICC) = 0.83). (3) Inter-rater reliability was adequate (ICC = 0.83). CONCLUSIONS: SCREEN II appears to be a valid and reliable tool for the identification of risk for impaired nutritional states in community-living older adults, and is an improvement over SCREEN I.

Cyclooxygenase-2 expression predicts survival in malignant pleural mesothelioma.

The expression of cyclooxygenase 2 (COX-2) protein is increased in many tumours and may be associated with a more aggressive phenotype. We aimed to assess COX-2 expression in a large series of archival mesothelioma specimens. Archival tissue was obtained from 86 malignant pleural mesothelioma samples (histological subtype: 42 epithelial, 28 biphasic and 16 sarcomatoid). Overexpression of COX-2 was detected by immunohistochemical analysis. Positive staining was located in the cytoplasm of malignant tumour cells. Overall 51/86 (59%) tumour sections demonstrated COX-2 overexpression. The frequency varied with histological subtype with 31/42 (73%) of epithelial sections, 14/28 (50%) of biphasic sections and 6/16 (37%) of sarcomatoid sections recorded as positive. Kaplan Meier survival analysis indicated that overexpression of COX-2 was significantly related to improved prognosis (P < 0.001) and was an independent prognostic factor in multivariant analysis. Overexpression of COX-2 protein may confer a survival advantage in mesothelioma patients.

Medication administration errors in adult patients in the ICU.

OBJECTIVE: To quantify the incidence and specify the types of medication administration errors from a list of error-prone medications and to determine if patient harm resulted from these errors. DESIGN: An observational evaluation. SETTING: Five intensive care units (ICUs) in the United States. PATIENTS AND PARTICIPANTS: Eight hundred fifty-one patients who were at least 18 years of age and admitted to surgical, medical or mixed ICUs during a 3 month period were included. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A list of error-prone medications was adapted from the literature and evaluated for medication errors and patient harm. Of 5,744 observations in 851 patients, 187 (3.3%) medication administration errors were detected. the therapeutic classes most commonly associated with errors were vasoactive drugs 61 (32.6%) and sedative/analgesics 48 (25.7%). The most common type of error was wrong infusion rate with 71 (40.1%) errors. Twenty-one errors did not reach the patient and 159 reached the patient but did not result in harm, increased monitoring or intervention. Five errors required increased patient monitoring and two required intervention. None of the errors resulted in patient death. CONCLUSIONS: This multicenter evaluation found fewer medication administration errors than the published literature, possibly due to the varying observational techniques and pharmacist involvement. Lorazepam and wrong infusion rates are associated with errors that occurred frequently, resulted in the greatest potential for harm and were common oversights in the system. These errors should be considered potential areas for betterment in the medication use process to improve patient safety.

High-flux hemodialysis without hemoperfusion is effective in acute valproic acid overdose.

OBJECTIVE: To report a case of valproic acid overdose treated successfully with high-flux hemodialysis without the addition of charcoal hemoperfusion. CASE SUMMARY: A 25-year-old white woman with a history of multiple suicide attempts and schizophrenia presented after ingesting an unknown amount of valproic acid. She became comatose and developed hypotension and lactic acidosis as valproic acid concentrations increased to > 1200 micrograms/mL (therapeutic concentration 50-100). High-flux hemodialysis was performed for four hours; the calculated elimination rate constant (kel) during the procedure was 0.2522 h-1 with a half-life (t1/2) of 2.74 hours compared with posthemodialysis kel of 0.0296 h-1 and t1/2 of 23.41 hours, suggesting that high-flux hemodialysis effectively eliminates valproic acid. The patient's hemodynamic status and mental function improved in conjunction with the acute reduction in valproic acid concentrations. Her subsequent hospital course was complicated only by transient thrombocytopenia. DISCUSSION: Most literature reports of valproic acid overdose have described the use of charcoal hemoperfusion alone or in combination with hemodialysis to accelerate valproic acid clearance at toxic concentrations. However, the pharmacokinetic properties of valproic acid indicate that hemodialysis alone would be effective therapy for an acute valproic acid overdose. CONCLUSIONS: We suggest that toxic concentrations of valproic acid can be effectively reduced with high-flux hemodialysis without the addition of charcoal hemoperfusion and its attendant risks.

Differences in hypothalamic 2-[125I]iodomelatonin binding in photoresponsive and non-photoresponsive white-footed mice, Peromyscus leucopus.

Photoperiod is an environmental cue used by many temperate-zone species to regulate their reproductive timing. Within species, the degree of reproductive photoresponsiveness can vary widely both among and within populations. The neuroendocrine mechanisms causing this individual variation in photoresponsiveness are unknown. Using selected lines from a population of white-footed mice known to vary genetically in reproductive photoresponsiveness, we tested the hypothesis that variation in the number and/or location of melatonin receptors is the basis for individual differences in reproductive photoresponsiveness. The brains and pars tuberalis of the pituitary from sixteen mice, (eight mice from each of two lines selected for two generations to respond strongly or weakly to photoperiod), were processed for autoradiography using the radioligand 2-[125I]-iodomelatonin (IMEL). We found significantly higher specific IMEL binding in the medial preoptic area and the bed nucleus of the stria terminalis of non-responsive mice than responsive mice. There were no differences between groups in specific IMEL binding in the suprachiasmatic and dorsomedial nuclei of the hypothalamus, pars tuberalis, or paraventricular nucleus of the thalamus. These results provide support for the hypothesis that individual variation in photoresponsiveness is due in part to differences in the density or affinity of melatonin receptors.

Effect of the framing of questionnaire items regarding satisfaction with training on residents' responses.

PURPOSE: To determine whether framing questions positively or negatively influences residents' apparent satisfaction with their training. METHOD: In 1993-94, 276 residents at five Canadian internal medicine residency programs responded to 53 Likert-scale items designed to determine sources of the residents' satisfaction and stress. Two versions of the questionnaire were randomly distributed: one in which half the items were stated positively and the other half negatively, the other version in which the items were stated in the opposite way. RESULTS: The residents scored 43 of the 53 items higher when stated positively and scored ten higher when stated negatively (p < .0001). When analyzed using an analysis-of-variance model, the effect of positive versus negative framing was highly significant (F = 129.81, p < .0001). While the interaction between item and framing was also significant, the effect was much less strong (F = 5.56, p < .0001). On a scale where 1 represented the lowest possible level of satisfaction and 7 the highest, the mean score of the positively stated items was 4.1 and that of the negatively stated items, 3.8, an effect of 0.3. CONCLUSIONS: These results suggest a significant "response acquiescence bias." To minimize this bias, questionnaires assessing attitudes toward educational programs should include a mix of positively and negatively stated items.

Discrimination and abuse in internal medicine residency. The Internal Medicine Program Directors of Canada.

OBJECTIVE: To survey the extent to which internal medicine housestaff experience abuse and discrimination in their training. DESIGN: Through a literature review and resident focus groups, we developed a self-administered questionnaire. In this cross-sectional survey, respondents were asked to record the frequency with which they experienced and witnessed different types of abuse and discrimination during residency training, using a 7-point Likert scale. PARTICIPANTS: Internal medicine housestaff in Canada. MEASUREMENTS AND MAIN RESULTS: Of 543 residents in 13 programs participating (84% response rate), 35% were female. Psychological abuse, as reported by attending physicians (68%), patients (79%), and nurses or other health workers (77%), was widespread. Female residents experienced gender discrimination by attending physicians (70%), patients (88%), and nurses (71%); rates for males were 23%, 38%, and 35%, respectively. Females reported being sexually harassed more often than males, by attending physicians (35% vs 4%, p < .01), peers (30% vs 6%, p < .01), and patients (56% vs 18%, p < .01). Physical assault by patients was experienced by 40% of residents. Half of the residents surveyed reported racial discrimination and homophobic remarks in the workplace, perpetrated by all groups of health professionals. CONCLUSIONS: Psychological abuse, gender discrimination, sexual harassment, physical abuse, homophobia, and racial discrimination are prevalent problems during residency training. Housestaff, medical educators, allied health workers, and the public need to work together to address these problems in the training environment.