Bird feeding at urban wetlands: A comparison of demographics, attitudes and norms between feeders and non-feeders.

The feeding of wild birds is a popular but often controversial activity. This study explored differences in demographics, attitudes, and normative beliefs between waterbird feeders and non-feeders at an urban wetland residential estate in Melbourne, Australia. An online survey of nearby residents and visitors (n = 206) identified those who have fed waterbirds at least once in the past two years (feeders; 32.4 %) and those who have not (non-feeders). No differences were observed in demographic profile or connection to nature between feeders and non-feeders, but feeders were significantly more likely to believe that waterbird feeding is an acceptable activity. When compared with non-feeders, feeders exhibited different injunctive and descriptive norms relating to waterbird feeding; feeders believed that most people would be relatively happy with them feeding waterbirds in their community, while non-feeders thought that most people would be moderately unhappy. Feeders believed that more than half of the people in their community fed waterbirds (55.5 %), while non-feeders believed that less than half fed birds (36.7 %). These findings suggest that education or behaviour change programs with bird feeding objectives could be enhanced with information about the actual and perceived social norms for this common activity.

Warfarin therapy in atrial fibrillation: assessment of patient knowledge of risks and benefits.

Patients with atrial fibrillation are at an increased risk for stroke, and many benefits from anticoagulation. Despite the emergence of direct oral anticoagulants, many patients continue to rely on warfarin for their anticoagulation due to logistical, pharmacokinetic, clinical, or patient preference issues. Previous work has suggested that outcomes of warfarin therapy are related to patient education/knowledge. We assessed knowledge of indications, benefits, and complications of warfarin therapy in 99 randomly selected patients enrolled in the Warfarin Anticoagulation Clinic at the Mayo Clinic in Florida who were taking warfarin for non-valvular atrial fibrillation. Patients were labeled as 'knowledgeable' or 'not knowledgeable' regarding warfarin therapy according to the results of a cross-sectional questionnaire. The majority of patients in both the knowledgeable and not knowledgeable groups displayed understanding that they were taking warfarin for atrial fibrillation (valvular vs non-valvular atrial fibrillation was not an included answer choice). However, there was a clear lack of knowledge amongst patients with atrial fibrillation in both groups about their stroke risk while on and off warfarin, and their risk of major bleeding or adverse events related to their warfarin therapy. There was only a significant difference between the two groups regarding their knowledge of what increases or decreases the risk of bleeding while on warfarin. There was no major difference between the groups with regards to demographic and medical characteristics, except that 'not knowledgeable' patients tended to have more peripheral vascular disease, ulcer disease, and moderate-severe renal disease compared to 'knowledgeable' patients.

A practical approach to assess the hazardous exposure potential of investigational drugs.

PURPOSE: A method to evaluate the hazardous exposure potential of investigational drugs was developed in order to comply with hazardous drug handling standards. SUMMARY: New nationwide standards require health-system pharmacies to recognize potential occupational risks and protect employees from any hazardous exposure. United States Pharmacopeia general chapter 800 (USP<800>) provides recommendations on handling precautions for commercial hazardous drugs. Recommendations for investigational drugs are less clear, with USP<800> suggesting more widespread protections when information is deemed insufficient to assess the risk. The investigational drug services pharmacy at a freestanding pediatric hospital developed a method to evaluate the hazardous potential of investigational drugs in order to determine the likelihood that a drug held an occupational handling risk. The goal of the project was to ensure compliance with hazardous drug handling standards and provide adequate employee protection while minimizing the financial burden on the health-system pharmacy. CONCLUSION: Investigational drugs that meet any of 4 defined criteria should be subject to hazardous drug handling precautions until adequate safety data are available.

Biosafety Practices for In Vivo Viral-Mediated Gene Therapy in the Health Care Setting.

Introduction: Gene therapy encompasses a diverse array of genetically engineered products in biomedical research. As novel products continue to gain regulatory approval, institutions will be challenged by translating research processes into the clinical environment. This article will provide a summary of the 5 in vivo viral-based therapies that have been approved or are under review in the United States or European Union and discuss the development of biosafety handling practices in the clinical setting. Discussion: Commercially approved gene therapies utilize adeno-associated viral vectors, lentiviruses, and modified herpes simplex viruses for genetic manipulation. Health care personnel must understand the location of the genetic manipulation, ex vivo or in vivo, in order to develop safe work practices when handling the products. Occupational exposure to a viral agent could lead to risks of infection or acquired immunity. Institutions must merge biosafety and hazardous drug handling standards in order to develop safe handling procedures for clinical care. Conclusion: As biotechnology continues to advance, so will the challenges of incorporating novel therapies into the clinical setting. Health systems must educate themselves on the current recommendations and maintain competency of this evolving science to ensure the safety of patients, families, and staff in the clinical environment.

Viral-mediated gene therapy and genetically modified therapeutics: A primer on biosafety handling for the health-system pharmacist.

PURPOSE: The guidance documents applicable to the manipulation of viral vectors in a health-system pharmacy are reviewed to provide recommendations for occupational safe drug handling. SUMMARY: Biosafety handling principles should be drawn from 2 guidance documents essential in the manipulation of biological material: Biosafety in Microbiological and Biomedical Laboratories, 5th Edition. and the National Institute of Health's NIH Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines). Incorporating the biosafety guidance of these 2 documents into the pharmaceutical standards of United States Pharmacopeia chapter 800, "Hazardous Drugs-Handling in Healthcare Settings," will assist in the establishment of viral gene therapy handling guidelines in a health-system pharmacy. CONCLUSION: Novel gene therapies and genetically modified therapeutic products will expose health-system pharmacists to classes of medications with unique biological handling requirements. Occupational safety data on the handling of these medications will be limited. The health-system pharmacy will need to rely on published biosafety recommendations to evaluate the infectious and genotoxic risks of these products while determining the necessary containment strategies to ensure safe work practice.

Modeling ovarian follicle growth in commercial and heritage Single Comb White Leghorn hens.

Approximately 84% of the energy in chicken eggs resides in the yolk. A robust model of ovarian follicle development is therefore valuable for estimating energy requirements of laying hens. The current experiment was designed to model the growth of ovarian follicles in 32-wk-old modern commercial line (CL) and unselected heritage line (HL) Single Comb White Leghorn hens. The volume of yolk deposited daily during the rapid growth phase (RGP) was estimated using a double dye technique. For 21 d, 8 CL and 8 HL hens were fed capsules (no. 1) containing Sudan IV (red) and Sudan Black dyes on alternate days. An additional 8 control CL hens were fed empty capsules. Eggs were collected, and the daily volume of yolk deposited was estimated. Significant differences are reported where P < 0.05. Dye had no significant effect on BW, ME intake, or egg weight. Maintenance ME requirements were 192 and 177 kcal/kg(0.67) for CL and HL hens, respectively. Duration of the RGP was shorter (7.35 d) in the CL hens compared with the HL hens (7.95 d). A nonlinear Lomolino model described follicular weight, which varied between strains over d 2 to 9 of follicle development; at each day during development, follicle weights were higher where RGP were shorter. The volume of yolk deposited for the 8 d preceding oviposition in CL was 0.17, 0.28, 0.43, 0.99, 1.84, 2.47, 2.82, 2.86, and 2.51 cm(3); and in HL was 0.17, 0.33, 0.72, 1.40, 2.15, 2.46, 2.48, 2.32, and 1.93 cm(3). The HL had a higher rate of yolk deposition 7 to 5 d before oviposition, and CL had a higher rate of yolk deposition 3 to 1 d before oviposition with no significant difference between lines on d 4 before oviposition. Although growth patterns differed, there were no differences among lines in final follicle weights (14.1 g) or retained energy (42.4 kcal).

Incidence and pattern of 12 years of reported transfusion adverse events in Zimbabwe: a retrospective analysis.

BACKGROUND: Haemovigilance hinges on a systematically structured reporting system, which unfortunately does not always exist in resource-limited settings. We determined the incidence and pattern of transfusion-related adverse events reported to the National Blood Service Zimbabwe. MATERIALS AND METHODS: A retrospective review of the transfusion-event records of the National Blood Service Zimbabwe was conducted covering the period from 1 January 1999 to 31 December 2011. All transfusion-related event reports received during the period were analysed. RESULTS: A total of 308 transfusion adverse events (0.046%) were reported for 670,625 blood components distributed. The majority (61.6%) of the patients who experienced an adverse event were female. The median age was 36 years (range, 1-89 years). The majority (68.8%) of the adverse events were acute transfusion reactions consisting of febrile non-haemolytic transfusion reactions (58.5%), minor allergies (31.6%), haemolytic reactions (5.2%), severe allergic reactions (2.4%), anaphylaxis (1.4%) and hypotension (0.9%). Two-thirds (66.6%) of the adverse events occurred following administration of whole blood, although only 10.6% of the blood was distributed as whole blood. Packed cells, which accounted for 75% of blood components distributed, were associated with 20.1% of the events. DISCUSSION: The incidence of suspected transfusion adverse events was generally lower than the incidences reported globally in countries with well-established haemovigilance systems. The administration of whole blood was disproportionately associated with transfusion adverse events. The pattern of the transfusion adverse events reported here highlights the probable differences in practice between different settings. Under-reporting of transfusion events is rife in passive reporting systems.

Human immunodeficiency virus prevalence, incidence, and residual transmission risk in first-time and repeat blood donations in Zimbabwe: implications on blood safety.

BACKGROUND: National Blood Service Zimbabwe human immunodeficiency virus (HIV) risk management strategy includes screening and discarding of first-time donations, which are collected in blood packs without an anticoagulant (dry pack). To evaluate the impact of discarding first-time donations on blood safety the HIV prevalence, incidence, and residual risk in first-time and repeat donations (wet packs) were compared. STUDY DESIGN AND METHODS: Donor data from 2002 to 2010 were retrieved from a centralized national electronic donor database and retrospectively analyzed. Chi-square test was used to compare HIV prevalence with relative risk (RR), and the RR point estimates and 95% confidence interval (CI) are reported. Trend analysis was done using Cochran-Armitage trend test. HIV residual risk estimates were determined using published residual risk estimation models. RESULTS: Over the 9 years the overall HIV prevalence estimates are 1.29% (n = 116,058) and 0.42% (n = 434,695) for first-time and repeat donations, respectively. The overall RR was 3.1 (95% CI, 2.9-3.3; p < 0.0001). The overall mean residual transmission risk of HIV window phase donations in first-time was 1:7384 (range, 1:11,308-1:5356) and in repeat donors it was 1:5496 (range, 1:9943-1:3347). CONCLUSION: The significantly high HIV prevalence estimates recorded in first-time over repeat donations is indicative of the effectiveness of the HIV risk management strategy. However, comparable residual transmission risk estimates in first-time and repeat donors point to the need to further review the risk management strategies. Given the potential wastage of valuable resources, future studies should focus on the cost-effectiveness and utility of screening and discarding first-time donations.

Gastroesophageal reflux.

Gastroesophageal reflux is common in infants and generally resolves spontaneously within the first year of life as the lower esophageal sphincter mechanism matures. The reflux is only considered a "disease" (GERD) when it becomes symptomatic or causes pathological consequences. GERD is commonly associated with esophageal atresia and there is a high incidence in neurologically impaired children; in both groups conservative treatment is notoriously ineffective. The diagnosis of GER is made on upper gastrointestinal contrast studies, endoscopy and pH monitoring. Medical management comprises antacids, reduction of gastric acid production and prokinetic agents. The indications for antireflux surgery include an established esophageal stricture, associated anatomical defect and failure of medical therapy. Apnoeic episodes secondary to documented GER in the infant, constitute an absolute indication for early surgery.

Social care's impact on emergency medicine: a model to test.

Mainly in response to the policy drive to avoid unnecessary acute hospital admissions and delayed discharge on social grounds, there has been a gradual development of social work services attached to emergency departments (EDs) in the UK. In the absence of a clearly articulated evidence base or debate about the roles of ED attached social workers, a model of ED based social work practice and indicative supporting evidence is presented. It is argued that social workers may be able to contribute to the efficiency and effectiveness of hospital services while providing a key point of access to social care services. A number of obstacles remain to the implementation of this model of service, including the narrow focus of current social care practice, the hours that a social work service is normally provided, chronic under-funding, and continuing perverse incentives in the health and social care system. More systematic evidence in the UK context is needed to support the case for change.

The public awareness of aphasia: an international survey.

We surveyed 929 shoppers in Exeter (England), Louisiana (USA) and Sydney (Australia) to determine what they knew of aphasia. Between 10% and 18% said they had heard of aphasia but only between 1.5% and 7.6% had even some basic knowledge of aphasia. We found that more females knew something about aphasia than males and that older people were more likely to have heard of it, although those with some knowledge were significantly younger. Informants had heard of aphasia mainly through their work or the media and were mainly professionals like teachers, nurses, therapists, managers and administrators, followed by a retired/student group. We found some differences in awareness levels in the different locations we sampled. Results have implications for targeting awareness raising and campaigning.

Assessment of mechanism of acquired skewed X inactivation by analysis of twins.

Skewed X-chromosome inactivation in peripheral blood granulocytes becomes more frequent with increasing age, affecting up to half of those over 75 years old. To investigate the mechanisms underlying this phenomenon, X-inactivation profiles in 33 monozygotic and 22 dizygotic elderly twin pairs were studied. Differential methylation-sensitive restriction enzyme cutting at a hypervariable locus in the human androgen receptor gene (HUMARA) was studied on purified granulocytes using T cells as controls. A large genetic effect on skewed granulocytic X inactivation was shown (P <.05); heritability was estimated to be 0.68. A minor part (SD.0151 relative allele frequency [ie, larger/smaller] units) of the observed variance is due to experimental error. A further contributor to acquired skewing is stochastic asymmetric stem cell division, which was modeled and shown as unlikely to account for a substantial part of variance. Two monozygotic twin pairs had X-inactivation ratios skewed markedly in opposite directions, evidence for a further stochastic mechanism, suggestive of a single overrepresented clone. In conclusion, all 3 suggested mechanisms contribute to acquired X inactivation but the dominant mechanism is genetic selection. The observed proportion of putatively clonal hematopoiesis is similar to the lifetime incidence of hematopoietic stem cell malignancy consistent with the concept that clonal hematopoiesis precedes stem cell malignancy.

Relationships of older women: exploring the implications for health professionals.

Five older women were interviewed about their relationships, particularly those with health professionals. The taped interviews were analyzed according to Colaizzi's method and four themes emerged. They were: older women do not matter any more; older women have no legitimate complaints; professionals who care about their work, care about me; and older women are worthy of being treated with honesty and respect. Findings indicated that there may be more negative stereotyping of older women by health professionals than by members of the public. Implications of this study include the need to: promote the concept of health co-existing with illness in health education; recognize the connection between personal feelings and professional responses to older women; and devise strategies to enhance positive attitudes and respect for all people, regardless of age.

Multicellular tumor spheroids grown from pancreatic carcinoma cell lines: use as an orthotopic xenograft in athymic nude mice.

Carcinoma of the pancreas is the fifth leading cause of cancer death, with the majority of patients presenting with unresectable disease. Research into new adjuvant therapies is hampered by the lack of suitable in vivo and in vitro models. We have examined the potential of seven pancreatic carcinoma cell lines to grow as multicellular tumor spheroids (MTS). Three of seven (43%) cell lines were scored positive for MTS formation, and the growth characteristics for spheroid models of the cell lines PANC1 and MIAPaCa2 are presented. Implantation of PANC1 MTS into the pancreas of athymic nude mice produces tumors with reproducible growth characteristics and histology.

Understanding practice management: a qualitative study in general practice.

Reports a qualitative study of practice managers' roles and responsibilities in eight practices in the Grampian region of Scotland. Observes wide variations in the roles and responsibilities of managers associated with the size and fundholding status of the practice. Notes that larger practices had better developed management structures allowing the managers to delegate tasks and undertake a more proactive planning and executive role, and that medium and smaller practices had less well developed management structures and managers were more likely to act as practice administrators with limited autonomy. Concludes that practice managers are playing an increasingly important role in general practice. Also that the influential role of the practice manager in the development of practice policies and the transfer of administrative responsibilities from the partners to the manager have all contributed to a change in general practitioners' perceptions of the practice manager.

Complement activation in platelet concentrates is surface-dependent and modulated by the platelets.

Activation of platelets during storage may contribute to the loss of function and viability known as the platelet storage lesion. We investigated the role of complement activation as a possible mediator of the platelet storage lesion. We studied platelet bags stored up to 5 days under standard blood bank conditions and monitored the generation of several complement activation fragments from both the classical and alternative pathways. To assess the role of noncellular artificial surfaces in the activation of complement, parallel bags were prepared containing platelet-poor plasma. The levels of C4d and C3a increased steadily over time in storage, as did the level of the inactivated membrane attack complex SC5b-9. Generation of C4d, C5a, and SC5b-9 was greater in the absence of platelets than when platelets were present in the container. C5a levels in both groups were low and remained so during storage, suggesting that the C5a generated became surface associated. Using flow cytometry we detected C3 and C3a, but not C9, on the platelet surface. The percentage of C3-positive platelets peaked at the third day of storage; by day five platelet-associated C3 had declined. Decay accelerating factor expression on the platelet surface increased with time in storage and in parallel with CD63 expression. Based on the C4d levels, complement activation proceeded via the classical pathway; minimal generation of the alternative pathway activation fragment. Bb was seen in either the presence or absence of platelets. As an indirect measure of the activation of C1, the functional level of C1 esterase inhibitor (C1INH) was determined. C1INH levels declined over time in storage in bags containing only plasma; however, in the presence of platelets, the levels remained constant presumably because of release of C1INH from the alpha-granules of activated platelets.

The challenges of educational program evaluation.

The demand for fiscal restraint and accountability has forced health care facilities to carefully evaluate the benefits of new programs. Some time ago, the Long Term Care Nursing Department of Sunnybrook Health Science Centre in Toronto, Ontario, collaborated with Centennial College to provide a Gerontology Certificate Program to registered nurses. While originally conceived as a retention and recruitment strategy, it became obvious that such a program could and should have additional benefits to staff and long term care residents alike. This article describes the changes as indicated by three scales, and the benefits described by the registered nurses. It also illustrates, rather humorously, that even the more educated and experienced among us can make mistakes and learn from them!