Building a strong public health nursing workforce in Canada: A continuing education solution.

Building a strong public health nursing (PHN) work-force capable of advancing population health and reducing inequities is critical. Though undergraduate nursing education is expected to provide introductory knowledge and practice of PHN in Canada, this is not always sufficient to adequately prepare nursing graduates for the complexity of PHN practice. To be practice ready for the full scope of PHN roles and interventions, new baccalaureate nurses and new registered nurses in public health are required to apply PHN competencies, theory, and knowledge of nursing and public health sciences, and to practice within the mandates of provincial and territorial public health legislation. To advance practice readiness a formal continuing education program is essential to foster these critical roles in PHN. This article describes the development of a postgraduate continuing education program for preparation to practice in PHN.

Effectiveness of XBB.1.5 Monovalent COVID-19 Vaccines During a Period of XBB.1.5 Dominance in EU/EEA Countries, October to November 2023: A VEBIS-EHR Network Study.

Using a common protocol across seven countries in the European Union/European Economic Area, we estimated XBB.1.5 monovalent vaccine effectiveness (VE) against COVID-19 hospitalisation and death in booster-eligible ≥ 65-year-olds, during October-November 2023. We linked electronic records to construct retrospective cohorts and used Cox models to estimate adjusted hazard ratios and derive VE. VE for COVID-19 hospitalisation and death was, respectively, 67% (95%CI: 58-74) and 67% (95%CI: 42-81) in 65- to 79-year-olds and 66% (95%CI: 57-73) and 72% (95%CI: 51-85) in ≥ 80-year-olds. Results indicate that periodic vaccination of individuals ≥ 65 years has an ongoing benefit and support current vaccination strategies in the EU/EEA.

Cattle production strategies to deliver protein with less land and lower environmental impact.

Global land resources are over-exploited and natural habitats are declining, often driven by expanding livestock production. In Ireland, pastureland for grazing cattle and sheep account for circa 60% of terrestrial land use. The agriculture, forestry and other land use sector (AFOLU) is responsible for 44% of national greenhouse gas (GHG) emissions. A new Grassland Animal response Model (GLAM) was developed to relate livestock-cohort grass and feed requirements to farm-grassland system areas, enhancing environmental assessment of prospective AFOLU configurations. Although land conversion targets are often well-defined, they tend to lack a clear definition of where land sparing can occur. Through analyses of 10 scenarios of milk and beef production and management strategies, we found that displacing beef cows with dairy cows can increase national protein output while sparing up to 0.75 million ha (18%) of grassland (albeit with a minor increase in overseas land requirement for additional concentrate feed). Reducing slaughter age, increasing exports of male dairy calves and increasing grassland use efficiency on beef farms each achieved between 0.19 and 0.32 million ha of land sparing. Sexed semen to achieve more favourable male-female birth ratios had a minor impact. GHG emissions, ammonia emissions and nutrient leaching were only reduced substantially when overall cattle numbers declined, confirming the need for cattle reductions to achieve environmental objectives. Nonetheless, application of GLAM shows potential for improved grass and cattle management to spare good quality land suitable for productive forestry and wetland restoration. This change is urgently needed to generate scalable carbon dioxide removals from the land sector in Ireland, and globally.

Sputum analysis by flow cytometry; an effective platform to analyze the lung environment.

Low dose computed tomography (LDCT) is the standard of care for lung cancer screening in the United States (US). LDCT has a sensitivity of 93.8% but its specificity of 73.4% leads to potentially harmful follow-up procedures in patients without lung cancer. Thus, there is a need for additional assays with high accuracy that can be used as an adjunct to LDCT to diagnose lung cancer. Sputum is a biological fluid that can be obtained non-invasively and can be dissociated to release its cellular contents, providing a snapshot of the lung environment. We obtained sputum from current and former smokers with a 30+ pack-year smoking history and who were either confirmed to have lung cancer or at high risk of developing the disease. Dissociated sputum cells were counted, viability determined, and labeled with a panel of markers to separate leukocytes from non-leukocytes. After excluding debris and dead cells, including squamous epithelial cells, we identified reproducible population signatures and confirmed the samples' lung origin. In addition to leukocyte and epithelial-specific fluorescent antibodies, we used the highly fluorescent meso-tetra(4-carboxyphenyl) porphyrin (TCPP), known to preferentially stain cancer (associated) cells. We looked for differences in cell characteristics, population size and fluorescence intensity that could be useful in distinguishing cancer samples from high-risk samples. We present our data demonstrating the feasibility of a flow cytometry platform to analyze sputum in a high-throughput and standardized matter for the diagnosis of lung cancer.

The environmental impact of dairy production on poorly drained soils under future climate scenarios for Ireland.

The environmental impact of dairy production in Ireland has been widely studied and it is known that regional differences in management and impact are driven by climate. Climate change projections for Ireland predict increasing temperature, change in rainfall patterns and decreasing in solar radiation, varying by agroclimatic region. This study evaluated the environmental impacts of low-cost, grass-based, rotational-grazing dairy production on poorly drained soils under climate change. The Dairy_sim model was used to determine the theoretical optimum dairy system management for five different locations in Ireland assuming a poorly drained soil resource under baseline (1981-2000) and future climate scenarios (2041-2060, high and low emissions scenarios). An optimum system was defined as having maximum grass production and grazed grass in the diet, minimum necessary silage, minimum imported feed, minimum housing days and a very small silage surplus. Life cycle assessment was then used to quantify the environmental impacts (climate change, eutrophication and acidification) for all scenarios. The dairy production systems were predicted to be more productive in the future, with climate change impacts per unit milk reduced or the same, acidification impacts reduced and eutrophication impacts reduced. The absolute emissions driving climate change and eutrophication were predicted to significantly increase for the future low emission scenario, and emissions driving acidification were predicted to slightly increase. The predictions indicate that system adaptation to mitigate absolute emissions are needed rather than just policies that focus on impacts per unit output.

Environmental impacts of alternative agricultural uses of poorly drained farm land in Ireland.

Abolition of the milk quota in the European Union and favourable market conditions have stimulated the expansion of the dairy sector in Ireland, causing more milk to be produced from poorly drained land. This work evaluated the environmental impacts of alternative agricultural uses for poorly drained farm land in Ireland using life cycle assessment (LCA). The avoided burden of the displaced product was used to calculate the net environmental consequences in the context of regional or global markets. The impact categories evaluated were climate change, eutrophication and acidification, all expressed per hectare of land for the alternative land uses, which were pasture-based milk, suckler beef and lowland sheep production and coniferous forestry. Beef had the lowest net climate change impact with global marginal and average product substitution while sheep had the lowest net climate change impact with European displaced product. For net eutrophication and acidification, dairy had the lowest impacts with European and global average displaced product. With global marginal displaced product, forestry had the lowest net eutrophication impact and sheep had the lowest net acidification impact. From an Irish perspective, forestry would generate the lowest environmental impacts and would also increase soil carbon stock, but this was not the best land use option from global perspective. Overall it can be concluded that a pasture based dairy or sheep system would have the greatest net global impact reduction (i.e. greatest global benefit) as land use options for farms with poorly drained soils. Prioritizing climate change, suckler beef system would perhaps be more favourable. It is clear that the choice of the displaced regional or global co-product from the market has a great influence on the results and there is a need to consider more detailed consumption modelling to better understand the substitution process.

Maternal Chorioamnionitis and Postneonatal Respiratory Tract Infection in Ex-Preterm Infants.

OBJECTIVE: To assess whether exposure to histologically confirmed chorioamnionitis (ie, histologic chorioamnionitis [HCA]) is associated with altered risk of infection-related hospitalization (IRH) during the first 24 months of life in very preterm infants. STUDY DESIGN: This single-center retrospective cohort study analyzed data on 1218 infants born at <30 weeks gestational age (GA). Semiquantitative placental histology, obstetric, and neonatal data were extracted from hospital databases and linked with discharge diagnoses on rehospitalization until age 24 months from statewide statutory data. The associations between HCA and overall and clinical categories of IRH were analyzed by Cox proportional hazards regression with left-truncated failure times. RESULTS: Mean GA was 27 weeks, and HCA was present in 577 placentas (47.4%). Among the 1088 infants surviving until the birth-related discharge, 684 (62.9%) of had at least 1 IRH by age 24 months, of whom 287 included a diagnosis of acute lower respiratory tract infection (ALRTI). Following adjustment for sex, birth weight z-score, GA, early-onset sepsis, late-onset sepsis, previous antibiotic use, age at birth-related discharge, and chronic lung disease, HCA was associated with a 32% increased risk of hospitalization with ALRTI (HR, 1.32; 95% CI, 1.02-1.70; P = .033). There was no association with infection overall or with other infection categories. CONCLUSIONS: HCA is associated with a significantly increased risk of hospitalization with ALRTI that is independent of known risk factors, including chronic lung disease.

Interannual variation in nitrous oxide emissions from perennial ryegrass/white clover grassland used for dairy production.

Nitrous oxide (N2 O) emissions are subject to intra- and interannual variation due to changes in weather and management. This creates significant uncertainties when quantifying estimates of annual N2 O emissions from grazed grasslands. Despite these uncertainties, the majority of studies are short-term in nature (<1 year) and as a consequence, there is a lack of data on interannual variation in N2 O emissions. The objectives of this study were to (i) quantify annual N2 O emissions and (ii) assess the causes of interannual variation in emissions from grazed perennial ryegrass/white clover grassland. Nitrous oxide emissions were measured from fertilized and grazed perennial ryegrass/white clover grassland (WC) and from perennial ryegrass plots that were not grazed and did not receive N input (GB), over 4 years from 2008 to 2012 in Ireland (52°51'N, 08°21'W). The annual N2 O-N emissions (kg ha(-1); mean ± SE) ranged from 4.4 ± 0.2 to 34.4 ± 5.5 from WC and from 1.7 ± 0.8 to 6.3 ± 1.2 from GB. Interannual variation in N2 O emissions was attributed to differences in annual rainfall, monthly (December) soil temperatures and variation in N input. Such substantial interannual variation in N2 O emissions highlights the need for long-term studies of emissions from managed pastoral systems.

Peer-supported learning during 'Health Mela'.

BACKGROUND: The Lancashire Gujarat Health Users Forum has organised several successful 'Health Mela' events in Preston, where medical students actively volunteered in health-promotion activities. The participating students enjoyed these events, but we were keen to assess whether students derived any benefit from it in developing their clinical skills. METHODS: A focus group of 12 medical students with varied experience was set up following one such event and a semi-structured interview was conducted. Their experiences were analysed qualitatively and grouped into various themes. RESULTS: The students found that the 'Health Mela' was very useful to increase their clinical skills and communication skills. It also improved their understanding of preventative medicine, which is not well covered in their curriculum. In addition, these events developed teamworking and leadership skills. Students were also very pleased because they could use their personal skills creatively in the planning and smooth running of the 'Health Mela'. DISCUSSION: We believe that medical students should be encouraged to form groups to engage in health-promotional activities in the community. This will no doubt be beneficial to the community, but in addition will also improve the students' knowledge and skills, which will help them to be successful doctors in the future.

A review of nitrous oxide mitigation by farm nitrogen management in temperate grassland-based agriculture.

Nitrous oxide (N2O) emission from grassland-based agriculture is an important source of atmospheric N2O. It is hence crucial to explore various solutions including farm nitrogen (N) management to mitigate N2O emissions without sacrificing farm profitability and food supply. This paper reviews major N management practices to lower N2O emission from grassland-based agriculture. Restricted grazing by reducing grazing time is an effective way to decrease N2O emissions from excreta patches. Balancing the protein-to-energy ratios in the diets of ruminants can also decrease N2O emissions from excreta patches. Among the managements of synthetic fertilizer N application, only adjusting fertilizer N rate and slow-released fertilizers are proven to be effective in lowering N2O emissions. Use of bedding materials may increase N2O emissions from animal houses. Manure storage as slurry, manipulating slurry pH to values lower than 6 and storage as solid manure under anaerobic conditions help to reduce N2O emissions during manure storage stage. For manure land application, N2O emissions can be mitigated by reducing manure N inputs to levels that satisfy grass needs. Use of nitrification inhibitors can substantially lower N2O emissions associated with applications of fertilizers and manures and from urine patches. N2O emissions from legume based grasslands are generally lower than fertilizer-based systems. In conclusion, effective measures should be taken at each step during N flow or combined options should be used in order to mitigate N2O emission at the farm level.

Static respiratory cilia associated with mutations in Dnahc11/DNAH11: a mouse model of PCD.

Primary ciliary dyskinesia (PCD) is an inherited disorder causing significant upper and lower respiratory tract morbidity and impaired fertility. Half of PCD patients show abnormal situs. Human disease loci have been identified but a mouse model without additional deleterious defects is elusive. The inversus viscerum mouse, mutated at the outer arm dynein heavy chain 11 locus (Dnahc11) is a known model of heterotaxy. We demonstrated immotile tracheal cilia with normal ultrastructure and reduced sperm motility in the Dnahc11(iv) mouse. This is accompanied by gross rhinitis, sinusitis, and otitis media, all indicators of human PCD. Strikingly, age-related progression of the disease is evident. The Dnahc11(iv) mouse is robust, lacks secondary defects, and requires no intervention to precipitate the phenotype. Together these findings show the Dnahc11(iv) mouse to be an excellent model of many aspects of human PCD. Mutation of the homologous human locus has previously been associated with hyperkinetic tracheal cilia in PCD. Two PCD patients with normal ciliary ultrastructure, one with immotile and one with hyperkinetic cilia were found to carry DNAH11 mutations. Three novel DNAH11 mutations were detected indicating that this gene should be investigated in patients with normal ciliary ultrastructure and static, as well as hyperkinetic cilia.

Measured and simulated nitrous oxide emissions from ryegrass- and ryegrass/white clover-based grasslands in a moist temperate climate.

There is uncertainty about the potential reduction of soil nitrous oxide (N(2)O) emission when fertilizer nitrogen (FN) is partially or completely replaced by biological N fixation (BNF) in temperate grassland. The objectives of this study were to 1) investigate the changes in N(2)O emissions when BNF is used to replace FN in permanent grassland, and 2) evaluate the applicability of the process-based model DNDC to simulate N(2)O emissions from Irish grasslands. Three grazing treatments were: (i) ryegrass (Lolium perenne) grasslands receiving 226 kg FN ha(-1) yr(-1) (GG+FN), (ii) ryegrass/white clover (Trifolium repens) grasslands receiving 58 kg FN ha(-1) yr(-1) (GWC+FN) applied in spring, and (iii) ryegrass/white clover grasslands receiving no FN (GWC-FN). Two background treatments, un-grazed swards with ryegrass only (G-B) or ryegrass/white clover (WC-B), did not receive slurry or FN and the herbage was harvested by mowing. There was no significant difference in annual N(2)O emissions between G-B (2.38±0.12 kg N ha(-1) yr(-1) (mean±SE)) and WC-B (2.45±0.85 kg N ha(-1) yr(-1)), indicating that N(2)O emission due to BNF itself and clover residual decomposition from permanent ryegrass/clover grassland was negligible. N(2)O emissions were 7.82±1.67, 6.35±1.14 and 6.54±1.70 kg N ha(-1) yr(-1), respectively, from GG+FN, GWC+FN and GWC-FN. N(2)O fluxes simulated by DNDC agreed well with the measured values with significant correlation between simulated and measured daily fluxes for the three grazing treatments, but the simulation did not agree very well for the background treatments. DNDC overestimated annual emission by 61% for GG+FN, and underestimated by 45% for GWC-FN, but simulated very well for GWC+FN. Both the measured and simulated results supported that there was a clear reduction of N(2)O emissions when FN was replaced by BNF.

An evaluation of life cycle assessment of European milk production.

Life cycle assessment (LCA) is a method regulated by ISO that conveys the environmental impact of products. LCA studies of the same product should be comparable to benefit environmental policy making. LCA of milk production has evaluated environmental issues such as greenhouse gas emissions, resource utilisation and land use change. Thirteen LCA studies of European milk production were analysed for comparability, and direct comparison was difficult due to technical issues, arbitrary choices and inconsistent assumptions. The strengths and weaknesses of LCA for evaluating an agricultural system are identified and improvements for comparability of future studies are also considered. Future LCA of milk production should ensure that: (1) the production system is appropriately characterized according to the goal of study; (2) a clear description of the system boundary and allocation procedures is provided according to ISO standards; (3) a common functional unit, probably Energy Corrected Milk, should be used or assumed fat and protein content presented to enable comparisons; (4) where appropriate, site-specific emission factors and characterization factors should be used in environmental hotspots (e.g. manure management, spreading of synthetic fertilizer, production of purchased feed), and phosphorous loss should be better addressed; (5) a range of impact categories including climate change, energy use, land use, acidification and eutrophication should be used to assess pollution swapping, all of which are subject to national or regional directives; perhaps in the future biodiversity should also be included; and (6) the sensitivity to choices of methods and uncertainty of final results should be evaluated.