Increased water contamination and grow-out Pekin duck mortality when raised with water troughs compared to pin-metered water lines using a United States management system.

Controversy has developed as to whether or not pin-metered water lines or water troughs are more appropriate for Pekin ducks. We hypothesized that water troughs would show improved duck body conditions and environmental quality compared to pin-metered water lines. To test this hypothesis, we housed ducks in 2 barns, one with water lines and one with water troughs. Water troughs were constructed to meet RSPCA guidelines for number and density of ducks and with recently described verandas. Ducks were divided into 4 pens per barn (n=1,000 ducks/pen). The study was then repeated (n=8 pens per water source) in a cross-over design so the barns each contained the opposite water source to the first experiment. We scored the ducks' body condition using an established scoring rubric and analyzed using SAS Proc GLM-Mix as binomial data. Ducks housed with water troughs showed higher (thus worse condition; P<0.001) scores for eyes, nostrils, feather quality, feather cleanliness, and foot pads. We also compared water condition, water quality, and duck mortality using a Student t test for both water sources each week. We found that the water troughs showed higher iron (P<0.001), nitrites (P<0.001), pH (P<0.01), and bacterial growth (P<0.001). The bacterial growth was shown to have higher (P<0.001)E. coli, coliforms, and Staphylococcusin the water troughs. Water lines typically showed no bacterial growth in culture-based assays. Ducks housed with water troughs used greater (P=0.001) volumes of water compared to ducks housed with water lines. Ducks with water troughs also showed a greater percent (P=0.008) mortality at all ages compared to ducks with water lines. These data suggest that water troughs may not be beneficial for duck welfare and could adversely impact both environment and duck or human health.

Clinical integration: an interdisciplinary approach to a system priority.

Clinical integration, a Mercy Health Services (MHS) system-wide priority, addresses MHS's ability to provide appropriate, effective clinical care across the continuum and to improve care outcomes. MHS chartered a Clinical Integration Priority Team (CIPT) that developed a common language for clinical integration; began to build infrastructure for coordinated systems of care in such areas as information systems and pharmacy; improved methods and technology for clinical decision making and care delivery; and educated clinicians to improve care processes, manage care for populations, and measure outcomes. Clinical professionals in corporate staff roles have supported clinicians' efforts across the system by providing direction, coaching, educating and supporting in activities to improve patient care.

Assuring quality through staff nurse performance.

Quality patient care requires a well-qualified nursing staff. The nurse must have basic credentials, performance must be measured against pre-established standards, and periodic evaluation and feedback must be given to the nurse. Effective clinical advancement programs and systems that define standards and appraise performance must be in place. Continuing education can help the nurse to remain competent and can close the gap between ineffective behaviors and performance standards that serve as goals.

Ultrasonic measurement of immobilization-induced osteopenia: an experimental study in sheep.

An animal model was used to examine the use of noninvasive transmission ultrasound to measure changes in bone mass which occur following disuse. Unilateral achilles tenectomy was performed on the left leg of eight adult sheep. Following a 12-week period of nonweight bearing, presacrifice transmission ultrasound measurements were taken across the calcanei of the intact and the experimental limbs and compared with those values taken postoperatively. Following specimen harvest, cross-sectional areas of the bones were quantified by microradiography and stereology, and compared with the in vivo ultrasound measurements. There was an average of 8.6% less total bone area, and 18.0% less trabecular volume fraction in the experimental nonweight-bearing limbs as compared with control intact calcanei. The difference in bone mass was associated with a 9.0% decrease in the velocity of sound from the postoperative to the presacrifice ultrasound measurements taken from the experimental calcanei, and a 2.3% increase in the control calcanei. The velocity of sound was found by the Student's t test to be a highly reliable discriminator between the experimental and control limbs.

The use of ultrasound in vivo to determine acute change in the mechanical properties of bone following intense physical activity.

The velocity of ultrasound was measured transcutaneously across the patella and tibia in 98 volunteers both before and after running the 26 mile Boston Marathon. Absolute sound velocities were 2.9% higher in those runners finishing before 3 h when compared to runners finishing after 3 h. Tibial velocities in males were 8.8% higher than in female runners. The mean velocity across the patella of three wheelchair racers was 28% lower than the mean combined patella velocity measured in all runners. These data suggest that 'faster' velocities are associated with bone that is better suited for high functional demands. Surprisingly, when pre- and post-race velocities were compared in each runner, there was a 1.6% increase in ultrasonic velocity across the tibia, and a 3.5% increase across the patella. An increase in ultrasonic velocity following extreme physical activity suggests that adaptive mechanisms exist in healthy bone to withstand, or possibly avoid, the microdamage which might be caused by repetitive cyclic loading.

Student participation in diabetic patient education.

As described, students who have participated in this innovative curriculum are familiar with individualized instruction. These students are thus experientially equipped to carry out the tasks of individualized patient education in the clinical setting. In the learning module the students study beginning teaching-learning principles and basic concepts of adult education in conjunction with learning to care for patients with endocrine dysfunction who require education for adaptation. Through the experience of assessing, planning, and implementing their own teaching in collaboration with the primary nurse and physician, the students learn to incorporate appropriate teaching behaviors into their concept of nursing. It is hoped that this knowledge and experience will make student nurses more effective nursing practitioners. This achievement is of utmost value to the consumer of nursing care.